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Tailored vs. General COVID-19 prevention for adults with mental disabilities residing in group homes: a randomized controlled effectiveness-implementation trial.
Bartels, Stephen; Levison, Julie H; Trieu, Hao D; Wilson, Anna; Krane, David; Cheng, David; Xie, Haiyi; Donelan, Karen; Bird, Bruce; Shellenberger, Kim; Cella, Elizabeth; Oreskovic, Nicolas M; Irwin, Kelly; Aschbrenner, Kelly; Fathi, Ahmed; Gamse, Stefanie; Holland, Sibyl; Wolfe, Jessica; Chau, Cindy; Adejinmi, Adeola; Langlois, Jasmine; Reichman, Jean-Louise; Iezzoni, Lisa I; Skotko, Brian G.
Afiliación
  • Bartels S; Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA. sjbartels@mgh.harvard.edu.
  • Levison JH; Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA. sjbartels@mgh.harvard.edu.
  • Trieu HD; Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
  • Wilson A; Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA.
  • Krane D; Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
  • Cheng D; Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
  • Xie H; Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
  • Donelan K; Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA.
  • Bird B; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Third Floor, HB 7261, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
  • Shellenberger K; Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
  • Cella E; Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA.
  • Oreskovic NM; Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA.
  • Irwin K; Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA.
  • Aschbrenner K; Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA.
  • Fathi A; Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA.
  • Gamse S; Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02214, USA.
  • Holland S; Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
  • Wolfe J; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
  • Chau C; Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA.
  • Adejinmi A; Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA.
  • Langlois J; Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA.
  • Reichman JL; Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA.
  • Iezzoni LI; Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
  • Skotko BG; Bay Cove Human Services, 66 Canal Street, Boston, MA, 02114, USA.
BMC Public Health ; 24(1): 1705, 2024 Jun 26.
Article en En | MEDLINE | ID: mdl-38926810
ABSTRACT

BACKGROUND:

People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA).

METHODS:

A hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (Tailored Best Practices TBP) to dissemination of standard prevention guidelines (General Best-Practices GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline 1/1/2021-3/31/2021) and fidelity scores (baseline 5/1/21-7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline 1/1/2021-3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections.

RESULTS:

GHs (n=415) were randomized to TBP (n=208) and GBP (n=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White 2.28, p = 0.03).

CONCLUSION:

Tailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities. TRIAL REGISTRATION ClinicalTrials.gov, NCT04726371, 27/01/2021. https//clinicaltrials.gov/study/NCT04726371 .
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Hogares para Grupos / COVID-19 / Trastornos Mentales Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: BMC Public Health Asunto de la revista: SAUDE PUBLICA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Hogares para Grupos / COVID-19 / Trastornos Mentales Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: BMC Public Health Asunto de la revista: SAUDE PUBLICA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos