Understanding capability, opportunity, and motivation for at-home COVID-19 testing in underserved populations during the pandemic

Background and purpose We investigated the capabilities, opportunities and motivations associated with decision making related to at-home COVID-19 testing in populations most affected by the pandemic. Methods We conducted semi-structured interviews to explore the capability, opportunity and motivation for COVID-19 testing by the pandemic populations most affected by the pandemic. Interviews were carried out according to the Critical Incident Technique, and analysis and interpretation were guided by the COM-B model for behavior change. Results We conducted 19 (13 in English, 6 in Spanish) semi-structured interviews with participants from both urban and rural areas in Utah. The following 6 key themes emerged: (i) Participants sought clear information about COVID-19 from trustworthy, credible sources, (ii) Economic concerns relating to job security and income loss as well as costs associated with COVID-19 testing were concerns, conversely access to free COVID-19 tests facilitated testing, (iii) Rapid testing with fast results at convenient locations including at-home were key facilitators to COVID-19 testing, (iv) Wide variation of trust levels related to at-home COVID-19 test accuracy, (v) Perception of risk to self and others, including misconceptions surrounding risk, and (vi) Intense emotions ranging from fear associated with loss to peace of mind associated with confirmation of a negative COVID-19 test. Conclusion The six themes identified surfaced as facilitators, barriers, and key considerations depending upon the context when participants were engaging in decision-making about COVID-19 testing. Providing validated easy to understand information, from trustworthy sources, while addressing and minimizing concerns about economic implications associated with testing are critical to increase patient engagement.