Increasing Representation of Black Communities in SARS-CoV-2 Serosurveys by Understanding Barriers and Motivations for Participation (Represent ATL)

Background: The purpose of this study was to identify barriers and motivations that influenced participation in population-based SARS-CoV-2 serosurveys among diverse Black sub-populations. Racial minorities faced disproportionate risk for SARS-CoV-2 diagnoses and severe outcomes, yet burden of disease in Black communities was likely underestimated because of limited access to testing and low participation in serosurveys. This study sought to clarify how sociodemographic differences shaped decision-making and to generate tailored recommendations for improving participation and representation in burden of disease estimates.

Materials/Methods: The interdisciplinary team used qualitative and quantitative methods within the context of SARS-CoV-2 serosurveys. A community advisory board of leaders serving Black communities in Atlanta collaborated on study design, refinement of instruments, and identification of community constituents for participation. The qualitative phase involved semi-structured interviews conducted with Black adults from three sociodemographically diverse neighborhoods to explore barriers and motivations for participation in SARS-CoV-2 antibody testing and vaccination. The interview guide was informed by value expectancy theories. Key themes and respondent language informed development of a quantitative survey, which assessed the relative influence of identified factors across sociodemographic subgroups in a sample of Black participants. The study examined how decision-making factors varied by gender, age, and education level to understand differences in participation patterns.

Outcome/Impact: The study provided actionable recommendations to increase participation of Black communities in SARS-CoV-2 serosurveys and improve their representation in population-level burden of disease estimates. Findings supported public health strategies designed to ensure equitable surveillance, guide resource allocation, and strengthen prevention and control efforts in communities disproportionately affected by COVID-19.