NYC Housing Authority Resident COVID Response (RCR) Project - Focus Group Analysis and Summary - RADx-UP
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NYC Housing Authority Resident COVID Response (RCR) Project Focus Group Analysis and Summary
ABSTRACT INTRODUCTION Figure 1. Referral Sources Disclosed
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As part of the National Institutes of Health-funded In response to the pandemic the National Insti-
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Rapid Acceleration of Diagnostics-Underserved tutes of Health launched the Rapid Acceleration
Populations initiative, New York University’s Rob- of Diagnostics (RADx)- Underserved Populations 6
ert I. Grossman School of Medicine and School initiative. In September 2020 New York University 4
of Global Public Health are studying barriers to received funding from this program to launch the 2
COVID-19 NYC housing authority. Focus groups NYCHA Resident COVID Response (RCR) project.
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were conducted from December 2020 - March The aims are to develop and implement a commu- HCC HSS CAMBA Flyer Word of mouth MAP Social media NYCHA Email
2021, in partnership with community-based or- nity -engaged intervention to increase COVID-19
ganizations, including Harlem Congregations for testing. To inform the design of the intervention, Focus Groups Figure 3. Main Themes
Community Improvement, Inc and Henry Street New York University, in partnership with communi- Due to COVID-19 restrictions in New York City,
1. Reasons for not getting tested
Settlement. This report summarizes the focus ty-based organizations, including Harlem Congre- focus groups were conducted using Zoom. Upon
2. Reasons for getting tested
group findings and implications for increasing gations for Community Improvement, Inc. (HCCI), logging on, each participant was renamed with an
3. Preferences for testing
testing among NYCHA residents. Findings are Henry Street Settlement (HSS), and Church alias, to maintain anonymity and confidentiality.
4. Strategies for increasing testing
informed the design of a community-engaged Avenue Merchant Block Association (CAMBA) Focus groups were recorded and then transcribed
5. Attitudes towards vaccine
intervention to enhance uptake of testing among conducted focus groups to gain a deeper under- verbatim for analysis.
racial/ethnic minority populations. standing of the barriers to testing among NYCHA
residents. This report summarizes findings from Figure 2. Participant Neighborhoods
the focus groups and suggests strategies for en- FINDINGS
SUMMARY hancing testing in this population. Participant
Neighborhoods We present the main findings from the analysis.
Focus groups (FG) with residents living in New York Issues related to trust, or lack of trust, emerged
City public housing elicited a range of structural METHODS Bronx throughout the discussions. They are therefore
barriers (e.g., long lines, homebound, challenges Harlem reported across the main themes.
quarantining), and attitudes, beliefs and gaps in Recruitment - Referral Sources East New York
knowledge that were associated with a reluctance Residents were recruited through flyers and infor- Lower East Side WHY RESIDENTS ARE NOT GETTING TESTED?
to get tested. These beliefs were related to a lack of mation sharing through our partnering communi-
trusted sources of information, the spread of mis- ty-based organizations, HCCI, HSS, and CAMBA. Fear of testing
information, concerns about the safety of the test Figure 1 summarizes the main source of refer- Fear of testing was primarily related to a lack of
The NYCHA Resident COVID Response (RCR)
and fear of receiving a positive test result. Residents rals based on residents’ response. Recruitment trust. Residents expressed fears about where the
Community Steering Committee (CSC) provided
were also unaware of recommendations for routine targeted six NYCHA developments in Harlem, testing data was being stored and who would have
feedback on the focus group guide before it was
testing. FG data was collected over 4 months, with a the Lower East Side, and East New York. These access to these data. The also feared the test itself.
finalized. Eight focus groups were hosted in English,
clear shift in attitudes towards greater trust in test- developments included Polo Grounds Towers and For example, there were concerns that the test itself
and one focus group was hosted for Spanish-
ing over time. More residents reported being tested Ralph J. Rangel houses in Harlem, Jacob Riis and might transmit COVID-19. They were also hearing that
speaking residents. All participants were reimbursed
for SARS CoV-2 infection and there was less con- Vladeck houses in the Lower East Side, and Pink the nasal swab test was painful or witnessed others
with a $30 Amazon electronic gift card via email.
