Southeast Asians in the US: Health Equity and Research to Understand COVID-19 Stories (SEA US, HEAR US)

Unlike other ethnic minority groups, data on the impacts of COVID-19 on Southeast Asian Americans (SEAAs) are limited, oftentimes aggregated with other Asian American groups, thus limiting targeted assistance efforts. Without adequate data to inform best practices around testing and vaccination, many SEAAs become invisible Americans who have difficulties navigating a health care system that inadvertently excludes them. SEAAs have large disparities gap due to a combination of historical trauma, discrimination, harsh immigrant policies, and language barriers. Many are undocumented, hold low wage jobs, and less likely to attend college. Social isolation, anxiety, and financial hardships resulting from COVID-19 have intensified existing health and mental health issues. Lack of disaggregated data and under-reporting of race/ethnicity data, potentially masks the true impacts of COVID-19 on SEAAs and thus exemplifies systemic barriers and structural racism that keep them invisible and hinder targeted assistance. The goal of this project, "Southeast Asians in the U.S.: Health Equity And Research to Understand COVID-19 Stories (SEA US, HEAR US)" was to understand and address multi-level social, ethical, and behavioral implications of COVID-19 testing, vaccination, and its sequelae among Cambodians, Filipinos, Thais, and Vietnamese Americans in Greater Los Angeles through a community-based approach. The central hypothesis was that provision of data-informed and community-informed best practices/guidelines will improve evidence-based COVID-19 testing, vaccination, and its sequelae among their communities. Aim 1: Conduct multi-level formative research using a mixed-methods approach to validate, refine, and tailor existing SEBI measures and potentially develop new, more culturally-relevant, measures for SEAAs. Focus groups with community members (N=30) and key informant interviews with community leaders (N=6) were conducted to confirm cultural relevancy, comprehension, and potential refinement of the existing RADx-UP Common Data Elements (CDEs) and the Social Determinants of Health (SDOH), COVID-19 research findings, and other relevant measures present in the PhenX Toolkit. Aim 2: Collect individual-level data about social, ethical, and behavioral implications (SEBI) of COVID-19 testing, vaccination, and its sequelae among Southeast Asian Americans in the Greater Los Angeles area through a prospective longitudinal study. Spanning 12 months (BL, 3, 6, and 12 months), the survey allowed a better understanding of critical areas in COVID-19 testing and vaccination such as structural, cultural, and intrapersonal barriers and assets in SEAA communities (N=1000). The study isolated barriers that hinder or facilitate testing and vaccination over time, such as lack of accessibility, health literacy, language barriers, self-efficacy, stigma, or lack of social capital. Findings identified areas for potential programs and interventions and/or better access points to underserved groups. Aim 3: Conduct in-depth interviews with community leaders and stakeholders (community-based and faith-based organizations) within SEAA communities to understand their capacity, perceptions, attitudes, beliefs, and intentions towards COVID-19 testing and vaccination. This approach provided insight into organizational infrastructure, community-level, and societal-level factors for COVID-19 testing and vaccinations from the perspectives of community leaders (N=60). The study was able to identify common potential gaps or assets in service delivery and navigation, and areas of resiliency between groups. SEA US, HEAR US studied Cambodians, Filipinos, Thais, and Vietnamese Americans at a time when health equity is a challenge and issues of structural discrimination and anti-Asian hate is at its peak. SEAAs are invisible Americans who will continue to experience health disparities and be structurally discriminated against in the absence of culturally targeted, relevant assistance. SEBISEAA gathered community-driven, culturally-sensitive data to inform existing and future COVID-19 programs and policies that improve necessary resources and support for these sub-ethnic AA communities.

