Perceptions of Coronavirus and COVID-19 Testing and Vaccination in Latino and Indigenous Mexican Immigrant Communities in the Eastern Coachella Valley | BMC Public Health
This study was conducted from August 2020 to January 2021, with focus groups conducted from November to December 2020. We used the principles of community-based participatory research (CBPR), an approach that builds on the strengths of various partners, shares resources and promotes shared decision-making and knowledge creation . In keeping with this approach, we convened a 10-member Community Advisory Board with representatives from health systems, health care providers, producers, community health workers, and medical and pre-medical students who met monthly to oversee the project, facilitate relationship building and offer advice. The leadership team also met regularly with public health officials and partner healthcare officials to discuss delivery of COVID-19 testing services (e.g. location of testing sites, hours of operation) and engaging the most vulnerable communities in testing services.
The larger project included three goals: 1) to support the delivery of COVID-19 testing services, 2) to widely disseminate public health information about COVID-19, and 3) to conduct research on perceptions of the coronavirus and testing and COVID-19 vaccination among native Latinx/Mexicans in rural farming communities in the interior of Southern California. As reported elsewhere, the larger project was successful in achieving study objectives 1 and 2 . Team leadership established access to routine COVID-19 testing for rural immigrant communities by partnering with a federally qualified health center and county public health to conduct 26 testing clinics providing approximately 1470 tests. In addition, community health workers or health promoters disseminated public health information related to COVID-19 via social media, at COVID-19 testing events and socially distanced in-person community discussions. These efforts have resulted in 22 COVID-19 Virtual Community Discussions (Pláticas de COVID-19) livestreamed on our @Unidoporsalud Facebook page and 10 in-person COVID-19 Community Discussions (Plastics in the Pueblo).
For the purposes of this article, we focus on the results of our third objective involving research on the coronavirus and perceptions of COVID-19. Before data collection began, we obtained ethics approval for the study from the Institutional Review Board of the University of California Riverside.
Our study focused on the effects of the coronavirus pandemic among Latinx and Indigenous Mexican immigrant communities in the rural desert region of the interior of Southern California. Our research was conducted in Riverside County, an area of California in which racial and ethnic minority populations have been disproportionately affected by the pandemic. At the time of the study, Riverside County had the second highest number of confirmed cases and deaths in the state. [28, 29]. There are more than 2 million Latinos in Riverside County, a majority minority population that outnumbers all other racial and ethnic groups in the area. [30,31,32]. Most Latinos are of Mexican descent, with smaller numbers Puerto Ricans, Salvadorans and Guatemalans, and Indigenous Nations . Latinos in this region suffer from health disparities due to low income and education, limited English proficiency and undocumented status [34,35,36]. Unsurprisingly, the pandemic has severely impacted this population in the region: At the start of research in the fall of 2020, which corresponded to the spread of the second wave of the coronavirus in California, county-level data indicated that the Latinx population accounted for 57% of COVID-19 cases and 46% of deaths in Riverside County [28, 29, 37, 38].
Our study focused on the engagement of Latinx and indigenous Mexicans in rural farming communities in the eastern part of the Coachella Valley in Riverside County. The Coachella Valley, a 45-mile-long valley encompassing nine towns and rural farming communities, is an area of particular racial and ethnic disparity. This area is home to several vulnerable communities, including the rural unincorporated communities of the Eastern Coachella Valley (ECV): Mecca, North Shore, Oasis, and Thermal, which are home to many Latin immigrants and Mexican natives living below. the poverty line and working in the surrounding area. agricultural fields. This region is home to the Purépecha community, an indigenous Mexican population from the state of Michoacán . Early in the pandemic, this area was identified as a hotspot, with some reports indicating a rate of COVID-19 infection in ECV 5 times higher than other communities in the Coachella Valley .
During our study, these rural unincorporated communities (Mecca, North Shore, Oasis, and Thermal) consistently reported the highest rates of COVID-19 cases per 1,000 population in the Coachella Valley. For example, in September 2020, Thermal reported >130 cases/1,000 population, which increased to >250 cases/1,000 population in January 2021. This is significantly higher than the case rates in Palm Springs (also in Coachella Valley), which reported >20 cases/1,000 population in September 2020 and >50 cases/1,000 population in January 2021 .
