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Webber E, Bishop S, Drain PK, Dupuis V, Garza L, Gregor C, Hassell L, Ibarra G, Kessler L, Ko L, Lambert A, Lyon V, Rowe C, Singleton M, Thompson M, Warne T, Westbroek W, Adams A. Critical lessons from a pragmatic randomized trial of home-based COVID-19 testing in rural Native American and Latino communities. J Rural Health 2024. [PMID: 38449317 DOI: 10.1111/jrh.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Native Americans and Latinos have higher COVID-19 infection and mortality rates and may have limited access to diagnostic testing. Home-based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID-19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington. METHODS A two-arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID-19 test kit registration and virtual swabbing support. The passive arm participants received standard-of-care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis. FINDINGS Overall, 63% of participants (n = 268) completed COVID-19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60 years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home-based testing. CONCLUSIONS CHW support led to higher COVID-19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues.
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Affiliation(s)
- Eliza Webber
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
| | - Sonia Bishop
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Paul K Drain
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Virgil Dupuis
- Extension Office, Salish Kootenai College, Pablo, Montana, USA
| | - Lorenzo Garza
- Family and Community Engagement, Sunnyside School District, Sunnyside, Washington, USA
| | - Charlie Gregor
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Laurie Hassell
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Geno Ibarra
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Larry Kessler
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Linda Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Alison Lambert
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
| | - Victoria Lyon
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Carly Rowe
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Michael Singleton
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Matthew Thompson
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Teresa Warne
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
| | - Wendy Westbroek
- Extension Office, Salish Kootenai College, Pablo, Montana, USA
| | - Alexandra Adams
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
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Thompson MJ, Drain PK, Gregor CE, Hassell LA, Ko LK, Lyon V, Ahmed S, Bishop S, Dupuis V, Garza L, Lambert AA, Rowe C, Warne T, Webber E, Westbroek W, Adams AK. A pragmatic randomized trial of home-based testing for COVID-19 in rural Native American and Latino communities: Protocol for the "Protecting our Communities" study. Contemp Clin Trials 2022; 119:106820. [PMID: 35691487 PMCID: PMC9181367 DOI: 10.1016/j.cct.2022.106820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/14/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Home-based testing for COVID-19 has potential to reduce existing health care disparities among underserved populations in the United States. However, implementation of home-based tests in these communities may face significant barriers. This study evaluates the acceptability, feasibility, and success of home-based testing and the potential added benefit of active support from trusted community health workers for Native Americans and Hispanic/Latino adults living in rural Montana and Washington states. METHODS/DESIGN The academic-community research team designed the trial to be responsive to community needs for understanding barriers and supports to home-based COVID-19 testing. The "Protecting Our Community" study is a two-arm pragmatic randomized controlled trial in which a total of 400 participants are randomized to active or passive arms. Participants of both study arms receive a commercially available home collection COVID-19 test kit, which is completed by mailing a self-collected nasal swab to a central laboratory. The primary study outcome is return of the kit to the central lab within 14 days. The cultural, social, behavioral, and economic barriers to home-based COVID-19 testing are also assessed by qualitative research methods. A survey and semi-structured interviews are conducted after the trial to evaluate perceptions and experience of home-based testing. DISCUSSION Implementing home-based testing in underserved populations, including among Native American and Hispanic/Latino communities, may require additional support to be successful. The Protecting Our Community trial examines the effect of trusted community health workers on use of home-based testing, which may be adaptable for community-driven models of home-based testing in other underserved populations.
