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

项目摘要 拉丁裔，特别是患有精神疾病的人，感染新冠肺炎的风险更高，以及相关的发病率更高 与非拉丁裔白人相比，他们的疫苗接种率更低。这种模式并不是 新冠肺炎；曾被观察到用于其他传染病，包括季节性流感。疫苗犹豫不决， 被理解为尽管提供了疫苗接种服务，但在接受疫苗接种方面的延迟，是主要的 新冠肺炎和拉丁裔接种流感疫苗的路障。通过的理论框架 关于疫苗迟疑问题SAGE工作组和先前的研究说明了减少疫苗的干预措施 拉美裔犹豫不决和增加疫苗接种率应采取以下战略：增加疫苗信心和 便利性；减少疫苗自满；应对背景、个人和疫苗相关因素 导致犹豫不决，包括但不限于健康和结构性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迟疑问题，但 行为健康在以社区为基础的综合保健环境中的潜在作用被忽视。还没有 行为健康，特别是在以社会决定因素为目标的联邦合格健康中心(FQHC)内 健康，可能是一个理想的环境，以帮助拉丁裔和其他患有精神疾病的优先人群，以解决 疫苗迟疑，促进疫苗接种率。与东波士顿社区卫生中心合作 (EBNHC)，马萨诸塞州最大的FQHC，拟议的研究将评估一种新的动机 访谈(MI)行为干预减少疫苗迟疑，增加新冠肺炎和流感 患有精神疾病的拉丁裔成年人的疫苗接种情况。干预的关键是拟议的MI协议 明确承认对拉丁裔人群至关重要并影响他们互动的文化价值观 与医疗保健提供者的关系。此外，干预措施已被特别设计为可行和容易实施 在以社区为基础的环境中实施，并在长期内可持续，无论发展多么迅速 不断变化的新冠肺炎疫苗接种格局正在演变。为了严格评估干预措施，我们将进行一项 EBNHC四个BH项目内实用的多周期群组随机交叉试验；关键 设计是每个程序充当自己的控制，并且多个开关增强统计能力。 据我们所知，这将是第一次严格检查BH提供商在增加 患有精神疾病的拉丁裔成年人的疫苗接种情况，这是一个特别脆弱的群体。解决问题的关键 预期影响是以学术界为基础的研究团队与EBNHC同事之间的合作 这反过来又将支持将证据迅速转化为实践，以及可持续发展的模式 协作和全国范围的扩展。

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.