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行为干预组件对未接种新冠疫苗的非裔美国/黑人及拉丁裔一线必要工作者增加新冠病毒检测的影响:一项优化随机对照试验的结果

Effects of behavioral intervention components to increase COVID-19 testing for African American/Black and Latine frontline essential workers not up-to-date on COVID-19 vaccination: Results of an optimization randomized controlled trial.

作者信息

Gwadz Marya, Heng Siyu, Cleland Charles M, Strayhorn Jillian, Robinson Jennifer A, Serrano Fernanda Gonzalez Blanco, Wang Pengyun, Parameswaran Lalitha, Chero Rauly

机构信息

New York University Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA.

School of Global Public Health, New York University, New York, NY, 10003, USA.

出版信息

J Behav Med. 2025 Apr 17. doi: 10.1007/s10865-025-00566-x.

Abstract

Racial/ethnic disparities in COVID-19, including incidence, hospitalization, and death rates, are serious and persistent. Among those at highest risk for COVID-19 and its adverse effects are African American/Black and Latine (AABL) frontline essential workers in public-facing occupations (e.g., food services, retail). Testing for COVID-19 in various scenarios (when exposed or symptomatic, regular screening testing) is an essential component of the COVID-19 control strategy in the United States. However, AABL frontline workers have serious barriers to COVID-19 testing at the individual (insufficient knowledge, distrust, cognitive biases), social (norms), and structural levels of influence (access). Thus, testing rates are insufficient and interventions are needed. The present study is grounded in the multiphase optimization strategy (MOST) framework. It tests the main and interaction effects of a set of candidate behavioral intervention components to increase COVID-19 testing rates in this population. The study enrolled adult AABL frontline essential workers who were not up-to-date on COVID-19 vaccination nor recently tested for COVID-19. It used a factorial design to examine the effects of candidate behavioral intervention components, where each component was designed to address a specific barrier to COVID-19 testing. All participants received a core intervention comprised of health education. The candidate components were motivational interviewing counseling (MIC), a behavioral economics intervention (BEI), peer education (PE), and access to testing (either self-test kits [SK] or a navigation meeting [NM]). The primary outcome was COVID-19 testing in the follow-up period. Participants were assessed at baseline, randomly assigned to one of 16 experimental conditions, and assessed six- and 12-weeks later. The study was carried out in English and Spanish. We used a logistic regression model and multiple imputation to examine the main and interaction effects of the four factors (representing components): MIC, BEI, PE, and Access. We also conducted a sensitivity analysis using the complete case analysis. Participants (N = 438) were 35 years old on average (SD = 10). Half identified as men/male (52%), and 48% as women/female/other. Almost half (49%) were African American/Black, and 51% were Latine/Hispanic (12% participated in Spanish). A total of 32% worked in food services. Attendance in components was very high (~ 99%). BEI had positive effect on the outcome (OR = 1.543; 95% CI: [0.977, 2.438]; p-value = 0.063) as did Access, in favor of SK (OR = 1.351; 95% CI: [0.859, 2.125]; p-value = 0.193). We found a three-way interaction among MICPEAccess (OR: 0.576; 95% CI: [0.367, 0.903]; p-value = 0.016): when MIC was present, SK tended to increase COVID testing when PE was not present. The study advances intervention science and takes the first step toward creating an efficient and effective multi-component intervention to increase COVID-19 testing rates in AABL frontline workers.

摘要

新冠疫情在发病率、住院率和死亡率等方面存在的种族/民族差异严重且持续存在。在面临新冠病毒感染及其不良影响风险最高的人群中,有从事面向公众职业(如食品服务、零售)的非裔美国人和拉丁裔一线 essential 工作者。在美国,新冠病毒检测在各种情况下(接触病毒或出现症状时、定期筛查检测)都是新冠疫情防控策略的重要组成部分。然而,非裔美国人和拉丁裔一线工作者在个人(知识不足、不信任、认知偏差)、社会(规范)和结构层面(获取途径)都面临着新冠病毒检测的严重障碍。因此,检测率不足,需要采取干预措施。本研究基于多阶段优化策略(MOST)框架。它测试了一组候选行为干预组件对提高该人群新冠病毒检测率的主要和交互作用。该研究招募了未接种新冠疫苗且近期未进行新冠病毒检测的成年非裔美国人和拉丁裔一线 essential 工作者。研究采用析因设计来检验候选行为干预组件的效果,每个组件旨在解决新冠病毒检测的一个特定障碍。所有参与者都接受了包括健康教育在内的核心干预。候选组件包括动机性访谈咨询(MIC)、行为经济学干预(BEI)、同伴教育(PE)以及检测途径(自我检测试剂盒[SK]或导航会议[NM])。主要结局是随访期间的新冠病毒检测情况。参与者在基线时接受评估,随机分配到16种实验条件之一,并在六周和十二周后再次接受评估。该研究以英语和西班牙语进行。我们使用逻辑回归模型和多重插补法来检验四个因素(代表组件):MIC、BEI、PE和检测途径的主要和交互作用。我们还使用完全病例分析进行了敏感性分析。参与者(N = 438)平均年龄为35岁(标准差 = 10)。一半参与者认定为男性(52%),48%为女性/其他性别。近一半(49%)是非裔美国人,51%是拉丁裔/西班牙裔(12%参与西班牙语组)。共有32%的人从事食品服务工作。各组件的参与率非常高(约99%)。BEI对结局有积极影响(优势比 = 1.543;95%置信区间:[0.977, 2.438];p值 = 0.063),检测途径也是如此,支持自我检测试剂盒(优势比 = 1.351;95%置信区间:[0.859, 2.125];p值 = 0.193)。我们发现MICPE检测途径之间存在三向交互作用(优势比:0.576;95%置信区间:[0.367, 0.903];p值 = 0.016):当存在MIC时,在没有PE的情况下,自我检测试剂盒往往会增加新冠病毒检测。该研究推动了干预科学的发展,并朝着创建一种高效且有效的多组件干预措施迈出了第一步,以提高非裔美国人和拉丁裔一线工作者的新冠病毒检测率。

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