cern about the safety, but the need for more conve- and Cypress houses in East New York. However, to experiencing discomfort which was associated
nient testing options persisted. Vaccine hesitancy increase the number of attendees we expanded with reluctance to get tested. Fear of a positive test
Analysis
was prevalent and persisted over time. Resident eligibility criteria beyond the original four NYCHA results was also reported as a barrier to testing. This
Focus group findings were analyzed using a qualita-
feedback suggested modifiable barriers to testing developments. Thirty-six residents participated included concerns about who would have access to
tive rapid analysis approach. This involved applying
and vaccination that are informing a community-en- in nine focus groups conducted from December these data and fears about being forced to isolate
a deductive approach in which data were systemat-
gaged intervention that is specifically addressing 2020 through March 2021. Figure 2 shows the themselves from their families without their consent.
ically coded using a template that outlined the main
residents’ concerns and their need for accurate distribution of participants by neighborhood. One resident noted, “some may not want to give their
topics covered in the focus group guide. The analysis
information about vaccine efficacy and safety, the personal information or to feel that they are being
also allowed other themes to emerge. The research
need for ongoing testing despite the availability of traced, so they hold back altogether on being tested.”
team used an iterative process of meeting weekly to
vaccines, referrals to more convenient testing loca-
discuss discrepancies until the team reached con-
tions, and support to improve access to vaccines.
sensus. The final themes are outlined in Figure 3.
“ “How do I know they’re not givin’ it to me
when they swab my throat or my nose?”
Misinformation WHY RESIDENTS ARE GETTING TESTED I would rather have someone who is educated in formation to residents’ homes, and some suggest-
Residents received information about COVID-19 doing do it, rather than me at home trying to do it ed knocking on doors. Residents also responded
from a wide range of sources including the news, More than half of the FG participants had been myself.” Another noted, “It would be easier, but then positively to the idea of a community health worker
local politicians, and word of mouth. When the tested at least once (Figure 4). Reasons included: again, you don’t know if you’re doing it correctly.” (CHWs) model in which CHWs were available to
latter was probed, word of mouth emerged as a prep for a medical procedure, exposed to some- provide this information and other resources.
primary source of misinformation and misunder-
standing of the risk of infection. For example, focus
group participants reported that many residents
one with the virus and having a high-risk job. As
one resident noted, “I’m always in the community.
I volunteer in the community.”
“ “If it’s a testing kit as a woman would
use to find out if she’s going to have a
baby, I’m all for it”
Figure 5. Resident Suggestions for
Increasing Testing
did not believe that COVID-19 was real, but rather
• Provide accurate easy to read information
a tactic to scare racial/ethnic minority groups. As Figure 4. Resident Testing Activity Testing at a central location.
(e.g., develop a COVID handbook)
one resident said, its,“just a government tactic to Some focus groups included members of the
• Host events/testing in developments or
scare people of color”. They were hearing from Residents Mayor’s Action Plan for Neighborhood Safety
community centers
neighbors that the novel coronavirus is “fake,” and Who Have (MAP), which has been very active in addressing
• Create multilingual materials
not as serious as it has been depicted in the media: Been Tested community needs related to COVID-19 (e.g., shar-
• Continue conducting outreach
“A lot of people, they just don’t know what’s going ing information, distributing food). MAP commit-
• Knock on doors with COVID tests on hand
on…They don’t believe in COVID, or that its real.” Did not share tee members and other residents endorsed onsite
• Post to social media/email information
This finding again illustrated how a lack of trust Did not test testing options that leveraged existing space
• Create age appropriate materials
in information sources and the government more Previously Tested including, community centers and mobile units.
• Make self-tests available
generally is driving reluctance to get tested.
“
• Keep testing convenient
“It’s very easy here, I don’t want to go any-
Challenges getting tested PREFERENCES FOR TESTING where else… we have it easy here with the
Three main themes emerged related to challenges mobile unit here below.” As previously described, self-testing was consis-
related to getting tested. tently the preferred method for testing. Residents
Most residents described a greater level of comfort
• Long Lines: Residents expressed concerns Testing by professionals were particularly intrigued by the idea of a saliva
with getting tested in a clinical setting (e.g., minute
about waiting in long lines for hours at sites As noted above, residents clearly described their test to identify COVID, “it’s convenient and less
clinics, hospital, or primary care practice) because
where they could not reserve an appointment preference for receiving the test from a trusted painful.” Residents were also responded positively
of greater confidence in the staff. However, many
ahead of time. Associated with the inconve- professional. Residents preferred licensed or cer- to an option that we described in which residents
residents endorsed onsite testing if it was clear that
nience was the fear that waiting would increase tified medical professionals to complete any tests, could self-administer the nasal swab test at con-
the staff conducting the testing were trained. Span-
their risk of COVID-19. As one resident said, “The specifically mentioning licensed practical nurse venient locations.
