Scaling and Sustaining COVID-19 Vaccination through Meaningful Community Engagement and Care Coordination for Underserved Communities

PROJECT SUMMARY/ABSTRACT COVID-19 vaccines have been inequitably distributed and vaccine uptake has lagged, particularly for immigrant, refugee, Latino, and Black, Indigenous, People of Color (BIPOC) communities. Underlying reasons for the slow and variable uptake of COVID-19 vaccines include individual (e.g., health literacy, trust), cultural (e.g., linguistic needs), and structural barriers, such as technological and systemic factors (e.g., complex and onerous processes to schedule and attend vaccine appointments). There is no one-size-fits-all approach to vaccine implementation. This is borne out in the data indicating enormous disparities in COVID-19 testing, morbidity, mortality, and inoculation rates. Culturally relevant and linguistically appropriate, dynamic, and scalable strategies are essential to the immediate and long-term success of COVID-19 vaccine uptake and pandemic mitigation. Changing COVID-19 vaccine uptake behaviors offers an opportunity to concurrently improve engagement in other preventive health behaviors that are important public health priorities (e.g., diabetes management, cancer screenings, recommended adult vaccinations). We propose to co-refine, test, and scale a multicomponent health program to address the multi-level barriers to vaccine uptake and engagement in preventative healthcare in immigrant, refugee, Latino, and BIPOC communities in San Diego. Harnessing reverse innovation thinking, we will apply the Practical Robust Implementation and Sustainability Model (PRISM) to co-create with our community partners, the Global ARC, and San Ysidro Health, the elements of a health program that combines mHealth outreach (community-driven text and voice messages) and enhanced care coordination. Responsive to NOSI NOT-MD-22-006, this R01 will build on our current CEAL and RADx-UP implementation research to scale and sustain a multicomponent health program to increase acceptance, access, and uptake of COVID-19 vaccination and preventive care engagement among underserved communities. We assembled an experienced team of community-engaged implementation scientists, health equity, public health, and infectious disease researchers to accomplish the following aims: 1) Optimize a multicomponent health program to promote COVID-19 vaccine uptake and engagement in preventive healthcare using our established co-creation approach to address multi-level (individual, community, systemic) barriers to vaccine uptake and preventive care engagement; 2) Evaluate the implementation, effectiveness, and sustainment of the multicomponent COVID-19 vaccine and preventive care engagement program using a hybrid type 3 implementation-effectiveness sequential multiple assignment randomized trial design across immigrant, refugee, Latino, and BIPOC communities in Central and East San Diego.