Public Health Intervention Example

Developing and evaluating interventions to address COVID-19 testing and vaccination among these populations are crucial to improving health inequities. The Schlechter et al study describes the application of a rapid-cycle design and adaptation process to address COVID-19 interventions for patients served in safety-net health systems. The rapid-cycle design and adaptation process included: (a) assessing context and determining relevant models/frameworks; (b) determining core and modifiable components of interventions; and (c) conducting iterative adaptations using Plan-DoStudy-Act (PDSA) cycles. PDSA cycles included: Plan. Gather information from potential adopters/implementers (e.g., Community Health Center [CHC] staff/patients) and design initial interventions; Do. Implement interventions in single CHC or patient cohort; Study. Examine process, outcome, and context data (e.g., infection rates); and, Act. If necessary, refine interventions based on process and outcome data, then disseminate interventions to other CHCs and patient cohorts. Seven CHC systems with 26 clinics participated in the trial. Rapid-cycle, PDSA-based adaptations were made to adapt to evolving COVID-19-related needs.

Why are COVI-19 Interventions Complex?

	CI Domain	COVID-19 Interventions
	The interventions have multiple components that are dependent on each other	They are comprised of Electronic Medical Records data at point of care, text messaging with patients and patient navigation at clinics. All activities are dependent on each other.
	The individuals delivering and receiving the intervention often exhibit a high set of coordinated behaviors	Clinical personnel coordinate efforts with EMR data, COVID-19 related policies, and patient needs/behaviors.
	Outcomes are numerous and they can change over time	Outcomes vary across phases of COVID-19 policies and treatment. They include test uptake, vaccination uptake, patient response to text messaging for alerts and access to healthcare.
	There is a need for flexibility in how the intervention is implemented daily	Flexibility on intervention timing and approach/delivery to tailor to patient and community resources, access and preferences.