Community-engaged research to promote SARS-CoV-2 vaccine uptake in Montana's American Indian and rural communities

项目总结/摘要 少数种族和族裔以及其他医疗服务不足的群体，包括农村成年人， 特别是受到导致COVID-19疾病的SARS-CoV-2病毒的严重打击。在美国 农村地区的COVID-19病死率比城市地区高25%。在蒙大拿州，一个大型的西部农村 在该州，美洲印第安人（AI）占人口的7%，但占COVID-19死亡人数的18%。截至 2021年4月，SARS-CoV-2疫苗可广泛提供给全州符合条件的成年人;然而，只有 蒙大拿州33%的成年人完全接种了疫苗，对疫苗的需求正在减少。当我们从 从最初实施到长期提供这些疫苗，初级保健提供者（PCP）将 负责推荐加强剂量，向新的合格人群提供疫苗， 儿童，并说服以前未接种疫苗的人接种疫苗。在这个人口中心 健康研究（CPHR）社区参与的研究项目，我们的长期目标是确定文化 具体和社区主管的卫生系统和提供者一级的战略，以增加SARS-CoV-2 疫苗在农村和农村地区的使用情况。为了实现这一目标，我们将与All Nations Health合作 中心在密苏拉，MT进行定性采访接种疫苗和未接种疫苗的AI和农村成年人 确定SARS-CoV-2疫苗信心和犹豫的原因（目标1）。使用定性内容 分析，我们还将确定疫苗信息的可靠来源和参与者产生的想法， 促进这些社区对疫苗的信心和接受。我们还将在全州范围内进行调查， PCP确定是否准备好应对SARS-CoV-2疫苗犹豫（目标2）。该调查将包括 关于SARS-CoV-2疫苗的知识、态度和信念的模块，包括问题 关于解决患者疫苗问题和担忧的信心，以及关于 对未来儿童疫苗授权的看法。由于我们与蒙大拿州的合作历史， 公共卫生和人类服务部免疫科和整个卫生系统 我们有能力促进这项研究结果迅速转化为免疫服务 交付实践。此外，我们预计这项研究的结果将推广到其他国家 与类似的人口，我们的团队将作为一个关键的贡献者，全国对话的有效 战略，以解决SARS-CoV-2疫苗在脆弱的AI和农村人口的犹豫。

Project Summary/Abstract Racial and ethnic minorities, and other medically underserved groups, including rural adults, have been particularly hard hit by SARS-CoV-2, the virus that causes COVID-19 disease. In the United States, the COVID-19 case fatality rate is 25% higher in rural versus urban areas. In Montana, a large, rural Western state, American Indians (AIs) are 7% of the population but have accounted for 18% of COVID-19 deaths. As of April 2021, SARS-CoV-2 vaccines are widely available to eligible adults throughout the state; however, only 33% of Montana adults are fully vaccinated, and demand for the vaccine is waning. As we transition from initial implementation to long-term delivery of these vaccines, primary care providers (PCPs) will be responsible for recommending booster doses, offering the vaccine to newly eligible populations such as children, and convincing previously unvaccinated people to get the vaccine. In this Center for Population Health Research (CPHR) community-engaged research project, our long-term goal is to identify culturally specific and community competent health systems- and provider-level strategies for increasing SARS-CoV-2 vaccine acceptance in AI and rural populations. To achieve this goal, we will collaborate with All Nations Health Center in Missoula, MT to conduct qualitative interviews with vaccinated and unvaccinated AI and rural adults to identify causes of SARS-CoV-2 vaccine confidence and hesitancy (Aim 1). Using qualitative content analyses, we will also identify trusted sources of vaccine information and participant-generated ideas for promoting vaccine confidence and uptake in these communities. We will also conduct a statewide survey of PCPs to determine readiness for addressing SARS-CoV-2 vaccine hesitancy (Aim 2). The survey will include a module regarding knowledge, attitudes, and beliefs about the SARS-CoV-2 vaccines, including questions about confidence in addressing patients’ vaccine questions and concerns, as well as questions regarding perceptions of future vaccine authorization for children. Due to our collaborative history with the Montana Department of Public Health and Human Services Immunization Section and health systems throughout the state, we are positioned to facilitate the rapid translation of this study’s results into immunization services delivery practice. Furthermore, we anticipate that findings from this study will be generalizable to other states with similar populations, and our team will serve as a key contributor to the national conversation on effective strategies to address SARS-CoV-2 vaccine hesitancy among vulnerable AI and rural populations.