Project Summary
Latinxs, particularly those with mental illness, are at higher risk of COVID-19 infection, and associated morbidity
and mortality, and yet have lower rates of vaccination, than non-Latinx whites. This pattern is not unique to
COVID-19; it has been observed for other infectious diseases, including seasonal influenza. Vaccine hesitancy,
understood as a delay in the acceptance of vaccination despite availability of vaccination services, is the primary
roadblock for COVID-19 and influenza vaccination among Latinxs. Theoretical frameworks endorsed by the
SAGE working group on vaccine hesitancy, and prior research, illustrate that interventions to reduce vaccine
hesitancy and increase vaccine uptake in Latinxs should adopt strategies that: increase vaccine confidence and
convenience; reduce vaccine complacency; and respond to contextual, individual and vaccine-related factors
driving hesitancy, which include but are not limited to the social determinants of health and structural racism.
While a variety of strategies have been developed to address vaccine hesitancy in priority populations, the
potential role of behavioral health in community-based integrated health care settings has been overlooked. Yet
behavioral health, particularly within federally qualified health centers (FQHCs) which target social determinants
of health, may be an ideal setting to reach Latinxs, and other priority populations with mental illness, to address
vaccine hesitancy and promote vaccine uptake. In collaboration with East Boston Neighborhood Health Center
(EBNHC), the largest FQHC of Massachusetts, the proposed study will evaluate a novel Motivational
Interviewing (MI) behavioral intervention to reduce vaccine hesitancy and increase COVID-19 and influenza
vaccine uptake in Latinx adults with mental illness. Key to the intervention is that the proposed MI protocol
explicitly acknowledges cultural values that are central to the Latinx population and that impact their interactions
with health care providers. Additionally, the intervention has been specifically designed to be feasible and readily
implemented in community-based settings, and to be sustainable in the long-term regardless of how the rapidly
changing COVID-19 vaccination landscape evolves. To rigorously evaluate the intervention, we will conduct a
pragmatic multiple-period cluster-randomized crossover trial within four BH programs at EBNHC; key to this
design is that each program serves as its own control and that the multiple switches enhance statistical power.
To our knowledge, this will be the first study to rigorously examine the potential role of BH providers in increasing
vaccine uptake among Latinx adults with mental illness, a particularly vulnerable population. Key to the
anticipated impact is the partnership between the academia-based research team and colleagues at EBNHC
which, in turn, will support the rapid translation of evidence into practice together with a model for sustainable
collaboration and national scaleup.
