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Muñoz Bohorquez J, Channell Doig A, Goldring S, Campos E, Burton K, Delacey JL, McCoy LH, Sorenson C, Crist G, Terhune C, Kim J. Access Barriers, Trusted Channels, and Misconceptions About the COVID-19 Vaccine Among Rural Immigrant Farmworkers. HISPANIC HEALTH CARE INTERNATIONAL 2024:15404153241262050. [PMID: 38881300 DOI: 10.1177/15404153241262050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background: Although COVID-19 has disproportionately impacted immigrant agricultural workers, vaccination efforts have been challenging. Barriers to immunization include language, visa status, and access to medical care. Additionally, vaccine hesitancy, mistrust, and misinformation contributed to low uptake. Methods: A community needs assessment was conducted with immigrant agricultural workers (n = 9) and community stakeholders (n = 15) in rural areas of Maryland and Delaware. In-depth interviews were recorded, transcribed verbatim, and analyzed using template analysis. Results: The participants named trusted and untrusted sources, sources of misinformation, and barriers to accessing information and physical locations to receive the vaccine as reasons for not getting the vaccine. Trusted sources included known community leaders and television programs. Some barriers mentioned were fear of deportation, lack of paid time off, language barriers, and difficulty navigating the U.S. healthcare system. Discussion: There is a need for culturally-tailored programs that address misinformation and barriers and use community-based programming.
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Affiliation(s)
- Juliana Muñoz Bohorquez
- Department of Behavioral and Community Health, University of Maryland, College Park, Maryland, USA
| | - Amara Channell Doig
- Department of Behavioral and Community Health, University of Maryland, College Park, Maryland, USA
| | - Sarah Goldring
- Cooperative Extension, University of Delaware, Newark, Delaware, USA
| | - Esmeralda Campos
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland, USA
| | - Kiarra Burton
- Department of Behavioral and Community Health, University of Maryland, College Park, Maryland, USA
| | - Jennifer Lynne Delacey
- Department of Health Policy and Management, University of Maryland, College Park, Maryland, USA
| | - Lisa H McCoy
- University of Maryland Extension, University of Maryland, College Park, Maryland, USA
| | - Catherine Sorenson
- University of Maryland Extension, University of Maryland, College Park, Maryland, USA
| | - Gina Crist
- Cooperative Extension, University of Delaware, Newark, Delaware, USA
| | - Crystal Terhune
- University of Maryland Extension, University of Maryland, College Park, Maryland, USA
| | - Jinhee Kim
- University of Maryland Extension, University of Maryland, College Park, Maryland, USA
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Jason K, Wilson M, Catoe J, Brown C, Gonzalez M. The Impact of the COVID-19 Pandemic on Black and Hispanic Americans' Work Outcomes: a Scoping Review. J Racial Ethn Health Disparities 2024; 11:1157-1172. [PMID: 37117935 PMCID: PMC10147367 DOI: 10.1007/s40615-023-01594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/30/2023]
Abstract
In early 2020, it was hypothesized that COVID-19 would lead to disproportionately negative health and work outcomes for Black and Hispanic adults, but sufficient data had yet been collected to fully support this claim. Now, we have empirical evidence, but little has been done to aggregate this information to fully understand its impact on these communities. Utilizing 44 articles from a scoping review of three databases (PubMed, Web of Science, and Business Source Complete), this study seeks to identify the primary work-related risks that help explain Black and Hispanic adults' disparate COVID-19-related work outcomes (e.g., loss of hours, job disruption, stress). Findings illuminate four primary risks faced by Black and Hispanic workers: (1) being an essential worker, (2) type of work performed, (3) workplace factors; and (4) community and geographic factors. We conclude with policy recommendations that will help inform policy and practice for economic recovery from the pandemic for other marginalized populations.
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Affiliation(s)
- Kendra Jason
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA.
| | - Miguel Wilson
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jamel Catoe
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Courtney Brown
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Mayleen Gonzalez
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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da Costa Miranda AL, da Paixão ART, Pedroso AO, do Espírito Santo Lima L, Parente AT, Botelho EP, Polaro SHI, de Oliveira E Silva AC, Reis RK, Ferreira GRON. Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon. Sci Rep 2024; 14:8776. [PMID: 38627601 PMCID: PMC11021420 DOI: 10.1038/s41598-024-59461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.
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Grants
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program – Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Affiliation(s)
| | | | - Andrey Oeiras Pedroso
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14040-092, Brasil
| | | | | | - Eliã Pinheiro Botelho
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal Do Pará, Belém, 66075-110, Brasil
| | | | | | - Renata Karina Reis
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14040-092, Brasil
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Harrison R, Iqbal MP, Chitkara U, Adams C, Chauhan A, Mitchell R, Manias E, Alston M, Hadley AM. Approaches for enhancing patient-reported experience measurement with ethnically diverse communities: a rapid evidence synthesis. Int J Equity Health 2024; 23:26. [PMID: 38342909 PMCID: PMC10860321 DOI: 10.1186/s12939-024-02107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 01/13/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Patient-reported experience measures (PREMs) are used to drive and evaluate unit and organisational-level healthcare improvement, but also at a population level, these measures can be key indicators of healthcare quality. Current evidence indicates that ethnically diverse communities frequently experience poorer care quality and outcomes, with PREMs data required from this population to direct service improvement efforts. This review synthesises evidence of the methods and approaches used to promote participation in PREMs among ethnically diverse populations. METHODS A rapid evidence appraisal (REA) methodology was utilised to identify the disparate literature on this topic. A search strategy was developed and applied to three major electronic databases in July 2022 (Medline; PsycINFO and CINAHL), in addition to websites of health agencies in Organisation for Economic Co-operation and Development countries via grey literature searches. A narrative evidence synthesis was undertaken to address the review question. RESULTS The review resulted in 97 included studies, comprised 86 articles from electronic database searches and 11 articles from the grey literature. Data extraction and synthesis identified five strategies used in PREM instruments and processes to enhance participation among ethnically diverse communities. Strategies applied sought to better inform communities about PREMs, to create accessible PREMs instruments, to support PREMs completion and to include culturally relevant topics. Several methods were used, predominantly drawing upon bicultural workers, translation, and community outreach to access and support communities at one or more stages of design or administration of PREMs. Limited evidence was available of the effectiveness of the identified methods and strategies. PREMs topics of trust, cultural responsiveness, care navigation and coordination were identified as pertinent to and frequently explored with this population. CONCLUSIONS The findings provide a basis for a maturity model that may guide change to increase participation of ethnically diverse communities in PREMs. In the short-medium term, health systems and services must be able to recognise and respond to cultural and linguistic diversity in the population when applying existing PREMs. In the longer-term, by working in collaboration with ethnically diverse communities, systems and services may co-create adapted or novel PREMs that tackle the factors that currently inhibit uptake and completion among ethnically diverse communities.
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Affiliation(s)
- Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Maha Pervaz Iqbal
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Upma Chitkara
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Corey Adams
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Rebecca Mitchell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, 3800, Australia
| | - Megan Alston
- Elevating the Human Experience Program, NSW Ministry of Health, Sydney, NSW, 2065, Australia
| | - Anne Marie Hadley
- Elevating the Human Experience Program, NSW Ministry of Health, Sydney, NSW, 2065, Australia
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Molina-Rogers N, Kam JA, Cornejo M, Mendez Murillo R. Using the Structural Influence Model to Explore U.S. Latina/O/X/E Undocumented Immigrants' COVID-19 Information Acquisition, Perceptions, and Prevention Behaviors. HEALTH COMMUNICATION 2024:1-15. [PMID: 38314754 DOI: 10.1080/10410236.2024.2309808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
In the first year of the COVID-19 pandemic, U.S. undocumented immigrants were at heightened risk of contracting COVID-19, with many of them being "frontline essential workers" and residing in crowded living spaces. Given undocumented immigrants' elevated susceptibility to contracting COVID-19 at the peak of uncertainty surrounding the virus, we used the structural influence model of communication to explore: (1) how undocumented immigrants acquired information about COVID-19; (2) how they assessed information trustworthiness and accuracy; (3) their perceptions of COVID-19; and (4) how they prevented or managed COVID-19. Drawing from semi-structured interviews with 46 Latina/o/x/e undocumented immigrants residing in California, we found four key themes: (1) (dis)trust in traditional media as participants relied heavily on social media for COVID-19 information; (2) weak and strong ties played a crucial role in co-constructing health outcomes with different levels of organization; (3) learning about COVID-19 through (in)direct experiences; and (4) coping through health literacy and cultural beliefs. The study's findings can inform future efforts to reach highly-vulnerable immigrant communities during a crisis (or different outbreaks in COVID-19 variants), and hopefully, help reduce health inequities.
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Oh H, Marsiglia FF, Pepin S, Ayers S, Wu S. Health Behavior and Attitudes During the COVID-19 Pandemic Among Vulnerable and Underserved Latinx in the Southwest USA. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:279-290. [PMID: 36862363 PMCID: PMC9978289 DOI: 10.1007/s11121-023-01512-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/03/2023]
Abstract
The COVID-19 pandemic highlighted deep-rooted health disparities, particularly among Latinx immigrants living on the Mexico-US border. This article investigates differences between populations and adherence to COVID-19 preventive measures. This study investigated whether there are differences between Latinx recent immigrants, non-Latinx Whites, and English-speaking Latinx in their attitudes and adherence to COVID-19 preventive measures. Data came from 302 participants who received a free COVID-19 test at one of the project sites between March and July 2021. Participants lived in communities with poorer access to COVID-19 testing. Choosing to complete the baseline survey in Spanish was a proxy for being a recent immigrant. Survey measures included the PhenX Toolkit, COVID-19 mitigating behaviors, attitudes toward COVID-19 risk behaviors and mask wearing, and economic challenges during the COVID-19 pandemic. With multiple imputation, ordinary least squares (OLS) regression was used to analyze between-group differences in mitigating attitudes and behaviors toward COVID-19 risk. Adjusted OLS regression analyses showed that Latinx surveyed in Spanish perceived COVID-19 risk behaviors as more unsafe (b = 0.38, p = .001) and had stronger positive attitudes toward mask wearing (b = 0.58, p = .016), as compared to non-Latinx Whites. No significant differences emerged between Latinx surveyed in English and non-Latinx Whites (p > .05). Despite facing major structural, economic, and systemic disadvantages, recent Latinx immigrants showed more positive attitudes toward public health COVID-19 mitigating measures than other groups. The findings have implications for future prevention research about community resilience, practice, and policy.
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Affiliation(s)
| | | | | | | | - Shiyou Wu
- Arizona State University, Phoenix, AZ, USA
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7
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Zheng X, Qian M, Ye X, Zhang M, Zhan C, Li H, Luo T. Implications for long COVID: A systematic review and meta-aggregation of experience of patients diagnosed with COVID-19. J Clin Nurs 2024; 33:40-57. [PMID: 36253950 PMCID: PMC9874539 DOI: 10.1111/jocn.16537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/19/2022] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
AIMS AND OBJECTIVES This review aims to synthesize the available evidence of what patients experience when infected with COVID-19, both in hospital and post-discharge settings. DESIGN This review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews and evidence synthesis. Reporting of results was presented according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist. BACKGROUND Coronavirus disease 2019 (COVID-19) continues to be a public health crisis worldwide. Many patients diagnosed with COVID-19 have varied levels of persisting mental disorders. Previous studies have reported the degree, prevalence and outcome of psychological problems. Minimal research explored the experience of patients with long COVID. The real-life experience of patients with COVID-19 from diagnosis to post-discharge can deepen the understanding of nurses, physicians and policymakers. METHODS All studies describing the experience of patients were included. Two authors independently appraised the methodological quality of the included studies using the JBI Critical Appraisal Checklist for Qualitative Research 2020. RESULTS This systematic review aggregated patients' experience of being diagnosed with COVID-19 in both hospitalized and post-discharge settings. Finally, 17 studies met inclusion criteria and quality appraisal guidelines. The selected studies in the meta-synthesis resulted in 12 categories, and further were concluded as five synthesized findings: physical symptoms caused by the virus, positive and negative emotional responses to the virus, positive coping strategies as facilitators of epidemic prevention and control, negative coping strategies as obstacles of epidemic prevention and control, and unmet needs for medical resource. CONCLUSIONS The psychological burden of patients diagnosed with COVID-19 is heavy and persistent. Social support is essential in the control and prevention of the epidemic. Nurses and other staff should pay more attention to the mental health of the infected patients both in and after hospitalization. RELEVANCE TO CLINICAL PRACTICE Nurses should care about the persistent mental trauma of COVID-19 survivors and provide appropriate psychological interventions to mitigate the negative psychological consequences of them. Besides, nurses, as healthcare professionals who may have the most touch with patients, should evaluate the level of social support and deploy it for them. It is also needed for nurses to listen to patient's needs and treat them with carefulness and adequate patience in order to decrease the unmet needs of patients.
