The COVID-19 pandemic continues to grow in scale and scope globally, and it represents a major threat to the health and safety of communities worldwide. However, recent epidemiological data indicate that minority populations in the United States, especially Hispanic communities, are disproportionately infected and hospitalized with COVID-19 [1-4]. To develop better public health and preventative measures, it is critical that we collect local data to understand the potential risk factors and perspectives of these populations as they experience the pandemic. This information is necessary to assess existing measures of prevention and create novel, targeted strategies to reduce the burden of COVID-19 on minority populations and control the spread of the virus in all communities [5].

As of October 2020, SARS-CoV-2 has infected more than 7 million people and has resulted in more than 200,000 deaths in the United States [6]. Globally, cases in the United States currently account for over 25% of COVID-19 cases worldwide, and the number of cases is continuing to grow at a concerning rate [7].

This pandemic has highlighted the health disparities that exist in our country, and some of the most apparent inequities are seen among the Hispanic population. In California, Hispanic people comprise only 38.9% of the population; however, they account for 56.1% of COVID-19 cases and 45.6% of COVID-19–related deaths in the state [8]. States across the country report similar case rate disparities, such as Oregon (13% of population vs 39.8% of COVID-19 cases), Washington (13% of population vs 44% of COVID-19 cases) and Utah (14% of population vs 39.4% of COVID-19 cases) [1]. In Chicago, Illinois, COVID-19 cases among Hispanic patients represent almost half of the total cases in the city [9].

Many hypotheses have been proposed for why minority populations and Hispanic communities are disproportionately affected by COVID-19, including limited access to care, increased exposure, and higher prevalence of comorbidities leading to worse outcomes [10,11]. First, it is important to note that Hispanic individuals have the highest uninsured rates of any racial or ethnic group within the United States, creating significant barriers to accessing COVID-19 testing and health care [12]. Additionally, individuals in Hispanic communities are more likely to be employed by public-facing businesses and institutions, including the food service, transportation, and sanitation industries [13]. Because these individuals do not enjoy the privilege of working from home and were required to come into work during stay-at-home orders, they would have been disproportionately exposed to the virus. Living conditions may also play a role in the increased exposure of Hispanic populations to the novel virus; many Hispanic families live in densely populated areas and multigenerational households, which can facilitate person-to-person transmission [10]. Finally, the Hispanic population has an increased burden of comorbidities, including diabetes, hypertension, and heart disease [14]. While these comorbidities do not increase a person’s susceptibility to contracting the virus, they lead to worse health care outcomes. In a recent study of the disproportionate rise in COVID-19 cases among our study population in Orange County, California, researchers at the University of California, Irvine suggested that low income level, household density, lower educational attainment and lower health care coverage are risk factors for COVID-19 infection [15].

While research and epidemiological data have identified COVID-19–related health inequities among minority populations, few efforts have been made to understand how these populations cope with and conceptualize the pandemic. One survey conducted by the Pew Research Center found that Hispanic individuals are more likely to be concerned about COVID-19 compared to the general public. Approximately 65% of Hispanic adults say that the novel virus is a major threat to the health of the US population as a whole, compared with approximately half (47%) of the general public. Additionally, Hispanic adults were more likely to express concern that they would be hospitalized with COVID-19 or spread the virus unknowingly to others [16,17]. These concerns warrant further exploration, especially in the context of a vaccine being released in the coming months. A recent poll conducted by the Associated Press-NORC Center for Public Affairs Research found that only 25% of African Americans and 37% of Hispanic individuals would get a COVID-19 vaccine, compared to 56% of whites [18]. Understanding the attitudes and perspectives of Hispanic communities as they experience the COVID-19 pandemic is equally significant to develop effective, culturally specific public health policies and messaging.

A knowledge, attitudes, and practices (KAP) survey is an ideal tool to understand the risk factors that could predispose Hispanic communities to excess COVID-19 infection and mortality. The data from our survey have yet to be analyzed; however, we believe that understanding these risk factors, as well as the perspectives of this population, will enable public health and clinical institutions to implement effective and culturally relevant interventions to reduce these outcomes. We believe that the methodology of our study to collect KAP and demographic information using a clinic telehealth setup during the COVID-19 pandemic can be an extremely valuable method that can be used to recruit participants in future studies.

Hispanic and other minority communities are experiencing disproportionately high rates of COVID-19 infection and severe outcomes in the United States. In Orange County, California, Hispanic individuals represent 35% of the population but account for almost half of COVID-19 infections and deaths [22,23]. Therefore, it is important to understand and assess the nature of this increased risk in Hispanic communities to contribute to future disease prevention in the next stages of this pandemic.

The KAP survey format has historically been a useful tool in identifying risk factors that exist within a specific population regarding a highly prevalent disease [24]. In addition, the KAP survey provides insight into the perceptions and stigmas that may be preventing people from seeking health care and following safety guidelines when experiencing a pandemic. Finally, some KAP surveys can also identify behavioral risks that cause a population to be more susceptible to a disease [19,25]. For example, our survey will identify individuals who worked outside of their home during the stay-at-home order because they were considered to work in “essential” industries.

We hope that the hybrid remote/in-person design of our pilot study can be used as a foundation for future COVID-19–related KAP studies. Specifically, we believe that the data from our study will pave the way for future COVID-19–related KAP studies in minority populations. Data from future KAP surveys will be used to create effective, evidence-based public health measures and highlight specific risk factors that affect vulnerable minority communities.

Our method of recruitment and data collection is novel and extremely useful for conducting cross-sectional surveys during the COVID-19 pandemic, where most medical practitioners are relying on telehealth appointments [26]. It is critical that during the pandemic, we are able to safely conduct scientific studies without compromising the health of the participants and the study team or the accuracy of the data.

Most importantly, we believe that future COVID-19–related KAP studies can partner with local primary care clinics because these clinics have maintained longevity, rapport, and trust with their patients. Therefore, patients are more inclined to be candid when answering surveys, heavily decreasing response bias. Private primary care clinics within minority communities are also agents for public health changes on a local level [27,28]. The clinic staff are typically advocates of their communities and have autonomy over their practices; hence, they can be open to taking study conclusions and directly implementing them in their patient care routine (ie, increasing COVID-19 education for their patients to prevent future misconceptions).

Our cross-sectional pilot study evaluates the COVID-19–related knowledge, attitudes, and practices of the Hispanic adult population to inform the development of evidence-based COVID-19 prevention policies and public health measures. It is important to partner with local clinics that have existing infrastructures and relationships with their communities to study and ultimately help these vulnerable populations in the era of COVID-19.