Confronting COVID-19 in under-resourced, African American neighborhoods: a qualitative study examining community member and stakeholders' perceptions

The purpose of this study was to examine perceptions of COVID-19 related to prevention, coping, and testing of African American residents in under-resourced communities in Alabama. Guided by the PRECEDE-PROCEED model, virtual focus groups were conducted in five urban and rural Alabama communities us...

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Bibliographic Details
Published in:	Ethnicity & health Vol. 26; no. 1; pp. 49 - 67
Main Authors:	Bateman, Lori Brand, Schoenberger, Yu-Mei M., Hansen, Barbara, Osborne, Tiffany N., Okoro, Grace C., Speights, Kimberly M., Fouad, Mona N.
Format:	Journal Article
Language:	English
Published:	England Taylor & Francis 2021 Taylor & Francis Ltd
Subjects:	Adaptation, Psychological African American health African Americans Alabama Apathy Barriers barriers to COVID-19 testing Black or African American - statistics & numerical data Clinical outcomes Community Contact tracing Coping Coronaviruses COVID-19 COVID-19 - prevention & control COVID-19 - psychology COVID-19 Testing Disease control Emotional behavior Female Focus Groups Food security Food sources Health care access Health disparities Health education Health problems Health Services Accessibility Healthy food Humans Information Dissemination Insecurity Male Medical education Medical schools Medicine Meetings Mental disorders Mental health Mental health services Messages Middle Aged Neighborhoods Perceptions Personal protective equipment Physical activity Physicians Population studies Poverty Prevention Protective equipment Qualitative Research Racial differences Religion Residence Characteristics Residents Rural communities social determinants of health Social factors Stakeholder Participation Stakeholders Tests Vulnerability Alabama United States > US COVID-19 social determinants of health African American health health disparities barriers to COVID-19 testing qualitative research coping
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Summary:	The purpose of this study was to examine perceptions of COVID-19 related to prevention, coping, and testing of African American residents in under-resourced communities in Alabama. Guided by the PRECEDE-PROCEED model, virtual focus groups were conducted in five urban and rural Alabama communities using secure Zoom meetings. Community residents and stakeholders (N = 36 total) participated; meetings were audio- and video-recorded, transcribed, and analyzed according to Thematic Analysis. Themes were organized by the PRECEDE portion of the model in Predisposing, Reinforcing, and Enabling barriers and facilitators in three focus areas: prevention, coping, and testing. Prevention barriers included apathy, difficulty with social distancing, lack of information, mixed messages from authority figures, and lack of personal protective equipment (PPE). Prevention facilitators included concerns about contracting COVID-19, clear and consistent messages from trusted sources, contact tracing, and the provision of PPE. Coping barriers included food insecurity, mental health issues, isolation, economic hardships, lack of health care access, and issues with virtual schooling and church services, which were exacerbated by the inability to connect to the internet. Facilitators to coping included religious faith, increased physical activity, and a sense of hope. Testing barriers included misunderstanding, fear, mistrust, testing restrictions, and location of testing sites. Facilitators to testing included incentives, clear information from trusted sources, convenient testing locations, and free tests. Gaining community members' perspectives can identify barriers and facilitators to prevention, coping, and testing and potentially improve outcomes. While addressing the social determinants of health (e.g. income, education, medical trust) would be an effective path by which to diminish health disparities related to COVID-19, there is an urgent need to mitigate the spread and severity of COVID-19 in vulnerable populations. Interventions should focus on downstream determinants, such as those emerging from our study.
ISSN:	1355-7858 1465-3419
DOI:	10.1080/13557858.2021.1873250