Participatory COVID-19 Surveillance Tool in Rural Appalachia

Abstract

Introduction Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia. Methods A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution. Results Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non–English-speaking groups. Practical Implications This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.

Rural Public Health Data Challenges During the COVID-19 Pandemic: The Case for Building Better Systems Ahead of a Public Health Crisis

“…While rural communities achieved a great deal in managing their COVID-19 responses,8–10 our analysis focused on identifying data-related challenges impeding LHD efforts and from the perspectives of rural public health personnel themselves. Data were seen as critical to the pandemic response among rural-serving staff in our sample; yet, there were major challenges with gathering and utilizing accurate data.…”

A Digital-First Health Care Approach to Managing Pandemics: Scoping Review of Pandemic Self-triage Tools

“…Of the articles included in this review, 12 were published in 2020, 8 were published in 2021, and 2 were published in 2010 to 2011. Tools studied were mostly located in the United States (6/22, 27%) [3,10,11,19,24,25]. A total of 12 studies were conducted in other countries, including France (3/12, 25%) [13,15,26], Iran (1/12, 8%) [27], Denmark (1/12, 8%) [28], China (1/12, 8%) [29], Nigeria (1/12, 8%) [30], Ireland (1/12, 8%) [31], Greece (1/12, 8%) [32], Finland (1/12, 8%) [33], Canada (1/12, 8%) [6], and Switzerland (1/12, 8%) [14].…”

“…This 8item triage tool showed to be useful for managing COVID-19 and the reporting of symptoms contributed to public health's ability to understand how to relieve burden on health systems and for prevention and control. [24], 2021 Developing a smartphone app which was a tiered tool for selftriage of COVID-19 symptoms was purported to be able to reduce burden on hospitals, provide further self-isolation instructions for users, and to help patients make hospital appointments on web or for virtual visits with health providers, such as with psychologists. The app showed to be a comprehensive tool that may help to reduce spread and panic.…”

“…One tool offered 8 levels of triage advice [25]. Some directed users to be tested [14,27,36], advised about over-the-counter medications [34], or provided a way to directly contact a caregiver or hotline [3,10,[13][14][15]24,26,31].…”

“…The studies included in this scoping review addressed a wide variety of research questions, as presented in Table 2. Overall, 8 studies reported on design, implementation, and use within a broader system [14,19,20,28,30,32,34,36]; 3 studies reported only on design and user testing of tools [29,31,34]; and 9 studies reported on the use of a tool already deployed [11,12,15,[24][25][26][27]33,35]. Some studies suggested that they would assess whether a self-triage tool reduced demand on care centers or call centers, although not all reported related findings [6,13,27,28].…”