Impact of COVID-19 on Marshallese Communities in the U.S.

• Sponsor: University of Arkansas (Other)
• Overall Status: Completed
• CT.gov ID: NCT04474496
• Collaborator: Patient-Centered Outcomes Research Institute (Other)
• Enrollment: 120
• Location: 1
• Actual Duration (Months): 4.1
• Patients Per Site Per Month: 29

Study Details

Study Description

Brief Summary

Marshallese adults in the U.S. will complete an online or telephone survey. This survey will collect data describing the impact of COVID-19 on Marshallese communities. Data collected will help describe: 1) risk exposure, 2) knowledge of preventive recommendations, 3) barriers and facilitators to implementing preventative recommendations, 4) barriers and facilitators to COVID-19 testing when appropriate, and 5) self-care behaviors during COVID-19. Participant inclusion criteria: 1) Self-reported Marshallese; 2) 18 years of age or older; 3) Live in the Continental U.S. or Hawaii.

Condition or Disease	Intervention/Treatment	Phase
COVID-19	Other: Assessing the impact of COVID-19

Detailed Description

Background and Rationale

While there is much we do not know about the differential effects of COVID-19, early data shows that minority communities are disproportionally effected by the virus. There are many factors that may increase the likelihood of contracting COVID-19 including: 1) community spread because of lack of access to testing in low-income communities, 2) work environments that may increase exposure, 3) more densely populated housing that reduces the ability to social distance, 4) limited understanding of preventive measures due to literacy and language barriers, 5) constrained financial resources to stay home and not work, and/or 6) lack of trust in the health care system. The Marshallese are a Pacific Islander population experiencing significant health disparities with some of the highest documented rates of type 2 diabetes mellitus (T2DM) of any population in the world. Estimated T2DM rates among Marshallese in the U.S. range from 25%-50%, much higher than the general U.S. population. People with T2DM are more likely to experience severe symptoms and complications when infected with COVID-19; however, those that manage their T2DM well are less likely to become extremely ill from the virus. In order to reduce the disparities caused by COVID-19 and ultimately compare the effectiveness of prevention interventions among the low-income minority communities most effected by COVID-19, it is critical to understand minority populations': 1) risk exposure, 2) knowledge of preventive recommendations, 3) barriers and facilitators to implementing preventative recommendations, 4) barriers and facilitators to COVID-19 testing when appropriate, and self-care behaviors during COVID-19.

Specific Aims

Aim 1: Document COVID-19 risk exposure for Marshallese community members.

Aim 2: Document Marshallese community members' knowledge of preventive recommendations.

Aim 3: Document barriers and facilitators to implementing preventative recommendations.

Aim 4: Document Marshallese community members' barriers and facilitators to COVID-19 testing when appropriate.

Aim 5: Document self-care behaviors during COVID-19.

Aim 6: Explore COVID-19 pandemic related barriers and facilitators to T2DM self-management among Marshallese adults with T2DM.

Aim 7: Assess the effect of the COVID-19 pandemic on T2DM self-management activities among Marshallese adults with T2DM.

Study Design and Procedures

Participants will complete an online or telephone survey. Up to 100 participants will also be invited to complete an in-depth qualitative interview in addition to the survey (these results are not presented here). Community-based recruitment for the online survey will be conducted by posting an informational flyer on social media. The flyer will contain a link to the study information sheet and survey documents. Study team members will also reach out to study participants via phone or electronic mediums (e.g. email, text, or messenger). Study staff will send potential participants a link to an electronic survey using REDcap. The REDcap system will include electronic documentation of consent prior to completing the survey. Access to study data will be limited to only those personnel who need it to complete relevant job duties. All data, regardless of whether it is identifiable or not, will be stored in a locked file cabinet in a locked room, or on a secure University of Arkansas for Medical Sciences (UAMS) server that requires two-factor authentication.Each participant who completes the survey will receive a $20 Walmart gift card as remuneration.

