# Why People Share (Or Don’t): Race/Ethnicity and Contextual Correlates of Willingness to Disclose Contact Information During the COVID-19 Pandemic in Rural North Carolina

## TL;DR

This study explores how race, trust, and access to health services affect willingness to share contact information for contact tracing in rural North Carolina during the pandemic.

## Contribution

The study provides new insights into how trust in healthcare providers influences contact tracing compliance in rural, low-resource areas, independent of race.

## Key findings

- Lack of access to testing and high trust in healthcare providers were strongly linked to willingness to share contact information.
- Race did not moderate the relationship between trust and contact tracing engagement.
- Contact tracing is viable in rural areas when trust is high and testing access is limited.

## Abstract

Public health relevance—how does this work relate to a public health issue?
Contact tracing has proven useful, but challenging.Given the potential of contact tracing as an effective tool for controlling the spread of communicable diseases, further investigation into factors that contribute to its successful implementation is warranted.

Contact tracing has proven useful, but challenging.

Given the potential of contact tracing as an effective tool for controlling the spread of communicable diseases, further investigation into factors that contribute to its successful implementation is warranted.

Public health significance—why is this work of significance to public health?
We seek to expand knowledge by examining the influence of race/ethnicity and trust on contact tracing compliance, while controlling for access to health services during a public health crisis in a rural sample in the southern United States.A better understanding of the individual and synergistic influences of race/ethnicity, interpersonal and macro-level factors on an individual’s willingness to share information with contact tracers in rural economically distressed areas has implications for improving the effectiveness of contact tracing in low-resourced communities.

We seek to expand knowledge by examining the influence of race/ethnicity and trust on contact tracing compliance, while controlling for access to health services during a public health crisis in a rural sample in the southern United States.

A better understanding of the individual and synergistic influences of race/ethnicity, interpersonal and macro-level factors on an individual’s willingness to share information with contact tracers in rural economically distressed areas has implications for improving the effectiveness of contact tracing in low-resourced communities.

Public health implications—what are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Findings support research that suggests contact tracing is a viable strategy for mitigating COVID-19 transmission in rural communities when trust in health care providers is high and access to testing is limited, regardless of race.The lack of racial differences in the association between trusting health care providers and engagement in contact tracing suggest the interactive effects of race and trust on engagement in public health interventions may be nuanced and requires that more attention be given to place and time.Health care providers and public health officials should work to build strong, trust-based relationships with community members that will, in turn, facilitate adherence to contact tracing recommendations during a crisis.

Findings support research that suggests contact tracing is a viable strategy for mitigating COVID-19 transmission in rural communities when trust in health care providers is high and access to testing is limited, regardless of race.

The lack of racial differences in the association between trusting health care providers and engagement in contact tracing suggest the interactive effects of race and trust on engagement in public health interventions may be nuanced and requires that more attention be given to place and time.

Health care providers and public health officials should work to build strong, trust-based relationships with community members that will, in turn, facilitate adherence to contact tracing recommendations during a crisis.

For historically marginalized groups and residents of low-resource rural communities, contact tracing is a critical tool for controlling the spread of communicable diseases. To improve its effectiveness, more research on identifying factors that influence an individual’s willingness to comply with contact tracers is needed. Therefore, we examined the association of race/ethnicity, contextual factors, and willingness to engage in contact tracing during the COVID-19 pandemic. The sample included 337 adults (56% Black/African American and 66% female). Approximately 80% of the participants indicated they would disclose the names of contacts. The results from the multivariate logistic regression analyses indicated lack of access to COVID-19 testing sites (aOR = 2.20; 95% CI = 1.08–4.48) and trust in health care providers (aOR = 7.57; 95% CI = 3.82–14.88) were significantly associated with willingness to share information with contact tracers. Race did not moderate the relationship between trust and engaging with contact tracers. The results suggest contact tracing is a viable strategy for mitigating disease transmission in rural communities, particularly when trust in health care providers is high and access to testing is limited, regardless of race. Public health officials should invest in maintaining contact tracing teams that include medical providers and prioritize building trusting relationships with all community members.