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Factors Associated with COVID-19 Testing in Structurally Vulnerable Populations: An Exploratory Study in Southern
Grace L Price1,2, Kathleen M Fairfield1,2, Sumayo Awale1
1MaineHealth Institute for Research, Scarborough, Maine.
Journal of Maine Medical Center
|May 4, 2026
Summary
Vulnerable populations engaged with at-home COVID-19 testing when provided. Further research is needed to understand the specific factors influencing testing behavior in these communities.
Area of Science:
- Public Health
- Epidemiology
- Health Behavior
Background:
- The COVID-19 pandemic disproportionately impacted vulnerable populations in the US.
- Lower COVID-19 testing rates were observed among racial and ethnic minority groups.
- Understanding testing behavior is crucial for controlling viral spread.
Purpose of the Study:
- To identify factors associated with desired COVID-19 testing behavior among structurally vulnerable populations.
- To explore engagement with at-home COVID-19 testing in diverse communities.
- To inform strategies for improving testing access and adherence.
Main Methods:
- Exploratory cohort study of at-home COVID-19 testing (March 2022-November 2023) in Portland, Maine.
- Engaged participants from immigrant, housing-unstable, substance-using, and low-income/uninsured communities.
- Collected survey data on demographics, COVID-19 exposures, symptoms, testing use, and behavioral factors.
Main Results:
- 93 participants enrolled, representing diverse vulnerable groups.
- Participants tested 66% of recommended times.
- Bivariate analysis showed associations between age, confidence, perceived usefulness, commitment, and desired testing, but these were not significant in multivariable analysis.
Conclusions:
- Vulnerable communities showed engagement with provided at-home COVID-19 tests.
- Additional research is necessary to elucidate the drivers of testing behavior in these populations.
- Tailored interventions may be needed to optimize COVID-19 testing adherence.
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