Barriers to COVID-19 Testing Among American Indian and Alaska Native People: Comparing Perspectives of Patients and Providers

Objectives: COVID-19 testing is an important strategy to limit the spread of COVID-19 and improve health outcomes. Although health care providers (hereinafter, providers) decide which strategies to implement to improve access to testing, they may not have fully accurate impressions of the barriers faced by patients. We examined patient and provider perspectives on barriers to COVID-19 testing. Methods: We surveyed 788 patients and 77 providers working at 5 health care organizations in the United States that served urban American Indian and Alaska Native people from January through May 2021. We asked patients and providers about barriers to COVID-19 testing and possible strategies that could improve access to testing. We compared patient and provider perspectives by using descriptive statistics and logistic regression; percentages were weighted. Results: Overall, we observed a high level of congruence among patients and providers regarding perceived efficacy of strategies to increase testing. Difficulty finding transportation to the clinic was the least commonly reported barrier by patients (14%) but was the most frequently cited barrier by providers (73%). The most commonly reported barrier by patients was concern for contracting COVID-19 during an in-person appointment (43%). Two strategies, providing mobile testing units (76%) and offering monetary incentives (57%), were not commonly used but were endorsed by most patients and providers. Conclusions: Overall, patient and provider perspectives were highly congruent on perceived barriers to and strategies to facilitate COVID-19 testing. Research on barriers to testing for communicable diseases such as COVID-19 should systematically examine perspectives of both patients and providers to identify potentially effective interventions.