Breaking Barriers: Simplifying COVID-19 Testing for Underserved Communities

Citation: Mauricio, A. M., Cioffi, C. C., Sanders, A. M., Kosty, D., Fernandes, L., Mueller, M. V., & Stormshak, E. A. (2025). A mixed methods evaluation of a motivational enhancement intervention to increase SARS-CoV-2 testing among people experiencing houselessness and people who inject drugs.

For many individuals experiencing houselessness or using syringe exchange services, accessing COVID-19 testing has been far from straightforward. Challenges like mistrust in healthcare systems, immediate survival priorities, and logistical hurdles often stand in the way. The Connect2Test program aimed to address these issues by delivering COVID-19 testing in trusted community spaces. While the program did not increase testing rates, it provided valuable lessons for improving health outreach initiatives.

What This Blog Covers

• The barriers to COVID-19 testing for underserved groups

• How Connect2Test was designed and implemented

• Key challenges and what worked

• Recommendations for improving health access programs

What Is Connect2Test?

Connect2Test was a brief motivational enhancement intervention delivered by a mental health clinician designed to encourage COVID-19 testing among people experiencing houselessness and those who inject drugs. The program was delivered in partnership with syringe exchange programs (SSPs) and community service centers to ensure participants could access testing in familiar, trusted locations. Staff and volunteers guided participants through short conversations focused on addressing hesitations and providing clear information about testing.

The intervention incorporated technology and motivational interviewing strategies, aiming to empower participants to take steps toward protecting their health. However, these features were met with mixed reactions due to concerns about complexity and a lack of personalization.

What We Learned

What Worked Well

Despite these barriers, Connect2Test had several strengths:

• Testing within trusted spaces: Embedding testing in locations participants already frequented reduced logistical burdens.

• Supportive conversations: Community partners felt that nonjudgmental interactions helped participants feel respected and empowered.

• Partnership with trusted organizations: Collaboration with syringe exchange programs may have enhanced credibility and outreach.

Barriers to Testing

Community partners highlighted several challenges that made accessing COVID-19 testing difficult:

• Competing priorities: Finding food and shelter often outweighed the urgency of getting tested.

• Mistrust of the healthcare system: Concerns about stigma and negative past experiences may have deterred many from seeking care.

• Intervention complexity: The use of scripted conversations and technology felt impersonal and may have reduced engagement.

• Misalignment with participant priorities: Community partners viewed the intervention as less relevant compared to immediate financial incentives or survival needs.

Lessons for Future Programs

1. Meet People Where They Are: Embedding health services into locations that people already visit—such as syringe exchange programs or shelters—makes accessing care easier and more convenient.

2. Simplify Interventions: Short, straightforward programs that respect participants' time and priorities are more likely to succeed. Overly complex processes can discourage engagement.

3. Prioritize Trust: Working with established community organizations and using nonjudgmental approaches are critical for overcoming mistrust and encouraging participation.

4. Leverage Existing Relationships: Participants were more likely to engage when interventionists were familiar and trusted individuals from the community partner organization.

5. Adapt to Participant Needs: Tailoring interventions to address immediate needs, such as offering financial incentives, can make programs more relevant and effective.

Moving Forward

The Connect2Test evaluation highlights the importance of trust, accessibility, and collaboration in delivering health interventions. While the program faced challenges, it also provided valuable insights for designing future initiatives that better meet the needs of underserved communities. By focusing on simplicity, respect, and partnership, we can create programs that reduce barriers and promote healthier lives.

This study, supported by the National Institutes of Health Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) initiative, involved 205 participants across Oregon from April to May 2021. Participants were predominantly male (65%), White (72%), and not Hispanic (87%). Despite the null findings, the study’s qualitative insights offer valuable guidance for redesigning health interventions for underserved populations.