COVID-19 testing is essential to controlling the COVID-19 pandemic to break transmissionchains and reduce community transmission. However, Black and Latino/Hispanic populationsin lower status frontline essential occupations such as food preparation, retail,building maintenance, personal services, and in-home health care have serious barriers toCOVID-19 testing and, therefore, insufficient testing rates. The proposed study will usethe multiphase optimization strategy framework to address the problem of low COVID-19testing rates for this population: We will test the effects of four distinct candidateintervention components and then create an efficient multicomponent made up of the mosteffective combination of the components that can be rapidly scaled up in communitysettings to boost COVID-19 testing rates.
The proposed study responds to RFA-OD-21-008 which calls for community-engaged
interventions to support COVID-19 testing in underserved and vulnerable populations.
Among those at highest risk for exposure to COVID-19 is the large population of frontline
essential workers (FEW) in lower status occupations (e.g., retail, in-home health care),
among whom Black and Latino/Hispanic (BLH) persons are over-represented. The CDC
recommends testing for all those experiencing symptoms of COVID-19. For those not
vaccinated, testing is recommended after exposure to individuals with a COVID-19
diagnosis, and regular COVID-19 screening testing is recommended even when asymptomatic
for those with frequent close contact with others in indoor settings such as FEW.
However, BLH-FEW experience serious impediments to COVID-19 testing at
individual/attitudinal- (e.g., lack of knowledge of guidelines, distrust), social- (e.g.,
social norms), and structural-levels of influence (e.g., poor access to testing). Indeed,
testing rates are lower among BLH than White populations and only 25-50% of BLH-FEW are
currently vaccinated. The proposed community-engaged study is led by a collaborative team
at New York University and the Northern Manhattan Improvement Corporation (NMIC). Its
main goal is to optimize a behavioral intervention to boost COVID-19 testing rates for
BLH-FEW. Consistent with RFA-OD-21-008, the proposed study uses the multiphase
optimization strategy (MOST) framework to test four candidate intervention components
grounded in our past research. The candidate components are informed by critical race
theory and guided by the theory of triadic influence, are brief or do not require
substantial staff time, and will be tested in a highly efficient factorial experimental
design. They are A) motivational interview counseling, B) a text message component
grounded in behavioral economics, C) peer education, and D) access to testing (via
navigation to a test appointment vs. a self-test kit). All participants receive the
standard of care, namely, health education on COVID-19 testing, and referrals. The
specific aims of the study are to: identify which of four candidate components contribute
meaningfully to improvement in the primary outcome, COVID-19 testing with medical
confirmation; the most effective combination of components will comprise the "optimized"
intervention (Aim 1), identify mediators (e.g., distrust, access) and moderators (e.g.,
sociodemographic characteristics) of the effects of each component (Aim 2), and use a
mixed-methods approach to explore relationships among barriers to, facilitators of, and
uptake of COVID-19 testing and COVID-19 vaccination (Aim 3). Participants will be N=448
BLH-FEW who have not been tested for COVID-19 in the past three months and have not been
vaccinated for COVID-19 in the past 12 months, randomly assigned to an intervention
condition, and assessed at 6- and 12-weeks post-baseline; N=50 participants will engage
in qualitative in-depth interviews. We will also uncover, describe, and plan for
implementation issues so the optimized intervention can be rapidly scaled up by NMIC and
other community-based organizations.
Behavioral: Motivational interviewing (MI) counseling
Those assigned to receive Component A will engage in a MI single session lasting
approximately 30-45 minutes. The overall goal of the session is to increase participants'
motivation and readiness to test for COVID-19 in various circumstances.
Behavioral: Text messages (TMs) and quiz questions (QQs)
This intervention lasts 6 weeks. This component is grounded in principles of behavioral
economics. Its main goal is to add interest and excitement to the goal of COVID-19
testing, serve as a reminder that COVID-19 testing is recommended in a number of
scenarios, and "nudge" participants toward testing and creating a habit of serial
screening and COVID-19 testing as needed. Participants first receive a brief orientation
to the component (15 min.), and the participant will put the study phone number into
his/her phone and a test TM and QQ will be sent. TMs and QQs are programmed into the
Telerivet program and sent automatically. Twice a week participants will receive a TM
with information about COVID and COVID-19 testing followed by a true/false question about
that TM two days later, for which they earn 10 points for a correct answer, and 5 points
for an incorrect answer. Participants earn modest prizes based on their points.
Behavioral: Peer education
This component has two aspects: Participants are trained to educate their peers on core
messages about the importance of COVID-19 testing that address social norms about
COVID-19 testing and highlight COVID-19 testing as an altruistic act (15-20 min.
training). Then, participants are given the opportunity to educate three peers who are
Black and Latino/Hispanic frontline essential workers on the core messages. These peers
contact the study directly and receive a brief assessment and referrals to testing, but
are not enrolled in the study.
Behavioral: Access to COVID testing
Component D is an adaptive intervention component that avoids unnecessary costs; it is
only provided if needed. Level 1: Over a 2-3 week period, navigation includes a brief
needs assessment and guidance to assist participants in prioritizing, accessing, and
completing COVID-19 testing sequences in a timely fashion and resolving barriers such as
transportation or the possible need to take off work if diagnosed with COVID-19. Level 2:
1 month after enrollment, participants will be contacted by phone. If they have not been
tested, we will provide them with a BinaxNOW test kit which can be picked up or mailed to
them.
INCLUSION CRITERIA: 1) age 18-70 years; 2) can engage in study activities in English or
Spanish; 3) Black or African American (including Caribbean, African, or multi-ethnic
Black) and/or Latino or Hispanic race/ethnicity; 4) resides in NYC; 5) in the past month,
was employed as a frontline worker in a lower status essential occupation in one or more
of the domains listed above; 6) has a phone that can be used for study participation and
can receive TMs; 7) has not received any doses of a COVID-19 vaccination in the past 12
months; 8) has not been tested for COVID-19 in the past three months; 9) if previously
diagnosed with COVID-19, has not been symptomatic in the past two weeks or 90 days has
passed since treatment with monoclonal antibodies or convalescent plasma98; 10) has not
been educated/interviewed as a peer for Component C; 11) willing to engage in a core
session and be randomly assigned to receive 1-4 components.
New York University Silver School of Social Work
New York, New York, United States
Investigator: Marya Gwadz, PhD
Contact: 212-998-5965
marya.gwadz@nyu.edu
Marya Gwadz, PhD
212-998-5968
mg2890@nyu.edu
Marya Gwadz, PhD, Principal Investigator
New York University