Co-creating a Theory of Change to advance COVID-19 testing and vaccine uptake in underserved communities

Need for strategic communications and stakeholder engagement to advance acceptability of an overdose preventing vaccine targeting fentanyl

BACKGROUND

Fentanyl is a synthetic opioid, exposure to which has led to hundreds of thousands of overdose deaths. Novel vaccines are being developed that might protect against fentanyl overdose. Proactive attention to strategic communications and stakeholder engagement may smooth uptake of a novel vaccine given known challenges around vaccine hesitancy and concern for stigma related to substance use.

METHODS

Qualitative interviews (N = 74) with a purposive sample of adolescents/young adults with opioid use disorder (OUD), family members of persons with OUD, experts in substance use treatment and harm reduction, and community members were conducted and thematically analyzed to discern attitudes toward a fentanyl vaccine, and directions for communications and engagement.

RESULTS

Major themes reflected personal concerns for biomedical risk and system-level concerns for alignment and integration of an overdose preventing vaccine with prevailing beliefs about addiction and associated frameworks and philosophies for treatment and response.

CONCLUSION

Acceptability and implementation of a novel fentanyl vaccine targeting overdose will need precision communications that address biomedical, moral/spiritual, and structural perspectives about the nature of addiction. Education about the purpose and limits of a fentanyl vaccine, partnerships with diverse stakeholders from throughout the opioid response ecosystem and interweaving of a vaccine strategy into comprehensive prevention and treatment are recommended.

Public health partnerships with faith-based organizations to support vaccination uptake among minoritized communities: A scoping review

Faith-based vaccine initiatives are of growing interest to public health agencies who are looking to increase vaccine confidence among ethnoracially minoritized populations. Despite evidence that support faith-based organizations' (FBOs) partnerships with public health agencies (PHAs) to increase vaccine confidence, reviews on the scope and efforts to ensure equitable vaccination delivery for ethnoracially minoritized populations are scarce. We aimed to understand how public health agencies collaborate with FBOs or faith communities to improve vaccine confidence among minoritized communities in high-, low- and middle- income countries. We conducted a scoping review by searching OVID MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, and PROQUEST from 2011 to 2023. We included case studies, news reports, observational studies, experimental, and quasi-experimental studies and multimedia content that describes PHA-FBO partnerships that created vaccine initiatives for marginalized and minoritized communities. The data was extracted, summarized, and results were described narratively. We included 167 initiatives reported in 160 publications; 83.8% of the included articles were published between 2019 to 2023. The interventions carried out by PHA-FBO partnerships attempted to increase vaccine uptake using any or all the following methods. First, the initiatives provided digital and in-person platforms for interfaith learning and established training programs to empower faith leaders to become vaccine ambassadors. Second, the initiatives designed and disseminated education and awareness materials that aimed to be sensitive to religious and gender norms. Third, PHA-FBO partnered to apply equity and faith-based frameworks and provided wrap-around support to enable equitable vaccine access. Majority of the initiatives reported that PHA-FBO partnerships improved vaccine confidence and uptake (71.3%). About 22.2% of the initiatives reported quantitative outcomes post-intervention. PHA-FBO initiatives over the past decade increased vaccine uptake and acceptance among diverse ethnoracially minoritized populations. Reporting of faith-based initiatives are subject to publication bias and can be strengthened by examining more evaluation studies and establishment of key outcome indicators to critically appraise intervention outcomes.

An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis

BACKGROUND

The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information.

OBJECTIVE

This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys.

METHODS

A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems.

RESULTS

Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample's percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained.

CONCLUSIONS

General COVID-19-related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey's results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general.

