Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.
Diné College, School of Science, Technology, Engineering and Math, Shiprock, NM, United States.
Front Public Health. 2022 Dec 14;10:1046634. doi: 10.3389/fpubh.2022.1046634. eCollection 2022.
INTRODUCTION/BACKGROUND: On 9 April 2021, the Centers for Disease Control and Prevention (CDC) reported that only 19. 9% of United States (US) adults were fully vaccinated against COVID-19. In that same week, the Navajo Nation (NN) reported that 37.4% of residents were fully vaccinated, making the NN a leader in the uptake of COVID-19 vaccines. Despite high vaccination rates, vaccine hesitancy exists within the NN. The Diné (Navajo) Teachings and Public Health Students Informing Peers and Relatives about Vaccine Education (RAVE) intervention was designed to utilize trusted health messengers as an effective means to address adults' vaccine concerns and hesitancy.
The research team used COVID-19 vaccine materials developed in a previous collaboration with non-Navajo tribal communities and publicly available materials. Diné Traditional Knowledge Holders (TKHs) were interviewed to develop and incorporate Diné-specific information on individual and collective health behaviors into the RAVE materials. These drafted health education materials were presented to NN community health representatives (CHRs) and Diné public health students using a consensus panel approach. NN residents who participated in the intervention completed a 16-element retrospective pretest.
The adaptation and tailoring process of materials yielded 4 health education materials. The students recruited 46 adults for health education sessions. These participants then completed the retrospective pretest. Changes in the 16 elements were in the desired direction, although only six were significant: four related to attitudes and two concerned with vaccination intention. Participants were more likely to consider vaccination and to try to get vaccinated after the education session.
Trusted messengers and culturally centered materials have been identified as effective means of health behavior education with Native American audiences. RAVE applied these intervention elements by (1) training Diné College public health students to leverage their cultural knowledge and social relationships (cultural and social capital) to recruit vaccine-hesitant adults and provide education; (2) building on previous understanding of Native American communities' vaccine concerns; and (3) integrating Diné perspectives on individual and collective health into the adaptation of materials designed for general audiences; this knowledge was gained from interviews with TKHs.
简介/背景：2021 年 4 月 9 日，美国疾病控制与预防中心（CDC）报告称，只有 19.9%的美国成年人完全接种了 COVID-19 疫苗。就在同一周，纳瓦霍族（NN）报告称，37.4%的居民已完全接种疫苗，使 NN 成为 COVID-19 疫苗接种的领导者。尽管疫苗接种率很高，但 NN 内部仍存在疫苗犹豫。Diné（纳瓦霍）教学和公共卫生学生向同龄人及亲属宣传疫苗教育（RAVE）干预措施旨在利用值得信赖的健康信息传播者作为解决成年人对疫苗的关注和犹豫的有效手段。
研究团队使用之前与非纳瓦霍部落社区合作开发的 COVID-19 疫苗材料和公开可用的材料。对 Diné 传统知识持有者（TKH）进行了采访，以开发并将个人和集体健康行为方面的 Diné 特定信息纳入 RAVE 材料中。这些起草的健康教育材料采用共识小组的方法呈现给 NN 社区卫生代表（CHR）和 Diné 公共卫生学生。参与干预措施的 NN 居民完成了 16 项回顾性预测试。
材料的改编和调整过程产生了 4 种健康教育材料。学生们招募了 46 名成年人参加健康教育课程。这些参与者随后完成了回顾性预测试。16 个元素的变化朝着理想的方向发展，尽管只有六个是显著的：四个与态度有关，两个与接种意愿有关。参与者更有可能考虑接种疫苗并在教育课程后尝试接种疫苗。
信任的信息传播者和以文化为中心的材料已被确定为对美洲原住民受众进行健康行为教育的有效手段。RAVE 通过以下方式应用这些干预元素：（1）培训 Diné 学院公共卫生学生利用他们的文化知识和社会关系（文化和社会资本）来招募疫苗犹豫的成年人并提供教育；（2）借鉴之前对美洲原住民社区疫苗担忧的理解；（3）将个人和集体健康方面的 Diné 观点纳入为一般受众设计的材料改编中；这方面的知识是从与 TKH 的访谈中获得的。