与其他少数族裔群体不同，针对东南亚裔美国人（Southeast Asian Americans, SEAAs）所受新冠疫情影响的相关数据十分有限，且常与其他亚裔美国群体的数据合并统计，这限制了针对性帮扶工作的开展。由于缺乏足够的数据来指导新冠检测与疫苗接种的最优实践，许多东南亚裔美国人沦为“隐形美国人”，他们难以适应无意中将其排除在外的医疗体系。东南亚裔美国人存在显著的健康差距，这源于历史创伤、歧视、严苛的移民政策与语言壁垒等多重因素叠加。其中许多人身份未合法化，从事低薪工作，且接受高等教育的比例较低。新冠疫情带来的社交隔离、焦虑情绪与经济困境，加剧了他们本已存在的生理与心理健康问题。缺乏细分数据以及种族/族裔数据上报不足的问题，可能掩盖了新冠疫情对东南亚裔美国人的真实影响，进而暴露了系统性壁垒与结构性种族主义——正是这些因素让他们沦为隐形群体，并阻碍了针对性帮扶工作的推进。本项目"Southeast Asians in the U.S.: Health Equity And Research to Understand COVID-19 Stories (SEA US, HEAR US)"旨在通过社区为本的研究方法，深入了解并应对大洛杉矶地区柬埔寨裔、菲律宾裔、泰国裔与越南裔美国人在新冠检测、疫苗接种及其后遗症方面所面临的多维度社会、伦理与行为层面的影响。本项目的核心假设为：提供基于数据与社区共识制定的最优实践方案/指南，将有助于提升其所在社区在新冠检测、疫苗接种及其后遗症相关事务中的循证实践水平。研究目标1：采用混合方法开展多维度形成性研究，对现有的社会、伦理与行为影响（Social, Ethical, and Behavioral Implications, SEBI）测量工具进行验证、优化与定制，并有可能开发出更贴合文化语境的东南亚裔美国人专属测量工具。研究团队通过开展30名社区成员焦点小组讨论与6名社区领袖关键知情人访谈，验证了现有RADx-UP通用数据元素（Common Data Elements, CDEs）、健康社会决定因素（Social Determinants of Health, SDOH）相关新冠研究结论，以及PhenX Toolkit工具库中其他相关测量工具的文化适配性、可理解性，并提出了潜在优化方向。研究目标2：通过一项前瞻性纵向研究，收集大洛杉矶地区东南亚裔美国人在新冠检测、疫苗接种及其后遗症方面的社会、伦理与行为影响相关个体层面数据。该研究为期12个月，分别在基线（BL）、3个月、6个月与12个月四个时间点开展调研，共招募1000名受访者，旨在更深入地了解东南亚裔美国人社区在新冠检测与疫苗接种方面的关键议题，包括结构性、文化性与个体内在的壁垒与优势资源。该研究梳理了随时间推移阻碍或促进新冠检测与疫苗接种的各类因素，例如可及性不足、健康素养欠缺、语言壁垒、自我效能感低下、污名化现象以及社会资本匮乏等。研究结果明确了可针对服务不足群体开发相关项目与干预措施，或优化其服务接入渠道的方向。研究目标3：对东南亚裔美国人社区内的社区领袖与利益相关方（包括社区组织与宗教组织）开展深度访谈，以了解他们对新冠检测与疫苗接种的能力、认知、态度、信念与意向。该访谈共招募60名社区领袖参与，从他们的视角揭示了影响新冠检测与疫苗接种的组织基础设施、社区层面与社会层面的各类因素。该研究明确了不同群体在服务提供与对接过程中普遍存在的潜在缺口与优势资源，以及群体间的韧性建设领域。"Southeast Asians in the U.S.: Health Equity And Research to Understand COVID-19 Stories (SEA US, HEAR US)"项目开展之际，正值健康公平面临严峻挑战、结构性歧视与反亚裔仇恨事件处于顶峰的时期。东南亚裔美国人作为“隐形美国人”，若缺乏针对性的文化适配帮扶措施，将持续面临健康差距问题并遭受结构性歧视。本项目所收集的社会、伦理与行为影响相关东南亚裔美国人数据（SEBISEAA），即由社区主导、贴合文化语境的数据，可为现有及未来的新冠相关项目与政策提供参考，以提升针对这些亚裔亚族群社区的必要资源供给与帮扶支持。