The purpose of this community-engaged study is to test the ability of county-levelstrategies to increase uptake of COVID-19 vaccination. In this study the key objective isto test whether health communication strategies or health communication + county-specificstructural/environmental support increases COVID-19 vaccine uptake and changesperceptions and beliefs about the vaccination at the county-level.
The intervention trial will be a community-based, three-arm cluster randomized controlled
trial. The three arms are: (1) multilevel invention (vaccine communication campaign +
community-level structural intervention),(2) health communications only intervention, and
(3) control/standard of care. Randomization will take place at the county level. The 15
participating counties will first be matched into blocks of three, with each block being
matched as closely as possible on recent county influenza vaccination rates. After
matching, the three counties within each matched block will be randomly assigned to one
of the three study arms. This technique of randomizing to study arm within each matched
block of counties increases confidence that community-level factors that might influence
vaccine uptake are equally distributed across study arms. Following randomization, the
intervention process will begin in counties in the multilevel and communication campaign
intervention arms. Assessment of primary and secondary study outcomes will take place 6
months after initiation of the intervention. Finally, after assessment of outcomes is
complete, the intervention components will be offered to the control counties.
Behavioral: Health Communication
Participants will experience a coordinated social marketing campaign including targeted
messaging related to vaccine education, self-efficacy, and informative resources to
receive the COVID-19 vaccine. The intervention messaging will be strategically layered
and disseminated to this intervention arm predominately via Facebook by trusted and local
communicators in the study counties.
Behavioral: Health Communication + Structural
This multi-level intervention will include the defined health messaging intervention
components, as well as a combination of structural-level intervention strategies targeted
to better facilitate access to community-based vaccination delivery. Health organizations
will receive a toolkit, which will include community-specific resources and training
modules such as: up to date evidence-based vaccination guidance that can be delivered to
patients; strategies for navigating conversations with patients about vaccination; any
applicable reimbursement, insurance, or qualifying enrollment information specific to the
healthcare organization; identifying locations that facilitate access for the community
members; provided advertising to promote the locations and timing of the vaccinations;
and generating community-based branding for all vaccination delivery based on the trusted
information sources identified.
Up to 2,250 participants will take part in the study --- approximately 150 residents in
each of the 15 participating Appalachian Kentucky Counties. In each of the fifteen
counties, the investigators will collect survey data from 150 adults who are served by
Homeplace, a medical and social services organization run by the UK Center for Excellence
in Rural Health, which provides services in each of the 15 partner counties. Homeplace
provides services to adults who are medically underserved and typically at 100-133% of
the federal poverty level, primarily through service delivery by trained local Community
Health Workers (CHWs). CHWs will recruit participants and collect the survey data from
the identified individuals. Importantly, the criteria for qualification for Homeplace
services are equivalent across the 15 counties, providing equivalence of sample across
counties. A random sample of 150 individuals per county will be drawn from the Homeplace
client database for that county. Gender, ethnic background, and health status will
roughly mirror that of the demographics of the county.
Inclusion Criteria:
1. Must be a current Homeplace client
2. Live in one of the 15 selected study counties
3. Over the age of 18
4. Have the ability to complete the survey in English
Exclusion Criteria:
1. Not a current Homeplace client
2. Primary residence is not in one of the 15 study counties
3. Not within the ages of 18-99 years old
4. English is not your primary language
University of Kentucky Center of Excellence in Rural Health
Hazard 4294349, Kentucky 6254925, United States