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Tough talks COVID-19 (TT-C) digital health intervention
multistate randomized controlled trial
Budhwani, H., Stoner, M. C. D., Stocks, J. B., Browne, E., Soberano, Z., Bond, C. L., Michaels, J., Mancuso, N., Larsen, M. A., Maragh-Bass, A. C., Tolley, E. E., Comello, M. L. G., Muessig, K. E., Pettifor, A. E., & Hightow-Weidman, L. B. (2025). Tough talks COVID-19 (TT-C) digital health intervention: multistate randomized controlled trial. Scientific Reports, 15(1), Article 21988. https://doi.org/10.1038/s41598-025-05386-2
During the COVID-19 pandemic, rapid changes in variant virulence, limited personal protective equipment availability, and diminished hospital capacity necessitated aggressive vaccine distribution. To promote COVID-19 vaccination to historically underserved populations, the National Institutes of Health funded a small group of clinical trials, including the Tough Talks for COVID-19 vaccine (TT-C) digital health intervention (DHI) randomized controlled trial (RCT). Black young adults, 18-29 years, who were unvaccinated or insufficiently vaccinated against COVID-19 were recruited via social media in Alabama, Georgia, and North Carolina and randomized to the intervention or standard of care control (N = 360). Self-report data and vaccine cards were collected at baseline, 1- and 3-months post-randomization. Post-intervention, 6.4% received a new COVID-19 vaccine (8.4% intervention; 4.7% control). Odds of new COVID-19 vaccination were 1.88 (CI: 0.76, 4.69, p = 0.174) times higher in intervention compared to control participants adjusting for state. At 3 months post-randomziation, vaccine hesitancy was lower among intervention than control participants (CI:-0.34,-0.03, p = 0.02), and vaccine confidence and vaccine knowledge were higher in intervention versus control participants (CI:0.00,0.32, p = 0.05, CI:0.21,0.79, p = 0.01 respectively). Under rapidly changing conditions, the TT-C DHI produced promising results on vaccine attitudes but not behaviors among Southern Black young adults. The intervention could be adapted to address vaccine uptake among other minority populations.Trial registration: NCT05490329, registered on 03082022.https://clinicaltrials.gov/study/NCT05490329.
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