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Sweet R, Kasali N. Public health intervention amidst conflict: Violence, politics, and knowledge frames in the 2018-20 Ebola epidemic in Democratic Republic of the Congo. Soc Sci Med 2024; 350:116854. [PMID: 38713978 DOI: 10.1016/j.socscimed.2024.116854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 05/09/2024]
Abstract
Research, policy, and donor interest in health systems in conflict environments has grown rapidly in recent years. The 2018-20 Ebola outbreak in Democratic Republic of the Congo is a critical case of healthcare militarization. The first-ever such outbreak in an active conflict zone, it grew notorious for violence against response teams, with attacks aggravating the spread of disease. However, while medical responders observed physical attacks, the causes of the violence remained largely unknown. Drawing on interviews and participant observation, we contribute civilian vantages of the way health intervention grew militarized, or associated with conflict. The argument builds in two core steps. A first reconstructs civilian experiences of conflict prior to Ebola to trace how the response took on a political meaning. We find that relationships linking state forces with the health response inadvertently tethered Ebola to what civilians perceived as security threats and that by repeating government statements about conflict, response teams unintentionally endorsed a version of the truth that silenced local voices. A second step addresses a central paradox: residents communicated these concerns directly, repeatedly, and via official response channels, yet healthcare teams failed to apply these insights. We locate this gap in the knowledge structures, or frames, accompanying intervention. Medical emergencies in warzones operate with dual sets of frames casting conflict players as "non-state" and public health resistance as "ignorance." Both frames intersect in ways that amplify invisibilities in each, clouding understandings of the nature of conflict and humanitarians' role in it. We suggest this places intervention teams at heightened risk of mis-stepping on political fault lines-and not understanding why. The study advances work on community engagement by showing that instead of simply providing scientific knowledge, effective engagement requires adjusting socio-political lenses within the response. It contributes to studies on health intervention, humanitarian emergencies, and the limits of medical neutrality.
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Affiliation(s)
- Rachel Sweet
- Kroc Institute for Institutional Peace Studies, Department of Political Science, Keough School of Global Affairs, University of Notre Dame, 306 Hesburgh International Center, Notre Dame, IN, 46556, USA.
| | - Noé Kasali
- Bethesda Counseling Center, Université Chrétienne Bilingue du Congo, Quartier Kipriani, Beni, North Kivu, Congo
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Accoe K, Criel B, Ag Ahmed MA, Buitrago VT, Marchal B. Conditions for health system resilience in the response to the COVID-19 pandemic in Mauritania. BMJ Glob Health 2023; 8:e013943. [PMID: 38050409 PMCID: PMC10693853 DOI: 10.1136/bmjgh-2023-013943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION A country's ability to manage a crisis depends on its level of resilience. Efforts are made to clarify the concept of health system resilience, but its operationalisation remains little studied. In the present research, we described the capacity of the local healthcare system in the Islamic Republic of Mauritania, in West Africa, to cope with the COVID-19 pandemic. METHODS We used a single case study with two health districts as units of analysis. A context analysis, a literature review and 33 semi-structured interviews were conducted. The data were analysed using a resilience conceptual framework. RESULTS The analysis indicates a certain capacity to manage the crisis, but significant gaps and challenges remain. The management of many uncertainties is largely dependent on the quality of the alignment of decision-makers at district level with the national level. Local management of COVID-19 in the context of Mauritania's fragile healthcare system has been skewed to awareness-raising and a surveillance system. Three other elements appear to be particularly important in building a resilient healthcare system: leadership capacity, community dynamics and the existence of a learning culture. CONCLUSION The COVID-19 pandemic has put a great deal of pressure on healthcare systems. Our study has shown the relevance of an in-depth contextual analysis to better identify the enabling environment and the capacities required to develop a certain level of resilience. The translation into practice of the skills required to build a resilient healthcare system remains to be further developed.
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Affiliation(s)
- Kirsten Accoe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Lowe M, Harmon SHE, Kholina K, Parker R, Graham JE. Public health communication in Canada during the COVID-19 pandemic. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:34-45. [PMID: 36329358 PMCID: PMC9633012 DOI: 10.17269/s41997-022-00702-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Communication is central to the implementation and effectiveness of public health measures. Informed by theories of good governance, COVID-19 pandemic public health messaging in 3 Canadian provinces is assessed for its potential to encourage or undermine public trust and adherence. METHODS This study employed a mixed-methods constant comparative approach to triangulate epidemiological COVID-19 data and qualitative data from news releases, press briefings, and key informant interviews. Communications were analyzed from January 2020 to October 2021 in Nova Scotia, Ontario, and Alberta. Interview data came from 34 semi-structured key informant interviews with public health actors across Canada. Team-based coding and thematic analysis were conducted to analyze communications and interview transcripts. RESULTS Four main themes emerged as integral to good communication: transparency, promptness, clarity, and engagement of diverse communities. Our data indicate that a lack of transparency surrounding evidence and public health decision-making, delays in public health communications, unclear and inconsistent terminology and activities within and across jurisdictions, and communications that did not consider or engage diverse communities' perspectives may have decreased the effectiveness of public health communications and adherence to public health measures throughout the COVID-19 pandemic. CONCLUSION This study suggests that increased federal guidance with wider jurisdictional collaboration backed by transparent evidence could improve the effectiveness of communication practices by instilling public trust and adherence with public health measures. Effective communication should be transparent, supported by reliable evidence, prompt, clear, consistent, and sensitive to diverse values. Improved communication training, established engagement infrastructure, and increased collaborations and diversity of decision-makers and communicators are recommended.
