Discussion
INFECTIOUS DISEASE
This implementation study capitalizes on the unique and complementary methods from community engagement, implementation science, health equity, health communication, infectious disease, and public health to co-create a multicomponent strategy to promote sustained uptake of effective public health approaches of COVID-19 vaccination and preventive services engagement for underserved communities in San Diego. This proposal extends the team’s current work [This study will contribute to the limited evidence base in implementation science on public health scaling and sustainment strategies by conducting a hybrid type 3 effectiveness-implementation study on a multicomponent strategy co-created with community leaders, residents, and frontline providers. Limited research exists on sustainment strategies so the explicit focus on scaling and sustaining will contribute to the field of implementation science by adding evidence to health equity-promoting sustainment strategies. This study will include a multi-level mixed-methods data collection approach at multiple time points guided by an implementation science model and is designed to assess sustained impact of our multicomponent program with a 12-month follow-up period. An adaptive implementation approach operationalized in a SMART design will be used to allow deployment of various components of our multicomponent program over time depending on the response to prior components. This approach will facilitate understanding the impact of various intervention components and delivering more intensive support those who benefit from it most. Finally, while the mHealth messaging will target COVID-19 vaccines and boosters, generalizable knowledge will be garnered that may support development of messages for other immunizations if this intervention is to be expanded and scaled.Balanced with these innovative features are potential challenges and limitations. Based on the team’s ongoing COVID-19 work, a primary challenge will be balancing reach with resource constraints. The underserved communities who reside in the partnering FQHC clinic regions are diverse in their cultures, languages, explanatory models of health and COVID-19, and healthcare needs. It will not be possible to engage all immigrant, refugee, and BIPOC communities through our co-created health program. However, the team will rely on the decades of community engaged participatory action research led by the Global ARC to successfully reach a diverse range of immigrant and refugee communities in ways that are meaningful, sustainable and resource appropriate, and leverage the quality care and clinical research supported by the partnering FQHC to reduce health disparities in their patient population.This study has great potential to contribute to implementation science through the operationalization of a relatively infrequently operationalized SMART design, the use of longitudinal, multi-level, and mixed-methods data collection informed by an implementation science framework, and the use of innovative implementation strategies of co-creation through CABs led by Community Weavers and care coordination. It is expected that the study will have meaningful population health impact by increasing COVID-19 vaccine and preventive services uptake for key historically underserved populations. Furthermore, findings of this study have potential to uniquely unpack the phenomenon of health and vaccine misinformation that was exacerbated through the COVID-19 pandemic [