Rural Americans are at higher risk of many severe COVID-19 related health outcomes. These
disparities are likely to endure given lower vaccination uptake in many rural
communities, and also the continued emergence of SARS-COV-2 variants, even as overall
vaccination rates and COVID-19 treatments improve. Better understanding and addressing
rural disparities in COVID-19 could be aided by SARS-CoV-2 antibody testing that can
measure herd immunity, assess vaccination efficacy and uptake, and perhaps inform
re-vaccination strategies. However, implementing antibody testing education and outreach
in rural contexts poses unique challenges, including that many rural communities remain
skeptical of COVID-19 testing and treatment. Moreover, rural communities are racially and
regionally diverse, including predominantly White populations in some rural regions, but
largely African American in others. Such diversity highlights that tailoring the use of
specific antibody communication strategies to particular rural contexts is critical.
Another challenge posed by rural contexts is in implementing biological sample
collections, including effectively distributing and receiving biospecimen collection kits
and ensuring proper sample collections. Taken together, there is an urgent need to
develop and evaluate communication and collection strategies that can better promote
SARS-CoV-2 antibody testing in diverse rural contexts. This study seeks to evaluate
communication strategies for better encouraging understanding and uptake of salivary
SARS-CoV-2 antibody testing among individuals residing in rural Northern Michigan. The
central hypothesis is that rural Americans will be receptive to antibody testing when
communication is specifically tailored, and when non-invasive home-based salivary
collection is used. The rationale is that combining effective rural health communication
with home-based salivary testing will reduce skepticism and mistrust, and promote uptake
that can lead to better grasping and addressing rural disparities in COVID-19. The
clinical trial aims for this study are to 1) develop and compare the effects of tailored
rural videos about antibody testing to general antibody education videos on salivary
antibody testing attitudes, intentions, and behavior among rural White Americans residing
in Michigan, and rural African Americans residing in Arkansas; 2) compare effects of
tailored rural videos on activation of medical mistrust among rural White Americans in
Michigan and rural African Americans in Arkansas when considering antibody testing; and
3) develop, evaluate, and compare the efficacy and fidelity of a protocol for home-based
salivary collection in rural contexts that includes sending, collecting, receiving and
successfully assaying for SARS-CoV-2 antibodies using salivary collection kits. In this
study iteration, the investigators will consider individuals recruited from rural
Northern Michigan and assess individuals' willingness to participate in home-based saliva
sample collections.