Disinformation, Misinformation and Inequality-Driven Mistrust in the Time of COVID-19: Lessons Unlearned from AIDS Denialism

Effects of Scanning Health News Headlines on Trust in Science: An Emotional Framing Perspective

Rooted in the emotions-as-frames model (EFM), this research examines how hope, fear, and annoyance are evoked through health news headline scanning, and how these emotions influence perceptions of news and medical science institutions as well as health behavioral intentions. A sample of U.S. adults (N = 327) were assigned to one of four headline framing conditions expected to associate with different emotions (positive future frame-hope; threat frame-fear/anxiety; reversal frame-annoyance; and control-neutral) and then asked about their emotional states, trust in science and news, and health-related behavioral intentions. Overall, health news headlines generated more hope than any other emotion across all conditions, and positive future-framed headlines evoked more hope than other framed headlines. Felt hope, in turn, generated greater trust in news and science, higher expectations of medical breakthroughs and cures, and greater intention to engage in preventative health behaviors. Felt anxiety had marginal positive benefits whereas felt annoyance negatively impacted the outcomes of interest. Notably, felt emotion mediated the headline frame-outcome relationships in the positive future/hope condition. These findings offer some support for the EFM and demonstrate that scanning headlines imbued with specific emotional frames can influence important health-related outcomes through the emotions they evoke. We discuss both the theoretical and practical implication of these findings.

Trust in Health Institutions Across Racial Groups: Implications for Dual Flu-Coronavirus Vaccine Adoption

This study investigates the factors that influence individuals' willingness to accept a combined COVID-19 and flu vaccine. The primary focus is on examining the impact of trust in health institutions, frequency of flu vaccine uptake, and COVID-19 vaccine uptake. The analysis further delves into racial differences to better understand variations among different racial groups.

METHODS

This study employs t-tests to compare the means of trust in health institutions, frequency of flu vaccine uptake, and COVID-19 vaccine uptake between individuals who are willing and unwilling to accept the combined vaccine. Additionally, a weighted logistic regression analysis is conducted to predict the likelihood of individuals to receive the combined vaccine, considering key independent and control variables.

RESULTS

The t-test results reveal that individuals who are willing to accept the combined vaccine exhibit higher levels of trust in health institutions, more frequent flu vaccine uptake, and higher COVID-19 vaccine uptake. This pattern holds true across all racial groups. The logistic regression analysis demonstrates that trust in health institutions, frequency of flu vaccine uptake, and COVID-19 vaccine uptake significantly predict individuals' willingness to accept the combined vaccine. Partisanship and demographic characteristics also exert influence on vaccine acceptance.

CONCLUSION

Trust in health institutions plays a pivotal role in vaccine acceptance among individuals from all racial groups. Encouraging routine vaccination practices and leveraging existing vaccination campaigns can facilitate the adoption of combined vaccines. It is imperative to address racial disparities and tailor communication strategies to specific demographic groups to enhance vaccine uptake.

Exploring COVID-19 vaccine uptake and hesitancy among vulnerable populations in inner city Vancouver, Canada: Insights into characteristics and clinical outcomes

The COVID-19 pandemic is having a profound impact on the health, social and economic well-being of people in Canada and around the world. To address vaccine disparity among vulnerable populations facing social-structural challenges, it is crucial to provide evidence-based information on the importance of completion of the recommended vaccination schedule. In this study, we investigated vaccination rates and variables as facilitators or barriers to COVID-19 vaccination among vulnerable populations living in Vancouver's inner-city residents. On a weekly basis, a team (including health care providers [HCPs] and support staff) conducts a Community Pop-up Clinic (CPC) event at single room occupancy dwellings in Vancouver's inner city to provide COVID-19 vaccine and/or related information. Participants also completed a survey about their COVID-19 vaccination status and COVID knowledge, including knowledge about COVID vaccination. We collected data from 892 CPC participants between January 2021-August 2023. The median age at baseline was 45 (IQR 36-55) years, with 317 (35.5 %) female and 285 (31.9 %) self-identified as Indigenous. Within the population, 512 (57.4 %) reported unstable housing and 441 (49.5 %) were active injection drug users. Regarding COVID-19 vaccinations, 235 (26.3 %) were unvaccinated, 119 (13.3 %) had received one dose of the COVID-19 vaccine, 432 (48.4 %) had received 2 doses, and 106 (11.8 %) had received at least 3 doses. Variables such as age (AOR 2.28, 95 % CI 1.37-3.80, p < 0.001) and HCV seropositivity (AOR 1.91, 95 % CI 1.20-3.04, p = 0.005) were significantly associated with higher odds of vaccination uptake. Conversely, unstable housing was significantly associated with a lower odds of vaccination uptake (AOR 0.53, 95 % CI 0.35-0.79, p = 0.002). Results from this study suggest that targeted community focused initiatives are crucial to address vaccine disparity among vulnerable populations living in Vancouver's inner city facing unstable housing and drug use injection.

From AIDS to COVID-19: the interplay between dual pandemics in social perceptions of disease

This paper is one of the few to examine how people who have lived through both COVID-19 and AIDS understand these pandemics in relation to each other. Data were collected in Uganda, and we found that the AIDS epidemic proved to be a key reference point for people in explaining why COVID-19 was perceived as so worrisome. In addition, AIDS-related stigma was a problematically common frame when discussing responsibility for HIV versus SARS-CoV-2 infection, and there was evidence of some forgetfulness regarding the toll AIDS had taken on the country. More positively, the legacy of AIDS made many people more attentive to social inequalities tied to health risks, and this at times prompted a more nuanced understanding of the socially varied effects of COVID-19. Overall, we argue that how individuals respond to a novel epidemic is shaped not only by their understandings of current threats but also by enduring perceptions of epidemics and pandemics that may have preceded it.

Elevating Home Health Aide Input in Co-Creation of COVID-19 Vaccine Messaging

Home health aides (HHAs) care for patients highly vulnerable to COVID-19 and are disproportionately women from minority communities that have been adversely impacted by COVID-19. Yet, direct care workers are less likely to be vaccinated against COVID-19 compared to others. As the pandemic evolves, interest in vaccination may decrease suggesting the need for relevant vaccine messaging to HHAs. Objectives: (1) to describe HHAs and administrators' perspectives related to COVID-19 vaccination messaging, and (2) to co-design a Communication Toolkit to create COVID-19 vaccine messages. Methods: HHAs and administrators from 4 geographically diverse Palliative Care Research Cooperative (PCRC) hospice agencies were recruited for a multi-method process involving qualitative interviews (17 HHAs and 5 administrators), community engagement (CE) studios, and development of a Communication Toolkit. Interviews were guided by the PEN-3 conceptual framework to explore barriers and facilitators to vaccination. Data were analyzed using qualitative content analysis. Results: Despite power differences, HHAs and administrators share a commitment to protecting patients affected by serious illness. HHAs desire vaccine messaging that includes personal narratives, good news about the vaccine, and facts about benefits and risks of the vaccine. Preferred message formats include the agency intranet, daily briefings, or "little seeds" (ie, short, high-impact information). Through the studios, HHAs provided input on a Toolkit prototype with messages tailored to the context of home care. Conclusions: Grounded in the commitment of HHAs and administrators to protecting vulnerable patients, we co-created an adaptable Communication Toolkit to address COVID-19 vaccination misinformation and mistrust among direct care workers.

