COVID-19 Community-Designed Testing Programs Benefit Rural and Underserved Communities in Oklahoma
The Public Health Institute of Oklahoma (PHIO) and partners at the Oklahoma State Department of Health
(OSDH), as well as the Oklahoma Clinical and Translational Science Institute (OCTSI) at the University
of Oklahoma Health Sciences Center (OUHSC) worked in collaboration on one arm of the Community-engaged Approaches to
Testing in Community and Healthcare settings for Underserved Populations (CATCH-UP Oklahoma)
research project with the goal of increasing COVID-19 testing in rural and underserved communities across
the state. The National Institutes of Health (NIH)-funded project focused on increasing access to COVID-19
testing through community-designed initiatives. Community partners were encouraged to design testing events
in a way that they knew would work for their communities; as long as they had a nurse and the various
components necessary to conduct COVID-19 testing-in-place, partners were able to offer these services to
their communities and increase COVID-19 testing response through local partnerships. OSDH provided COVID-19
testing supplies and access to the public health lab, including the state's virtual COVID-19 test scheduling
and results platforms. The team at PHIO supported the training and implementation of the platform across all
CATCH-UP testing site partners.
Public Health Planning
PHIO serves as the managing body and state hub of the Oklahoma Primary Healthcare Extension System
(OPHES) and the 70 supporting County and Community Health Improvement Organizations (CHIOs) that work to
link communities throughout the state to primary care and other health improvement opportunities. While
the concept for CATCH-UP was in response to COVID-19, PHIO's involvement in the extension system allowed
for public health capacity development and the strengthening of stakeholder relationships prior to the
pandemic. This existing infrastructure allowed community partners to quickly activate the OPHES for a
new purpose, mobilizing coalitions and other health- and social-focused entities for community-designed
emergency response. Faith-based organizations, the Lions Club, and the Elks Lodge were among the
coalition members that were already organized to provide health improvement activities within their
local communities. PHIO recruited these community partners to become COVID-19 testing and outreach
leaders on the local level. Additional testing site partners were recruited from across rural and urban
underserved communities including Critical Access Hospitals (CAHs), social hospice nonprofit
organizations, rural and urban school districts, and both secondary and higher education student
Highlights multiple events hosted by the Tri-County Health Improvement Organization (TRI-CHIO)
focused on COVID-19 community testing events in 2021.
The CATCH-UP project increased access to COVID-19 testing resources in rural and underserved communities
by providing community partners with supplies, including rapid antigen, PCR, and code serology
antibodies testing materials, as well as funding to perform community-designed testing events with local
residents. Throughout the course of the project, which lasted nine months and started in March of 2021,
the community-designed testing-in-place initiative hosted nearly 400 testing events and administered
around 7,500 COVID-19 tests of varying types to communities across Oklahoma. The project generated
micro-testing sites through 49 testing site partners offering COVID-19 tests to various groups and
communities within the state as COVID-19 relief and response activities during the ongoing pandemic.
CATCH-UP operated as a collaborative model, emphasizing community design and relying on partnerships for
success. One such partnership with the Chickasaw Nation allowed PHIO to utilize the tribe's
early-pandemic community testing guide, developed to inform COVID-19 relief activities and testing
initiatives within Chickasaw Tribal territory, to create highly specialized guidance for communities
hosting COVID-19 testing events. The Chickasaw Nation shared the guide with PHIO so that they could
adapt the tribal-specific content for implementation by local testing site partners.
Due to the community-designed element of the CATCH-UP project, COVID-19 testing events took place
throughout communities in both traditional and unexpected spaces. Public health-focused coalitions,
faith-based organizations, and charity groups were already organized to provide health improvement
activities and to convene within their communities; these organizations were among the first to come
forth as COVID-19 testing sites under CATCH-UP recruitment. Outreach in communities led to
unconventional testing sites as well, with partner collaboration at social clubs, children's summer
camps, festivals and Pride events, school classrooms, and military diversion programs. The
community-design aspect of the project ensured that community voices were included at every point
possible, from where an event should be hosted, to how it should be organized, and to where the
resources would be located in the community going forward. Local stakeholders developed relationships
with health departments that they then leveraged in pushing benefits back into communities. Throughout
the duration of the CATCH-UP project, COVID-19 testing and pandemic responses were carefully designed
with the community in mind at every level.