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Affiliation(s)
- Xutong Zheng
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Min Qian
- Department of NursingBeijing Ji Shui Tan Hospital and the 4th Medical College of Peking UniversityBeijingChina
| | - Xinxin Ye
- Department of Sports and Exercise ScienceZhejiang UniversityHangzhouChina
- School of Public HealthZhejiang University School of MedicineHangzhouChina
| | - Man Zhang
- School of MedicineYan'an UniversityYan'anChina
| | - Chenju Zhan
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Hui Li
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Tiantian Luo
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of Scientific ResearchXiamen Xianyue HospitalXiamenChina
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Cervantes L, Sinclair M, Camacho C, Santana C, Novick T, Cukor D. Social and Behavioral Barriers to Effective Care During the Transition to End-Stage Kidney Care. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:21-27. [PMID: 38403390 DOI: 10.1053/j.akdh.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 02/27/2024]
Abstract
Individuals living with CKD are disproportionately burdened by a multitude of adverse clinical and person-centered outcomes. When patients transition from advanced kidney disease to kidney failure, the psychosocial effects as well as social determinants of health challenges are magnified, making this a particularly difficult time for patients beginning kidney replacement therapy. The key social determinants of health challenges often include food and housing insecurity, poverty, unreliable transportation, low level education and/or health literacy, lack of language interpreters and culturally concordant educational materials, lack of health care insurance coverage, and mistrust of the health care system. Psychosocial and physical stressors, such as depression, anxiety, sexual dysfunction, sleep difficulty, fatigue, and pain, are often part of the illness burden among individuals living with CKD and can interact synergistically with the social challenges making the transition to kidney replacement therapy particularly challenging. To better support patients during this time, it is critical that social and structural determinants of health as well as mental health be assessed and if needs are identified, that services be provided.
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Affiliation(s)
- Lilia Cervantes
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Matthew Sinclair
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Claudia Camacho
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | | | - Tessa Novick
- Division of Nephrology, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, TX
| | - Daniel Cukor
- Behavioral Health, The Rogosin Institute New York, NY.
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9
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Mbuthia G, Machaki D, Shaibu S, Kimani RW. Surviving Covid-19 Diagnosis Among Registered Nurses: Reactions, Consequences, and Coping Mechanisms. Saf Health Work 2023; 14:467-475. [PMID: 38187200 PMCID: PMC10770275 DOI: 10.1016/j.shaw.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 01/09/2024] Open
Abstract
Background To mitigate the spread of Covid-19, nurses infected with the virus were required to isolate themselves from their families and community. Isolated patients were reported to have experienced mental distress, posttraumatic stress disorder symptoms, and suicide. Though studies have reported the psychological impact of the Covid-19 pandemic, less is known about the lived experiences of nurses who survived Covid-19 infection in sub-Saharan Africa. Methods A descriptive phenomenological approach was used to study the lived experiences of registered nurses who survived Covid-19 disease. In-depth interviews were conducted among nurses diagnosed with Covid-19 from two hospitals in Kenya between March and May, 2021. Purposive and snowball sampling were used to recruit registered nurses. Data were analyzed using Giorgi's steps of analysis. Results The study included ten nurses between 29 and 45 years of age. Nurses' experiences encompassed three themes: diagnosis reaction, consequences, and coping. Reactions to the diagnosis included fear, anxiety, and sadness. The consequence of the diagnosis and isolation was stigma, isolation, and loneliness. Nurses coping mechanisms included acceptance, creating routines, support, and spirituality. Conclusion Our findings aid in understanding how nurses experienced Covid-19 infection as patients and will provide evidence-based content for supporting nurses in future pandemics. Moreover, as we acknowledge the heroic contribution of frontline healthcare workers during the Covid-19 pandemic, it is prudent to recognize the considerable occupational risk as they balance their duty to care, and the risk of infection to themselves and their families.
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Affiliation(s)
- Gladys Mbuthia
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
| | - Doris Machaki
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
| | - Sheila Shaibu
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
| | - Rachel W. Kimani
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
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10
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Lemon ED, Crookes DM, Del Carmen Chacón L, Santiago C, Urbina B, Livingston M, Woods-Jaeger B. Facing a dual threat: Pandemic stress and immigration policy vulnerability on mental health among Latinx immigrant parents. Int J Soc Psychiatry 2023; 69:2139-2147. [PMID: 37691431 DOI: 10.1177/00207640231194480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Exclusionary immigration policies rooted in structural racism threaten the wellbeing of Latinx families, increasing stress, anxiety, depression, and distress among immigrant parents. The COVID-19 pandemic has had devastating and disproportionate impacts on communities of color with unique impacts on Latinx immigrant parents in mixed-status families. AIMS From a syndemic theory lens, we explored the convergence of structural racism and the COVID-19 pandemic to explore if the stress of the COVID-19 pandemic may compound harmful immigration-related policies. METHODS Our community-based participatory research cross-sectional study administered 145 surveys among Latinx immigrant parents in mixed-status families in Georgia. We examined the relationship of pandemic stress and perceived statewide immigration policy vulnerability to depressive, anxiety, and PTSD symptoms. We conducted multiple linear regression analyses to test these relationships and their interaction. RESULTS We found that that greater perceived policy immigration vulnerability and reported pandemic stress were associated with higher symptoms of depression. Increased PTSD symptoms were also associated with immigration policy vulnerability, but not pandemic stress. Tests to assess if pandemic stress strengthened the relationship between policy vulnerability on depressive, anxiety, and PTSD symptoms revealed no statistically significant interactions. CONCLUSION Our findings suggest that stress of the COVID-19 pandemic and longstanding anti-immigrant policies in Georgia were salient for and related to the mental health of these Latinx immigrant parents.
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Affiliation(s)
- Emily D Lemon
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Danielle M Crookes
- Department of Health Sciences Bouvé College of Health Sciences and Department of Anthropology and Sociology, College of Social Sciences and Humanities, Northeastern University, Boston, MA, USA
| | - Liliana Del Carmen Chacón
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Melvin Livingston
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Briana Woods-Jaeger
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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11
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Waidyaratne G, Steinbrook E, Roy S, Opoku A, Jaffe K, Goold SD. Trust and distrust in low-income Michigan residents during the early COVID-19 pandemic: A qualitative study. Health Expect 2023; 26:2245-2251. [PMID: 37452517 PMCID: PMC10632642 DOI: 10.1111/hex.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/07/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Trust and distrust have shaped health behaviour during the COVID-19 pandemic. Since the start of the pandemic, misinformation and polarization eroded trust across the United States. In states like Michigan, pandemic restrictions led to significant unrest. Michiganders also faced disproportionate morbidity and mortality from COVID-19 during this period. OBJECTIVE The objective of this qualitative study was to understand the individual experiences of trust in low-income Michiganders during the early COVID-19 pandemic. PARTICIPANTS Twenty-four participants at or below 200% of the federal poverty line who resided in Michigan were recruited for this study. APPROACH Interviews were conducted during the winter of 2020 using a formal interview guide that addressed sources of information, perceptions of risk and exposure, protective behaviours and impacts of the pandemic at home, work and in receiving healthcare. RESULTS Thematic analysis showed that themes of trust and distrust emerged in multiple facets of our participants' experiences, including in the context of information sources, the behaviours of others, health, financial security, employment and overall safety. Trust and distrust in low-income communities often stemmed from significant financial and economic vulnerabilities and instability in access to healthcare that was exacerbated in the pandemic. Furthermore, participant trust was shaped by internal (e.g., relationships with others) and external (e.g., source of information, social inequity) factors that influenced their perceptions and experiences during the pandemic. CONCLUSION Trust has played an important role in many aspects of the experiences of low-income communities during the COVID-19 pandemic. This is important for clinicians to consider as COVID-19 becomes endemic, and trust continues to impact patients' approaches to vaccines, testing and treatment options. PATIENT OR PUBLIC CONTRIBUTION This study was designed and conducted with the assistance and input of the members of the DECIDERS Steering Committee, a diverse statewide network of community members in Michigan. The DECIDERS team allows community members to have a voice in the design and conduct of health research, and collaborates with researchers to improve health across the state of Michigan.
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Affiliation(s)
- Gavisha Waidyaratne
- Department of Internal MedicineOhio State University Wexner Medical CenterColumbusOhioUSA
| | | | - Shalini Roy
- University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Annabella Opoku
- Department of Community Medicine and Population Health, College of Community Health SciencesUniversity of AlabamaTuscaloosaAlabamaUSA
| | - Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan Dorr Goold
- Center for Bioethics and Social Sciences in Medicine and Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
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12
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Owens C, Lamb C, Sanchez J, Quintero M, Lopez-Yunez A. Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study. BMJ Open 2023; 13:e073781. [PMID: 38030244 PMCID: PMC10689395 DOI: 10.1136/bmjopen-2023-073781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES The WHO designated individuals with low oxygen saturation, SpO2<94%, as severe SARS-CoV2 infection (COVID-19) and recommendations to seek care in a hospital setting were advised. A rapid, office-based method to select patients with severe COVID-19 who need intensive care was necessary during the peak of the pandemic. DESIGN, SETTING AND PARTICIPANTS This is a prospective cohort study of patients with confirmed severe COVID-19 between September 2020 and April 2021. OUTCOME MEASURES AND ANALYSIS Oxygen saturation was obtained at rest (SpO2r), following exertion from a 20 m walk test (SpO2e), and the difference was calculated (SpO2Δ). Radiographs and laboratory values were obtained and recorded. Logistic regression models were used to determine variables associated with hospitalisation. A lung injury score was used to quantify pulmonary involvement. RESULTS Out of 103 patients enrolled with severe COVID-19 infection, 19 (18.4%) were admitted to the hospital (no deaths). Patients managed as outpatients had a standard treatment protocol. The SpO2Δ and SpO2e were associated with hospitalisation (p<0.005) while SpO2r was no different between non-hospitalised and hospitalised patients (90.7%±2.7% vs 90.8%±2.3%, p=0.87). By contrast, exertional SpO2e was significantly different between non-hospitalised and hospitalised (87.3%±2.6% vs 84.4%±3.4%, p=0.0005). The mean lung injury score was 11.0±3.5 (18-point scale) and did not discriminate against those who would need hospitalisation. Lower lung fields were significantly more involved than the upper (p<0.0001). All patients had elevated biomarkers of inflammation, C reactive protein (CRP) median 82.5 IQR (43-128.6) mg/L and evidence of elevated liver enzymes. A logistic regression model was constructed including SpO2Δ, CRP and alanine aminotransferase to predict hospitalisation. Only SpO2Δ was significant, p=0.012, 95% CI (1.128 to 2.704) and correctly classified 85.71% of patients who could remain at home or would need to receive treatment in the hospital. CONCLUSION An office-based, 20 m walk test can help diverge patients with severe COVID-19 who need escalated care. Further, an aggressive standardised treatment protocol can be used to successfully manage patients outside of hospitals despite having severe COVID-19.
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Affiliation(s)
| | - Chris Lamb
- Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA
- BioSolutions Services LLC, Englewood Cliffs, New Jersey, USA
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Duan E, Garry K, Horwitz LI, Weerahandi H. "I Am Not the Same as I Was Before": A Qualitative Analysis of COVID-19 Survivors. Int J Behav Med 2023; 30:663-672. [PMID: 36227557 PMCID: PMC9559269 DOI: 10.1007/s12529-022-10129-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the illness experience of patients' long-term emotional and physical recovery from severe COVID-19 infection. This study aimed to expand upon the recovery process of COVID-19 survivors up to 6 months after hospital discharge. METHODS Qualitative analysis of free-response answers from a cohort study of 152 patients ≥ 18 years hospitalized with laboratory-confirmed SARS-CoV-2 surveyed at 1-month post hospital discharge and 6-months post hospital discharge. Responses were analyzed with a grounded theory approach to identify overarching themes. RESULTS Participants described persistent complications, both physical and mental, that have affected their recovery from COVID-19. Five overarching themes of post-acute patient experiences were generated: (1) an increased awareness of a mind and body connection, (2) feelings of premature aging, (3) an overall decline in quality of life, (4) a continued fear of infection, and (5) methods of coping. CONCLUSIONS Patients described lasting changes to their mental health and overall quality of life in connection to physical complications after severe COVID-19 infection. Patients' reports of their experience call for a greater awareness of the psychological aspects of COVID-19 recovery to provide both physical and psychological rehabilitation services. Additional resources such as education around re-infection and financial resources are needed.
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Affiliation(s)
- Emily Duan
- NYU Grossman School of Medicine, New York, NY, USA
| | - Kira Garry
- University Park Program, Pennsylvania State College of Medicine, State College, Hershey, PA, USA
| | - Leora I Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, 227 East 30th St., NY, 10016, New York, USA
| | - Himali Weerahandi
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, 227 East 30th St., NY, 10016, New York, USA.
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Chatterjee K, Markham Shaw C, Brannon GE, Jang CY, Christie TB, Rodriguez J, Sinta V. COVID-19 Vaccination Hesitancies: A Spanish-Language Focus Group Analysis in Texas. HEALTH COMMUNICATION 2023:1-12. [PMID: 37712138 DOI: 10.1080/10410236.2023.2258310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
COVID-19 related health disparities are prevalent among higher risk populations like the Hispanic community. Vaccination is one readily available public health tool, yet vaccine uptake is lower among minority populations and hesitations and concerns are high. In the present study, interpersonal and media sources of information about COVID-19 were discussed in a series of six focus groups with Spanish-language dominant and bilingual English-Spanish respondents in a large metropolitan area in Texas. Participants reported using legacy media as a main source of information about COVID-19 vaccines and encountered conspiracy theories and misinformation on social media. Using the Health Belief Model as the theoretical lens, we found individuals' and family members' perceived susceptibility to COVID-19 played a part in participants wanting to find and get the vaccine. Provider recommendations may have served as cues to action. Ease of receiving the vaccines at church and pharmacies may have served to boost participants self-efficacy. Perceived barriers include vaccine specific reasons such as the fast pace of initial authorization, side effects, and long-term effects along with conspiracy theories. Prevailing information gaps regarding the COVID-19 vaccines and the resulting uncertainty are discussed. Understanding information sources and the trust Hispanic communities place in these sources is important in designing effective health messages.
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Affiliation(s)
| | | | | | - Chyng-Yang Jang
- Department of Communication, University of Texas at Arlington
| | | | | | - Vinicio Sinta
- Department of Communication, University of Texas at Arlington
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15
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Ritchie ND, Gurfinkel D, Sajatovic M, Carter M, Glasgow RE, Holtrop JS, Waxmonsky JA, Kwan BM. A Multi-Method Study of Patient Reach and Attendance in a Pragmatic Trial of Diabetes Shared Medical Appointments. Clin Diabetes 2023; 41:526-538. [PMID: 37849523 PMCID: PMC10577507 DOI: 10.2337/cd23-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Shared medical appointments (SMAs) are an evidence-based approach to diabetes care in primary care settings, yet practices can struggle to ensure participation, especially among racial and ethnic minority and low-income patients. We conducted a multimethod evaluation of reach and attendance in the Invested in Diabetes study of the comparative effectiveness of two SMA delivery models (standardized and patient-driven) in two practice settings (federally qualified health centers [FQHCs] and clinics serving more commercially insured patients). Through this study, 22 practices reached 6.2% of patients with diabetes through SMAs over 3 years, with good attendance for both practice types and both SMA delivery models. FQHCs were especially successful at enrolling underserved populations and improved attendance with virtual SMAs.
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Affiliation(s)
- Natalie D. Ritchie
- Center for Health Systems Research, Denver Health & Hospital Authority, Denver, CO
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Dennis Gurfinkel
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Madelaine Carter
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Russell E. Glasgow
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jodi Summers Holtrop
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jeanette A. Waxmonsky
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Bethany M. Kwan
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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16
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Duncan WL, Nabor Vazquez L. 'I don't feel that we are a burden': Latinx immigrants and deservingness during the COVID-19 pandemic. Soc Sci Med 2023; 333:116125. [PMID: 37556991 DOI: 10.1016/j.socscimed.2023.116125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
In this paper, we explore the material and symbolic effects of "deservingness projects" (Kline, 2019) for Latinx immigrants as they have played out over the COVID-19 pandemic. On a material level, exclusionary policies have exacerbated Latinx immigrants' disenfranchisement and contributed to disproportionate sickness and economic strife during the pandemic. On a symbolic level, they have contributed to subjective experiences of fear, distress, and desperation, and have eroded many immigrants' trust in institutions and support systems. Crucially, though, the pandemic's injustices have also crystallized a sense of outrage and indignation among some Latinx immigrants, provoking assertions of self-worth and sociopolitical projects of belonging and mutual care. Our findings thus challenge the notion that subjective self-understandings as 'undeserving' are fundamental to the undocumented experience and show that the pandemic's fallout has strengthened some immigrants' ability and willingness to "make claims for inclusion" (Abrego, 2011) and sociopolitical change.
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Affiliation(s)
- Whitney L Duncan
- University of Northern Colorado, USA; Colorado School of Public Health, USA.
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17
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Gili A, Caminiti M, Lupi C, Zichichi S, Minicucci I, Pezzotti P, Primieri C, Bietta C, Stracci F. Socio-Economic Factors Associated with Ethnic Disparities in SARS-CoV-2 Infection and Hospitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6521. [PMID: 37569061 PMCID: PMC10418672 DOI: 10.3390/ijerph20156521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/15/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND There is evidence that non-Italians presented higher incidence of infection and worse health outcomes if compared to native populations in the COVID-19 pandemic. The aim of the study was to compare Italian- and non-Italian-born health outcomes, accounting for socio-economic levels. METHODS We analyzed data relative to 906,463 people in Umbria (Italy) from 21 February 2020 to 31 May 2021. We considered the National Deprivation Index, the Urban-Rural Municipalities Index and the Human Development Index (HDI) of the country of birth. We used a multilevel logistic regression model to explore the influence of these factors on SARS-CoV-2 infection and hospitalization rates. Diagnosis in the 48 h preceding admission was an indicator of late diagnosis among hospitalized cases. RESULTS Overall, 54,448 persons tested positive (6%), and 9.7% of them were hospitalized. The risk of hospital admission was higher among non-Italians and was inversely related to the HDI of the country of birth. A diagnosis within 48 h before hospitalization was more frequent among non-Italians and correlated to the HDI level. CONCLUSIONS COVID-19 had unequal health outcomes among the population in Umbria. Reduced access to primary care services in the non-Italian group could explain our findings. Policies on immigrants' access to primary healthcare need to be improved.
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Affiliation(s)
- Alessio Gili
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Marta Caminiti
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Chiara Lupi
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Salvatore Zichichi
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Ilaria Minicucci
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00162 Rome, Italy
| | - Chiara Primieri
- Epidemiology Unit, Department of Preventive Medicine, Local Health Unit 1, 06126 Perugia, Italy
| | - Carla Bietta
- Epidemiology Unit, Department of Preventive Medicine, Local Health Unit 1, 06126 Perugia, Italy
| | - Fabrizio Stracci
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
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Salgin L, Ayers LO, Burola ML, Engler AM, Osuna A, Gay L, Cain K, Stadnick N, Rabin B, Zaslavsky I, Laurent LC, Tukey R, Seifert M. Perceived COVID-19 risk and testing experiences in the San Ysidro U.S./Mexico border region. Transl Behav Med 2023; 13:432-441. [PMID: 36999822 PMCID: PMC10314726 DOI: 10.1093/tbm/ibac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Racial and ethnic disparities in COVID-19 incidence are pronounced in underserved U.S./Mexico border communities. Working and living environments in these communities can lead to increased risk of COVID-19 infection and transmission, and this increased risk is exacerbated by lack of access to testing. As part of designing a community and culturally tailored COVID-19 testing program, we surveyed community members in the San Ysidro border region. The purpose of our study was to characterize knowledge, attitudes, and beliefs of prenatal patients, prenatal caregivers, and pediatric caregivers at a Federally Qualified Health Center (FHQC) in the San Ysidro region regarding perceived risk of COVID-19 infection and access to testing. A cross-sectional survey was used to collect information on experiences accessing COVID-19 testing and perceived risk of COVID-19 infection within San Ysidro between December 29, 2020 and April 2, 2021. A total of 179 surveys were analyzed. Most participants identified as female (85%) and as Mexican/Mexican American (75%). Over half (56%) were between the age of 25 and 34 years old. Perceived Risk: 37% reported moderate to high risk of COVID-19 infection, whereas 50% reported their risk low to none. Testing Experience: Approximately 68% reported previously being tested for COVID-19. Among those tested, 97% reported having very easy or easy access to testing. Reasons for not testing included limited appointment availability, cost, not feeling sick, and concern about risk of infection while at a testing facility. This study is an important first step to understand the COVID-19 risk perceptions and testing access among patients and community members living near the U.S./Mexico border in San Ysidro, California.
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Affiliation(s)
- Linda Salgin
- San Ysidro Health, San Diego, CA, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Public Health, San Diego, CA, USA
| | - Lawrence O Ayers
- University of California, San Diego Department of Obstetrics, Gynecology, and Reproductive Sciences, San Diego, CA, USA
| | - Maria-Linda Burola
- University of California, San Diego Department of Obstetrics, Gynecology, and Reproductive Sciences, San Diego, CA, USA
| | - Anne-Marie Engler
- University of California, San Diego Department of Obstetrics, Gynecology, and Reproductive Sciences, San Diego, CA, USA
| | | | - Luis Gay
- San Ysidro Health, San Diego, CA, USA
| | - Kelli Cain
- University of California, San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA
| | - Nicole Stadnick
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA
- University of California, San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Borsika Rabin
- University of California, San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA
- University of California, San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, San Diego, CA, USA
| | - Ilya Zaslavsky
- University of California San Diego, Spatial Information Systems Lab, San Diego Supercomputer Center, San Diego, CA, USA
| | - Louise C Laurent
- University of California, San Diego Department of Obstetrics, Gynecology, and Reproductive Sciences, San Diego, CA, USA
| | - Robert Tukey
- University of California San Diego, Department of Chemistry and Biochemistry, San Diego, CA, USA
| | - Marva Seifert
- University of California San Diego, Division of Pulmonary and Critical Care Medicine, San Diego, CA, USA
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Bonilla Altera D, Cabassa I, Martinez-Garcia G. A Tale of Two Audiences: Formative Research and Campaign Development for Two Different Latino Audiences, to Improve COVID-19 Prevention Behavior. Healthcare (Basel) 2023; 11:1819. [PMID: 37444652 DOI: 10.3390/healthcare11131819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
The COVID-19 pandemic disproportionately affected the Latino population in the United States, further exacerbating the existing racial and ethnic health disparities that this group faces. While government health entities rushed to develop COVID-19 prevention educational materials in Spanish, these failed to recognize the unique motivators and barriers that move different Latino audience segments to act. We conducted five online focus groups with two different Latino audience segments, general Latino people, and Latino migrant workers, to assess their experience navigating the pandemic, their engagement in preventive behavior, and their consumption of health news. While the general Latino audience had higher levels of social capital and established preventive healthcare, they were more skeptical about getting the COVID-19 vaccine. Migrant workers needed to be vaccinated to retain their jobs, and saw the vaccine as the only way to keep their families healthy. We used the focus group results to develop two different creative concepts that aligned with each audience's unique experience. Our study highlights the importance of developing hyper-focused messages, responsive to the experience of distinct audience segments, for maximum impact.
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Evered JA, Castellanos MEP, Dowrick A, Camargo Goncalves Germani AC, Rai T, Navarro de Souza A, Qureshi K, Gandolfo Conceição MI, Cabral I, Grob R. Talking about inequities: A comparative analysis of COVID-19 narratives in the UK, US, and Brazil. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100277. [PMID: 37197405 PMCID: PMC10163940 DOI: 10.1016/j.ssmqr.2023.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/28/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
Disproportionate mortality and morbidity burdens of the COVID-19 pandemic and coinciding media coverage of public acts of violence perpetrated against people of color in 2020 precipitated reckonings with structural inequities in global, national, and local contexts. This cross-country comparative analysis aims to describe how people voice and make sense race, racism, and privilege in their experiences with COVID-19 infection in the United States, United Kingdom, and Brazil. Anchored by continuous reflection on our individual and collective positionality, we conducted an inductive comparative analysis conceptually situated in intersectionality and critical race theory. Countries used a shared qualitative methodology to collect and analyze 166 narratives of people with experience of COVID-19 infection from 2020 to 2023. We selected 19 cases that illustrate cross-national differences in peoples' acknowledgment and narration of structural privilege and disadvantage in their observations of COVID-19 in their countries and in their personal experiences. People in the US had the most fluency with voicing race directly. In Brazil, while some respondents (especially younger people) demonstrated high racial consciousness, others struggled to identify and talk about racial relationships. In the UK, people voiced racial identifications, though often within white norms of politeness and an accompanying sense of discomfort. The findings overall illustrate moments the interview becomes or does not become a space for voicing social categories and systemic underpinnings of difference in COVID-19 infections and healthcare experiences. We reflect on cross-country differences in historical and contemporary racialized discourse and elaborate on implications of focusing on voicing in qualitative research.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ivone Cabral
- Universidade do Estado do Rio de Janeiro (UERJ), RJ, Brazil
| | - Rachel Grob
- University of Wisconsin, Madison, Madison, WI, USA
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Matus Gonzalez A, Lorca E, Cabrera S, Hernandez A, Zúñiga-Sm C, Sola L, Michea L, Ferreiro Fuentes A, Cervantes L, Madero M, Teixeira-Pinto A, Wong G, Craig J, Jaure A. Nephrologists' perspectives on the impact of COVID-19 on caring for patients undergoing dialysis in Latin America: a qualitative study. BMJ Open 2023; 13:e062321. [PMID: 37173110 PMCID: PMC10186081 DOI: 10.1136/bmjopen-2022-062321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE To describe the experiences of nephrologists on caring for patients undergoing in-centre haemodialysis during the COVID-19 pandemic in Latin America. DESIGN Twenty-five semistructured interviews were conducted by Zoom videoconference in English and Spanish languages during 2020 until data saturation. Using thematic analysis, we conducted line-by-line coding to inductively identify themes. SETTING 25 centres across nine countries in Latin America. PARTICIPANTS Nephrologists (17 male and 8 female) were purposively sampled to include diverse demographic characteristics and clinical experience. RESULTS We identified five themes: shock and immediate mobilisation for preparedness (overwhelmed and distressed, expanding responsibilities to manage COVID-19 infection and united for workforce resilience); personal vulnerability (being infected with COVID-19 and fear of transmitting COVID-19 to family); infrastructural susceptibility of dialysis units (lacking resources and facilities for quarantine, struggling to prevent cross-contamination, and depletion of personal protective equipment and cleaning supplies); helplessness and moral distress (being forced to ration life-sustaining equipment and care, being concerned about delayed and shortened dialysis sessions, patient hesitancy to attend to dialysis sessions, being grieved by socioeconomic disparities, deterioration of patients with COVID-19, harms of isolation and inability to provide kidney replacement therapy); and fostering innovative delivery of care (expanding use of telehealth, increasing uptake of PD and shifting focus on preventing syndemics). CONCLUSION Nephrologists felt personally and professionally vulnerable and reported feeling helpless and morally distressed because they doubted their capacity to provide safe care for patients undergoing dialysis. Better availability and mobilisation of resources and capacities to adapt models of care, including telehealth and home-based dialysis, are urgently needed.
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Affiliation(s)
- Andrea Matus Gonzalez
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Eduardo Lorca
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | | | | | - Carlos Zúñiga-Sm
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
- Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Laura Sola
- Centro de Hemodiálisis Crónica, Centro de Asistencia del Sindicato Medico del Uruguay- Institución de Asistencia Medica Privada de Profesionales sin fines de lucro (CASMU-IAMPP), Montevideo, Uruguay
| | - Luis Michea
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | | | - Lilia Cervantes
- Department of Medicine and Office of Research, Denver Health, Denver, Colorado, USA
| | - Magdalena Madero
- Departamento de Nefrologia, Instituto Nacional de Cardiología, Ciudad de México, ciudad de Mexico (CDMX), México
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Faculty of Medicine Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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22
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Wagner KM, Chatham AA, Prado K, Walsdorf AA, Villatoro AP, Garcia D, de Snyder NS, Valdez CR. Emotional wellbeing and coping among Latinx young adults in the time of COVID-19. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1217-1232. [PMID: 36573877 PMCID: PMC9880755 DOI: 10.1002/jcop.22983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has disrupted the wellbeing of the general US population, but even more so among Latinx young adults. The current study provides a detailed picture of the emotional wellbeing and coping of Latinx young adults during the first summer of the pandemic. Six virtual focus groups (n = 21) were conducted between May and August of 2020 with a community-based sample of Latinx young adults to explore (1) how the pandemic affected wellbeing and (2) how they coped with pandemic-related stress. Contextualistic thematic analysis identified important themes and subthemes. Perceived stressors impacting emotional wellbeing yielded one overarching theme: COVID-related disruptions in the participants' environment. To manage this heightened stress, another overarching theme was self-care and intentionality during the pandemic. Future studies should examine the wellbeing of young adults across social contexts and at more recent stages of the pandemic. Findings from this study suggest culturally- and developmentally-tailored interventions are needed as this population navigates contextual stress during a sensitive period in their life.
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Affiliation(s)
- Kevin M. Wagner
- Department of Educational PsychologyThe University of TexasAustinTexasUSA
- Department of Population Health, Dell Medical SchoolThe University of TexasAustinTexasUSA
| | - Ana A. Chatham
- Department of Population Health, Dell Medical SchoolThe University of TexasAustinTexasUSA
- Steve Hicks School of Social WorkThe University of TexasAustinTexasUSA
| | - Kimberly Prado
- Steve Hicks School of Social WorkThe University of TexasAustinTexasUSA
| | - Ashley A. Walsdorf
- Couple and Family TherapyAlliant International UniversitySan DiegoCaliforniaUSA
- The Latino Research InstituteThe University of TexasAustinTexasUSA
| | | | | | - Nelly Salgado de Snyder
- The Latino Research InstituteThe University of TexasAustinTexasUSA
- Instituto Nacional de Salud PúblicaCuernavacaMexico
| | - Carmen R. Valdez
- Department of Population Health, Dell Medical SchoolThe University of TexasAustinTexasUSA
- Steve Hicks School of Social WorkThe University of TexasAustinTexasUSA
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23
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Alvarado F, Delgado C, Nicholas SB, Jaure A, Cervantes L. Qualitative analysis of stakeholder perspectives on engaging Latinx patients in kidney-related research. BMC Nephrol 2023; 24:79. [PMID: 36991364 PMCID: PMC10061843 DOI: 10.1186/s12882-023-03128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Latinx individuals are disproportionally burdened by kidney diseases compared to non-Latinx White individuals and are underrepresented in kidney-related research. We aimed to describe stakeholder perspectives on Latinx patient engagement in kidney-related research.
Methods
We conducted a thematic analysis of two online moderated discussions and an interactive online survey with open-text responses involving participants (i.e. stakeholders), with personal and/or professional experiences with Latinx patients with kidney diseases and their families/caregivers.
Results
Among the eight stakeholders (Female:75%; Latinx ethnicity:88%), there were three physicians, one nurse, one patient with kidney disease who received a kidney transplant, one policy maker, one Doctor of Philosophy, and one executive director of a non-profit health organization. We identified five themes. The majority of themes and their respective subthemes (in parentheses) reflected barriers to engagement: Lack of personal relevance (unable to relate to research staff and marketing resources, and unclear benefit of research to self, family, and community); fear and vulnerability (immigration concerns, stigma with seeking care, skepticism of Western medicine); logistical and financial barriers (limited opportunities to enroll in clinical trials, out-of-pocket costs, transportation issues); and distrust and asymmetry of power (related to limited English proficiency or health literacy, and provider bias). The last theme centered on stimulating interest and establishing trust in the research process.
Conclusions
To overcome barriers to engagement in kidney-related research and establish trust among potential Latinx research participants, stakeholders recommended employing cultural responsiveness and community-based strategies. These strategies can help identify local health priorities, enhance research recruitment and retention strategies, and establish partnerships that continue to elevate research endeavors aiming to enhance the health of Latinx individuals with kidney diseases.
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Häfliger C, Diviani N, Rubinelli S. Communication inequalities and health disparities among vulnerable groups during the COVID-19 pandemic - a scoping review of qualitative and quantitative evidence. BMC Public Health 2023; 23:428. [PMID: 36879229 PMCID: PMC9986675 DOI: 10.1186/s12889-023-15295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated health disparities in vulnerable groups (e.g., increased infection, hospitalization, and mortality rates in people with lower income, lower education, or ethnic minorities). Communication inequalities can act as mediating factors in this relationship. Understanding this link is vital to prevent communication inequalities and health disparities in public health crises. This study aims to map and summarize the current literature on communication inequalities linked with health disparities (CIHD) in vulnerable groups during the COVID-19 pandemic and to identify research gaps. METHODS A scoping review of quantitative and qualitative evidence was conducted. The literature search followed the guidelines of PRISMA extension for scoping reviews and was performed on PubMed and PsycInfo. Findings were summarized using a conceptual framework based on the Structural Influence Model by Viswanath et al. RESULTS: The search yielded 92 studies, mainly assessing low education as a social determinant and knowledge as an indicator for communication inequalities. CIHD in vulnerable groups were identified in 45 studies. The association of low education with insufficient knowledge and inadequate preventive behavior was the most frequently observed. Other studies only found part of the link: communication inequalities (n = 25) or health disparities (n = 5). In 17 studies, neither inequalities nor disparities were found. CONCLUSIONS This review supports the findings of studies on past public health crises. Public health institutions should specifically target their communication to people with low education to reduce communication inequalities. More research about CIHD is needed on groups with migrant status, financial hardship, not speaking the language in the country of residence, sexual minorities, and living in deprived neighborhoods. Future research should also assess communication input factors to derive specific communication strategies for public health institutions to overcome CIHD in public health crises.
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Affiliation(s)
- Clara Häfliger
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil, Lucerne, 6207, Switzerland. .,Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Lucerne, 6002, Switzerland.
| | - Nicola Diviani
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil, Lucerne, 6207, Switzerland.,Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Lucerne, 6002, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil, Lucerne, 6207, Switzerland.,Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Lucerne, 6002, Switzerland
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Impact of the COVID-19 Pandemic on the Experiences of Hospitalized Patients: A Scoping Review. J Patient Saf 2023; 19:e46-e52. [PMID: 36459699 PMCID: PMC9940789 DOI: 10.1097/pts.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE This study aimed to identify the factors that exerted an impact on the experiences of hospitalized patients during the COVID-19 pandemic from the quality and safety perspectives. METHOD A scoping review that followed the 5 stages described by Arksey and O'Malley was used. A systematized search of original studies was conducted in 9 databases: PubMed/MEDLINE, BDENF, CINAHL, LILACS, SciELO, Embase, Scopus, Web of Science, and Google Scholar. The factors that exerted an impact on patients' experiences were summarized, considering the perspective of quality and patient safety in health institutions. The factors were categorized using the Content Analysis technique. RESULTS A total of 6950 studies were screened, and 32 met the eligibility criteria. The main factors that exerted an impact on the patients' experience were as follows: caregiver/family concern with the patients' well-being during hospitalization, search for alternative communication and interaction means between the patients and their family, and changes in health care organization. The restrictions inherent to the policy regarding visits and companions exerted a negative impact on the experiences, increasing the patients' feelings of loneliness and isolation. Negative impacts were also evidenced in the hospital admission and discharge process and in the limitation of treatment possibilities offered to the patients, because of contact restrictions. CONCLUSIONS The factors that exerted an impact on the patients' experiences permeate communication between professionals, patients, and family members, with implications for health care quality.
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Genovese E, Page KR, Cailhol J, Jackson Y. Learning from the COVID-19 pandemic response to strengthen undocumented migrant-sensitive health systems: case studies from four countries. Lancet Reg Health Eur 2023; 27:100601. [PMID: 37013113 PMCID: PMC9972251 DOI: 10.1016/j.lanepe.2023.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Undocumented migrants are a vulnerable population group in the context of the COVID-19 pandemic due to increased risk of infection, severe morbidity, and mortality. In this Personal View, we analyze the COVID-19 pandemic responses, particularly vaccination campaigns, vis à vis undocumented migrants, and discuss lessons learned. Our empirical observations as clinicians and public health practitioners in Italy, Switzerland, France, and the United States are supplemented by a literature review, and presented through country case studies focusing on Governance, Service Delivery, and Information. We propose recommendations to capitalize on the COVID-19 pandemic response as an entry point to strengthen migrant-sensitive provisions into health system frameworks, by: providing specific guidance in health policies and plans; developing tailored implementation approaches with outreach and mobile services, with translated and socio-culturally adapted information, and engagement of migrant communities and third sector actors; and developing systematic monitoring & evaluation systems with disaggregated migrant data from National Health Service and third sector providers.
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Affiliation(s)
- Eleonora Genovese
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Kathleen R. Page
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Johann Cailhol
- Department of Public Health, Paris Seine Saint Denis University Hospital, Bobigny, France
- Laboratoire Education et Promotion de La Santé – UR3412, Université Sorbonne Paris Nord, Bobigny, France
| | - Yves Jackson
- Department of Community Health and Medicine, University of Geneva, Geneva, Switzerland
- Division of Primary Care Medicine, Geneva University Hospital, Geneva, Switzerland
- Corresponding author. Division of primary care medicine, Geneva University Hospital, 1211, Geneva, Switzerland.
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27
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Escobedo LE, Cervantes L, Havranek E. Barriers in Healthcare for Latinx Patients with Limited English Proficiency-a Narrative Review. J Gen Intern Med 2023; 38:1264-1271. [PMID: 36720766 PMCID: PMC9888733 DOI: 10.1007/s11606-022-07995-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 12/23/2022] [Indexed: 02/02/2023]
Abstract
Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and ethnic minority group in the United States (US). Many members of this group report limited English proficiency, experience discrimination, feel distrust in the healthcare setting, and face poorer health outcomes than non-Latinx Whites. As healthcare systems assess internal structures of care, understanding the experiences of Latinx patients may inform strategies to improve care. This narrative review describes studies that assessed the experiences of Latinx patients with limited English proficiency (LEP) in the inpatient and outpatient settings in the US. We searched PubMed for studies published between January 1, 1990, and March 2021. We reviewed all citations and available abstracts (n = 429). We classified study titles (n = 156) as warranting detailed consideration of the original article. Limited English proficiency is a well-documented challenge reported by Latinx patients seeking care in the outpatient setting, resulting in mistrust of healthcare organizations and clinicians. The effects of LEP overlap substantially with challenges related to patients' immigration status, cultural traditions, and socioeconomic needs. Use of professional interpretation rather than ad hoc interpretation improves trust and satisfaction. There is no consensus about the most effective mode of delivering professional interpretation (in person, telephonic, video conferencing), although rapid simultaneous telephone translation is a promising modality. Increasing awareness of the barriers to effective communication, improving skills in communicating through translators, and increasing the amount of time spent with patients may improve communication and trust more than structural changes like mode of translation or bedside rounding. Cultural fluency training, standardized language training for providers, and incentive pay for fluency are also deserving of further consideration.
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Affiliation(s)
- Luis E Escobedo
- University of Colorado Internal Medicine Residency Training Program, Aurora, CO, USA.
| | - Lilia Cervantes
- Division of Hospital Medicine and General Internal Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Edward Havranek
- Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
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28
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Earnest M, Wong SL, Federico S, Cervantes L. A Model of Advocacy to Inform Action. J Gen Intern Med 2023; 38:208-212. [PMID: 36323827 PMCID: PMC9629756 DOI: 10.1007/s11606-022-07866-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
The need for effective advocacy on the part of health professionals has never been greater. The recent COVID-19 pandemic has made the connection between human health and social conditions clear, while highlighting the limitations of biomedical interventions to address those conditions. Efforts to increase the frequency and effectiveness of advocacy activities by health professionals have been hampered by the lack of a practical framework to define and develop advocacy competencies among trainees as well as to plan and execute advocacy activities. The authors of this article propose a framework which defines advocacy as occurring across three domains of influence (practice, community, and government) using three categories of advocacy skills (policy, communication, and relationships). When these skills are successfully applied in the appropriate domains of influence, the resulting change falls into three levels: individual, adjacent, and structural. The authors assert that this framework is immediately applicable to a broad variety of health professionals, educators, researchers, organizations, and professional societies as they individually and collectively seek to improve the health and well-being of those they care for.