Factors Influencing Engagement Across the Motivational PrEP Cascade Among Latino SMM: A Mixed-Methods Analysis from the Perspectives of Community Providers and Latino SMM

Latino sexual minority men (SMM) are a highly vulnerable population to HIV, and while pre-exposure prophylaxis (PrEP) has emerged as a promising biomedical tool for HIV prevention among them, its utilization remains disproportionately low in this community despite its potential. Understanding the barriers along the PrEP continuum of care, known as the "PrEP cascade," is crucial for effectively implementing PrEP interventions. Therefore, the objective of our study was twofold: first, to explore the stage of Latino SMM in the PrEP cascade by examining disparities in demographics, social factors, and healthcare aspects; second, to gain insights from healthcare providers who have direct clinical experience with our population regarding the challenges faced by Latino SMM in accessing and adhering to PrEP. Based on the study findings, the majority of participants (n = 74; 49%) were in the contemplation stage, and only one in ten Latino SMM (10.6%) were currently adherent to PrEP. Compared to those who were at least second-generation, first-generation status had a positive association (B = 0.699, SE = 0.208, β = 0.351, p < .001) with engagement along the PrEP Contemplation Ladder. Conversely, having at least one parent who did not have legal residency, relative to those whose parents were both U.S. citizens or held legal residency documentation, was found to have a negative association (B = - 0.689, SE = 0.245, β = 0.245, p = .006) with engagement along the PrEP Contemplation Ladder. Additionally, discussing PrEP with a healthcare provider had a positive association (B = 0.374, SE = 0.179, β = 0.185, p = .038) with engagement along the PrEP Contemplation Ladder. Qualitative results from our study suggest that some Latinos who initially agreed to start using PrEP ended up getting lost in the care pipeline and failed to attend their scheduled appointments. Providers also noted that many patients lacked access to a pharmacy where they felt comfortable obtaining their PrEP prescription, leading them to discontinue use after only a few months. These findings emphasize the importance of considering the unique needs, culture, and background of Latinos, including care delivery and provider attitudes that can facilitate progress through the PrEP cascade.

Evaluation of the New York City COVID-19 case investigation and contact tracing program: a cascade of care analysis

BACKGROUND

New York City (NYC) was the first COVID-19 epicenter in the United States and home to one of the country's largest contact tracing programs, NYC Test & Trace (T2). Understanding points of attrition along the stages of program implementation and follow-up can inform contact tracing efforts for future epidemics or pandemics. The objective of this study was to evaluate the completeness and timeliness of T2 case and contact notification and monitoring using a "cascade of care" approach.

METHODS

This cross-sectional study included all SARS-CoV-2 cases and contacts reported to T2 from May 31, 2020 to January 1, 2022. Attrition along the "cascade of care" was defined as: (1) attempted, (2) reached, (3) completed intake (main outcome), (4) eligible for monitoring, and (5) successfully monitored. Timeliness was assessed: (1) by median days from a case's date of testing until their positive result was reported to T2, (2) from result until the case was notified by T2, and (3) from a case report of a contact until notification of the contact.

RESULTS

A total of 1.45 million cases and 1.38 million contacts were reported to T2 during this period. For cases, attrition occurred evenly across the first three cascade steps (~-12%) and did not change substantially until the Omicron wave in December 2021. During the Omicron wave, the proportion of cases attempted dropped precipitously. For contacts, the largest attrition occurred between attempting and reaching (-27%), and attrition rose with each COVID-19 wave as contact volumes increased. Attempts to reach contacts discontinued entirely during the Omicron wave. Overall, 67% of cases and 49% of contacts completed intake interviews (79% and 57% prior to Omicron). T2 was timely, with a median of 1 day to receive lab results, 2 days to notify cases, and < 1 day to notify contacts.

CONCLUSIONS

T2 provided a large volume of NYC residents with timely notification and monitoring. Engagement in the program was lower for contacts than cases, with the largest gap coming from inability to reach individuals during call attempts. To strengthen future test-and-trace efforts, strategies are needed to encourage acceptance of local contact tracer outreach attempts.

Collective Sensemaking and Healthcare Workers' Ripple Effect Influencing Vaccine Hesitancy in West Michigan

The social efficacy of vaccines has been a central concern around COVID-19 vaccine uptake rates. As partners on the Vaccinate West Michigan Coalition, we conducted a rapid ethnographic assessment project among adults living in West Michigan. Three case studies are presented to convey the nuanced context around decisions with a focus on the influence of fear, trust, and the ripple effect of healthcare workers' (HCW) beliefs around vaccines. While HCWs' attitudes and beliefs influence their patients, the unique contribution of this study is its focus on how HCWs' perceptions influence friends and family members.

Strategies and bottlenecks to tackle infodemic in public health: a scoping review

Background

The World Health Organization defines "infodemic" as the phenomenon of an uncontrolled spread of information in digital and physical environments during a disease outbreak, causing confusion and risk-taking behaviors that can harm health. The aim of this scoping review is to examine international evidence and identify strategies and bottlenecks to tackle health-related fake news.

Methods

We performed a scoping review of the literature from 1 January 2018 to 26 January 2023 on PubMed, Web of Science, and Scopus electronic databases. We also performed a search of grey literature on institutional websites. The research question has been defined according to the PCC (population, concept, and context) mnemonic for constructing research questions in scoping reviews.

Results

The overall research in the scientific databases yielded a total of 5,516 records. After removing duplicates, and screening the titles, abstracts, and full texts, we included 21 articles from scientific literature. Moreover, 5 documents were retrieved from institutional websites. Based on their content, we decided to group recommendations and bottlenecks into five different and well-defined areas of intervention, which we called strategies: "foster proper communication through the collaboration between science and social media companies and users," "institutional and regulatory interventions," "check and debunking," "increase health literacy," and "surveillance and monitoring through new digital tools."

Conclusion

The multidisciplinary creation of standardized toolkits that collect recommendations from the literature and institutions can provide a valid solution to limit the infodemic, increasing the health education of both citizens and health professionals, providing the knowledge to recognize fake news, as well as supporting the creation and validation of AI tools aimed at prebunking and debunking.

Have we found a solution for health misinformation? A ten-year systematic review of health misinformation literature 2013-2022

BACKGROUND

Health misinformation (HM) has emerged as a prominent social issue in recent years, driven by declining public trust, popularisation of digital media platforms and escalating public health crisis. Since the Covid-19 pandemic, HM has raised critical concerns due to its significant impacts on both individuals and society as a whole. A comprehensive understanding of HM and HM-related studies would be instrumental in identifying possible solutions to address HM and the associated challenges.

METHODS

Following the PRISMA procedure, 11,739 papers published from January 2013 to December 2022 were retrieved from five electronic databases, and 813 papers matching the inclusion criteria were retained for further analysis. This article critically reviewed HM-related studies, detailing the factors facilitating HM creation and dissemination, negative impacts of HM, solutions to HM, and research methods employed in those studies.

RESULTS

A growing number of studies have focused on HM since 2013. Results of this study highlight that trust plays a significant while latent role in the circuits of HM, facilitating the creation and dissemination of HM, exacerbating the negative impacts of HM and amplifying the difficulty in addressing HM.

CONCLUSION

For health authorities and governmental institutions, it is essential to systematically build public trust in order to reduce the probability of individuals acceptation of HM and to improve the effectiveness of misinformation correction. Future studies should pay more attention to the role of trust in how to address HM.

The impact of COVID-19 on health professions student's perceptions, future education and career aspirations and confidence in public health responses

Objective: To understand student perceptions, interest and intentions of pursuing public health as a result of COVID-19 during educational experiences. Participants: Two hundred seventy-seven students completed the survey representing 38 states and two countries. Methods: An online survey was administered to current undergraduate and graduate students at two institutions. Results: The difference between the ease of attaining a public health job for nonpublic health and public health students was significant prior to (p = .002) and during the pandemic (p = .015). There was an increase of 5.8% in student interest in continuing education in public health. 13% of respondents agreed the pandemic had been handled appropriately at the national level and 33% at the state level, and 57% expressed distrust of future responses. Conclusions: This study demonstrates a positive influence of COVID-19 on the desire to seek further education and careers in public health, highlights a lack of confidence in effective future pandemic responses.

Trusted sources of information on COVID-19 vaccine in Uganda

BACKGROUND

The COVID-19 pandemic has dramatically impacted communities worldwide, particularly in developing countries. To successfully control the pandemic, correct information and more than 80% vaccine coverage in a population were required. However, misinformation and disinformation could impact this, thus increasing COVID-19 vaccine hesitancy in communities. Several studies observed the effect of misinformation and disinformation on COVID-19 vaccine acceptance and other responses to the pandemic in the African continent. Thus, the most trusted sources of information on COVID-19 vaccines are critical for the successful management and control of the pandemic. This study aimed to assess the most trusted sources of information on COVID-19 vaccines during the pandemic in Uganda.

