An agricultural community’s perspectives on COVID-19 testing to support safe school reopening

Introduction: School-based COVID-19 testing may be an effective strategy for reducing transmission in schools and keeping schools open. The study objective was to examine community perspectives on school-based COVID-19 testing as a mitigation strategy to support safe school reopening.

Methods: We conducted a qualitative study in Yakima County, an agricultural region of Washington state, where over half of residents are Hispanic/Latino. From June to July 2021, we interviewed 18 students (13 years old, on average) and 19 school employees, and conducted four focus groups (2 in Spanish, 2 in English) with 26 parents. We audio-recorded the semi-structured interviews and focus group discussions which were then transcribed. We used an inductive, constant comparison approach to code the transcripts and conducted a thematic analysis to generate themes.

Results: We identified four main themes. Students, parents, and school employees desired a return to in-person learning (Theme 1). Schools implemented numerous COVID-19 mitigation strategies (e.g., masking) to facilitate a safe return to school but felt that adding testing would not be feasible due to a lack of resources and overworked staff (Theme 2). Parents and school employees’ familiarity with COVID-19 testing procedures influenced their support for testing (Theme 3). Parents and school employees felt there were inadequate resources for individuals who test positive for COVID-19 (Theme 4).

Discussion: Schools require adequate resources and medical personnel to implement COVID-19 testing. Individuals also need resources after testing positive, including physical space to isolate, financial resources for those without paid time off, and delivery of food and other necessities to households in rural communities.

1. Introduction

In March 2020, all U.S. states enacted school closures to mitigate Coronavirus Disease 2019 (COVID-19) transmission (1). Beyond providing academic instruction, schools are an essential resource for children’s physical, mental, and social health needs. With schools closed, social inequities that existed prior to the COVID-19 pandemic were exacerbated (2). Consequently, the American Academy of Pediatrics urged a safe return to in-person learning (3). In response, state officials developed policies based on the Centers for Disease Control and Prevention guidelines to reopen schools safely by implementing COVID-19 mitigation strategies.

COVID-19 mitigation strategies (e.g., masking, social distancing) were widely implemented in schools to support a safe return to in-person learning, but acceptance of these strategies among under-resourced communities and communities of color was not fully explored. During the COVID-19 pandemic, public health communication errors (e.g., providing conflicting information) and disinformation campaigns undermined public trust in scientific information and increased public fear and confusion, especially among communities of color (4, 5). Therefore, understanding community perspectives on COVID-19 mitigation strategies, including fears, concerns, and/or questions, is critical to inform approaches that encourage community acceptance of COVID-19 mitigation strategies (6).

Rapid Acceleration of Diagnostics Underserved Populations (RADx-UP), an initiative by the National Institutes of Health, aims to accelerate implementation of COVID-19 testing in communities most affected by the pandemic (7). RADx-UP funded ReOpening Schools Safely and Educating Youth (ROSSEY), a community–academic partnership aiming to develop, test, and evaluate multi-level COVID-19 risk communication strategies. The strategies promote participation in school-based COVID-19 testing to enable students’ safe return to school and help schools stay open for onsite learning in Yakima County, Washington (8–10).

Yakima County is a rural agricultural community with a large population of migrants and farmworkers (11). Over 50% of Yakima County residents are Hispanic/Latino, 15% of residents live in poverty, and 28% of jobs are in agriculture (12, 13). In June 2020, Yakima County had the most COVID-19 cases per capita among West Coast counties. The outbreak was attributed to the work and housing conditions of agricultural workers (14).

To inform the development of community-appropriate COVID-19 risk communication strategies for ROSSEY, we conducted this qualitative study to identify the social, ethical, and behavioral needs of communities in Yakima County to safely return to school and maintain onsite learning. This paper describes the community’s perspectives on school-based COVID-19 testing as a mitigation strategy to support safe school reopening.

