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

项目摘要 拉丁裔，特别是那些患有精神疾病的人，感染COVID-19的风险更高， 和死亡率，但接种率较低，比非拉丁裔白人。这种模式并不是只有 COVID-19;已观察到其他传染病，包括季节性流感。疫苗犹豫， 被理解为尽管有疫苗接种服务，但接受疫苗接种的延迟， 为拉丁裔人接种COVID-19和流感疫苗设置路障。核可的理论框架 SAGE疫苗犹豫工作组和先前的研究表明，减少疫苗接种的干预措施 在拉丁美洲人中，犹豫和增加疫苗接种应采取以下策略：增加疫苗信心， 便利性;减少疫苗自满;并对环境、个人和疫苗相关因素作出反应 这些因素包括但不限于健康的社会决定因素和结构性种族主义。 虽然已经制定了各种战略来解决优先人群的疫苗犹豫问题， 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了。然而 行为健康，特别是在针对社会决定因素的联邦合格健康中心（WHCs）内 健康，可能是一个理想的设置，以达到拉丁美洲人，和其他优先人群与精神疾病，以解决 疫苗犹豫和促进疫苗吸收。与东波士顿社区健康中心合作 （EBNHC），马萨诸塞州最大的公共卫生中心，拟议的研究将评估一种新的动机 面试（MI）行为干预，以减少疫苗犹豫和增加COVID-19和流感 患有精神疾病的拉丁裔成年人的疫苗接种率。干预的关键是拟议的MI协议 明确承认对拉丁裔人口至关重要并影响其互动的文化价值观 医疗保健提供者。此外，干预措施经过专门设计，具有可行性， 在以社区为基础的环境中实施，并在长期内可持续，无论如何迅速， 不断变化的COVID-19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 在EBNHC的四个BH项目中进行的一项实用的多阶段群集随机交叉试验;这一试验的关键 设计的一个重要特点是，每个程序都充当其自身的控制，并且多个开关增强了统计能力。 据我们所知，这将是第一项严格审查BH提供者在增加 患有精神疾病的拉丁裔成年人的疫苗接种率，这是一个特别脆弱的人群。的关键 预期的影响是位于迈阿密的研究小组与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，并建立一个可持续发展的模式。 合作和国家推广。

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.