METHODS

We conducted a cross-sectional study on 587 adult population members in northern Uganda. Single-stage stratified and systematic sampling methods were used to select participants from northern Uganda. An interviewer-administered questionnaire with an internal validity of Cronbach's α = 0.72 was used for data collection. An Institution Review Board (IRB) approved this study and Stata version 18 was used for data analysis. A Pearson Chi-square (χ2) analysis was conducted to assess associations between trusted sources of COVID-19 vaccine information and selected independent variables. Fisher's exact test considered associations when the cell value following cross-tabulation was < 5. A P-value < 0.05 was used as evidence for an association between trusted sources of information and independent variables. All results were presented as frequencies, proportions, Chi-square or Fisher's exact tests, and P-values at 95% Confidence Intervals (CI).

RESULTS

In a study of 587 participants, most were males, 335(57.1%), in the age group of 25-34 years, 180(31.4%), and the most trusted source of COVID-19 vaccine information were the traditional media sources for example, Televisions, Radios, and Newspapers, 349(33.6%). There was no significant association between sex and trusted sources of COVID-19 vaccine information. However, by age-group population, COVID-19 vaccine information was significantly associated with internet use (14.7% versus 85.3%; p = 0.02), information from family members (9.4% versus 90.6%; p < 0.01), and the Government/Ministry of Health (37.9% versus 62.1%; p < 0.01). Between healthcare workers and non-health workers, it was significantly associated with internet use (32.2% versus 67.8%; p = 0.03), healthcare providers (32.5% versus 67.5%; p < 0.018), the Government/Ministry of Health (31.1% versus 68.9%; p < 0.01), and scientific articles (44.7% versus 55.3%; p < 0.01).

CONCLUSION

The most trusted sources of COVID-19 vaccine information in northern Uganda were Televisions, Radios, and Newspapers. The trusted sources of COVID-19 vaccine information were not significantly different between males and females. However, there were significant differences among age groups and occupations of participants with younger age groups (≤ 44 years) and non-healthcare workers having more trust in Televisions, Radios, and Newspapers. Thus, for effective management of an epidemic, there is a need for accurate communication so that misinformation, disinformation, and malinformation in the era of "infodemic" do not disrupt the flow of correct information to communities.

Multi-cancer early detection (MCED) tests: prioritizing equity from bench to bedside

Multi-cancer early detection (MCED) tests are blood-based tests designed to screen for signals of multiple cancers. There is growing interest and investment in examining the potential benefits and applications of MCED tests. If MCED tests are shown to have clinical utility, it is important to ensure that all people-regardless of their demographic or socioeconomic background-equitably benefit from these tests. Unfortunately, with health care innovation, such considerations are often ignored until after inequities emerge. We urge for-profit companies, scientists, clinicians, payers, and government agencies to prioritize equity now-when MCEDs are still being developed and researched. In an effort to avoid creating and exacerbating cancer inequities, we propose 9 equity considerations for MCEDs.

Uncertainties beyond preparedness: COVID-19 vaccination in Senegal

Vaccination is one of the most recognised strategies in public health for preventing the spread of epidemics, and the availability of a vaccine is often expected by health actors to be a 'game-changer'. However, the COVID-19 (coronavirus disease 2019) vaccine in Senegal was not the magic bullet that the international community expected. A very low vaccination coverage rate (less than 10% by April 2023) was observed in this country, once considered a model in West Africa for its epidemic response. Beyond the population's alleged hesitancy to be vaccinated, was a lack of preparedness to blame? Previous analyses show that outbreak preparation limited to standard interventions is not sufficient in the face of the social, cultural, and political configurations of each epidemic context and that uncertainty limits response capacity. This paper examines the social life of the COVID-19 vaccine to identify the forms and contextual dimensions of uncertainty related to immunisation in Senegal. The authors explore how vaccination was implemented and compare experiences with the preparedness process, to offer insight on uncertainties. Using Stirling's theoretical model that defines various expressions of incertitude, the authors identify four nexuses at various stages of the social life of COVID-19 vaccine in Senegal: (1) material uncertainty related to vaccine availability, (2) ambiguity of the population about the purpose of vaccination and the risks of the disease, (3) uncertainty related to side effects, and (4) uncertainty about vaccination strategies shared by scientific and health authorities. These uncertainties were only partly considered in the preparedness process, for they are related to systemic structural dimensions and reflect the impact of global/regional powers on the local level. The findings of this research are relevant not only to support better communication around vaccines in Senegal but also more generally to the prevention of emerging epidemics shaped by human behaviours.

Marginalisation and distrust in the context of the COVID-19 vaccination programme: experiences of communities in a northern UK city region

BACKGROUND

There are clear inequalities in COVID - 19 vaccination rates amongst marginalised groups, with lower rates for some minoritised ethnic and religious groups, younger people, those living in more deprived areas, and with lower socio-economic status. Existing research focuses on psychological and socio-economic factors that influence vaccine uptake and does not explore broader social and historical contexts. Understanding inequalities in COVID-19 vaccine uptake requires a critical examination of the drivers of, and barriers to, vaccination.

METHODS

We present findings from a co-designed qualitative research study undertaken during the COVID-19 pandemic. Focus groups and interviews were used to examine the context underpinning responses to the COVID-19 vaccination in Greater Manchester, particularly focussing on experiences of marginalisation. Thematic framework analysis was used to analyse the data.

RESULTS

We found that the public's responses to the COVID-19 vaccination programme are intertwined with a longstanding history of institutional distrust and disenfranchisement, resulting from experiences of marginalisation and social inequalities. This was exacerbated further by the disproportionate impacts of the COVID-19 pandemic on minoritised ethnic groups, younger people, and those with existing health conditions.

CONCLUSIONS

Histories of structural inequalities experienced by minoritised groups invoked feelings of suspicion and scepticism at the motivations of the agencies behind the vaccination rollout. This highlights the need for a contextualised analysis of attitudes to vaccines, considering pre-existing inequalities, which may be especially relevant for conceptualising public responses to the vaccination programme. Finally, our study shows the important ways in which public (dis)trust can impact public health policies. We recommend this should be incorporated into responses to future public health crises.

Assessing the Impact of the COVID-19 Pandemic on Maternal and Child Health Services: A Comprehensive Analysis of Government Initiatives in Northern India

BACKGROUND

The coronavirus disease (COVID-19) pandemic has significantly impacted healthcare services globally, with particular challenges observed in maternal and child health (MCH) care. This study aimed to assess the impact of the pandemic on MCH services in northern India, focusing on key government programs.

METHODS

Data were collected from four major MCH programs in India: Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), and the Universal Immunization Program (UIP). The study compared MCH service utilization and outcomes during the pandemic period (March-September 2020) with the same period in 2019.

RESULTS

Preliminary findings indicated a significant reduction in the utilization of MCH services during the pandemic, with a decrease observed in institutional deliveries, antenatal care visits, and immunization coverage. For instance, institutional deliveries declined by 30% compared with the previous year, with a similar decrease observed in antenatal care visits. Immunization coverage also decreased by approximately 25%, indicating a substantial decline in preventive care services. Challenges in accessing essential treatments for sick infants have also been reported, with a 40% decrease in the utilization of free treatment services under the JSSK program.

CONCLUSION

The COVID-19 pandemic has substantially impacted MCH services in northern India, highlighting the vulnerability of these essential health programs during public health emergencies. Addressing the challenges identified in this study is crucial to ensuring the continuity and resilience of MCH services in similar settings.

Beliefs in COVID-19 Vaccine Misinformation Among Unvaccinated Black Americans: Prevalence, Socio-Psychological Predictors, and Consequences

Health-related misinformation is a major threat to public health and particularly worrisome for populations experiencing health disparities. This study sets out to examine the prevalence, socio-psychological predictors, and consequences of beliefs in COVID-19 vaccine misinformation among unvaccinated Black Americans. We conducted an online national survey with Black Americans who had not been vaccinated against COVID-19 (N = 800) between February and March 2021. Results showed that beliefs in COVID-19 vaccine misinformation were prevalent among unvaccinated Black Americans with 13-19% of participants agreeing or strongly agreeing with various false claims about COVID-19 vaccines and 35-55% unsure about the veracity of these claims. Conservative ideology, conspiracy thinking mind-set, religiosity, and racial consciousness in health care settings predicted greater beliefs in COVID-19 vaccine misinformation, which were associated with lower vaccine confidence and acceptance. Theoretical and practical implications of the findings are discussed.

