Project IMPROVE: Implementing Community-Engaged Intervention Research to Increase Rapid SARS-CoV-2 Self-Testing Among Diverse Underserved and Vulnerable Asian Americans

改进项目：实施社区参与的干预研究，以提高各种服务不足和弱势的亚裔美国人的快速 SARS-CoV-2 自我检测能力

• 批准号: 10845411
• 负责人: Carolyn Y. Fang
• 金额: $ 111.63万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10845411
• 关键词: 2019-nCoV; Address; Adherence; Advocate; Area; Asian; Asian Americans; Behavior; COVID testing; COVID-19; COVID-19 complications; COVID-19 diagnostic; COVID-19 disparity; COVID-19 pandemic effects; COVID-19 test; COVID-19 testing; COVID-19 vaccination; Caring; Chinese; Cities; Clinical; Cluster randomized trial; Colon Carcinoma; Communicable Diseases; Communities; Community Health; Commuting; Crowding; Day center care; Death Rate; Diagnostic tests; Discrimination; Disease; Disparity; Elderly; Ethnic Origin; Ethnic Population; Evaluation; FDA Emergency Use Authorization; FDA approved; Fright; Frontline worker; Goals; Health; Health Benefit; Health Insurance; Health system; Hepatitis B Virus; Hepatitis C virus; Hospitalization; Household; Housing; Human Papillomavirus; Immigrant; Individual; Industry; Intervention; Intervention Studies; Koreans; Language; Lifting; Light; Limited English Proficiency; Low income; Malignant Neoplasms; Masks; Medical; Misinformation; Multilingualism; Nail plate; National Institute on Minority Health and Health Disparities; Needs Assessment; Neighborhoods; Persons; Phase; Philadelphia; Population; Provider; Public Health; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Resources; Restaurants; Risk; Role; SARS-CoV-2 BA.2; SARS-CoV-2 infection; SARS-CoV-2 positive; Safety; Services; Sick Leave; Site; Social Distance; Socialization; Symptoms; Testing; Time; Transportation; Trust; United States National Institutes of Health; Vaccination; Variant; Vietnamese; Vulnerable Populations; Wages; Work; anti-Asian; barrier to care; barrier to testing; community based participatory research; community engagement; community organizations; coronavirus disease; design; digital; digital tool; economic impact; effectiveness evaluation; empowerment; evidence base; experience; health care settings; health disparity; health literacy; innovation; low health literacy; medical vulnerability; multi-component intervention; novel; online community; patient home care; patient navigation; peer; pragmatic trial; prevent; primary outcome; racial population; racism; screening; secondary outcome; self testing; social cognitive theory; social culture; social vulnerability; statistics; systemic barrier; testing uptake; tool; transmission process; uptake; ventilation

Project Summary Low-Income Asian Americans (AA) with limited English proficiency (LEP) represent a meaningful proportion of low-wage frontline workers in essential service industries. Many also live in multigenerational households with crowded conditions and with their elderly relatives in ethnic neighborhoods, areas that have experienced high rates of COVID-19 infection. Unfortunately, AAs have encountered numerous barriers to COVID-19 testing across individual, provider/health system and community/societal levels, including anti-Asian racism and discrimination, fear of safety at test sites and on public transportation, lack of health insurance, lack of culturally and language-appropriate COVID-19 information and navigation, and limited access to COVID-19 testing sites. As a result, AAs have the lowest COVID-19 testing rate across all racial/ethnic groups. This is particularly concerning in light of the recent surge in cases due to the BA.2 variant and lifting of COVID restrictions, which has led to increases in COVID-19 infections and hospitalizations especially among vulnerable populations. FDA- approved over-the-counter (OTC) COVID-19 diagnostic tests offer a valuable evidence-based strategy for empowering vulnerable AAs (who are hesitant or otherwise unable to obtain in-person PCR testing) to complete self-testing. Although prior studies have demonstrated the feasibility of COVID-19 self-testing in communities with access barriers, no intervention study has focused on vulnerable low-income frontline workers and seniors with LEP across diverse AA ethnic groups (Chinese, Vietnamese, Korean), the fastest growing US population. Thus, the overall goal of this application is to implement a community-engaged multifaceted intervention (herein called the IMPROVE intervention) to increase access to and uptake of rapid COVID-19 self-testing across diverse AA populations. Guided by the NIMHD Research Framework and Social Cognitive Theory to address sociocultural/environmental and individual/interpersonal influences for COVID self-testing, our central hypothesis is that trusted messengers (community health navigators, heath providers, and peer advocates) are essential to reducing testing barriers and increasing uptake of COVID-19 self-testing. The Specific Aims are to: (1) Engage community partners to implement a pragmatic cluster-randomized trial in 12 CBO sites to evaluate the effectiveness of the community-engaged and evidence-based IMPROVE intervention in increasing access to and uptake of COVID-19 self-testing (primary outcome) and changes in mitigation behaviors including adherence to mask wearing and COVID-19 vaccination (secondary outcomes) in underserved and vulnerable ethnic AAs (N=1200 AAs: 400 Chinese, 400 Korean and 400 Vietnamese); and (2) Evaluate Intervention Reach, Effectiveness, Adoption, Implementation and Maintenance using the RE-AIM framework to facilitate IMPROVE intervention dissemination to more CBOs and enhance its sustainability over time. The proposed project will be one of the first to evaluate an evidence-based community-engaged approach to reducing systemic barriers and will fill gaps in research on COVID-19 self-testing and mitigation adherence in 3 ethnic AA vulnerable populations.

项目总结