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.
