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

500-1000 words Could use abstract from the grant, if it is up-to-date. This will be used for the registration in dbGaP, where there will be a study page and number. This description needs to be consistent in dbGaP and the RADx data hub. This project will employ 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, will 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. We will also analyze the social, ethical, economic, and behavioral drivers and consequences of our outreach and testing approaches according to the degree to which participants contribute to the co-creation of study-related messaging. Finally, we will leverage our existing infrastructures to expand testing uptake and analyze (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 will be 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 will be informed by the CDCC, including AboutML-informed consent approaches and with the other RADxUP studies and relevant federal agencies. The central hypothesis of this study argues that a persuasive mHealth Suite of apps and videos (yet to be 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 will be 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. (Any analysis of mediators will be limited to the adult sample). This will be accomplished utilizing a repeated measures, pre-post-test mediational design. Interviews will be 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 will be recruited to participate in this study (see figure 1 below). The first group will be recruited from the 14 Mile Square Health Center (MSHC) practice sites. The second group will be recruited through contact tracing of COVID-19 test positives from MSHC. The third group will be recruited from the community through posted study ads and flyers online, which will first contain the study contact number and eventually will contain 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 will have access to smartphone apps to track symptoms, improve knowledge of COVID-19, and learn self-management skills while at home. Participants who are not initially identified via a call or in-person visit to Mile Square Health Clinic will have the opportunity to partake in rapid, COVID-19 nasal swab self-collection at home. Research members will share the data collected from the biological specimens, interviews, and apps with the Illinois Department of Public Health. The final goal of this study will be 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.