COVID-19 Vaccinations, Trust, and Vaccination Decisions within the Refugee Community of Calgary, Canada

Refugee decisions to vaccinate for COVID-19 are a complex interplay of factors which include individual perceptions, access barriers, trust, and COVID-19 specific factors, which contribute to lower vaccine uptake. To address this, the WHO calls for localized solutions to increase COVID-19 vaccine uptake for refugees and evidence to inform future vaccination efforts. However, limited evidence engages directly with refugees about their experiences with COVID-19 vaccinations. To address this gap, researchers conducted qualitative interviews (N = 61) with refugees (n = 45), sponsors of refugees (n = 3), and key informants (n = 13) connected to local COVID-19 vaccination efforts for refugees in Calgary. Thematic analysis was conducted to synthesize themes related to vaccine perspectives, vaccination experiences, and patient intersections with policies and systems. Findings reveal that refugees benefit from ample services that are delivered at various stages, that are not solely related to vaccinations, and which create multiple positive touch points with health and immigration systems. This builds trust and vaccine confidence and promotes COVID-19 vaccine uptake. Despite multiple factors affecting vaccination decisions, a key reason for vaccination was timely and credible information delivered through trusted intermediaries and in an environment that addressed refugee needs and concerns. As refugees placed trust and relationships at the core of decision-making and vaccination, it is recommended that healthcare systems work through trust and relationships to reach refugees. This can be targeted through culturally responsive healthcare delivery that meets patients where they are, including barrier reduction measures such as translation and on-site vaccinations, and educational and outreach partnerships with private groups, community organizations and leaders.

Adaptation of the brainwriting premortem technique to inform the co-creation of COVID-19 testing strategies in underserved communities in South San Diego

INTRODUCTION

Meaningful engagement of partners in co-creating and refining health-related programs can increase the initial uptake, sustained implementation, broad reach, and effectiveness of these programs. This is especially important for underserved communities where resources are limited and need to be prioritized. Brainwriting premortem is a novel qualitative approach to partner engagement that combines the strengths of individual idea generation with the concept of premortem exercise that addresses failure points prior to the implementation of new programs.

METHODS

An adapted form of brainwriting premortem was used to inform iterative refinements to a COVID-19 testing program at a Federally Qualified Health Center (FQHC) in San Diego. Patients and providers from the FQHC participated in interviews at two time points (early- and mid-implementation of the program). Interview data were transcribed, translated, and analyzed using a rapid qualitative approach. Key themes and sub-themes were identified and used to inform refinements to the program.

RESULTS

A total of 11 patients (7 Spanish- and 4 English-speaking) and 8 providers participated in the brainwriting premortem interviews. Key themes related to possible reasons for COVID-19 testing program failure: advertising/sharing information; access to testing; handling of test results; staff and patient safety; patient beliefs and views regarding the SARS-CoV-2 virus; and COVID-19 testing options offered. Proposed solutions were offered for the key failures except for patient beliefs and views regarding the SARS-CoV-2 virus. Additional solutions offered were related to education, physical operations, and recruitment strategies. Real-time changes to the program flow and components were made in response to 7 suggestions from patients and 11 from providers. Changes related to the process of returning results were the most common, and included sending results via email with distinct workflows based on the test result.

CONCLUSION

The implementation of the adapted brainwriting premortem technique allowed us to incorporate the perspective of key partners in the delivery and iterative refinement of the COVID-19 testing program. This was an effective tool in the context of an FQHC and can be a promising and approach to incorporate iterative input from patients and providers to ensure successful program implementation. Future studies, particularly those requiring rapid response to public health emergencies, should consider the use of this technique.

Community-engaged optimization of COVID-19 rapid evaluation and testing experiences: roll-out implementation optimization trial

BACKGROUND

There continues to be a need for COVID-19 testing that is pragmatic, community-centered, and sustainable. This study will refine and test implementation strategies prioritized by community partners: (1) walk-up no-cost testing, (2) community health worker (promotores)-facilitated testing and preventive care counseling, (3) vending machines that dispense no-cost, self-testing kits.

