Figure - available from: Journal of Clinical Microbiology
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Timeline of RADx-UP Testing Core activities during the COVID-19 pandemic. CDC, Centers for Disease Control and Prevention; FDA, U.S. Food and Drug Administration; HHS, U.S. Department of Health and Human Services; LDT, laboratory-developed tests; OTC, over the counter; POC, point-of-care; PREP, public readiness and emergency preparedness; WHO, World Health Organization.
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Research on the COVID-19 pandemic revealed a disproportionate burden of COVID-19 infection and death among underserved populations and exposed low rates of SARS-CoV-2 testing in these communities. A landmark National Institutes of Health (NIH) funding initiative, the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program, was d...
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Context
Despite the recognition that social determinants of health (SDOH) are key to improving the health of all communities, the causality and specific mechanisms through which SDOH impacts health behaviors and outcomes are often ambiguous.
Objective
The aim of this study was to use systems thinking to document pathways through which SDOH affected health-seeking behaviors and identify how community engagement strategies intervened to address SDOH barriers.
Design
We leveraged the case context of a large federal initiative (Rapid Acceleration of Diagnostics-Underserved Populations [RADx-UP]) designed to improve COVID-19 testing for underserved populations through community-engaged and participatory approaches. First, we used structured sessions with RADx-UP partners to create causal maps that documented relationships between factors relevant to SDOH, a health-seeking behavior (COVID-19 testing), and community engagement strategies. Second, we searched, reviewed, and tied evidence from RADx-UP peer-reviewed literature to contextualize the causal maps.
Results
We identified 17 unique pathways that linked SDOH to COVID-19 testing. The map also highlighted 3 mechanisms through which the community engagement addressed SDOH: (1) improving access to testing, (2) addressing health and digital literacy, and (3) conducting social needs screening and assistance.
Conclusions
Our findings highlighted the complexity of public health issues such as COVID-19 and how community engagement is critical to addressing SDOH and health equity. Importantly, dedicating resources to community engagement created positive reinforcing dynamics to improve the health of communities; however, as COVID-19 became better managed, funding also diminished and decreased the capacity for community-engaged efforts. Research in public health needs to focus on understanding and reshaping systems that better support community-engaged efforts.
