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。拟议的研究对RFA-OD-21-008的回答，要求社区参与 在服务不足和弱势群体中支持COVID-19的干预措施。在最高的 接触COVID-19的风险是一大量的前线基本工人（很少）地位较低 职业（例如零售，家庭医疗保健），黑人和拉丁裔/西班牙裔（BLH）的人是 代表过多。疾病预防控制中心建议测试Covid-19的所有经验症状。对于那些 未接种疫苗，建议对患有COVID-19诊断和常规的个人接触后进行测试 即使对于那些经常接触的人无症状，也建议进行Covid-19-19筛查测试 与其他人在室内环境中（例如很少）。但是，BLH-FEW对COVID-19的严重障碍 - 19 对个人/态度进行测试 - （例如，缺乏准则，不信任的知识），社会 - （例如，社会规范）和 结构性的影响力（例如，访问测试的不良访问）。确实，BLH的测试率低于 目前，白人人口和仅25-50％的BLH-FEW接种疫苗。拟议的社区参与 研究由纽约大学和曼哈顿北部改进的合作团队领导 公司（NMIC）。它的主要目标是优化行为干预措施，以提高Covid-19的测试率 blh-few。与RFA-OD-21-008一致，拟议的研究使用多相优化策略 （大多数）测试在过去的研究中基于的四个候选干预组件的框架。这 候选组件以批判种族理论告知，并在三合会影响理论的指导下是 简短或不需要大量的员工时间，并将在高效的阶乘实验设计中进行测试。 他们是a）激励访谈咨询，b）以行为为基础的短信组成部分 经济学，c）同伴教育和d）访问测试（通过导航进行预约与自测套件）。 所有参与者都会获得护理标准，即有关COVID-19测试的健康教育和推荐。 该研究的具体目的是：确定四个候选组件中的哪个有意义地贡献 改善主要结果，通过医学确认进行COVID-19测试；最有效的 组件的组合将包括“优化”干预措施（AIM 1），确定介体（例如，不信任， 访问）和主持人（例如，社会人口统计学特征）每个组件的影响（AIM 2）， 并使用混合方法方法来探索与 COVID-19测试和COVID-19疫苗接种（AIM 3）。参与者将是n = 448 BLH-few 在过去的六个月中测试了COVID-19，未接种疫苗为Covid-19，随机分配给 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 定性深入访谈。我们还将发现，描述和计划实施问题，因此 NMIC和其他基于社区的组织可以迅速扩大优化的干预措施。