ArticleJournal of Maine Medical Center2026
Factors Associated with COVID-19 Testing in Structurally Vulnerable Populations: An Exploratory Study in Southern Maine.
Article in Journal of Maine Medical Center, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
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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.
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