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Affiliation(s)
- Mark Earnest
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Shale L Wong
- Department of Pediatrics, Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Steve Federico
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, USA.,Denver Health and Hospital Authority, Denver, USA
| | - Lilia Cervantes
- Division of Hospital Medicine, University of Colorado Anschutz Medical, Aurora, USA
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Galletly CL, Barreras JL, Lechuga J, Glasman LR, Cruz G, Dickson-Gomez JB, Brooks RA, Ruelas DM, Stringfield B, Espinoza-Madrigal I. US public charge policy and Latinx immigrants' thoughts about health and healthcare utilization. ETHNICITY & HEALTH 2023; 28:96-113. [PMID: 35166623 PMCID: PMC9376191 DOI: 10.1080/13557858.2022.2027879] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 01/05/2022] [Indexed: 06/08/2023]
Abstract
OBJECTIVES We examined Latinx immigrants' perceptions of US policy related to restrictions on immigrants' use of public resources and their thoughts about the influence of these on immigrants' healthcare utilization. DESIGN A series of 16 focus group discussions with Latinx immigrant men and women (documented and undocumented) (N = 130) were conducted between May and July 2017 across four US cities. RESULTS Four central themes emerged: participants attributed the limited resources available for affordable healthcare for many uninsured US immigrants (both documented and undocumented) to the US government's view of immigrants as burdens on public resources and its subsequent unwillingness to dedicate funds for their care; participants expressed concerns, some unfounded, about negative immigration ramifications arising from diagnosis with health conditions perceived to be serious and/or expensive to treat; participants noted that some immigrants avoided using health programs and services to which they were entitled because of immigration concerns; finally, participants described how access to information on immigration laws and healthcare resources, and conversely, misinformation about these, influenced healthcare utilization. CONCLUSIONS Participants were acutely aware of the image of immigrants as public charges or potential burdens on government resources that underlies US immigration policy. In some cases, participants came to inaccurate and potentially harmful conclusions about the substance of laws and regulations based on their beliefs about the government's rejection of immigrants who may burden public resources. This underscores the importance of ensuring that immigrants have access to information on immigration-related laws and regulations and on healthcare resources available to them. Participants noted that access to information also fostered resilience to widespread misinformation. Importantly, however, participants' beliefs had some basis in US immigration policy discourse. Law and policy makers should reconsider legislation and political commentary that frame self-reliance, the guiding principle of US immigration policy, in terms of immigrants' use of publicly funded healthcare resources.
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Affiliation(s)
- Carol L Galletly
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joanna L Barreras
- School of Social Work, California State University, Long Beach, Long Beach, CA, USA
- Bienestar Human Services Inc., Los Angeles, CA, USA
| | - Julia Lechuga
- Public Health Sciences, University of Texas, El Paso, TX, USA
| | - Laura R Glasman
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gerardo Cruz
- Bienestar Human Services Inc., Los Angeles, CA, USA
| | - Julia B Dickson-Gomez
- Center for AIDS Intervention Research, Center for Health Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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Uellner F, Röhr F, Denkinger C, Bärnighausen T, Deckert A, Souares A, McMahon SA. Kopfkino: Phases of quarantine among asymptomatic SARS-COV-2 carriers in Germany. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100070. [PMID: 35340589 PMCID: PMC8938303 DOI: 10.1016/j.ssmqr.2022.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/01/2022] [Accepted: 03/20/2022] [Indexed: 01/12/2023]
Abstract
Although a majority of SARS-COV-2 diagnosis are asymptomatic, presymptimatic or minimally symptomatic, little has been described and understood about the illness careers of these individuals. This study explored the lived experience of a SARS-COV-2 diagnosis and subsequent quarantine among individuals in Germany who were diagnosed with SARS-COV-2 during the second wave of the pandemic (late 2020-early 2021), but whose diagnosis was unexpected due to a lack of a known contact, or the asymptomatic nature of their case at the time of diagnosis. In-depth interviews (n = 22) were conducted by phone or video call, audio-recorded, and transcribed verbatim. Routine debriefings guided data collection and facilitated analysis, which followed a framework approach. Regardless of age, gender or socioeconomic status, data consistently demonstrated a diagnosis and quarantine career marked by five emotional phases: overconfidence, shock and denial, coming to grips and asking questions, enduring, and cautious optimism as quarantine ended. These experiences suggest that providing trustworthy, easily accessible information regarding certain key aspects of the post diagnosis and quarantine period could benefit patients in terms of reducing stress, understanding the consequences of a diagnosis and mitigating foreseeable challenges in terms of personal, logistical and emotional issues. Follow-up research with providers and public health bureaus could inform how to best tailor such messaging for clients who experience an unexpected diagnosis.
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Affiliation(s)
- Ferdinand Uellner
- Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 130/3, Heidelberg, Germany,Corresponding author. Im Neuenheimer Feld 130.0, 69120, Heidelberg, Germany
| | - Freda Röhr
- Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 130/3, Heidelberg, Germany
| | - Claudia Denkinger
- Division of Clinical Tropical Medicine, Centre for Infectiology, Heidelberg University Hospital, Heidelberg, Germany,German Center for Infection Research Heidelberg Site, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 130/3, Heidelberg, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 130/3, Heidelberg, Germany
| | - Aurelia Souares
- Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 130/3, Heidelberg, Germany,German Center for Infection Research Heidelberg Site, Heidelberg, Germany
| | - Shannon A. McMahon
- Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 130/3, Heidelberg, Germany,International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St Suite E8527, Baltimore, MD, 21205, USA
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Goldsmith LP, Rowland-Pomp M, Hanson K, Deal A, Crawshaw AF, Hayward SE, Knights F, Carter J, Ahmad A, Razai M, Vandrevala T, Hargreaves S. Use of social media platforms by migrant and ethnic minority populations during the COVID-19 pandemic: a systematic review. BMJ Open 2022; 12:e061896. [PMID: 36396309 PMCID: PMC9676419 DOI: 10.1136/bmjopen-2022-061896] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Migrants and ethnic minority groups have been disproportionately impacted by COVID-19 and have lower levels of vaccine uptake in some contexts. We aimed to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake. DESIGN A systematic review of published and grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched databases including Embase, Web of Science, PubMed NIH, CINAHL, facilitated through the WHO Global Research on COVID-19 database from 31 December 2019 to 9 June 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Research reporting the use of social media by migrants and/or ethnic minority groups in relation to COVID-19. DATA EXTRACTION We extracted data on key outcomes, study design, country, population under study and sample size. RESULTS 1849 unique records were screened, and 21 data sources were included, including populations in the UK, USA, China, Jordan, Qatar and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. Some evidence suggested circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings which are likely relevant to multiple population groups. CONCLUSIONS Social media platforms are an important source of information about COVID-19 for some migrant and ethnic minority populations. Urgent actions and further research are now needed to better understand effective approaches to tackling circulating misinformation, and to seize on opportunities to better use social media platforms to support public health communication and improve vaccine uptake. REGISTRATION This study has been registered with PROSPERO (CRD42021259190).
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Affiliation(s)
- Lucy Pollyanna Goldsmith
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- Population Health Research Institute, St George's University of London, London, UK
| | - May Rowland-Pomp
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Kristin Hanson
- Faculty of Health, Social Care and Education, Kingston University, Kingston-Upon-Thames, London, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison F Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Sally E Hayward
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- Population Health Research Institute, St George's University of London, London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Ayesha Ahmad
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - M Razai
- Population Health Research Institute, St George's University of London, London, UK
| | - Tushna Vandrevala
- Faculty of Health, Social Care and Education, Centre for Applied Health and Social Care Research, Kingston University, Kingston, Surrey, UK
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Hall MA, Bertoni AG, McCoy TP, Aguilar-Palma SK, Garcia M, Miranda D, Turner MJ. Increasing COVID-19 testing and vaccination among Spanish speakers in the USA: protocol for the development and evaluation of the Nuestra Comunidad Saludable intervention using a group-randomised trial design. BMJ Open 2022; 12:e066585. [PMID: 36385019 PMCID: PMC9670094 DOI: 10.1136/bmjopen-2022-066585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Our community-based participatory research partnership aims to expand understanding of the social, ethical and behavioural implications of COVID-19 testing and vaccination to inform the development of an integrated intervention that harnesses community-based peer navigation and mHealth strategies to improve COVID-19 testing and vaccination; test the intervention; and develop and disseminate practice, research and policy recommendations to further increase COVID-19 testing and vaccination among Spanish-speaking Latine communities in the USA. METHODS AND ANALYSIS We will conduct 50 individual in-depth interviews with health providers, who have conducted COVID-19 testing and/or vaccination activities within Spanish-speaking communities, and with representatives from Latine-serving community-based organisations. We will also conduct six focus groups with 8-12 Spanish-speaking Latine community member participants each for a total number of about 60 focus group participants. Next, we will develop the Nuestra Comunidad Saludable intervention based on findings from interviews and focus groups and use a longitudinal group-randomised trial design with two arms (intervention and delayed intervention) to evaluate the impact of the intervention. We will recruit, enrol and collect baseline data from 20 community-based peer navigators (Navegantes) and their social network members (n=8 unique social network members per Navegante). Navegantes (coupled with their social networks) will be randomised to intervention or delayed intervention groups (10 Navegantes and 80 social network members per group). ETHICS AND DISSEMINATION Ethical approval for data collection was granted by the Wake Forest University School of Medicine Institutional Review Board. Following the description of study procedures, we will obtain consent from all study participants. Study findings will be disseminated through an empowerment theory-based community forum, peer-reviewed publications and presentations at scientific meetings, and reports and briefs for lay, community and practitioner audiences. TRIAL REGISTRATION NUMBER NCT05302908.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Amanda E Tanner
- Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark A Hall
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Wake Forest University School of Law, Winston-Salem, North Carolina, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas P McCoy
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | | | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Bigelow BF, Saxton RE, Martínez DA, Flores-Miller A, Shin JM, Parent C, Williams S, Phillips KH, Yang C, Page KR. High Uptake and Series Completion of COVID-19 Vaccine at Community-Based Vaccination for Latinos With Limited English Proficiency. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E789-E794. [PMID: 36074797 PMCID: PMC9528932 DOI: 10.1097/phh.0000000000001625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite the disproportionate impact of COVID-19 on Latinos, there were disparities in vaccination, especially during the early phase of COVID-19 immunization rollout. METHODS Leveraging a community-academic partnership established to expand access to SARS-CoV2 testing, we implemented community vaccination clinics with multifaceted outreach strategies and flexible appointments for limited English proficiency Latinos. RESULTS Between February 26 and May 7 2021, 2250 individuals received the first dose of COVID-19 vaccination during 18 free community events. Among them, 92.4% (95% confidence interval [CI], 91.2%-93.4%) self-identified as Hispanic, 88.7% (95% CI, 87.2%-89.9%) were limited English proficiency Spanish speakers, 23.1% (95% CI, 20.9%-25.2%) reported prior COVID-19 infection, 19.4% (95% CI, 16.9%-22.25%) had a body mass index of more than 35, 35.0% (95% CI, 32.2%-37.8%) had cardiovascular disease, and 21.6% (95% CI, 19.2%-24.0%) had diabetes. The timely second-dose completion rate was high (98.7%; 95% CI, 97.6%-99.2%) and did not vary by outreach method. CONCLUSION A free community-based vaccination initiative expanded access for Latinos with limited English proficiency at high risk for COVID-19 during the early phase of the immunization program in the US.
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Affiliation(s)
- Benjamin F. Bigelow
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
| | - Ronald E. Saxton
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
| | - Diego A. Martínez
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
| | - Alejandra Flores-Miller
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
| | - Jong M. Shin
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
| | - Cassandra Parent
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
| | - Samantha Williams
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
| | - Katherine Hartman Phillips
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
| | - Cui Yang
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
| | - Kathleen Raquel Page
- Department of Medicine (Messrs Bigelow and Saxton, Dr Page, and Ms Flores-Miller) Emergency Medicine (Dr Martinez), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontíficia Universidad Católica de Valparaíso, Valparaíso, Chile (Dr Martínez); Johns Hopkins Whiting School of Engineering, Baltimore, Maryland (Mr Shin and Ms Parent); Esperanza Center, Baltimore, Maryland (Mss Williams and Phillips); and Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Yang)
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Bigelow BF, Martínez DA, Phillips K, Parent C, Saxton RE, Yang C, Page KR. Coalition of Faith Leaders, Community Organizations, and Governmental Organizations to Implement a COVID-19 Campaign in a Latino Neighborhood, Baltimore, Maryland, 2020-2021. Am J Public Health 2022; 112:S913-S917. [PMID: 36446060 PMCID: PMC9707716 DOI: 10.2105/ajph.2022.307074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Abstract
The disproportionate impact of COVID-19 on low-income Latinos with limited access to health care services prompted the expansion of community-based COVID-19 services. From June 25, 2020, to May 20, 2021, we established a coalition of faith leaders, community organizations, and governmental organizations to implement a Spanish-language hotline and social media campaign that linked people to a COVID-19 testing site at a local church in a high-density Latino neighborhood in Baltimore, Maryland. This retrospective analysis compared the characteristics of Latinos accessing testing in community versus health care facility-based settings. (Am J Public Health. 2022;112(S9):S913-S917. https://doi.org/10.2105/AJPH.2022.307074).
