Abstract
BackgroundCOVID-19 vaccine coverage in the Latinx community depends on delivery systems that overcome barriers such as institutional distrust, misinformation, and access to care. We hypothesized that a community-centered vaccination strategy that included mobilization, vaccination, and “activation” components could successfully reach an underserved Latinx population, utilizing its social networks to boost vaccination coverage.MethodsOur community-academic-public health partnership, “Unidos en Salud,” utilized a theory-informed approach to design our “Motivate, Vaccinate, and Activate” COVID-19 vaccination strategy. Our strategy’s design was guided by the PRECEDE Model and sought to address and overcome predisposing, enabling, and reinforcing barriers to COVID-19 vaccination faced by Latinx individuals in San Francisco. We evaluated our prototype outdoor, “neighborhood” vaccination program located in a central commercial and transport hub in the Mission District in San Francisco, using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework during a 16-week period from February 1, 2021 to May 19, 2021. Programmatic data, city-wide COVID-19 surveillance data, and a survey conducted between May 2, 2021 and May 19, 2021 among 997 vaccinated clients ≥16 years old were used in the evaluation.ResultsThere were 20,792 COVID-19 vaccinations administered at the neighborhood site during the 16-week evaluation period. Vaccine recipients had a median age of 43 (IQR 32–56) years, 53.9% were male and 70.5% were Latinx, 14.1% white, 7.7% Asian, 2.4% Black, and 5.3% other. Latinx vaccinated clients were substantially more likely than non-Latinx clients to have an annual household income of less than $50,000 a year (76.1% vs. 33.5%), be a first-generation immigrant (60.2% vs. 30.1%), not have health insurance (47.3% vs. 16.0%), and not have access to primary care provider (62.4% vs. 36.2%). The most frequently reported reasons for choosing vaccination at the site were its neighborhood location (28.6%), easy and convenient scheduling (26.9%) and recommendation by someone they trusted (18.1%); approximately 99% reported having an overall positive experience, regardless of ethnicity. Notably, 58.3% of clients reported that they were able to get vaccinated earlier because of the neighborhood vaccination site, 98.4% of clients completed both vaccine doses, and 90.7% said that they were more likely to recommend COVID-19 vaccination to family and friends after their experience; these findings did not substantially differ according to ethnicity. There were 40.3% of vaccinated clients who said they still knew at least one unvaccinated person (64.6% knew ≥3). Among clients who received both vaccine doses (n = 729), 91.0% said that after their vaccination experience, they had personally reached out to at least one unvaccinated person they knew (61.6% reached out to ≥3) to recommend getting vaccinated; 83.0% of clients reported that one or more friends, and/or family members got vaccinated as a result of their outreach, including 18.9% who reported 6 or more persons got vaccinated as a result of their influence.ConclusionsA multi-component, “Motivate, Vaccinate, and Activate” community-based strategy addressing barriers to COVID-19 vaccination for the Latinx population reached the intended population, and vaccinated individuals served as ambassadors to recruit other friends and family members to get vaccinated.
Highlights
COVID-19 has disproportionately affected underserved communities of color, including Latinx in the United States, further amplifying long-standing health disparities [1,2,3,4]
There were 20,792 COVID-19 vaccinations administered at the neighborhood site during the 16-week evaluation period
Among clients who received both vaccine doses (n = 729), 91.0% said that after their vaccination experience, they had personally reached out to at least one unvaccinated person they knew (61.6% reached out to 3) to recommend getting vaccinated; 83.0% of clients reported that one or more friends, and/or family members got vaccinated as a result of their outreach, including 18.9% who reported 6 or more persons got vaccinated as a result of their influence
Summary
COVID-19 has disproportionately affected underserved communities of color, including Latinx in the United States, further amplifying long-standing health disparities [1,2,3,4]. Some of the barriers to COVID-19 vaccine uptake among Latinx persons in the United States include a distrust in health systems stemming from historical experience, structural and medical racism [9], anti-immigration policies [10, 11] and anti-immigrant rhetoric [12], and inadequate access to language-concordant information on vaccinations [2, 13,14,15]. Latinx and other socio-economically vulnerable populations may face substantial structural barriers to vaccine access, including less access to health insurance or a primary care provider, inadequate access to language/culturally-concordant health services, online appointment registration services that may be difficult to access and/or navigate, requirements to show identification and prove vaccine eligibility (possibly due to immigration concerns or difficulty obtaining official identification), and the direct and indirect costs associated with scheduling and attending vaccination appointments that may differentially impact low-income individuals [5, 16]. We hypothesized that a community-centered vaccination strategy that included mobilization, vaccination, and “activation” components could successfully reach an underserved Latinx population, utilizing its social networks to boost vaccination coverage
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