The goal of this clinical trial is to test whether modified behavioral health services,integrating motivational interviewing, will reduce vaccine hesitancy and increase uptakefor the COVID-19 and influenza vaccines among Latinx adults with mental illness.
Prior to the Coronavirus disease (COVID-19) pandemic, the World Health Organization
declared vaccine hesitancy, defined as a delay in the acceptance or refusal of
vaccination despite availability of vaccination services, as one of the top 10 threats to
global health. Today, despite massive recent and ongoing global efforts, vaccine
hesitancy remains a major threat, particularly in populations that experience health
disparities rooted in structural racism. One such population is Hispanic/Latinx adults
(Latinxs). Prior to the national COVID-19 vaccine campaign, Latinxs had twice the rate of
COVID-19 infection, 2.8 times the rate of hospitalization and 2.3 times the death rate of
non-Latinx whites. Despite being at higher risk of COVID-19 related morbidity and
mortality, Latinxs have been particularly hesitant to get vaccinated. In the early stages
of vaccine rollout, vaccine uptake rates among Latinxs lagged at least 10% percentage
points behind non-Latinxs and, as of Feb 2022, only 37% of Latinxs compared to 56% of
non-Latinx whites had received a booster shot.
Adults with mental illness are also at high risk for COVID-19 infection, with more severe
complications and higher mortality Yet there are no strategies for addressing vaccine
hesitancy in this population. This gap is particularly important for Latinxs, who have
disproportionately borne the mental health burden of the pandemic. There is, therefore,
an urgent need for innovative, practical, and sustainable strategies to address vaccine
hesitancy among the priority population of Latinx adults with mental illness.
The investigators will address this gap with a novel intervention that integrates
evidence-based motivational interviewing (MI) into behavioral health (BH) services,
coupled with electronic prompting, and vaccination access at the point of care. Key to
the intervention is that the proposed MI protocol explicitly acknowledges cultural values
that are central to the Latinx population and impact their interactions with health care
providers. Additionally, the intervention has been specifically designed to: (i) be
feasible and readily implemented in an integrated care setting, such as that offered by
federally qualified health centers (FQHC); (ii) be sustainable in the long-term
regardless of how the rapidly-changing COVID-19 vaccination landscape evolves; and, (iii)
provide additional potential benefits in the form of increasing influenza vaccination
which is generally low in the Latinx population.
Other: EHR alert
An EHR alert will be fired if a behavioral health patient is missing a COVID-19 or
influenza vaccine.
Behavioral: Motivational Interviewing
In response to the alert and using support tools in the EHR, the behavioral health
clinician will integrate motivational interviewing into the counseling session to discuss
vaccine hesitancy (if it is deemed appropriate based on patient needs and clinical
judgment).
Behavioral: Warm hand off to nurse
For patients interested in vaccination following motivational interviewing, the
behavioral health clinician will do a warm hand off to a nurse for vaccination
Patient Inclusion Criteria:
- Aged 18 years and older
- Identifies as Latinx
- Completed an eligible behavioral health (BH) visit between the start and end dates
of the intervention period.
- Patient is missing a COVID-19 vaccine/booster or the influenza vaccine at the
beginning of their behavioral health visit (i.e., they are not fully up to date with
their COVID-19 and influenza vaccines)
Patient Exclusion Criteria:
- NA
South End Community Health Center
Boston 4930956, Massachusetts 6254926, United States
East Boston Neighborhood Health Center
Boston 4930956, Massachusetts 6254926, United States
Kirsten Davison, PhD, Principal Investigator
Boston College