2. Materials and methods

We conducted semi-structured interviews with school employees (e.g., teachers, nurses, principals) and students as well as focus groups with parents in Yakima County. We engaged community representatives throughout the study as co-investigators, advisors, field managers, and community health workers (CHWs).

2.1. Ethical approval

The University of Washington Institutional Review Board approved the study (STUDY00013064). Study participants provided verbal or electronic informed consent. We obtained parental consent and child assent for student participants.

2.2. Participant recruitment

Figure 1 illustrates participant recruitment. We used purposive sampling to recruit school employees. The research team generated a list of administrators, teachers, and support staff from school districts throughout Yakima County. Trained CHWs and research staff recruited participants via email and/or telephone and obtained consent for participation. CHWs were bilingual (English and Spanish) and bicultural.

FIGURE 1

Figure 1. Diagram of participant recruitment, enrollment, and data collection.

We also used purposive sampling to recruit parents for the focus groups. We sent recruitment letters to a sample of parents who participated in the Together We STRIDE study (Strategizing Together Relevant Interventions for Diet and Exercise) and agreed to be contacted for participation in future studies; eligible parents had at least one child in grade K–8 (15). A week after the recruitment letters were sent, the CHWs contacted the parents to screen and obtain consent for participation. When 10 parents were enrolled, the CHWs scheduled a date and time for the focus groups. We convened four focus groups (2 in English and 2 in Spanish) with a total of 26 parents.

We asked parents who participated in a focus group whether they were interested in their child being interviewed by a member of the research team. If a parent agreed, a research team member contacted the parent to obtain parental consent and child assent and schedule an interview.

School employees and parents received a $30 gift card for compensation and students received a $15 gift card.

2.3. Setting and participant characteristics

We conducted school employee interviews via a Health Insurance Portability and Accountability Act (HIPAA)-approved virtual platform or phone call, parent focus groups via a HIPAA-approved virtual platform, and student interviews via a phone call. All interviewers and focus group moderators were trained and experienced in qualitative data collection. A CHW moderated the focus groups. Interviews and focus groups took place from June to July 2021. Table 1 provides characteristics of study participants. All students, 84% of parents, and 60% of school employees identified as Hispanic/Latino.

TABLE 1

Table 1. Study participant characteristics.

2.4. Data collection

Figure 2 shows the focus areas of the semi-structured interview and focus group guides, which were informed by the Theory of Planned Behavior, Social Cognitive Theory, and socio-contextual factors (16–19). A community advisory board provided feedback during development of the guides. A professional translated the focus group guide from English to Spanish and reviewed by English–Spanish bilingual staff members for accuracy. Interviews with school employees lasted 45–60 min, focus groups with parents lasted 60–90 min, and interviews with students lasted 25–30 min. We audio-recorded all interviews and focus groups which were transcribed and translated by a professional service.

FIGURE 2

Figure 2. Focus areas of the interview and focus group moderator guides were informed by multiple theoretical frameworks (16–19).

2.5. Data analysis

We coded transcripts for school employees, parents, and children separately using Dedoose version 9.0.62 (Los Angeles, CA). We used an inductive, constant comparison approach to code the transcripts (20). Five members of the research team coded the transcripts using inductive coding, followed by deductive coding. We used a priori codes based on the interview and focus group guides to ensure that information from the questions was retained during coding. The team met weekly to refine the codebooks by adding, removing, and revising codes to address inter-rater agreements and compare new and existing data.

For the present study, we analyzed the set of codes regarding school-based COVID-19 testing. The first author (MR) identified themes from the codes by first reviewing the excerpts within each code and identifying tentative themes based on the content of the excerpts (21). The interrelationship across and within themes was analyzed, resulting in a collection of candidate themes. Next, MR reviewed the candidate themes with a research team member (MD). They refined the themes to ensure that excerpts within themes cohered and that each final theme was distinct from the others.

