When Usability Isn't Enough: Understanding Rural Challenges in Respiratory Virus Test Interpretation

Background/Objectives: This study aimed to evaluate the usability and comprehension of at-home respiratory diagnostic tests for COVID-19 and influenza among rural and urban populations in Georgia. It sought to identify disparities in test interpretation and outcomes that could inform public health interventions tailored to underserved communities. Methods: Participants with respiratory symptoms (N = 592) were enrolled through community events in three rural Georgia counties (N = 188) and urban clinics in Atlanta (N = 404). Structured usability assessments and RT-PCR-confirmed diagnostic testing were conducted. Demographic, clinical, and survey data were analyzed using t-tests, z-tests, and Fisher's exact tests to compare rural and urban participants. Results: Rural participants were older and more likely to be White. Urban participants had significantly higher infection positivity rates for COVID-19 (18.5% vs. 10.2%) and Flu A (29.2% vs. 1.8%). While overall usability ratings were high across both groups (>94%), rural participants had significantly lower odds of identifying invalid test results and were more likely to continue using tests after procedural errors. Conclusions: Despite strong usability ratings, diagnostic test comprehension differed by geography. Rural participants demonstrated notable gaps in recognizing invalid results, underscoring the need for targeted educational strategies and simplified instructions to ensure equitable test interpretation and public health response.