The ongoing Oregon Saludable: Juntos Podemos (OSJP, Healthy Oregon: Together We Can)project was developed to directly address the COVID-19 related health disparities amongLatinx communities through community engagement funded by Phase I and II of the RADx-UPinitiative. This project is organized by the University of Oregon's Oregon Saludable:Juntos Podemos (OSJP) project.In this Phase III study, study investigators build on the successful Phase I and Phase IIpartnerships with Latinx-serving community-based organizations and the project'sestablished Community Scientific Advisory Board (CSAB) to employ a data-informed approachfor implementing preventive interventions designed to advance health equity andameliorate health disparities among vulnerable populations. Based on identity-stress andstereotype threat models for racial and ethnic minorities, study investigators willfurther tailor the Promotores de Salud COVID-19 evidence-based health promotionintervention to experimentally evaluate a brief behavioral self-affirming implementationintention (SAII) intervention; an approach that is evidence-based for increasingacceptance of health messaging, increasing intentions to change, increasing healthpromoting behaviors, and decreasing psychological distress.In collaboration with the Mexican Consulate (MC), research team members will attend theMC mobile events, invite MC attendees to participate in the research study and complete asurvey, offer the Promotores de Salud, and SAII intervention to all attendees (if eventis assigned to the intervention condition), and distribute rapid tests to participants.
There remains a critical need to understand and address barriers to testing among
vulnerable populations. Consistent evidence from national initiatives have shown that
Latinx individuals are underrepresented at SARS-CoV-2 testing sites, suggesting that
better understanding of psychosocial and behavioral barriers is needed. Latinx
individuals are more likely to test positive when testing, with representative data
showing that for every 1 percent increase in underrepresentation of Latinx persons in
testing, a state's mortality rate is 1.04 percentage points more over-representative
compared to non-Latinx COVID-19 mortality rates. Further compounding challenges for
Latinx communities is mounting evidence demonstrating the deleterious effects of racial
and ethnic discrimination on mental and physical health, which has only been exacerbated
by the COVID-19 pandemic.
The key targets of the SAII intervention will be structural social determinants of health
(i.e., discrimination and mistrust) as barriers to testing acceptance. The study research
team will employ demonstrated survey collection strategies to accomplish the following
specific aims in partnership with the project's existing relationships with the state
health authority and the study's community partners:
Aim 1. Pilot test rapid SARS-CoV-2 test distribution and an English and Spanish version
of the SAII intervention. In the first quarter of Year 1, the study research team will
tailor and pilot the existing "ultra-brief" SAII intervention to be offered in Spanish
and English. The study research team will consult with the project's established
community partners and CSAB to develop manualized protocols and train the research study
team to administer an oral version of SAII that can be readily applied by the study
research team and does not require English language proficiency or literacy. The study
research team will also be trained to distribute SARS-CoV-2 rapid test kits. The purpose
of Aim 1 will be to assess if the new protocol has acceptable levels of usability with
this population.
Aim 2. Conduct a clustered randomized trial (CRT) testing a health equity effectiveness
hypothesis. The study research team will use a 2-group × 2-time (pre-post) design to
randomly assign 400 participants sampled from Mexican Consulate event attendees to either
an SAII + Promotores de Salud condition or to a control condition (Promotores de Salud
only) and test (a) hypothesized main effects of the SAII intervention on testing and
vaccine acceptance and health outcomes, and (b) hypothesized buffering effects of
COVID-19 stressors and discrimination on testing and health outcomes.
The research strategy for this project involves a data-informed approach for the study
design, with the primary aim of testing a SAII intervention hypothesized to reduce
barriers to SARS-CoV-2 testing. In Aim 1, the study research team will tailor and pilot a
brief intervention (SAII) designed to increase health messaging uptake and rapid testing
acceptance for a vulnerable population - Latinx individuals. The SAII is an "ultra-brief"
exercise, where participants are asked to formulate an if-then plan with one preferred
self-affirmation-inducing cognition. Together with the project's CSAB, study
investigators will tailor the extant SAII intervention to be offered in Spanish and
English. Based on practicing and piloting activities, the investigative team will examine
the length of SAII intervention delivery, any comprehension or translation challenges,
and cultural appropriateness to iteratively refine the SAII protocols for the Latinx
population before study activities begin. In addition, the study research team will be
trained on the use and distribution of SARS-CoV-2 rapid testing kits. Both the rapid
testing distribution and the SAII will be examined for Aim 1.
In Aim 2, study investigators will experimentally evaluate the effectiveness of SAII
using a 2-group × 2-time (pre-post) clustered randomized trial. The study research team
will randomly assign 400 participants sampled from Mexican Consulate event attendees to
either an SAII + Promotores de Salud condition or to a control condition (the Promotores
de Salud only). For Aim 2, members of the study research team will approach individuals
attending an event and confirm their eligibility using a recruitment screener to
determine individual's eligibility. If individuals are eligible, the research team will
invite them to: 1) complete the research survey; 2) receive the Promotores de Salud, and
3) receive free COVID-19 rapid testing kits. If the event is assigned to the Intervention
Condition, the participants will also receive the ultra-brief SAII.
Study investigators hypothesize (a) the SAII will increase SARS-CoV-2 rapid testing,
testing and vaccine acceptance, and health outcomes through enhancing health promotion
messaging, reducing stigma, and affirming self-perceptions; and (b) the SAII will serve
as a buffer that moderates (lowers) negative effects of COVID-19-related stressors and
discrimination on testing and health outcomes. The study research team will conduct
project activities at events sponsored by the Mexican Consulate throughout the state of
Oregon.
Behavioral: Self-Affirmation Implementation Intentions (SAII) Intervention
In an "brief" exercise, participants are asked to provide a personal story and positive
experience during the challenging and sometimes stressful COVID19 pandemic, "...a time
when you felt successful and proud of yourself. ...You can also tell us about a time that
you did something to help someone in need." The self-affirmation is designed to offset
effects of threats to self. In the next section participants are asked to formulate an
if-then plan with one preferred self-affirmation-inducing cognition: "If I feel sad,
threatened, or discriminated against, then I will... a)...think about things I value
about myself, b)...remember things that I have succeeded in, c) ...think about what I
stand for, or d)...think about things that are important to me". After selecting
response, participants read the full If-Then plan out loud and are provided with a paper
copy of their exercise to take home.
Behavioral: Promotores de Salud (Health Education)
The Promotores de Salud intervention includes: (1) a culturally tailored health education
to increase knowledge about COVID-19 and the benefits of testing; (2) motivational
interviewing (MI) strategies to explore personal, social, and behavioral barriers to
testing and to discuss available resources to resolve these barriers; (3) emotional
support to address testing-related concerns and anxieties that may dissuade Latinx
individuals from getting tested; and (4) service navigation. When promotores (community
health advocates) are on-site at Mexican Consulate events, they will provide information
about COVID-19 and preventive behaviors using in-person instruction on effective mask
wearing, hand washing, and physical distancing, as well as the importance of repeated
testing and vaccines.
Inclusion Criteria:
- 18 or older
- Attending a Mexican Consulate event that our team is attending
Exclusion Criteria:
- Unable to understand Spanish or English or another language translated by a
qualified translator at a 5th grade level
- Individual has previously enrolled in the research project
University of Oregon
Eugene, Oregon, United States
Dave DeGarmo, PhD, Principal Investigator
University of Oregon