Racial and ethnic minorities with chronic illness suffer disproportionately from infectious diseases. Analysis
of COVID-19 and influenza data suggest multiple determinants of vaccination inequities among non-Hispanic
whites and other racial/ethnic groups. These include manifestations of structural racism such as poor access to
care and lack of cultural, language, and literacy-appropriate factual information to promote awareness of and
motivation to partake in protective vaccination behaviors. Integrated within health and community systems
alike, community health worker (CHW) interventions are an effective strategy to simultaneously address
structural and social determinants of health in multiple settings.
Building on a long-standing partnership between RAND, Clinical Directors Network (CDN), and local
community groups and leaders, we propose a study to tailor, implement and evaluate a community health
worker (CHW intervention) to increase vaccination acceptance and vaccination rates for COVID-19 (primary
outcome) and influenza (secondary outcome) among individuals with chronic illness who receive their primary
care in Federally Qualified Health Centers (FQHCs). Tailoring of the CHW intervention will be grounded on the
Capability, Opportunity, Motivation, Behavior (COM-B) theoretical behavioral model and in partnership with a
Community Advisory Board (CAB) composed of patients and representatives from local community
organizations. We propose a randomized controlled trial (RCT) to determine the efficacy of the CHW-VB
(Community Health Worker Intervention to enhance Vaccination Behaviors) intervention to improve
vaccine acceptance, uptake, and implementation among racial/ethnic minority adults with any of 7 chronic
conditions (asthma, diabetes, hypertension, obesity, depression, anxiety disorder, or PTSD).
The study has 4 aims over 5 years: 1) tailor the CHW intervention based on formative research (Aim 1:
Year 1); 2) conduct the RCT to test the efficacy of CHW-VB (Aim 2: Years 2-4); 3) understand the effects of
CHW-VB and examine measures of capability, motivation, and opportunity as mediators and demographic
characteristics and chronic medical/mental conditions as moderators (Aim 3: Years 3-4); and, 5) assess
contextual factors affecting implementation and sustainability (Aim 4: Year 5). Our community-based
participatory research approach is anchored in partnership with the CAB in all stages of the research, through
regular meetings for the formative assessment, co-designing the adaptation of the intervention, troubleshooting
any implementation hurdles, and actively participating in the interpretation and dissemination of the results.
FHQCs employ CHWs as part of the lifeline of health care services delivered to mostly non-white and
under/uninsured patients with chronic illnesses. Community engagement is also a core value for FQHCs who
are governed by individuals and community-based agencies from the impoverished communities they serve.
The CHW-VB intervention, if efficacious, has a high potential for scalability and sustainability in this setting.
