Social, Ethical, and Behavioral Implications Research on COVID-19: Testing and Vaccine Uptake Among Rural Latino Migrants in Southwest Florida

Latinos in Florida account for over 30% of all COVID-19 cases and hospitalizations. Most Latinos live in rural areas, work as migrant farmworkers and have higher rates of underlying medical conditions, limited access to health care, and live in circumstances that interfere with implementation of community mitigation measures, all potentially leading to increased risk of COVID-19 exposure, morbidity and mortality. The community partner, the Hispanic Services Council (HSC) trained local promotoras de salud (community health workers), and in the past two years has reached 5,900 underserved Latino immigrant families in SW Florida. Recently, HSC promotoras reached over 300 Latino families to ask about the impact of COVID-19 on their health and well-being. The study built on ongoing partnership (R34At010661-01) with HSC and the promotoras to collect data using mixed methods to assess healthcare, social, economic, and contextual factors that influence the ability and willingness to get tested for COVID-19 and/or vaccinated. The findings guided products, including community education and population-specific marketing strategies, to improve testing and vaccination uptake. In partnering with and sharing information with other NOSI recipients the study hoped to increase testing for COVID-19 across diverse communities in the USA and to inform targeted implementation of COVID-19 vaccines. AIM 1: To work with the community partner, HSC and promotoras to examine in southwest Florida rural Latino migrant and immigrant communities, the multilevel barriers that affect COVID-19 testing and vaccine uptake at individual, interpersonal, institutional (e.g., health care system) and community levels. Aim 1a. Qualitative focus groups (in 4 rural cities) will be facilitated by promotora partners using interview guides informed by an NIMHD framework and existing COVID-19 relevant measures. Aim 1b. Facilitators and barriers identified in Aim 1a and responses to questions that are adapted from existing questionnaires will be used to predict willingness for COVID-19 testing and vaccination (in n = 500 rural Latinos), as well as actual testing behavior. Exploratory moderators will be investigated. AIM 2: Determine strategies to address social determinants of health (SDOH) that present barriers to participation in testing, testing follow-up and vaccine uptake to inform development of intervention strategies to increase access to and acceptability of testing and vaccine behavior in rural Latino groups. Aim 2a. Based on Aim 1, community engagement strategies will be formulated to inform culturally sensitive implementation of testing and vaccines for Florida's rural Latino population. Products including education materials for improved COVID-19 health literacy and social marketing strategies will be developed. Aim 2b. Charlas (informal group conversations, n = 50) facilitated by promotoras will provide feedback on potential products. Findings will lead to further product refinement, which can then be implemented by HSC in the Latino communities they serve, while being evaluated for effectiveness by the research group.