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Affiliation(s)
- Benjamin F Bigelow
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Diego A Martínez
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Katherine Phillips
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Cassandra Parent
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Ronald E Saxton
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Cui Yang
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Kathleen R Page
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
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Wang Y, Reyes L, Greenfield EA, Allred SR. Municipal Ethnic Composition and Disparities in COVID-19 Infections in New Jersey: A Blinder-Oaxaca Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13963. [PMID: 36360847 PMCID: PMC9656431 DOI: 10.3390/ijerph192113963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 has disproportionally impacted Latinx and Black communities in the US. Our study aimed to extend the understanding of ethnic disparities in COVID-19 case rates by using a unique dataset of municipal case rates across New Jersey (NJ) during the first 17 months of the pandemic. We examined the extent to which there were municipal-level ethnic disparities in COVID-19 infection rates during three distinct spikes in case rates over this period. Furthermore, we used the Blinder-Oaxaca decomposition analysis to identify municipal-level exposure and vulnerability factors that contributed to ethnic disparities and how the contributions of these factors changed across the three initial waves of infection. Two clear results emerged. First, in NJ, the COVID-19 infection risk disproportionally affected Latinx communities across all three waves during the first 17 months of the pandemic. Second, the exposure and vulnerability factors that most strongly contributed to higher rates of infection in Latinx and Black communities changed over time as the virus, alongside medical and societal responses to it, also changed. These findings suggest that understanding and addressing ethnicity-based COVID-19 disparities will require sustained attention to the systemic and structural factors that disproportionately place historically marginalized ethnic communities at greater risk of contracting COVID-19.
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Affiliation(s)
- Yuqi Wang
- Department of Social Work, China Youth University of Political Studies, Beijing 100089, China
| | - Laurent Reyes
- School of Social Welfare, University of California, Berkeley, CA 94720, USA
| | | | - Sarah R. Allred
- Department of Psychology, Rutgers University, Camden, NJ 08102, USA
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Hofstetter L, Tinhof V, Mayfurth H, Kurnikowski A, Rathkolb V, Reindl-Schwaighofer R, Traugott M, Omid S, Zoufaly A, Tong A, Kropiunigg U, Hecking M. Experiences and challenges faced by patients with COVID-19 who were hospitalised and participated in a randomised controlled trial: a qualitative study. BMJ Open 2022; 12:e062176. [PMID: 36220325 PMCID: PMC9556753 DOI: 10.1136/bmjopen-2022-062176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES As part of a randomised controlled trial, this qualitative study aimed to identify experiences and challenges of hospitalised patients with COVID-19 during illness and treatment (objective 1: COVID-19-related perspectives; objective 2: trial participation-related perspectives). DESIGN Semistructured interviews following a prespecified interview guide, transcribed verbatim and analysed in accordance with the grounded theory process. Investigator triangulation served to ensure rigour of the analysis. SETTING Interviews were embedded in a multicentre, randomised, active-controlled, open-label platform trial testing efficacy and safety of experimental therapeutics for patients with COVID-19 (Austrian Corona Virus Adaptive Clinical Trial). PARTICIPANTS 20 patients (60±15 years) providing 21 interviews from 8 June 2020 to 25 April 2021. RESULTS Qualitative data analysis revealed four central themes with subthemes. Theme 1, 'A Severe Disease', related to objective 1, was characterised by subthemes 'symptom burden', 'unpredictability of the disease course', 'fear of death' and 'long-term aftermaths with lifestyle consequences'. Theme 2, 'Saved and Burdened by Hospitalization', related to objective 1, comprised patients describing their in-hospital experience as 'safe haven' versus 'place of fear', highlighting the influence of 'isolation'. Theme 3, 'Managing One's Own Health', related to objective 1, showed how patients relied on 'self-management' and 'coping' strategies. Theme 4, 'Belief in Medical Research', related to objective 2, captured patients' 'motivation for study participation', many expressing 'information gaps' and 'situational helplessness' in response to study inclusion, while fewer mentioned 'therapy side-effects' and provided 'study reflection'. Investigator triangulation with an expert focus group of three doctors who worked at the study centre confirmed the plausibility of these results. CONCLUSIONS Several of the identified themes (2, 3, 4) are modifiable and open for interventions to improve care of patients with COVID-19. Patient-specific communication and information is of utmost importance during clinical trial participation, and was criticised by participants of the present study. Disease self-management should be actively encouraged. TRIAL REGISTRATION NUMBER NCT04351724.
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Affiliation(s)
- Lukas Hofstetter
- Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Viktoria Tinhof
- Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Hannah Mayfurth
- Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Amelie Kurnikowski
- Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Vincent Rathkolb
- Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | | | | | - Sara Omid
- Department of Internal Medicine IV, Klinik Favoriten, Wien, Austria
| | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ulrich Kropiunigg
- Department of Medical Psychology, Medical University of Vienna, Wien, Austria
| | - Manfred Hecking
- Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
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Serving the public? A content analysis of COVID-19 public service announcements airing from March - December of 2020 in the U.S. Prev Med Rep 2022; 29:101971. [PMID: 36090963 PMCID: PMC9444310 DOI: 10.1016/j.pmedr.2022.101971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/28/2022] [Accepted: 08/27/2022] [Indexed: 11/21/2022] Open
Abstract
The objective of this research was to examine the health messages conveyed in public service announcements (PSAs) affiliated with the U.S. federal government response to the COVID-19 pandemic in 2020. To do so, we conducted a content analysis of 132 federally-affiliated PSAs that were aired 170,820 times between March 12 and December 16, 2020. Using a quantitative coding instrument, we analyzed health behavioral guidance, messages about groups, people depicted, and other PSA features. We calculated frequencies of exposure to messages at the airing-level to account for the varying number of times each PSA was aired. Far more PSAs aired between March and June than between July and December. The most common health guidance was to stay at home (80.7%), practice social distancing (61.9%), and wash hands (54.5%); 36.1% of airings included guidance to wear masks. Few PSAs referenced group differences in risk of infection or transmission, nor did they reference scientific evidence or the future availability of vaccines. PSAs aired in 2020 missed opportunities to convey important information to the public and to center health equity in public communication.
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Zhong Y, Zhao H, Lee TY, Yu T, Liu MF, Ji J. Experiences of COVID-19 patients in a Fangcang shelter hospital in China during the first wave of the COVID-19 pandemic: a qualitative descriptive study. BMJ Open 2022; 12:e065799. [PMID: 36104127 PMCID: PMC9475958 DOI: 10.1136/bmjopen-2022-065799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This study aimed to examine COVID-19 patients' experiences in a Fangcang shelter hospital in China, to provide insights into the effectiveness of this centralised isolation strategy as a novel solution to patient management during emerging infectious disease outbreaks. DESIGN This study adopted a qualitative descriptive design. Data were collected by individual semistructured interviews and analysed using thematic analysis. SETTING This study was undertaken in 1 of the 16 Fangcang shelter hospitals in Wuhan, China between 28 February 2020 and 7 March 2020. Fangcang shelter hospitals were temporary healthcare facilities intended for large-scale centralised isolation, treatment and disease monitoring of mild-to-moderate COVID-19 cases. These hospitals were an essential component of China's response to the first wave of the COVID-19 pandemic. PARTICIPANTS A total of 27 COVID-19 patients were recruited by purposive sampling. Eligible participants were (1) COVID-19 patients; (2) above 18 years of age and (3) able to communicate effectively. Exclusion criteria were (1) being clinically or emotionally unstable and (2) experiencing communication difficulties. RESULTS Three themes and nine subthemes were identified. First, COVID-19 patients experienced a range of psychological reactions during hospitalisation, including fear, uncertainty, helplessness and concerns. Second, there were positive and negative experiences associated with communal living. While COVID-19 patients' evaluation of essential services in the hospital was overall positive, privacy and hygiene issues were highlighted as stressors during their hospital stay. Third, positive peer support and a trusting patient-healthcare professional relationship served as a birthplace for resilience, trust and gratitude in COVID-19 patients. CONCLUSIONS Our findings suggest that, while sacrificing privacy, centralised isolation has the potential to mitigate negative psychological impacts of social isolation in COVID-19 patients by promoting meaningful peer connections, companionship and support within the shared living space. To our knowledge, this is the first study bringing patients' perspectives into healthcare service appraisal in emergency shelter hospitals.
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Affiliation(s)
- Yaping Zhong
- Academic Nursing Unit, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Huan Zhao
- Institute of Innovation, Science and Sustainability, Federation University Australia - Berwick Campus, Berwick, Victoria, Australia
| | - Tsorng-Yeh Lee
- School of Nursing, York University, Toronto, Ontario, Canada
| | - Tianchi Yu
- Department of Nephrology and Urology, Sir Run Run Hospital Nanjing Medical University, Nanjing, Jiangsu, China
- Kidney Disease Centre, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Ming Fang Liu
- Operation Room, Sir Run Run Hospital Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ji Ji
- Department of Nursing, Shandong First Medical University, Jinan, China
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021 Jinan, Shandong, China
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Sebastian T, Carlson JJ, Gaensbauer J, Podewils LJ. Epidemiology and Transmission Dynamics of COVID-19 in an Urban Pediatric US Population. Public Health Rep 2022; 137:1013-1022. [PMID: 35786113 PMCID: PMC9357825 DOI: 10.1177/00333549221105232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This analysis summarizes observational epidemiologic data and transmission dynamics of SARS-CoV-2 among people aged <18 years to better characterize the pediatric COVID-19 pandemic. METHODS We conducted a retrospective study of public health surveillance data among children in Denver, Colorado, who were reported to have COVID-19 from March 1, 2020, through September 30, 2021. We used descriptive statistics and bivariate rate ratios (RRs) to describe demographic and clinical characteristics, transmission dynamics, case trends, and ecological associations. RESULTS A total of 9815 children and adolescents who had COVID-19 were reported during the study period. Adolescents aged 14-17 years had the highest incidence rate (IR) per 1000 people (IR = 107.5; 3021 of 28 108). Hispanic/Latino children had a 1.6 times higher rate of infection than non-Hispanic White children (RR = 1.57; 95% CI, 1.50-1.65; P < .001). Few hospitalizations (n = 138, 1.4%) and deaths (n = 3, 0%) occurred. Most children were symptomatic (4487 of 5499, 81.6%). Within household clusters, a large proportion of pediatric cases (n = 6136) were a secondary case (n = 3959, 64.5%), followed by index case (n = 1170, 19.1%) and co-index case (n = 1007, 16.4%). Non-Hispanic White children had an increased risk of being an index or co-index case (RR = 1.14; 95% CI, 1.06-1.23; P < .001), while Hispanic/Latino children had an increased risk of being a secondary case (RR = 1.07; 95% CI, 1.03-1.11; P < .001). From 2020 to 2021, the association between pediatric case rates and neighborhoods with higher poverty and households with ≥3 people decreased. CONCLUSIONS Older children and those identifying as Hispanic/Latino had a disproportionate incidence of disease. A sizable proportion of children were considered index cases or co-index cases. Pediatric prevention strategies, especially vaccinations, are vital for pandemic control.
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Affiliation(s)
- Thresia Sebastian
- Department of Pediatrics, Denver Health
and Hospital Authority, Denver, CO, USA
- Department of Pediatrics, University of
Colorado School of Medicine, Aurora, CO, USA
| | - Jesse J. Carlson
- Public Health Institute at Denver
Health, Denver Health and Hospital Authority, Denver, CO, USA
| | - James Gaensbauer
- Department of Pediatrics, Denver Health
and Hospital Authority, Denver, CO, USA
- Department of Pediatrics, University of
Colorado School of Medicine, Aurora, CO, USA
- Public Health Institute at Denver
Health, Denver Health and Hospital Authority, Denver, CO, USA
- School of Public Health, University of
Colorado Anschutz Medical Campus, Denver, CO, USA
- Department of Pediatrics and Adolescent
Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Laura Jean Podewils
- Public Health Institute at Denver
Health, Denver Health and Hospital Authority, Denver, CO, USA
- School of Public Health, University of
Colorado Anschutz Medical Campus, Denver, CO, USA
- Office of Research, Denver Health and
Hospital Authority, Denver, CO, USA
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Ro A, Bruckner TA, Huynh MP, Du S, Young A. Emergency Department Utilization Among Undocumented Latino Patients During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01382-8. [PMID: 35982287 PMCID: PMC9388205 DOI: 10.1007/s40615-022-01382-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023]
Abstract
Objective To determine whether Latino undocumented immigrants had a steeper decline in Emergency Department (ED) utilization compared to Latino Medi-Cal patients in a Los Angeles safety-net hospital, March 13, 2020, to May 8, 2020. Study Design The data were extracted from patient medical records for ED visits at LAC + USC Medical Center from January 2018 to September 2020. We analyzed weekly ED encounters among undocumented Latino patients in the nine-week period after COVID was declared a national emergency. We applied time-series routines to identify and remove autocorrelation in ED encounters before examining its relation with the COVID-19 pandemic. We included Latino patients 18 years of age and older who were either on restricted or full-scope Medi-Cal (n = 230,195). Results All low-income Latino patients, regardless of immigration status, experienced a significant decline in ED utilization during the first nine weeks of the pandemic. Undocumented patients, however, experienced an even steeper decline. ED visits for this group fall below expected levels between March 13, 2020, and May 8, 2020 (coef. = − 38.67; 95% CI = − 71.71, − 5.63). When applied to the weekly mean of ED visits, this translates to a 10% reduction below expected levels in ED visits during this time period. Conclusion Undocumented immigrants’ health care utilization was influenced by external events that occurred early in the pandemic, such as strict stay-at-home orders and the public charge rule change. Health care institutions and local policy efforts could work to ensure that hospitals are safer spaces for undocumented immigrants to receive care without immigration concerns.
