Leveraging community-based behavioral health to increase vaccine uptake in Latinx adults with mental illness

利用基于社区的行为健康来增加患有精神疾病的拉丁裔成年人的疫苗接种率

• 批准号: 10585609
• 负责人: Rocio Calvo
• 金额: $ 59.32万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10585609
• 关键词: Academia; Address; Adopted; Adult; Automobile Driving; Behavior Therapy; Boston; COVID-19; COVID-19 morbidity; COVID-19 pandemic; COVID-19 risk; COVID-19 vaccination; COVID-19 vaccine; Caring; Collaborations; Communicable Diseases; Communities; Counseling; Country; Coupled; Cross-Over Trials; Death Rate; Development; Diagnosis; Discrimination; Elements; Federally Qualified Health Center; Health Personnel; Health Services; Hispanic; Individual; Influenza vaccination; Intervention; Knowledge; Language; Latinx; Latinx population; Leadership; Massachusetts; Mental Health; Mental disorders; Modeling; Morbidity - disease rate; Neighborhood Health Center; Neighborhoods; Pathway interactions; Patients; Pattern; Plant Roots; Population; Positioning Attribute; Protocols documentation; Provider; Randomized; Research; Research Personnel; Risk; Role; SARS-CoV-2 infection; Safety; Series; Services; Structural Racism; Time; Training; Translations; Trauma; Trust; Universities; Vaccinated; Vaccination; Vaccines; Vulnerable Populations; World Health Organization; base; behavioral health; behavioral health intervention; clinical practice; college; coronavirus disease; cultural values; design; effectiveness evaluation; effectiveness testing; evidence base; experience; global health; health care settings; health disparity; high risk; hospitalization rates; influenza virus vaccine; innovation; intervention effect; mortality; motivational enhancement therapy; novel; pandemic disease; person centered; point of care; programs; response; scale up; seasonal influenza; social health determinants; theories; treatment as usual; trial design; uptake; vaccine acceptance; vaccine access; vaccine distribution; vaccine hesitancy; vaccine refusal; working group

Project Summary Latinxs, particularly those with mental illness, are at higher risk of COVID-19 infection, and associated morbidity and mortality, and yet have lower rates of vaccination, than non-Latinx whites. This pattern is not unique to COVID-19; it has been observed for other infectious diseases, including seasonal influenza. Vaccine hesitancy, understood as a delay in the acceptance of vaccination despite availability of vaccination services, is the primary roadblock for COVID-19 and influenza vaccination among Latinxs. Theoretical frameworks endorsed by the SAGE working group on vaccine hesitancy, and prior research, illustrate that interventions to reduce vaccine hesitancy and increase vaccine uptake in Latinxs should adopt strategies that: increase vaccine confidence and convenience; reduce vaccine complacency; and respond to contextual, individual and vaccine-related factors driving hesitancy, which include but are not limited to the social determinants of health and structural racism. While a variety of strategies have been developed to address vaccine hesitancy in priority populations, the potential role of behavioral health in community-based integrated health care settings has been overlooked. Yet behavioral health, particularly within federally qualified health centers (FQHCs) which target social determinants of health, may be an ideal setting to reach Latinxs, and other priority populations with mental illness, to address vaccine hesitancy and promote vaccine uptake. In collaboration with East Boston Neighborhood Health Center (EBNHC), the largest FQHC of Massachusetts, the proposed study will evaluate a novel Motivational Interviewing (MI) behavioral intervention to reduce vaccine hesitancy and increase COVID-19 and influenza vaccine uptake in Latinx adults with mental illness. Key to the intervention is that the proposed MI protocol explicitly acknowledges cultural values that are central to the Latinx population and that impact their interactions with health care providers. Additionally, the intervention has been specifically designed to be feasible and readily implemented in community-based settings, and to be sustainable in the long-term regardless of how the rapidly changing COVID-19 vaccination landscape evolves. To rigorously evaluate the intervention, we will conduct a pragmatic multiple-period cluster-randomized crossover trial within four BH programs at EBNHC; key to this design is that each program serves as its own control and that the multiple switches enhance statistical power. To our knowledge, this will be the first study to rigorously examine the potential role of BH providers in increasing vaccine uptake among Latinx adults with mental illness, a particularly vulnerable population. Key to the anticipated impact is the partnership between the academia-based research team and colleagues at EBNHC which, in turn, will support the rapid translation of evidence into practice together with a model for sustainable collaboration and national scaleup.

项目概要 拉丁裔，尤其是患有精神疾病的拉丁裔，感染 COVID-19 的风险较高，相关发病率也较高 死亡率，但疫苗接种率低于非拉丁裔白人。这种模式并不是独一无二的 新冠肺炎;在其他传染病中也观察到了这种情况，包括季节性流感。疫苗犹豫不决， 被理解为尽管有疫苗接种服务但延迟接受疫苗接种是主要问题 拉丁裔中 COVID-19 和流感疫苗接种的障碍。认可的理论框架 SAGE 疫苗犹豫问题工作组和之前的研究表明，减少疫苗接种的干预措施 拉丁美洲人的犹豫和增加疫苗接种率应采取以下策略： 增加疫苗信心和 方便;减少疫苗自满情绪；并对背景、个人和疫苗相关因素做出反应 犹豫不决的因素包括但不限于健康的社会决定因素和结构性种族主义。 尽管已经制定了多种策略来解决重点人群对疫苗的犹豫问题，但 行为健康在以社区为基础的综合卫生保健环境中的潜在作用被忽视了。然而 行为健康，特别是在针对社会决定因素的联邦合格健康中心 (FQHC) 内 健康，可能是接触拉丁裔和其他患有精神疾病的优先人群的理想环境，以解决 疫苗犹豫并促进疫苗接种。与东波士顿邻里健康中心合作 （EBNHC）是马萨诸塞州最大的 FQHC，拟议的研究将评估一种新颖的动机 访谈 (MI) 行为干预可减少疫苗犹豫并增加 COVID-19 和流感 患有精神疾病的拉丁裔成年人接种疫苗。干预的关键是提出的 MI 协议 明确承认对拉丁裔人口至关重要并影响他们互动的文化价值观 与医疗保健提供者。此外，干预措施经过专门设计，具有可行性且易于实施 在以社区为基础的环境中实施，并且无论快速发展如何，都能长期可持续 COVID-19 疫苗接种格局正在发生变化。为了严格评估干预措施，我们将进行 EBNHC 的四个 BH 计划中进行务实的多阶段整群随机交叉试验；关键是 其设计是每个程序都充当自己的控制，并且多个开关增强了统计能力。 据我们所知，这将是第一项严格研究 BH 提供商在增加收入方面的潜在作用的研究。 患有精神疾病的拉丁裔成年人（特别脆弱的人群）的疫苗接种情况。关键是 预期影响是学术界研究团队与 EBNHC 同事之间的合作 反过来，这将支持将证据与可持续发展模式一起快速转化为实践 合作和全国范围的扩大。