Improving the Collaborative Health of Minority COVID-19 Survivor & Carepartner Dyads Through Interventions Targeting Social and Structural Health Inequities

PROJECT SUMMARY/ABSTRACT Persons of color (POC) from underserved communities are at increased risk of COVID-19 related morbidity and mortality due to a variety of social and structural health determinants (SSDH; e.g., barriers to health care access) and higher rates of underlying chronic diseases such as diabetes, hypertension, and cardiovascular disease. Additionally, stressors associated with experiences of racism/discrimination (personal and systemic) and the impact of the pandemic on their communities may further complicate the recovery and management of underlying chronic diseases for minority COVID-19 survivors, undermining the mental and physical health not only of the patient but carepartners who provide critical support. This study tests the efficacy of a telehealth- enhanced, RN-Community Health Worker (CHW) delivered dyad intervention, ICINGS FAM (Integrating Community-based Intervention Under Nurse Guidance with Families), on quality of life (QoL), and health- related outcomes in vulnerable African American (AA) adults with preexisting chronic illness and their informal carepartners (IC). Adapted from our previous WISSDOM CINGs model tested in AA stroke patients, key features of this intervention include a) strategies to address racial- and pandemic-related stressors perceived by COVID-19 survivors and ICs; and b) incorporation of the survivor/IC dyad as a unit of analysis to better understand how interpersonal and interdependent relationships impact health and health related outcomes for both partners. We hypothesize that survivor/IC dyads receiving the intervention (i.e., coaching related to COVID-19 risk mitigation, chronic disease management information, and assistance navigating the health care system) will demonstrate improved QoL and health-related secondary outcomes compared to the attention control arm receiving monthly general health promotion. The objective of iCINGS FAM is to strengthen the efficacy and agency of the dyad to manage illness behaviors as an integrated unit, termed "dyad illness management. In Aim 1, we will conduct interviews and focus groups with key community stakeholders to refine iCINGS FAM components to the individual, interpersonal, community, social environment, and SSDH assets/barriers of study dyads. In Aim 2, we will employ an RCT design to test intervention efficacy on QoL of adult AA survivors and ICs (250 dyads) with pre-existing chronic health conditions. Intervention effects on symptoms, dyadic confidence, and social support will also be investigated (Aim 2.1). In Aim 3, we will identify individual - and family - level social and structural racial trauma exposures and family illness management behaviors associated with reduced/improved QoL and health outcomes on a subset of dyads (n=50). Finally, to further contextualize study findings, in Exploratory Aim 4 we will examine associations between outcomes and community-level SSDH using PhenX structural determinant variables. This intervention has the potential to reduce health disparities and increase understanding of SSDH, sociodemographic and psychosocial factors that affect QoL and dyadic illness management behaviors in minority patients.