Tailored vs. General COVID-19 prevention for adults with mental disabilities residing in group homes: a randomized controlled effectiveness-implementation trial.
COVID-19 prevention
Congregate care settings
Equity-focused implementation
Health disparities
Hybrid effectiveness-implementation trial
Intellectual and developmental disability
Intersectionality
Mental disabilities
Serious mental illness
Vaccine acceptance
Vaccine hesitancy
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
26 Jun 2024
26 Jun 2024
Historique:
received:
20
11
2023
accepted:
13
05
2024
medline:
27
6
2024
pubmed:
27
6
2024
entrez:
26
6
2024
Statut:
epublish
Résumé
People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA). A hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (Tailored Best Practices: TBP) to dissemination of standard prevention guidelines (General Best-Practices: GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including: (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline: 1/1/2021-3/31/2021) and fidelity scores (baseline: 5/1/21-7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline: 1/1/2021-3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections. GHs (n=415) were randomized to TBP (n=208) and GBP (n=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White: 2.28, p = 0.03). Tailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities. ClinicalTrials.gov, NCT04726371, 27/01/2021. https://clinicaltrials.gov/study/NCT04726371 .
Sections du résumé
BACKGROUND
BACKGROUND
People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA).
METHODS
METHODS
A hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (Tailored Best Practices: TBP) to dissemination of standard prevention guidelines (General Best-Practices: GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including: (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline: 1/1/2021-3/31/2021) and fidelity scores (baseline: 5/1/21-7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline: 1/1/2021-3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections.
RESULTS
RESULTS
GHs (n=415) were randomized to TBP (n=208) and GBP (n=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White: 2.28, p = 0.03).
CONCLUSION
CONCLUSIONS
Tailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov, NCT04726371, 27/01/2021. https://clinicaltrials.gov/study/NCT04726371 .
Identifiants
pubmed: 38926810
doi: 10.1186/s12889-024-18835-w
pii: 10.1186/s12889-024-18835-w
doi:
Substances chimiques
COVID-19 Vaccines
0
Banques de données
ClinicalTrials.gov
['NCT04726371']
Types de publication
Journal Article
Randomized Controlled Trial
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1705Subventions
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Organisme : Patient-Centered Outcomes Research Institute
ID : COVID-2020C2-10803
Pays : United States
Informations de copyright
© 2024. The Author(s).
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