Project Summary

In the United States, COVID-19 was first seen in long-term care facilities (LTCFs). The pandemic has particularly burdened these facilities. It is crucial that workers at LTCFs are vaccinated against COVID-19 to protect themselves, their families, and the older adults in their care. However, LTCF workers have lower vaccination rates than needed to protect them and the people they care for.

LTCF workers might not be confident about the COVID-19 vaccine. Giving them vaccine information in ways that match their language or cultural groups could make them more confident about getting the COVID-19 vaccine. Studies, including by the research team, show that working with communities on the best ways to offer information about vaccines can help community members learn about vaccines and trust them enough to get vaccinated.

Many LTCF staff belong to immigrant, refugee, and/or racial and ethnic groups that due to historical and current racism and mistreatment do not trust information from governments or doctors about vaccines. This project will work with LTCF staff to offer COVID-19 vaccine information that is trustworthy and tailored to the needs of language or cultural groups. The specific goals of this project are to:

  1. Compare two ways of tailoring information about the COVID-19 vaccines for specific LTCFs staff populations versus the generic materials that are usually distributed. We will test if and how much more these two tailoring approaches increase vaccination rates of LTCFs staff compared to generic messages.
  2. Study if the way COVID-19 vaccine information is developed and offered is practical for use by LTCFs and other community health organizations.

This study will be carried out in Georgia and Washington State, with 60 LTCFs, 30 in each state. It will include frontline workers at the LTCFs, which will be about 6,000 individuals. Each LTCF will be randomly assigned to either:

  1. Enhanced usual care. These LTCFs will receive information about the COVID-19 vaccine from the Centers for Disease Control and Prevention, with one to three hours of help on how to give the information to their staff.
  2. Full intervention. Over 10 weeks, LTCF workers in each of the two states will work with the study team to codesign materials with vaccine information. They will also find ways to give the information to other LTCF workers and learn to be peer advocates for the vaccine.
  3. Limited intervention. Materials created by the groups at the full intervention sites will be taken to LTCFs where the staff do not get enhanced usual care and do not go through the codesign process. Materials will be given to staff by LTCF leaders, who will receive one to three hours of help from the study team.

To test how well these different approaches to tailoring and distributing vaccine information work, the LTCFs will provide staff vaccination rates at the beginning of the study; shortly before the intervention at 7 months; and at 12, 14, and 17 months into the study. Researchers will also give LTCF workers a survey and ask some to be in interviews and focus groups to find out what they think about the COVID-19 vaccines and their reactions to the interventions at their workplaces.

To plan this study, the research team engaged a focus group with LTCF frontline workers. During the study, two coinvestigators, an LTCF administrator and an LTCF caregiver, will advise the team. Both are immigrants and fluent in English and another language. A stakeholder advisory panel will also help with the study.

This study will provide actionable results and resources for communicating information about COVID-19 vaccines that people trust and that are effective at improving vaccine hesitancy and uptake. The results might be useful for other places where workers are at risk of contracting COVID-19, such as medical clinics, food preparation sites, and grocery stores.

Project Information

Clarissa Hsu, PhD, MA
Kaiser Foundation Health Plan of Washington (Kaiser Permanente Washington Health Research Institute)

Key Dates

August 2025


Award Type
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
Research Priority Area
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 4, 2022