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Experiences of Latinx Individuals Hospitalized for COVID-19A Qualitative Study

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Can experiences of Latinx adults hospitalized with coronavirus disease 2019 (COVID-19) inform improvements to public health and health care?

Findings  In this qualitative study of 60 Latinx adults, participants reported COVID-19 misinformation, felt COVID-19 compounded existing social disadvantage, and risked infection because of the need to work. Participants hesitated to seek hospital care because of immigration and economic concerns.

Meaning  These findings suggest that to contain community spread and reduce unnecessary morbidity, immigration, employment, and economic distress must be addressed through tailored public health messaging and public policy interventions that improve economic conditions.

Abstract

Importance  Latinx individuals, particularly immigrants, are at higher risk than non-Latinx White individuals of contracting and dying from coronavirus disease 2019 (COVID-19). Little is known about Latinx experiences with COVID-19 infection and treatment.

Objective  To describe the experiences of Latinx individuals who were hospitalized with and survived COVID-19.

Design, Setting, and Participants  The qualitative study used semistructured phone interviews of 60 Latinx adults who survived a COVID-19 hospitalization in public hospitals in San Francisco, California, and Denver, Colorado, from March 2020 to July 2020. Transcripts were analyzed using qualitative thematic analysis. Data analysis was conducted from May 2020 to September 2020.

Main Outcomes and Measures  Themes and subthemes that reflected patient experiences.

Results  Sixty people (24 women and 36 men; mean [SD] age, 48 [12] years) participated. All lived in low-income areas, 47 participants (78%) had more than 4 people in the home, and most (44 participants [73%]) were essential workers. Four participants (9%) could work from home, 12 (20%) had paid sick leave, and 21 (35%) lost their job because of COVID-19. We identified 5 themes (and subthemes) with public health and clinical care implications: COVID-19 was a distant and secondary threat (invincibility, misinformation and disbelief, ingrained social norms); COVID-19 was a compounder of disadvantage (fear of unemployment and eviction, lack of safeguards for undocumented immigrants, inability to protect self from COVID-19, and high-density housing); reluctance to seek medical care (worry about health care costs, concerned about ability to access care if uninsured or undocumented, undocumented immigrants fear deportation); health care system interactions (social isolation and change in hospital procedures, appreciation for clinicians and language access, and discharge with insufficient resources or clinical information); and faith and community resiliency (spirituality, Latinx COVID-19 advocates).

Conclusions and Relevance  In interviews, Latinx patients with COVID-19 who survived hospitalization described initial disease misinformation and economic and immigration fears as having driven exposure and delays in presentation. To confront COVID-19 as a compounder of social disadvantage, public health authorities should mitigate COVID-19–related misinformation, immigration fears, and challenges to health care access, as well as create policies that provide work protection and address economic disadvantages.

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Article Information

Accepted for Publication: January 13, 2021.

Published: March 11, 2021. doi:10.1001/jamanetworkopen.2021.0684

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Cervantes L et al. JAMA Network Open.

Corresponding Author: Lilia Cervantes, MD, Denver Health, 777 Bannock, MC 4000, Denver, CO 80204 (lilia.cervantes@dhha.org).

Author Contributions: Dr Tong and Ms Gonzalez had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Powe and Fernandez contributed equally to the study.

Concept and design: Cervantes, Martin, Tong, Powe, Fernandez.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Cervantes, Martin, Kearns, Camacho, Mundo, Powe, Fernandez.

Critical revision of the manuscript for important intellectual content: Cervantes, Frank, Farfan, Kearns, Rubio, Tong, Matus Gonzalez, Collings, Mundo, Powe.

Statistical analysis: Cervantes, Rubio, Collings.

Obtained funding: Fernandez.

Administrative, technical, or material support: Cervantes, Martin, Frank, Farfan, Kearns, Camacho, Mundo, Powe.

Supervision: Cervantes, Martin, Powe, Fernandez.

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Cervantes is funded by National Institute of Diabetes and Digestive and Kidney Diseases grant K23DK117018 and Robert Wood Johnson Foundation Clinical Scholars Program grant 77887. Dr Fernandez is funded by National Institute of Diabetes and Digestive and Kidney Diseases grant K24DK102057. Funding was provided by an internal grant made available from the University of California Office of the President.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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