A Culturally Grounded Intervention with Vulnerable and Underserved Communities of the Southwest U.S. to Reduce COVID-19-Related Health Disparities

Background: A community-university collaborative is addressing COVID-19-related disparities among historically underserved communities in the Southwest U.S. by designing and implementing a Community Health Worker (CHW)-led COVID-19 testing intervention model. This paper aims to describe the R.A.P.I.D. (Respectful, Action-oriented, Proactive, Inclusive, and Direct-resources) model and present an initial profile of participants.

Methods: Guided by two theoretical approaches (i.e., the cross-sector alignment theory and the World Health Organization model on the social determinants of health), we engaged community partners , including a CHW organization, a blood testing lab, and a local community health center, in designing and implementing the R.A.P.I.D. model through four key phases. Phase 1. Using data from the zip code tabulation area (ZCTA), we identified communities with high COVID-19 case rates but few available testing locations. Using biweekly case counts in each ZCTA, linear regressions helped identify ZCTAs lacking testing sites relative to case numbers. The findings helped the Community and Scientific Advisory Board to prioritize communities to participate in the R.A.P.I.D. program. Phase 2. A robust promotional outreach effort began in the prioritized communities. A public health education team created culturally relevant and predominantly visual COVID-19-related educational materials in English and Spanish which were distributed throughout the community. Phase 3. The R.A.P.I.D. program was offered at easily accessible locations (e.g., schools) at the prioritized communities in coordination with local stakeholders. CHWs played a key role in generating a culturally welcoming climate during the COVID-19 testing, addressing linguistic, cultural, and structural barriers to COVID-19 testing. Additional resources were provided at the testing events (e.g., food boxes). Phase 4. COVID-19 test results were available within 48 hours. CHWs offered “How Are You Doing Calls” within 48 hours of testing. These calls were critical in facilitating access the COVID-19 testing results and in addressing unmet psychosocial and economic needs (e.g., signing up under the Affordable Care Act) Participants who tested positive were contacted by medical personnel form a local community health center for primary care with their consent.

Findings: Between November 2020-November 2021, the model tested 3,930 participants, of which 15.4% tested positive for COVID-19 infection, 56.6% did not access their online test results, and 44.7% reported not having an email. The intervened communities tended to have a higher percentage of Latinx/Hispanic residents, higher poverty rate, and lower median household income compared to Arizona state average.

Conclusion: An emerging thread is the importance of training and engaging CHWs to provide culturally grounded COVID-19 testing and follow-up calls that open a window of engagement to address unmet needs. CHWs discovered and addressed barriers associated with the digital divide, which disproportionately affects many participants in the R.A.P.I.D. model. The innovative method used to prioritize the most vulnerable communities could serve to identify other dynamic community health needs over time to cope with present and future public health crises. Lastly, subsequent analyses of the R.A.P.I.D. model will provide information on the efficacy of this intervention, the participants’ behaviors and attitudes toward COVID-19 mitigating measures, and insights on community capacity building at the grassroots level.