3. Results

We identified four main themes and 11 subthemes, which are shown in Table 2 with illustrative quotes. Parents, students, and school employees wanted students to return to in-person learning (Theme 1). School employees noted a lack of resources and overworked staff as barriers to adding COVID-19 testing to schools’ mitigation strategies (Theme 2). Parents and school employees’ familiarity with COVID-19 testing procedures influenced their support for testing (Theme 3). Parents and school employees felt there were inadequate resources for individuals who test positive for COVID-19 (Theme 4).

TABLE 2

Table 2. Illustrative quotes from study participants, by theme and subtheme.

3.1. Theme 1: there is a shared desire for students to return to in-person learning

All three participant groups agreed schools need to reopen as students experienced challenges with remote learning. During remote school hours, students needed to prioritize household chores, care for younger siblings while parents were at work, and assist siblings in their remote learning. A student shared that the biggest challenge to remote learning was “probably having to take care of my brother while learning.” Students, especially those from large households, did not have a quiet space free of distractions.

All three participant groups reported that remote teaching was of lower quality than in-person teaching as teachers were unaccustomed to using technology in their instructional practices. School districts provided training on remote teaching but reported that their efforts fell short. Numerous students said remote instruction was fast-paced, and they struggled to keep up and ask questions. Some parents reported that their children asked them for help, but parents with children in high school found the curriculum challenging and were unable to help.

Challenges with remote learning affected students’ motivation and engagement. Students logged on to class late or not at all and often turned in assignments late. While teachers and parents found this problematic, they also found it difficult to hold students accountable, given what they were going through. A school staff member said that students would say, “How do they want us to concentrate, and we have to be taking care of the other kids?” Working parents reported feeling guilty. One said, “I feel I failed my child…I worked two jobs during the pandemic … I wasn’t at home as much to be that parent that needed to make sure that they were logging in on time, making sure that they were completing their assignments.”

3.2. Theme 2: schools implemented numerous COVID-19 mitigation strategies—adding COVID-19 testing may send them “over the edge”

School staff described implementing numerous COVID-19 mitigation strategies, including social distancing, masking, disinfecting, daily screening for COVID-19 symptoms, and contact tracing. While parents and students were supportive of the mitigation strategies, there were mixed feelings about adding school-based COVID-19 testing as a mitigation strategy. Many school staff and parents believed that the existing mitigation strategies were effective at preventing outbreaks and therefore adding testing was unnecessary. Some school staff and parents believed testing should be optional and only administered to students with parent permission. On the other hand, students were supportive of COVID-19 testing because they viewed it as a step toward returning to normal life.

Many school staff shared that it would not be feasible to take on the responsibility of COVID-19 testing as they were already overworked from responding to the pandemic. A school nurse explained, “Our health services team is stretched so thin right now … even asking us to do one more thing I think is going to send some of the nurses over the edge.” In addition, a school-based COVID-19 testing program would further shift schools’ responsibilities from education to health. A school administrator stated, “We are not staffed or resourced appropriately for that. And that’s probably one of my greatest fears of schools becoming responsible for health as well as education.”

3.3. Theme 3: familiarity with COVID-19 testing procedures influences support for testing

All three participant groups were used to COVID-19 mitigation strategies such as masking and social distancing, but not testing. Many parents, school employees, and students reported that they had never been tested for COVID-19. Others had been tested via oropharyngeal or nasopharyngeal swabs or heard negative experiences from others. All three participant groups described COVID-19 tests as invasive, painful, uncomfortable, and bothersome, and they were less supportive of regular, school-based testing. A school nurse believed the community would be more supportive of regular testing if samples were collected with nasal swabs. The nurse shared that 80%–85% of parents declined COVID-19 testing for their children, which at the time used nasopharyngeal swabs, because they did not want to subject their children to a painful procedure.

In addition, parents were concerned about repeated swabbing. For example, one parent said, “My only concern is if they are going to continually take a sample from the same area … that might cause irritation or a rash or like a pimple.” School employees noted that if schools were to implement a COVID-19 testing program, they must first address parents’ concerns about testing to gain their support and participation. School employees and parents wanted health professionals (not educators) to provide information about the testing procedure, including qualifications of test administrators, sample collection, and interpretation of results given the likelihood of a false positive/negative.

