Profiles of Culturally Grounded Intervention Participants Developed to Address Disparities in Access to COVID-19 Testing

Background/Purpose: The COVID-19 pandemic's health disparities were conveyed graphically through photos of COVID-19 testing centers with an interminable queue of people waiting in communities with a high proportion of racial/ethnic minorities. Numerous advocacy organizations in Arizona quickly identified barriers for COVID-19 testing, which were largely created by social determinants of health (SDoH), and developed the R.A.P.I.D. (Respectful, Action-oriented, Proactive, Inclusive, and Direct-resources) model. It is a culturally grounded COVID-19 testing intervention for historically underserved groups in Arizona. We predicted that the R.A.P.I.D. model could help community members with greater socioeconomic vulnerability, which would lead to higher risk-aversive behaviors as to COVID-19 risk compared to individuals participating in a state-run COVID-19 testing program that lacked cultural grounding.

Methods/Design: The intervention group includes 826 participants in the R.A.P.I.D. program who completed the culturally grounded COVID-19 testing and pre-test survey between June, 2021 and February 2022. During the same time period, bilingual surveyors recruited 91 participants of the control group who were contacted after their COVID-19 testing at the state-run site. The survey inquired about SDoH (e.g., education attainment) and attitudes and behaviors related to COVID-19 risk mitigation that included Number of COVID Mitigating Behaviors, Attitude toward COVID-19 Risking Behaviors, Attitude toward Mask Wearing, and Economic Challenges during the Pandemic. In addition to unadjusted group comparisons between intervention and control groups, we further split the total sample as COVID-19 surge and non-surge period groups for comparisons of attitudes and behaviors related to COVID-19 risk mitigation between the two groups. Propensity score matching based on all the SDoH variables enabled adjusted comparisons of the attitudes and behaviors related to COVID-19 risk mitigation between intervention and control groups on matched sample (n = 230).

Findings: As for demographics and SDoH, the intervention group was more likely to be older (p=.013), be an American Indian or a Black (p=.014), had less than high school degree (p<.001), and be uninsured (p<.001). As for the comparison during the COVID-19 surge, the intervention group demonstrated increased adherence to COVID-19 mitigating behaviors during surge (p=.001) and non-surge periods (p<.001) compared to the control group. The intervention group showed lower tolerance toward COVID-19 risking behaviors during the surge (p=.026) and the non-surge (p<.001). The propensity score matching demonstrated that the intervention group had a stronger level of adherence to COVID-19 mitigating behaviors (p<.001), less tolerance toward COVID-19 risking behaviors (p<.001), and higher economic challenges during the pandemic (p=.013) than the control group.

Conclusion/Implications: The findings showed that the R.A.P.I.D. program delivered COVID-19 testing to a group with high socioeconomic vulnerabilities and who were not sufficiently served by the state-operating COVID-19 testing. The presence of CHWs and leveraging trust and cultural capital of the long-servicing community health organization will explain the different profile of participants. The intervention group showed better acceptance of public health recommendations to protect themselves and the larger community from COVID-19 risk. This effective model can be replicated to enhance outreach efforts to address disparities in access to health care.