Measures/outcomes

Our survey will be based on CDC risk assessments and utilize the NIH funded COVID-19 items that are part of the PhenX Toolkit, as well as other standardized survey items/scales. Those participants with T2DM will be asked to complete questions pertaining to T2DM self-management during COVID-19.

Data Analysis

Given the descriptive nature of the study aims, the analytic strategy will focus on presenting results of item-level descriptive analyses, with an emphasis on frequencies and proportions. There will be no attempt to impute missing responses for any items. For each analysis, the number of included responses will be reported.

Study Design

• Study Type: Observational
• Actual Enrollment: 120 participants
• Observational Model: Other
• Time Perspective: Cross-Sectional
• Official Title: Impact of COVID-19 on Marshallese Communities in the U.S.
• Actual Study Start Date: Jul 27, 2020
• Actual Primary Completion Date: Nov 30, 2020
• Actual Study Completion Date: Nov 30, 2020

Arms and Interventions

Arm	Intervention/Treatment
Marshallese adults in the U.S. Marshallese persons 18 years of age or older currently residing in the United States	Other: Assessing the impact of COVID-19; Surveying Marshallese adults in the U.S. to determine the impact of COVID-19

Outcome Measures

Primary Outcome Measures

1. Personal Preventative Behaviors to Decrease Risk of COVID-19 Exposure [Baseline]

   Participants will report behaviors they regularly engage in to lessen their risk of contracting COVID-19 (e.g., social distancing, wearing a mask, etc.). Participants were asked "Which of the following measures have you taken to prevent infection from COVID-19? (Select all that apply)"

2. Workplace Preventative Actions to Decrease Risk of COVID-19 Exposure [Baseline]

   Participants will report specific steps taken by their employers to reduce risk of contracting COVID-19 (e.g., requiring remote work, mask mandates, etc.). Participants were asked to "Please check all of the following your workplace has done since the COVID-19 outbreak (Select all that apply)".

Secondary Outcome Measures

1. Effects of COVID-19 on General Health Status [Baseline]

   Participants will be asked to rate their general health status compared with before the COVID-19 outbreak. Participants were asked "Compared to the time before the COVID-19 outbreak, is your physical health status better, worse, or about the same?"

2. Effects of COVID-19 on Access to Healthcare Services [Baseline]

   Participants will be asked to report ways in which the COVID-19 pandemic has disrupted access to healthcare (e.g., seeking routine care, getting necessary medications, etc.). Participants were asked "In what ways has the COVID-19 outbreak affected your overall healthcare? (Select all that apply)".

3. Effects of COVID-19 on Dietary Habits [Baseline]

   Participants will be asked to compare their current dietary behaviors with before the COVID-19 outbreak. Participants were asked "How do you think your eating habits have changed compared to before the COVID-19 outbreak?"

4. Effects of COVID-19 on Physical Activity Behaviors (Not Specifically for Exercise) [Baseline]

   After reporting how many times per week they engaged "in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.)", participants were then asked "Is this more, less or about the same as the number of days you participated in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.) in a typical week before the COVID-19 outbreak?"

5. Effects of COVID-19 on Physical Activity Behaviors (Specifically for Exercise) [Baseline]

   After reporting how many times per week they engaged "in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking, etc.)", participants were then asked "Is this more, less or about the same as the number of days you participated in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking etc.) in a typical week before the COVID-19 outbreak?"

6. Effects of COVID-19 on Weight [Baseline]

   Participants were asked to report changes in weight. Participants were asked "Have you noticed your weight change since the COVID-19 outbreak?"

7. Effects of COVID-19 on HbA1c (Glycated Hemoglobin) [Baseline]

   After reporting their most recent HbA1c reading, participants were then asked "How different was this HbA1c reading from your average HbA1c reading before the COVID-19 outbreak?"

