ABSTRACT PR currently has the second-lowest COVID-19 vaccination rate in the nation. In response to NOT-MD-21-012, the "PR-COVACUPS: "Puerto Rico (PR) COVID-19 Vaccine Uptake Study", we will evaluate the effectiveness of an educational intervention to increase vaccine uptake among socioeconomically disadvantaged adults aged 18-50 years. This multifaceted educational intervention will consist of health promoters with print communication materials, online interactive health communication, and follow-up boost calls to address stages of change (pre-contemplation, contemplation, preparation, action, maintenance (second dose), misinformation, and barriers to COVID-19 vaccination). A total of 386 eligible men and women will be recruited from the University of Puerto Rico Medical Sciences Campus (UPR-MSC) outpatient clinic, complete a baseline survey, and randomly assign them to the intervention or a comparison condition. A two-group randomized controlled trial is proposed to determine the effectiveness of this study. We will assess the intervention's effectiveness on COVID-19 vaccination willingness, uptake, and adherence. Other intermediate outcomes such as vaccine confidence and willingness, vaccine attitudes and beliefs, and other constructs from the Health Belief Model will be used to measure the effectiveness of our trial at four different time points (baseline, 2 weeks, 2, and 4 months). PR-COVACUPS will leverage and expand ongoing collaborations at the UPR-MSC outpatient clinics, the largest and comprehensive academic outpatient clinic in the Caribbean, and recent infrastructure (COVID-19 immunization clinic) to maximize synergy and optimize resources and effectively measure our primary outcome. Our study will generate critical information to help reduce disparities in COVID-19 vaccine uptake.

PROJECT NARRATIVE In PR, only 5.8% of the population has been fully vaccinated, and 11% has been partially vaccinated, placing the US territory amongst the states and territories with the lowest vaccination rates. In collaboration with the University of Puerto Rico Medical Outpatient Clinic, our study "PR-COVACUPS: "Puerto Rico (PR) COVID-19 Vaccine Uptake Study" will evaluate the effectiveness of an educational toolkit intervention to maximize vaccine acceptability, uptake, and adherence. Our team is well-positioned to conduct this study which will generate critical information and measurable outcomes to reduce disparities in COVID-19 vaccine uptake among Spanish-speaking Hispanics.