Background: The COVID-19 pandemic has spared no communities. Yet, not all feel the effects equally, nor do all agree on the solution. Rural communities are no exception. Rural communities with an agricultural base have essential workers involved in the food production system—fields or orchards, in animal production, or meatpacking—and those who own or manage them. These communities also have other social, educational, and health systems that weave together to form a network. County-level health systems are working to find ways to serve all of their residents and follow recommended guidelines but must work within the realities of their often-under-resourced communities. The COVID-19 pandemic has underscored the differing views that people have about the best course of action to protect oneself and the people around them. Despite the availability of vaccines, recent data show that rural communities have the largest COVID-19 vaccine hesitancy.
Proposed Solution to the Problem: The project team’s solution is to build on existing relationships in Lafayette County, in rural Missouri, using a multi-stakeholder approach, to engage representation from the systems throughout the county, including those who create policy, deliver services, and engage the population in everyday activities. The team will create a patient-centered/comparative effectiveness research agenda that represents the various stakeholder priorities and needs that guide decision making about COVID-19, including vaccines. The team will increase knowledge among these systems and individuals about patient-centered outcomes research/comparative effectiveness research (PCOR/CER), thus building knowledge and capacity to support and strengthen participation in future research.
Objectives: The team’s objectives are to create a patient-centered/comparative effectiveness rural research agenda specific to COVID-19 decision making, including vaccines, and increase rural stakeholder knowledge about PCOR/CER. The team will achieve these objectives by using the following strategies:
- Convene a diverse county-wide steering committee
- Hold listening sessions with the various stakeholder groups to document their specific needs and ideas about COVID-19 decision making
- Hold a multi-stakeholder convening to create a patient-centered/comparative effectiveness research agenda, using summary themes from the listening sessions to support the conversations
- Share information about PCOR/CER and the research process throughout the above steps to build capacity for future research
- Obtain input from national consultants to inform the work for use in other communities
Projected Outcomes and Outputs:
As a result of this Engagement Award, the team anticipates achieving the following short-term outcomes:
- Increase rural partners’ knowledge of PCOR/CER and the research process
- Prepare a patient-centered/comparative effectiveness research agenda specific to rural residents and COVID-19, including the vaccines
- Identify workable strategies for integrating farmworkers’ and other agricultural persons’ perspectives into a multi-stakeholder process, thus increasing the sustainability of this type of endeavor.
For medium-term outcomes, after the project has ended, the team expects that health providers, researchers, and policy makers will have a better understanding of factors that influence rural residents’ decision making about COVID-19, including the vaccines, and can use it to inform approaches and strategies when working with rural communities. Additionally, they will have more information on where patient-centered/comparative effectiveness research is needed to support real-world policies, practices, and data.
For long-term outcomes, the team expects a research study to be underway that begins to address topic(s) identified in the research agenda. This step will help build and maintain engagement, extend capacity building, and support the ability for informed decision making.
Patient and Stakeholder Engagement Plan: To complete this work, the team will have a steering committee that meets six times, representing primary systems and perspectives, a farmworkers group that meets six times, an individual listening session with each system, and a multi-stakeholder convening. Information from the steering committee and farmworkers group will help inform the listening sessions and the multi-stakeholder convening.
Project Collaborators: Partnering with the University of Kansas on this project is the Migrant Farmworkers Assistance Fund as the community co-lead along with HCC Network and Lafayette Regional Health Center. Additional partners will be added as the project commences.