8. Barriers to Type 2 Diabetes Management Due to COVID-19 [Baseline]

   Participants with type 2 diabetes were asked to report how the COVID-19 outbreak affected their access to type 2 diabetes supplies (insulin, needles, etc.). Participants were asked "Has the COVID-19 outbreak affected your level of access to the following? (Select all that apply)"

9. COVID-19 Screening [Baseline]

   Participants were asked to report whether they have been screened for COVID-19 and by what method (by phone, online, at work, etc.). Participants were asked "Were you screened for COVID-19? (Select all that apply)".

10. COVID-19 Testing [Baseline]

    Participants were asked to report whether they have been tested for COVID-19 and the results of the test. Participants were asked "Have you had the nose swab test for the virus that causes COVID-19? (Mark all that apply)"

11. COVID-19 Vaccine Willingness/Hesitancy [Baseline]

    Participants were asked to report whether they would accept a COVID-19 vaccine. Participants were asked "If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?"

12. Trusted Sources of COVID-19 Information [Baseline]

    Participants were asked to report which sources of information they trust the most to stay informed about COVID-19. Participants were asked "What resource do you trust most for reliable information about COVID-19?"

13. Effects of COVID-19 on Housing [Baseline]

    Participants were asked how COVID-19 has impacted their housing situation. Participants were asked "Please check all of the following that have happened to you since the COVID-19 outbreak".

14. Effects of COVID-19 on Employment [Baseline]

    Participants were asked how COVID-19 has impacted their employment. Participants were asked "In what ways has the COVID-19 outbreak affected your work? (Select all that apply)".

15. Effects of COVID-19 on Income [Baseline]

    Participants were asked how COVID-19 has impacted their income. Participants were asked "As a result of COVID-19, has your family income changed?"

16. Sources of Stress During COVID-19 [Baseline]

    Participants were asked to report their greatest sources of stress from the COVID-19 outbreak (e.g., health concerns, financial concerns, etc.). Participants were asked "What have been your greatest sources of stress from the COVID-19 outbreak? (Select all that apply)"

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All

Inclusion Criteria:

• Self-reported Marshallese

• 18 years of age or older

• Live in the Continental U.S. or Hawaii

Exclusion Criteria:

• Does not meet inclusion criteria

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Arkansas for Medical Sciences Northwest	Fayetteville	Arkansas	United States	72703

Sponsors and Collaborators

• University of Arkansas
• Patient-Centered Outcomes Research Institute

Investigators

• Principal Investigator: Pearl A McElfish, PhD, University of Arkansas

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Sep 15, 2020

More Information

Publications

None provided.

• Responsible Party: University of Arkansas
• ClinicalTrials.gov Identifier: NCT04474496
• Other Study ID Numbers: 261131
• First Posted: Jul 16, 2020
• Last Update Posted: Apr 5, 2021
• Last Verified: Apr 1, 2021

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by University of Arkansas: Marshallese; Pacific Islanders; Type 2 Diabetes; COVID-19
• Additional relevant MeSH terms: COVID-19

Study Results

Participant Flow

Recruitment Details	Recruitment was open from July 27, 2020 to November 30, 2020. The study was advertised by posting informational flyers on social media. Flyers contained a link to the study information sheet and survey.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Period Title: Overall Study
STARTED	120
COMPLETED	120
NOT COMPLETED	0

Baseline Characteristics

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Overall Participants	120
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	35.5 (8.8)
Sex: Female, Male (Count of Participants)
Female	77 64.2%
Male	43 35.8%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%
Asian	0 0%
Native Hawaiian or Other Pacific Islander	120 100%
Black or African American	0 0%
White	0 0%
More than one race	0 0%
Unknown or Not Reported	0 0%
Region of Enrollment (participants) [Number]
United States	120 100%