ish-speaking participants similarly supported more
lines are long, and we can catch COVID [while (LPN), registered nurse (RN), and medical assis-
“
convenient testing opportunities including having a
waiting in line].” It was notable that so many tants (MA). However, most also agreed that they The source of information should be ...
mobile van in their development. In terms of prefer-
residents were relying on “minute clinics” as a lo- would be comfortable if the individual demon- “someone who looks like us, who
ences for the type of test, residents clearly preferred
cation for testing and other urgent care options. strated an appropriate level of knowledge. talks like us.”
a self-testing option or options that caused less
• Travel to Healthcare Facility: For similar reasons, discomfort and were interested in home testing.
residents were concerned about being on public STRATEGIES FOR INCREASING TESTING All of the residents emphasized that messages must
transportation, within an enclosed space with come from a trusted source, and preferably some-
Self-testing options
others who may be infected with COVID-19. “We Many residents were eager to share recommen- one from within their community. They liked the idea
Preferences for self-testing and at home testing
worry to go on the bus because if we go on the bus, dations for increasing the uptake of testing in of one-on-one interactions with a knowledgeable
were associated with an interest in having more
we are worried to catch COVID and then worried to their communities. Participants suggested a more person from the community: “that’s a great thing,
control over the process. One resident described
take the train because we could catch COVID.” proactive approach to engaging residents to share [it] just has to be community structured. Meaning
the ideal test as one that was similar to an at-home
• Cost: This issue was only mentioned by a knowledge about COVID-19 testing options and it has to be discrete, very one-on-one.”
pregnancy test, “If it’s a testing kit as a woman
couple of participants but is important to would use to find out if she’s going to have a baby, other information about COVID-19 including the
note. These residents reported receiving a bill vaccine to counter misinformation, as summa- ATTITUDES TOWARDS VACCINES
I’m all for it.” Although there was general enthusi-
despite having Medicaid. One resident recalled, asm for self-testing options, several residents also rized in Figure 5. Residents suggested that NYCHA
“Some people went…and they got a big bill from disseminate this information through flyers, social Waiting to see what happens and need for more
expressed concerns about their ability to conduct
being tested for the coronavirus…a lot of people media posts and emails and that the information information.
the test correctly. For example, one resident said, “I
don’t want to go to these sites because [they] is translated into multiple languages. They also In the earlier focus groups, most residents were
feel doing it yourself I would be wary about whether
are getting billed for the corona test.” described tabling in the developments, sending in- not planning to get vaccinated. Most wanted to
or not it was done correctly. That’s why I would feel
wait to see what happened to other so that they the potential negative impact of misinformation that IMPLICATIONS inclination to “wait until others have gone first”.
could be more confident that the vaccine is safe. is often spread by word of mouth. Other recommendations include creating easy
As one resident explained, “I want to hear expe- We identified a range of modifiable barriers to access to vaccinations and providing support to
riences from the people and not just one person. Lack of trust surrounding vaccination. testing that can be addressed with a number of older adults and those who are less “tech savvy”
I’m going to watch the news, of course, and I Many residents described a lack of trust based on the strategies that residents suggested. These include to sign up for vaccines. Among Latinx families who
want to hear people like the nurses that got it and history of unethical treatment of Black Americans by creating more accessible and convenient testing appear more open to vaccination, focusing on
politicians.” Residents also expressed the need the medical community and lack of transparency. As locations and adding at home and self-testing access will continue to be important.
