Document text
Principal Investigator: Carolyn Y. Fang
Organization: TEMPLE UNIV OF THE COMMONWEALTH
Fiscal Year: 2023
Award: $1,116,272
Funding agency: National Institute on Minority Health and Health Disparities
Project Summary
Low-Income Asian Americans (AA) with limited English proficiency (LEP) represent a meaningful proportion of
low-wage frontline workers in essential service industries. Many also live in multigenerational households with
crowded conditions and with their elderly relatives in ethnic neighborhoods, areas that have experienced high
rates of COVID-19 infection. Unfortunately, AAs have encountered numerous barriers to COVID-19 testing
across individual, provider/health system and community/societal levels, including anti-Asian racism and
discrimination, fear of safety at test sites and on public transportation, lack of health insurance, lack of culturally
and language-appropriate COVID-19 information and navigation, and limited access to COVID-19 testing sites.
As a result, AAs have the lowest COVID-19 testing rate across all racial/ethnic groups. This is particularly
concerning in light of the recent surge in cases due to the BA.2 variant and lifting of COVID restrictions, which
has led to increases in COVID-19 infections and hospitalizations especially among vulnerable populations. FDA-
approved over-the-counter (OTC) COVID-19 diagnostic tests offer a valuable evidence-based strategy for
empowering vulnerable AAs (who are hesitant or otherwise unable to obtain in-person PCR testing) to complete
self-testing. Although prior studies have demonstrated the feasibility of COVID-19 self-testing in communities
with access barriers, no intervention study has focused on vulnerable low-income frontline workers and seniors
with LEP across diverse AA ethnic groups (Chinese, Vietnamese, Korean), the fastest growing US population.
Thus, the overall goal of this application is to implement a community-engaged multifaceted intervention (herein
called the IMPROVE intervention) to increase access to and uptake of rapid COVID-19 self-testing across
diverse AA populations. Guided by the NIMHD Research Framework and Social Cognitive Theory to address
sociocultural/environmental and individual/interpersonal influences for COVID self-testing, our central hypothesis
is that trusted messengers (community health navigators, heath providers, and peer advocates) are essential
to reducing testing barriers and increasing uptake of COVID-19 self-testing. The Specific Aims are to: (1) Engage
community partners to implement a pragmatic cluster-randomized trial in 12 CBO sites to evaluate the
effectiveness of the community-engaged and evidence-based IMPROVE intervention in increasing access to
and uptake of COVID-19 self-testing (primary outcome) and changes in mitigation behaviors including
adherence to mask wearing and COVID-19 vaccination (secondary outcomes) in underserved and vulnerable
ethnic AAs (N=1200 AAs: 400 Chinese, 400 Korean and 400 Vietnamese); and (2) Evaluate Intervention Reach,
Effectiveness, Adoption, Implementation and Maintenance using the RE-AIM framework to facilitate IMPROVE
intervention dissemination to more CBOs and enhance its sustainability over time. The proposed project will be
one of the first to evaluate an evidence-based community-engaged approach to reducing systemic barriers and
will fill gaps in research on COVID-19 self-testing and mitigation adherence in 3 ethnic AA vulnerable populations.
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randomization trial><Cluster randomized trial><CoV disease><CoV-2><CoV2><Cognitive Discrimination><Colon Cancer><Colon Carcinoma><Communicable Diseases><Communities><Community Health><Commuting><Crowding><Day center care><Death Rate><Diagnostic tests><Discrimination><Disease><Disorder><Disparities><Disparity><Elderly><Ethnic Group><Ethnic Origin><Ethnic People><Ethnic Population><Ethnic individual><Ethnicity><Ethnicity People><Ethnicity Population><Evaluation><FDA EUA><FDA Emergency Use Authorization><FDA approved><Fear><Food and Drug Administration EUA><Food and Drug Administration Emergency Use Authorization><Fright><Front line employee><Front line person><Front line personnel><Front line staff><Front line worker><Frontline employee><Frontline person><Frontline personnel><Frontline staff><Frontline worker><Goals><HBV><HCV><HPV><Health><Health Benefit><Health Insurance><Health system><Hepatitis B Virus><Hepatitis C virus><Home Care><Homologous Serum Hepatitis Virus><Hospital Admission><Hospitalization><Household><Housing><Human Papilloma Virus><Human Papillomavirus><Immigrant><Individual><Industry><Infectious Disease Pathway><Infectious Diseases><Infectious Disorder><Infectious Human Wart Virus><Intervention><Intervention Strategies><Intervention Studies><Koreans><Language><Lifting><Light><Limited English Proficiency><Low income><Malignant Neoplasms><Malignant Tumor><Masks><Medical><Misinformation><Multilingualism><NCMHD><NIH><NIMHD><Nail plate><Nails><National Center