K-VAC: Kentucky Vaccinating Appalachian Communities

摘要 成人接种疫苗是控制SARS-CoV-2/新冠肺炎和多种其他传染病的核心。 未能参与疫苗接种是一个复杂的、多层次的系统问题--个人因素，如 宿命论、缺乏事实信息、医疗和政府的不信任以及政治派别都是众所周知的 疫苗接种的抑制因素，以及社区因素，如缺乏获得疫苗的机会，有限的递送机制， 以及来自不可信通信者的消息。因此，解决疫苗的犹豫不决需要多层面的 调整和解决个人、关系和结构元素的干预措施，以整合所有 必要和充足的组成部分，以增加吸收。阿巴拉契亚地区接种新冠肺炎疫苗的情况 居民的房价低得令人无法接受，几个月前利率就已经持平。阿巴拉契亚肯塔基州包括 对于一个对疫苗犹豫不决的人群来说，许多人口特征加在一起构成了一场“完美风暴”。 从结构上讲，该区域是农村地区，许多社区地理上与世隔绝，缺乏卫生保健服务。 关心。这一点，再加上贫困、低教育和高水平的慢性病，使这一人口处于 新冠肺炎感染导致并发症和死亡的显著风险。在一个历史上有 在不信任机构的情况下，疫苗接种干预必须利用文化上合适的社区伙伴关系 和策略。这项社区参与研究的目的是通过以下方式优化SARS-CoV-2疫苗的接种 这些高度脆弱的阿巴拉契亚肯塔基州人口。我们将实现三个具体目标：目标1：使用 社区参与方法，阐明：a)信息内容和框架的关键主题 个人层面的因素，b)受信任的传播者传递文化敏感的信息，以及c)结构 有效疫苗交付的障碍，以及决定这些因素在多大程度上是社区特有的 而不是更具普遍性。目的2：采用整群随机试验设计，评价多水平 干预，提供针对受信任本地用户的主题和演示而量身定做的个人级别目标消息 通信器，并提供结构组件以便于轻松和可接受地访问 疫苗接种送货。目标3：确定影响达到、接受和实施的流程因素 干预组件的保真度，以及更广泛的必要适应组件 干预措施的可转移性、传播性和传递性。我们作为一个研究团队的长期目标是 制定有效的、多层次的干预策略，可用于解决疫苗在 阿巴拉契亚和类似的农村人口对现有疫苗接种的关注。

ABSTRACT Vaccination of adults is central to control of SARS-CoV-2/COVID-19 and multiple other infectious diseases. Failure to engage in vaccine uptake is a complex, multilevel systems problem--individual factors such as fatalism, lack of factual information, medical and government mistrust, and political affiliation are all known inhibitors to vaccine uptake, as are community factors such as lack of access, limited delivery mechanisms, and messages from untrusted communicators. Thus, addressing vaccine hesitancy requires a multilevel intervention that aligns and addresses individual, relational, and structural elements to incorporate all of the necessary and sufficient components to increase uptake. COVID-19 vaccine uptake among Appalachian residents has been unacceptably low, with rates plateauing months ago. Appalachian Kentucky encompasses a number of population characteristics that add up to a "perfect storm" for a vaccine hesitant population. Structurally, the region is rural, with many communities geographically isolated and lacking access to health care. This, in addition to poverty, low education and high levels of chronic disease, place this population at significant risk of complications and mortality due to COVID-19 infection. In a population that historically has distrusted institutions, vaccination interventions must leverage culturally appropriate community partnerships and strategies. The purpose of this community-engaged study is to optimize SARS-CoV-2 vaccine uptake by this highly vulnerable Appalachian Kentucky population. We will achieve three specific aims: Aim 1: Using a community-engaged approach, elucidate: a) key themes for message content and framing that address individual-level factors, b) trusted communicators to deliver culturally-sensitive messages, and c) structural barriers to effective vaccine delivery, as well determining to what degree such factors are community-specific versus more generalizable. Aim 2: Using a cluster randomized trial design, assess the efficacy of a multilevel intervention that delivers individual-level target messaging tailored for theme and presentation by trusted local communicators AND that provides structural components to facilitate easy and acceptable access to vaccination delivery. Aim 3: Determine the process factors that affect reach, acceptance, and implementation fidelity for the intervention components, as well as necessary adaptation components for broader transferability, dissemination, and delivery of the intervention. Our long-term goal as a research team is to develop effective, multilevel intervention strategies that can be used to address vaccine hesitancy in Appalachian and similar rural populations for existing vaccination concerns.