A multidimensional Digital Approach to Address Vaccine Hesitancy and Increase COVID-19 Vaccine Uptake among African American Young Adults in the South

PROJECT SUMMARY Young Adults (YA) are a key "super-spreader" population transmitting SARS-Co-V2, the causative agent of COVID-19 (COVID). Given their high rate of asymptomatic infection compounded by transmission rates that are being fueled by behaviors that run contrary to physical distancing and face covering regulations, YA represent a priority population upon which to focus efforts to ensure high levels of COVID vaccine uptake. While COVID vaccines can protect African American young adults (AA-YA) against COVID related morbidity and mortality, this population will only accept vaccination if interventions assure AA-YA of its safety and benefit, while also addressing historical contexts and systemic forces that propagate mistrust. Digital Health Interventions (DHIs) can reach large numbers of AA-YA regardless of geographic location and empower them to make informed decisions about their health using a familiar modality that YAs value and trust. Our collaborative team developed the theory informed DHI Tough Talks to assist YA with HIV disclosure decision making, specifically by considering the social, ethical and behavioral implications of their choices and the consequences that follow. In response to NOT-MD-21-008: Research to Address Vaccine Hesitancy, Uptake, and Implementation among Populations that Experience Health Disparities, we propose to apply a community- based participatory research (CBPR) approach to assess multi-level factors identified within the NIMHD Research Framework and adapt and test Tough Talks to address COVID vaccine hesitancy (VH), Tough Talks-COVID (TT-C). In aim 1, we will conduct multi-method formative research to elicit the behavioral, cognitive, and environmental determinants influencing COVID VH among AA-YA (ages 18-29) in three southern states. We combine validated survey measures, with novel CBPR methods including choose-your- own adventure journeys and digital storytelling to better understand vaccine decision-making in AA-YA. In collaboration with expert advisors, community partners, and AA-YA end-users, in aim 2, we will leverage ADAPT-ITT to develop and refine TT-C. User-centered participatory design and rapid prototyping focus groups will be conducted with AA-YA (n=12-16) in southern states. Once finalized, we will conduct a technical pilot with AA-YA (N=24) to assess TT-C's feasibility and acceptability. In aim 3, we will conduct a hybrid type 1 effectiveness implementation 3-arm RCT with n=540 AA-YA from three southern states. Participants will be randomized to receive standard of care (control), TT-C delivered remotely, and TT-C delivered in-person. Primary effectiveness outcomes are COVID vaccine uptake and series completion. Secondary effectiveness outcomes are VH, confidence, and knowledge, attitudes and beliefs. We will conduct qualitative interviews with participants (n=12-16) and site staff (n=6-8) to assess implementation barriers and facilitators. We leverage our existing infrastructure to meaningfully engage with southern AA-YA communities, working to dismantle inequitable research relationships and medical mistrust to increase COVID vaccine uptake.