Project IMPROVE: Implementing Community-Engaged Intervention Research to Increase Rapid SARS-CoV-2 Self-Testing Among Diverse Underserved and Vulnerable Asian Americans

改进项目：实施社区参与的干预研究，以提高各种服务不足和弱势的亚裔美国人的快速 SARS-CoV-2 自我检测能力

• 批准号: 10845411
• 负责人: Carolyn Y. Fang
• 金额: $ 111.63万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10845411
• 关键词: 2019-nCoV; Address; Adherence; Advocate; Area; Asian; Asian Americans; Behavior; COVID testing; COVID-19; COVID-19 complications; COVID-19 diagnostic; COVID-19 disparity; COVID-19 pandemic effects; COVID-19 test; COVID-19 testing; COVID-19 vaccination; Caring; Chinese; Cities; Clinical; Cluster randomized trial; Colon Carcinoma; Communicable Diseases; Communities; Community Health; Commuting; Crowding; Day center care; Death Rate; Diagnostic tests; Discrimination; Disease; Disparity; Elderly; Ethnic Origin; Ethnic Population; Evaluation; FDA Emergency Use Authorization; FDA approved; Fright; Frontline worker; Goals; Health; Health Benefit; Health Insurance; Health system; Hepatitis B Virus; Hepatitis C virus; Hospitalization; Household; Housing; Human Papillomavirus; Immigrant; Individual; Industry; Intervention; Intervention Studies; Koreans; Language; Lifting; Light; Limited English Proficiency; Low income; Malignant Neoplasms; Masks; Medical; Misinformation; Multilingualism; Nail plate; National Institute on Minority Health and Health Disparities; Needs Assessment; Neighborhoods; Persons; Phase; Philadelphia; Population; Provider; Public Health; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Resources; Restaurants; Risk; Role; SARS-CoV-2 BA.2; SARS-CoV-2 infection; SARS-CoV-2 positive; Safety; Services; Sick Leave; Site; Social Distance; Socialization; Symptoms; Testing; Time; Transportation; Trust; United States National Institutes of Health; Vaccination; Variant; Vietnamese; Vulnerable Populations; Wages; Work; anti-Asian; barrier to care; barrier to testing; community based participatory research; community engagement; community organizations; coronavirus disease; design; digital; digital tool; economic impact; effectiveness evaluation; empowerment; evidence base; experience; health care settings; health disparity; health literacy; innovation; low health literacy; medical vulnerability; multi-component intervention; novel; online community; patient home care; patient navigation; peer; pragmatic trial; prevent; primary outcome; racial population; racism; screening; secondary outcome; self testing; social cognitive theory; social culture; social vulnerability; statistics; systemic barrier; testing uptake; tool; transmission process; uptake; ventilation

