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，老年人口的COVID-19负担很大，占确诊COVID-19病例的23%， 据报告，75%的死亡发生在这一群体中，在65岁以上的人群中，检测率很低（每10万人中有3.4人）。的 关于COVID-19感染风险、症状、检测和 疫苗接种仍然是波多黎各一个公共卫生问题。2019年，居住在PR的人口中有21.3%是老年人（> 65岁），43.3%的人生活在贫困中，他们因慢性病而被隔离和医疗脆弱。隔离 由于在文化上关心和照顾老年人的家庭成员的高迁移率， 为他们波多黎各社区行动研究和参与倡议旨在重点关注 因地理、性和/或性别认同、无家可归而处于不利地位的PR老年社区 和/或收入，以确定多种因素如何在COVID-19检测中使这一高危人群处于不利地位， 疫苗摄取。我们完善的社区合作伙伴网络，使用混合方法研究策略， 目标是审查除了关键的政策和环境因素之外，健康的社会决定因素如何解决 在波多黎各的老年人（> 65岁）中进行检测和疫苗接种， 社会脆弱性（即，无家可归者），地理上孤立的人（即，居住在偏远地区或农村地区）， 贫困，性别或性多样性（即，L.G.B.T.T.Q.I.A.+）。我们的战略由四个理论框架指导： 社区参与连续体，交叉性知情的方法，安德森的健康行为模型， 历史创伤这些模型将使我们能够描绘一系列重要的多领域健康决定因素， 了解弱势群体的健康差距和医疗保健利用，特别是COVID-19检测和疫苗接种， 老年社区。我们的目标是：1）评估联邦和波多黎各联邦政策对COVID-19的影响 在波多黎各的低资源和社会弱势老年人中进行测试; 2）检查 影响低资源和社会弱势老年人接受COVID-19诊断的健康状况， 波多黎各和3）联合收割机结合系统政策审查和关键信息提供者（目标1：定性）和老年人 （目标2：定量和定性），以确定挑战、障碍和有效战略， 支持和改善这一弱势群体的COVID-19检测和其他相关健康结果。社区 包括PR-CARE在内的参与性研究将致力于扩大COVID-19的范围、覆盖面、获取和吸收 为波多黎各的弱势老年人群进行检测。与此同时，它将确定和建立永久的途径， 卫生政策，增加弱势群体获得卫生服务的机会，促进卫生公平， 社会、伦理和行为影响的透镜。