COVID-19 Community-Designed Testing Programs Benefit Rural and Underserved Communities in Oklahoma

What Happened

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 associations.

Pandemic Response

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.

Success Factors

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.

Tribal Partnerships

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.

Pre-existing Infrastructures

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.

Innovative Response

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 Readiness

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 outreach efforts.

Barriers

State-level Challenges

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 response.

Lessons Learned

Capacity-building

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.

Collaboration

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.

Advice

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 subject-matter 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 continued operations.
• Emphasize a focus on how language is used to communicate. For example, using the term “community-designed testing” is not only accurate but empowering.

Person(s) Interviewed

Laura Ross, CATCH-UP Oklahoma, Program Director
Public Health Institute of Oklahoma