A novel community intervention to reduce disparate impact from COVID-19 on vulnerable adolescents

项目总结 黑人中不良的性健康和生殖健康(SRH)和心理健康(MH)结果的负担 来自低资源社区的青少年人数很多。缓解新冠肺炎大流行的努力已经 减少获得护理的机会，并有可能加剧现有的差距；因此，开展研究以改善负面影响 大流行对SRH和MH结果的影响是迫切需要的。建立在以前工作的基础上， 借鉴经过验证的战略，我们提出了增加获得护理的机会的新方法。我们会比较一下 我们的社区层面干预，青少年健康外展(THO)，到我们的多层次干预，青少年健康 外展+(tho+)。在THO+中，我们将提供针对个人的干预(例如，医疗系统导航 培训)、人际关系(例如，社交网络传播信息)和社区(例如，领导支持关怀 获取服务(包括远程医疗和移动医疗单位)。我们将进行整群随机对照 试验以评估干预的可行性。我们的伙伴社区组织的青少年领导人将 招募朋友组成小型网络(N-96名14-18岁的青少年)。我们将对网络进行随机化以： (1)THO(受信任的社区组织促进医疗保健来源，包括我们的MHU、远程医疗和 传统诊所)或(2)THO+(同行领导与卫生专业人员和信任的成年人合作，以管理工具包 包含健康材料[例如，信息图表、视频]和传播策略[例如，社交媒体、小型 小组会议]积极地将他们朋友网络中的青少年联系到与THO相同的护理来源)。 我们将使用混合方法评估这些可行性构建：可接受性、需求、实施、 实用性、整合性、扩充性、效率性有限。我们比较两个手臂以确定有效率的大小。 关于开始避孕的问题。在规模上，这种干预可以完全融入我们的社区，并作为一种 受大流行挑战的卫生组织的典范。从这项研究中获得的知识将转化为 转变为值得信赖的外展干预措施，以应对快速变化的卫生需求，包括未来 新冠肺炎疫苗接种和投放环境。

PROJECT SUMMARY The burden of poor sexual and reproductive health (SRH) and mental health (MH) outcomes among Black adolescents from low-resource communities is substantial. Efforts to mitigate the COVID-19 pandemic have reduced access to care and threaten to worsen existing disparities; thus, research to ameliorate the negative impact of the pandemic on SRH and MH outcomes is desperately needed. Building on previous work and drawing on proven strategies, we propose our novel approach to increasing access to care. We will compare our community-level intervention, TeenHealth Outreach (THO), to our multi-level intervention, TeenHealth Outreach+ (THO+). In THO+, we will provide intervention at the individual (e.g., health system navigation training), interpersonal (e.g., social networks diffuse information), and community (e.g., leaders support care access including telemedicine and mobile health units) levels. We will conduct a cluster randomized controlled trial to evaluate intervention feasibility. Adolescent leaders from our partner community organizations will recruit friends to form small networks (N ~ 96 adolescents aged 14-18 years). We will randomize networks to: (1) THO (trusted community organizations promote health care sources including our MHU, telemedicine, and traditional clinics) or (2) THO+ (peer leaders work with health professionals and trusted adults to curate toolkits containing health materials [e.g., infographics, videos] and strategies for diffusion [e.g., social media, small group sessions] to actively connect adolescents in their friend networks to the same sources for care as THO). We will assess these feasibility constructs using mixed methodology: acceptability, demand, implementation, practicality, integration, expansion, and limited-efficacy. We compare two arms to determine size of effect rates on contraception initiation. At scale, this intervention can be fully integrated into our community and serve as a model for health organizations challenged by the pandemic. Knowledge gained from this research will translate into trusted outreach interventions equipped to respond to rapidly changing health needs, including future vaccination against COVID-19, and delivery environments.