METHODS

A co-designed Theory of Change from an earlier study phase and the Practical, Robust Implementation and Sustainment Model (PRISM) will guide the study design, measures selection, and evaluation. The first aim is to refine and operationalize a multi-component implementation strategy bundle and outcome measures for COVID-19 testing. A Community and Scientific Advisory Board (CSAB) will be established and include community members, clinical providers/staff from the partnering Federally Qualified Health Center (FQHC), public health researchers, policymakers, and a county health department ambassador. Engagement of CSAB members will be assessed through structured ethnography and a survey about the quality and quantity of engagement practices. The second aim is to implement and evaluate the impact of the implementation strategy bundle to optimize COVID-19 testing in communities using a roll-out implementation optimization (ROIO) design. Seven thousand and five hundred community members will be enrolled across four FQHC clinics over 18 months. Participants will be invited to complete an electronic survey about their demographics, health, and COVID-19 testing results and experiences. CSAB members and clinic partners will participate in PRISM fit and determinant assessments prior to each clinic rollout and post-trial. Interviews will be conducted with 60 community participants and 12 providers/staff following a 3-month rollout period at each clinic, inquiring about their experiences with the implementation strategies. Quantitative data will be analyzed using hierarchical multilevel models to determine the impact of implementation strategies. Qualitative data will be analyzed using rapid qualitative approaches to summarize implementation experiences and identify necessary changes prior to subsequent rollouts. A matrix approach will be used to triangulate data from quantitative and qualitative sources based on PRISM domains.

DISCUSSION

This is one of the first pragmatic implementation trials to use a ROIO design and aims to co-create a sustainable and equitable COVID-19 testing program. Findings are likely to generalize to other public health prevention efforts.

TRIAL REGISTRATION

NCT05894655 March 2, 2023.

Access to COVID-19 testing by individuals with housing insecurity during the early days of the COVID-19 pandemic in the United States: a scoping review

Introduction

The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pandemic as they faced increased risk of infection and difficulty in accessing testing and medical care. Individuals experiencing housing insecurity are a particularly vulnerable population given the additional barriers they face. In this scoping review, we identify some of the barriers this high-risk group experienced during the early days of the pandemic and assess novel solutions to overcome these barriers.

Methods

A scoping review was performed following PRISMA-Sc guidelines looking for studies focusing on COVID-19 testing among individuals experiencing housing insecurity. Barriers as well as solutions to barriers were identified as applicable and summarized using qualitative methods, highlighting particular ways that proved effective in facilitating access to testing access and delivery.

Results

Ultimately, 42 studies were included in the scoping review, with 143 barriers grouped into four categories: lack of cultural understanding, systemic racism, and stigma; medical care cost, insurance, and logistics; immigration policies, language, and fear of deportation; and other. Out of these 42 studies, 30 of these studies also suggested solutions to address them.

Conclusion

A paucity of studies have analyzed COVID-19 testing barriers among those experiencing housing insecurity, and this is even more pronounced in terms of solutions to address those barriers. Expanding resources and supporting investigators within this space is necessary to ensure equitable healthcare delivery.

Scaling and sustaining COVID-19 vaccination through meaningful community engagement and care coordination for underserved communities: hybrid type 3 effectiveness-implementation sequential multiple assignment randomized trial

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.

Perceived COVID-19 risk and testing experiences in the San Ysidro U.S./Mexico border region

Racial and ethnic disparities in COVID-19 incidence are pronounced in underserved U.S./Mexico border communities. Working and living environments in these communities can lead to increased risk of COVID-19 infection and transmission, and this increased risk is exacerbated by lack of access to testing. As part of designing a community and culturally tailored COVID-19 testing program, we surveyed community members in the San Ysidro border region. The purpose of our study was to characterize knowledge, attitudes, and beliefs of prenatal patients, prenatal caregivers, and pediatric caregivers at a Federally Qualified Health Center (FHQC) in the San Ysidro region regarding perceived risk of COVID-19 infection and access to testing. A cross-sectional survey was used to collect information on experiences accessing COVID-19 testing and perceived risk of COVID-19 infection within San Ysidro between December 29, 2020 and April 2, 2021. A total of 179 surveys were analyzed. Most participants identified as female (85%) and as Mexican/Mexican American (75%). Over half (56%) were between the age of 25 and 34 years old. Perceived Risk: 37% reported moderate to high risk of COVID-19 infection, whereas 50% reported their risk low to none. Testing Experience: Approximately 68% reported previously being tested for COVID-19. Among those tested, 97% reported having very easy or easy access to testing. Reasons for not testing included limited appointment availability, cost, not feeling sick, and concern about risk of infection while at a testing facility. This study is an important first step to understand the COVID-19 risk perceptions and testing access among patients and community members living near the U.S./Mexico border in San Ysidro, California.

