Health Departments Share Successes and Barriers to Implementing a Community-focused, Free, At-home COVID-19 Testing Program
Health Departments share experiences on community engagement and relationships during implementation of a free, at-home, COVID-19 self-testing program.
State and local health departments, serving on the front lines of their communities, provide a unique and important perspective to public health response activities. In our article, “Experiences of Health Departments on Community Engagement and Implementation of a COVID-19 Self-testing Program,” we captured important insights from health departments on community engagement and outreach during a public health program. Say Yes! COVID Test (SYCT), a federally funded collaboration where nine health departments were selected and distributed 5.8 million COVID-19 self-tests to communities with high COVID-19 transmission, high social vulnerability, and low vaccination rates between March 31 and November 30, 2021. We gathered lessons learned to help state and local governments reach higher risk populations during future public health responses.
What we found
Between November and December 2021, a trained facilitator interviewed key informants using a field-tested interview guide to identify themes and subthemes within and across responses. We assessed the perceived impact of different languages, media types, and locations the health departments used to distribute free COVID-19 at-home self-testing kits. We found that local health departments who invested time and resources to maintain partnerships with trusted community leaders and organizations serving a wide variety of populations saw easier implementation and greater public acceptance of the COVID-19 self-testing activities. A proactive community engagement strategy is crucial to prepare front-line public health departments to respond to emergencies and outbreaks.
Health departments that did not routinely work with community outreach organizations were unable to quickly ramp up engagement. They needed to find and vet organizations with deep community ties while trying to influence those communities during a public health emergency. Existing relationships with community organizations with close ties to populations of interest enabled more acceptance of public health interventions, allowing seamless program implementation and engagement. Public health programs expanded their reach by using appropriate languages for their unique communities, media types relevant to different age groups, and locations accessible to all community members. Public health practitioners can use these findings as evidence, demonstrating that investment in stronger partnerships between health departments and communities is necessary to achieve health equity.
“Experiences of Health Departments on Community Engagement and Implementation of a COVID-19 Self-testing Program” showcases not only the importance of self-testing programs to reach communities at high risk, but also the necessity of having strong relationships between health departments and community leaders in place. The goal of public health responses during emergencies is to provide the necessary prevention and treatment measures to all who reside in the community. During the COVID-19 pandemic, implementation of these goals was more successful in communities that had built and established relationships between health departments and community leaders. Using the lessons learned from this qualitative study, health departments can better assist the community during a public health emergency by forming and maintaining relationships with communities.
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Diana Valencia is a Health Scientist at CDC. She has participated in several CDC responses including Zika, COVID-19, mpox, and Marburg. During the COVID-19 and the mpox responses, she supported several health equity projects including those addressing access to COVID-19 home testing and access to mpox vaccines in high-risk populations.
Christi Lane-Barlow was the Reporting Unit Lead for the Multinational Mpox and COVID-19 Emergency Responses at CDC. She completed a Master of Science in Epidemiology from London School of Hygiene and Tropical Medicine and has participated in global research since 1986.
Dr. Andrew Weitz is a Program Director with the National Institute of Biomedical Imaging and Bioengineering, a part of the National Institutes of Health (NIH). He supports a variety of initiatives on health informatics, digital health, and open science. Prior to joining NIH, Dr. Weitz was a research assistant professor at the University of Southern California Institute for Biomedical Therapeutics.
Libby Horter, MPH, is an experienced public health professional and analyst currently working as a contract epidemiology and data specialist with the CDC in the National Center for Emerging and Zoonotic Infectious Diseases Division of Preparedness and Emerging Infections. She worked with a Special Projects Team Science Unit on the CDC Covid-19 Response working on outbreak investigations, cross-sectional and qualitative studies with state, tribal, local, and territorial health department partners.