Does social empathy moderate fear-induced minority blaming during the COVID-19 pandemic?

This study investigated the minority-blaming phenomenon in South Korea during the COVID-19 pandemic. The pandemic amplified fear, discrimination, and structural inequalities among minoritized groups during the COVID-19 pandemic. This study identified who was blamed for the spread of COVID-19 and the sociodemographic characteristics associated with this blame. Additionally, it examines the roles of individual and interpersonal fear and social empathy in minority blaming. We measured the fear of COVID-19 at both individual and interpersonal levels. Individual fear was assessed through personal health concerns, while the fear of transmitting the virus to others was measured as interpersonal fear. Social empathy was defined by macro perspective-taking, cognitive empathy, self-other awareness, and affective responses. The study was conducted through an online survey involving a quota sample of 1,500 South Korean participants aged 19-69 years, based on age, gender, and residential area. The response was collected in December 2020, when mass infections in specific communities received attention from mass and social media before the national spread of the COVID-19 pandemic. Analytical strategies, including OLS and hierarchical regression models, were employed to examine the roles of socioeconomic factors, individual and interpersonal fear, and social empathy in minority blaming. This study found varying correlations between sociodemographic factors and attitudes toward ethnic, religious, sexual, economic, and age-minority groups. Individual fear of contracting COVID-19 was associated with increased blame across all minority groups. In contrast, interpersonal fear was associated with increased blame only for ethnic and religious minority groups. Similarly, social empathy presented mixed associations, as it displayed a buffering role on blaming ethnic, religious, and sexual minorities when considered alongside interpersonal fear, yet mildly intensified blame for economic and age minorities. These findings provide an understanding on fear-induced minority blaming during the pandemic and the potential role of social empathy in mitigating blame.

Exploring the COVID-19 Knowledge, Attitudes, and Practices (KAPs) in the Black Community: a Scoping Review

INTRODUCTION AND BACKGROUND

Racial minorities have been the focal point of media coverage, attributing the disproportionate impact of COVID-19 to their individual actions; however, the ability to engage in preventative practices can also depend on one's social determinants of health. Individual actions can include knowledge, attitudes, and practices (KAPs). Since Black communities are among those disproportionately affected by COVID-19, this scoping review explores what is known about COVID-19 KAPs among Black populations.

METHODS

A comprehensive literature search was conducted in 2020 for articles written in English from the Medline, Embase, and PsycInfo databases. Reviews, experimental research, and observational studies were included if they investigated at least one of COVID-19 KAP in relation to the pandemic and Black communities in OECD peer countries including Canada, the United States, and the United Kingdom.

RESULTS AND ANALYSIS

Thirty-one articles were included for analysis, and all employed observational designs were from the United States. The following KAPs were examined: 6 (18.8%) knowledge, 21 (65.6%) attitudes, and 22 (68.8%) practices. Black communities demonstrated high levels of adherence to preventative measures (e.g., lockdowns) and practices (e.g., mask wearing), despite a strong proportion of participants believing they were less likely to become infected with the virus, and having lower levels of COVID-19 knowledge, than other racial groups.

CONCLUSIONS AND IMPLICATIONS

The findings from this review support that Black communities highly engage in COVID-19 preventative practices within their realm of control such as mask-wearing and hand washing and suggest that low knowledge does not predict low practice scores among this population.

Amplifying the voices of Black racial minorities in mental health research through public involvement and engagement: The importance of advisory roles

INTRODUCTION

Ensuring adequate representation and the active, meaningful and visible involvement of groups likely to be most impacted by research findings and/or the lack of research inquiry are increasingly acknowledged. This is particularly relevant for Black racially minoritised groups who are less visible as research participants and in patient and public involvement and engagement (PPIE) roles. Our viewpoint article sought to discuss reflections and insights on their involvement experience, with particular attention to perceived barriers and enablers to PPIE involvement.

METHODS

Qualitative data were collected as part of facilitated group discussions from nine Black racially minoritised experts-by-experience involved in a PPIE advisory group. Data were subjected to thematic analysis to identify key themes.

RESULTS

Five main themes were identified that reflected factors linked to practicalities: role unfamiliarity, benefits for the larger community, acknowledgement of previous harm and mental health stigma.

CONCLUSION

Given the existence and importance of the direct links between research and service and treatment innovations in health and social care, ensuring that those from underrepresented Black racial communities are meaningfully and equitably supported to have roles in advising and influencing research programmes should be prioritised and an ongoing consideration for different stakeholders, including research funders, researchers, healthcare providers and community leaders/representatives.

PATIENT OR PUBLIC CONTRIBUTION

This viewpoint article is a collaboration between lived experience stakeholders and researchers, comprising conceiving the original idea for the paper, its conceptualisation and data generation and the coproduction including editing of the manuscript.

HIV Information Avoidance, HIV Stigma, and Medical Mistrust among Black Sexual Minority Men in the Southern United States: Associations with HIV Testing

Uptake of HIV testing is a critical step in the HIV prevention and treatment care cascade. Barriers to HIV testing, however, remain and innovative research in this area is warranted to improve uptake of testing. As such, we investigated the role of HIV information avoidance - a novel construct potentially related to HIV testing. We analyzed this construct in relation to other factors known to impact HIV testing, namely HIV stigma and medical mistrust. Multiple linear regression analyses indicated that HIV information avoidance was negatively associated with HIV testing, while medical mistrust was positively associated with HIV testing. HIV testing stigma was not associated with HIV testing. This work contributes to the developing literature on HIV information avoidance and its relationships with HIV stigma and HIV testing uptake. Further, these findings can inform HIV testing interventions which often do not focus on HIV information avoidance. Future research on the mechanisms of information avoidance that are amenable to intervention, and the temporal ordering of the relationship between information avoidance and HIV testing is warranted.

Shifting the Paradigm From Participant Mistrust to Researcher & Institutional Trustworthiness: A Qualitative Study of Researchers' Perspectives on Building Trustworthiness With Black Communities

INTRODUCTION

Black communities are deeply underrepresented in research, due, in large part, to research mistrust. It is critical to shift the burden of trust building from communities to researchers and research institutions, which have perpetrated harm against Black communities for centuries. In this study, we examine researchers' perspectives on how to become trustworthy to Black-identifying participants and communities.

METHODS

We conducted semi-structured interviews with researchers affiliated with our institution's Clinical and Translational Science Institute. Participants were recruited through email and responded to the study team if they wished to participate. Interviews occurred through Zoom, took 60 minutes, and were audio recorded. We used an inductive thematic data analysis approach.

RESULTS

Sixteen researchers, who were affiliated with medicine, public health, psychology, education, and nursing, participated in this study. Participants agreed that researchers bear the responsibility for building trust and noted how critical it is to address the underrepresentation of Black participants in research through equitable recruitment and that researchers must be transparent and engage in reciprocal research practices. Community-partnered research was highlighted as a way to develop trustworthiness. Finally, participants noted that trustworthiness must also be built at the institutional level, rather than just by individual researchers.

DISCUSSION

To our knowledge, this is one of the first studies to examine researchers' perspectives on how to build their own trustworthiness, with a specific focus on trust-building with Black communities. Explicit training and resources are needed to build trustworthiness into academic centers.