Sustainable Community Recovery
NIH grant funding allowed the CATCH-UP project to reinvest in communities by compensating partners for
testing. Incentive funds were distributed by PHIO through its Community Partnership Program (CPP). PHIO
created the CPP as an innovative pathway to support the delivery of funds to entities supporting local
healthcare improvement. Researchers, state agencies, academics, philanthropic funders, and other
healthcare improvement agents partnered with PHIO and its stakeholders to design opportunities for
community engagement in health improvement activities. Participating communities received incentive
funds for their efforts.
Funds from CATCH-UP Oklahoma were designed to act as an incentive to host testing events in the
community, which served a dual purpose since funds were required to be reinvested back into COVID-19
morbidity and mortality mitigation initiatives. It also served as a sustainable community improvement
model. Rather than the testing events being “voluntold” work, nearly $1 million of the
funding was reinvested into additional community projects. Some examples of successful community project
actions include funding micro-grant programs that allowed teachers to apply for innovative funds to
improve classroom health, hiring new staff to run coalitions for sustainable program planning,
developing publicly available dashboards and websites to showcase coalition initiatives, investing in a
technology platform called Unite Us to develop a referral network, and creating walking paths at places
of worship to allow congregations to meet outdoors. Each CATCH-UP partner was required to compile a
grant report, outlining how the reinvestment funds were impactful to their communities through use of
photographs, videos, stories, and testimonials. The CATCH-UP project shares examples of community projects from around the
state on their dashboard.
CATCH-UP community partners have used innovative outreach methods to increase COVID-19 testing across
the state of Oklahoma. Outreach has spread to multiple sectors of interest in rural and underserved
communities, allowing these testing teams to build their knowledge of both how to test communities and
how to connect people to their local resources. Testing partners have become community champions for
COVID-19 relief and recovery efforts; they have embraced their role in supporting the work of the public
health system and using health department technology and public health labs. One of the greatest results
of the CATCH-UP project, however, is the capacity and resiliency built into community-designed
programming. CATCH-UP partners have become recognized, sustainable community advocates and are now
developing new projects to address continuing concerns, such as vaccine hesitancy, in their communities,
neighborhoods, and micro-cultures. Additionally, PHIO has been in conversations with 5 other states
interested in implementing the CATCH-UP project model in their own rural and underserved communities.
The model is highly adaptable, and allows for programs to accommodate different initiatives, depending
on a state's specific needs, for the continued deployment of COVID-19 relief and response work.
Reinvestment in Communities
The availability of NIH funding allowed the CATCH-UP team to compensate community partners for their
testing efforts and to incentivize COVID-19 relief activities through community reinvestment. The
availability of funds in “a world of scarcity” allowed community organizations and
nonprofits to truly serve their communities in ways that they already knew would work. By investing in
communities, CATCH-UP was able to invigorate coalitions and stakeholders, with a focus on building
resiliency and capacity at the forefront of concern.
Early in the COVID-19 pandemic, the Chickasaw Nation produced a COVID-19 testing guide outlining how to
host a COVID-19 testing event. The CATCH-UP team collaborated with tribal partners and adapted their
community testing guide to the research project's needs. Due to the relationship between PHIO and the
Chickasaw Nation, CATCH-UP was able to produce a unique resource tailored to community testing needs and
built-upon proven community response methods.
The Cherokee County Health Services Council (CCHSC) collaborated with the CATCH-UP project to
provide COVID-19 testing to their community, with special focus on those without regular access to
Since PHIO is the managing body of the Oklahoma Primary Healthcare Extension System, health
infrastructure throughout the state was already available to the CATCH-UP team. Activating the system
for a different purpose allowed the project to successfully develop a sustainable model of
community-designed response, as the necessary infrastructure was already in place. CATCH-UP partners and
stakeholders continued to support these resources in furthering community capacity and ability to serve.
