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

利用基于社区的行为健康来增加患有精神疾病的拉丁裔成年人的疫苗接种率

• 批准号: 10710053
• 负责人: Rocio Calvo
• 金额: $ 54.87万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10710053
• 关键词: Academia; Address; Adopted; Adult; Automobile Driving; Behavior Therapy; Boston; COVID-19; COVID-19 morbidity; COVID-19 pandemic; COVID-19 vaccination; COVID-19 vaccine; Caring; Collaborations; Communicable Diseases; Communities; Counseling; Country; Coupled; Cross-Over Trials; Death Rate; Development; Diagnosis; Discrimination; Electronics; Elements; Federally Qualified Health Center; Health Personnel; Health Services; Hispanic; Individual; Influenza vaccination; Intervention; Knowledge; Language; Latinx; Latinx population; Leadership; Massachusetts; Mental Health; Mental disorders; Modeling; Morbidity - disease rate; Neighborhood Health Center; Neighborhoods; Pathway interactions; Patients; Pattern; Population; Positioning Attribute; Protocols documentation; Provider; Randomized; Research; Research Personnel; Risk; Role; SARS-CoV-2 infection; Safety; Series; Services; Structural Racism; Time; Training; Translations; Trauma; Trust; Universities; Vaccinated; Vaccination; Vaccines; Vulnerable Populations; World Health Organization; behavioral health; behavioral health intervention; booster vaccine; clinical practice; college; cultural values; design; effectiveness evaluation; effectiveness testing; evidence base; experience; global health; health care settings; health disparity; high risk; hospitalization rates; influenza virus vaccine; innovation; integrated care; intervention effect; mortality; motivational enhancement therapy; novel; pandemic disease; person centered; point of care; programs; response; scale up; seasonal influenza; social health determinants; theories; treatment as usual; trial design; uptake; vaccine acceptance; vaccine access; vaccine distribution; vaccine hesitancy; vaccine refusal; working group

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.

项目摘要 拉丁裔，尤其是患有精神疾病的拉丁裔，患有较高的Covid-19感染风险，以及相关的发病率 与非Latinx白人相比，死亡率和疫苗接种发生率较低。这种模式不是唯一的 新冠肺炎;已经观察到其他传染病，包括季节性流感。疫苗犹豫不决， 尽管有疫苗接种服务可用，但被认为是延迟接受疫苗接种的延迟，是主要的 在拉丁裔中进行Covid-19和流感疫苗接种的障碍。理论框架由 疫苗犹豫和先前研究的鼠尾草工作组说明了减少疫苗的干预措施 拉丁裔犹豫和增加疫苗的摄取应采用：增加疫苗信心和 方便;减少疫苗自满；并响应上下文，个人和疫苗相关因素 驾驶犹豫，其中包括但不限于健康和结构种族主义的社会决定因素。 虽然已经制定了各种策略来解决优先人群中的疫苗犹豫，但 行为健康在基于社区的综合卫生保健环境中的潜在作用已被忽略。然而 行为健康，尤其是在联邦合格的卫生中心（FQHC）中，其针对社会决定因素 健康，可能是吸引拉丁裔和其他精神疾病的优先人群的理想环境，以解决 疫苗犹豫并促进疫苗摄取。与东波士顿邻里健康中心合作 （EBNHC）是马萨诸塞州最大的FQHC，拟议的研究将评估一种新颖的动机 采访（MI）行为干预以减少疫苗犹豫并增加Covid-19和流感 有精神疾病的拉丁裔成年人的疫苗摄取。干预的关键是拟议的MI协议 明确承认文化价值是拉丁人的核心，这影响了他们的互动 与医疗保健提供者。此外，该干预措施是专门设计的，以便于可行且容易 在基于社区的环境中实施，并在长期内可持续 改变COVID-19疫苗接种景观的发展。为了严格评估干预措施，我们将进行 在EBNHC的四个BH计划中，务实的多个周期群集群跨试验；关键 设计是每个程序都可以作为自己的控制，并且多个开关增强了统计能力。 据我们所知，这将是第一个严格研究BH提供商在增加的潜在作用的研究 患有精神疾病的拉丁裔成年人的疫苗摄取，这是一个特别脆弱的人群。关键 预期的影响是基于学术界的研究团队与EBNHC的同事之间的伙伴关系 反过来，这将支持将证据快速转化为实践，以及可持续的模型 协作和国家规模。