Project Summary
Low-Income Asian Americans (AA) with limited English proficiency (LEP) represent a meaningful proportion of
low-wage frontline workers in essential service industries. Many also live in multigenerational households with
crowded conditions and with their elderly relatives in ethnic neighborhoods, areas that have experienced high
rates of COVID-19 infection. Unfortunately, AAs have encountered numerous barriers to COVID-19 testing
across individual, provider/health system and community/societal levels, including anti-Asian racism and
discrimination, fear of safety at test sites and on public transportation, lack of health insurance, lack of culturally
and language-appropriate COVID-19 information and navigation, and limited access to COVID-19 testing sites.
As a result, AAs have the lowest COVID-19 testing rate across all racial/ethnic groups. This is particularly
concerning in light of the recent surge in cases due to the BA.2 variant and lifting of COVID restrictions, which
has led to increases in COVID-19 infections and hospitalizations especially among vulnerable populations. FDA-
approved over-the-counter (OTC) COVID-19 diagnostic tests offer a valuable evidence-based strategy for
empowering vulnerable AAs (who are hesitant or otherwise unable to obtain in-person PCR testing) to complete
self-testing. Although prior studies have demonstrated the feasibility of COVID-19 self-testing in communities
with access barriers, no intervention study has focused on vulnerable low-income frontline workers and seniors
with LEP across diverse AA ethnic groups (Chinese, Vietnamese, Korean), the fastest growing US population.
Thus, the overall goal of this application is to implement a community-engaged multifaceted intervention (herein
called the IMPROVE intervention) to increase access to and uptake of rapid COVID-19 self-testing across
diverse AA populations. Guided by the NIMHD Research Framework and Social Cognitive Theory to address
sociocultural/environmental and individual/interpersonal influences for COVID self-testing, our central hypothesis
is that trusted messengers (community health navigators, heath providers, and peer advocates) are essential
to reducing testing barriers and increasing uptake of COVID-19 self-testing. The Specific Aims are to: (1) Engage
community partners to implement a pragmatic cluster-randomized trial in 12 CBO sites to evaluate the
effectiveness of the community-engaged and evidence-based IMPROVE intervention in increasing access to
and uptake of COVID-19 self-testing (primary outcome) and changes in mitigation behaviors including
adherence to mask wearing and COVID-19 vaccination (secondary outcomes) in underserved and vulnerable
ethnic AAs (N=1200 AAs: 400 Chinese, 400 Korean and 400 Vietnamese); and (2) Evaluate Intervention Reach,
Effectiveness, Adoption, Implementation and Maintenance using the RE-AIM framework to facilitate IMPROVE
intervention dissemination to more CBOs and enhance its sustainability over time. The proposed project will be
one of the first to evaluate an evidence-based community-engaged approach to reducing systemic barriers and
will fill gaps in research on COVID-19 self-testing and mitigation adherence in 3 ethnic AA vulnerable populations.
