The Puerto Rico Community Action Research and Engagement (PR-CARE) to Eliminate Disparities of COVID-19 Among Rural Underserved and Vulnerable Populations

Background: The purpose of this study was to examine how multiple intersecting factors including geography, gender and sexual identity, homelessness, and income disadvantaged elderly populations in Puerto Rico in relation to COVID-19 testing and vaccine uptake. The Puerto Rico Community Action Research and Engagement (PR-CARE) initiative sought to understand and address the social, ethical, behavioral, and structural factors influencing testing and vaccination behaviors among this at-risk population.

Materials/Methods: This study used a mixed-methods community-engaged design to explore the social determinants of health and policy influences affecting COVID-19 testing and vaccination among elderly populations in Puerto Rico. In partnership with three community-based organizations along with community leaders and promoters, the study conducted surveys, policy reviews, and qualitative interviews to understand how overlapping vulnerabilities shaped healthcare access and utilization for older adults (aged 65 and above) living in rural or isolated regions, in poverty, or identifying as LGBTQIA+. Policy analysis and key informant interviews were conducted to assess the effects of federal and Puerto Rico Commonwealth policies on testing and vaccination. Findings from the policy review and individual data collection were integrated to identify challenges, barriers, and effective communication strategies for improving health behaviors and service accessibility.

Outcome/Impact: The PR-CARE initiative advanced understanding of how structural, social, and behavioral determinants affected COVID-19 testing and vaccine uptake among Puerto Rico’s elderly populations. The study illuminated how policy and environmental conditions intersected with social identity and geographic isolation to shape vulnerability. The study strengthened community capacity by creating sustained partnerships between academic and community organizations and promoted equitable access to testing and vaccination. Importantly, PR-CARE established pathways for lasting policy change to improve health equity and access to essential health services for underserved elderly populations in Puerto Rico.