on Minority Health and Health Disparities><National Institute of Minority Health and Health Disparities><National Institute on Minority Health and Health Disparities><National Institutes of Health><Needs Assessment><Neighborhoods><Omicron BA.2><Persons><Phase><Philadelphia><Photoradiation><Physical distancing><Population><Provider><Public Health><RE-AIM><Racial Group><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Research><Research Resources><Resources><Restaurants><Risk><Role><SARS corona virus 2><SARS-CO-V2><SARS-COVID-2><SARS-CoV-2><SARS-CoV-2 BA.2><SARS-CoV-2 diagnostic><SARS-CoV-2 infection><SARS-CoV-2 positive><SARS-CoV-2 positivity><SARS-CoV-2 test><SARS-CoV-2 testing><SARS-CoV-2 tests><SARS-CoV-2 vaccination><SARS-CoV2><SARS-CoV2 infection><SARS-associated corona virus 2><SARS-associated coronavirus 2><SARS-coronavirus-2><SARS-related corona virus 2><SARS-related coronavirus 2><SARSCoV2><Safety><Salaries><Services><Severe Acute Respiratory Coronavirus 2><Severe Acute Respiratory Distress Syndrome CoV 2><Severe Acute Respiratory Distress Syndrome Corona Virus 2><Severe Acute Respiratory Distress Syndrome Coronavirus 2><Severe Acute Respiratory Syndrome CoV 2><Severe Acute Respiratory Syndrome-associated coronavirus 2><Severe Acute Respiratory Syndrome-related coronavirus 2><Severe acute respiratory syndrome associated corona virus 2><Severe acute respiratory syndrome coronavirus 2><Severe acute respiratory syndrome coronavirus 2 infection><Severe acute respiratory syndrome coronavirus 2 positive><Severe acute respiratory syndrome coronavirus 2 positivity><Severe acute respiratory syndrome coronavirus 2 vaccination><Severe acute respiratory syndrome related corona virus 2><Sick Leave><Site><Social Distance><Socialization><Symptoms><Testing><Time><Transmission><Transportation><Trust><United States National Institutes of Health><Vaccination><Variant><Variation><Vietnamese><Vulnerable Populations><Wages><Work><Wuhan coronavirus><advanced age><anti-Asian><assess effectiveness><barrier to care><barrier to health care><barrier to healthcare><barrier to testing><barrier to treatment><cancer in the colon><community based organizations><community based participatory research><community engagement><community led research><community organizations><community participatory research><community research><community-based health><complications due to COVID-19><corona virus disease><corona virus disease 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effectiveness><evidence base><examine effectiveness><experience><geriatric><hCoV19><health care settings><health disparity><health insurance plan><health literacy><healthcare settings><hurdle to testing><inadequate health literacy><infected with COVID-19><infected with COVID19><infected with SARS-CoV-2><infected with SARS-CoV2><infected with coronavirus disease 2019><infected with severe acute respiratory syndrome coronavirus 2><innovate><innovation><innovative><intervention research><interventional research><interventional strategy><interventional study><interventions research><late life><later life><low health literacy><malignancy><medical vulnerability><multi-component intervention><multi-faceted intervention><multi-modal intervention><multicomponent intervention><multifaceted intervention><multilingual><multimodal intervention><nCoV2><neoplasm/cancer><novel><obstacle to care><obstacle to healthcare><obstacle to testing><older adult><older person><on-line community><online community><participatory action research><patient home care><patient homecare><patient navigation><peer><poor health literacy><pragmatic effectiveness trial><pragmatic trial><prevent><preventing><primary outcome><racial population><racial subgroup><racism><reach, efficacy, adoption, implementation, and maintenance><reduced health literacy><screening><screenings><secondary outcome><self testing><senior citizen><severe acute respiratory syndrome coronavirus 2 BA.2><severe acute respiratory syndrome coronavirus 2 diagnostic><severe acute respiratory syndrome coronavirus 2 test><severe acute respiratory syndrome coronavirus 2 testing><severe acute respiratory syndrome coronavirus 2 tests><social cognitive theory><social culture><social learning theory><social role><social vulnerability><socio-cultural><sociocultural><statistics><systemic barrier><systemic hurdle><systemic obstacle><testing barrier><testing for COVID><testing hurdle><testing obstacle><testing of COVID><testing uptake><tool><transmission process><uptake><vaccinate against COVID-19><vaccinate against COVID19><vaccinate against SARS-CoV-2><vaccinate against coronavirus disease 2019><vaccinate against severe acute respiratory syndrome coronavirus 2><vaccination against COVID-19><vaccination against COVID19><vaccination against SARS-CoV-2><vaccination against Severe acute respiratory syndrome coronavirus 2><vaccination against coronavirus disease 2019><ventilation><virtual community><vulnerable group><vulnerable individual><vulnerable people><wart virus>