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Ohta R, Yakabe T, Sano C. Addressing health challenges in rural Japan: a thematic analysis of social isolation and community solutions. BMC PRIMARY CARE 2024; 25:26. [PMID: 38216862 PMCID: PMC10790262 DOI: 10.1186/s12875-024-02266-y] [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: 05/22/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND The establishment of sustainable connections between medical professionals and rural citizens is pivotal for effective community healthcare. Our study focuses on understanding and resolving health problems arising from social isolation, a critical barrier to achieving this goal, especially in the context of the coronavirus disease 2019(COVID-19) pandemic's impact on community dynamics respecting social cognitive theory. This study investigates the link between social isolation and rural community healthcare. We aim to develop methods that improve interaction and collaboration between healthcare providers and rural communities, ultimately enhancing the region's healthcare system. METHODS Employing thematic analysis based on social cognitive theory, we conducted semi-structured interviews with 57 community workers in rural communities. This qualitative approach enabled us to delve into the nuances of social isolation and its multifaceted impact on health and community well-being. RESULTS Our analysis revealed four key themes: the impact of aging on social dynamics, shifts in community relationships, unique aspects of rural community networking, and the role of these networks in driving community health. Notably, we identified specific challenges, such as the erosion of intergenerational interactions and the hesitancy to seek support, exacerbated by social isolation and negatively impacting community health. CONCLUSIONS Our study reveals the complex factors affecting rural community sustainability, particularly social isolation influenced by privacy concerns and changing social dynamics. Emphasizing the importance of social cognitive theory, it highlights the need for adaptable healthcare systems and strong community-medical collaborations. Future research should focus on developing culturally sensitive, practical strategies for enhancing these collaborations, especially involving physicians, to address rural communities' unique challenges.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-Cho, Unnan, Shimane Prefecture, Japan.
| | - Toshihiro Yakabe
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-Cho, Unnan, Shimane Prefecture, Japan
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo, Shimane Prefecture, 693-8501, Japan
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Kalocsányiová E, Essex R, Fortune V. Inequalities in Covid-19 Messaging: A Systematic Scoping Review. HEALTH COMMUNICATION 2023; 38:2549-2558. [PMID: 35850593 DOI: 10.1080/10410236.2022.2088022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The impact of the Covid-19 pandemic has been widely documented. While deaths are now in the millions and many more have been impacted in other ways, the impact of Covid-19 has not been felt equally, with it exacerbating existing inequalities and disproportionately impacting a number of populations. With this Covid-19 has created unprecedented challenges in relation to health communication, with the need to reach disadvantaged populations. This systematic scoping review sought to 1) synthesize the existing research regarding communication inequalities in the response to the Covid-19 pandemic, and 2) analyze the recommendations that emerge from this body of evidence on how to best address these inequalities. This review includes 40 studies that fell into three broad groups (1) those revealing a disadvantage or inequality in studies of general population; (2) those focussing on communication with sub-groups disproportionately affected by the pandemic; and (3) those reporting and evaluating practical attempts to address inequalities. The results largely corroborate those found in past pandemics, highlighting the role of sociodemographic, cultural/religious, and economic factors in facilitating/jeopardizing the public's capacity to access and act upon public health messaging. In a number of studies it was encouraging to see recommendations from the literature - particularly, lessons learnt on the importance of community partnerships, trusted messengers and the co-creation of health and risk messages - being applied, however many challenges remain unmet. Covid-19 has also highlighted the need to actively tackle misinformation, something which was recognized, but largely unaddressed.
