Project IMPROVE: Implementing Community-Engaged Intervention Research to Increase Rapid SARS-CoV-2 Self-Testing Among Diverse Underserved and Vulnerable Asian Americans

Background: The purpose of this study was to address barriers to COVID-19 testing among low-income Asian Americans with limited English proficiency who were frontline workers and lived in crowded multigenerational households. These communities faced high rates of COVID-19 infection and had the lowest testing rates across racial groups. They also experienced racism, safety concerns at testing sites, limited insurance coverage, lack of culturally and language-appropriate information, and limited transportation and site access. The study focused on Chinese, Vietnamese, Korean, Filipino, Indian, and other South Asian American groups, and aimed to support and expand the use of FDA-approved over-the-counter self-test kits through trusted, community-led approaches.

Materials/Methods: This study used a community-engaged, multi-component intervention to increase access to and uptake of rapid COVID-19 self-testing. The intervention addressed sociocultural, environmental, and individual factors influencing testing behaviors. The study worked with community partners across 12 community-based organization sites in a pragmatic cluster-randomized trial that enrolled Asian American adults. Trusted messengers such as community health navigators, providers, and peer advocates delivered culturally and linguistically appropriate education, navigation support, and self-test guidance. Data collection included use of self-test kits, difficulties accessing testing, challenges using kits, and follow-up behaviors. The RE-AIM framework supported a structured evaluation of reach, effectiveness, adoption, implementation, and maintenance to support sustainability across additional community sites.

Outcome/Impact: The study increased access to COVID-19 self-testing and improved uptake of at-home rapid tests across diverse Asian American groups. Participants reported improved access to testing resources, greater comfort with self-testing, and fewer navigation barriers. The intervention also supported positive shifts in mitigation behaviors, including mask use, vaccination actions, and intentions to test when needed. Evaluation findings offered early evidence for a scalable community-engaged model that reduced systemic barriers for low-income Asian American populations and addressed gaps in COVID-19 testing research for ethnic subgroups often excluded or overlooked.