Outcome Measures

1. Primary Outcome

Title	Personal Preventative Behaviors to Decrease Risk of COVID-19 Exposure
Description	Participants will report behaviors they regularly engage in to lessen their risk of contracting COVID-19 (e.g., social distancing, wearing a mask, etc.). Participants were asked "Which of the following measures have you taken to prevent infection from COVID-19? (Select all that apply)"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=117 due to missing data on this item for three participants.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	117
Hand washing for at least 20 seconds	114 95%
Avoiding touching your eyes, nose, and mouth with unwashed hands	112 93.3%
Use disinfectants to clean hands when soap and water not available for washing hands	114 95%
Staying home when you are sick or when you have a cold	109 90.8%
Asked family members or friends not to visit me	105 87.5%
Covering your mouth when you cough	113 94.2%
Wearing a face mask	115 95.8%
Physical distancing (keeping minimum 6 feet between you and others from outside your household)	113 94.2%
Staying at home even if you do not feel sick	99 82.5%
Disinfecting surfaces	114 95%

2. Primary Outcome

Title	Workplace Preventative Actions to Decrease Risk of COVID-19 Exposure
Description	Participants will report specific steps taken by their employers to reduce risk of contracting COVID-19 (e.g., requiring remote work, mask mandates, etc.). Participants were asked to "Please check all of the following your workplace has done since the COVID-19 outbreak (Select all that apply)".
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	120
Required employees to work remotely or from home	27 22.5%
Suggested employees work remotely or from home	23 19.2%
Required employees to wear face masks	73 60.8%
Suggested employees wear face masks	41 34.2%
Provided employees with face masks	58 48.3%
Required social distancing at work	59 49.2%
Installed barriers / shields to reduce contact between employees and others	31 25.8%
Taken employee temperatures before entering workplace	61 50.8%
Asked COVID-19 screening questions of employees before entering workplace	41 34.2%
Was tested for COVID-19	47 39.2%
None of these	5 4.2%
Don't know/Not sure	3 2.5%

3. Secondary Outcome

Title	Effects of COVID-19 on General Health Status
Description	Participants will be asked to rate their general health status compared with before the COVID-19 outbreak. Participants were asked "Compared to the time before the COVID-19 outbreak, is your physical health status better, worse, or about the same?"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=119 due to missing data on this item for one participant.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	119
Better	20 16.7%
About the same	74 61.7%
Worse	19 15.8%
Don't know/Not sure	6 5%

4. Secondary Outcome

Title	Effects of COVID-19 on Access to Healthcare Services
Description	Participants will be asked to report ways in which the COVID-19 pandemic has disrupted access to healthcare (e.g., seeking routine care, getting necessary medications, etc.). Participants were asked "In what ways has the COVID-19 outbreak affected your overall healthcare? (Select all that apply)".
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	120
I did not go to healthcare appointments because of concern about entering my provider's office	20 16.7%
My healthcare provider canceled appointment	14 11.7%
My healthcare provider changed to phone or online visits	20 16.7%
My healthcare provider told me to self-isolate or quarantine	21 17.5%
None of these apply	53 44.2%
Don't know/Not sure	5 4.2%

5. Secondary Outcome

Title	Effects of COVID-19 on Dietary Habits
Description	Participants will be asked to compare their current dietary behaviors with before the COVID-19 outbreak. Participants were asked "How do you think your eating habits have changed compared to before the COVID-19 outbreak?"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=119 due to missing data on this item for one participant.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	119
I feel that I am eating more healthy now than before the COVID-19 outbreak	25 20.8%
I am eating about the same as before the COVID-19 outbreak	41 34.2%
I feel that I am eating less healthy now than before the COVID-19 outbreak	30 25%
I have not noticed	18 15%
Don't know/Not sure	5 4.2%

6. Secondary Outcome

Title	Effects of COVID-19 on Physical Activity Behaviors (Not Specifically for Exercise)
Description	After reporting how many times per week they engaged "in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.)", participants were then asked "Is this more, less or about the same as the number of days you participated in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.) in a typical week before the COVID-19 outbreak?"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=119 due to missing data on this item for one participant.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	119
More	27 22.5%
About the same	52 43.3%
Less	35 29.2%
Don't know/Not sure	5 4.2%

