TY - JOUR
T1 - Scaling and sustaining COVID-19 vaccination through meaningful community engagement and care coordination for underserved communities
T2 - hybrid type 3 effectiveness-implementation sequential multiple assignment randomized trial
AU - Rabin, Borsika A.
AU - Cain, Kelli L.
AU - Watson Jr., Paul
AU - Oswald, William
AU - Laurent, Louise C.
AU - Meadows, Audra R.
AU - Seifert, Marva
AU - Munoz, Fatima A.
AU - Salgin, Linda
AU - Aldous, Jeannette
AU - Diaz, Edgar A.
AU - Villodas, Miguel
AU - Vijaykumar, Santosh
AU - O’Leary, Sean T.
AU - Stadnick, Nicole A.
N1 - Funding information: This study was funded through the National Institute of Minority Health and Health Disparities R01 MD017222.
PY - 2023/7/14
Y1 - 2023/7/14
N2 - Background: COVID-19 inequities are abundant in low-income communities of color. Addressing COVID-19 vaccine hesitancy to promote equitable and sustained vaccination for underserved communities requires a multi-level, scalable, and sustainable approach. It is also essential that efforts acknowledge the broader healthcare needs of these communities including engagement in preventive services. Methods: This is a hybrid type 3 effectiveness-implementation study that will include a multi-level, longitudinal, mixed-methods data collection approach designed to assess the sustained impact of a co-created multicomponent strategy relying on bidirectional learning, shared decision-making, and expertise by all team members. The study capitalizes on a combination of implementation strategies including mHealth outreach with culturally appropriate messaging, care coordination to increase engagement in high priority preventive services, and the co-design of these strategies using community advisory boards led by Community Weavers. Community Weavers are individuals with lived experience as members of an underserved community serving as cultural brokers between communities, public health systems, and researchers to co-create community-driven, culturally sensitive public health solutions. The study will use an adaptive implementation approach operationalized in a sequential multiple assignment randomized trial design of 300 participants from three sites in a Federally Qualified Health Center in Southern California. This design will allow examining the impact of various implementation strategy components and deliver more intensive support to those who benefit from it most. The primary effectiveness outcomes are COVID-19 vaccine completion, engagement in preventive services, and vaccine confidence. The primary implementation outcomes are reach, adoption, implementation, and maintenance of the multicomponent strategy over a 12-month follow-up period. Mixed-effects logistic regression models will be used to examine program impacts and will be triangulated with qualitative data from participants and implementers. Discussion: This study capitalizes on community engagement, implementation science, health equity and communication, infectious disease, and public health perspectives to co-create a multicomponent strategy to promote the uptake of COVID-19 vaccination and preventive services for underserved communities in San Diego. The study design emphasizes broad engagement of our community and clinic partners leading to culturally sensitive and acceptable strategies to produce lasting and sustainable increases in vaccine equity and preventive services engagement. Trial registration: ClinicalTrials.gov Identifier: NCT05841810 May 3, 2023
AB - Background: COVID-19 inequities are abundant in low-income communities of color. Addressing COVID-19 vaccine hesitancy to promote equitable and sustained vaccination for underserved communities requires a multi-level, scalable, and sustainable approach. It is also essential that efforts acknowledge the broader healthcare needs of these communities including engagement in preventive services. Methods: This is a hybrid type 3 effectiveness-implementation study that will include a multi-level, longitudinal, mixed-methods data collection approach designed to assess the sustained impact of a co-created multicomponent strategy relying on bidirectional learning, shared decision-making, and expertise by all team members. The study capitalizes on a combination of implementation strategies including mHealth outreach with culturally appropriate messaging, care coordination to increase engagement in high priority preventive services, and the co-design of these strategies using community advisory boards led by Community Weavers. Community Weavers are individuals with lived experience as members of an underserved community serving as cultural brokers between communities, public health systems, and researchers to co-create community-driven, culturally sensitive public health solutions. The study will use an adaptive implementation approach operationalized in a sequential multiple assignment randomized trial design of 300 participants from three sites in a Federally Qualified Health Center in Southern California. This design will allow examining the impact of various implementation strategy components and deliver more intensive support to those who benefit from it most. The primary effectiveness outcomes are COVID-19 vaccine completion, engagement in preventive services, and vaccine confidence. The primary implementation outcomes are reach, adoption, implementation, and maintenance of the multicomponent strategy over a 12-month follow-up period. Mixed-effects logistic regression models will be used to examine program impacts and will be triangulated with qualitative data from participants and implementers. Discussion: This study capitalizes on community engagement, implementation science, health equity and communication, infectious disease, and public health perspectives to co-create a multicomponent strategy to promote the uptake of COVID-19 vaccination and preventive services for underserved communities in San Diego. The study design emphasizes broad engagement of our community and clinic partners leading to culturally sensitive and acceptable strategies to produce lasting and sustainable increases in vaccine equity and preventive services engagement. Trial registration: ClinicalTrials.gov Identifier: NCT05841810 May 3, 2023
KW - COVID-19
KW - Implementation science
KW - Health equity
KW - mHealth
KW - Hybrid type 3 effectiveness-implementation study
KW - Underserved communities
KW - Vaccination
KW - Care coordination
KW - Sequential multiple assignment randomized trial
UR - http://www.scopus.com/inward/record.url?scp=85164846659&partnerID=8YFLogxK
U2 - 10.1186/s13012-023-01283-2
DO - 10.1186/s13012-023-01283-2
M3 - Article
SN - 1748-5908
VL - 18
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 28
ER -