Confronting COVID-19 in under-resourced, African American neighborhoods: a qualitative study examining community member and stakeholders’ perceptions

Abstract

Objective: The purpose of this study was to examine perceptions of COVID-19 related to prevention, coping, and testing of African American residents in under-resourced communities in Alabama. Design: Guided by the PRECEDE-PROCEED model, virtual focus groups were conducted in five urban and rural Alabama communities using secure Zoom meetings. Community residents and stakeholders (N = 36 total) participated; meetings were audio-and video-recorded, transcribed, and analyzed according to Thematic Analysis. Themes were organized by the PRECEDE portion of the model in Predisposing, Reinforcing, and Enabling barriers and facilitators in three focus areas: prevention, coping, and testing. Results: Prevention barriers included apathy, difficulty with social distancing, lack of information, mixed messages from authority figures, and lack of personal protective equipment (PPE). Prevention facilitators included concerns about contracting COVID-19, clear and consistent messages from trusted sources, contact tracing, and the provision of PPE. Coping barriers included food insecurity, mental health issues, isolation, economic hardships, lack of health care access, and issues with virtual schooling and church services, which were exacerbated by the inability to connect to the internet. Facilitators to coping included religious faith, increased physical activity, and a sense of hope. Testing barriers included misunderstanding, fear, mistrust, testing restrictions, and location of testing sites. Facilitators to testing included incentives, clear information from trusted sources, convenient testing locations, and free tests. Conclusion: Gaining community members' perspectives can identify barriers and facilitators to prevention, coping, and testing and potentially improve outcomes. While addressing the social determinants of health (e.g. income, education, medical trust) would be an effective path by which to diminish health disparities related to COVID-19, there is an urgent need to mitigate the spread and severity of COVID-19 in vulnerable populations. Interventions should focus on downstream determinants, such as those emerging from our study.

“It’s possibly made us feel a little more alienated”: How people from ethnic minority communities conceptualise COVID-19 and its influence on engagement with testing

“…Disease outbreaks and pandemics can expose and exacerbate long-standing health inequities, systemic racism and marginalisation. Recent studies from the US have highlighted similar issues of mistrust in healthcare and government among African Americans, 27 with decades of racism, marginalisation and discrimination isolated communities and making them particularly vulnerable and susceptible to COVID-19. 28,29 Our work is the first to emphasise the impacts of this historical mistrust on the UK test, trace and isolate systems.…”

“The Risk Seems Too High”: Thoughts and Feelings about COVID-19 Vaccination

“…Quantitative approaches have been used by various studies focused on examining COVID-19 vaccine attitudes and behaviors [11][12][13]. However, studies using qualitative approaches to understanding hesitancy towards the COVID-19 vaccine are still emerging and have focused on racial or ethnic or specific national populations [14,15]. This is the first qualitative study to analyze COVID-19 vaccine hesitancy among a broad general population in the US.…”

Rural, Underserved, and Minority Populations' Perceptions of COVID-19 Information, Testing, and Vaccination: Report from a Southern State

“…Fear and misunderstanding, including the fear of contracting COVID-19 from getting tested, also may be an issue. 19 Again, education and information from trusted sources on the importance of COVID-19 testing is important in rural communities where residents are particularly at risk for severe infection.…”

“…CoV-2), the cause of coronavirus disease 2019 (COVID- 19), was first detected in the United States on January 19, 2020. Just 20 months later, more than 42 million cases of COVID-19 have been diagnosed in the United States and more than 675,000 people have died.…”