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Affiliation(s)
- Annie Ro
- Department of Health, Society, and Behavior, Anteater Instruction and Research Building (AIRB), UC Irvine Program in Public Health, 653 E. Peltason Road, Irvine, CA, 92697, USA.
| | - Tim A Bruckner
- Department of Health, Society, and Behavior, Anteater Instruction and Research Building (AIRB), UC Irvine Program in Public Health, 653 E. Peltason Road, Irvine, CA, 92697, USA
| | - Michael Pham Huynh
- Department of Health, Society, and Behavior, Anteater Instruction and Research Building (AIRB), UC Irvine Program in Public Health, 653 E. Peltason Road, Irvine, CA, 92697, USA
| | - Senxi Du
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Young
- Division of Geriatric, Hospital, Palliative and General Internal Medicine, Department of Medicine, Keck School of Medicine, Los Angeles, CA, USA
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Sudhinaraset M, Choi HY, Nwankwo E, De Trinidad Young ME. Association between immigration enforcement encounters and COVID-19 testing and delays in care: a cross-sectional study of undocumented young adult immigrants in california. BMC Public Health 2022; 22:1558. [PMID: 35974358 PMCID: PMC9379231 DOI: 10.1186/s12889-022-13994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Undocumented immigrants are expected to face increased risks related to COVID-19 due to marginalizing restrictive immigration policies. However, few studies have assessed the prevalence of direct encounters with the immigration enforcement system among the undocumented and its impacts on their COVID-related health behaviors and outcomes. In this study, we quantify undocumented immigrants' lifetime exposure to various immigration enforcement tactics and their association with delays in COVID-19 testing and healthcare behaviors. METHODS This cross-sectional study included a non-random sample of 326 Asian and Latinx undocumented immigrants in California from September 2020 to February 2021. The primary exposure was immigration enforcement encounter scores ranging from 0-9, assessed through self-reports of direct experiences with the immigration system, immigration officials, and law enforcement. The main outcomes were positive test for COVID-19, had or suspected having COVID-19, and delayed or avoided testing and/or treatment for COVID-19 due to immigration status. We used multivariable logistic regression models to examine the association between the primary exposure and outcomes of interest. RESULTS Among 326 participants, 7% had received a positive COVID-19 test result, while 43% reported having or suspected having COVID-19. Almost 13% delayed or avoided COVID-19 testing and/or treatment because of their immigration status. Overall, an increase in immigration enforcement encounters was associated with higher odds of suspecting having had COVID-19 (aOR = 1.13; 95% CI: 1.01,1.26). Reporting an additional enforcement encounter was associated with higher odds of delaying or avoiding testing and/or treatment because of immigration status (aOR = 1.53, 95% CI: 1.26,1.86). Compared to their Latino counterparts, Asian respondents were more likely to report higher odds of delaying or avoiding testing and/or treatment (aOR = 3.13, 95% CI: 1.17,8.42). There were no significant associations between the enforcement score and testing positive for COVID-19. Additionally, while Latinxs were more likely to report immigration enforcement encounters than Asians, there were no differences in the effects of race on COVID-19 testing and healthcare behaviors in models with race as an interaction term (p < 0.05). CONCLUSIONS Immigration enforcement encounters compound barriers to COVID-19 testing and treatment for undocumented immigrants.
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Affiliation(s)
- May Sudhinaraset
- Fielding School of Public Health, Community Health Sciences Jonathan and Karin, University of California Los Angeles, Los Angeles, CA, USA.
| | - Hye Young Choi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ezinne Nwankwo
- Fielding School of Public Health, Community Health Sciences Jonathan and Karin, University of California Los Angeles, Los Angeles, CA, USA
| | - Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, CA, USA
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Meza E, Giglio L, Franco AO, Rodriguez E, Stock L, Balmes J, Torres JM, Fernandez A. Worker Perspectives on COVID-19 Risks: A Qualitative Study of Latino Construction Workers in Oakland, California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169822. [PMID: 36011454 PMCID: PMC9408167 DOI: 10.3390/ijerph19169822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 05/10/2023]
Abstract
Latino construction workers in the U.S. have faced a disproportionate risk for COVID-19 infection in the workplace. Prior studies have focused on quantifying workplace risk for COVID-19 infection; few have captured workers' experiences and perspectives. This study describes COVID-19-related workplace risks from the perspectives of Latino construction workers. We conducted a qualitative study using semi-structured phone interviews with Latino construction workers from the Fruitvale District of Oakland, California. Twenty individuals were interviewed from December 2020 to March 2021. Nearly all participants (19/20) were Spanish-speaking men; mean age 42.6 years. The majority were low-income and over one-third did not have health insurance. Participants worked in varied construction-related jobs ranging from demolition to office work; additionally, four were day laborers, and three belonged to a labor union. We identified four major themes with public health policy and workplace safety implications: (1) Major concern about the risk of SARS-CoV-2 infection for family health and economic wellbeing; (2) Clarity about mask use and social distancing but not disclosure; (3) Variability in access to additional resources provided by employers; and (4) Uncertainty around structural support for SARS-CoV-2 quarantine/isolation. Our findings provide further evidence from workers' own perspectives of the major gaps experienced during the pandemic in workplace protections and resources.
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Affiliation(s)
- Erika Meza
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
- Correspondence:
| | - Leslie Giglio
- Department of Medicine, Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA 94110, USA
| | - Ana O. Franco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Elizabeth Rodriguez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
- Department of Biology, San Francisco State University, San Francisco, CA 94132, USA
| | - Laura Stock
- Labor Occupational Health Program, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - John Balmes
- Division of Occupational and Environmental Medicine, School of Medicine, University of California, San Francisco, CA 94143, USA
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94704, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Alicia Fernandez
- Department of Medicine, Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA 94110, USA
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Mehta SN, Burger ZC, Meyers-Pantele SA, Garfein RS, Ortiz DO, Mudhar PK, Kothari SB, Kothari J, Meka M, Rodwell T. Knowledge, Attitude, Practices, and Vaccine Hesitancy Among the Latinx Community in Southern California Early in the COVID-19 Pandemic: Cross-sectional Survey. JMIR Form Res 2022; 6:e38351. [PMID: 35925649 PMCID: PMC9359308 DOI: 10.2196/38351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background The Latinx population in the United States has experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices (KAP) specifically in Latinx communities in the United States. Objective We aimed to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages of the COVID-19 pandemic (from July 2020 to October 2020), at a unique time when a vaccine was not available. Methods Participants aged ≥18 years were recruited at a primary care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. A subset of the participants answered the vaccine hesitancy assessment as it was added after the start of data collection. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes toward the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fitted to test associations between sociodemographic characteristics and KAP scores. For our analysis, we only included patients who self-identified as Latinx. Results Our final data set included 265 participants. The participants had a mean age of 49 (IQR 38.5-59) years, and 72.1% (n=191) were female, 77% (n=204) had at most a high school degree, 34.7% (n=92) had an annual income <US $25,000, and 11.7% (n=31) had previously tested positive for COVID-19. We found high knowledge regarding transmission and spread; moderate knowledge regarding symptoms awareness; overall negative attitudes, which included high pessimism in government public health efforts and high amounts of fear, anxiety, and frustration due to COVID-19 pandemic; and moderate participation in preventive practices. A college education was positively associated with a higher knowledge score than those without a college education (β=0.14, 95% CI 0.01-1.60; P=.04) when adjusted for covariates. Male gender had a positive association with COVID-19 attitude scores compared to female gender (β=1.61, 95% CI 0.50-2.72; P=.05), and male gender was negatively associated with the COVID-19 practices score compared to female gender (β=–0.16, 95% CI –0.56 to –0.06; P=.03), when both were adjusted for covariates. Among a subset of 203 patients, 26.6% (n=54) indicated that if the vaccine was available, they would not take a COVID-19 vaccine, and 18.7% (n=38) were unsure. Conclusions Good knowledge and preventative practices in the population may have reflected effective public health messaging and the implementation of public health laws during the first wave of the pandemic; however, the overall fear and anxiety may have reflected the negative impact that the pandemic had on vulnerable populations such as the Latinx community. Although our data are a reflection of a previous time in the pandemic, we believe it captures a critical time that can be used to provide unique insights regarding potential avenues to better protect the Latinx communities against future vaccine-resistant COVID-19 strains. International Registered Report Identifier (IRRID) RR2-10.2196/25265
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Affiliation(s)
- Shivani N Mehta
- San Diego School Of Medicine, University of California, La Jolla, CA, United States
- Amistad Medical Clinic, Santa Ana, CA, United States
| | - Zoe C Burger
- San Diego School Of Medicine, University of California, La Jolla, CA, United States
| | | | - Richard S Garfein
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, CA, United States
| | - Dayanna O Ortiz
- San Diego School Of Medicine, University of California, La Jolla, CA, United States
| | - Pavan K Mudhar
- Amistad Medical Clinic, Santa Ana, CA, United States
- Department of Audiology, Arizona School of Health Sciences, Mesa, AZ, United States
| | - Smit B Kothari
- Amistad Medical Clinic, Santa Ana, CA, United States
- University of Rochester, Rochester, NY, United States
| | - Jigna Kothari
- Amistad Medical Clinic, Santa Ana, CA, United States
| | - Meena Meka
- Amistad Medical Clinic, Santa Ana, CA, United States
| | - Timothy Rodwell
- San Diego School Of Medicine, University of California, La Jolla, CA, United States
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Martínez-Donate AP, Correa-Salazar C, Bakely L, González-Fagoaga JE, Asadi-Gonzalez A, Lazo M, Parrado E, Zhang X, Rangel Gomez MG. COVID-19 testing, infection, and vaccination among deported Mexican migrants: Results from a survey on the Mexico-U.S. border. Front Public Health 2022; 10:928385. [PMID: 35968453 PMCID: PMC9372570 DOI: 10.3389/fpubh.2022.928385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Migrants detained and held in immigration and other detention settings in the U.S. have faced increased risk of COVID-19 infection, but data on this population is scarce. This study sought to estimate rates of COVID-19 testing, infection, care seeking, and vaccination among Mexican migrants detained by U.S. immigration authorities and forcibly returned to Mexico. Methods We conducted a cross-sectional probability survey of Mexican migrants deported from the U.S. to three Mexican border cities: Tijuana, Ciudad Juárez, and Matamoros (N = 306). Deported migrants were recruited at Mexican migration facilities after being processed and cleared for departure. A two-stage sampling strategy was used. Within each city, a selection of days and shifts were selected during the operating hours of these deportation facilities. The probability of selection was proportional to the volume of migrants deported on each day of the month and during each time period. During the selected survey shifts, migrants were consecutively approached, screened for eligibility, and invited to participate in the survey. Survey measures included self-reported history of COVID-19 testing, infection, care seeking, vaccination, intentions to vaccinate, and other prevention and risk factors. Weighted data were used to estimate population-level prevalence rates. Bivariate tests and adjusted logistic regression models were estimated to identify associations between these COVID-19 outcomes and demographic, migration, and contextual factors. Results About 84.1% of migrants were tested for COVID-19, close to a third were estimated to have been infected, and, among them, 63% had sought care for COVID-19. An estimated 70.1% had been vaccinated against COVID-19 and, among those not yet vaccinated, 32.5% intended to get vaccinated. Close to half (44.3%) of respondents had experienced crowdedness while in detention in the U.S. Socio-demographic (e.g. age, education, English fluency) and migration-related (e.g. type of detention facility and time in detention) variables were significantly associated with COVID-19 testing, infection, care seeking, and vaccination history. Age, English fluency, and length of detention were positively associated with testing and vaccination history, whereas detention in an immigration center and length of time living in the U.S. were negatively related to testing, infection, and vaccination history. Survey city and survey quarter also showed adjusted associations with testing, infection, and vaccination history, reflecting potential variations in access to services across geographic regions and over time as the pandemic unfolded. Conclusion These findings are evidence of increased risk of COVID-19 infection, insufficient access to testing and treatment, and missed opportunities for vaccination among Mexican migrants detained in and deported from the U.S. Deportee receiving stations can be leveraged to reduce disparities in testing and vaccination for deported migrants. In addition, decarceration of migrants and other measures informed by public health principles must be implemented to reduce COVID-19 risk and increase access to prevention, diagnostic, and treatment services among this underserved population.
