Southeast Asians in the US: Health Equity and Research to Understand COVID-19 Stories (SEA US, HEAR US)

Background: The purpose of the study, Southeast Asians in the U.S.: Health Equity and Research to Understand COVID-19 Stories (SEA US, HEAR US), was to understand and address the multi-level social, ethical, and behavioral implications (SEBI) of COVID-19 testing, vaccination, and its sequelae among Cambodians, Filipinos, Thais, and Vietnamese Americans in Greater Los Angeles through a community-based approach. Unlike other ethnic minority groups, data on the impacts of COVID-19 on Southeast Asian Americans (SEAAs) were limited and often aggregated with other Asian American populations, obscuring disparities and preventing targeted assistance. SEAAs faced significant inequities due to historical trauma, discrimination, harsh immigration policies, and language barriers. Many were undocumented, worked in low-wage jobs, and were less likely to attend college. These conditions, compounded by social isolation, anxiety, and financial hardship during the pandemic, intensified existing health and mental health challenges. The study’s central hypothesis was that providing data-informed and community-informed best practices and guidelines would improve evidence-based COVID-19 testing, vaccination, and related outcomes among SEAA communities.

Materials/Methods: This mixed-methods, community-based participatory study was conducted over 12 months and consisted of three major phases. In the first phase, the study conducted formative research using focus groups with community members and key informant interviews with community leaders to validate, refine, and tailor existing SEBI measures to ensure cultural relevance. These efforts focused on refining instruments such as the RADx-UP Common Data Elements (CDEs), Social Determinants of Health (SDOH) indicators, and measures from the PhenX Toolkit to better capture the lived experiences of Southeast Asian Americans. In the second phase, a prospective longitudinal survey was administered to SEAA participants. Surveys were conducted at baseline, 3, 6, and 12 months to collect detailed data on individual-level social, ethical, and behavioral factors related to COVID-19 testing, vaccination, and its sequelae. The survey examined structural, cultural, and intrapersonal barriers such as limited accessibility, language differences, health literacy gaps, stigma, and lack of social capital that influenced participation in testing and vaccination. In the final phase, in-depth interviews were conducted with community leaders and stakeholders from community-based and faith-based organizations to understand their capacity, perceptions, attitudes, and beliefs toward COVID-19 testing and vaccination. These interviews provided valuable insights into organizational infrastructure, community engagement, and the broader societal factors affecting public health responses within SEAA communities.

Outcome/Impact: This study identified critical structural and cultural barriers that hindered access to COVID-19 testing and vaccination among SEAAs, as well as community strengths that facilitated engagement. The study revealed how language barriers, health literacy, and systemic racism perpetuated invisibility and inequity within these populations. By gathering community-driven, culturally sensitive data, the study informed the development of targeted public health interventions and policies to improve testing, vaccination, and healthcare navigation for SEAA communities. The findings contributed to a foundation for long-term strategies addressing health equity and combating structural discrimination against these underserved groups.