Factors Associated With US Public Motivation to Use and Distribute COVID-19 Self-tests

This survey study examines factors associated with motivation to use and distribute self-tests for COVID-19 infection among US adults.


Introduction
The coronavirus disease 2019 (COVID-19) pandemic has compelled the rapid development and implementation of novel diagnostics to detect the causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). One potential strategy to increase testing coverage is the secondary distribution of COVID-19 self-testing kits, 1,2 whereby at-risk or infected individuals distribute test kits to contacts in their social network; this strategy has been successfully implemented to increase HIV testing. 3 Furthermore, this strategy may be associated with improved contact tracing by facilitating case detection if test kits are distributed to contacts of infected individuals. Given the urgent need to increase COVID-19 testing coverage and contact tracing, we examined individuals' motivation to self-test and to distribute self-test kits.

This survey study used data from Amazon's Mechanical Turk (MTurk), an online platform that
provides high-quality health-related data. 4 We limited participation to US adults 18 years or older.
The University of Pennsylvania institutional review board reviewed and approved this study and granted a waiver of informed consent because the research presented no more than minimal risk of harm to participants and involved no procedures for which informed consent is normally required.
This study followed American Association for Public Opinion Research (AAPOR) reporting guideline.
Participants were given information about self-test kits and an explanation of how the kits were to be used. We used 6-point scales (1 indicating extremely unlikely and 6 indicating extremely likely) to measure levels of motivation to do the following: (1) distribute self-test kits to contacts if the individual tested positive, (2) self-test if the individual received a kit from a potentially infected contact, and (3) order a free self-test kit online if exposed to COVID-19. We dichotomized levels of motivation (1-3 vs 4-6) and used logistic regression to assess the association between motivation and specific sociodemographic characteristics (age, income, gender, race/ethnicity, marital status, and education). All tests were 2-sided, and statistical significance was set at P < .05. Analyses were performed using Stata, version 15.1 (StataCorp LLC).
In multivariable analyses, motivation to distribute self-test kits was associated with above-

Discussion
We found that the majority of survey participants were motivated to distribute COVID-19 self-test kits and to use self-test kits. Motivation is a prerequisite for voluntary behavior, 5 and our findings suggest that the secondary distribution of COVID-19 self-test kits may be associated with increased test uptake and case detection. However, individuals with lower socioeconomic status reported lower motivation and may be less likely to distribute test kits and self-test; behavioral interventions may help increase motivation in this population. Limitations include use of online sampling methods, which may limit generalizability of prevalence estimates and introduce sampling bias; however, observed associations from MTurk sampling are often comparable to those obtained by conventional survey methods. 4 In addition, we did not assess behavioral outcomes, and social desirability may be present with self-report data. Nonetheless, measures of motivation have been shown to more accurately predict health behavior than alternative variables. 5 Future research may help determine whether COVID-19 self-testing and secondary distribution of self-test kits are associated with increased testing coverage.