Increasing Latino Vaccination through Behavioral Health: The Mi Vacuna Pragmatic Trial

Background: Latinos in the U.S. face higher rates of infectious diseases but have lower vaccination rates, especially among those with mental health conditions. MI Vacuna (Motivational Interviewing for VACcine Uptake in LatiNx Adults) is an evidence-based intervention designed to increase COVID-19 and influenza vaccinations among Latino adults with mental health challenges. This intervention, supported by the NIH, was developed and implemented as a pragmatic cluster randomized crossover trial by a team of researchers, healthcare providers, administrators, patients, and community members at New England's largest federally qualified healthcare center (FQHC). The Center primarily serves Spanish-speaking Latinos who are either enrolled in Medicaid or uninsured. This study highlights effective strategies and their potential for replication in other FQHCs serving Latino populations.

Methods: Behavioral health clinicians were trained to engage Latino patients missing a COVID-19 or influenza vaccine in guided conversations about vaccination using Motivational Interview (MI). These discussions encouraged patients to reflect on their reasons for not being fully vaccinated and consider the pros and cons of vaccination. In the integrated care setting, behavioral clinicians connected patients who decided to get vaccinated with a nurse through a “warm handoff.” The workflow was implemented at one site (the implementation site) of the Center, while the other site continued with usual care for one year. The following year, the sites switched roles. Data were collected from deidentified Electronic Health Records and in-depth interviews with behavioral health clinicians.

Results: Vaccination rates for both flu and COVID-19 were higher among patients who received MI Vacuna. Out of 552 eligible patients, clinicians had an MI conversation with 32%. The main reasons for not implementing the intervention were time constraints and forgetfulness. Clinicians with 10 or more years of experience and those with high vaccine confidence were about three times more likely to have an MI conversation with eligible patients compared to their counterparts. Patients who received an MI conversation reported higher vaccine confidence (55% vs. 45% for influenza and 52% vs. 48% for COVID-19) and higher vaccination rates (36% vs. 31% for influenza and 13% vs. 10% for COVID-19).

Implications: Behavioral health has been overlooked as a potential avenue for vaccination, particularly for hard-to-reach or vulnerable populations. This study demonstrates that leveraging the trust between behavioral health clinicians and their clients to provide a safe space for vaccine-hesitant adults to reflect on their attitudes and beliefs about vaccines may be a promising strategy to leverage social work science that informs practice and policy aimed at reducing health inequities.