Immigrant communities may be more hesitant to disclose personal health information due to fears of bullying or deportation, a new study finds.
While public health experts maintain that contract tracing is an important part of any COVID-19 mitigation plan, that bumps up against the reality that certain individuals or populations are resistant to sharing health information with a government entity, particularly if they are not legal US citizens. Engendering trust may hinge on strengthening privacy policies that will reassure undocumented residents they will not be subject to surveillance, discrimination, or even deportation.
A small study published in JAMA Network Open sheds some light on concerns about COVID-19 expressed by people in the undocumented immigrant community. Two scientists from the Harvard T.H. Chan School of Public Health and the Fielding School of Public Health, University of California, Los Angeles, conducted interviews with 20 undocumented immigrants between June 2020 and October 2020. The subjects, who were Latinx and Asian, answered questions about COVID-19’s impact on them in terms of finances, personal health, and social bonds.
After the fourth subject was interviewed, the researchers realized they needed to include specific questions about contact tracing and how it is used in this community. Of the 16 subjects asked about how much they knew about contract tracing, 6 were unfamiliar with it and only 2 had ever been in touch with a contact tracer. After being briefed on the basics of contact tracing, 13 participants said they were concerned about revealing information and 10 said they were worried specifically about immigration issues.
Participants were asked about their Deferred Action for Childhood Arrivals (DACA) status, as DACA offers extra protection to people who were brought to the U.S. as children or young adults. “Our question about DACA status did not intend to reveal patterns about contact tracing distrust, specifically,” Hye Young Choi, a Harvard T. H. Chan School MPH student and co-author of the study, said. “Rather, we asked about DACA status as part of a general sociodemographic survey we conducted at the beginning of each interview. This is because DACA is a key determinant of numerous social, economic, and health outcomes among undocumented immigrants.”
The study revealed that subjects who were DACA recipients expressed greater trust in contract tracing than non-DACA subjects because they felt it would not negatively impact them, in contrast to their non-DACA relatives whose situations were judged to be more precarious given their immigration status and limited English.
Public health departments might do well to consider the thoughts of the subjects in this study as they pertain to boosting trust. “Expanding DACA or DACA-like protections could ensure more immigrants feel comfortable engaging with contact tracers,” Choi said. “Other participants recommended affirmation of sanctuary policies by public health departments, specific and unprompted reassurance from contact tracers about privacy and confidentiality from law enforcement and immigration agents, being able to speak with trusted community members rather than contact tracers, and more education about contact tracing within trusted and understandable information sources.”
Other concerns the subjects expressed included not having the ability to access recommended health care during the pandemic and not being able to call in sick at work for fear of being fired or having employers reject their requests for sick leave.
The study’s limitations include its small size and the fact that a snowball sample was used, meaning participants recommended other participants for the study. However, with more than 16.7 million people in the US living in families that have mixed immigration status or at least 1 person who is undocumented, the concerns of this population are important if the US is to make meaningful progress toward ending the pandemic.