3.4. Theme 4: there are inadequate resources to support families after a positive COVID-19 test

School staff and parents explained that many parents do not have remote jobs or paid time off, making it difficult to stay home if their child has COVID-19. One staff member stated, “You know if you do not go to work … sadly you do not get paid. So, I can still see that as being an issue in our community.”

In addition, adhering to the recommendation to isolate after a positive COVID-19 test was deemed nearly impossible for many families. A school staff member explained, “I can tell you that 60% of (families) here in our community are doubling up, tripling up (in a single home). It would make it very hard for somebody to isolate in their home.” When students test positive at school, they isolate in the school’s holding room until a parent/guardian picks them up. Once students go home, however, they cannot easily separate themselves from family members to maintain isolation. School staff further shared that transmission among entire households was common.

Some parents and school employees felt it would be difficult for parents to maintain isolation at home because of the need to obtain food and other necessities. This was highlighted as a potential barrier to participating in COVID-19 testing and following isolation recommendations after a positive test. While some participants mentioned that people could get food delivered to their home (e.g., from grocery stores, food banks, family members, and school employees), others reported minimal access to food delivery services, especially for migrant and farmworker families and those living in rural areas of Yakima County.

4. Discussion

In our qualitative analysis to understand parent, student, and school employee perspectives on school-based COVID-19 testing, we identified four main themes. First, there was a desire for schools to reopen because remote learning was challenging for teachers, parents, and students. Second, a perceived lack of resources led school employees to oppose the idea of adding school-based COVID-19 testing to the existing COVID-19 mitigation strategies. Schools prepared for safe reopening but were strained by their new responsibility for children’s health. School employees and parents believed existing mitigation strategies were sufficiently effective at preventing COVID-19 outbreaks. Third, parents were reluctant to let their children undergo regular testing as many parents had never been tested and believed the procedure would be painful. Fourth, following isolation recommendations after a positive COVID-19 test was seen as untenable since many parents did not have paid time off, homes were not conducive to isolation, and food delivery was inaccessible in rural communities.

Previous studies have examined parent, student, and school employee perspectives on schools reopening and implementing COVID-19 mitigation measures (22–27). While our study found a widespread desire to return to in-person learning, previous studies report mixed findings. The studies found that some parents, students, and school employees were ready for school to reopen, while others were concerned about the risk of COVID-19 transmission in schools and preferred to continue remote learning (22–26). Similar to our study, the previous studies also report mixed community perspectives on using COVID-19 testing to support safe school reopening (24, 25, 27). The studies found that teachers and other school staff were receptive of school-based COVID-19 testing (24, 25), while school administrators questioned the need for testing and were concerned about the cost and logistics of incorporating testing into their reopening plans (25). Furthermore, a qualitative study conducted in an urban region of Southern California, where school districts have a large population of Hispanic/Latino students, found that students were supportive of school-based COVID-19 testing but were concerned about the physical discomfort of testing (25). These students’ parents also worried about the children experiencing physical discomfort while undergoing COVID-19 testing (25). Generally, however, the previous studies report that parents were supportive of school-based COVID-19 testing (22, 24, 25). The parents in our study were hesitant about COVID-19 testing in schools because of the perceived physical discomfort their children would experience. While these findings may be interpreted as parents’ distrust of the medical system, they may also be biased by the testing technology. At the time of our data collection, COVID-19 testing commonly used nasopharyngeal swabs, which can be perceived as more unpleasant relative to other less invasive sample collection methods (28).

