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

Racial minorities have disproportionate risk for SARS-CoV-2 diagnoses and adverse outcomes including death. Burden of disease in Black populations is likely underestimated due to sub-optimal access to, and usage of, SARS-CoV-2 testing. Serosurveys, which use probability-based methods to select persons for SARS-CoV-2 testing and an accompanying survey, have potential to improve understanding of population-level burden of disease and risk factors for infection. However, early results from U.S.-based serosurveys indicate sub-optimal participation rates among Black populations, which results in their under-representation in burden of disease estimates and a limited understanding of risk factors for infection. The current project aimed to identify barriers and motivations for participation in population-based SARS-CoV-2 serosurveys among diverse Black sub-populations (e.g., by gender, age, and education level). Understanding factors that influence Black people's decision-making about serosurvey participation and how these factors differ by socio-demographic characteristics enabled tailored recommendations for increasing Black populations' participation in serosurveys and representation in burden of disease estimates. The interdisciplinary team of epidemiologists, behavioral scientists, and community health advocates/practitioners used qualitative and quantitative methods in the context of serosurveys to understand how influences on decision-making are related to actual decisions about participation in SARS-CoV-2 antibody testing. The qualitative interview guide was informed by the family of value expectancy theories and was developed in collaboration with a community advisory board (CAB), who also helped to identify community constituents for participation in qualitative interviews. Key themes from the qualitative interviews, and language used by respondents, informed a quantitative survey instrument, which assessed relative strengths of influences on serosurvey participation and how they differ socio-demographically across Black sub-populations. The Specific Aims of this study were: (1) Convene a community advisory board (CAB) comprising leaders from organizations serving Black communities in Atlanta (e.g., professional, faith-based, health and social services); (2) In the context of a SARS-CoV-2 serosurvey, conduct 50 semi-structured interviews about barriers and motivations for serosurvey and vaccine participation with Black persons from 3 diverse neighborhoods, representing a range of socio-demographic characteristics; (3) Determine the distribution of barriers and motivations for serosurvey participation across socio-demographic subgroups of 2,000 Black persons using a quantitative survey. Recommendations for increasing participation of black communities in SARS-CoV-2 serosurveys were provided, which is critical as SARS-CoV-2 serosurveys were likely to be used for on-going disease surveillance in the U.S. and to inform both resource allocation and design and monitoring of prevention and control strategies.