Factors Associated with COVID-19 Testing in Structurally Vulnerable Populations: An Exploratory Study in Southern Maine

Authors

Grace L Price, MaineHealth Institute for Research, Scarborough, Maine AND Department of Internal Medicine, Mainehealth Maine Medical Center, Portland, MaineFollow
Kathleen M. Fairfield, MaineHealth Institute for Research, Scarborough, Maine AND Department of Internal Medicine, Mainehealth Maine Medical Center, Portland, Maine
Sumayo Awale, MaineHealth Institute for Research, Scarborough, Maine
Renee Fay-LeBlanc, Greater Portland Health, Portland, Maine
Caroline Fernandes, Preble Street, Portland, Maine
Ann Marie R. Hess, MaineHealth Institute for Research, Scarborough, Maine
Elizabeth A. Jacobs, Department of Internal Medicine, University of California Riverside School of Medicine, Riverside, California
Donna Lawlor, MaineHealth Institute for Research, Scarborough, Maine
David Ngandu, MaineHealth Institute for Research, Scarborough, Maine
Leslie Nicoll, Portland Community Free Clinic, Portland, Maine
Kinna Thakarar, MaineHealth Institute for Research, Scarborough, Maine AND Department of Internal Medicine, Mainehealth Maine Medical Center, Portland, Maine
Ellyn Touchette, MaineHealth Institute for Research, Scarborough, Maine
Andrew Volkers, Preble Street, Portland, Maine
Gloria D. Sclar, MaineHealth Institute for Research, Scarborough, Maine

Submission Type

Original Research

Abstract

Introduction: The COVID-19 pandemic disproportionately affected structurally vulnerable populations in the United States. COVID-19 testing was instrumental in controlling viral spread and linking people to treatment; however, testing rates were lower among racial and ethnic minority groups. Our objective was to identify factors associated with desired COVID-19 testing behavior among vulnerable populations.

Methods: We conducted an exploratory cohort study of at-home COVID-19 testing between March 2022 and November 2023 in Portland, Maine. Partnering with trusted community organizations, we engaged participants from immigrant, housing-unstable, substance-using, and low-income/uninsured communities. Participants received 5 at-home COVID-19 tests every 8 weeks for 48 weeks. Participants completed a baseline survey and follow-up surveys every 4 weeks on COVID-19 exposures and symptoms, as well as use of COVID-19 tests, with additional questions every 8 weeks on behavioral factors (ie, risk perceptions, attitudes, norms) around COVID-19 testing. The primary outcome was “desired testing behavior score,” or the proportion of instances a participant tested when they should have based on guidance from the Centers for Disease Control and Prevention.

Results: We enrolled 93 participants, of whom 39 (42%) were immigrants, 30 (32%) were unhoused or had a history of chronic homelessness, 28 (30%) reported substance use, and 60 (65%) were low income and/or uninsured. Overall, participants tested 66% of the recommended times. In bivariate regression, 4 factors (age, confidence in ability to use a COVID-19 test, perceived usefulness of testing, and commitment to testing) were significantly associated with desired testing behavior. However, these associations were not statistically significant in multivariable linear regression.

Discussion and Conclusions: Participants from vulnerable communities engaged with COVID-19 testing when provided with at-home tests, but more research is needed to understand what factors drive testing behavior.

Recommended Citation

Price, Grace L; Fairfield, Kathleen M.; Awale, Sumayo; Fay-LeBlanc, Renee; Fernandes, Caroline; Hess, Ann Marie R.; Jacobs, Elizabeth A.; Lawlor, Donna; Ngandu, David; Nicoll, Leslie; Thakarar, Kinna; Touchette, Ellyn; Volkers, Andrew; and Sclar, Gloria D. (2026) "Factors Associated with COVID-19 Testing in Structurally Vulnerable Populations: An Exploratory Study in Southern Maine," Journal of Maine Medical Center: Vol. 8 : Iss. 1 , Article 10.
Available at: https://doi.org/10.46804/2641-2225.1241