Abstract
BACKGROUND: COVID-19 disproportionately affected Latine communities in the United States, particularly Spanish-speaking and immigrant Latines. Our community-based participatory research (CBPR) partnership developed and tested Nuestra Comunidad Saludable, a Spanish-language intervention harnessing community-based peer navigation and mHealth. The objective of this work is to test the intervention using a cluster randomized trial design to increase COVID-19 testing and vaccination among Spanish-speaking Latino communities in the United States. METHODS: We used a longitudinal, two-group randomized controlled trial design to evaluate the intervention. We recruited 20 peer navigators (Navegantes), each with -eight non-overlapping social network members, and randomly assigned them with their social networks to either the intervention or delayed-intervention group (10 Navegantes and 80 social network members per group) for a total of 160 social network participants at baseline. Data were collected from social network member participants at baseline and immediately post-intervention (six months after intervention-group Navegante training). Participant retention rate was 98.1%. Regression modeling was used to assess changes in testing and vaccination outcomes and intervention-related psychosocial determinants between baseline and follow-up. RESULTS: Mean age of participants was 42 years (SD = 12.8); 77% identified as cisgender women; 85% spoke only or more Spanish than English; and 44% had beyond high school/GED equivalent educational attainment. At follow-up, there were no significant increases in ever having been tested or ever having been vaccinated. Both intervention and delayed-intervention groups experienced improvements in being up to date on recommended vaccine doses and in the number of doses received. Intervention participants reported improvements in some intervention-related psychosocial determinants such as increased testing intention (p<0.001), decreased testing barriers (p=0.034), and fewer number of testing barriers (p=0.043). CONCLUSION: The results of this intervention, including the high retention rates, increased intention to get tested, and reduced testing barriers reveal valuable insights for future efforts aimed at addressing the profound challenges faced by Spanish-speaking Latines in accessing COVID-19, in particular, and other healthcare resources, more generally. Peer navigation and mHealth hold promise for promoting community engagement and improving access to services and overall health outcomes for populations facing barriers to healthcare.