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Affiliation(s)
| | - Ryan Essex
- Institute for Lifecourse Development, University of Greenwich
| | - Vanessa Fortune
- Institute for Lifecourse Development, University of Greenwich
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Binter J, Pešout O, Pieniak M, Martínez-Molina J, Noon EJ, Stefanczyk MM, Eder SJ. Predictors and motives for mask-wearing behavior and vaccination intention. Sci Rep 2023; 13:10293. [PMID: 37357247 DOI: 10.1038/s41598-023-37072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/15/2023] [Indexed: 06/27/2023] Open
Abstract
Containing a pandemic requires that individuals adhere to measures such as wearing face-masks and getting vaccinated. Therefore, identifying predictors and motives for both behaviors is of importance. Here, we study the decisions made by a cross-national sample in randomized hypothetical scenarios during the COVID-19 pandemic. Our results show that mask-wearing was predicted by empathic tendencies, germ aversion, and higher age, whilst belief in misinformation and presentation of an interaction partner as a family member lowered the safety standards. The main motives associated with taking the mask off included: rationalization, facilitating interaction, and comfort. Vaccination intention was positively predicted by empathy, and negatively predicted by belief in misinformation and higher costs of the vaccine. We found no effect of immunization status of the surrounding social group. The most common motive for vaccination was protection of oneself and others, whereas undecided and anti-vaccine groups reported doubts about the effectiveness and fear of side effects. Together, we identify social and psychological predictors and motives of mask-wearing behavior and vaccination intention. The results highlight the importance of social context for mask-wearing, easy access to vaccines, empathy, and trust in publicly distributed information.
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Affiliation(s)
- Jakub Binter
- Faculty of Social and Economic Studies, Jan Evangelista Purkyně University, Moskevská 54, 400 96, Ústí nad Labem, Czech Republic.
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic.
| | - Ondra Pešout
- Department of Psychology, Jan Evangelista Purkyně University, Ústí nad Labem, Czech Republic
| | - Michał Pieniak
- Institute of Psychology, University of Wroclaw, Wroclaw, Poland
| | | | - Edward J Noon
- Institute of Childhood and Education, Leeds Trinity University, Leeds, UK
| | | | - Stephanie J Eder
- Department of Neurosciences and Developmental Biology, University of Vienna, Djerrassiplatz 1, 1030, Vienna, Austria.
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Cherryhomes E, Guillot-Wright S. Dissemination and Implementation of a Text Messaging Campaign to Improve Health Disparities among Im/Migrant Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5311. [PMID: 37047927 PMCID: PMC10094327 DOI: 10.3390/ijerph20075311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/02/2023] [Accepted: 03/12/2023] [Indexed: 06/19/2023]
Abstract
The use of short message service (SMS) text messaging technology has grown in popularity over the last twenty years, but there is limited data on the design and feasibility of campaigns to reduce work-related injury, particularly among rural workers, non-native English speakers, and illiterate or low-literacy populations. Although there is a critical need for tech equity or 'TechQuity' interventions that reduce injury and enhance the wellbeing of under-reached communities, the barriers and benefits to implementation must be empirically and systematically examined. Thus, our team used D&I science to design and implement an 18-week texting campaign for under-reached workers with a higher-than-average risk of fatal and non-fatal injury. The experimental project was conducted with English-, Spanish-, and Vietnamese-speaking commercial fishermen in the Gulf of Mexico to test the design and feasibility, and messaging focused on preventing injury from slips, trips, and falls, as well as hurricane preparedness. The ubiquity of mobile devices and the previous success of texting campaigns made this a promising approach for enhancing health and preventing injury among an under-reached population. However, the perceived benefits were not without their barriers. The lessons learned included the difficulty of navigating federal regulations regarding limits for special characters, enrolling migratory participants, and navigating areas with limited cellular service or populations with limited accessibility to technology. We conclude with short- and long-term suggestions for future technology interventions for under-reached worker populations, including ethical and policy regulations.