Acceptability and Feasibility of Saliva-delivered PCR Coronavirus 2019 Tests for Young Children

OBJECTIVES

Access to readily available, reliable, and easy-to-use coronavirus disease 2019 (COVID-19) tests remains critical, despite great vaccination progress. Universal back-to-school testing offered at early care and education ([ECE]; ie, preschool) sites to screen for positive cases may help preschoolers safely return to, and stay in, ECE. We examined the acceptability and feasibility of using a quantitative polymerase chain reaction COVID-19 saliva test for young children (n = 227, 54.0% girls: mean age = 52.3 ± 8.1 months) and their caregivers (n = 70 teachers: mean = 36.6 ± 14.7 years; n = 227 parents: mean = 35.5 ± 9.1 years) to mitigate the spread of COVID-19 and reduce days of school and work missed for households with children who test positive.

METHODS

Participants were recruited at ECE sites serving low-income communities as part of the Rapid Acceleration of Diagnostic Testing-Underserved Populations Back to Early Care and Education Safely with Sustainability via Active Garden Education project (NCT05178290).

RESULTS

Surveys in English or Spanish administered at testing events to children and caregivers at ECE sites showed child and adult acceptability and feasibility ratings were generally high. More favorable child and parent ratings were positively associated with child age and whether the child was able to produce a saliva sample. Language preference was not associated with any outcomes.

CONCLUSIONS

Saliva sampling for COVID-19 at ECE sites is an acceptable strategy as an additional layer of protection for 4- and 5-year-olds; however, alternate testing strategies may be needed for younger children.

The Agile Co-production and Evaluation framework for developing public health interventions, messaging and guidance

A lesson identified from the COVID-19 pandemic is that we need to extend existing best practice for intervention development. In particular, we need to integrate (a) state-of-the-art methods of rapidly coproducing public health interventions and messaging to support all population groups to protect themselves and their communities with (b) methods of rapidly evaluating co-produced interventions to determine which are acceptable and effective. This paper describes the Agile Co-production and Evaluation (ACE) framework, which is intended to provide a focus for investigating new ways of rapidly developing effective interventions and messaging by combining co-production methods with large-scale testing and/or real-world evaluation. We briefly review some of the participatory, qualitative and quantitative methods that could potentially be combined and propose a research agenda to further develop, refine and validate packages of methods in a variety of public health contexts to determine which combinations are feasible, cost-effective and achieve the goal of improving health and reducing health inequalities.

Insights from Immigrant and Refugee Communities Regarding COVID-19 Needs and Opportunities: A Mixed Methods Study

Introduction

: This mixed methods study describes processes to actively engage underserved, immigrant, and refugee communities in COVID-19 vaccine efforts to co-create culturally relevant resources and dissemination.

Methods

: A survey on health care characteristics and COVID-19 attitudes was deployed between March-November 2021 followed by listening sessions conducted in December 2021. All participants were recruited through the project's Community Advisory Board. The survey, completed by 77 adults, was available in English, Spanish, Burmese, Kizigua, and Karen. Listening sessions were led by trained, multilingual, and multicultural interviewers.

Results

: Doctors/healthcare providers were rated as the most trusted messengers of COVID-19 information, however, trusted sources varied across communities. Data from three listening sessions (with a total of 14 participants) expanded survey findings with a focus on trusted sources of COVID-19 communication.

Conclusions

: This study confirmed the importance of healthcare professionals as trusted messengers for COVID-19 information among underserved communities. Qualitative data highlighted the importance of schools, ethnically-based community organizations, and friends/family with health and English literacy skills for immigrant and refugee communities. Findings suggest opportunities for collaboration with specific trusted sources for future public health dissemination efforts.

Trial registration

: not applicable.

