Project IMPROVE: Implementing Community-Engaged Intervention Research to Increase Rapid SARS-CoV-2 Self-Testing Among Diverse Underserved and Vulnerable Asian Americans

项目摘要 英语水平有限的低收入亚裔美国人(AA)占相当大的比例 基本服务行业的低工资一线工人。许多人还生活在几代人的家庭中 拥挤的条件和他们年迈的亲戚在少数民族社区，这些地区经历了 新冠肺炎感染率。不幸的是，AA在新冠肺炎测试中遇到了无数障碍 在个人、提供者/保健系统和社区/社会各级，包括反亚洲种族主义和 歧视，对考点和公共交通安全的恐惧，缺乏医疗保险，缺乏文化 和语言适配的新冠肺炎信息和导航，以及对新冠肺炎考试网站的有限访问。 因此，在所有种族/民族中，AA的新冠肺炎测试率最低。这是特别的 考虑到最近因BA.2变种和取消COVID限制而出现的案件激增， 导致新冠肺炎感染和住院人数增加，特别是在弱势人群中。FDA- 经批准的场外(OTC)新冠肺炎诊断测试为以下疾病提供了宝贵的循证战略 使易受攻击的AA(犹豫不决或因其他原因无法获得面对面的PCR检测)能够完成 自我测试。尽管之前的研究已经证明了新冠肺炎在社区自测的可行性 有了准入障碍，没有干预研究将重点放在脆弱的低收入一线工人和老年人身上 LEP遍及不同的AA种族(中国人、越南人、韩国人)，是增长最快的美国人口。 因此，该应用程序的总体目标是实现社区参与的多方面干预(在此 称为改进干预)，以增加对快速新冠肺炎自我检测的获取和接受 不同的再生障碍性贫血人群。在NIMHD研究框架和社会认知理论的指导下解决 社会文化/环境和个人/人际对COVID自我检测的影响，这是我们的中心假设 值得信赖的信使(社区健康导航者、健康提供者和同伴倡导者)是必不可少的吗 降低测试门槛，增加对新冠肺炎自测的接受度。具体目标是：(1)参与 社区合作伙伴将在12个CBO站点实施务实的整群随机试验，以评估 社区参与和循证改进干预的有效性，以增加获得 和接受新冠肺炎自我测试(主要结果)和缓解行为的变化，包括 在服务不足和弱势群体中坚持戴口罩和接种新冠肺炎疫苗(次要结果) 少数民族AA(N=1200名AA：400名中国人、400名韩国人和400名越南人)；以及(2)评估干预范围。 使用RE-AIM框架的有效性、采用、实施和维护，以促进改进 干预措施将传播给更多的社区组织，并随着时间的推移加强其可持续性。拟议的项目将是 首批评估以证据为基础、社区参与的方法以减少系统性障碍和 将填补在新冠肺炎自测和缓解对3个AA弱势人群依从性方面的研究空白。

Project Summary Low-Income Asian Americans (AA) with limited English proficiency (LEP) represent a meaningful proportion of low-wage frontline workers in essential service industries. Many also live in multigenerational households with crowded conditions and with their elderly relatives in ethnic neighborhoods, areas that have experienced high rates of COVID-19 infection. Unfortunately, AAs have encountered numerous barriers to COVID-19 testing across individual, provider/health system and community/societal levels, including anti-Asian racism and discrimination, fear of safety at test sites and on public transportation, lack of health insurance, lack of culturally and language-appropriate COVID-19 information and navigation, and limited access to COVID-19 testing sites. As a result, AAs have the lowest COVID-19 testing rate across all racial/ethnic groups. This is particularly concerning in light of the recent surge in cases due to the BA.2 variant and lifting of COVID restrictions, which has led to increases in COVID-19 infections and hospitalizations especially among vulnerable populations. FDA- approved over-the-counter (OTC) COVID-19 diagnostic tests offer a valuable evidence-based strategy for empowering vulnerable AAs (who are hesitant or otherwise unable to obtain in-person PCR testing) to complete self-testing. Although prior studies have demonstrated the feasibility of COVID-19 self-testing in communities with access barriers, no intervention study has focused on vulnerable low-income frontline workers and seniors with LEP across diverse AA ethnic groups (Chinese, Vietnamese, Korean), the fastest growing US population. Thus, the overall goal of this application is to implement a community-engaged multifaceted intervention (herein called the IMPROVE intervention) to increase access to and uptake of rapid COVID-19 self-testing across diverse AA populations. Guided by the NIMHD Research Framework and Social Cognitive Theory to address sociocultural/environmental and individual/interpersonal influences for COVID self-testing, our central hypothesis is that trusted messengers (community health navigators, heath providers, and peer advocates) are essential to reducing testing barriers and increasing uptake of COVID-19 self-testing. The Specific Aims are to: (1) Engage community partners to implement a pragmatic cluster-randomized trial in 12 CBO sites to evaluate the effectiveness of the community-engaged and evidence-based IMPROVE intervention in increasing access to and uptake of COVID-19 self-testing (primary outcome) and changes in mitigation behaviors including adherence to mask wearing and COVID-19 vaccination (secondary outcomes) in underserved and vulnerable ethnic AAs (N=1200 AAs: 400 Chinese, 400 Korean and 400 Vietnamese); and (2) Evaluate Intervention Reach, Effectiveness, Adoption, Implementation and Maintenance using the RE-AIM framework to facilitate IMPROVE intervention dissemination to more CBOs and enhance its sustainability over time. The proposed project will be one of the first to evaluate an evidence-based community-engaged approach to reducing systemic barriers and will fill gaps in research on COVID-19 self-testing and mitigation adherence in 3 ethnic AA vulnerable populations.