Few studies have examined community perspectives on COVID-19 mitigation efforts in schools (22–27), and we could not identify studies focused on Hispanics/Latinos in rural regions of the U.S. For COVID-19 mitigation efforts to succeed, communities must support these efforts and have access to resources to adopt the recommended behaviors (6, 23). This study with mostly Hispanic/Latino participants in Yakima County extends our understanding of Hispanic/Latino communities’ acceptance of school-based COVID-19 testing (25). Our study found that school employees were apprehensive about the responsibility of children’s health being increasingly shifted to the purview of schools during the COVID-19 pandemic, especially since they had inadequate resources and were not medical experts. COVID-19 testing was not widespread in Yakima County at the time of data collection, and the lack of familiarity with testing procedures may have negatively influenced support for testing in schools. Public health practitioners should consider building partnerships with schools to understand their concerns and provide adequate resources that equip schools to address these concerns.

This study has limitations worth noting. The data was collected from June to July 2021, and perceptions on COVID-19 testing in schools may have since changed given the rapid and ever-evolving nature of the COVID-19 pandemic. Nonetheless, the study findings are relevant and important for understanding the acceptance of public health measures and the resources needed to adopt them in a population that is under-represented in research and often disproportionately burdened by disease. Future research is needed to examine how community perceptions of school-based COVID-19 testing have evolved since schools initially reopened for in-person learning.

Our findings suggest that school employees would support school-based COVID-19 testing if adequate resources and healthcare professionals are available to implement the testing infrastructure. In addition, we found a preference for healthcare professionals, not educators, to provide evidence-based COVID-19 testing information to the community. Finally, our findings show that many families do not have the physical space for a child to isolate, parents must decide between quarantining/isolating or losing income because they do not have paid time off or the ability to work remotely, and parents may not be able to follow isolation recommendations because of limited alternatives to in-person shopping for food and other essentials in rural regions where food delivery is inaccessible. COVID-19 testing policies must consider and help mitigate the downstream effects on households when a child and their family members test positive. Implementing testing programs without adequate planning and resources for those who test positive could unintentionally create a net decrease in well-being within some communities. It is critical that COVID-19 testing programs provide families with the resources needed to isolate after a positive test. Implementing properly resourced school-based COVID-19 testing programs could be an opportunity to form school–community linkages and pool community resources in rural regions so that families can follow isolation guidelines and still have access to basic needs like income and food (29).

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The University of Washington Institutional Review Board approved the study. Parental consent and child assent for student participants were obtained alongside verbal or electronic informed consent to participate in this study.

Author contributions

MR led the analysis of the coded excerpts, drafted the initial manuscript, and revised the manuscript based on co-author feedback. SB conducted school employee interviews, supervised data collection from students and parents, and supervised and had oversight of the data analysis team. GI contributed to the methodology and data curation. PS consulted on study design, methodology, and resources and had supervision/oversight of study staff. MD assisted with data curation and formal analysis. HC contributed to data curation and formal analysis. LH managed administrative aspects of the study, liaised with the national coordinating center, mentored student workers, and supported the investigative team. LG and SL contributed to the methodology, investigation, funding acquisition, data curation, and formal analysis. MG consulted on study design. PD contributed to the study investigation. LK contributed to the conceptualization of the study, methodology, investigation, supervision, funding acquisition, data curation, and formal analysis. All authors contributed to the article and approved the submitted version.

Funding

This publication was supported by the National Institutes of Health under Award Number 1OT2HD107544-01. This research was also supported by the Office of Community Outreach & Engagement of the Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium (P30 CA015704). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Acknowledgments

The authors would like to thank Jenny Wool, Luis Aceves, and Thomas Quigley for assistance with data collection and coding, Teyj Menon for administrative support, and Emily Brown for editing the manuscript.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. CDC Museum COVID-19 Timeline. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/museum/timeline/covid19.html#Early-2020

Google Scholar

2. Chen, CYC, Byrne, E, and Vélez, T. Impact of the 2020 pandemic of COVID-19 on families with school-aged children in the United States: roles of income level and race. J Fam Issues. (2022) 43:719–40. doi: 10.1177/0192513X21994153