COVID-19 Testing, Vaccine Perceptions, and Trust among Hispanics Residing in an Underserved Community

The Borderplex region has been profoundly impacted by the COVID-19 pandemic. Borderplex residents live in low socioeconomic (SES) neighborhoods and lack access to COVID-19 testing. The purpose of this study was two-fold: first, to implement a COVID-19 testing program in the Borderplex region to increase the number of residents tested for COVID-19, and second, to administer a community survey to identify trusted sources of COVID-19 information and factors associated with COVID-19 vaccine uptake. A total of 4071 community members were tested for COVID-19, and 502 participants completed the survey. COVID-19 testing resulted in 66.8% (n = 2718) positive cases. The community survey revealed that the most trusted sources of COVID-19 information were doctors or health care providers (67.7%), government websites (e.g., CDC, FDA, etc.) (41.8%), and the World Health Organization (37.8%). Logistic regression models revealed several statistically significant predictors of COVID-19 vaccine uptake such as having a trusted doctor or health care provider, perceiving the COVID-19 vaccine to be effective, and perceiving that the COVID-19 vaccine does not cause side-effects. Findings from the current study highlight the need for utilizing an integrated, multifactorial approach to increase COVID-19 testing and to identify factors associated with COVID-19 vaccine uptake in underserved communities.

Using ethnographic approaches to document, evaluate, and facilitate virtual community-engaged implementation research

BACKGROUND

Community Advisory Boards (CABs) have been frequently used to engage diverse partners to inform research projects. Yet, evaluating the quality of engagement has not been routine. We describe a multi-method ethnographic approach documenting and assessing partner engagement in two "virtual" CABs, for which we conducted all meetings remotely.

METHODS

Two research projects for increasing equitable COVID-19 testing, vaccination, and clinical trial participation for underserved communities involved remote CAB meetings. Thirty-three partners representing 17 community groups participated in 15 sessions across the two CABs facilitated by a social change organization. We developed ethnographic documentation forms to assess multiple aspects of CAB member engagement (e.g., time spent speaking, modality used, types of interactions). Documenters were trained to observe CAB sub-groups via virtual sessions. Debriefing with the documentation team after CAB meetings supported quality assurance and process refinement. CAB members completed a brief validated survey after each meeting to assess the quality and frequency of engagement. Content and rapid thematic analysis were used to analyze documentation data. Quantitative data were summarized as frequencies and means. Qualitative and quantitative findings were triangulated.

RESULTS

A total of 4,540 interactions were identified across 15 meetings. The most frequent interaction was providing information (44%), followed by responding (37-38%). The quality and frequency of stakeholder engagement were rated favorably (average 4.7 of 5). Most CAB members (96%) reported good/excellent engagement. Specific comments included appreciation for the diversity of perspectives represented by the CAB members and suggestions for improved live interpretation. Debriefing sessions led to several methodological refinements for the documentation process and forms.

CONCLUSION

We highlight key strategies for documenting and assessing community engagement. Our methods allowed for rich ethnographic data collection that refined our work with community partners. We recommend ongoing trainings, including debriefing sessions and routinely reviewed assessment of data to strengthen meaningful community engagement.

Codesign and community outreach to create COVID-19 safe communities: A Karen community case study

During the COVID-19 pandemic, government directives for health and community services focused on building capacity for COVID-19 safe behaviors. During 2020-2021, there was mounting pressure to increase vaccination numbers to boost population-wide immunity, thereby enabling the lessening of pandemic response restrictions. The Australian population, in general, faced communication hurdles in understanding COVID-19, government directives and policies, and health initiatives. This was particularly challenging given the rapid changes in disease behaviors and community response requirements. This community case study documents local experience in delivering information about COVID-19 safety and vaccination to a former refugee community (the Karen community) in regional Victoria. Community outreach and codesign approaches established closer engagement between the Karen community and Bendigo Community Health Services (BCHS). This case study is explored through semi-structured interviews conducted face-to-face and via videoconferencing with key Karen community leaders, Karen community members, vaccination clinic volunteers, and BCHS staff and bicultural workers. A hybrid approach that employed community outreach and codesign approaches in tandem built trust and closer ties between the Karen community and BCHS, leading to increased understanding and compliance with COVID-19 safe messages and vaccination uptake. Community-led innovations included codesign of COVID-19 fact sheets and videos in the Karen language, involvement of "local champions," assisting Karen businesses with COVID-19 safe plans, and creation of a COVID-19 information hotline. The latter was facilitated by BCHS bicultural staff. These innovations supported the delivery of vaccination clinics at the local Karen Temple. Embedding multi-level, tailored, and responsive public health approaches is particularly important in complex settings where there are disproportionately high levels of community disadvantage, as occurred during the COVID-19 pandemic.

