Using the multiphase optimization strategy (MOST) to optimize an intervention to increase COVID-19 testing for Black and Latino/Hispanic frontline essential workers

使用多阶段优化策略 (MOST) 优化干预措施，以增加对黑人和拉丁裔/西班牙裔一线基本工作人员的 COVID-19 检测

• 批准号: 10544753
• 负责人: Marya Gwadz
• 金额: $ 118.8万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10544753
• 关键词: Address; Age; Altruism; Appointment; Attitude; Behavior Therapy; Black race; COVID-19; COVID-19 diagnosis; COVID-19 disparity; COVID-19 pandemic; COVID-19 screening; COVID-19 severity; COVID-19 testing; COVID-19 vaccination; Characteristics; Cognitive; Communities; Counseling; Critical Race Theory; Data; Diagnostic Reagent Kits; Diagnostic tests; Disparity; Education; Emotions; Essential worker; Experimental Designs; Exposure to; Fright; Goals; Guidelines; Health education; Hispanic; Hispanic Populations; Home Care Services; Individual; Intervention; Interview; Joints; Knowledge; Language; Latino; Maintenance; Mediator; Medical; Methods; New York; New York City; Occupations; Participant; Persons; Population; Qualitative Research; Randomized; Readiness; Recommendation; Research; Research Design; SARS-CoV-2 exposure; Services; Sick Leave; Site; Social Distance; Specific qualifier value; Symptoms; Testing; Text Messaging; Time; Underserved Population; Universities; Vaccinated; Vulnerable Populations; behavioral economics; community organizations; community setting; community transmission; coronavirus disease; distrust; ethnic disparity; experience; food preparation; future pandemic; health belief; high risk; implementation barriers; implementation intervention; improved; motivational enhancement therapy; multi-component intervention; multiphase optimization strategy; peer; primary outcome; public health relevance; racial disparity; scale up; screening; self testing; social; social norm; sociodemographics; standard of care; text messaging intervention; theories; transmission process; unvaccinated; uptake

PROJECT SUMMARY. The proposed study responds to RFA-OD-21-008 which calls for community-engaged interventions to support COVID-19 testing in underserved and vulnerable populations. Among those at highest risk for exposure to COVID-19 is the large population of frontline essential workers (FEW) in lower status occupations (e.g., retail, in-home health care), among whom Black and Latino/Hispanic (BLH) persons are over-represented. The CDC recommends testing for all those experiencing symptoms of COVID-19. For those not vaccinated, testing is recommended after exposure to individuals with a COVID-19 diagnosis, and regular COVID-19 screening testing is recommended even when asymptomatic for those with frequent close contact with others in indoor settings such as FEW. However, BLH-FEW experience serious impediments to COVID-19 testing at individual/attitudinal- (e.g., lack of knowledge of guidelines, distrust), social- (e.g., social norms), and structural-levels of influence (e.g., poor access to testing). Indeed, testing rates are lower among BLH than White populations and only 25-50% of BLH-FEW are currently vaccinated. The proposed community-engaged study is led by a collaborative team at New York University and the Northern Manhattan Improvement Corporation (NMIC). Its main goal is to optimize a behavioral intervention to boost COVID-19 testing rates for BLH-FEW. Consistent with RFA-OD-21-008, the proposed study uses the multiphase optimization strategy (MOST) framework to test four candidate intervention components grounded in our past research. The candidate components are informed by critical race theory and guided by the theory of triadic influence, are brief or do not require substantial staff time, and will be tested in a highly efficient factorial experimental design. They are A) motivational interview counseling, B) a text message component grounded in behavioral economics, C) peer education, and D) access to testing (via navigation to a test appointment vs. a self-test kit). All participants receive the standard of care, namely, health education on COVID-19 testing, and referrals. The specific aims of the study are to: identify which of four candidate components contribute meaningfully to improvement in the primary outcome, COVID-19 testing with medical confirmation; the most effective combination of components will comprise the “optimized” intervention (Aim 1), identify mediators (e.g., distrust, access) and moderators (e.g., sociodemographic characteristics) of the effects of each component (Aim 2), and use a mixed-methods approach to explore relationships among barriers to, facilitators of, and uptake of COVID-19 testing and COVID-19 vaccination (Aim 3). Participants will be N=448 BLH-FEW who have not been tested for COVID-19 in the past six months and who are not vaccinated for COVID-19, randomly assigned to an intervention condition, and assessed at 6- and 12-weeks post-baseline; N=50 participants will engage in qualitative in-depth interviews. We will also uncover, describe, and plan for implementation issues so the optimized intervention can be rapidly scaled up by NMIC and other community-based organizations.

项目摘要。拟议的研究响应了 RFA-OD-21-008，其中呼吁社区参与 采取干预措施，支持对服务不足和弱势群体进行 COVID-19 检测。 接触 COVID-19 的风险是大量地位较低的一线基本工作人员 (FEW) 职业（例如零售、家庭医疗保健），其中黑人和拉丁裔/西班牙裔 (BLH) 人 CDC 建议对所有出现 COVID-19 症状的人进行检测。 不是疫苗接种，建议在接触确诊为 COVID-19 的个人后进行检测，并定期进行检测 即使对于那些经常密切接触的人来说，即使没有症状，也建议进行 COVID-19 筛查检测 然而，BLH-FEW 在室内环境中遇到了严重的 COVID-19 障碍。 测试个人/态度（例如缺乏指南知识、不信任）、社会（例如社会规范）和 事实上，BLH 的测试率低于 BLH。 目前，白人和 BLH-FEW 中只有 25-50% 接种了疫苗。 研究由纽约大学和北曼哈顿改进项目的一个合作团队领导 Corporation (NMIC) 的主要目标是优化行为干预，以提高 COVID-19 检测率。 BLH-FEW 与 RFA-OD-21-008 一致，所提出的研究使用多阶段优化策略。 （MOST）框架来测试基于我们过去研究的四个候选干预成分。 候选成分以批判种族理论为基础，并以三元影响理论为指导， 简短或不需要大量的工作人员时间，并将在高效的因子实验设计中进行测试。 它们是 A) 动机面试咨询，B) 基于行为的短信组件 经济学，C) 同伴教育，以及 D) 获得测试的机会（通过导航到测试预约与自测套件）。 所有参与者都会接受标准护理，即有关 COVID-19 检测的健康教育和转诊。 该研究的具体目标是：确定四个候选成分中哪一个对 主要结果的改善，经医学证实的 COVID-19 检测是最有效的； 各组成部分的组合将包括“优化”干预（目标 1），确定调解因素（例如，不信任、 每个组成部分的影响的影响因素（例如，社会人口特征）和调节因素（目标 2）， 并使用混合方法来探索障碍、促进因素和吸收之间的关系 COVID-19 检测和 COVID-19 疫苗接种（目标 3） 参与者将为 N=448 名尚未接受过疫苗接种的 BLH-FEW。 在过去六个月内接受过 COVID-19 检测且未接种过 COVID-19 疫苗的人被随机分配到 干预条件，并在基线后 6 周和 12 周进行评估，N=50 名参与者将参与； 我们还将发现、描述和规划实施问题，以便 NMIC 和其他社区组织可以迅速扩大优化干预措施。