Actively listening to community needs allowed the CATCH-UP project to produce an innovative
community-led response through which project partners were empowered to incorporate resource-sharing and
problem solving on an intra-community level.
Community partners demonstrated enthusiasm and dedication while implementing COVID-19 testing events.
Partner readiness for community-based participatory research contributed to the CATCH-UP project's
success, as state-level actors at PHIO were able to engage local partners by invoking passion in
Changes in state policies and procedures regarding the COVID-19 pandemic posed significant challenges to
CATCH-UP response at state and local levels due to disjointed action and varying guidance across
multiple state jurisdictions. These factors compounded with national sentiments of fear and uncertainty
to create high levels of stigma associated with COVID-19.
Stigma in Communities
Community testing site partners faced additional COVID-19 related stigma at the local level. Backlash
against community group efforts manifested both online and in-person. Community partners, however, were
undeterred in their efforts to increase COVID-19 testing in their communities.
Public Health Infrastructure
The CATCH-UP project faced multiple, significant infrastructure barriers to community-designed COVID-19
emergency response. During the COVID-19 pandemic, the only public health lab in the state moved
locations, which resulted in staffing changes, including changes in leadership, and operational delays.
There were also several changes in the systems used to schedule COVID-19 testing and report results to
the state, which were designed to cater to the needs of larger healthcare laboratory reporting systems.
Shortages and Sharing
The varying availability of testing supplies within different communities meant that community testing
partners had to collaborate and share resources to continue community COVID-19 testing procedures. The
CATCH-UP project tapped into the existing infrastructure of organized public health stakeholders that
helped empower community partners to overcome supply shortages.
Anticipated Project Barriers
Ultimately, as a research project, CATCH-UP is highly regulated and necessarily “asks a lot” of
its community testing partners. There was some initial concern that the project would cause fatigue
among community partners, disincentivizing participation; however, responses indicated the opposite.
Community partners built highly effective, sustainable models for community engagement and emergency
The CATCH-UP research project legitimized community partners by building their capacity and funding
community-designed initiatives for health improvement. This project revealed the benefits of community
investment and invigorated stakeholders and coalitions to implement innovative testing design during the
pandemic. Through infrastructure and financial support from the CATCH-UP project, community-designed
testing partners took the opportunity to build resiliency from COVID-19 relief and response efforts.
Uses of the Unconventional
Due to the nature of community-designed emergency response, testing events may not always take place in
the most obvious setting. While COVID-19 testing events were organized and hosted in traditional spaces
for community public health, such as the parking lots of nonprofits, CATCH-UP outreach also extended
past these traditional venues to better serve the community. Community testing events at Pride
festivals, children's church camps, military diversion programs, and local Elks Lodge bars are a few
examples of how implementing unconventional testing site locations can improve outreach to a population
of interest when considering the geographical and sociocultural needs of a community.
Through capacity-building efforts and unconventional testing design, CATCH-UP partners were able to
address community needs with greater efficacy. By building resiliency at a local level, partners
developed innovative resource-sharing techniques and utilized infrastructure collaboratively throughout
the course of the community-designed testing process. Oklahoma's state-level collaboration with tribal
partners and other states throughout the country further demonstrates the collaborative benefits to
implementing community-designed emergency response.
For rural community organizations or state health departments looking to implement similar programs,
program director Laura Ross suggests:
Trust the community and local stakeholders to identify community needs and best practices.
Ask community stakeholders to participate, not only as intervention recipients, but as
experts on community inclusion. Understand that they know their community best.
Empower community partners to do the work and help set them up to develop a sustainable model of
Emphasize a focus on how language is used to communicate. For example, using the term
“community-designed testing” is not only accurate but empowering.
Laura Ross, CATCH-UP Oklahoma, Program Director
Public Health Institute of Oklahoma
Opinions expressed are those of the interviewee(s) and do not necessarily reflect the views of the Rural
Health Information Hub.