Increasing COVID-19 testing and vaccination among Spanish speakers in the USA: protocol for the development and evaluation of the Nuestra Comunidad Saludable intervention using a group-randomised trial design

INTRODUCTION

Our community-based participatory research partnership aims to expand understanding of the social, ethical and behavioural implications of COVID-19 testing and vaccination to inform the development of an integrated intervention that harnesses community-based peer navigation and mHealth strategies to improve COVID-19 testing and vaccination; test the intervention; and develop and disseminate practice, research and policy recommendations to further increase COVID-19 testing and vaccination among Spanish-speaking Latine communities in the USA.

METHODS AND ANALYSIS

We will conduct 50 individual in-depth interviews with health providers, who have conducted COVID-19 testing and/or vaccination activities within Spanish-speaking communities, and with representatives from Latine-serving community-based organisations. We will also conduct six focus groups with 8-12 Spanish-speaking Latine community member participants each for a total number of about 60 focus group participants. Next, we will develop the Nuestra Comunidad Saludable intervention based on findings from interviews and focus groups and use a longitudinal group-randomised trial design with two arms (intervention and delayed intervention) to evaluate the impact of the intervention. We will recruit, enrol and collect baseline data from 20 community-based peer navigators (Navegantes) and their social network members (n=8 unique social network members per Navegante). Navegantes (coupled with their social networks) will be randomised to intervention or delayed intervention groups (10 Navegantes and 80 social network members per group).

ETHICS AND DISSEMINATION

Ethical approval for data collection was granted by the Wake Forest University School of Medicine Institutional Review Board. Following the description of study procedures, we will obtain consent from all study participants. Study findings will be disseminated through an empowerment theory-based community forum, peer-reviewed publications and presentations at scientific meetings, and reports and briefs for lay, community and practitioner audiences.

TRIAL REGISTRATION NUMBER

NCT05302908.

Wastewater research and surveillance: an ethical exploration

The current COVID-19 pandemic has given wastewater research a huge impetus. While wastewater research has some promising applications, there are as yet no well-developed ethical guidelines on how and under what conditions to use wastewater research. The current perspective paper aims to explore the different ethical questions pertaining to wastewater research and surveillance and to provide some tentative guidelines on the desirability of different types of applications. This paper shows that wastewater research offers interesting possibilities, but that legal regulation and ethical guidelines are still lacking, while there are ethical risks involved. The perspective indicates that it is important to look beyond the regulation of data collection and to shift the focus to the question how the analysis and use of wastewater data can be supervised.

Stroke and TIA Survivors' Perceptions of the COVID-19 Vaccine and Influences on Its Uptake: Cross Sectional Survey

BACKGROUND

People who have experienced a stroke or transient ischaemic attack (TIA) have greater risks of complications from COVID-19. Therefore, vaccine uptake in this vulnerable population is important. To prevent vaccine hesitancy and maximise compliance, we need to better understand individuals' views on the vaccine.

OBJECTIVES

We aimed to explore perspectives of the COVID-19 vaccine and influences on its uptake from people who have experienced a stroke or TIA.

METHOD

A cross-sectional, electronic survey comprising multiple choice and free text questions. Convenience sampling was used to recruit people who have experienced a stroke/TIA in the UK/Ireland.

RESULTS

The survey was completed by 377 stroke/TIA survivors. 87% (328/377) had either received the first vaccine dose or were booked to have it. The vaccine was declined by 2% (7/377) and 3% (11/377) had been offered the vaccine but not yet taken it up. 8% (30/377) had not been offered the vaccine despite being eligible. Some people expressed concerns around the safety of the vaccine (particularly risk of blood clots and stroke) and some were hesitant to have the second vaccine. Societal and personal benefits were motivations for vaccine uptake. There was uncertainty and lack of information about risk of COVID-19 related complications specifically for people who have experienced a stroke or TIA.

CONCLUSION

Despite high uptake of the first vaccine, some people with stroke and TIA have legitimate concerns and information needs that should be addressed. Our findings can be used to identify targets for behaviour change to improve vaccine uptake specific to stroke/TIA patients.

