JMIR Publications

ABSTRACT

Background:

COVID-19 remains an on-going public health crisis. Black Americans remain underrepresented among those vaccinated, and overrepresented in both COVID-19 morbidity and mortality. Medical misinformation, specifically related to COVID-19, has exacerbated the impact of the disease in Black American communities. Communication tools and strategies to build relationships and disseminate credible and trustworthy diagnostic and preventative health information are necessary to improve outcomes and equity for historically oppressed populations.

Objective:

As the initial phase of a larger mixed methods project to develop, pilot, and evaluate a mHealth intervention among a population at high risk for COVID-19 and cardiovascular co-morbidities, this study sought to explore COVID-19 information behavior among Black Americans. Specifically, this study examined (1) preferences for COVID-19 education via mHealth, (2) barriers and facilitators to COVID- 19 education and diagnostic testing, and routine care for associated cardiovascular and respiratory comorbidities in the local community, and (3) key content for inclusion in a COVID-19 mHealth application.

Methods:

This qualitative study utilized principles of community-based participatory research and information systems research to conduct seven focus groups across three sites. Focus groups were audio recorded and transcribed for thematic analysis using an abductive approach.

Results:

The study sample included 54 individuals across sites with a mean age 50.24 years (SD=11.76, 20-71 years). Participants were primarily female (n=42, 77.78%) and Black (n=54, 100%), with varied education levels. Over half of the participants were employed full-time (n=29, 53.70%), and nearly three fourths had household incomes below $65,000 (n=40, 74.07%). Participants used both android (n=23, 42.59%) and IOS devices (n=29, 53.70%), and reported they were “very comfortable” (n=37, 68.52%) using their mobile devices. Participants reported using a variety of sources for health information. Content related preferences reported focused on visual presentation, user-friendly design, and privacy, and highlighted the importance of community relevance, access and community-specific content. Key barriers identified included health literacy limiting application use, access to technology and information, and lack of trust. Increasing community relevance through community specific messaging, and the inclusion of Black providers were noted as facilitators that may increase credibility and trust. Key content identified included user-specific information such as where to get vaccines and tests, updated local COVID-19 data, travel protocols, information about long COVID-19, co-morbidities, frequently asked questions, and testimonials or personal stories.

Conclusions:

Increasing transparency and building trust are two key strategies that may improve the impact of health information messaging in Black communities. Focusing on content over context fails in the provision of critical health information and perpetuates health inequities by reinforcing systemic and structural racism. COVID-19 messaging must consider contextual information, patient needs and preferences and patient information seeking and searching behaviors to establishing trust and credibility, positively impact patient health outcomes, and improve health equity. Clinical Trial: N/A