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Bartels S, Levison JH, Trieu HD, Wilson A, Krane D, Cheng D, Xie H, Donelan K, Bird B, Shellenberger K, Cella E, Oreskovic NM, Irwin K, Aschbrenner K, Fathi A, Gamse S, Holland S, Wolfe J, Chau C, Adejinmi A, Langlois J, Reichman JL, Iezzoni LI, Skotko BG. Tailored vs. General COVID-19 prevention for adults with mental disabilities residing in group homes: a randomized controlled effectiveness-implementation trial. BMC Public Health 2024; 24:1705. [PMID: 38926810 PMCID: PMC11201789 DOI: 10.1186/s12889-024-18835-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA). METHODS A hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (Tailored Best Practices: TBP) to dissemination of standard prevention guidelines (General Best-Practices: GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including: (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline: 1/1/2021-3/31/2021) and fidelity scores (baseline: 5/1/21-7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline: 1/1/2021-3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections. RESULTS GHs (n=415) were randomized to TBP (n=208) and GBP (n=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White: 2.28, p = 0.03). CONCLUSION Tailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities. TRIAL REGISTRATION ClinicalTrials.gov, NCT04726371, 27/01/2021. https://clinicaltrials.gov/study/NCT04726371 .
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Affiliation(s)
- Stephen Bartels
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA.
| | - Julie H Levison
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA
| | - Hao D Trieu
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Anna Wilson
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - David Krane
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - David Cheng
- Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA
| | - Haiyi Xie
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Third Floor, HB 7261, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Karen Donelan
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Bruce Bird
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | | | - Elizabeth Cella
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Nicolas M Oreskovic
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02214, USA
| | - Kelly Irwin
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kelly Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Ahmed Fathi
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Stefanie Gamse
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Sibyl Holland
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Jessica Wolfe
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Cindy Chau
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Adeola Adejinmi
- Bay Cove Human Services, 66 Canal Street, Boston, MA, 02114, USA
| | | | | | - Lisa I Iezzoni
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02214, USA
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Newman PA, Dinh DA, Nyoni T, Allan K, Fantus S, Williams CC, Tepjan S, Reid L, Guta A. Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01882-1. [PMID: 38117443 DOI: 10.1007/s40615-023-01882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada. METHODS Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations. RESULTS The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information. DISCUSSION We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
| | - Duy A Dinh
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Thabani Nyoni
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kate Allan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Sophia Fantus
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Luke Reid
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
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Kim NY, Kim HR. The Relationship between Depression and COVID-19 Vaccine Uptake and Intention among Korean Adults: The 2021 Community Health Survey. Healthcare (Basel) 2023; 11:2809. [PMID: 37957954 PMCID: PMC10649113 DOI: 10.3390/healthcare11212809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Individuals with depressive symptoms are vulnerable to COVID-19 infection and mortality; therefore, their vaccination status must be investigated to reduce these rates. This study investigated the association between depressive symptoms and COVID-19 vaccine uptake and intention and identified the reasons for vaccine avoidance. Data were collected from the 2021 Korea Community Health Survey and analyzed using logistic regression. A statistically significant association was found between the presence of depressive symptoms and no COVID-19 vaccine uptake. Among individuals who reported experiencing depression, 4.6% were unvaccinated and 7.7% reported no intention to get vaccinated. Among the unvaccinated, the adjusted odds ratio (aOR) for depression was 1.53 (95% confidence interval: 1.45-1.61) compared to the vaccinated. Similarly, a significant association was observed between depressive symptoms and no intention to get vaccinated. In the group with no vaccine intention, the aOR for depression was 2.06 (95% CI: 1.86-2.27) compared to the group with vaccine intention. Furthermore, "health-related reasons" and "concerns about side effects or past experience of side effects" accounted for 89% of the reasons for vaccine avoidance among individuals with depression. Therefore, it is important to provide tailored information and develop programs to increase awareness and promote COVID-19 vaccine uptake among these individuals.
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Affiliation(s)
- Nan Young Kim
- Department of Nursing, Graduate School, Chosun University, Gwangju 61452, Republic of Korea;
- Department of Nursing, Chosun University Hospital, Gwangju 61453, Republic of Korea
| | - Hae Ran Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
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