Perceived Risk and COVID-19 Testing Engagement in the Black Population in Atlanta Restricted; Files Only
He, Jianning (Spring 2025)
Abstract
Background: Diagnostic testing is fundamental to pandemic control, yet engagement is often hindered by structural inequities and psychosocial barriers. The Health Belief Model (HBM) identifies perceived risk as a primary determinant of protective behaviors, though this relationship remains complex when considering fear of positive results and logistical constraints in underserved communities.
Objective: This study evaluated the association between baseline perceived risk, fear of positive results, and engagement with COVID-19 home antigen tests and PCR tests among Black residents in Atlanta.
Methods: Data were analyzed from the Represent ATL 2.0 study, a community-based cohort of 807 Black adults. Participants were provided with free kits containing a rapid home antigen test and a mail-in saliva PCR test, with financial incentives for completion. Outcomes were measured as self-reported COVID-19 antigen test use and the mailing of PCR test samples. Bivariate associations were evaluated using Chi-square tests, followed by multivariable logistic regression models to estimate independent associations while adjusting for sociodemographic factors, vaccination status, and disability.
Results: Testing engagement was high across the sample, with 91.0% using home antigen tests and 87.0% mailing PCR samples. Contrary to HBM-based expectations, baseline perceived risk was not significantly associated with home test use (aOR = 0.70; 95% CI: 0.30, 1.63) or PCR mailing (aOR = 0.82; 95% CI: 0.37, 1.85). While fear of positive results showed a marginal association with home testing, age emerged as a predictor for PCR test participation. Participants aged 35–54 had significantly higher odds of mailing samples compared to those aged 18–34 (aOR = 5.53; 95% CI: 1.86, 16.47).
Conclusion: The free distribution of COVID-19 test kits and incentives likely functioned as a structural equalizer, reducing the influence of individual risk perception and fear on testing behavior. However, testing modality complexity remains a critical factor, as evidenced by lower PCR test return rates among younger adults. Future public health efforts should focus on increasing testing engagement by directly providing free test kits and, ideally, financial incentives to eliminate cost and logistical barriers. Testing modalities should also be tailored to the routines and preferences of different demographic groups to ensure health equity.
Table of Contents
Introduction ... 1
Methods ... 2
Study Design and Population ... 2
Outcomes and Exposure ... 3
Fear of Positive Testing Results ... 3
Covariates ... 4
Statistical Analysis ... 5
Results 5
Participant Characteristics ... 5
Distribution of Characteristics by Perceived Risk and Bivariate Associations ... 7
Multivariable Predictors of Testing Engagement ... 10
Home Test Use ... 10
PCR Test Use ... 11
Discussion ... 14
Strengths and Limitations ... 15
Conclusion ... 16
References ... 17
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