Methods: #SafeHandsSafeHearts was designed and implemented by a multidisciplinary team of researchers, practitioners, and trainees, with the goal of reducing psychological distress and increasing COVID-19 knowledge and protective behaviors among predominantly racialized LGBTQ+ individuals amid the pandemic. The intervention was based on motivational interviewing and psychoeducation, which have demonstrated effectiveness across many health domains, and in eHealth interventions, among various LGBTQ+ populations. MSW interns and community-based peer counselors received training on COVID-19, the intervention, and research ethics, and ongoing clinical supervision. After completion of screening and a baseline survey (n=202), the intervention was implemented in three sequential 1-hour online modules conducted every two weeks, followed by post-intervention (2-week) and follow-up (2-month) surveys. A customized, mobile-optimized, web-based platform enabled self-administered online screening, baseline and post-intervention surveys, designed to navigate rolling lockdowns in Toronto. The four presentations draw on theory (i.e., structural violence) and analyses of baseline and outcome data from #SafeHandsSafeHearts to: 1) characterize the sample and impacts of the pandemic on SDOH; 2) examine associations between COVID-19-related stress and mental health; 3) explore pandemic-related risks of intimate partner violence; and 4) evaluate the effectiveness of the intervention on psychological distress, COVID-19 protective behaviors and knowledge outcomes.
Results: We identified pervasive pandemic-related impacts on economic, housing, and food insecurity, and access to healthcare among racialized LGBTQ+ individuals. Loneliness and social isolation, and COVID-19 stress were significantly associated with depression and anxiety. The pandemic and related responses exacerbated risks of intimate partner violence. Overall, #SafeHandsSafeHearts was effective in significantly reducing depression and anxiety over time, with no statistically significant increases in COVID-19 knowledge. Significant increases in protective behaviors were identified at 2-month follow-up.
Conclusion and Implications: #SafeHandsSafeHearts highlights the exacerbation of social-structural inequities, mental health risks, and IPV among racialized LGBTQ+ populations in the COVID-19 pandemic, as well as the effectiveness of a culturally tailored, community-based and peer-delivered eHealth intervention in significantly reducing psychological distress. Our findings suggest an urgent need to consider the impacts of structural violence on pandemic-related risks, and the imperative of including marginalized communities in developing culturally appropriate pandemic preparedness and responses.