Understanding implementation research collaborations from a co-creation lens: Recommendations for a path forward

Increasing calls within the field of implementation science (IS) research seek to promote active engagement of diverse and often disenfranchised stakeholder voices to increase buy-in, fidelity, outcome relevance, and sustainment of evidence-based practices (EBPs). Including such voices requires cultural humility and the integration of multiple perspectives and values among organizations, groups, and individuals. However, the IS field lacks guidance for researchers on structuring collaborative approaches to promote a co-created process (i.e., synergistic approach to goal attainment). We contend that improved operationalization of co-created implementation collaborations is critical to sparking synergy and addressing differentials based on power, privilege, knowledge, and access to resources among stakeholders. These differentials can undermine future implementation and sustainment efforts if not addressed early in the research effort. An insufficient understanding of the guiding principles of co-created implementation collaborations may limit the scientific value of evaluation processes, and researchers' ability to replicate outcomes. We propose a perspective foregrounded in the concept of co-creation to guide the structuring of implementation collaboratives through five principles. We offer three case examples informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to illustrate the application of these co-creation principles. Lastly, we offer recommendations for promoting co-creation in IS research moving forward.

Research and Scholarly Methods: Implementation Science Studies

Traditional research focuses on efficacy or effectiveness of interventions but lacks evaluation of strategies needed for equitable uptake, scalable implementation, and sustainable evidence-based practice transformation. The purpose of this introductory review is to describe key implementation science (IS) concepts as they apply to medication management and pharmacy practice, and to provide guidance on literature review with an IS lens. There are five key ingredients of IS, including: (1) evidence-based intervention; (2) implementation strategies; (3) IS theory, model, or framework; (4) IS outcomes and measures; and (5) stakeholder engagement, which is key to a successful implementation. These key ingredients apply across the three stages of IS research: (1) pre-implementation; (2) implementation; and (3) sustainment. A case example using a combination of IS models, PRISM (Practical, Robust Implementation and Sustainability model) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), is included to describe how an IS study is designed and conducted. This case is a cluster randomized trial comparing two clinical decision support tools to improve guideline-concordant prescribing for patients with heart failure and reduced ejection fraction. The review also includes information on the Standards for Reporting Implementation Studies (StaRI), which is used for literature review and reporting of IS studies,as well as IS-related learning resources.

STOP COVID-19 CA: Community engagement to address the disparate impacts of the COVID-19 pandemic in California

Objective

To describe the early activities and lessons of the Share, Trust, Organize, Partner COVID-19 California Alliance (STOP COVID-19 CA), the California awardee of the NIH-funded multi-state Community Engagement Alliance (CEAL) against COVID-19. The Alliance was established to ensure equity in Coronavirus-19 disease (COVID-19) research, clinical practice, and public health for communities most impacted by the COVID-19 pandemic.

Study setting

The STOP COVID-19 CA Alliance network of 11 universities and affiliated partner community-based organizations (CBOs) across California.

Study design

Mixed methods evaluation consisting of an analysis of activity (August 2020 to December 2021) detailed in reports submitted by community-academic teams and a survey (August 2021) of academic investigators and affiliated community-based organization (CBO) partners.

Data collection

We summarized activities from the 11 community-academic teams' progress reports and described results from an online survey of academic investigators and CBO partners in the California Alliance.

Principal findings

A review of progress reports (n = 256) showed that teams fielded surveys to 11,000 Californians, conducted 133 focus groups, partnered with 29 vaccine/therapeutics clinical trials, and led more than 300 town halls and vaccine events that reached Californians from communities disproportionately impacted by COVID-19. Survey responses from academic investigators and CBO partners emphasized the importance of learning from the successes and challenges of the California Alliance teams' COVID-19 initiatives. Both academic and CBO respondents highlighted the need for streamlined federal and institutional administrative policies, and fiscal practices to promote more effective and timely operations of teams in their efforts to address the numerous underlying health and social disparities that predispose their communities to higher rates of, and poor outcomes from, COVID-19.

Conclusions

STOP COVID-19 CA represents a new and potentially sustainable statewide community engagement model for addressing health disparities in multiethnic/multicultural and geographically dispersed communities.