Development, Design, and Initial Evaluation of a Culturally Tailored Intervention to Address COVID-19 Disparities Among Latinx Communities Across Oregon


The COVID-19 pandemic has spared no community or demographic group. Contagion, hospitalization, and fatalities have disproportionately affected those who already experience structural inequities, such as immigrants and Latinx communities. This symposium presents three integrated papers reporting on the NIH-funded Oregon Saludable: Juntos Podemos (OSJP) collaborative study designed to increase the rates of SARS-CoV-2 testing (colloquially ‘COVID-19 testing’) and participation in COVID-19 preventive strategies among Latinx residents in nine Oregon counties. The first paper describes the development and components of the Promotores de Salud outreach and health education intervention. The second paper describes the planning, implementation, and evaluation of the intervention through an implementation science lens with an emphasis on community engagement to build its success in reaching Latinx populations. The third paper reports an initial intent to treat evaluation of the experimental design, focusing on per capita testing of Latinx Oregonians.

Learning Objectives
At the end of the session, participants will be able to:
Explain the importance of cultural tailoring of interventions to address health disparities.
2. Describe the main components of the Promotores de Salud intervention.
3. Describe the application of implementation strategies across the evolution of a SARS-CoV-2 testing program.
4. Describe the effectiveness of the empirically-informed Promotores de Salud intervention to promote Latinx COVID-19 testing.
5. Identify strategies for mitigating and eliminating health disparities among Latinx Oregonians.

Program Type
Standard D.1.3.
Program content focuses on topics related to psychological practice, education or research other than application of psychological assessment and/or intervention methods that are supported by contemporary scholarship grounded in established research procedures.

Development and Design of the Promotores de Salud Intervention to Reduce COVID-19 Testing Disparities Among Latinx Communities
In Oregon, Latinx residents make up 13% of the population, but they comprise 31% of Oregon’s COVID-19 cases and experience higher hospitalization and death rates than non-Hispanic Whites. Testing is a critical tool for prevention and control of COVID-19, but Latinx testing rates are lower than other ethnic and racial groups due to lack of access, language barriers, and mistrust of government authorities, among other factors. A culturally appropriate intervention to promote COVID-19 testing and other preventive behaviors among Latinx Oregonians is needed to reduce COVID-19 disparities. In this presentation we describe the development and components of the culturally-tailored, trauma-informed Promotores de Salud intervention that aims to increase COVID-19 testing and prevention behaviors among Latinx residents in nine Oregon counties. Development activities included a literature review on culturally tailored health promotion interventions for Latinx individuals, a survey of 67 Latinx residents attending Lane County COVID-19 testing events, interviews with 13 leaders of Lane County community-based organizations serving Latinx residents, bi-monthly consultations with a community advisory board, and on-going, and bi-monthly meetings with interventionists that continuously inform intervention adaptations. Intervention components, delivered by Promotores (bilingual, bicultural community members), include community outreach to increase participation in testing events, psychoeducation regarding COVID-19 and the importance of testing, and information support and service navigation at testing events to connect participants to community resources. Throughout, we share how culture, contexts, and trauma-informed principals were embedded throughout the intervention.

Ellen Hawley McWhirter, University of Oregon
Elizabeth Budd, University of Oregon

Implementation Processes in the Development of Community-Partnership Based Research to Ameliorate Disparities in COVID-19 Testing
The gravity of the scale and urgency to ameliorate COVID-19 Latinx disparities underscores the importance of multi-disciplinary interventions. While research and practice in Psychology has tended to culturally-responsive interventions, arguably more attention in the field is needed toward implementation science so that the effectiveness and reach of the best culturally informed interventions are not undermined by overlooking the processes that maximize their “uptake” by local communities. We applied an implementation science lens to examine the role of community-engagement in the implementation of a SARS-CoV-2 (virus that causes COVID-19 disease) testing intervention targeting Latinx populations in 38 sites across 9 counties in Oregon. To examine the intervention’s local uptake, we describe its planning, implementation, and evaluation using implementation science frameworks and strategies, with an emphasis on community engagement of key stakeholders. We built a robust multi-county community engagement collaborative including Community Based Organizations, the Oregon Health Authority, and additional stakeholders. The collaborative was instrumental in dynamically restructuring and adapting planned implementation strategies to optimize SARS-CoV-2 testing access, feasibility, and acceptability. For each implementation phase - exploration, preparation, implementation, and sustainment - we identified several culturally-responsive collaboration practices that contributed to achieving project outcomes. Our analysis offers steps and strategies that inform intervention research at the community engagement and local implementation (“uptake”) levels. By and large, our findings support participatory implementation, as well as multi-disciplinary team science as critical to the success of complex multi-site interventions that seek to make an impact on Latinx health disparities.

Jorge Ramírez García, Prevention Science Institute, University of Oregon
Camille Cioffi, University of Oregon

Intent to Treat Evaluation of Promotores de Salud: Addressing Health Disparities of Latinx Oregonians
Latinx individuals in Oregon experience a disproportionate COVID-19 burden. Culturally-tailored outreach interventions are needed to address the disparity. In this presentation we report on the impact of the outreach component of the Promotores de Salud intervention (see abstract for paper one) designed to increase testing rates among Latinx Oregonians. We hypothesized that the culturally-tailored Promotores de Salud outreach would result in more Latinx persons tested as compared with community outreach as usual. The design involved a clustered randomized trial. Test sites were optimized using input from community-based organizations and census data geo-coded to identify centrally located sites in dense Latinx neighborhoods. Specifically, thirty-eight sites from 9 counties were randomized (19 with Promotores de Salud intervention, 19 outreach as usual). As of July 2021, we conducted 323 site-randomized testing events with approximately 1,500 individual samples collected for testing. Multilevel time series models indicated that controlling for historical time and community sociodemographic characteristics, Promotores outreach strategies were effective in collecting testing samples for 2.3 times more Latinx individuals per Latinx Oregonians tested at an OAU event (d = .46, a medium effect). Best practice guidelines will be presented for addressing health disparities among Latinx community members.

Anne Marie Mauricio, Prevention Science Institute, University of Oregon
David S. DeGarmo, University of Oregon

Continuing Education
1.5 CE

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