Marginalized ethnic/racial and sexual and gender minority populations experience adverse social determinants of health, and health disparities, which increase vulnerability amid the COVID-19 pandemic. Nevertheless, pandemic response preparedness and public health responses typically operate from Eurocentric, hetero- and cis-normative perspectives that fail to account for population-specific impacts of marginalization. We tested a theory-informed, peer-delivered intervention to reduce depression and anxiety, and increase public health-recommended protective behaviors and COVID-19 knowledge among racialized LGBTQ+ populations in the Greater Toronto Area (GTA).
#SafeHandsSafeHearts was designed by a multidisciplinary, university-community team. The manualized intervention was based on motivational interviewing and psychoeducation, which have demonstrated effectiveness in many domains of health and eHealth, including LGBTQ+ populations. The three-session intervention was delivered online every two-weeks by trained peer counselors, including MSW intern and community-based staff serving racialized LGBTQ+ populations. Inclusion criteria were ≥18-years-old, residing in GTA, and identifying as lesbian/bisexual/women who have sex with women; gay/bisexual/men who have sex with men; or transgender/gender nonbinary people. Recruitment was conducted through community-based organization and health center listservs and social media, with outreach designed to reach racialized sexual/gender minority populations. We used a one-group pre- and post-test research design, ensuring all received the intervention in the pandemic context. Participants completed mobile-optimized baseline and post-intervention survey questionnaires designed for cellphones, tablets, laptops. We used Generalized Estimating Equations (GEE) with robust standard errors to account for the correlated nature of observations in the longitudinal data, in order to estimate population-averaged outcomes of depression (PHQ-2), anxiety (GAD-2), COVID-19 protective behaviors and knowledge scores, and to identify significant predictors of outcomes over time.
From March-November 2021, racially/ethnically diverse LGBTQ+ participants (n=202) (mean age: 29.7 [SD=10.3]) enrolled in the #SafeHandsSafeHearts eHealth intervention. Results of GEE demonstrate that the intervention significantly reduced depression (change in mean depression score = -.33, 95% Confidence Interval [CI], -.65– -.009, p=.04) and anxiety (change in mean anxiety score = -.39, 95% CI, -.71– -.08, p=.01) over time—from baseline to post-intervention. COVID-19 stress (.06, 95% CI .04–.08, p<.001) and loneliness (.38, 95% CI .28–.47, p<.001) were positively associated with depression over time; being employed (-.60, 95% CI -.96– -.24, p=.001) was negatively associated with depression over time. COVID-19 stress (.10, 95% CI .08–.13, p<.001) was positively associated with anxiety over time, and resilience (-.10, 95% CI -.16– -.04, p<.01) was negatively associated with anxiety over time. Statistically significant increases were not observed in COVID-19 protective behaviors or knowledge at post-intervention, although the intervention increased protective behaviors at 2-month follow-up. Misinformation/conspiracy beliefs (-.001, 95% CI -.003– -.0001, p=.02) were negatively associated with COVID-19 knowledge over time. COVID-19 knowledge (.98, 95% CI .53–1.44, p<.001) and resilience (.12, 95% CI .03–.21, p<.01) were positively associated with COVID-protective behaviors over time.
Conclusions and Implications:
#SafeHandsSafeHearts demonstrated effectiveness in reducing psychological distress among diverse racialized LGBTQ+ populations amid the COVID-19 pandemic. This peer-delivered, commmunity-based eHealth intervention appears to be culturally adaptable and cost-effective, and may be tailored for diverse sexual and gender minority communities.