An international multi-site, randomized controlled trial of a brief eHealth intervention to increase COVID-19 knowledge and protective behaviors, and reduce pandemic stress among diverse LGBT+ people

The extreme global impact and still uncertain path of COVID-19 demands collaboration among researchers and communities in high- (HIC) and low-income countries (LMIC) to effectively halt the pandemic. Currently, public health recommended behavioural measures, such as handwashing and physical distancing, are the only effective approach to prevent COVID-19. However, COVID-19 exerts a disproportionate impact on marginalized populations. Existing disparities in health and its social determinants increase vulnerability to COVID-19, and creates barriers to adopting public health measures, which deepen resulting inequities. LGBT+ populations, including intersections with other forms of marginalization by race/ethnicity, gender, age and HIV status, experience extensive health disparities, and challenges due to unstable housing, employment, healthcare discrimination, and violence. Yet, there are no coordinated pandemic responses to address the expectable excess burden of COVID-19 among diverse LGBT+ people in Canada or LMIC. Community-engaged approaches are essential to bridging mistrust and loss of confidence in public health communications on the part of vulnerable communities, fueled by existing inequities. To address substantial gaps in the pandemic response, we will rapidly mobilize our existing global research team to adapt, test, and disseminate a community-engaged, brief, online peer-delivered intervention (#SafeHandsSafeHearts) with diverse LGBT+ populations to reduce risk in the pandemic. We will test the intervention's effectiveness in increasing COVID-19 knowledge and protective behaviours, and reducing psychological distress among cisgender gay/bisexual men, cisgender lesbian/bisexual women, and transgender people in Canada, India, and Thailand. In addition to immediate impact in slowing the spread of COVID-19, results will inform health system and public health responses to support engagement of LGBT+ and other marginalized populations in the pandemic response.