Impact of a Community Care Intervention to Address Inequities in COVID-19 and Influenza Vaccination Among Adults Suffering from Disproportionate Chronic Disease

社区护理干预措施对解决患有不成比例慢性病的成年人中 COVID-19 和流感疫苗接种不公平问题的影响

• 批准号: 10419818
• 负责人: Marielena Lara
• 金额: $ 76.69万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-18 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10419818
• 关键词: Address; Adult; Affect; Anxiety Disorders; Asthma; Attitude; Awareness; Behavior; Behavior Therapy; Behavioral; Behavioral Model; COVID-19; COVID-19 vaccination; COVID-19 vaccine; Caring; Case Management; Characteristics; Chronic; Chronic Disease; Clinical; Color; Communicable Diseases; Communities; Community Health Aides; Conscious; Data; Decision Making; Diabetes Mellitus; Education; Educational Materials; Effectiveness of Interventions; Emotional; Equilibrium; Ethnic Origin; Ethnic group; Exhibits; Federally Qualified Health Center; Goals; Habits; Health; Health Services Accessibility; Hypertension; Individual; Influenza; Influenza vaccination; Information Dissemination; Intention; Intervention; Interview; Knowledge; Language; Link; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Mental disorders; Methods; Modeling; Modification; Motivation; New Jersey; New York City; Not Hispanic or Latino; Obesity; Participant; Patient Representative; Patient-Focused Outcomes; Patients; Physical Capacity; Physical environment; Population; Population Heterogeneity; Post-Traumatic Stress Disorders; Poverty; Primary Health Care; Psyche structure; Race; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Risk Assessment; Role; Social Environment; Structural Racism; System; Techniques; Telephone; Time; Treatment Efficacy; Treatment outcome; Trust; Uninsured; Vaccinated; Vaccination; Vulnerable Populations; World Health Organization; base; behavior change; bilingualism; community based participatory research; community engagement; community organizations; comparison intervention; contextual factors; design; effective intervention; efficacy testing; ethnic minority; ethnic minority population; evidence base; experience; follow-up; formative assessment; health care service; healthcare community; improved; intervention effect; literacy; meetings; multi-component intervention; poor communities; population based; primary outcome; psychoeducational; psychologic; racial and ethnic; racial minority; response; risk perception; secondary outcome; skills; social; social health determinants; social norm; transmission process; treatment as usual; uptake; vaccine acceptance; vaccine access; vaccine hesitancy

Racial and ethnic minorities with chronic illness suffer disproportionately from infectious diseases. Analysis of COVID-19 and influenza data suggest multiple determinants of vaccination inequities among non-Hispanic whites and other racial/ethnic groups. These include manifestations of structural racism such as poor access to care and lack of cultural, language, and literacy-appropriate factual information to promote awareness of and motivation to partake in protective vaccination behaviors. Integrated within health and community systems alike, community health worker (CHW) interventions are an effective strategy to simultaneously address structural and social determinants of health in multiple settings. Building on a long-standing partnership between RAND, Clinical Directors Network (CDN), and local community groups and leaders, we propose a study to tailor, implement and evaluate a community health worker (CHW intervention) to increase vaccination acceptance and vaccination rates for COVID-19 (primary outcome) and influenza (secondary outcome) among individuals with chronic illness who receive their primary care in Federally Qualified Health Centers (FQHCs). Tailoring of the CHW intervention will be grounded on the Capability, Opportunity, Motivation, Behavior (COM-B) theoretical behavioral model and in partnership with a Community Advisory Board (CAB) composed of patients and representatives from local community organizations. We propose a randomized controlled trial (RCT) to determine the efficacy of the CHW-VB (Community Health Worker Intervention to enhance Vaccination Behaviors) intervention to improve vaccine acceptance, uptake, and implementation among racial/ethnic minority adults with any of 7 chronic conditions (asthma, diabetes, hypertension, obesity, depression, anxiety disorder, or PTSD). The study has 4 aims over 5 years: 1) tailor the CHW intervention based on formative research (Aim 1: Year 1); 2) conduct the RCT to test the efficacy of CHW-VB (Aim 2: Years 2-4); 3) understand the effects of CHW-VB and examine measures of capability, motivation, and opportunity as mediators and demographic characteristics and chronic medical/mental conditions as moderators (Aim 3: Years 3-4); and, 5) assess contextual factors affecting implementation and sustainability (Aim 4: Year 5). Our community-based participatory research approach is anchored in partnership with the CAB in all stages of the research, through regular meetings for the formative assessment, co-designing the adaptation of the intervention, troubleshooting any implementation hurdles, and actively participating in the interpretation and dissemination of the results. FHQCs employ CHWs as part of the lifeline of health care services delivered to mostly non-white and under/uninsured patients with chronic illnesses. Community engagement is also a core value for FQHCs who are governed by individuals and community-based agencies from the impoverished communities they serve. The CHW-VB intervention, if efficacious, has a high potential for scalability and sustainability in this setting.

患有慢性病的种族和少数民族因传染病而遭受不成比例的遭受。分析 COVID-19和流感数据表明非西班牙裔疫苗不平等的多个决定因素 白人和其他种族/族裔。这些包括结构性种族主义的表现，例如不良的机会 关心和缺乏文化，语言和适当的事实信息，以促进对和 参与保护性疫苗接种行为的动机。集成在健康和社区系统中 同时，社区卫生工作者（CHW）干预措施是同时解决的有效策略 在多种环境中健康的结构和社会决定因素。 建立在RAND，临床董事网络（CDN）和本地的长期合作伙伴关系的基础上 社区团体和领导者，我们建议一项研究以量身定制，实施和评估社区健康 工人（CHW干预）以增加COVID-19的疫苗接种接受和疫苗接种率（主要 结果）和流感（次要结果）在慢性疾病的患者中 联邦资格卫生中心（FQHC）的护理。 CHW干预的裁缝将接地 能力，机会，动力，行为（COM-B）理论行为模型，并与 由当地社区的患者和代表组成的社区顾问委员会（CAB） 组织。我们提出了一项随机对照试验（RCT）来确定CHW-VB的功效 （社区卫生工作者干预以增强疫苗接种行为）干预以改善 种族/少数民族成年人的疫苗接受，摄取和实施，有7个慢性 疾病（哮喘，糖尿病，高血压，肥胖，抑郁症，焦虑症或PTSD）。 该研究在5年内具有4个目标：1）根据形成性研究调整CHW干预（AIM 1： 1年）; 2）进行RCT测试CHW-VB的功效（AIM 2：2-4）； 3）了解 CHW-VB并检查作为调解人和人口的能力，动机和机会的度量 特征和慢性医学/心理状况作为主持人（目标3：3-4年）；和，5）评估 影响实施和可持续性的情境因素（目标4：5年级）。我们的社区 参与性研究方法是在研究的各个阶段与CAB合作的，通过 定期进行形成性评估的会议，共同设计干预措施的改编，故障排除 任何实施都会障碍，并积极参与结果的解释和传播。 FHQCS雇用CHW作为提供大部分非白人的医疗服务生命线的一部分， 慢性疾病的/没有保险的患者。社区参与也是FQHC的核心价值 由他们所服务的贫困社区的个人和社区机构管辖。 CHW-VB干预（如果有效）在这种情况下具有很高的可伸缩性和可持续性潜力。