Availability Versus Accessibility: Identifying COVID-19 Testing Deserts Across Massachusetts.

Throughout the COVID-19 pandemic, communities of color have faced significantly higher rates of COVID-19 infection, as well as poor clinical outcomes. These differences are driven by long-standing structural inequities that prevent effective social distancing efforts and are further exacerbated by disparities in COVID-19 testing. Our study applied the concept of "COVID-19 testing deserts" to systematically identify gaps in testing resource allocation across Massachusetts in May 2020 and March 2021. Testing deserts were identified at the census tract level, using criteria developed by the Department of Agriculture for food deserts. Testing deserts occurred more frequently in segregated Hispanic, segregated Black, mixed minority, and integrated communities, as well as in neighborhoods with low vehicle access and in federally designated Medically Underserved Areas. Segregated communities were those in which more than 50 percent of the population self-identified as non-Hispanic White, Hispanic, non-Hispanic Black, or non-Hispanic Asian, respectively. Testing deserts were overrepresented in counties with high COVID-19 incidence rates, suggesting that testing accessibility is essential for prompt COVID-19 diagnosis and self-isolation.

The Power and Promise of Postpartum Self Care: Evaluation of a Web-Based Tool for Underserved Women.

OBJECTIVES: Joyuus is a culturally diverse, comprehensive online tool designed to address the self-care needs of underserved postpartum women. The tool provides actionable self-care information, knowledge, and skills to improve postpartum health and identifies red flags for when self-care shifts to seeking care. METHODS: We employed a mixed-methods multiphase design to evaluate the Joyuus prototype, including a pre-post evaluation (N = 87) to assess behavioral health outcomes before and after using the tool for a one-month period. 91% completed the post-test (N = 79). The analysis focused on estimation of treatment effect (via 95% confidence intervals) and fitness of instruments in this population. RESULTS: Participants were between 6 months pregnant and one year postpartum, a mean age of 30 years, 100% female, 99% Black, with nearly equal distribution of married (55%) and not married (44%), and above (47%) and below (46%) annual income of $60 K. Key measures saw significant improvement from pre- (mean = 26.44, SD = 5.39) to post (mean = 28.29, SD = 5.26) on the Connor-Davidson Resilience Scale (p < 0.001) Trends toward improvement (not statistically significant) were noted for Depression (EPDS) (p = 0.624) and Anxiety (STAI) (p = 0.286), and no meaningful change on MOS Social Support or COVID-19 Mental Health Impacts Measures. CONCLUSIONS FOR PRACTICE: This pilot study demonstrates that a self-care mobile tool has the potential to address significant health outcomes related to maternal morbidity and mortality. By providing a continuously available companion addressing physical, mental, and real-life questions, it creates value during postpartum for mothers who can often feel overwhelmed or isolated.

Disparities from bedside to "webside": barriers to achieving equity in telemedicine in obstetrics.

Given the urgency of the COVID-19 pandemic, telehealth was swiftly implemented in the United States and shifted from an optional to an essential modality of care. This was important in both maintaining continuity of care, especially for those with chronic illnesses, and in evaluating individuals presenting with illness or acute needs. One of the primary benefits of telemedicine is convenience; however, this is juxtaposed with the various downsides that result from a lack of physical appointments and accessible technology. Notably, there are large barriers to achieving equity for certain communities, of which the most apparent is the "digital divide" that results from a lack of adequate broadband infrastructure and lower technology literacy among members of certain communities and those in rural areas. Without attention to factors that can improve availability, uptake, and experience, disparities will increase with telemedicine. As this technology becomes common practice, it will be important to provide equal reimbursement for in-person and telehealth visits, center patient design and cultural competency in telemedicine programs, and improve broadband and technology access, ensuring that the highest-quality care is delivered to all patients.