Leveraging community-based behavioral health to increase vaccine uptake in Latinx adults with mental illness

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Project Summary Latinxs, particularly those with mental illness, are at higher risk of COVID-19 infection, and associated morbidity and mortality, and yet have lower rates of vaccination, than non-Latinx whites. This pattern is not unique to COVID-19; it has been observed for other infectious diseases, including seasonal influenza. Vaccine hesitancy, understood as a delay in the acceptance of vaccination despite availability of vaccination services, is the primary roadblock for COVID-19 and influenza vaccination among Latinxs. Theoretical frameworks endorsed by the SAGE working group on vaccine hesitancy, and prior research, illustrate that interventions to reduce vaccine hesitancy and increase vaccine uptake in Latinxs should adopt strategies that: increase vaccine confidence and convenience; reduce vaccine complacency; and respond to contextual, individual and vaccine-related factors driving hesitancy, which include but are not limited to the social determinants of health and structural racism. While a variety of strategies have been developed to address vaccine hesitancy in priority populations, the potential role of behavioral health in community-based integrated health care settings has been overlooked. Yet behavioral health, particularly within federally qualified health centers (FQHCs) which target social determinants of health, may be an ideal setting to reach Latinxs, and other priority populations with mental illness, to address vaccine hesitancy and promote vaccine uptake. In collaboration with East Boston Neighborhood Health Center (EBNHC), the largest FQHC of Massachusetts, the proposed study will evaluate a novel Motivational Interviewing (MI) behavioral intervention to reduce vaccine hesitancy and increase COVID-19 and influenza vaccine uptake in Latinx adults with mental illness. Key to the intervention is that the proposed MI protocol explicitly acknowledges cultural values that are central to the Latinx population and that impact their interactions with health care providers. Additionally, the intervention has been specifically designed to be feasible and readily implemented in community-based settings, and to be sustainable in the long-term regardless of how the rapidly changing COVID-19 vaccination landscape evolves. To rigorously evaluate the intervention, we will conduct a pragmatic multiple-period cluster-randomized crossover trial within four BH programs at EBNHC; key to this design is that each program serves as its own control and that the multiple switches enhance statistical power. To our knowledge, this will be the first study to rigorously examine the potential role of BH providers in increasing vaccine uptake among Latinx adults with mental illness, a particularly vulnerable population. Key to the anticipated impact is the partnership between the academia-based research team and colleagues at EBNHC which, in turn, will support the rapid translation of evidence into practice together with a model for sustainable collaboration and national scaleup.