Tough talks COVID-19 (TT-C) digital health intervention: multistate randomized controlled trial

Abstract 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 Institut...

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Main Authors: Henna Budhwani, Marie C. D. Stoner, Jacob B. Stocks, Erica Browne, Zachary Soberano, Christyenne L. Bond, Jenna Michaels, Noah Mancuso, Margo Adams Larsen, Allysha C. Maragh-Bass, Elizabeth E. Tolley, Maria Leonora G. Comello, Kathryn E. Muessig, Audrey E. Pettifor, Lisa B. Hightow-Weidman
Format: Article
Language:English
Published: Nature Portfolio 2025-07-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-05386-2
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Summary:Abstract 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 .
ISSN:2045-2322