Investigating the Effectiveness of COVID-19 Testing Choices, Community Engagement, and Culturally-Embedded mHealth Literacy Delivery in a Medically-Underserved, Community-Based Sample

This project employed sentinel and community-based epidemiological surveillance and participatory research methods to evaluate whether a person-centered, rapid COVID-19 testing intervention (at-home swab and send, or on-site point of care testing), coupled with a novel mHealth COVID-19 Literacy and Outreach Suite of apps and videos, would serve to increase the acceptance, access, reach, uptake, and impact of COVID-19 testing at UI Health and in the 14 FQHC practice sites and their corresponding catchment areas. The social, ethical, economic, and behavioral drivers and consequences of this outreach and testing approaches were evaluated according to the degree to which participants contributed to the co-creation of study-related messaging. The study leveraged existing infrastructures to expand testing uptake and analyzed (by PCR) viral load at infection onset/exposure and following onset/exposure to determine viral dynamics and identify individuals at early and late stages of infection. NIH PhenX self-report measures were used to test intervention effects on testing and retesting uptake, time-to-diagnosis, COVID-19 knowledge, healthcare access and seeking, disclosure, medical adherence, and practice of home self-isolation, quarantine, and other infection control behaviors. All data acquisition, collection and curation approaches were informed by the CDCC, including AboutML-informed consent approaches and with the other RADx-UP studies and relevant federal agencies. The central hypothesis of this study argued that a persuasive mHealth Suite of apps and videos (co-created with community members) combined with person-centered COVID-19 testing choices (remote at home nasal swab versus on-site nasal swab), will lead to higher COVID-19 testing uptake in 7000 adults and children living in the geographic catchment areas of the 14 Mile Square Health Center practice sites (as compared with baseline rates of testing uptake in the same geographic catchment area). This relationship was mediated by a number of social, economic, and behavioral determinants of health, including self-reported COVID-19-related knowledge, COVID-19 social capital, COVID-19 racial/ethnic bias and stigma, and COVID-19 preventative and risk behaviors. Analysis of mediators was limited to the adult sample. This was accomplished utilizing a repeated measure, pre-post-test mediational design. Interviews were conducted over the phone on Day 1 and Day 28 of a 28-day study period, to track outcomes. With improved access to testing and care, self-management strategies of COVID-19 and increased knowledge, a higher percentage of people living in underserved neighborhoods will have access to testing and necessary follow-up care and are expected to develop a stronger sense of empowerment over their own healthcare decisions related to COVID-19. Three groups were recruited to participate in this study. The first group was recruited from the 14 Mile Square Health Center (MSHC) practice sites. The second group was recruited through contact tracing of COVID-19 test positives from MSHC. The third group was recruited from the community through posted study ads and flyers online, which first contained the study contact number and eventually contained an invitation to find out about the study through the mobile health (mHealth) suite of apps and videos. In addition to nasal swab testing for COVID-19, participants had access to smartphone apps to track symptoms, improve knowledge of COVID-19, and learn self-management skills while at home. Participants who were not initially identified via a call or in-person visit to Mile Square Health Clinic were given the opportunity to partake in rapid, COVID-19 nasal swab self-collection at home. Research members shared the data collected from the biological specimens, interviews, and apps with the Illinois Department of Public Health. The final goal of this study was the prevention of COVID-19 transmission through increased COVID-19 literacy and empowerment, combined with early intervention via rapid diagnosis, contact tracing, and earlier access to treatment.