PCORI Biweekly COVID-19 Scan: Mobile Health Application, National Black Church Initiative (October 14-27, 2021)

ECRI Horizon Scanning has selected the topics below as those with potential for impact relative to COVID-19 in the United States within the next 12 months. All views presented are preliminary and based on readily available information at the time of writing.

Because these topics are rapidly developing, we cannot guarantee the accuracy of this information after the date listed on this publication. In addition, all views expressed in the commentary section are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders. Topics are listed in alphabetical order.

Description

The COVID-19 pandemic has highlighted and magnified racial and ethnic health disparities for underserved populations in the United States. Asian, Black, Latinx, and American Indian individuals have experienced higher rates of severe illness and death from COVID-19, as well as greater personal, social, and economic stress than non-Latino White individuals. Heightened stress increases the risk of negative physical and mental health outcomes; an issue that is already exacerbated by inadequate access to health care.

The EASE mobile health app, under investigation by the University of Houston in collaboration with the University of Oklahoma and Oklahoma State University, is intended to decrease health disparities among Black, Latinx, and American Indian individuals as a result of the COVID-19 pandemic by treating elevated anxiety and depressive symptoms. EASE is a validated app that purportedly targets anxiety sensitivity, a factor in the development and progression of anxiety and depressive symptoms. It uses twice-daily assessments to personalize behavioral health care. The application is adapted with COVID-19–specific elements, including symptom monitoring, exposure-management skills, and education on COVID-19–related stress and its impact on the immune system.

An unphased, randomized controlled clinical trial is comparing the EASE mobile app with educational videos covering meditation, mindfulness, and stress reduction techniques in 800 participants. The trial’s primary completion date is estimated as August 2023. 

Commentary

The EASE mobile health app is an investigational intervention for treating anxiety and depressive symptoms. It is intended to decrease the disparities in access to mental health care and health outcomes among ethnic and racial minorities in the United States.

Early feedback from ECRI internal stakeholders suggests that, if effective and easy to use, the EASE app might provide an opportunity for early intervention, reduce the prevalence and severity of mental health conditions, and improve population health outcomes in underserved populations.

This accessible and relatively low-cost intervention might improve the manner in which mental health care is delivered to individuals who have limited access to care because of geographic or economic disparities. The impact of this app might be limited, however, by the availability of other mental health apps, varied access to reliable internet service, and the perceived social stigma of seeking mental health care. Data from the ongoing trial are needed to determine the efficacy of this intervention.  

• Categories: Public health, systems, and management
• Areas of potential impact: Patient outcomes, population health outcomes, patient management, health care disparities, health care delivery and process

Description

The NBCI is a coalition of 150 000 Black and Latino churches that intends to reduce racial and ethnic disparities in health care across the United States. Racial and ethnic minority populations are at a higher risk of SARS-CoV-2 infection and COVID-19 complications. Effective COVID-19 vaccination programs are needed to address the concerns of these populations and improve uptake. As of October 4, 2021, the proportion of White individuals who received at least one dose of the COVID-19 vaccine (54%) was about 1.2 times higher than the proportion of Black individuals (46%) and 1.1 times higher than the proportion of Latino individuals (51%).

The NBCI has announced a 5-year plan, published in JAMA, in partnership with the CDC to leverage churches as vaccination centers and partner with about 1000 Black and Latino medical professionals to administer vaccines. Additionally, the program will mobilize volunteers to increase awareness about COVID-19, provide transportation to vaccination centers, and ensure that people in underserved communities complete the vaccination series. ​As of August 2021, NBCI had held more than 157 vaccination events to increase uptake and engaged 2.5 million volunteers to support vaccination efforts in low-income Black and Latino communities. The NBCI program also disseminates reliable information about the COVID-19 vaccines to all members, congregants, churches, and the public. On October 14, 2021, the NBCI released its newspaper, called VACCNEWS, containing information about COVID-19 and testimonials from Black and Hispanic doctors about the COVID-19 vaccine.​

Commentary

The NBCI’s program to reduce COVID-19 vaccine hesitancy and increase immunizations might reduce disparities and improve outcomes for individuals at high risk for contracting severe COVID-19.

Early feedback from ECRI internal stakeholders suggested that holding vaccination events at convenient times and locations could increase access to COVID-19 vaccines and might help decrease disparities. This might improve patient and population health in underserved communities at higher risk of severe COVID-19 with limited access to health care services. Information from a trusted and more personal source might be more effective than announcements from public health officials.

Stakeholders also thought that, if effective, this program might mitigate the effects of misinformation regarding COVID-19 vaccines, which is widely spread through social media and other mass outlets. It could increase vaccinations rates, which would ultimately reduce hospitalizations and deaths due to COVID-19. Improving the quality of medical information about COVID-19 might also be later applied to broader efforts for improving overall health in these communities (such as programs to address hypertension and diabetes). Stakeholders stated concerns that booster authorizations might temporarily restrict vaccine supply and offset the initiative’s effectiveness.

Although the NBCI’s 5-year plan is impressive, questions remain about whether the initiative will be able to vaccinate enough people in underserved areas promptly. Because of the program’s ties to churches, stakeholders wondered whether the NBCI might have more success reaching older members of underserved communities than connecting with their younger neighbors.

• Categories: Public health, systems, and management
• Areas of potential impact: Patient outcomes, patient management, health care disparities, health care costs

Horizon scanning is a systematic process that serves as an early warning system to inform decision makers about possible future opportunities and threats. Health care horizon scanning identifies technologies, innovations, and trends with potential to cause future shifts or disruptions—positive or negative—in areas such as access to care, care delivery processes, care setting, costs of care, current treatment models or paradigms, health disparities, health care infrastructure, public health, and patient health outcomes.

The PCORI Health Care Horizon Scanning System (HCHSS) conducts horizon scanning to better inform its patient-centered outcomes research investments. Initially, PCORI defined the HCHSS project scope to focus on interventions with high potential for disruption in the United States in 5 priority areas: Alzheimer’s disease and other dementias, cancer, cardiovascular diseases, mental and behavioral health conditions, and rare diseases. In addition, the system captures high-level disruptive trends across all clinical areas, which may lead PCORI to expand the project scope to include other priority areas in the future.

In early 2020, the COVID-19 pandemic created a fast-moving, widespread public health crisis. In May 2020, PCORI expanded its HCHSS to elucidate the landscape of potentially impactful applications for COVID-19. The HCHSS COVID-19 supplement scans for, identifies, monitors, and reports on emerging and available COVID-19-related treatments, diagnostics, preventive measures, management strategies, and systems changes with potential for high impact to patient outcomes—for individuals and populations—in the United States in the next 12 months.

The HCHSS COVID-19 supplement produces 3 main outputs:

• Biweekly COVID-19 Scans (eg, this document) provide ECRI Horizon Scanning with a vehicle to inform PCORI and the public in a timely manner of important topics of interest identified during ongoing scanning and topic identification or through the ECRI stakeholder survey process.
• Status Reports (quarterly) briefly list and describe all COVID-19-related topics identified, monitored, and recently archived.
• High Impact Reports (every 4 months) highlight those topics that ECRI internal stakeholders (eg, physicians, nurses, allied health professionals, public health professionals, first responders, health systems experts, clinical engineers, researchers, business and finance professionals, and information technology professionals) have identified as having potential for high impact relative to COVID-19 in the United States.