PROJECT SUMMARY/ABSTRACT Migrant agricultural workers and their families face formidable challenges in accessing COVID-19 testing, treatment, and preventive measures due to geographic, cultural, linguistic, and social isolation from community institutions and resources. Our research team has partnered with migrant families in rural Nebraska to improve access to COVID-19 testing, healthcare, and community response resources by implementing the Mobile Health for Migrant Health (mHealth-4-Mhealth) program. This program collaborates with state and local health departments and the Title IC Nebraska Migrant Education Program and seeks to mitigate direct and indirect negative effects of the pandemic by providing mHealth-guided decision support for at-home COVID-19 antigen testing and infection management coupled with mHealth-assisted social determinants of health (SDOH) screening and response protocols to connect families to community resources and aid. Our experience to date highlights the feasibility and acceptability of mHealth-based public health interventions to engage marginalized communities in COVID-19 responses and facilitate access to community and health systems resources. The research objective of this study is to evaluate the impact of mHealth-4-Mhealth program implementation on migrant families’ utilization of COVID-19 testing, treatment, and related healthcare resources by achieving three specific aims. Aim #1: Determine the effectiveness of self-directed decision support via an mHealth tool and human-assisted systems navigation for engaging rural migrant families in COVID-19 (1a) testing and (1b) treatment. Aim #2: Identify SDOH and other implementation factors at participant, household, and community levels associated with program adoption among rural migrant families. Aim #3: Determine the cost- effectiveness of implementing mHealth and systems navigation to increase COVID-19 (3a) testing and (3b) treatment among rural migrant families. We will conduct a prospective, cluster-randomized clinical trial among Nebraska rural migrant families. Households will be randomized to one of three study arms to first receive free at-home antigen test kits for varying periods of baseline observation followed by addition of our mHealth tool and then the tool combined with human-assisted systems navigation. A fourth study arm will consist of existing mHealth-4-mHealth families who already receive all program components. Primary outcomes will be COVID-19 test and antiviral therapy utilization. Secondary outcomes will include COVID-19 vaccination and unplanned healthcare utilization. We will analyze these outcomes across intervention states. For Aim 2 we will assess the association of SDOH and other implementation factors that may contribute to rural migrant families’ use (adoption) of program interventions. For Aim 3 we will determine the incremental cost-effectiveness of program implementation using the mHealth tool with or without systems navigation. Results will provide evidentiary support to scale the intervention to migrant-serving programs nationally, inform health policy development, and drive future programs aimed at improving community resilience in public health emergencies.

PROJECT NARRATIVE Migrant agricultural workers and their families experience persistent negative health consequences from the SARS-CoV-2 pandemic due to disparities in access to effective testing and treatment and pre-existing social and economic inequities; in response we have engaged rural migrant families in Nebraska to improve access to COVID-19 testing, healthcare, and community response resources through the Mobile Health for Migrant Health (mHealth-4-Mhealth) program. In the proposed study we will evaluate the impact, moderators, and cost- effectiveness of implementing mHealth-4-Mhealth program elements on migrant families’ access to and utilization of COVID-19 testing, treatment, and related healthcare resources. Given the portability and adaptability of mHealth tools to diverse communities, our findings can inform national-scale interventions to empower families to adapt to public health emergencies.