A multidimensional Digital Approach to Address Vaccine Hesitancy and Increase COVID-19 Vaccine Uptake among African American Young Adults in the South

项目摘要 年轻人（YA）是传播SARS-Co-V2的关键“超级传播者”群体， COVID-19（COVID）.鉴于他们的无症状感染率高，加上传播率， 正在被违反物理距离和面临覆盖法规的行为所推动， 代表重点人群，应集中努力确保高水平的COVID疫苗接种。 虽然COVID疫苗可以保护非洲裔美国年轻人（AA-YA）免受COVID相关的发病率 和死亡率，只有在干预措施确保AA-YA的安全性， 这不仅有益于增进信任，同时也解决了传播不信任的历史背景和系统性力量。数字健康 干预措施（DHIs）可以接触到大量的AA-YA，无论其地理位置如何，并赋予他们权力 使用YAs重视和信任的熟悉模式，对他们的健康做出明智的决定。我们 一个协作小组制定了告知DHI坚韧会谈的理论，以协助YA做出艾滋病毒披露决定 特别是通过考虑他们的选择的社会，道德和行为影响， 后果随之而来。针对NOT-MD-21-008：解决疫苗犹豫、摄取、 在经历健康差异的人群中实施，我们建议应用一个社区- 基于参与性研究（CBPR）的方法来评估NIMHD中确定的多层次因素 研究框架和适应和测试坚韧会谈，以解决COVID疫苗犹豫（VH），坚韧 Talks-COVID（TT-C）.在目标1中，我们将进行多方法的形成性研究， 认知和环境决定因素影响AA-YA（18-29岁）中的COVID VH， 南方各州。我们将联合收割机有效的调查措施与新的CBPR方法相结合，包括 自己的冒险之旅和数字故事，以更好地了解AA-YA的疫苗决策。在 与专家顾问、社区合作伙伴和AA-YA最终用户合作，在目标2中，我们将利用 ADAPT-ITT开发和完善TT-C。以用户为中心的参与式设计和快速原型焦点小组 将在南部各州使用AA-YA（n=12-16）进行。一旦敲定，我们将进行技术试点 用AA-YA（N=24）评估TT-C的可行性和可接受性。在目标3中，我们将进行混合型1 有效性实施3组RCT，n=540 AA-YA，来自南方三个州。参与者将被 随机接受标准护理（对照）、远程递送TT-C和亲自递送TT-C。 主要有效性结果是COVID疫苗接种和系列完成。次要有效性 结果是VH，信心，知识，态度和信念。我们将进行定性访谈， 参与者（n=12-16）和研究中心工作人员（n=6-8）评估实施障碍和促进因素。我们利用我们 现有的基础设施，有意义地与南部AA-YA社区接触，努力拆除 不公平的研究关系和医学上的不信任增加了COVID疫苗的使用。

PROJECT SUMMARY Young Adults (YA) are a key “super-spreader” population transmitting SARS-Co-V2, the causative agent of COVID-19 (COVID). Given their high rate of asymptomatic infection compounded by transmission rates that are being fueled by behaviors that run contrary to physical distancing and face covering regulations, YA represent a priority population upon which to focus efforts to ensure high levels of COVID vaccine uptake. While COVID vaccines can protect African American young adults (AA-YA) against COVID related morbidity and mortality, this population will only accept vaccination if interventions assure AA-YA of its safety and benefit, while also addressing historical contexts and systemic forces that propagate mistrust. Digital Health Interventions (DHIs) can reach large numbers of AA-YA regardless of geographic location and empower them to make informed decisions about their health using a familiar modality that YAs value and trust. Our collaborative team developed the theory informed DHI Tough Talks to assist YA with HIV disclosure decision making, specifically by considering the social, ethical and behavioral implications of their choices and the consequences that follow. In response to NOT-MD-21-008: Research to Address Vaccine Hesitancy, Uptake, and Implementation among Populations that Experience Health Disparities, we propose to apply a community- based participatory research (CBPR) approach to assess multi-level factors identified within the NIMHD Research Framework and adapt and test Tough Talks to address COVID vaccine hesitancy (VH), Tough Talks-COVID (TT-C). In aim 1, we will conduct multi-method formative research to elicit the behavioral, cognitive, and environmental determinants influencing COVID VH among AA-YA (ages 18-29) in three southern states. We combine validated survey measures, with novel CBPR methods including choose-your- own adventure journeys and digital storytelling to better understand vaccine decision-making in AA-YA. In collaboration with expert advisors, community partners, and AA-YA end-users, in aim 2, we will leverage ADAPT-ITT to develop and refine TT-C. User-centered participatory design and rapid prototyping focus groups will be conducted with AA-YA (n=12-16) in southern states. Once finalized, we will conduct a technical pilot with AA-YA (N=24) to assess TT-C’s feasibility and acceptability. In aim 3, we will conduct a hybrid type 1 effectiveness implementation 3-arm RCT with n=540 AA-YA from three southern states. Participants will be randomized to receive standard of care (control), TT-C delivered remotely, and TT-C delivered in-person. Primary effectiveness outcomes are COVID vaccine uptake and series completion. Secondary effectiveness outcomes are VH, confidence, and knowledge, attitudes and beliefs. We will conduct qualitative interviews with participants (n=12-16) and site staff (n=6-8) to assess implementation barriers and facilitators. We leverage our existing infrastructure to meaningfully engage with southern AA-YA communities, working to dismantle inequitable research relationships and medical mistrust to increase COVID vaccine uptake.