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ORIGINAL RESEARCH article

Front. Public Health
Sec. Life-Course Epidemiology and Social Inequalities in Health
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1433476
This article is part of the Research Topic The Health and Illness Beliefs and Experiences of Minoritized Groups View all articles

A Qualitative Study of How Structural Vulnerability Shaped COVID-19 Testing Behaviors in Portland, Maine

Provisionally accepted
Michael R. Kohut Michael R. Kohut 1,2*Gloria D. Sclar Gloria D. Sclar 1,2Leslie Nicoll Leslie Nicoll 3Caroline Fernandes Caroline Fernandes 4Andrew Volkers Andrew Volkers 4Ann Tucker Ann Tucker 5Elizabeth A. Jacobs Elizabeth A. Jacobs 6Kathleen M. Fairfield Kathleen M. Fairfield 2,7
  • 1 School of Medicine, Tufts University, Boston, Massachusetts, United States
  • 2 MaineHealth Institute of Research (MHIR), Scarborough, Maine, United States
  • 3 Friends of the Portland Community Free Clinic, Portland, United States
  • 4 Preble Street, Portland, United States
  • 5 Greater Portland Health, Portland, United States
  • 6 Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
  • 7 Maine Medical Center, Maine Health, Portland, Maine, United States

The final, formatted version of the article will be published soon.

    Background: People with structural vulnerabilities (including immigrants, people who use drugs, and those who are unhoused or uninsured) are more likely to experience COVID-19 testing disparities relative to other groups. We documented barriers and facilitators to COVID-19 testing and explored how structural vulnerabilities created and/or exacerbated COVID-19 testing barriers.Methods: Between 2021 and 2022, we conducted semi-structured interviews with 34 members of structurally vulnerable populations and 27 key informants who provide health and social services to them. Our abductive analysis was iterative, utilizing both inductive and deductive coding processes. Recognizing that adequate and appropriate testing for COVID-19 is a complex health behavior that involves both decision-making and issues related to access, we developed of a hybrid model of COVID-19 testing behavior to organize reported barriers. We then used that model for more in-depth analysis of structural vulnerabilities in the context of testing.Results: Our model of testing behaviors provides a framework for understanding the many barriers and facilitators relevant to COVID-19 testing. After identifying locally-reported barriers, we found that specific conditions-economic precarity, legal precarity, the confusing U.S. healthcare landscape, English-exclusive environments, and stigmatizing medical encounters-make adequate and appropriate testing less likely by making COVID-19 testing feel riskier (entailing legal, financial, and psycho-social risks) and making healthcare, and thus vicariously testing, more difficult to access.The COVID-19 pandemic exposed disparities in health care delivery. To avoid undertesting and its associated health consequences during the next pandemic, public health efforts should address structural conditions to ameliorate risks and bolster testing infrastructure to improve access.

    Keywords: COVID-19 testing, Structural vulnerability, Qualitative, Access barriers, health behavior model

    Received: 15 May 2024; Accepted: 26 Sep 2024.

    Copyright: © 2024 Kohut, Sclar, Nicoll, Fernandes, Volkers, Tucker, Jacobs and Fairfield. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Michael R. Kohut, School of Medicine, Tufts University, Boston, 02111, Massachusetts, United States

    Disclaimer: 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.