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Affiliation(s)
- Matthew J Thompson
- Institute of Translational Health Sciences, University of Washington, 850 Republican Street, Box 358051, Seattle, WA 98109, USA; Department of Family Medicine, University of Washington, Box 354696, Seattle, WA 98195, USA
| | - Paul K Drain
- Department of Global Health, University of Washington, Box 351620, Seattle, WA 98195, USA; Department of Medicine, University of Washington, Box 356420, Seattle, WA 98195, USA; Department of Epidemiology, University of Washington, Box 351619, Seattle, WA 98195, USA
| | - Charlie E Gregor
- Institute of Translational Health Sciences, University of Washington, 850 Republican Street, Box 358051, Seattle, WA 98109, USA
| | - Laurie A Hassell
- Institute of Translational Health Sciences, University of Washington, 850 Republican Street, Box 358051, Seattle, WA 98109, USA
| | - Linda K Ko
- Institute of Translational Health Sciences, University of Washington, 850 Republican Street, Box 358051, Seattle, WA 98109, USA; Department of Health Systems and Population Health, University of Washington, Box 351621, Seattle, WA 98195, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, PO Box 19024, Seattle, WA 98109, USA
| | - Victoria Lyon
- Department of Family Medicine, University of Washington, Box 354696, Seattle, WA 98195, USA
| | - Selena Ahmed
- Center for American Indian and Rural Health Equity (CAIRHE), Montana State University, PO Box 173485, Bozeman, MT 59717, USA
| | - Sonia Bishop
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, PO Box 19024, Seattle, WA 98109, USA
| | - Virgil Dupuis
- Salish Kootenai College, 58138 US-93, Pablo, MT, USA
| | - Lorenzo Garza
- Sunnyside School District, 1110 S 6th St., Sunnyside, WA, USA
| | - Allison A Lambert
- Institute of Translational Health Sciences, University of Washington, 850 Republican Street, Box 358051, Seattle, WA 98109, USA; Department of Medicine, University of Washington, Box 356420, Seattle, WA 98195, USA; Providence Medical Research Center, Providence Health Care, 105 W 8th Ave, Suite 6050W, Spokane, WA, USA
| | - Carly Rowe
- Institute of Translational Health Sciences, University of Washington, 850 Republican Street, Box 358051, Seattle, WA 98109, USA
| | - Teresa Warne
- Center for American Indian and Rural Health Equity (CAIRHE), Montana State University, PO Box 173485, Bozeman, MT 59717, USA
| | - Eliza Webber
- Center for American Indian and Rural Health Equity (CAIRHE), Montana State University, PO Box 173485, Bozeman, MT 59717, USA
| | | | - Alexandra K Adams
- Center for American Indian and Rural Health Equity (CAIRHE), Montana State University, PO Box 173485, Bozeman, MT 59717, USA.
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LeRouge C, Durneva P, Lyon V, Thompson M. Health Consumer Engagement, Enablement, and Empowerment in Smartphone-Enabled Home-Based Diagnostic Testing for Viral Infections: Mixed Methods Study. JMIR Mhealth Uhealth 2022; 10:e34685. [PMID: 35771605 PMCID: PMC9284354 DOI: 10.2196/34685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Health consumers are increasingly taking a more substantial role in decision-making and self-care regarding their health. A range of digital technologies is available for laypeople to find, share, and generate health-related information that supports their health care processes. There is also innovation and interest in home testing enabled by smartphone technology (smartphone-supported home testing [smart HT]). However, few studies have focused on the process from initial engagement to acting on the test results, which involves multiple decisions.
Objective
This study aimed to identify and model the key factors leading to health consumers’ engagement and enablement associated with smart HT. We also explored multiple levels of health care choices resulting from health consumer empowerment and activation from smart HT use. Understanding the factors and choices associated with engagement, enablement, empowerment, and activation helps both research and practice to support the intended and optimal use of smart HT.
Methods
This study reports the findings from 2 phases of a more extensive pilot study of smart HT for viral infection. In these 2 phases, we used mixed methods (semistructured interviews and surveys) to shed light on the situated complexities of health consumers making autonomous decisions to engage with, perform, and act on smart HT, supporting the diagnostic aspects of their health care. Interview (n=31) and survey (n=282) participants underwent smart HT testing for influenza in earlier pilot phases. The survey also extended the viral infection context to include questions related to potential smart HT use for SARS-CoV-2 diagnosis.
Results
Our resulting model revealed the smart HT engagement and enablement factors, as well as choices resulting from empowerment and activation. The model included factors leading to engagement, specifically various intrinsic and extrinsic influences. Moreover, the model included various enablement factors, including the quality of smart HT and the personal capacity to perform smart HT. The model also explores various choices resulting from empowerment and activation from the perspectives of various stakeholders (public vs private) and concerning different levels of impact (personal vs distant).
Conclusions
The findings provide insight into the nuanced and complex ways health consumers make decisions to engage with and perform smart HT and how they may react to positive results in terms of public-private and personal-distant dimensions. Moreover, the study illuminates the role that providers and smart HT sources can play to better support digitally engaged health consumers in the smart HT decision process.
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Affiliation(s)
- Cynthia LeRouge
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
- Primary Care Innovation Lab, Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Polina Durneva
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
| | - Victoria Lyon
- Primary Care Innovation Lab, Department of Family Medicine, University of Washington, Seattle, WA, United States
- Get-Grin Inc, Austin, TX, United States
| | - Matthew Thompson
- Primary Care Innovation Lab, Department of Family Medicine, University of Washington, Seattle, WA, United States
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