7. Secondary Outcome

Title	Effects of COVID-19 on Physical Activity Behaviors (Specifically for Exercise)
Description	After reporting how many times per week they engaged "in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking, etc.)", participants were then asked "Is this more, less or about the same as the number of days you participated in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking etc.) in a typical week before the COVID-19 outbreak?"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=119 due to missing data on this item for one participant.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	119
More	17 14.2%
About the same	56 46.7%
Less	37 30.8%
Don't know/Not sure	9 7.5%

8. Secondary Outcome

Title	Effects of COVID-19 on Weight
Description	Participants were asked to report changes in weight. Participants were asked "Have you noticed your weight change since the COVID-19 outbreak?"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=119 due to missing data on this item for one participant.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	119
I have lost weight	30 25%
I think I weigh about the same	26 21.7%
I have gained weight	34 28.3%
I have not noticed	26 21.7%
Don't know/Not sure	3 2.5%

9. Secondary Outcome

Title	Effects of COVID-19 on HbA1c (Glycated Hemoglobin)
Description	After reporting their most recent HbA1c reading, participants were then asked "How different was this HbA1c reading from your average HbA1c reading before the COVID-19 outbreak?"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

Using survey skip logic, only those participants who selected "yes" to being previously diagnosed with type 2 diabetes were asked this question (n=13).

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	13
Higher	2 1.7%
About the same	5 4.2%
Lower	3 2.5%
Don't know/Not sure	3 2.5%

10. Secondary Outcome

Title	Barriers to Type 2 Diabetes Management Due to COVID-19
Description	Participants with type 2 diabetes were asked to report how the COVID-19 outbreak affected their access to type 2 diabetes supplies (insulin, needles, etc.). Participants were asked "Has the COVID-19 outbreak affected your level of access to the following? (Select all that apply)"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

Using survey skip logic, only those participants who selected "yes" to being previously diagnosed with type 2 diabetes were asked this question (n=13).

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	13
Insulin	2 1.7%
Needles	1 0.8%
Blood glucose meters	1 0.8%
Testing strips	3 2.5%
Other diabetes medication	0 0%
No issues to report	9 7.5%

11. Secondary Outcome

Title	COVID-19 Screening
Description	Participants were asked to report whether they have been screened for COVID-19 and by what method (by phone, online, at work, etc.). Participants were asked "Were you screened for COVID-19? (Select all that apply)".
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	120
Yes, by phone	9 7.5%
Yes, online	7 5.8%
Yes, at a drive-through screening	45 37.5%
Yes, at a healthcare clinic or hospital	32 26.7%
Yes, at work	27 22.5%
No	28 23.3%
Don't know/Not sure	6 5%

12. Secondary Outcome

Title	COVID-19 Testing
Description	Participants were asked to report whether they have been tested for COVID-19 and the results of the test. Participants were asked "Have you had the nose swab test for the virus that causes COVID-19? (Mark all that apply)"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	120
No, I never tried to get tested	20 16.7%
No, I tried to get tested but was not able to	1 0.8%
Yes, and I am waiting for the results	6 5%
Yes, and I tested negative	54 45%
Yes, and I tested positive	33 27.5%
Don't know/Not sure	9 7.5%

13. Secondary Outcome

Title	COVID-19 Vaccine Willingness/Hesitancy
Description	Participants were asked to report whether they would accept a COVID-19 vaccine. Participants were asked "If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=113 due to missing data on this item for seven participants.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	113
Extremely likely	39 32.5%
Somewhat likely	25 20.8%
Unlikely	8 6.7%
Very unlikely	9 7.5%
Don't know/Not sure	32 26.7%

