Puerto Rico Community Action Research and Engagement (PR-CARE) to Eliminate Disparities in Diagnostic of COVID-19 among Rural Underserved and Vulnerable Populations.

波多黎各社区行动研究和参与 (PR-CARE) 旨在消除农村服务不足和弱势群体中 COVID-19 诊断的差异。

• 批准号: 10544754
• 负责人: EDNA ACOSTA-PEREZ
• 金额: $ 102.07万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10544754
• 关键词: Action Research; Address; Adopted; Attitude; Behavioral; Behavioral Model; Belief; COVID-19; COVID-19 diagnostic; COVID-19 disparity; COVID-19 impact; COVID-19 testing; COVID-19 vaccine; Caribbean Hispanic; Caring; Cessation of life; Chronic Disease; Clinical Research; Collaborations; Communities; Community Actions; Computer Assisted; Data; Dedications; Disadvantaged; Discrimination; Elderly; Environmental Risk Factor; Ethics; Family member; Funding; Future; Gender; Generations; Geography; Goals; Health; Health Policy; Health Services Accessibility; Health behavior; Hispanic; Homelessness; Income; Individual; Intervention; Interview; Knowledge; Language; Low income; Methods; Modeling; National Institute of General Medical Sciences; Outcome; Pathway interactions; Perception; Phase; Policies; Population; Populations at Risk; Poverty; Public Health; Puerto Rican; Puerto Rico; RADx Underserved Populations; Reduce health disparities; Reporting; Research Methodology; Resources; Rural; SARS-CoV-2 infection; Services; Sexual and Gender Minorities; Shapes; Social Work; Structure; Surveys; Symptoms; Testing; Thick; Translational Research; Trauma; Underserved Population; Vaccination; Validation; Vulnerable Populations; Work; community engaged research; community engagement; community organizations; community partnership; coronavirus disease; disparity elimination; disparity reduction; gender diversity; geographic disparity; health care service utilization; health determinants; health disparity; health equity promotion; human old age (65+); improved; infection risk; informant; intersectionality; medical vulnerability; migration; policy implication; population health; programs; rural area; rural underserved; social; social health determinants; social vulnerability; testing access; testing uptake; uptake; vaccine acceptance; vaccine access; vulnerable community

In Puerto Rico, the COVID-19 burden in the elderly population is significant as 23% of the confirmed COVID-19 cases and 75% of the deaths have been reported in this group with a low testing rate (3.4 per 100,000) in those > 65 years. The knowledge, beliefs, attitudes, and practices about the risk of infection from COVID-19, symptoms, testing and vaccination, remain a public health concern in Puerto Rico. In 2019, 21.3% of the population living in PR were elderly (> 65 years) with 43.3% living in poverty, were isolated, and medically vulnerable due to their chronic diseases. Isolation for elders has been exacerbated due to the high rate of migration of their family members that culturally cared and lookout for them. The Puerto Rico Community Action Research and Engagement (PR-CARE) initiative aims to focus on the elderly communities in PR who are disadvantaged by geography, sexual and/or gender identification, homelessness and/or income to identify how multiple factors serve to disadvantage this at-risk population in COVID-19 testing and vaccine uptake. Our well-established community partner network, using a mixed methods research strategy, has the goal of examining how social determinants of health, in addition to critical policy and environmental factors, address testing and vaccine access and uptake in elderly (> 65 years old) populations in Puerto Rico who suffer from high levels of social vulnerability (i.e., homeless), who are geographically isolated (i.e., living in isolated or rural areas), living in poverty, and gender or sexual diverse (i.e., L.G.B.T.T.Q.I.A.+). Our strategies are guided by four theoretical frameworks: Community Engagement Continuum, Intersectionality-Informed Approach, Anderson’s Behavioral Model of Health, and Historical Trauma. These models will enable us to portray a critical array of multi-domain determinants of health to understand health disparities and healthcare utilization, specifically COVID-19 testing, and vaccinations, in vulnerable elderly communities. Our aims are to: 1) assess federal and Puerto Rico Commonwealth policy implications on COVID-19 testing in low-resourced and socially vulnerable elderly in Puerto Rico; 2) examine individual and social determinants of health that influence the uptake of the COVID-19 diagnostics among low-resourced and socially vulnerable elderly in Puerto Rico and 3) combine results from the systematic policy review and key informants (Aim 1: qualitative) and elderly individuals (Aim 2: quantitative and qualitative) to identify challenges, barriers and effective strategies and language to support and improve COVID-19 testing and other related health outcomes in this vulnerable population. The community engagement research that comprises PR-CARE will work to expand the scope, reach, access to and uptake of COVID-19 testing for vulnerable elderly populations in Puerto Rico. Concurrently, it will identify and create permanent pathways in health policy that increase the availability of health services for vulnerable populations, promoting health equity using the lens of social, ethical, and behavioral implications.

在波多黎各，总体人口中的Covid-19 Burnen显着，占确认的Covid-19案件的23％，并且 在这一组中，已经报告了75％的死亡人数，其中> 65年的测试率较低（每100,000）。这 知识，信念，吸引力和实践有关COVID-19，症状，测试和 疫苗接种，仍然是波多黎各的公共卫生问题。 2019年，居住在PR的人口中有21.3％的人数年长（> 65岁）有43.3％的生活在贫困中，由于其慢性疾病而被孤立，并且在医学上脆弱。隔离 由于其在文化关心和监视的家庭成员的迁移率很高，因此长者被加剧了 为他们。波多黎各社区行动研究与参与（PR-CARE）倡议旨在专注于 公关中的老年社区因地理，性和/或性别身份，无家可归而处于不利地位 和/或收入，以确定多个因素如何灾难的灾难，这是在COVID-19测试中的高危人群和 疫苗的吸收。我们建立良好的社区合作伙伴网络，使用混合方法研究策略，具有 除关键政策和环境因素外，还要研究健康的社会决定者如何解决 在波多黎各老年（> 65岁）人口中的测试和疫苗接种和吸收 社会脆弱性（即无家可归），他们在地理上孤立（即生活在孤立或粗糙的地区） 贫穷，性别或性潜水员（即L.G.B.T.T.Q.I.A.+）。我们的策略以四个理论框架为指导： 社区参与连续性，交叉性的方法，安德森的健康行为模型以及 历史创伤。这些模型将使我们能够描绘出一系列重要的健康决定者 了解健康分配和医疗保健利用，特别是COVID-19测试，以及在脆弱的情况下进行疫苗接种 老年社区。我们的目标是：1）评估联邦和波多黎各英联邦对Covid-19的影响 在波多黎各的低资源和社会脆弱性中进行测试； 2）检查个人和社会决定者 影响低资源和社会脆弱的COVID-19诊断的摄取的健康 波多黎各和3）结合了系统的政策审查和关键信息（AIM 1：定性）和较早的结果 个人（目标2：定量和定性），以确定挑战，障碍以及有效的策略和语言 支持并改善该脆弱人群中的Covid-19测试和其他相关的健康结果。社区 包括PR-CARE的参与研究将有助于扩大Covid-19的范围，触及，访问和吸收 对波多黎各的脆弱较老人口进行测试。同时，它将识别并创建永久的途径 卫生政策增加了弱势群体的卫生服务的可用性，使用 社会，道德和行为影响的镜头。