for information about safety and effectiveness one resident stated, the “History of things regarding options. The findings also indicated that a cadre of
among different populations including racial/eth- shots and vaccines is where the stress value lies.” residents and/or community health workers, who Our data collection timeline allowed us to obtain
nic minorities, older adults, and those with chronic Others offered more general statements that re- are viewed as trusted sources of information, are feedback before and after the vaccine became
health conditions. They were not convinced that flected this lack of trust saying that residents, “do needed to disseminate information about COVID-19 available. Attitudes towards testing changed over
these groups were appropriately represented in not trust them. Do not trust the government.” that addresses the specific concerns raised in the time with most of the residents in the later groups
the clinical trials. These beliefs persisted in the FGs. This model has the potential to increase resi- having been tested and fewer raising concerns
final focus group, which occurred after vaccines In contrast to the English language focus groups dents’ access to accurate information and increase about testing safety. A lack of convenient testing
became available. In that group two residents that included primarily African American parti- trust in both the testing process and vaccination. sites remained a barrier. However, just as residents
were vaccinated but among others the reserva- ci-pants, those in the Spanish language group are becoming more inclined to get tested, residents
tions described in the first few groups persisted. report-ed no vaccine hesitancy except for some Similarly, there is a need to disseminate accurate believe that once vaccinated they no longer need-
concerns about having a preexisting condition that information through channels that are trusted ed to be tested. Again, accurate and consistent
The few residents who were willing to get the might result in a side effect from the injection. This by the community to reduce vaccine hesitancy. messaging from trusted sources will continue to be
vaccine acknowledged that they did not know the higher level of trust may have been due to timing. Educational information should include data that important as the pandemic and response evolves.
long-term effects and indicated that they knew they This focus group was hosted later in the timeline of participants indicated would be most likely to
would still have to protect themselves with a mask vaccine distribution and therefore residents would motivate them to get vaccinated. This included Ongoing engagement with community-based
and maintain social distance. One resident who did Riishave been exposed to more information that may specific breakdowns of vaccine efficacy among organizations like HCCI and HSS is a core compo-
want to get vaccinated was rethinking this decision have impacted their beliefs. Another possibility for subgroups (e.g., older adults, racial/ethnic mi- nent of these efforts given the central role they are
based on others’ opinions, “[I] think I’m going to •take
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Report Authors and Suggested Citation:
“Kaitlyn VanAllen MPH, Emily Gill MPH, Chigozirim Izeogu MD, Filippa Juul
PhD, Albert Tovar, Natasha Williams PhD, Lorna E. Thorpe PhD, Donna
R. Shelley MD, MPH. NYC Housing Authority Resident COVID Response
(RCR) Project: Focus Group Analysis and Summary. April 2021.”
NYCHA IMAGE SOURCES:
Polo Grounds Vladeck
• newyork.cbslocal.com/2010/11/02/the-polo- • www.flickr.com/photos/joel-
grounds-then-and-now/ rnyc/24299731390/in/pool-nycha/
• www.nymag.com/intelligencer/2017/06/ • www.flickr.com/photos/joelrnyc/18395175790/
could-the-grenfell-tower-disaster-happen-in- in/pool-nycha/
new-york.html • www.flickr.com/photos/jeklee/465433534/in/
• www.www.flickr.com/photos/wallyg/213470920 photolist-H8tb7-FCEwB
Rangel Pink
• www.flickr.com/photos/28516908@ • www.vice.com/sv/article/bnpkp3/one-of-new-
N08/3265386204/ yorks-most-dangerous-housing-projects-now-
• upload.wikimedia.org/wikipedia/com- has-its-own-youtube-show
mons/1/16/Rangel_Houses_NYCHA_jeh.jpg • www.bkreader.com/2017/05/11/nycha-farms-
• www.flickr.com/photos/15499914@ bring-fresh-produce-residents/
N06/9082129056/sizes/l/ • www.usdoh.org/property/ny_Linden_louis-hea-
ton-pink-houses
Riis
• upload.wikimedia.org/wikipedia/commons/c/ Cypress
cc/Riis_Houses_(2020).jpg • www.nydailynews.com/news/crime/nycha-resi-
• ny.curbed.com/2019/8/12/20802171/nycha-au- dents-rise-major-crime-2016-article-1.2934944
dit-fema-sandy-recovery-work-city-council • www.stvinc.com/project/nycha-cypress-hills-boil-
• www.flickr.com/photos/nicolaso- er-and-domestic-hot-water-heater-replacements
ran/6337517836/sizes/l/ • upload.wikimedia.org/wikipedia/commons/1/12/
Cypress_Hill_Houses_NYCHA_jeh.JPG
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