14. Secondary Outcome

Title	Trusted Sources of COVID-19 Information
Description	Participants were asked to report which sources of information they trust the most to stay informed about COVID-19. Participants were asked "What resource do you trust most for reliable information about COVID-19?"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=117 due to missing data on this item for three participants.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	117
University of Arkansas for Medical Sciences	12 10%
Community Clinic	15 12.5%
Another healthcare organization	1 0.8%
Dr. Sheldon Riklon's radio show or Facebook Live videos	14 11.7%
News outlets	4 3.3%
US Dept of Health (CDC, NIH, and other federal health agencies)	40 33.3%
Your state Dept of Health	17 14.2%
Marshallese Consulate/RMI Ministry of Health	7 5.8%
Your pastor	1 0.8%
Other	1 0.8%
None	1 0.8%
Don't know/Not sure	4 3.3%

15. Secondary Outcome

Title	Effects of COVID-19 on Housing
Description	Participants were asked how COVID-19 has impacted their housing situation. Participants were asked "Please check all of the following that have happened to you since the COVID-19 outbreak".
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=118 due to missing data on this item for two participants.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	118
I have moved into a friend or family member's household	3 2.5%
A friend or family member(s) have moved into my household	12 10%
I became homeless (e.g., lived in a shelter, outside, or in a car)	4 3.3%
None of these	98 81.7%
Don't know/Not sure	1 0.8%

16. Secondary Outcome

Title	Effects of COVID-19 on Employment
Description	Participants were asked how COVID-19 has impacted their employment. Participants were asked "In what ways has the COVID-19 outbreak affected your work? (Select all that apply)".
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	120
I lost my job permanently	12 10%
I lost my job temporarily	13 10.8%
I got a new job	9 7.5%
I reduced my work hours	27 22.5%
I increased my work hours	4 3.3%
My job put me at increased risk of getting COVID-19	23 19.2%
I laid off employees	4 3.3%
None of these apply	27 22.5%
Don't know/Not sure	5 4.2%

17. Secondary Outcome

Title	Effects of COVID-19 on Income
Description	Participants were asked how COVID-19 has impacted their income. Participants were asked "As a result of COVID-19, has your family income changed?"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

N=119 due to missing data on this item for one participant.

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	119
Yes, it increased our income	3 2.5%
Yes, it decreased our income	66 55%
No	43 35.8%
Don't know/Not sure	7 5.8%

18. Secondary Outcome

Title	Sources of Stress During COVID-19
Description	Participants were asked to report their greatest sources of stress from the COVID-19 outbreak (e.g., health concerns, financial concerns, etc.). Participants were asked "What have been your greatest sources of stress from the COVID-19 outbreak? (Select all that apply)"
Time Frame	Baseline

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
Measure Participants	120
Health concerns	75 62.5%
Financial concerns	90 75%
Impact on work	75 62.5%
Impact on your child	79 65.8%
Impact on your community	61 50.8%
Impact on family members	75 62.5%
Access to food	59 49.2%
Access to baby supplies (e.g., formula, diapers, wipes)	24 20%
Access to personal care products or household supplies	43 35.8%
Access to medical care, including mental health care	32 26.7%
Access to medical supplies (e.g., prescriptions, testing supplies, etc.)	27 22.5%
Social distancing or being quarantined	47 39.2%
Other	5 4.2%
I am not stressed about the COVID-19 outbreak	1 0.8%
Don't know/Not sure	2 1.7%

Adverse Events

Time Frame	Day of survey
Adverse Event Reporting Description	This was a one-time cross-sectional survey, so there was no contact with participants prior to, or after the completion of, the survey.
Arm/Group Title	Marshallese Adults in the U.S.
Arm/Group Description	Marshallese persons 18 years of age or older currently residing in the United States Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
All Cause Mortality
	Marshallese Adults in the U.S.
	Affected / at Risk (%)	# Events
Total	0/120 (0%)
Serious Adverse Events
	Marshallese Adults in the U.S.
	Affected / at Risk (%)	# Events
Total	0/120 (0%)
Other (Not Including Serious) Adverse Events
	Marshallese Adults in the U.S.
	Affected / at Risk (%)	# Events
Total	0/120 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.