Project Summary Low-Income Asian Americans (AA) with limited English proficiency (LEP) represent a meaningful proportion of low-wage frontline workers in essential service industries. Many also live in multigenerational households with crowded conditions and with their elderly relatives in ethnic neighborhoods, areas that have experienced high rates of COVID-19 infection. Unfortunately, AAs have encountered numerous barriers to COVID-19 testing across individual, provider/health system and community/societal levels, including anti-Asian racism and discrimination, fear of safety at test sites and on public transportation, lack of health insurance, lack of culturally and language-appropriate COVID-19 information and navigation, and limited access to COVID-19 testing sites. As a result, AAs have the lowest COVID-19 testing rate across all racial/ethnic groups. This is particularly concerning in light of the recent surge in cases due to the BA.2 variant and lifting of COVID restrictions, which has led to increases in COVID-19 infections and hospitalizations especially among vulnerable populations. FDA- approved over-the-counter (OTC) COVID-19 diagnostic tests offer a valuable evidence-based strategy for empowering vulnerable AAs (who are hesitant or otherwise unable to obtain in-person PCR testing) to complete self-testing. Although prior studies have demonstrated the feasibility of COVID-19 self-testing in communities with access barriers, no intervention study has focused on vulnerable low-income frontline workers and seniors with LEP across diverse AA ethnic groups (Chinese, Vietnamese, Korean), the fastest growing US population. Thus, the overall goal of this application is to implement a community-engaged multifaceted intervention (herein called the IMPROVE intervention) to increase access to and uptake of rapid COVID-19 self-testing across diverse AA populations. Guided by the NIMHD Research Framework and Social Cognitive Theory to address sociocultural/environmental and individual/interpersonal influences for COVID self-testing, our central hypothesis is that trusted messengers (community health navigators, heath providers, and peer advocates) are essential to reducing testing barriers and increasing uptake of COVID-19 self-testing. The Specific Aims are to: (1) Engage community partners to implement a pragmatic cluster-randomized trial in 12 CBO sites to evaluate the effectiveness of the community-engaged and evidence-based IMPROVE intervention in increasing access to and uptake of COVID-19 self-testing (primary outcome) and changes in mitigation behaviors including adherence to mask wearing and COVID-19 vaccination (secondary outcomes) in underserved and vulnerable ethnic AAs (N=1200 AAs: 400 Chinese, 400 Korean and 400 Vietnamese); and (2) Evaluate Intervention Reach, Effectiveness, Adoption, Implementation and Maintenance using the RE-AIM framework to facilitate IMPROVE intervention dissemination to more CBOs and enhance its sustainability over time. The proposed project will be one of the first to evaluate an evidence-based community-engaged approach to reducing systemic barriers and will fill gaps in research on COVID-19 self-testing and mitigation adherence in 3 ethnic AA vulnerable populations.

项目摘要 英语能力有限（LEP）的低收入亚裔美国人（AA）代表有意义的比例 基本服务行业的低薪前线工人。许多人还生活在多代家庭中 拥挤的条件及其在族裔社区的老年亲戚，那里经历了很高的地区 共vid-19感染的发生率。不幸的是，AAS遇到了Covid-19测试的许多障碍 跨个体，提供者/卫生系统以及社区/社会层面，包括反亚洲种族主义和 歧视，对测试地点和公共交通的安全性害怕，缺乏健康保险，缺乏文化 以及适合语言的COVID-19信息和导航，以及对Covid-19测试站点的访问有限。 结果，AAS在所有种族/族裔群体中具有最低的COVID-19测试率。尤其是 鉴于鉴于BA.2变体和covid限制的案件的近期激增， 尤其是在弱势群体中，导致了199次感染和住院的增加。 fda- 批准的非处方（OTC）COVID-19诊断测试为有价值的基于证据的策略提供 赋予弱势AAS（犹豫不决或无法获得面对面的PCR测试）完成 自我测试。尽管先前的研究表明，社区中共同测试的可行性 在访问障碍的情况下，没有干预研究专注于脆弱的低收入前线工人和老年人 LEP在不同的AA族裔（中国，越南，韩国人）中，美国人口增长最快。 因此，本应用程序的总体目标是实施社区参与的多方面干预措施（此处 称为改进干预措施）以增加对快速共同访问和吸收的访问和吸收 不同的AA人群。在NIMHD研究框架和社会认知理论的指导下 社会文化/环境和个人/个人/人际影响共同自我测试，我们的中心假设 是值得信赖的使者（社区健康导航员，荒地提供商和同伴倡导者）是必不可少的 降低测试障碍并增加了共同测试的吸收。具体目的是：（1）参与 社区合作伙伴在12个CBO站点中实施务实的集群随机试验，以评估 社区参与和基于证据的有效性改善干预措施，以增加对 并吸收COVID-19自我测试（主要结果）和缓解行为的变化包括 在服务不足和脆弱的情况下，遵守口罩戴口罩和共同疫苗接种（次要结果） 民族AAS（n = 1200 AAS：400中文，400韩语和400个越南）； （2）评估干预措施， 使用RE-AIM框架有效性，采用，实施和维护，以促进改进 干预传播更多的CBO并随着时间的推移增强其可持续性。拟议的项目将是 最早评估基于证据的社区参与方法的方法之一，以减少系统性障碍和 将填补3个AA弱势群体中的CoVID-19自我测试和缓解依从性的研究空白。