Many factors contribute to inequities in vaccination rates among racial and ethnic
minorities, including differences in vaccine acceptance and intention and related
variability in social behavioral norms, knowledge, risk perception, trust, and structural
barriers. The World Health Organization has called for community health workers (CHWs) as
a key strategy to address vaccination inequities among vulnerable populations worldwide.
CHWs are trusted messengers and cultural brokers that can address barriers to vaccination
access and provide language, culturally, and literacy-appropriate information to promote
awareness of and motivation to partake in protective vaccination behaviors. CHWs can have
a central role in Federally Qualified Health Centers (FQHCs) by helping link their mostly
non-White patients with health care and community resources.

This study examines whether a CHW intervention can be effective in increasing vaccination
rates by providing education, help with behavior changes, and assistance in navigating
barriers to increase equal access to vaccination. The CHW intervention consists of up to
3 psychoeducational sessions in English or Spanish targeting the specific reason(s) why a
patient is not up to date with their COVID-19 vaccine. According to the reason(s), the
CHW implements strategies to educate, motivate, and help navigate any access barriers to
getting vaccinated. CHWs use motivational interviewing techniques to encourage patients
to get vaccinated. Patients also receive educational flyers designed by a local artist
addressing their own COVID-19 vaccination knowledge gaps. Toward the end of each session,
the CHW works with the patient to create a Patient Action Plan with steps the patient can
take to overcome their barriers to vaccination.

RAND and Clinical Directors Network (CDN) are conducting a randomized controlled trial
(RCT) in New York City FHQCs to determine the efficacy of the CHW intervention to improve
vaccine acceptance and uptake among racial/ethnic minority adults with any of 7 chronic
conditions (asthma, diabetes, hypertension, obesity, depression, anxiety disorder, or
PTSD). This research study plans to randomly assign (like the flip of a coin) a total of
800 patients to a "Usual Care Group" (400 patients who will continue to receive usual
care with no changes) or "CHW Group" (400 patients who will receive the CHW intervention
and usual care).

The following four research questions guide the study:

- What makes being up to date for COVID and Flu vaccines difficult for people with
chronic illness?

- Can a CHW intervention help patients be up to date with the COVID and Flu vaccines?

- What about the CHW intervention specifically works for different types of patients?

- What can help expand the CHW program to more people for a longer time?

The main study hypothesis is that participants assigned to the intervention will exhibit
significantly higher vaccine acceptance and actual increases in vaccination rates.

If the intervention is effective, it has the potential to decrease disparities in severe
illness resulting from COVID-19 and influenza by increasing vaccination rates among
racial and ethnic minority populations with chronic illness. Since FQHCs employ CHWs to
help deliver care to patients with chronic illnesses, the intervention would be easily
implementable and scalable for future COVID-19 and influenza vaccination seasons.