Impact of a Community Care Intervention to Address Inequities in COVID-19 and Influenza Vaccination Among Adults Suffering from Disproportionate Chronic Disease

患有慢性病的少数种族和族裔不成比例地患传染病。分析 的COVID-19和流感数据表明，非西班牙裔人群中疫苗接种不公平的多个决定因素 白人和其他种族/族裔群体。这些问题包括结构性种族主义的表现，如难以获得 关心和缺乏文化，语言和识字适当的事实信息，以促进认识和 参与保护性疫苗接种行为的动机。纳入卫生和社区系统 同样，社区卫生工作者（CHW）干预是同时解决 健康的结构和社会决定因素。 建立在兰德、临床主任网络（CDN）和当地 社区团体和领导人，我们提出了一项研究，以定制，实施和评估社区健康 工作人员（CHW干预），以提高COVID-19疫苗接种接受率和疫苗接种率（初级 结果）和流感（次要结果）在接受主要 联邦合格卫生中心（FATHCs）。CHW干预措施的定制将基于 能力、机会、动机、行为（COM-B）理论行为模型，并与 社区咨询委员会（CAB）由患者和当地社区代表组成 组织的我们提出了一项随机对照试验（RCT），以确定CHW-VB的疗效 （社区卫生工作者干预，以加强疫苗接种行为）干预，以改善 在患有7种慢性疾病中任何一种的种族/少数民族成年人中接受、摄取和实施疫苗 疾病（哮喘、糖尿病、高血压、肥胖、抑郁症、焦虑症或PTSD）。 该研究在5年内有4个目标：1）根据形成性研究调整CHW干预措施（目标1： 第1年）; 2）进行随机对照试验，以测试CHW-VB的疗效（目标2：第2-4年）; 3）了解 CHW-VB和检查能力，动机和机会作为中介和人口统计的措施 特征和慢性医学/精神状况作为调节因素（目标3：3-4年）;以及，5）评估 影响执行和可持续性的背景因素（目标4：第5年）。我们的社区 参与式研究方法在研究的所有阶段都与CAB建立伙伴关系，通过 定期召开形成性评估会议，共同设计干预措施的调整，排除故障 任何执行障碍，并积极参与解释和传播结果。 FHQC雇用社区卫生工作者，作为向大多数非白人提供卫生保健服务的生命线的一部分， 患有慢性病的投保不足/未投保的病人。社区参与也是社区卫生组织的核心价值， 由他们所服务的贫困社区的个人和社区机构管理。 CHW-VB干预措施如果有效，在这种情况下具有很大的可扩展性和可持续性潜力。

Racial and ethnic minorities with chronic illness suffer disproportionately from infectious diseases. Analysis of COVID-19 and influenza data suggest multiple determinants of vaccination inequities among non-Hispanic whites and other racial/ethnic groups. These include manifestations of structural racism such as poor access to care and lack of cultural, language, and literacy-appropriate factual information to promote awareness of and motivation to partake in protective vaccination behaviors. Integrated within health and community systems alike, community health worker (CHW) interventions are an effective strategy to simultaneously address structural and social determinants of health in multiple settings. Building on a long-standing partnership between RAND, Clinical Directors Network (CDN), and local community groups and leaders, we propose a study to tailor, implement and evaluate a community health worker (CHW intervention) to increase vaccination acceptance and vaccination rates for COVID-19 (primary outcome) and influenza (secondary outcome) among individuals with chronic illness who receive their primary care in Federally Qualified Health Centers (FQHCs). Tailoring of the CHW intervention will be grounded on the Capability, Opportunity, Motivation, Behavior (COM-B) theoretical behavioral model and in partnership with a Community Advisory Board (CAB) composed of patients and representatives from local community organizations. We propose a randomized controlled trial (RCT) to determine the efficacy of the CHW-VB (Community Health Worker Intervention to enhance Vaccination Behaviors) intervention to improve vaccine acceptance, uptake, and implementation among racial/ethnic minority adults with any of 7 chronic conditions (asthma, diabetes, hypertension, obesity, depression, anxiety disorder, or PTSD). The study has 4 aims over 5 years: 1) tailor the CHW intervention based on formative research (Aim 1: Year 1); 2) conduct the RCT to test the efficacy of CHW-VB (Aim 2: Years 2-4); 3) understand the effects of CHW-VB and examine measures of capability, motivation, and opportunity as mediators and demographic characteristics and chronic medical/mental conditions as moderators (Aim 3: Years 3-4); and, 5) assess contextual factors affecting implementation and sustainability (Aim 4: Year 5). Our community-based participatory research approach is anchored in partnership with the CAB in all stages of the research, through regular meetings for the formative assessment, co-designing the adaptation of the intervention, troubleshooting any implementation hurdles, and actively participating in the interpretation and dissemination of the results. FHQCs employ CHWs as part of the lifeline of health care services delivered to mostly non-white and under/uninsured patients with chronic illnesses. Community engagement is also a core value for FQHCs who are governed by individuals and community-based agencies from the impoverished communities they serve. The CHW-VB intervention, if efficacious, has a high potential for scalability and sustainability in this setting.