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Affiliation(s)
- Ellie Cherryhomes
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX 77550, USA
| | - Shannon Guillot-Wright
- Center for Violence Prevention, Department of Family Medicine, University of Texas Medical Branch, Galveston, TX 77550, USA
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Pond K, Samuels K, Meinhardt G, Jacobs C. Examining Health Disparities in Orthopedic Care During COVID-19. Am Surg 2023:31348231153551. [PMID: 36717093 PMCID: PMC9895312 DOI: 10.1177/00031348231153551] [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: 02/01/2023]
Abstract
BACKGROUND Demographics and socioeconomic status affect the delivery of medical care resulting in healthcare disparities. The purpose of this study was to investigate the impact of COVID-19 on existing healthcare disparities, including access to healthcare in the outpatient orthopedic surgery clinic. METHODS The medical records of 3006 patients treated at the University of Kentucky Orthopedic Surgery Department prior to COVID-19 (April 2018, 2019), and during the COVID-19 pandemic (2020) were retrospectively reviewed for demographic data, distance to clinic, and type of visit. We then compared the total number of patient visits, new patient visits, telehealth visits, and the patient's insurance provider (public or private) between the time period prior to and during the pandemic. RESULTS During the COVID-19 pandemic, there were significant declines in the number of patients seen, new patient presentations, and publicly insured patients. Thirty-three percent of visits were telemedicine visits in 2020 compared to 0% pre-COVID (P < .0001). There was a lower proportion of initial visits in 2020 (P < .0001). The majority of patients paid via private/commercial insurance (1798, 59.8%), with a greater proportion paying via private/commercial insurance in 2020 (P < .001). The median average household income was increased in 2020 (P < .001). DISCUSSION While COVID-19 resulted in a significant decline in overall access to care, there were negative ramifications particularly on patients with new complaints and those of lower socioeconomic status. Future endeavors should be focused on correcting the obstacles to accessing care, exacerbated by the pandemic, that these vulnerable populations face.
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Affiliation(s)
- Kristina Pond
- College of Medicine, University of Kentucky, Lexington, KY, USA,Kristina Pond, BS, Orthopaedic Surgery
& Sports Medicine, University of Kentucky College of Medicine 800 Rose
Street Lexington, KY 40506, USA.
| | - Kaitlyn Samuels
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Gerek Meinhardt
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Cale Jacobs
- Massachusetts General Brigham
Sports Medicine, Brigham and Women's
Hospital, Foxborough, MA, USA
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Boehmer TK, Koumans EH, Skillen EL, Kappelman MD, Carton TW, Patel A, August EM, Bernstein R, Denson JL, Draper C, Gundlapalli AV, Paranjape A, Puro J, Rao P, Siegel DA, Trick WE, Walker CL, Block JP. Racial and Ethnic Disparities in Outpatient Treatment of COVID-19 - United States, January-July 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1359-1365. [PMID: 36301738 PMCID: PMC9620572 DOI: 10.15585/mmwr.mm7143a2] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sparling A, Walls M, Mayfield CA, Priem JS, Durham J, Hetherington T, Taylor YJ. Racial/Ethnic Disparities in Health Care Setting Choice for Adults Seeking Severe Acute Respiratory Syndrome Coronavirus 2 Testing. Med Care 2022; 60:3-12. [PMID: 34739414 PMCID: PMC8662947 DOI: 10.1097/mlr.0000000000001654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Equitable access to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing is important for reducing disparities. We sought to examine differences in the health care setting choice for SARS-CoV-2 testing by race/ethnicity and insurance. Options included traditional health care settings and mobile testing units (MTUs) targeting communities experiencing disproportionately high coronavirus disease 2019 (COVID-19) rates. METHODS We conducted a retrospective, observational study among patients in a large health system in the Southeastern US. Descriptive statistics and multinomial logistic regression analyses were employed to evaluate associations between patient characteristics and health care setting choice for SARS-CoV-2 testing, defined as: (1) outpatient (OP) care; (2) emergency department (ED); (3) urgent care (UC); and (4) MTUs. Patient characteristics included race/ethnicity, insurance, and the existence of an established relationship with the health care system. RESULTS Our analytic sample included 105,386 adult patients tested for SARS-CoV-2. Overall, 55% of patients sought care at OP, 24% at ED, 12% at UC, and 9% at MTU. The sample was 58% White, 24% Black, 11% Hispanic, and 8% other race/ethnicity. Black patients had a higher likelihood of getting tested through the ED compared with White patients. Hispanic patients had the highest likelihood of testing at MTUs. Patients without a primary care provider had a higher relative risk of being tested through the ED and MTUs versus OP. CONCLUSIONS Disparities by race/ethnicity were present in health care setting choice for SARS-CoV-2 testing. Health care systems may consider implementing mobile care delivery models to reach vulnerable populations. Our findings support the need for systemic change to increase primary care and health care access beyond short-term pandemic solutions.