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Affiliation(s)
- Maya Lowe
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Shawn H. E. Harmon
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Ksenia Kholina
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Rachel Parker
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Janice E. Graham
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
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Umer H. Does pro-sociality or trust better predict staying home behavior during the Covid-19? JOURNAL OF BEHAVIORAL AND EXPERIMENTAL ECONOMICS 2022; 100:101926. [PMID: 35975104 PMCID: PMC9372020 DOI: 10.1016/j.socec.2022.101926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/25/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Voluntary compliance of preventive and mitigation measures due to social concerns can play a crucial role in slowing down the spread of the Covid-19. The existing economic models for disease spread however do not direct a lot of focus on the possible role of pro-social behavior and general trust in predicting preventive behaviors amid the Covid-19. Therefore, this study analyzes whether pro-sociality and general trust measured in the short run (2020 and 2019) and in the long run (2015 and 2010) predict attitudes towards the stay home behavior and the intended stay home behavior in case the government mandates it due to the Covid-19 in the Netherlands. The results suggest that these preferences positively influence attitudes towards staying home behavior. However, trust in comparison to pro-sociality is a stable and robust predictor of stay home attitudes both in the short as well as long run. On the other hand, neither trust nor pro-sociality influences the intended stay home behavior in case the government mandates the lockdown, and it is most likely due to the timing of the survey coinciding with a significant drop in the Covid-19 infections and easing out of the lockdown restrictions by the Dutch government.
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Affiliation(s)
- Hamza Umer
- Institute of Economic Research (IER), Hitotsubashi University, Tokyo, Japan
- International Research Fellow, Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
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West E, Nair P, Aker N, Sampson EL, Moore K, Manthorpe J, Rait G, Walters K, Kupeli N, Davies N. Rapid development of a COVID-19 care planning decision-aid for family carers of people living with dementia. Health Expect 2022; 25:1954-1966. [PMID: 35716078 PMCID: PMC9327830 DOI: 10.1111/hex.13552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/29/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION COVID-19 has disproportionately affected people living with dementia and their carers. Its effects on health and social care systems necessitated a rapid-response approach to care planning and decision-making in this population, with reflexivity and responsiveness to changing individual and system needs at its core. Considering this, a decision-aid to help families of persons with dementia was developed. OBJECTIVES To coproduce with people living with dementia, and the people who care for them, a decision-aid for family carers of people living with dementia, to support decisions during the COVID-19 pandemic and beyond. METHODS Semi-structured interviews were undertaken in 2020 with: (1) staff from two English national end-of-life and supportive care organizations; and (2) people living with dementia and family carers. Simultaneously, a rapid review of current evidence on making decisions with older people at the end of life was undertaken. Evidence from these inputs was combined to shape the decision-aid through a series of workshops with key stakeholders, including our patient and public involvement group, which consisted of a person living with dementia and family carers; a group of clinical and academic experts and a group of policy and charity leads. RESULTS The rapid review of existing evidence highlighted the need to consider both process and outcome elements of decision-making and their effects on people living with dementia and their families. The qualitative interviews discussed a wide range of topics, including trust, agency and confusion in making decisions in the context of COVID-19. The decision-aid primarily focussed on care moves, legal matters, carer wellbeing and help-seeking. CONCLUSIONS Combining different sources and forms of evidence was a robust and systematic process that proved efficient and valuable in creating a novel decision-aid for family carers within the context of COVID-19. The output from this process is an evidence-based practical decision-aid coproduced with people living with dementia, family carers, clinical and academic experts and leading national dementia and palliative care organizations. PATIENT OR PUBLIC CONTRIBUTION We worked with people living with dementia and family carers and other key stakeholders throughout this study, from study development and design to inclusion in stakeholder workshops and dissemination.
