PROJECT SUMMARY. The proposed study responds to NOT-MD-23-008, which calls for community-engaged
interventions to increase vaccine uptake among populations experiencing health disparities. We focus on
COVID-19 and influenza vaccination, both of which now require annual vaccines. Among those at highest risk
for morbidity, hospitalization, and mortality are African American/Black and Latino (ABBL) persons who are not
up-to-date on these vaccinations. Only 20-28% of adult AABL persons are up-to-date on COVID-19
vaccination, compared to 31% of White persons, and
only 30-40% of AABL persons receive the influenza
vaccine annually compared to >55% among White persons. AABL experience serious impediments to COVID-
19 (and to a lesser extent, influenza) vaccination at individual- (e.g., distrust, insufficient knowledge, low
perceived risk, cognitive biases), social- (e.g., peer norms), and structural-levels of influence (e.g., poor
access). Taken together, these comprise multi-level vaccine hesitancy. Factors that promote vaccination
include trusted AABL health educators (peers, nurses), tapping into altruism and collective responsibility,
circumventing cognitive biases, and reducing structural barriers. Without efforts to address multi-level vaccine
hesitancy, rates of COVID-19 and influenza vaccination will remain unacceptably low and racial/ethnic health
disparities in infectious disease morbidity and mortality will persist. The proposed study is led by a collaborative
team at New York University and the Northern Manhattan Improvement Corporation. It uses the multiphase
optimization strategy (MOST), an engineering-inspired framework, to test effects of individual candidate
intervention components in a factorial design and then optimize a multi-component intervention made up of the
most cost-effective combination of components. Staying up-to-date with COVID-19 vaccination (confirmed with
documentary evidence) is the primary outcome, and influenza vaccination is the secondary outcome. We have
identified four promising candidate components, with an emphasis on brevity, low-touch, and future scalability:
A) nurse-led shared decision making, B) a text message intervention, C) modest lottery prizes for vaccination,
and D) peer navigation to vaccination appointments. Participants will be N=560 community-residing adult
English and Spanish-speaking AABL persons who are not up-to-date on COVID-19 and influenza vaccinations
but with at least one COVID-19 vaccine dose. Specific aims are: Aim 1) identify which of four components
contribute meaningfully to improvement in the outcomes; Aim 2) identify mediators (e.g., altruism, norms) and
moderators (e.g., sociodemographic characteristics, distrust) of the effects of each component; and Aim 3)
build the most cost-effective intervention package(s). Participants will be randomly assigned to an experimental
condition, and assessed at 3- and 6-months post-baseline; N=45 participants will engage in qualitative in-depth
interviews. We will also uncover, describe, and plan for implementation issues so the optimized intervention
can be rapidly scaled up by community-based and outpatient health organizations.