Manifestation of Health Denialism in Attitudes toward COVID-19 Vaccination: A Qualitative Study

Science denialism is characterized by the refusal to accept existing consensus and available evidence. Typical strategies denialists employ include spreading conspiracies, selective use of information, relying on fake experts, or general fallacies in logic. A flood of misinformation, fake news, and conspiracy theories accompanied the COVID-19 pandemic. Simultaneously, it was a subject of many denialistic opinions, from denying the existence of the epidemic challenge to claims that questioned the safety and effectiveness of the COVID-19 vaccines. This study's main aim was to assess the manifestations of denialism in attitudes toward the preventive measures recommended during the pandemic, with a special focus on vaccination. In-depth interviews were conducted with fifty representatives of the general population, demonstrating diversified opinions about COVID-19 vaccines and other preventive behaviors. The interviews were performed face to face in participants' houses or at other places they identified as convenient. Some of the interviewees preferred to do the interview via teleconference. The interviews were carried out from November 2022 to March 2023. The interviewees were recruited initially by convenience, and in further stages, the snowball technique was used. The interviewees were residents of four main administrative districts in Poland. Out of 50 participants, 26 were males, 29 were between 18-40, 16 were inhabitants of rural areas, and 28 had a university level of education. The interviews were based on a semi-structured guide that addressed, in addition to views about the origin of the new coronavirus, respondents' attitudes toward vaccination and sanitary recommendation, the health status of interviewees, their use of healthcare services, and their health behaviors. The interviews were transcribed and analyzed with MAXQDA Analytics Pro 2022 software (Release 22.7.0). Thematic analysis (TA) was applied to the content generated from the interviews. Based on the uptake of the COVID-19 vaccine, the participants were divided into three groups: unvaccinated, hesitant, and vaccinated (18, 4, and 28 interviewees, respectively). The main themes were established based on the TA of the interviews: attitudes toward COVID-19 vaccination, perception of sources of information, and the origin of the new coronavirus. The first theme decidedly drew the greatest attention of the interviewees. There was also a clear relationship between vaccination status and the presence of denialist thinking among interviewees. Interestingly, the role of experts as a key source of information about the pandemic was underlined by study participants. However, the criteria for being an expert differed. The subject of the origin of a new coronavirus was not interesting to interviewees. The analysis of the adherence to preventive measures revealed an interplay of diversified attitudes and motivations. Individuals presenting denialist views most frequently abstained from COVID-19 vaccination. However, such views were also present among those who hesitated or even among those who had been vaccinated. Furthermore, denialism was only one of the determinants of adherence to preventive measures.

Medical Mistrust Mediates the Relationship Between Nonconsensual Intersex Surgery and Healthcare Avoidance Among Intersex Adults

BACKGROUND

Intersex individuals experience poor health due, in part, to healthcare avoidance. Nonconsensual intersex surgery may contribute to medical mistrust and avoidance among intersex populations.

PURPOSE

The purpose of this study was to explore the relationship between nonconsensual surgery and healthcare avoidance among intersex populations and to examine if medical mistrust mediates this relationship.

METHODS

Data for this cross-sectional study were collected in 2018 and analyzed in 2022. Participants completed a survey collecting information on demographics, medical mistrust, history of nonconsensual surgery, and history of postponing healthcare. One hundred nine participants with valid responses to all regression model variables were included in the study. Multivariable logistic regression models controlling for age, race, and income, examined the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. Mediation analyses of cross-sectional data examined whether medical mistrust mediated the relationship between nonconsensual surgery and postponing preventive and emergency healthcare.

RESULTS

Mean medical mistrust score was 2.8 (range = 1-4; standard deviation = 0.8), 49.7% of participants had nonconsensual surgery in their lifetime, 45.9% postponed emergency healthcare, and 61.5% postponed preventive healthcare in their lifetime. Nonconsensual surgery was associated with increased odds of delaying preventive (adjusted odds ratio [AOR] = 4.17; confidence interval [CI] = 1.76-9.88; p = .016) and emergency healthcare (AOR = 4.26; CI = 1.71-10.59; p = .002). Medical mistrust mediated the relationship between nonconsensual surgery and delaying preventive (indirect effect = 1.78; CI = 1.16-3.67) and emergency healthcare (indirect effect = 1.66; CI = 1.04-3.30).

CONCLUSIONS

Nonconsensual surgery contributed to healthcare avoidance in this intersex population by increasing medical mistrust. To decrease healthcare avoidance, intersex health promotion interventions should restrict nonconsensual surgery and build trust through trauma-informed care.

Social Media Fact-Checking: The Effects of News Literacy and News Trust on the Intent to Verify Health-Related Information

The recent health crisis and the rapid development of Artificial Intelligence have caused misinformation on social media to flourish by becoming more sophisticated and challenging to detect. This calls upon fact-checking and questions users' competencies and attitudes when assessing social media news. Our study provides a model of how fact-checking intent is explained by news literacy and news trust to examine how users behave in the misinformation-prone social media environment. Structural equation modeling was used to examine survey data gathered from social media users. The findings revealed that users' intent to fact-check information in social media news is explained by (1) news literacy, such as the awareness of various techniques used by creators to depict situations about COVID-19; (2) news trust, in terms of the conviction that the news contains all the essential facts; and (3) intent, such as an aim to check information in multiple pieces of news. The presented findings may aid policymakers and practitioners in developing efficient communication strategies for addressing users less prone to fact-checking. Our contribution offers a new understanding of news literacy as a sufficient tool for combating misinformation, which actively equips users with knowledge and an attitude for social media news fact-checking.

Impact of strategies to mitigate misinformation in diverse settings and populations: a protocol for a living evidence synthesis

INTRODUCTION

Misinformation refers to inadvertent misleading information that the public may be exposed and share without intent to cause harm, and can delay or prevent effective care, affect mental health, lead to misallocation of health resources and/or create or exacerbate public-health crises. There are many strategies to address misinformation, but there is a need to evaluate their effects. Our objective is to synthesise and routinely update evidence to assess the impact of strategies to mitigate health-related misinformation in diverse settings, and populations.

METHODS AND ANALYSIS

We will search seven databases in May 2023 with planned updates at 6 and 9 months, which will be supplemented with searches for grey literature and reference lists of included studies and contacting experts. Two reviewers will independently screen all search results for studies that evaluate one or more approaches to addressing health-related misinformation. One researcher will conduct data extraction and risk of bias assessments, which will be reviewed by a second reviewer for accuracy. We will include experimental, quasi-experimental and observational studies for any populations, settings and diseases without language or publication restrictions. We will conduct quantitative analysis if meta-analytical pooling is possible. If pooling is not possible, we will synthesise quantitative data according to outcomes and interventions addressed, and present a narrative summary of findings disaggregated by sex and/or gender, irrespective of whether differences were found.

ETHICS AND DISSEMINATION

There are no individuals or protected health information involved and no safety issues identified. Results will be published through the Global Commission on Evidence and COVID-END websites, in a peer-reviewed journal, as well as through plain-language materials.

PROSPERO REGISTRATION NUMBER

CRD42023421149.

Does Trust Mediate the Relationship Between Experiences of Discrimination and Health Care Access and Utilization Among Minoritized Canadians During COVID-19 Pandemic?

OBJECTIVES

We sought to determine if trust in government institutions mediate the relationship between experiences of discrimination and health care utilization during the COVID-19 pandemic.

METHODS

We used data from Statistics Canada's Crowdsourcing Data: Impacts of COVID-19 on Canadians-Experiences of Discrimination. We used generalized linear latent and mixed models (Gllamm) with a binomial and logit link function as well as generalized structural equation modeling (GSEM) to determine if reported discrimination and trust were associated with difficulties in accessing health services, health care, and the likelihood of experiencing negative health impacts. We also examined if trust mediated the relationship between experiences of discrimination and these health outcomes. Our analytical sample consisted of 2568 individuals who self-identified as belonging to a visible minority group.

RESULTS

The multivariate results indicate that experiences of discrimination during COVID-19 were associated with higher odds of reporting difficulties in accessing general health services (OR = 1.99, p ≤ 0.01), receiving care (OR = 1.65, p ≤ 0.01), and higher likelihood of reporting negative health impacts (OR = 1.68, p ≤ 0.01). Our mediation analysis indicated that trust in public institutions explained a substantial portion of the association between reported discrimination and all the health outcomes, although the effects of experiencing discrimination remain significant and robust.

CONCLUSION

The findings show that building and maintaining trust is important and critical in a pandemic recovery world to build back better.

Openness to change among COVID misinformation endorsers: Associations with social demographic characteristics and information source usage

RATIONALE

Misinformation is a major concern for public health, with its presence and impact strongly felt in the COVID-19 pandemic. Misinformation correction has drawn strong research interest. In contrast, relatively little attention has been given to the likelihood of favorable behavioral change post correction (i.e., openness to change).

