Factors Affecting COVID-19 Testing Decisions: Social and Economic Heterogeneities in a Representative Sample

Introduction: Willingness to participate in COVID-19 testing and tracing programs has potential to exacerbate health disparities due to systematic variation by social determinants of health. This study evaluates sociodemographic, economic, and psychological factors associated with COVID-19 testing motivations. Methods: We used data from the Person to Person Health Interview Study, collected by telephone in April and May 2020, using a representative sample of Indiana residents (n=943). Testing intentions were assessed across six motivations: treatment affordability, ability to work if positive, hospital effectiveness, symptom severity, proximity to infected, and risk of transmitting to others. Bivariate analyses and ordinal logistic models were used to assess the influence of race/ethnicity, education, financial strain, and COVID-19 worries on each outcome. Results: Respondents strongly agree that symptom severity, proximity to infected, and risk of transmitting to others would be important considerations in COVID-19 test decisions. Black and Latino respondents were more likely than white respondents to agree that ability to work if positive (b = 0.48 and 0.96) and hospital effectiveness (b = 0.92 and 0.96) would influence their decision to get tested. Test affordability (b = 2.80), hospital effectiveness (b = 2.00), and risk of transmission (b = 0.99) were considerations among participants reporting financial strain. Desire to reduce transmission (b = 1.49) and concern about proximity to infected (b = 2.66) were reported among those who expressed COVID-19 worries. Conclusions: In a representative sample in Indiana, people consider their own and others’ vulnerability to COVID-19 in testing decisions. Lower-SES groups and Black and Latino people were more likely to cite resource constraints. Policies expanding financial assistance and prosocial message framing may increase testing rates, particularly among vulnerable subpopulations.
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