CrossRef Full Text | Google Scholar

3. COVID-19 Guidance for Safe Schools and Promotion of In-Person Learning. American Academy of Pediatrics. (2022) 1. Available at: https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/

Google Scholar

4. Austin, EW, Borah, P, and Domgaard, S. COVID-19 disinformation and political engagement among communities of color: the role of media literacy. Harvard Kennedy School Misinform Rev. (2021). doi: 10.37016/mr-2020-58

CrossRef Full Text | Google Scholar

5. Kim, DKD, and Kreps, GL. An analysis of government communication in the United States during the COVID-19 pandemic: recommendations for effective government health risk communication. World Med Health Policy. (2020) 12:398–412. doi: 10.1002/wmh3.363

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Cerise, FP, Moran, B, and Bhavan, K. Delivering COVID-19 vaccines by building community trust. NEJM Catal. (2021). doi: 10.1056/CAT.20.0692

CrossRef Full Text | Google Scholar

7. RADx® Underserved Populations (RADx-UP). Available at: https://radx-up.org/

Google Scholar

8. Ko, LK, Tingey, L, Ramirez, M, Pablo, E, Grass, R, Larzelere, F, et al. Mobilizing established school partnerships to reach underserved children during a global pandemic. Pediatrics. (2022) 149:e2021054268F. doi: 10.1542/peds.2021-054268F

CrossRef Full Text | Google Scholar

9. Haroz, EE, Kalb, LG, Newland, JG, Goldman, JL, Mast, DK, Ko, LK, et al. Implementation of school-based COVID-19 testing programs in underserved populations. Pediatrics. (2022) 149:1–14. doi: 10.1542/peds.2021-054268G

PubMed Abstract | CrossRef Full Text | Google Scholar

10. D’Agostino, EM, Haroz, EE, Linde, S, Layer, M, Green, M, and Ko, LK. School-academic partnerships in support of safe return to schools during the COVID-19 pandemic. Pediatrics. (2022) 149:e2021054268C. doi: 10.1542/PEDS.2021-054268C

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Oates, B. Immigrant farm owners and farm workers help drive Yakima County’s diverse Ag The Daily Yonder (2017) Available at: https://dailyyonder.com/immigrant-owners-workers-help-drive-yakima-countys-diverse-ag-business/2017/04/18/.

Google Scholar

12. QuickFacts Yakima County, Washington. United States Census Bureau. Available at: https://www.census.gov/quickfacts/yakimacountywashington

Google Scholar

13. Meseck, D. Yakima County Profile Employment Security Department Washington State (2022) Available at: https://esd.wa.gov/labormarketinfo/county-profiles/yakima.

Google Scholar

14. Baquero, B, Gonzalez, C, Ramirez, M, Chavez Santos, E, and Ornelas, IJ. Understanding and addressing Latinx COVID-19 disparities in Washington state. Health Educ Behav. (2020) 47:845–9. doi: 10.1177/1090198120963099

PubMed Abstract | CrossRef Full Text | Google Scholar

15. Ko, LK, Rillamas-Sun, E, Bishop, S, Cisneros, O, Holte, S, and Thompson, B. Together we STRIDE: a quasi-experimental trial testing the effectiveness of a multi-level obesity intervention for Hispanic children in rural communities. Contemp Clin Trials. (2017) 67:81–6. doi: 10.1016/j.cct.2018.02.013

PubMed Abstract | CrossRef Full Text | Google Scholar

16. Ajzen, I, and Fishbein, M. Understanding attitudes and predicting social behavior. Englewood, NJ: Prentice Hall (1980).

Google Scholar

17. Burke, NJ, Bird, JA, Clark, MA, Rakowski, W, Guerra, C, Barker, JC, et al. Social and cultural meanings of self-efficacy. Health Educ Behav. (2009) 36:111S–28S. doi: 10.1177/1090198109338916

PubMed Abstract | CrossRef Full Text | Google Scholar

18. Pasick, RJ, Burke, NJ, Barker, JC, Joseph, G, Bird, JA, Otero-Sabogal, R, et al. Behavioral theory in a diverse society: like a compass on Mars. Health Educ Behav. (2009) 36:11S–35S. doi: 10.1177/1090198109338917

PubMed Abstract | CrossRef Full Text | Google Scholar

19. Bandura, A. Social foundations of thought and action: a social cognitive theory. Englewood, NJ: Prentice Hall (1986).

