Abstract
BackgroundThe efficacy of testing and tracing programs to reduce COVID-19 transmission hinges not only on widespread access to testing, but also on the public’s willingness to participate in them. To the extent that testing intentions are patterned by social determinants of health, this constitutes an understudied mechanism of disparities in COVID-19 morbidity and mortality.DesignUsing data from a representative household probability sample, the Person to Person Health Interview Study (n = 935), sociodemographic, economic, and psychological determinants of testing considerations were evaluated across six domains: treatment affordability, ability to work if positive, hospital effectiveness, symptom severity, proximity to infected, and risk of transmitting to others.ResultsFindings demonstrated significant differences in testing motivations across race/ethnicity, education level, socioeconomic status, and worry about self and loved ones. Notably, Black (p<0.01) and Latino (p<0.05) respondents and those experiencing financial strain (p<0.001) were disproportionately likely to indicate that resource factors would influence their decision to get tested. Desire to reduce transmission and concern about proximity to the infected were reported among those who expressed COVID-19 worries (p<0.001).ConclusionPublic health efforts to combat the COVID-19 pandemic must address social, economic, and psychological factors that enable and constrain individual behavior. Increasing access to preventative interventions and technologies, including vaccines, is unlikely to markedly reduce morbidity and mortality without effective messaging and economic support to improve uptake in vulnerable populations.
Highlights
Strict COVID-19 social distancing through bans on mass gatherings, closing schools, and working remotely have been effective worldwide in reducing the spread of the virus, but are not a feasible long-term solution given the enormous cost to social and economic wellbeing
Rates of agreement with each outcome varied widely, with 21% of respondents agreeing that their decision to test for COVID-19 would be influenced by their ability to work if tested positive and a majority (83%) agreeing that their proximity to people infected with COVID-19 would influence their decision to get tested
Black respondents were more likely to agree that the affordability of treatment would influence their decision to get tested for COVID-19 (b = 0.52), and Latino respondents were more likely to agree their testing decisions would be influenced by their ability to work if tested positive (b = 0.91)
Summary
Strict COVID-19 social distancing through bans on mass gatherings, closing schools, and working remotely have been effective worldwide in reducing the spread of the virus, but are not a feasible long-term solution given the enormous cost to social and economic wellbeing. This has prompted research on “exit strategies” that would permit activities and economies to remain open while still protecting healthcare resources and reducing viral transmission. Though willingness of people experiencing symptoms of COVID-19 to participate in testing and tracing programs is likely to be an essential determinant of their efficacy, few studies have examined factors contributing to testing intentions [4, 5]. To the extent that testing intentions are patterned by social determinants of health, this constitutes an understudied mechanism of disparities in COVID-19 morbidity and mortality
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