Although everyone is affected by COVID-19 and the resulting pandemic, not all populations are equally affected. In the United States, for example, COVID-19 cases and death rates among Latinos and Indigenous peoples have been disproportionately high.
To understand how health determinants influence perceptions of the coronavirus, its spread, and decision-making related to COVID-19 testing and immunization in vulnerable populations, a team of researchers from the University of California, Riverside conducted a study in the Eastern Coachella Valley region in inland Southern California, home to Latino and Indigenous Mexican farmworker communities.
Led by Ann Cheney, an associate professor of social medicine, population and public health at the School of Medicine, the team reports BMC Public Health that these immigrant groups are vulnerable to inequalities that increase their risk of COVID-19 exposure, morbidity and mortality.
Common themes that emerged in seven focus groups we conducted included misinformation, lack of trust in institutions, and insecurity around employment and residency. Our study clearly shows that the pandemic has reinforced historically rooted structural inequalities and social factors that shape health disparities among marginalized communities of color. Minority groups suffer disproportionately from chronic conditions and have poor access to health care.”
Ann Cheney, Associate Professor of Social Medicine, Population and Public Health, School of Medicine, University of California – Riverside
Cheney and her colleagues conducted the study from August 2020 to January 2021 and used community-based participatory research. The team conducted six focus groups in Spanish and one focus group on Purépecha, a language spoken by indigenous Latin Americans in the Mexican state of Michoacán. Fifty-five people participated, all identifying as either Hispanic/Latino and/or Purépecha. More than a third of the participants identified themselves as agricultural workers.
“Most of the participants felt affected by the coronavirus due to reduced hours and income, incapacity or absence from work, childcare responsibilities, and COVID-19 infection,” said Daniel Gehlbach, first author of the research paper and a fourth-year medical student. “Issues such as misinformation, as well as insecurity and fear related to employment and deportation concerns, came up in discussions in our focus groups. It was clear that exclusion, discrimination and violence are shaping eastern Coachella Valley attitudes towards the coronavirus and its spread, influencing behaviors related to COVID-19 testing and immunization and ultimately increased risk of COVID-19 exposure.
The Coachella Valley, a racially and ethnically diverse area identified as a hotspot early in the pandemic, includes nine cities and rural farming communities. Many Latino and Indigenous Mexican immigrants in the region live below the poverty line and work in the nearby agricultural fields.
“There is an urgent need for interventions to address distrust of government and public health in this population, which would help reduce structural vulnerabilities,” Cheney said. “Residents of the eastern Coachella Valley suffer from health disparities due to low income and education, limited English proficiency and undocumented status. It should come as no surprise that the pandemic has hit this population hard.”
Key findings from the study are that many East Coachella Valley residents:
- have limited access to the internet and may not have access to reliable public health sources for information about COVID-19. Many rely on word of mouth or social media platforms.
- There is a lack of reliable and trustworthy sources of information in Spanish and Purépecha, leading some to believe that they would get infected by visiting test sites.
- Experience job insecurity, shape decision-making around COVID-19 testing, and fear losing your job if you test positive.
- Are unsure about using COVID-19 testing services due to their immigration and citizenship status. Participants noted that fear of being identified as undocumented at testing and vaccination sites is a significant concern among Latino and Indigenous Mexican farmworker communities.
- Have limited faith in government agencies. Participants spoke about public perceptions of government and public health working together to harm minority groups. This lack of trust in institutions extends to hospitals and the healthcare system.
“One way to build trust in government institutions and the health care system is to involve those who are most vulnerable to COVID-19 in decision-making related to outreach and service delivery,” Cheney said. “Positive COVID-19 messages from vendors and trusted community members, such as Community health workers or promoters de salud increase vaccine uptake. When medical leaders and trusted members of the community promote COVID-19 testing and vaccination, it can positively influence COVID-19 decisions.”
Cheney calls for more attention to be given to delivering public health information and news in a way that is accessible to culturally and linguistically diverse communities, particularly underserved and marginalized communities who may not speak English and have limited access to broadband have internet connections.
“We encourage sharing COVID-19 materials with vulnerable Latin American communities through community and ethnic media sources such as print, radio and television,” she said. “A printable community report we created is available in English and Spanish.”
Cheney and Gehlbach were joined on the study by community researcher María Pozar, co-investigator Evelyn Vázquez, graduate and medical students Gabriela Ortiz, Erica Li, Cintya Beltran Sánchez, and community health worker Sonia Rodríguez.
The study was supported by grants from the Desert Healthcare District & Foundation and the National Institutes of Health Community Engagement Alliance (CEAL) initiative.
University of California – Riverside
Gehlbach, D. et al. (2022) Perceptions of the coronavirus and COVID-19 testing and immunizations in Latino and Indigenous Mexican immigrant communities in the eastern Coachella Valley. BMC Public Health. doi.org/10.1186/s12889-022-13375-7.