OBJECTIVE

This study seeks to identify the characteristics of COVID misinformation endorsers who are open to adopt more self-protective behaviors after misinformation correction.

METHODS

COVID misinformation endorsers (N = 1991) in a large, nationally representative survey (fielded in October and November 2021) were asked how likely they would adopt self-protective behaviors if a source they trusted debunked their prior misperceptions. Multiple linear regression estimated the relationships between openness to change and socio-demographics, health-related factors, and health information source usage patterns.

RESULTS

Less than half of the misinformation endorsers in the sample (41.3%) indicated any openness to change. Openness to change was positively associated with minority status and negatively associated with leaning Republican in political affiliation, higher income, being currently unvaccinated or unsure about vaccination status, better health, and a greater number of misinformation items endorsed. Past-month use of government, community, and personal sources for health information positively predicted openness. The use of online media was negatively associated with openness.

CONCLUSIONS

Openness to change is not guaranteed after misinformation correction. Targeted interventions based on openness to change are needed to enhance the public health impact of misinformation correction efforts.

Medical Mistrust Among a Racially and Ethnically Diverse Sample of Sexual Minority Men

Purpose: Medical mistrust is a barrier to health care utilization and is associated with suboptimal health outcomes. Research on mistrust among sexual minority men (SMM) is limited and largely focuses on Black SMM and HIV, with few studies assessing mistrust among SMM of other race/ethnicities. The purpose of this study was to examine differences in medical mistrust among SMM by race. Methods: From February 2018 to February 2019, a mixed-methods study examined the health-related beliefs and experiences of young SMM in New York City. The Group-Based Medical Mistrust Scale (GBMMS) was used to measure medical mistrust related to race, and a modified version of the scale assessed mistrust related to one's "sexual/gender minority" status (Group-Based Medical Mistrust Scale-Sexual/Gender Minority [GBMMS-SGM]). With an analytic sample of 183 cisgender SMM, a one-way multivariate analysis of variance was used to examine differences in GBMMS and GBMMS-SGM scores by race/ethnicity [Black, Latinx, White, "Another Racial Group(s)"]. Results: There were significantly different GBMMS scores by race, with participants of color reporting higher levels of race-based medical mistrust than White participants. This finding is supported by effect sizes ranging from moderate to large. Differences in GBMMS-SGM scores by race were borderline; however, the effect size for Black and White participants' GBMMS-SGM scores was moderate, indicating that higher GBMMS-SGM scores among Black participants is meaningful. Conclusion: Multilevel strategies should be used to earn the trust of minoritized populations, such as addressing both historical and ongoing discrimination, moving beyond implicit bias trainings, and strengthening the recruitment and retention of minoritized health care professionals.

Understanding the Link between COVID-19 and HIV/AIDS Stigmas

While the HIV/AIDS epidemic has informed the responses to the COVID-19 pandemic, there is a lack of understanding of the empirical links between stigmas associated with COVID-19 and HIV/AIDS. Surveying 247 adults in the United States online, this study aims to examine the relationships between COVID-19 and HIV/AIDS stigmas in order to understand how they are similar and different from each other, taking into consideration the context relevant to the COVID-19 pandemic. Four scales of stigmas conveying different attitudes (i.e., rejection, despise, accusation, and caution) were used to examine the relationships between the stigmas of these two infectious diseases. Findings based on the mean comparisons from paired t tests showed the mean difference in scores between respondents who supported the exclusion of COVID-19-infected individuals versus HIV-infected individuals was statistically significant. In addition, the mean difference in scores between respondents who were wary of their need to protect their rights around COVID-19-infected persons versus HIV-infected persons was statistically significant. Controlling for the respondents' sociodemographics and factors that were relevant to the COVID-19 pandemic, multiple regression analyses showed that all four types of COVID-19 stigmas were positively associated with their corresponding types of HIV/AIDS stigmas. The preliminary findings between COVID-19 and HIV/AIDS stigmas suggested that HIV/AIDS stigma mitigation strategies may present a fruitful approach to inform stigma mitigation of COVID-19.

What contributes to COVID-19 online disinformation among Black Canadians: a qualitative study

BACKGROUND

Black Canadians are disproportionately affected by the COVID-19 pandemic, and the literature suggests that online disinformation and misinformation contribute to higher rates of SARS-CoV-2 infection and vaccine hesitancy in Black communities in Canada. Through stakeholder interviews, we sought to describe the nature of COVID-19 online disinformation among Black Canadians and identify the factors contributing to this phenomenon.

METHODS

We conducted purposive sampling followed by snowball sampling and completed in-depth qualitative interviews with Black stakeholders with insights into the nature and impact of COVID-19 online disinformation and misinformation in Black communities. We analyzed data using content analysis, drawing on analytical resources from intersectionality theory.

RESULTS

The stakeholders (n = 30, 20 purposively sampled and 10 recruited by way of snowball sampling) reported sharing of COVID-19 online disinformation and misinformation in Black Canadian communities, involving social media interaction among family, friends and community members and information shared by prominent Black figures on social media platforms such as WhatsApp and Facebook. Our data analysis shows that poor communication, cultural and religious factors, distrust of health care systems and distrust of governments contributed to COVID-19 disinformation and misinformation in Black communities.

INTERPRETATION

Our findings suggest racism and underlying systemic discrimination against Black Canadians immensely catalyzed the spread of disinformation and misinformation in Black communities across Canada, which exacerbated the health inequities Black people experienced. As such, using collaborative interventions to understand challenges within the community to relay information about COVID-19 and vaccines could address vaccine hesitancy.

The moderating role of resilience in the relationship between experiences of COVID-19 response-related discrimination and disinformation among people who inject drugs

BACKGROUND

Due to the persistence of COVID-19, it remains important to measure and examine potential barriers to COVID-19 prevention and treatment to avert additional loss of life, particularly among stigmatized populations, such as people who inject drugs (PWID), who are at high risk for contracting and spreading SARS-CoV-2. We assessed the psychometrics of a novel COVID-19 response-related discrimination scale among PWID, and characterized associations between COVID-19 response-related discrimination, resilience to adversity, and endorsement of COVID-19 disinformation.

METHODS

We assessed internal reliability, structural validity and construct validity of a 4-item COVID-19 response-related discrimination scale among PWID living in San Diego County, completing interviewer-administered surveys between October 2020 and September 2021. Using negative binomial regression, we assessed the relationship between COVID-19 response-related discrimination and disinformation and the potential moderating role of resilience.

RESULTS

Of 381 PWID, mean age was 42.6 years and the majority were male (75.6 %) and Hispanic (61.9 %). The COVID-19 response-related discrimination scale had modest reliability (α = 0.66, ω = 0.66) as a single construct with acceptable construct validity (all p ≤ 0.05). Among 216 PWID who completed supplemental surveys, a significant association between COVID-19 response-related discrimination and COVID-19 disinformation was observed, which was moderated by resilience (p = 0.044). Specifically, among PWID with high levels of resilience, endorsement of COVID-19 disinformation significantly increased as exposure to COVID-19 response-related discrimination increased (p = 0.011).

CONCLUSIONS

These findings suggest that intervening on COVID-19 response-related discrimination may offset the negative outcomes associated with COVID-19 disinformation.

Development and Validation of COVID-19 Vaccine Messaging Materials for Latinx Communities

With pervasive health misinformation and mistrust, many of those at greatest risk from COVID-19 have demonstrated lower vaccine acceptance. In Chicago, IL, surveillance data has revealed lower rates of vaccine uptake among Black and Latinx individuals compared with others. We partnered with two local federally qualified health centers (FQHCs) to develop and implement language-concordant, low literacy patient education materials to promote COVID-19 vaccine knowledge, acceptance, and uptake. Our multi-phase study included: 1) iterative content generation and refinement by health literacy experts, health center providers and staff, and community-dwelling adults; and 2) materials testing via a two-arm randomized experiment among adults from Latinx communities in the Chicagoland area. Results indicate that our English and Spanish-language COVID-19 Fact Sheets increase knowledge about COVID-19 vaccination. These materials are publicly available and can be used by health centers or community organizations to promote COVID-19 vaccination among diverse populations.