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Affiliation(s)
- Ana P. Martínez-Donate
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- *Correspondence: Ana P. Martínez-Donate
| | - Catalina Correa-Salazar
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Leah Bakely
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | | | - Ahmed Asadi-Gonzalez
- School of Medicine and Psychology, Autonomous University of Baja California, Tijuana, Mexico
| | - Mariana Lazo
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Emilio Parrado
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States
| | - Xiao Zhang
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Maria Gudelia Rangel Gomez
- Mexico Section of the U.S.-Mexico Border Health Commission, Tijuana, Mexico
- El Colegio de la Frontera Norte, Tijuana, Mexico
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45
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LaBerge A, Osuna AI, Cavanagh C, Cauffman E. Mothers with justice-involved sons: Socioeconomic impacts of COVID-19 by neighborhood disorder in the United States. THE JOURNAL OF SOCIAL ISSUES 2022; 79:JOSI12527. [PMID: 35942487 PMCID: PMC9349875 DOI: 10.1111/josi.12527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
Women, particularly mothers, have faced disparate socioeconomic consequences throughout the COVID-19 pandemic. Research has yet to examine whether the consequences of the pandemic vary based on the level of neighborhood disorder, which is associated with various health conditions, including COVID-19 complications. The present study utilizes data from a diverse sample of 221 women with justice-involved sons interviewed during the early months of the COVID-19 pandemic. Negative binominal and logistic regression analyses were conducted to examine whether perceived neighborhood social disorder is related to socioeconomic impacts of the COVID-19 pandemic, and whether the relation varies for mothers with and without children in their home during the pandemic. The results suggest that greater perceived neighborhood social disorder was associated with increased in COVID-19-related socioeconomic consequences. Neighborhood social disorder affected socioeconomic impacts above and beyond the effects of having a child living in the home. Additionally, Latinas experienced greater socioeconomic impacts than women of other races and ethnicities. The results indicate a key relationship between the neighborhood conditions a woman lives in and the extent of the socioeconomic consequences they faced during the early months of the COVID-19 pandemic. Future directions and direct implications of the study findings are discussed.
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Affiliation(s)
- Alyssa LaBerge
- School of Criminal JusticeMichigan State UniversityEast LansingMichiganUSA
| | | | - Caitlin Cavanagh
- School of Criminal JusticeMichigan State UniversityEast LansingMichiganUSA
| | - Elizabeth Cauffman
- Department of Psychological ScienceUniversity of CaliforniaIrvineCaliforniaUSA
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De Ramos IP, Lazo M, Schnake-Mahl A, Li R, Martinez-Donate AP, Roux AVD, Bilal U. COVID-19 Outcomes Among the Hispanic Population of 27 Large US Cities, 2020-2021. Am J Public Health 2022; 112:1034-1044. [PMID: 35588187 PMCID: PMC9222469 DOI: 10.2105/ajph.2022.306809] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To examine racial/ethnic disparities in COVID-19 outcomes between Hispanics and Whites across 27 US jurisdictions whose health departments are members of the Big Cities Health Coalition (BCHC). Methods. Using surveillance data from the BCHC COVID-19 dashboard as of mid-June 2021, we computed crude incidence, age-adjusted hospitalization and mortality, and full vaccination coverage rates for Hispanics and Whites by city. We estimated relative and absolute disparities cumulatively and for 2020 and 2021 and explored associations between city-level social vulnerability and the magnitude of disparities. Results. In most of the cities with available COVID-19 incidence data, rates among Hispanics were 2.2 to 6.7 times higher than those among Whites. In all cities, Hispanics had higher age-adjusted hospitalization (1.5-8.6 times as high) and mortality (1.4-6.2 times as high) rates. Hispanics had lower vaccination coverage in all but 1 city. Disparities in incidence and hospitalizations narrowed in 2021, whereas disparities in mortality remained similar. Disparities in incidence, hospitalization, mortality, and vaccination rates were wider in cities with lower social vulnerability. Conclusions. A deeper exploration of racial/ethnic disparities in COVID-19 outcomes is essential to understand and prevent disparities among marginalized communities. (Am J Public Health. 2022;112(7): 1034-1044. https://doi.org/10.2105/AJPH.2022.306809).
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Affiliation(s)
- Isabel P De Ramos
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Mariana Lazo
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Alina Schnake-Mahl
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Ran Li
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Ana P Martinez-Donate
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Ana V Diez Roux
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Usama Bilal
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
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Addressing COVID-19 vaccination equity for Hispanic/Latino communities by attending to aguantarismo: A Californian US-Mexico border perspective. Soc Sci Med 2022; 305:115096. [PMID: 35691209 PMCID: PMC9158329 DOI: 10.1016/j.socscimed.2022.115096] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 12/11/2022]
Abstract
With an eye to health equity and community engagement in the context of the initial COVID-19 vaccine roll-out, the COVID-19-related concerns of the Latinx (Hispanic/Latino) community in southern San Diego (California, USA) were examined using 42 rapid, ethnographically-informed interviews and two focus groups conducted in early-mid 2021. An anthropologically oriented qualitative analysis delimited the cultural standpoint summarized as aguantarismo, which celebrates human durability in the face of socioeconomic hardship and the capacity to abide daily life's challenges without complaint. After characterizing aguantarismo, its role in both undermining and supporting vaccine uptake is explored. To avoid diverting attention from the structural factors underlying health inequities, the analysis deploys the theoretical framework of critical medical anthropology, highlighting inequities that gain expression in aguantarismo, and the indifference toward vaccination that it can support. In placing critical medical anthropology into conversation with the cultural values approach to public health, the analysis sheds new light on the diversity of human strategies for coping with infectious disease and uncovers new possibilities for effective vaccination promotion. Findings will be useful to public health experts seeking to convert non-vaccinators and optimize booster and pediatric COVID-19 vaccine communications. They will also contribute to the literature on cultural values in relation to Hispanic/Latino or border health more broadly, both by confirming the vital flexibility of cultural standpoints like aguantarismo and by documenting in situ what is to the social science and health literature, albeit not to cultural participants, a novel constellation.
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Zhang H, Xie F, Yang B, Zhao F, Wang C, Chen X. Psychological experience of COVID-19 patients: A systematic review and qualitative meta-synthesis. Am J Infect Control 2022; 50:809-819. [PMID: 35121042 PMCID: PMC8806710 DOI: 10.1016/j.ajic.2022.01.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has not only placed an unprecedented strain on healthcare systems worldwide, but has also caused irreparable physical and psychological damage to those infected. It is essential to understand the disease process and psychological experience of patients with COVID-19, to provide them with efficacious psychological guidance and interventions. This qualitative systematic review sought to explore the experience of COVID-19 patients. METHODS The meta-analysis methodology developed by the Joanna Briggs Institute guided this systematic review and qualitative meta-analysis. Seven databases were searched, with no language restrictions. This study was registered with PROSPERO under accession number CRD42021279266. RESULTS A total of 3107 potentially eligible articles were identified through database and reference list searches, among which 23 studies (from 10 countries) were ultimately included in our analysis. Five interrelated themes emerged: the complex psychological course of COVID-19 patients; the impact of the disease on the body; the expectation of support and guidance from multiple sources; coping strategies; and post-traumatic growth. CONCLUSIONS Psychological distress among patients with COVID-19 was found to be widespread. Healthcare providers should pay attention to the psychological changes in patients, ensure continuity of care and provide professional support from hospital to home, and build patients' confidence so that they can return to their families and society. Long-term follow-up studies may provide deeper insight into the psychological needs of survivors.
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Gwadz M, Cleland CM, Lizardo M, Hawkins RL, Bangser G, Parameswaran L, Stanhope V, Robinson JA, Karim S, Hollaway T, Ramirez PG, Filippone PL, Ritchie AS, Banfield A, Silverman E. Using the multiphase optimization strategy (MOST) framework to optimize an intervention to increase COVID-19 testing for Black and Latino/Hispanic frontline essential workers: A study protocol. BMC Public Health 2022; 22:1235. [PMID: 35729622 PMCID: PMC9210062 DOI: 10.1186/s12889-022-13576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Among those at highest risk for COVID-19 exposure is the large population of frontline essential workers in occupations such food service, retail, personal care, and in-home health services, among whom Black and Latino/Hispanic persons are over-represented. For those not vaccinated and at risk for exposure to COVID-19, including frontline essential workers, regular (approximately weekly) COVID-19 testing is recommended. However, Black and Latino/Hispanic frontline essential workers in these occupations experience serious impediments to COVID-19 testing at individual/attitudinal- (e.g., lack of knowledge of guidelines), social- (e.g., social norms), and structural-levels of influence (e.g., poor access), and rates of testing for COVID-19 are insufficient. METHODS/DESIGN The proposed community-engaged study uses the multiphase optimization strategy (MOST) framework and an efficient factorial design to test four candidate behavioral intervention components informed by an integrated conceptual model that combines critical race theory, harm reduction, and self-determination theory. They are A) motivational interview counseling, B) text messaging grounded in behavioral economics, C) peer education, and D) access to testing (via navigation to an appointment vs. a self-test kit). All participants receive health education on COVID-19. The specific aims are to: identify which components contribute meaningfully to improvement in the primary outcome, COVID-19 testing confirmed with documentary evidence, with the most effective combination of components comprising an "optimized" intervention that strategically balances effectiveness against affordability, scalability, and efficiency (Aim 1); identify mediators and moderators of the effects of components (Aim 2); and use a mixed-methods approach to explore relationships among COVID-19 testing and vaccination (Aim 3). Participants will be N = 448 Black and Latino/Hispanic frontline essential workers not tested for COVID-19 in the past six months and not fully vaccinated for COVID-19, randomly assigned to one of 16 intervention conditions, and assessed at 6- and 12-weeks post-baseline. Last, N = 50 participants will engage in qualitative in-depth interviews. DISCUSSION This optimization trial is designed to yield an effective, affordable, and efficient behavioral intervention that can be rapidly scaled in community settings. Further, it will advance the literature on intervention approaches for social inequities such as those evident in the COVID-19 pandemic. TRIAL REGISTRATION ClinicalTrials.gov: NCT05139927 ; Registered on 11/29/2021. Protocol version 1.0. May 2, 2022, Version 1.0.
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Affiliation(s)
- Marya Gwadz
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA.
- Center for Drug Use and HIV Research (CDUHR), NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Charles M Cleland
- Center for Drug Use and HIV Research (CDUHR), NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
- Division of Biostatistics, Department of Population Health at NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Maria Lizardo
- Northern Manhattan Improvement Corporation (NMIC), 45 Wadsworth Avenue, New York, NY, 10033, USA
| | - Robert L Hawkins
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Greg Bangser
- Northern Manhattan Improvement Corporation (NMIC), 45 Wadsworth Avenue, New York, NY, 10033, USA
| | - Lalitha Parameswaran
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Victoria Stanhope
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Jennifer A Robinson
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Shristi Karim
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Tierra Hollaway
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Paola G Ramirez
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Prema L Filippone
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Amanda S Ritchie
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | | | - Elizabeth Silverman
- SUNY Research Foundation, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
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Cervantes L, Hazel CA, Mancini D, Pereira RI, Podewils LJ, Stella SA, Durfee J, Barshney A, Steiner JF. Perspectives of Latinx Individuals Who Were Unvaccinated And Hospitalized for COVID-19: A Qualitative Study. JAMA Netw Open 2022; 5:e2218362. [PMID: 35713898 PMCID: PMC9206184 DOI: 10.1001/jamanetworkopen.2022.18362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Importance Latinx individuals in the United States have lower COVID-19 vaccination rates and higher rates of COVID-19 infections, hospitalizations, and deaths than non-Latinx White individuals. Little is known about the perspectives of Latinx adults who had not received the COVID-19 vaccination and were hospitalized for COVID-19. Objective To describe the perspectives of Latinx individuals who were unvaccinated and subsequently hospitalized for COVID-19. Design, Setting, and Participants This qualitative study was conducted using semistructured phone interviews with 25 Latinx adults who were unvaccinated and survived a COVID-19 hospitalization in a public safety net hospital in Colorado from February to November 2021. Interviews were audio recorded, and transcripts were analyzed using thematic analysis. Main Outcomes and Measures Themes and subthemes of perspectives on vaccination. Results Among 25 adults (14 [56.0%] women, 11 [44.0%] men; mean [SD] age, 51 [15] years) who participated, all participants self-identified as Latino, Latina, or Latinx or Hispanic. There were 11 individuals who relied on emergency Medicaid (hospital coverage for Denver residents who are undocumented), while 10 individuals (40.0%) were essential workers and 13 individuals (52.0%) were unemployed. In interviews, 3 themes (with subthemes) were identified: factors associated with vaccination after hospitalization (subthemes: fear of death, avoiding hospitalization and reinfection, convinced COVID-19 is real, and responded to pressure from others), concerns about the COVID-19 vaccine (subthemes: experimental status and short timeline for production, contents of vaccine unknown or concerning, vaccine considered ineffective, worrisome immediate and long-term adverse effects, mixed and conflicting information, and government aimed to control or mark population through vaccination), and opportunities to improve vaccine uptake (subthemes; sharing personal experiences through social media, testimonials about minimal vaccine adverse effects, connecting with friends and family about the hospitalization experience, making the vaccine more accessible, and connecting with trusted sources of information). Conclusions and Relevance This study found that Latinx individuals who were unvaccinated and subsequently hospitalized for COVID-19 were motivated to engage in advocacy to encourage vaccination in their communities. These findings suggest that supporting patient advocacy after hospital discharge and continued efforts to create low-barrier, patient-informed public health strategies may be associated with increased vaccine uptake in Latinx communities.
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Affiliation(s)
- Lilia Cervantes
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
- Department of Medicine, University of Colorado, Aurora
| | | | - Diana Mancini
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | - Rocio I. Pereira
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | - Laura J. Podewils
- Office of Research, Denver Health and Hospital Authority, Denver, Colorado
| | - Sarah A. Stella
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | - Joshua Durfee
- Office of Research, Denver Health and Hospital Authority, Denver, Colorado
| | - Alana Barshney
- Office of Research, Denver Health and Hospital Authority, Denver, Colorado
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