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. Our community partner, the Hispanic Services Council (HSC) trains 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. We will build on our 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. Our findings will guide 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 we hope 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 our 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 our research group.

佛罗里达州的拉丁裔群体占新型冠状病毒肺炎（COVID-19）确诊病例与住院病例总数的30%以上。该群体多数居住在农村地区，从事移民农场工人职业，且基础疾病患病率更高、医疗服务可及性有限，同时所处生活环境不利于落实社区防控措施，上述因素均可能提升新冠病毒暴露、发病与死亡的风险。

我们的社区合作伙伴为西班牙裔服务委员会（Hispanic Services Council, HSC），该机构长期培训本地健康宣传员（promotoras de salud, 即社区卫生工作者），在过去两年间已为佛罗里达州西南部的5900个服务不足的拉丁裔移民家庭提供帮扶。近期，HSC的健康宣传员已走访300余户拉丁裔家庭，调研新冠疫情对其健康与福祉的影响。

本研究将延续与HSC及健康宣传员的现有合作项目（项目编号：R34At010661-01），采用混合研究方法收集数据，以评估影响拉丁裔群体新冠病毒检测与/或疫苗接种意愿及能力的医疗、社会、经济及情境因素。研究结果将指导包括社区教育与针对特定人群的营销策略在内的相关方案制定，以提升新冠检测与疫苗接种覆盖率。

通过与其他NOSI资助获得者开展合作并共享信息，本研究期望提升美国多元社区的新冠检测覆盖率，并为新冠疫苗的精准接种实施提供参考。

AIM 1: 与社区合作伙伴HSC及健康宣传员合作，调查佛罗里达州西南部农村地区的拉丁裔移民与务工群体，梳理影响个体、人际、机构（如医疗系统）及社区层面新冠检测与疫苗接种率的多维度障碍因素。
Aim 1a: 由健康宣传员合作伙伴在4个农村城市开展定性焦点小组访谈，访谈提纲基于美国国立少数族裔健康与健康差异研究所（National Institute on Minority Health and Health Disparities, NIMHD）框架及现有新冠相关测评工具制定。
Aim 1b: 结合Aim 1a中识别的促进与阻碍因素，以及改编自现有问卷的问题应答数据，预测n=500名农村拉丁裔群体的新冠检测与疫苗接种意愿及实际检测行为，并探索潜在调节变量。

AIM 2: 明确可解决健康社会决定因素（SDOH）的策略，此类因素是阻碍新冠检测、检测随访及疫苗接种参与的障碍，以此为制定干预方案提供依据，以提升农村拉丁裔群体的新冠检测与疫苗接种可及性及接受度。
Aim 2a: 基于Aim 1的研究结果，制定社区参与策略，为佛罗里达州农村拉丁裔群体提供符合文化敏感性的新冠检测与疫苗接种实施方案。本阶段将开发包括提升新冠健康素养的教育材料在内的相关产品及社会营销策略。
Aim 2b: 由健康宣传员主持的50场非正式小组座谈（Charlas）将收集对潜在产品的反馈意见。研究结果将用于进一步优化产品，随后由HSC在所服务的拉丁裔社区中推行，并由本研究团队评估其实施效果。