An Adaptive Intervention Trial of Home Testing with Behavioral Nudges for Improving COVID-19 Testing and Prevention among People Affected by Diabetes

Background: Georgia faced challenges including low vaccine rates, over-extended community health partners, declining testing numbers, and large populations at elevated risk, including those with or at risk for diabetes, individuals at lower socioeconomic levels, and African American/Black and LatinX communities. This study designed and evaluated a home-based COVID-19 testing program. The program included behavioral nudges delivered via mobile phone texts to increase uptake of COVID-19 prevention activities such as testing, vaccination, and preventive behaviors.

Materials/Methods: Aim 1 used both quantitative methods and qualitative methods, including in-depth interviews with community members, stakeholders, and partners. These data were used to develop text message behavioral nudges promoting testing, reporting, vaccination, and preventive behaviors tailored by race/ethnicity, sex, age, vaccination status, and testing history. Aim 2a evaluated uptake, usage, and views of a home testing platform that provided a single home COVID-19 test kit for each household family member, collected results through an online reporting system, and delivered targeted behavioral nudges by text. Aim 2b assessed how the home testing platform influenced vaccine uptake and hesitancy among participants and their families.

Outcome/Impact: This study built on community-academic partnerships to further promote COVID-19 testing among vulnerable communities in Georgia. Lessons learned were to be disseminated to other at-risk communities and adapted to promote home-based testing for additional conditions beyond COVID-19.