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Affiliation(s)
| | - Morgan Walls
- Division of Academic General Pediatrics, Deparment of Pediatrics
| | | | | | - Jason Durham
- Information and Analytic Services, Atrium Health, Charlotte, NC
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Kelly JD, Bravata DM, Bent S, Wray CM, Leonard SJ, Boscardin WJ, Myers LJ, Keyhani S. Association of Social and Behavioral Risk Factors With Mortality Among US Veterans With COVID-19. JAMA Netw Open 2021; 4:e2113031. [PMID: 34106264 PMCID: PMC8190626 DOI: 10.1001/jamanetworkopen.2021.13031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE The US Department of Veterans Affairs (VA) offers programs that reduce barriers to care for veterans and those with housing instability, poverty, and substance use disorder. In this setting, however, the role that social and behavioral risk factors play in COVID-19 outcomes is unclear. OBJECTIVE To examine whether social and behavioral risk factors were associated with mortality among US veterans with COVID-19 and whether this association might be modified by race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained data from the VA Corporate Data Warehouse to form a cohort of veterans who received a positive COVID-19 test result between March 2 and September 30, 2020, in a VA health care facility. All veterans who met the inclusion criteria were eligible to participate in the study, and participants were followed up for 30 days after the first SARS-CoV-2 or COVID-19 diagnosis. The final follow-up date was October 31, 2020. EXPOSURES Social risk factors included housing problems and financial hardship. Behavioral risk factors included current tobacco use, alcohol use, and substance use. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality in the 30-day period after the SARS-CoV-2 or COVID-19 diagnosis date. Multivariable logistic regression was used to estimate odds ratios, clustering for health care facilities and adjusting for age, sex, race, ethnicity, marital status, clinical factors, and month of COVID-19 diagnosis. RESULTS Among 27 640 veterans with COVID-19 who were included in the analysis, 24 496 were men (88.6%) and the mean (SD) age was 57.2 (16.6) years. A total of 3090 veterans (11.2%) had housing problems, 4450 (16.1%) had financial hardship, 5358 (19.4%) used alcohol, and 3569 (12.9%) reported substance use. Hospitalization occurred in 7663 veterans (27.7%), and 1230 veterans (4.5%) died. Housing problems (adjusted odds ratio [AOR], 0.96; 95% CI, 0.77-1.19; P = .70), financial hardship (AOR, 1.13; 95% CI, 0.97-1.31; P = .11), alcohol use (AOR, 0.82; 95% CI, 0.68-1.01; P = .06), current tobacco use (AOR, 0.85; 95% CI, 0.68-1.06; P = .14), and substance use (AOR, 0.90; 95% CI, 0.71-1.15; P = .41) were not associated with higher mortality. Interaction analyses by race/ethnicity did not find associations between mortality and social and behavioral risk factors. CONCLUSIONS AND RELEVANCE Results of this study showed that, in an integrated health system such as the VA, social and behavioral risk factors were not associated with mortality from COVID-19. Further research is needed to substantiate the potential of an integrated health system to be a model of support services for households with COVID-19 and populations who are at risk for the disease.
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Affiliation(s)
- J. Daniel Kelly
- San Francisco VA Medical Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Dawn M. Bravata
- US Department of Veterans Affairs, Health Services and Development, Center for Health Information and Communication, Indianapolis, Indiana
- Department of Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
- Veterans Affairs Medical Center, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis
- Regenstrief Institute, Indianapolis, Indiana
| | - Stephen Bent
- San Francisco VA Medical Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Charlie M. Wray
- San Francisco VA Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Samuel J. Leonard
- Department of Medicine, University of California, San Francisco, San Francisco
| | - W. John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Laura J. Myers
- US Department of Veterans Affairs, Health Services and Development, Center for Health Information and Communication, Indianapolis, Indiana
| | - Salomeh Keyhani
- San Francisco VA Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco
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