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The COVID-19 pandemic disproportionately impacted marginalized populations globally. Pandemic preparedness measures, typically designed for cisgender, heterosexual populations, may contribute to marginalization among lesbian, gay, bisexual, transgender, gender diverse and queer (LGBTQ+) people. In a university-community-based organization (CBO) partnership, we developed and tested a peer-delivered eHealth intervention to increase COVID-19 knowledge and public health-recommended protective behaviors and reduce psychological distress among LGBTQ+ people in Bangkok and Mumbai.
Methods
We developed #SafeHandsSafeHearts, a theory-informed manualized psychosocial intervention based on motivational interviewing and psychoeducation. The three-session individual intervention was delivered online weekly by trained peer counselors. Inclusion criteria were ≥18-years-old, residing in Bangkok or Mumbai, and identifying as a lesbian/bisexual/woman who has sex with women, gay/bisexual/man who has sex with men, or transgender/gender diverse (TGD) individual. Recruitment was conducted online through LGBTQ+ CBO listservs and social media. We used a 1:1 waitlist controlled randomized trial design. Participants completed mobile-optimized baseline, 2-week post-intervention and 2-month follow-up survey questionnaires designed for cellphones, tablets, and laptops. We conducted an intention-to-treat analysis using multilevel modelling, to account for the correlated nature of observations in the longitudinal data, to estimate outcomes: COVID-19 knowledge scores (range, 0–8) and protective behavior scores (range, 0–18), clinically-significant depression (PHQ-2) and anxiety (GAD-2).
Results
From August 2021 to February 2022, participants (n=650; median age, 29.0 years [IQR=10]; 26.2% [n=170] cisgender women, 36.9% [n=240] transgender/gender diverse people, 36.9% [n=240] cisgender men) completed a baseline assessment; 49.2% (n=320) were randomized to immediate intervention group (IIG) and 50.8% (n=330) to waitlist control (WLC) conditions. 531 participants (81.7%) completed postintervention and 452 (69.5%) completed follow-up assessments. Baseline COVID-19 knowledge scores were 6.31 for WLC, 6.44 IIG (ns), protective behavior scores 14.13 for WLC, 14.56 IIG (ns). Estimated depression prevalence at baseline was 26.2% for WLC, 24.0% IIG (ns), with anxiety at baseline 24.0% for WLC and 25.5% IIG (ns). Compared to WLC, the IIG showed a statistically significant increase in COVID-19 knowledge scores at postintervention (b=.31, 95% Confidence Interval [CI] .03–.60, p<.05) with Cohen’s d=0.35 (medium effect size), but not at follow-up (b=.28, 95% CI -11–.68, p=.15). Compared to WLC, the IIG showed significant increases in COVID-19 protective behavior scores at postintervention (b=1.08, 95% CI .45–1.71, p<.01) and follow-up (b=0.96, 95% CI .56–1.36, p<.001), with Cohen’s d=0.38 (medium effect size) at postintervention. Compared to WLC, IIG showed statistically significant reductions in the prevalence of depression by 13.7% (b= -.03, 95% CI -.04– -.01, p<.001) at postintervention and 22.8% at follow-up (b= -.05, 95% CI -.09– -.009; p<.05). There were no significant reductions in the prevalence of anxiety at postintervention or follow-up. No significant differences in outcomes were identified by gender/sexual orientation.
Conclusions
#SafeHandsSafeHearts demonstrated effectiveness in improving COVID-19 knowledge and protective behaviors, and in reducing depression among LGBTQ+ populations amid the pandemic. This peer-delivered eHealth intervention appears to be culturally adaptable for diverse sexual and gender minority communities, cost-effective with delivery through CBOs, and supports the importance of meaningful engagement of LGBTQ+ communities in pandemic preparedness and interventions.