Google Scholar

20. Miles, MB, Huberman, AMM, and Saldana, J. Qualitative data analysis: a methods sourcebook. 4th ed. Los Angeles, CA: Sage Publications (2019).

Google Scholar

21. Braun, V, and Clarke, V. Qualitative research in psychology using thematic analysis in psychology using thematic analysis in psychology. Qual Res Psychol. (2006) 3:77–101. doi: 10.1191/1478088706qp063oa

CrossRef Full Text | Google Scholar

22. Chua, KP, DeJonckheere, M, Reeves, SL, Tribble, AC, and Prosser, LA. Factors associated with school attendance plans and support for COVID-19 risk mitigation measures among parents and guardians. Acad Pediatr. (2021) 21:684–93. doi: 10.1016/j.acap.2020.11.017

PubMed Abstract | CrossRef Full Text | Google Scholar

23. Gilbert, LK, Strine, TW, Szucs, LE, Crawford, TN, Parks, SE, Barradas, DT, et al. Racial and ethnic differences in parental attitudes and concerns about school reopening during the COVID-19 pandemic—United States, July 2020. MMWR Morb Mortal Wkly Rep. (2020) 69:1848–52. doi: 10.15585/mmwr.mm6949a2

PubMed Abstract | CrossRef Full Text | Google Scholar

24. Lorenc, A, Kesten, JM, Kidger, J, Langford, R, and Horwood, J. Reducing COVID-19 risk in schools: a qualitative examination of secondary school staff and family views and concerns in the south west of England. BMJ Paediatr Open. (2021) 5:1–9. doi: 10.1136/bmjpo-2020-000987

CrossRef Full Text | Google Scholar

25. Unger, JB, Soto, D, Lee, R, Deva, S, Shanker, K, and Sood, N. COVID-19 testing in schools: perspectives of school administrators, teachers, parents, and students in Southern California. Health Promot Pract. (2021) 24:350–9. doi: 10.1177/15248399211066076

PubMed Abstract | CrossRef Full Text | Google Scholar

26. Pudjiadi, AH, Putri, ND, Sjakti, HA, Yanuarso, PB, Gunardi, H, Roeslani, RD, et al. Parents’ perspectives toward school reopening during COVID-19 pandemic in Indonesia—a National Survey. Front Public Health. (2022) 10:10. doi: 10.3389/fpubh.2022.757328

PubMed Abstract | CrossRef Full Text | Google Scholar

27. Kenworthy, T, Harmon, SL, Delouche, A, Abugattas, N, Zwiebel, H, Martinez, J, et al. Community voices on factors influencing COVID-concerns and health decisions among racial and ethnic minorities in the school setting. Front Public Health. Published online. (2022) 10:1002209. doi: 10.3389/fpubh.2022.1002209

PubMed Abstract | CrossRef Full Text | Google Scholar

28. Pondaven-Letourmy, S, Alvin, F, Boumghit, Y, and Simon, F. How to perform a nasopharyngeal swab in adults and children in the COVID-19 era. Eur Ann Otorhinolaryngol Head Neck Dis. (2020) 137:325–7. doi: 10.1016/j.anorl.2020.06.001

PubMed Abstract | CrossRef Full Text | Google Scholar

29. Ausenhus, C, Gold, JM, Perry, CK, Kozak, AT, Wang, ML, Jang, SH, et al. Factors impacting implementation of nutrition and physical activity policies in rural schools. BMC Public Health. (2023) 23:308–10. doi: 10.1186/s12889-023-15176-y

PubMed Abstract | CrossRef Full Text | Google Scholar