Trusted Messengers: Supporting Physicians in Promoting COVID-19 Vaccination

项目概要/摘要 严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 和相关冠状病毒疾病 2019 年 (COVID-19) 大流行是毁灭性的。在美国 (US)，超过 2500 万人 已被感染，导致超过43万人死亡。黑人和拉丁裔社区遭受了 COVID-19 的影响明显不成比例，加剧了现有的健康差距。多方批准 有效的 COVID-19 疫苗让人们燃起了恢复“正常”生活指日可待的希望，但要实现全面 疫苗的好处需要得到广泛的接受和采用。我们的工作和其他人的工作表明 很大一部分美国人不愿意接种疫苗。相关因素之间的重叠 对 COVID-19 疾病和 COVID-19 疫苗犹豫不决，包括黑人或拉丁裔种族/族裔，以及 社会经济劣势，有可能严重加剧现有的健康差距。总体目标 该提案的目的是克服对 COVID-19 疫苗的犹豫，特别是在弱势群体中。 以现有的强大社区合作伙伴关系为基础，我们将完善、实施和评估多方面的 支持初级保健提供者和社区组织作为值得信赖的使者进行干预，以促进 马萨诸塞州伍斯特及其附近的弱势患者接种了 COVID-19 疫苗。我们的干预措施将包括：(1) 解决常见疫苗问题的在线视频库，由 PCP 和当地传播 社区组织； (2) PCP 向患者发送基于证据的短信，传达 有关 COVID-19 疫苗接种的建议和信息； (3) 简明的教育材料 PCP 支持与患者就 COVID-19 疫苗进行对话。我们将实施并 通过在两个联邦合格健康中心进行的大型实用临床试验来评估干预措施，以及 麻省大学纪念健康中心。这三个临床系统共同服务于大量种族群体 和/或少数族裔群体（黑人、拉丁裔、非主要英语使用者）和社会经济方面 弱势患者。我们的具体目标是： (1) 完善和调整工具以支持有效的 PCP 关于 PCP 和社区的 COVID-19 疫苗接种和信息传播的建议 弱势患者的组织； (2) 实施干预措施并评估其对 COVID-19 的影响 最初未接种疫苗的患者的疫苗接种情况，以及 (3) 根据 RE- 评估干预措施 AIM 框架，融合了患者、初级保健提供者和诊所领导者的观点。我们会 描述干预期之前、期间和之后当地社区环境的特征，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 如何在弱势群体中有效促进 COVID-19 疫苗接种的重要证据。我们的 研究结果可用于促进其他疫苗的接种（包括可能的 COVID-19 疫苗“加强剂”） 面临疫苗犹豫和健康差异风险的人群。

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.