Co-creating a Theory of Change to advance COVID-19 testing and vaccine uptake in underserved communities

Nicole A Stadnick; Kelli L Cain; William Oswald; Paul Watson; Marina Ibarra; Raphael Lagoc; Lawrence O Ayers; Linda Salgin; Shelia L Broyles; Louise C Laurent; Keith Pezzoli; Borsika Rabin

doi:10.1111/1475-6773.13910

Co-creating a Theory of Change to advance COVID-19 testing and vaccine uptake in underserved communities

Health Serv Res. 2022 Jun;57 Suppl 1(Suppl 1):149-157. doi: 10.1111/1475-6773.13910. Epub 2022 Mar 4.

Authors

Nicole A Stadnick^{1

2

3}, Kelli L Cain⁴, William Oswald⁵, Paul Watson⁵, Marina Ibarra⁵, Raphael Lagoc⁵, Lawrence O Ayers⁶, Linda Salgin^{7

8}, Shelia L Broyles^{9

10}, Louise C Laurent⁶, Keith Pezzoli^{11

12

13}, Borsika Rabin^{2

4}

Affiliations

¹ Department of Psychiatry, University of California San Diego, La Jolla, California, USA.
² Dissemination and Implementation Science Center, UC San Diego Altman Clinical and Translational Research Institute, La Jolla, California, USA.
³ Child and Adolescent Services Research Center, San Diego, California, USA.
⁴ The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.
⁵ The Global Action Research Center, San Diego, California, USA.
⁶ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California, USA.
⁷ San Ysidro Health, San Diego, California, USA.
⁸ San Diego State University/University of California San Diego Joint Doctoral Program in Public Health, San Diego, California, USA.
⁹ Department of Pediatrics, University of California San Diego, La Jolla, California, USA.
¹⁰ Community Engagement Unit, UC San Diego Altman Clinical and Translational Research Institute, La Jolla, California, USA.
¹¹ Department of Urban Studies and Planning, University of California San Diego, La Jolla, California, USA.
¹² Bioregional Center for Sustainability Science, Planning and Design, University of California San Diego, La Jolla, California, USA.
¹³ Superfund Research Center, Community Engagement and Research Translation Cores, University of California, San Diego, La Jolla, California, USA.

Abstract

Objectives: To describe the use of a Theory of Change to meaningfully engage community members from or support underserved communities in two National Institutes of Health-funded implementation science projects aimed at promoting equitable access to COVID-19 testing and vaccination for underserved communities.

Study setting: Both projects focused on Latino, Black, and immigrant and refugee communities in South/Central San Diego and/or individuals accessing care at a federally qualified health center near the US/Mexico border during December 2020-April 2021.

Study design: By using a participatory action research design, Community Advisory Boards (CABs) were established for each project with 11 and 22 members. CAB members included community organizers, promotores de salud (community health workers), clinic providers and administrators, and public health researchers. The CABs were guided through a seven-session Theory of Change process, focused on identifying necessary conditions that must exist to eliminate COVID-19 disparities along with specified actions to create those conditions and a blueprint for assessing the impact of those actions.

Data collection: Each session lasted 2 h hosted virtually and was augmented by interactive web-based activities. There was a live interpreter who facilitated the participation of Spanish-speaking CAB members. A Theory of Change for each project was completed in approximately 4 months.

Principal findings: Nine necessary conditions were identified related to (1) accessible and available services; (2) culturally and linguistically competent programming; (3) investment in trusted community and faith leaders; (4) social safety nets to provide ancillary services. Corresponding actions to create these conditions and measures to indicate success in creating these conditions were operationalized by the CAB.

Conclusions: While resource-intensive, a CAB-led Theory of Change process yielded a rich opportunity to engage diverse groups that typically are not invited to inform these processes.

Keywords: COVID-19; Theory of Change; community engagement; implementation; methods; testing; vaccination.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Testing
COVID-19* / prevention & control
Community Health Workers
Hispanic or Latino
Humans
Vaccines*

Substances

Vaccines

Abstract

Publication types

MeSH terms

Substances

Grants and funding