Community-Based Participatory Research to Enhance Vaccine Uptake Across the Lifespan through Innovative Points of Access and Altering Norms in Border and Rural Regions

Abstract Vaccination is a highly effective public health intervention that saves millions of lives per year, yet declination rates for are increasing in the US for a variety of reasons ranging from safety concerns to religious and philosophical objection. In the wake of declining vaccination rates associated with the COVID-19 pandemic, the Chiricahua Community Health Centers, Inc. (CCHCI) in rural southeast Arizona initiated an innovative project to enhance vaccination through placement of an immunization specialist in dental clinics affiliated with the federally qualified health center (FQHC) system. The literature suggests that there are multiple salient and modifiable points to promote vaccine uptake within a multilevel approach that engages adults, adolescents, providers, families and communities. To enhance vaccine coverage through novel strategies, we propose the following specific aims: 1) Identify barriers and facilitators to vaccine uptake for specific vaccine types and populations in rural and border regions through engagement of individuals, communities, providers, and public health officials; 2) Determine the sustainability of the CCHCI FQHC dental clinic immunization program and scalability of the intervention to dental clinics at the Mariposa Community Health Center (MCHC) FQHC clinics in Santa Cruz County; and 3) Implement and evaluate a multilevel intervention to enhance vaccination uptake in populations unlikely to access FQHC care via an Underserved Population Study Team deployed through the MHU. Our approach will integrate socioecological and health beliefs model framing to understand the roles of socioeconomic factors, trust in health systems and public health authorities, and perceptions of vaccine efficacy and risk. We propose implementation of the dental clinic immunization program at the MCHC and support for the continuation of the program at CCCHCI. We also propose that staff from both CCHCI and MCHC work with the study investigators to author an implementation guide, rooted in Normalization Process Theory and a Dynamic Sustainability Framework, to participate in rigorously evaluating adaptability, effectiveness, and sustainability of this approach in FQHCs. We will develop, pilot, and assess a multilevel intervention strategy aimed at improving vaccination rates within populations that face barriers to healthcare access, particularly those residing in rural and hard-to-reach areas or individuals who do not typically utilize FQHCs. We will leverage the UA College of Public Health Primary Prevention Mobile Health Unit (MHU) program as a strategic platform for delivering vaccinations, utilizing community events as key touchpoints for outreach. At the community level, our focus will be on fostering a supportive environment that promotes vaccination through education, awareness campaigns, and collaboration with local community leaders. Simultaneously, at the individual level, the MHU team will provide personalized education, addressing specific concerns and providing tailored information to encourage vaccine uptake.