Considering social inequalities in health in large-scale testing for COVID-19 in Montréal: A qualitative case study

Evidence shows that COVID-19 is exacerbating social inequalities in health (SIH). The aim of this qualitative study was to assess how SIH were considered in the design of large-scale COVID-19 testing programs in Montreal (Quebec, Canada). We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo. Findings suggest that large-scale COVID-19 testing in Montreal did not initially consider SIH in their planning phases. However, adaptations were made over time to improve the accessibility, acceptability, and availability of testing services. Actors from the community sector played an important role to ensure that public health interventions considered SIH. These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programmes must address structural barriers to accessing healthcare services through multisectoral collaboration. This will be necessary to ensure that future health crises do not further increase SIH.

Note: Funding: This work was supported by the Canadian Institute of Health Research under Grant number DC0190GP; the French National Research Agency (ANR Flash COVID 2019) Grant number ANR‑20‑COVI‑0001‑01; and the Japan Science and Technology Agency (JST J‑RAPID) grant number JPMJJR2011.

Declaration of Interests: The authors declare that they have no conflict of interest.

Ethics statement:Ethical approval was granted by each hospital involved in the study, and by the Science and Health Research Ethics Board at the University of Montreal for the entire project (CERSES20-061-D). All participants interviewed gave their written informed consent.

Keywords: COVID-19, large-scale testing, social inequalities in health, equity, Canada

Suggested Citation: Suggested Citation

Gagnon-Dufresne, Marie-Catherine and Gautier, Lara and Beaujoin, Camille and Savard, Ashley and Mikanagu, Rachel and Cloos, Patrick and Ridde, Valéry and Zinszer, Kate, Considering social inequalities in health in large-scale testing for COVID-19 in Montréal: A qualitative case study (September 7, 2021). Available at SSRN: https://ssrn.com/abstract=3919128 or http://dx.doi.org/10.2139/ssrn.3919128