How Trust in Cancer Information Has Changed in the Era of COVID-19: Patterns by Race and Ethnicity

COVID-19 emerged during an era of heightened attention to systemic racism and the spread of misinformation. This context may have impacted public trust in health information about chronic diseases like cancer. Here, we examine data from the 2018 and 2020 Health Information National Trends Survey (N = 7,369) to describe how trust in cancer information from government health agencies, doctors, family and friends, charitable organizations, and religious organizations changed after COVID-19 became a pandemic, and whether that change varied by race/ethnicity. Statistical methods included chi-square tests and multiple logistic regression modeling. Overall, the proportion of respondents who reported a high degree of trust in cancer information from doctors increased (73.65% vs. 77.34%, p = .04). Trends for trust in information from government health agencies and family and friends varied significantly by race/ethnicity, with substantial declines observed among non-Hispanic Blacks (NHB) only. The odds of reporting a high degree of trust in cancer information from government health agencies and friends and family decreased by 53% (OR = 0.47, 95% CI = 0.24-0.93) and 73% (OR = 0.27, 95% CI = 0.09-0.82), respectively, among NHB, but were stable for other groups. Future studies should monitor whether recent declines in trust among NHB persist and unfavorably impact participation in preventive care.

Understanding the psychological antecedents of COVID-19 vaccine acceptance among Black Americans: implications for vaccine communication

BACKGROUND

Guided by the 5C (confidence, complacency, constraints, calculation, and collective responsibility) model of vaccination behavior, we examine the psychological antecedents of COVID-19 vaccine acceptance (i.e. attitudes and intentions toward COVID-19 vaccination) among Black Americans, a group disproportionately affected by the coronavirus pandemic.

METHOD

We conducted a national survey of Black Americans (N = 1,497) in February/March 2021.

RESULTS

We found that, among the five psychological antecedents, three (confidence, calculation - or extensive information searching, and collective responsibility) significantly predicted attitudes toward COVID-19 vaccination and had indirect effects on vaccination intentions through vaccination attitudes. Two antecedents (confidence and collective responsibility) also directly predicted vaccination intentions. Our analysis suggests that a partially mediated model produced better fit than a fully mediated model.

CONCLUSIONS

Developing culturally tailored interventions for Black Americans that build confidence in COVID-19 vaccines, highlight collective responsibility, and attend to Black Americans' information sources is key to boosting Black Americans' COVID-19 vaccine acceptance. Future research is needed to understand how historical and ongoing racism affects the psychological antecedents of COVID-19 vaccine acceptance among Black Americans.

Confronting the Infodemic and Fake News to End Stigma and Discrimination in HIV/AIDS: Promoting Zero Discrimination Practices in Brazil With Massive Open Online Course

INTRODUCTION

Overcoming misinformation is essential considering stigma and discrimination in the HIV/AIDS epidemic. This report presents the preliminary results of a health education strategy based on the massive open online course (MOOC) on Zero Discrimination in Brazil.

METHODS

Case study describing the development of the MOOC and its validation using the Delphi technique. Pre- and posttests were administered. People who enrolled from October 2021 to March 2022 were included in the study.

RESULTS AND DISCUSSION

MOOC was made available free of charge for mobile phones, tablets, and desktops and included a 90-hr study certificate. Over 6 months, there were n = 665 people enrolled from different regions, mainly from the health field or working in the public health system. The completion rate of people included in the study (26.62%; n = 177) was above the average for other MOOCs.

CONCLUSIONS

Initial results are promising but demand more extensive monitoring.

Impact of the COVID-19 Pandemic on Black Communities in Canada

The COVID-19 pandemic has resulted in differential impacts on the Black communities in Canada and has unmasked existing race-related health inequities. The purpose of this study was to illuminate the impacts of the COVID-19 pandemic on Black people in Canada. Historically, social inequalities have determined the impacts of pandemics on the population, and in the case of the COVID-19 pandemic, disproportionate infections and mortalities have become evident among racialized communities in Canada. This qualitative descriptive study utilized an intersectionality framework. We invited Black stakeholders across Canada to participate in semi-structured interviews to deepen our knowledge of the impacts of the COVID-19 pandemic on Black communities in Canada. A total of 30 interviews were recorded, transcribed verbatim, and analyzed using content analysis. Our findings fell into three categories: (1) increased vulnerability to COVID-19 disease, (2) mental impacts, and (3) addressing impacts of the COVID-19 pandemic. The findings show the underlying systemic inequities in Canada and systemic racism exacerbated health inequities among the Black communities and undermined interventions by public health agencies to curb the spread of COVID-19 and associated impacts on Black and other racialized communities. The paper concludes by identifying critical areas for future intervention in policy and practice.

Taking a Shot: The Impact of Information Frames and Channels on Vaccination Willingness in a Pandemic

The reluctance of people to receive safe and recommended available vaccines is a well-documented public health challenge. As information and communication technologies evolve, this challenge gets more complex and even harder to manage during complex public health situations. In this experimental study, we examine the relationship between vaccine information frames (with scientific information vs. without scientific information) and channels (through government vs. religious organizations) and vaccination willingness in the U.S. in the context of a pandemic. Additionally, we evaluate the interaction between vaccine skepticism, vaccine information frames, and vaccine information channels on vaccination willingness. This experimental study uses data from Amazon Mechanical Turk (MTURK) to evaluate the relationships between vaccine skepticism, vaccine information frames, and channels on vaccination willingness. We find that contrary to our hypothesis, a vaccine advisory framed with scientific information decreases people's vaccination willingness compared to one framed without scientific information. Additionally, the impact of framing on vaccination willingness is conditioned on participants' skepticism-participants who hold skepticism toward the vaccine but received information framed with scientific information score significantly higher in vaccination willingness compared to participants who do not hold skepticism toward a vaccine. The results suggest that the factors impacting vaccination willingness are complex and nuanced. Thus, policymakers should be more strategic with the delivery of vaccination information, especially during complex health crises.

Science Communication and Biomedical Visualization: Two Sides of the Same Coin

Biomedical visualization has a long history as a tool for education around public health. However, recent advances in our understanding of how to be more effective at communicating complex scientific ideas to a public audience necessitate a re-examination of approaches to biomedical visualization. Scientific knowledge has expanded dramatically in the twenty-first century, as has its availability beyond the scientific arena. This chapter briefly discusses the historical approaches in biomedical visualization from the perspective of Western public health. It also outlines the approach that biomedical visualization should take according to best practices in effective science communication.

Testing Vicarious Experiences as Antecedents of Medical Mistrust: A Survey of Black and White Americans

In response to recent calls to examine medical mistrust antecedents, the present study investigated the influence of negative healthcare (personal, vicarious interpersonal, vicarious media) and racial discrimination (personal, vicarious interpersonal, vicarious media) experiences on medical mistrust, and whether these relationships were mediated by perceived racism and perceived financial corruption in healthcare. Multigroup structural equation modeling was utilized to test the model using a cross-sectional survey of Black and White adults. Personal negative healthcare experiences and vicarious media racial discrimination experiences were directly related to medical mistrust for Black and White participants. Additionally, personal negative healthcare experiences exerted indirect effects through both perceived racism in healthcare and perceived financial corruption in healthcare. Vicarious media racial discrimination experiences exerted indirect effects through perceived financial corruption for both Black and White participants and through perceived racism for Black participants. Finally, both types of vicarious interpersonal experiences and racial discrimination experiences exerted indirect effects through perceived racism for White participants. The findings have implications for medical mistrust scholarship going forward. It is necessary to acknowledge the role vicarious experiences plays in medical mistrust antecedents, which may include recognizing the impact of news depictions of racial discrimination on patients' behaviors. Additionally, there is a need to further investigate the role of perceived financial corruption in healthcare in medical mistrust.

