Project Summary

PCORI has identified COVID-19 as an important research topic. Patients, clinicians, and others want to learn: What are effective ways to prevent or reduce the impact of COVID-19, especially on vulnerable populations and the healthcare workforce? To help answer this question, PCORI launched an initiative in 2020 to Strengthen Understanding of COVID-19 Impact and Inform Healthcare Responses. The initiative funded this research project and others.

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Long term care centers, or LTCCs, provide medical and personal care to people who can’t live on their own. Types of LTCCs include nursing homes and assisted living centers. LTCC workers are at high risk for COVID-19, but many aren’t vaccinated. Higher vaccination rates would better protect both LTCC workers and the people they care for from COVID-19.

Many LTCC workers belong to immigrant, refugee, or racial and ethnic groups who have experienced mistreatment or historical and current racism. These communities may not trust information about vaccines coming from doctors or the government. To improve trust, past studies have led experts to recommend working with community members to tailor information about vaccines,

In this study, the research team is partnering with LTCC workers to design materials to help inform other LTCC workers about COVID-19 vaccines. The team is comparing vaccination rates at LTCCs where workers receive:

  • Tailored materials designed by workers at their LTCC.
  • General information about COVID-19 vaccines from the Centers for Disease Control and Prevention, or CDC.

Who can this research help?

Results may help LTCC administrators when considering ways to increase vaccination rates among workers.

What is the research team doing?

The research team is enrolling 50 LTCCs in Georgia and Washington State. The LTCCs employ about 5,000 workers. The team is assigning LTCCs by chance to one of two groups. Each group includes 12–13 LTCCs from each state.

In the first group, LTCC workers take part in a 10-week co-design process in which workers from a cultural group help design messages for that cultural group. These workers also receive training to be peer advocates and help share the messages they create with other workers.

In the second group, LTCCs receive information about COVID-19 vaccines from the CDC. The research team is consulting with LTCC leaders on effective ways to get messages to workers.

The research team is looking at vaccination rates in LTCCs at the start of the study and 7, 10, and 13 months later. The team is also surveying and interviewing workers about their opinions on and knowledge about COVID-19 vaccines and how likely they are to recommend the vaccines to others.

LTCC workers, staff, and administrators are helping to plan and conduct this study.

Design Element Description
Design Randomized controlled trial
Population LTCC workers
  • Full intervention: LTCC workers co-design vaccine materials for selected language groups and cultural groups and serve as peer advocates
  • Enhanced usual care: provide the LTCCs with a vaccination toolkit from CDC and 1–3 hours of consultation

Primary: COVID-19 booster vaccination rates, net promoter scores (i.e., likelihood of recommending COVID-19 vaccines to others)

Secondary: vaccine hesitancy and knowledge

Timeframe Timeframe Length of follow-up for collecting data on primary outcomes. View Glossary 13-month follow-up for primary outcome

Project Information

Clarissa Hsu, PhD, MA
Kaiser Foundation Health Plan of Washington (Kaiser Permanente Washington Health Research Institute)
ENSPIRE Study: Engaging Staff to Improve COVID-19 Vaccination Rates at Long-Term Care Facilities

Key Dates

October 2025


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: September 26, 2023