Trusted Messengers: Supporting Physicians in Promoting COVID-19 Vaccination

项目摘要/摘要 严重急性呼吸综合征冠状病毒2型及相关冠状病毒病 2019年(新冠肺炎)大流行是毁灭性的。在美国，超过2500万人 已经被感染，导致超过43万人死亡。黑人和拉丁裔社区已经承受了 新冠肺炎的影响明显不成比例，加剧了现有的健康差距。多个项目的批准 有效的新冠肺炎疫苗让人们燃起了希望，人们可能很快就会恢复正常生活，但同时也意识到 疫苗的好处将需要被广泛接受和接受。我们和其他人的工作表明 相当大一部分美国人口不愿接种疫苗。关联因素之间的重叠 新冠肺炎病和新冠肺炎疫苗接种犹豫不决，包括黑人或拉丁裔种族/族裔，以及 在社会经济方面处于不利地位，有可能严重加剧现有的健康差距。首要目标是 这项提议的目的之一是克服新冠肺炎疫苗的犹豫不决，特别是在脆弱人群中。 在现有社区伙伴关系的基础上，我们将完善、实施和评估一个多方面的 支持初级保健提供者和社区组织作为值得信赖的信使的干预措施，以促进 在马萨诸塞州伍斯特及其附近的弱势患者中接种新冠肺炎疫苗。我们的干预措施将包括：(1) 一个在线视频资料库，讨论常见的疫苗问题，将由初级保健医生和当地 社区组织；(2)从初级保健医生到他们的病人的基于证据的短信，传达 新冠肺炎疫苗接种的建议和信息；以及(3)简明的教育材料，用于 PCP支持他们与患者就新冠肺炎疫苗进行对话。我们将实施和 通过在两个联邦合格健康中心进行的大型务实临床试验来评估干预措施，以及 马萨诸塞州纪念健康中心。这三个临床系统共同服务于大量的种族 和/或少数族裔群体(黑人、拉丁裔、非主要说英语的人)和社会经济 处境不利的病人。我们的具体目标是：(1)改进和调整工具，以支持有效的PCP 初级预防控制中心和社区对新冠肺炎疫苗接种和信息传播的建议 组织对弱势患者的支持；(2)实施和评估干预对新冠肺炎的影响 初步未接种疫苗患者的疫苗接种率，以及(3)根据RE-2评价干预措施。 AIM框架，纳入患者、初级保健提供者和诊所负责人的观点。我们会 在干预期之前、期间和之后描述当地社区环境，并将 确定环境支持或抑制干预效果的方式。这项研究将产生 为如何在弱势人群中有效推广新冠肺炎疫苗接种提供了关键证据。我们的 这一发现可用于促进其他疫苗的使用(包括可能的新冠肺炎疫苗“助推器”) 在面临疫苗接种迟疑和健康差距风险的人群中。

PROJECT SUMMARY/ABSTRACT The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and associated coronavirus disease 2019 (COVID-19) pandemic have been devastating. In the United States (US), more than 25 million people have been infected, resulting in more than 430,000 deaths. Black and Latino communities have borne a starkly disproportionate impact of COVID-19, compounding existing health disparities. The approval of multiple effective COVID-19 vaccines has raised hope that a return to “normal” life may be at hand, but realizing the full benefits of vaccines will require widespread acceptance and uptake. Our work and that of others indicate a significant proportion of the US population are reluctant to be vaccinated. Overlap between factors associated with COVID-19 disease and COVID-19 vaccine hesitancy, including being of Black or Latino race/ethnicity, and socioeconomic disadvantage, threaten to severely exacerbate existing health disparities. The overarching goal of this proposal is to overcome COVID-19 vaccine hesitancy, particularly among vulnerable populations. Building on strong existing community partnerships, we will refine, implement, and evaluate a multi-faceted intervention to support primary care providers and community organizations as trusted messengers to promote COVID-19 vaccination among vulnerable patients in and near Worcester, MA. Our intervention will include: (1) an online library of videos addressing common vaccine concerns to be disseminated by PCPs and local community organizations; (2) evidence-based text messaging from PCPs to their patients conveying recommendations for and information about COVID-19 vaccination; and (3) concise educational materials for PCPs to support their conversations with patients about the COVID-19 vaccine. We will implement and evaluate the intervention via a large pragmatic clinical trial at two Federally Qualified Health Centers, and the UMass Memorial Health Center. These three clinical systems collectively serve large populations of racial and/or ethnic minority groups (Black, Latino, non-primary English speakers) and socioeconomically disadvantaged patients. Our specific aims are: (1) To refine and adapt tools to support effective PCP recommendations for COVID-19 vaccination and information dissemination by PCPs and community organizations to vulnerable patients; (2) To implement and assess the impact of the intervention on COVID-19 vaccine uptake among initially unvaccinated patients and (3) To evaluate the intervention according to the RE- AIM framework, incorporating the perspectives of patients, primary care providers, and clinic leaders. We will characterize the local community environment before, during and beyond the intervention period and will identify ways the environment supports or inhibits intervention effectiveness. This research will generate crucial evidence of how to effectively promote COVID-19 vaccination among vulnerable populations. Our findings can be applied to promote uptake of other vaccines (including possible COVID-19 vaccine “boosters”) among populations at risk of vaccine hesitancy and health disparities.