K-VAC: Kentucky Vaccinating Appalachian Communities

摘要 成人接种疫苗是控制SARS-CoV-2/COVID-19和多种其他传染病的核心。 疫苗接种失败是一个复杂的多层次系统问题-个体因素，如 宿命论，缺乏事实信息，医疗和政府的不信任，以及政治派别都是众所周知的 疫苗吸收的抑制因素，以及社区因素，如缺乏机会，有限的交付机制， 以及来自不可信通信者的消息。因此，解决疫苗犹豫需要多层次的 干预，调整和解决个人，关系和结构要素，以纳入所有的 必要和足够的成分，以增加吸收。阿巴拉契亚地区的COVID-19疫苗接种率 居民的生活水平低得令人无法接受，几个月前就已经稳定下来。阿巴拉契亚肯塔基州包括 一些人群特征加起来，对疫苗犹豫不决的人群来说，这是一场“完美风暴”。 从结构上讲，该地区是农村地区，许多社区在地理上与世隔绝，无法获得保健服务。 在乎再加上贫困、教育水平低和慢性病高发， COVID-19感染导致的严重并发症和死亡风险。在历史上， 不信任的机构，疫苗接种干预措施必须利用文化上适当的社区伙伴关系 和战略。这项社区参与研究的目的是通过以下方式优化SARS-CoV-2疫苗的接种： 这群极度脆弱的阿巴拉契亚肯塔基州居民我们将实现三个具体目标：目标1：使用 社区参与的方法，阐明：a）信息内容的关键主题和框架， 个人层面的因素，B）可信的传播者传递文化敏感的信息，以及c）结构性 有效提供疫苗的障碍，以及确定这些因素在多大程度上是社区特有的 而不是更普遍的。目的2：采用整群随机试验设计，评估多水平 干预措施，通过受信任的本地服务提供针对主题和演示定制的个人级别目标消息 沟通者，并提供结构组件，以方便方便和可接受的访问， 接种疫苗。目标3：确定影响到达、接受和实现的过程因素 对干预内容的忠实度，以及更广泛的必要的适应内容 干预的可转移性、传播和交付。我们作为研究团队的长期目标是 制定有效的多层次干预策略，可用于解决疫苗犹豫， 阿巴拉契亚和类似的农村人口现有的疫苗接种问题。

ABSTRACT Vaccination of adults is central to control of SARS-CoV-2/COVID-19 and multiple other infectious diseases. Failure to engage in vaccine uptake is a complex, multilevel systems problem--individual factors such as fatalism, lack of factual information, medical and government mistrust, and political affiliation are all known inhibitors to vaccine uptake, as are community factors such as lack of access, limited delivery mechanisms, and messages from untrusted communicators. Thus, addressing vaccine hesitancy requires a multilevel intervention that aligns and addresses individual, relational, and structural elements to incorporate all of the necessary and sufficient components to increase uptake. COVID-19 vaccine uptake among Appalachian residents has been unacceptably low, with rates plateauing months ago. Appalachian Kentucky encompasses a number of population characteristics that add up to a "perfect storm" for a vaccine hesitant population. Structurally, the region is rural, with many communities geographically isolated and lacking access to health care. This, in addition to poverty, low education and high levels of chronic disease, place this population at significant risk of complications and mortality due to COVID-19 infection. In a population that historically has distrusted institutions, vaccination interventions must leverage culturally appropriate community partnerships and strategies. The purpose of this community-engaged study is to optimize SARS-CoV-2 vaccine uptake by this highly vulnerable Appalachian Kentucky population. We will achieve three specific aims: Aim 1: Using a community-engaged approach, elucidate: a) key themes for message content and framing that address individual-level factors, b) trusted communicators to deliver culturally-sensitive messages, and c) structural barriers to effective vaccine delivery, as well determining to what degree such factors are community-specific versus more generalizable. Aim 2: Using a cluster randomized trial design, assess the efficacy of a multilevel intervention that delivers individual-level target messaging tailored for theme and presentation by trusted local communicators AND that provides structural components to facilitate easy and acceptable access to vaccination delivery. Aim 3: Determine the process factors that affect reach, acceptance, and implementation fidelity for the intervention components, as well as necessary adaptation components for broader transferability, dissemination, and delivery of the intervention. Our long-term goal as a research team is to develop effective, multilevel intervention strategies that can be used to address vaccine hesitancy in Appalachian and similar rural populations for existing vaccination concerns.