Understanding Factors Influencing COVID-19 Testing and Vaccination in Immigrant Low-Income and Homeless Populations and Testing Targeted Interventions

Background: Many immigrant, low-income, and homeless residents of Cumberland County, Maine faced major barriers to COVID-19 testing and vaccination. These barriers included limited access to accurate information, fear of the healthcare system, language challenges, and unstable living conditions. The study addressed these gaps by working with community partners to understand how people in these groups viewed COVID-19, what they knew about testing and vaccination, and what fears or obstacles prevented them from seeking care. The purpose was to build a public health intervention driven by community needs and to evaluate how well this intervention improved testing and vaccination uptake among immigrants from sub-Saharan Africa, the Middle East, and Central America, people using safety-net health services, and individuals experiencing homelessness.

Materials/Methods: The study used a longitudinal design that combined surveys, interviews, and community engagement activities. Participants were recruited from immigrant communities, a public health facility with a sexually transmitted infections clinic and a needle exchange, a free clinic, and outreach programs serving people experiencing homelessness. Data collection focused on beliefs about COVID-19, knowledge of testing and vaccination, and personal barriers to accessing these services. Information gathered was used to co-develop public health messages with community partners and create clear educational materials tailored to language and cultural needs. These materials were pilot tested with participants to verify comprehension and relevance. The study then used these findings to design and implement a walk-up COVID-19 testing program that reduced logistical barriers and allowed immediate access to testing without appointments. Testing events were paired with on-site education provided by trusted messengers from partner organizations to improve engagement.

Outcome/Impact: The intervention improved understanding of COVID-19 and increased trust in testing and vaccination among immigrant, low-income, and homeless residents. The walk-up testing model increased testing uptake by making services accessible in familiar community locations. Public health messaging created through community input improved awareness, reduced fear, and supported clear decision-making about testing and vaccination. Findings showed that culturally grounded outreach, paired with low-barrier testing access, strengthened engagement and addressed disparities in care. The results offered practical strategies that local partners continued to use and provided a model for other regions seeking to improve testing and vaccination in marginalized communities.