This trend of increasing total confirmed COVID-19 cases in these ECV communities continued throughout the study period. In September 2020, Makkah had 455 cases rising to 1079 cases in January 2021; North Shore had 136 cases rising to 331 cases; Oasis had 333 cases rising to 826 cases; and Thermal had 185 cases dropping to 440 cases . An increase in deaths from COVID-19 has accompanied the increase in cases. In September 2020, Makkah had 9 reported deaths rising to 16 in January 2021; North Shore recorded 1 death and remained stable; Oasis had 5 reported deaths increasing slightly to 6; and Thermal had 0 reported deaths rising to 4 deaths .
During community advisory board meetings, meetings with partners (e.g., public health, health officials), and attendance at meetings with producers, we made ethnographic observations and noted key discussion topics . . Team members reflected on these observations and used this information to inform the focus group interview guide and data analysis and interpretation.
Focus Group Eligibility and Recruitment
health promoters recruited community members into the focus groups by distributing study flyers with eligibility criteria and study contact information to individuals and families in their social networks. Eligibility criteria were met if a community member: 1) was 18 years of age or older, 2) lived in the ECV and/or Salton Seaside Farmworker Community, 3) was s identified as Latino/Hispanic, Latinx and/or Native Latin American, and 4) spoke Spanish and/or Purépecha. Monolingual English-speaking Latinos and monolingual speakers of an indigenous dialect other than Purépecha were excluded from participation.
A focus group is a group interview that allows qualitative researchers to collect collective data on a specific phenomenon of interest. This method of data collection allows participants to build on the insights of others , providing collective (rather than individual) knowledge about the structural and socio-cultural factors that shape perceptions of the coronavirus and attitudes and behaviors around COVID-19 testing and vaccination. From November to December 2020, we conducted seven virtual focus groups (six to ten people each) to gain insights into shared structural stressors and socio-cultural factors that shape attitudes and behaviors around testing and prevention. vaccination against COVID-19. For non-probability samples, 80% of themes can be identified in two to three focus groups and 90% in three to six focus groups .
health promoters facilitated the focus groups with the help of medical and pre-medical students. All facilitators have received training in qualitative data collection and data analysis. Facilitators used a semi-structured interview guide with open-ended questions to elicit information about shared beliefs and attitudes regarding the virus, its spread, COVID-19 testing and future vaccination, as well as harm reduction behaviors. risks such as social distancing and use. of face coverings. We sparked discussions around themes emerging from our ethnographic observations and conversations with community members at public health outreach and testing events, including trust in public health officials, government and health providers/systems, as well as strategies and tools to support people with COVID -19 and increase risk reduction behaviors and uptake of COVID-19 testing services. At the end of all focus groups, participants were asked to complete a demographic survey, either by using a link to a Qualtrics (online) version of the survey or by asking a team member to administer the survey to them by telephone.
Focus groups were conducted via Zoom video conferencing, audio recorded, transcribed and analyzed using pattern and matrix analysis, a rapid qualitative analysis technique [44,45,46]. This technique involved summarizing all of the focus group transcripts using a template organized according to the key topics of the semi-structured interview guide (template analysis). Key areas included: the coronavirus, its spread and ways to reduce the spread of the virus; attitudes and beliefs about COVID-19 testing, barriers to testing, and resources for people who test positive; and thoughts on COVID-19 vaccines and barriers to vaccination. A matrix was then created to organize the responses from each summary template (as rows) by key areas (as columns). Promoters of health and students participated in a two-part training on pattern and matrix analysis and led data analysis with support from experts in this analytical approach. Team members read the transcripts line by line and inserted data, including illustrative excerpts from the interviews, into the templates. Next, a matrix (focus group × domain) was created and data from each model was inserted into the matrix. The matrix facilitated the identification of cross-cutting themes/patterns in the seven focus groups conducted.
Through this iterative process of theme identification and constant comparison between cases, we have developed a data-driven conceptual model (Fig. 1) that reflects the relationships between themes and their connection to COVID-19 testing and the vaccination. We used exemplary citations to support these models. Participant quotes were translated from Spanish to English by the first author, a native English speaker fluent in Spanish. Bilingual (Spanish-English) graduate and doctoral level team members then checked participants’ quotes for accuracy and validated them.