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: 10616921
• 负责人: Carolyn Y. Fang
• 金额: $ 114.03万
• 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/10616921
• 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.

项目概要 英语水平 (LEP) 有限的低收入亚裔美国人 (AA) 在 基本服务行业的低工资一线工人。许多人还生活在多代同堂的家庭中 拥挤的环境以及他们年老的亲戚生活在少数民族聚居区、经历过高风险的地区 COVID-19 感染率。不幸的是，AA 在进行 COVID-19 检测时遇到了许多障碍 跨越个人、提供者/卫生系统和社区/社会层面，包括反亚裔种族主义和 歧视、对考试地点和公共交通安全的恐惧、缺乏健康保险、缺乏文化 适合语言的 COVID-19 信息和导航，以及对 COVID-19 检测站点的有限访问。 因此，AA 在所有种族/族裔群体中的 COVID-19 检测率最低。这一点特别 鉴于最近 BA.2 变种导致的病例激增以及取消了新冠病毒限制，这令人担忧 导致 COVID-19 感染和住院人数增加，尤其是弱势群体。 FDA- 经批准的非处方 (OTC) COVID-19 诊断测试为以下患者提供了有价值的循证策略： 授权易受攻击的 AA（犹豫不决或无法进行现场 PCR 检测）完成 自测。尽管之前的研究已经证明了在社区进行 COVID-19 自检的可行性 由于存在准入障碍，没有干预研究关注弱势低收入一线工人和老年人 不同 AA 族裔（中国人、越南人、韩国人）的 LEP 是美国人口增长最快的群体。 因此，该应用程序的总体目标是实施社区参与的多方面干预（本文 称为 IMPROVE 干预），以增加人们对快速 COVID-19 自我检测的获取和采用 不同的 AA 人群。以 NIMHD 研究框架和社会认知理论为指导，解决 社会文化/环境和个人/人际对新冠病毒自我测试的影响，我们的中心假设 值得信赖的使者（社区健康导航者、健康提供者和同伴倡导者）至关重要 减少检测障碍并提高 COVID-19 自我检测的采用率。具体目标是： (1) 参与 社区合作伙伴在 12 个 CBO 地点实施务实的整群随机试验，以评估 社区参与和基于证据的改进干预措施在增加获得服务的机会方面的有效性 COVID-19 自我测试（主要结果）的采用以及缓解行为的变化，包括 服务不足和弱势群体坚持佩戴口罩和接种 COVID-19 疫苗（次要结果） 种族 AA（N=1200 AA：400 名中国人、400 名韩国人和 400 名越南人）； (2) 评估干预范围， 使用 RE-AIM 框架促进 IMPROVE 的有效性、采用、实施和维护 向更多社区组织传播干预措施，并随着时间的推移增强其可持续性。拟议的项目将是 率先评估以证据为基础的社区参与方法以减少系统性障碍和 将填补 3 个 AA 族裔弱势群体的 COVID-19 自我测试和缓解依从性研究空白。