Increasing representation of black communities in SARS-CoV-2 serosurveys by understanding barriers and motivations for participation

AbstractRacial minorities have disproportionate risk for SARS-CoV-2 diagnoses and adverse outcomes includingdeath. Burden of disease in Black populations is likely underestimated due to sub-optimal access to, andusage of, SARS-CoV-2 testing. Serosurveys, which use probability-based methods to select persons forSARS-CoV-2 testing and an accompanying survey, have potential to improve our understanding of population-level burden of disease and risk factors for infection. However, early results from U.S.-based serosurveysindicate sub-optimal participation rates among Black populations, which results in their under-representation inburden of disease estimates and a limited understanding of risk factors for infection. The current project aimsto identify barriers and motivations for participation in population-based SARS-CoV-2 serosurveys amongdiverse Black sub-populations (e.g. by gender, age, and education level). Understanding factors that influenceBlack people's decision-making about serosurvey participation and how these factors differ by socio-demographic characteristics will allow us to provide tailored recommendations for increasing Black populations'participation in serosurveys and representation in burden of disease estimates. Our interdisciplinary team ofepidemiologists, behavioral scientists, and community health advocates/practitioners will use qualitative andquantitative methods in the context of serosurveys to understand how influences on decision-making arerelated to actual decisions about participation in SARS-CoV-2 antibody testing. Our qualitative interview guidewill be informed by the family of value expectancy theories and will be developed in collaboration with acommunity advisory board (CAB), who will also help us to identify community constituents for participation inqualitative interviews. Key themes from the qualitative interviews, and language used by respondents, willinform a quantitative survey instrument, which will assess relative strengths of influences on serosurveyparticipation and how they differ socio-demographically across Black sub-populations. Our Specific Aims are:(1) Convene a community advisory board (CAB) comprising leaders from organizations serving Blackcommunities in Atlanta (e.g., professional, faith-based, health and social services); (2) In the context of aSARS-CoV-2 serosurvey, conduct 50 semi-structured interviews about barriers and motivations for serosurveyand vaccine participation with Black persons from 3 diverse neighborhoods, representing a range of socio-demographic characteristics; (3) Determine the distribution of barriers and motivations for serosurveyparticipation across socio-demographic subgroups of 2,000 Black persons using a quantitative survey. We willprovide recommendations for increasing participation of black communities in SARS-CoV-2 serosurveys, whichis critical as SARS-CoV-2 serosurveys are likely to be used for on-going disease surveillance in the U.S. and toinform both resource allocation and design and monitoring of prevention and control strategies.