Explaining demographic differences in COVID-19 vaccination stage in the United States - April-May 2021

COVID-19 vaccine coverage in the US has marked demographic and geographical disparities, but few explanations exist for them. Our paper aimed to identify behavioral and social drivers that explain these vaccination disparities. Participants were a national probability sample of 3562 American adults, recruited from the Ipsos KnowledgePanel. Participants completed an online survey in spring 2021, when COVD-19 vaccination was available for higher-risk groups but not yet available to all US adults. The survey assessed COVID-19 vaccination stage (intentions and vaccine uptake), constructs from the Increasing Vaccination Model (IVM) domains (thinking and feeling, social processes, and direct behavior change), self-reported exposure to COVID-19 vaccine information, and demographic characteristics. Analyses used multiple imputation to address item nonresponse and linear regressions to conduct mediation analyses. Higher COVID-19 vaccination stage was strongly associated with older age, liberal political ideology, and higher income in adjusted analyses (all p < .001). Vaccination stage was more modestly associated with urbanicity, white race, and Hispanic ethnicity (all p < .05). Some key mediators that explained more than one-third of demographic differences in vaccination stage were perceived vaccine effectiveness, social norms, and recommendations from family and friends across most demographic characteristics (all p < .05). Other mediators included safety concerns, trust, altruism, provider recommendation, and information seeking. Access to vaccination, barriers to vaccination, and self-efficacy explained few demographic differences. One of the most reliable explanations for demographic differences in COVID-19 vaccination stage is social processes, including social norms, recommendations, and altruism. Interventions to promote COVID-19 vaccination should address social processes and other domains in the IVM.

Cognitive and Cultural Factors That Affect General Vaccination and COVID-19 Vaccination Attitudes

The development of COVID-19 vaccines is a major scientific accomplishment that has armed communities worldwide with powerful epidemic control tools. Yet, COVID-19 vaccination efforts in the US have been marred by persistent vaccine hesitancy. We used survey methodology to explore the impact of different cognitive and cultural factors on the public's general vaccination attitudes, attitudes towards COVID-19 vaccines, and COVID-19 vaccination status. The factors include information literacy, science literacy, attitudes towards science, interpersonal trust, public health trust, political ideology, and religiosity. The analysis suggests that attitudes towards vaccination are influenced by a multitude of factors that operate in a complex manner. General vaccination attitude was most affected by attitudes towards science and public health trust and to a lesser degree by information literacy, science literacy, and religiosity. Attitudes towards COVID-19 vaccines were most affected by public health trust and to a lesser extent by general trust, ideology and attitudes towards science. Vaccination status was most influenced by public health trust. Possible mediating effects of correlated variables in the model need to be further explored. The study underscores the importance of understanding the relationship between public health trust, literacies, and sociocultural factors.

Wastewater to clinical case (WC) ratio of COVID-19 identifies insufficient clinical testing, onset of new variants of concern and population immunity in urban communities

Clinical testing has been the cornerstone of public health monitoring and infection control efforts in communities throughout the COVID-19 pandemic. With the anticipated reduction of clinical testing as the disease moves into an endemic state, SARS-CoV-2 wastewater surveillance (WWS) will have greater value as an important diagnostic tool. An in-depth analysis and understanding of the metrics derived from WWS is required to interpret and utilize WWS-acquired data effectively (McClary-Gutierrez et al., 2021; O'Keeffe, 2021). In this study, the SARS-CoV-2 wastewater signal to clinical cases (WC) ratio was investigated across seven cities in Canada over periods ranging from 8 to 21 months. This work demonstrates that significant increases in the WC ratio occurred when clinical testing eligibility was modified to appointment-only testing, identifying a period of insufficient clinical testing (resulting in a reduction to testing access and a reduction in the number of daily tests) in these communities, despite increases in the wastewater signal. Furthermore, the WC ratio decreased significantly in 6 of the 7 studied locations, serving as a potential signal of the emergence of the Alpha variant of concern (VOC) in a relatively non-immunized community (40-60 % allelic proportion), while a more muted decrease in the WC ratio signaled the emergence of the Delta VOC in a relatively well-immunized community (40-60 % allelic proportion). Finally, a significant decrease in the WC ratio signaled the emergence of the Omicron VOC, likely because of the variant's greater effectiveness at evading immunity, leading to a significant number of new reported clinical cases, even when community immunity was high. The WC ratio, used as an additional monitoring metric, could complement clinical case counts and wastewater signals as individual metrics in its potential ability to identify important epidemiological occurrences, adding value to WWS as a diagnostic technology during the COVID-19 pandemic and likely for future pandemics.

Digital Health Equity: Addressing Power, Usability, and Trust to Strengthen Health Systems

BACKGROUND

Without specific attention to health equity considerations in design, implementation, and evaluation, the rapid expansion of digital health approaches threatens to exacerbate rather than ameliorate existing health disparities.

METHODS

We explored known factors that increase digital health inequity to contextualize the need for equity-centered informatics. This work used a narrative review method to summarize issues about inequities in digital health and to discuss future directions for researchers and clinicians. We searched literature using a combination of relevant keywords (e.g., "digital health", "health equity", etc.) using PubMed and Google Scholar.

RESULTS

We have highlighted strategies for addressing medical marginalization in informatics according to vectors of power such as race and ethnicity, gender identity and modality, sexuality, disability, housing status, citizenship status, and criminalization status.

CONCLUSIONS

We have emphasized collaboration with user and patient groups to define priorities, ensure accessibility and localization, and consider risks in development and utilization of digital health tools. Additionally, we encourage consideration of potential pitfalls in adopting these diversity, equity, and inclusion (DEI)-related strategies.

Increasing diversity in developmental cognitive neuroscience: A roadmap for increasing representation in pediatric neuroimaging research

Understanding of human brain development has advanced rapidly as the field of developmental cognitive neuroscience (DCN) has matured into an established scientific discipline. Despite substantial progress, DCN lags behind other related disciplines in terms of diverse representation, standardized reporting requirements for socio-demographic characteristics of participants in pediatric neuroimaging studies, and use of intentional sampling strategies to more accurately represent the socio-demographic, ethnic, and racial composition of the populations from which participants are sampled. Additional efforts are needed to shift DCN towards a more inclusive field that facilitates the study of individual differences across a variety of cultural and contextual experiences. In this commentary, we outline and discuss barriers within our current scientific practice (e.g., research methods) and beliefs (i.e., what constitutes good science, good scientists, and good research questions) that contribute to under-representation and limited diversity within pediatric neuroimaging studies and propose strategies to overcome those barriers. We discuss strategies to address barriers at intrapersonal, interpersonal, community, systemic, and structural levels. Highlighting strength-based models of inclusion and recognition of the value of diversity in DCN research, along with acknowledgement of the support needed to diversify the field is critical for advancing understanding of neurodevelopment and reducing health inequities.

Why do people believe health misinformation and who is at risk? A systematic review of individual differences in susceptibility to health misinformation

RATIONALE

Health misinformation poses a significant threat to public health. Understanding why people believe health misinformation and who is at risk is crucial for developing effective interventions to reduce the harmful impact of misinformation.

APPROACH

We conducted a systematic review of published empirical research that examined individual differences in susceptibility to health misinformation, focusing on the psychological, demographic, and behavioral correlates of health misinformation susceptibility. To guide our review on psychological correlates, we developed an integrative psychological model of susceptibility to health misinformation based on one's ability and motivation to reason.

RESULTS

We identified 47 publications (61 empirical studies) that met our criteria. Our review suggests that subject knowledge, literacy and numeracy, analytical thinking (vs. intuitive thinking), and trust in science confer strong resistance to health misinformation, whereas conspiracy thinking, religiosity, conservative ideology, and conservative party identification are associated with more susceptibility to health misinformation. Demographically, older age and higher educational attainment predict less susceptibility to health misinformation, whereas racial minority status is associated with greater susceptibility. Behaviorally, relying on health professionals or scientists as information sources predicts less susceptibility to health misinformation, whereas social media use is associated with greater susceptibility.

CONCLUSIONS

Susceptibility to health misinformation is driven by multiple psychological processes. Interventions for reducing the spread and impact of health misinformation should be tailored to the psychological mechanism underlying susceptibility to health misinformation. Limited resources should be used to support interventions targeted at individuals at risk.