Background: During the COVID-19 outbreak in Louisville, KY, Essential Needs Program (ENP) provided supplemental services to help residents complete their isolation or quarantine (I/Q) without entering public spaces. ENP provided food, household and hygiene products, coordinated prescription deliveries and Medication Assisted Treatment (MAT) for opioid use disorders, and temporary isolation housing away from household members. We aimed to (1) explore the usefulness of ENP services among priority groups and understand barriers for completing I/Q period (2) develop a context-specific framework grounded in experiences of resident consumers to help create equitable preparedness infrastructure.

Methods: The ENP evaluation employed a mixed-methods approach to describe lessons learned from NP consumers who requested to receive ENP services between April 2020 and June 2022 in Louisville, Kentucky. The consumers responded to multiple questions in four domains to assess: (1) quality and timely delivery of services received on a 6-point Likert scale, (2) perceived barriers to staying in I/Q, (3) adequacy of services received, (4) the extent of changes in protective practices among the study groups. Qualitative open-ended questions were also incorporated in most domains. The primary outcome was the self-reported successful completion of the I/Q period, as directed by public health recommendations. Standard established principles of analytic induction such as concrete coding and constant comparative methods were utilized to analyze qualitative responses.

Results: Online survey links were distributed via SMS text messages among 8,898 unique consumer phone numbers and 817 completed surveys were received. When asked whether ENP was able to help participants complete I/Q period, 56% of respondents agreed. 46% of respondents reported ENP services significantly reduced their need to leave I/Q, while 15% thought their need was somewhat reduced. 50% of the respondents with disabilities thought ENP greatly reduced their need to leave I/Q. When asked, the 19.5% respondents who reported leaving I/Q specified reasons such as food and durable goods shortage; lack of childcare; work requirements; lack of help from family or friends; and family or friend-related emergencies. The burden was particularly hard on families with children and households with more than two individuals. However, 35% of the overall respondents reported an increase in preventive practices due to a COVID-19 infection.

Conclusion: Survey respondents reported a heightened sense of shared responsibility and adapting protective measures after testing positive. Therefore, integrating enhanced messaging and health education to this subset of individuals and across public health infrastructure may help decrease the community’s spread of communicable diseases. For better adherence to I/Q policies and the success of supplemental services like ENP, the scope of food and household items should include items more appropriate for households with children. However, to more fully represent social world complexity, virtual in-person interviews with ENP consumers (N=20) will be completed between May-June 2023.

Public Health Implications: Creating local evidence may impart knowledge about the current systemic barriers to creating an equitable and sustainable infrastructure-driven recovery process for at-risk populations of Louisville, KY.