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Affiliation(s)
- Emily West
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Pushpa Nair
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Narin Aker
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Department of Psychological Medicine, Royal London HospitalEast London NHS Foundation TrustLondonUK
| | - Kirsten Moore
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- National Ageing Research InstituteParkvilleVictoriaAustralia
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care WorkforceKing's College London, StrandLondonUK
- NIHR Applied Research Collaborative (ARC) South LondonKing's College London, StrandLondonUK
| | - Greta Rait
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Kate Walters
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Nathan Davies
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
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Li X, Yang SL, Li J, Rao TT, Shen C, Hu S, Guo Y. The Prevention Behaviors and Impact Mechanisms Among Different Chinese Social Classes at the Early Stage of COVID-19 Pandemic. Psychol Res Behav Manag 2022; 15:711-723. [PMID: 35342312 PMCID: PMC8949869 DOI: 10.2147/prbm.s345380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Whether the pandemic can be effectively prevented and controlled depends on the entire population’s adherence to recommendations and preventive behaviors. The present study aimed to investigate the social class differences and internal mechanisms of prevention behaviors in the COVID-19 pandemic. Methods We conducted an online cross-sectional survey among the general Chinese population at the early stage of the COVID-19 pandemic. The survey website’s subscribers could access the questionnaire through the Tencent online platform, and a total of 1948 participants voluntarily completed it. Most of the participants were female (n = 1257, 64.528%), between the ages of 18–29 (n = 999, 51.284%), university graduates (n = 1015, 52.105%), and had an annual family income below 100,000 yuan (n = 1119, 57.444%). The differences in COVID-19 prevention behaviors among different social classes, the mediating role of infectious threat perception and the moderating role of perceived epidemic transparency were examined. Results 1) There were significant differences in prevention behaviors among different social classes. 2) The level of infectious threat perception played a mediating role in the relationship between social class and prevention behavior. When the individuals were from a lower social class, the level of threat perception and the level of COVID-19 prevention behaviors were also lower. 3) Perceived epidemic transparency played a moderating role in the relationship between social class and COVID-19 prevention behavior. It also played a moderating role in the relationship between social class and infectious threat perception. Conclusion In the implementation of epidemic prevention and control measures, different social classes should be targeted and guided differently. In particular, lower-class individuals can be guided by improving the perceptions of epidemic transparency and infectious threat.
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Affiliation(s)
- Xiaoxin Li
- Center of Mental Health Education, Huaqiao University, Quanzhou, 362021, People’s Republic of China
| | - Shen-Long Yang
- School of Humanities and Social Science, Xi’an Jiaotong University, Xi’an, 710049, People’s Republic of China
- Correspondence: Shen-Long Yang; Yongyu Guo, Tel +86 15389428303; +86 13397176318, Email ;
| | - Jing Li
- School of Psychology, Central China Normal University, Key Laboratory of Cyberpsychology and Behavior, Ministry of Education, and Hubei Human Development and Mental Health Key Laboratory, Wuhan, 430079, People’s Republic of China
| | - Ting-Ting Rao
- School of Humanities and Social Science, Xi’an Jiaotong University, Xi’an, 710049, People’s Republic of China
| | - Chuangang Shen
- College of Business Administration, Huaqiao University, Quanzhou, 362021, People’s Republic of China
| | - Sanman Hu
- College of Business Administration, Huaqiao University, Quanzhou, 362021, People’s Republic of China
| | - Yongyu Guo
- School of Psychology, Nanjing Normal University, Nanjing, 210097, People’s Republic of China
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Yuan H, Long Q, Huang G, Huang L, Luo S. Different roles of interpersonal trust and institutional trust in COVID-19 pandemic control. Soc Sci Med 2022; 293:114677. [PMID: 35101260 PMCID: PMC8692240 DOI: 10.1016/j.socscimed.2021.114677] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022]
Abstract
The absence of pharmaceutical interventions made it particularly difficult to mitigate the first outbreak of coronavirus disease 2019 (COVID-19). The current study investigated how interpersonal trust and institutional trust influenced the control process. Trusts and COVID-19 data in 44 countries and 50 US states were analyzed; institutional trust was associated with case fatality rate, and interpersonal trust was associated with control speed. Two independent behavioral experiments showed that institutional trust manipulation increased participants’ willingness to complete the COVID-19 test and that interpersonal trust manipulation increased conscious compliance with prevention norms and decreased unnecessary outdoor activities. Agent-based modeling further confirmed these behavioral mechanisms for two types of trust in the COVID-19 control process. New interventions are needed to help countries heighten interpersonal and institutional trust as they continue to battle COVID-19 and other collective threats.
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Affiliation(s)
- Hang Yuan
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China
| | - Qinyi Long
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China
| | - Guanglv Huang
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China
| | - Liqin Huang
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China
| | - Siyang Luo
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China.
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Hanson C, Luedtke S, Spicer N, Stilhoff Sörensen J, Mayhew S, Mounier-Jack S. National health governance, science and the media: drivers of COVID-19 responses in Germany, Sweden and the UK in 2020. BMJ Glob Health 2021; 6:bmjgh-2021-006691. [PMID: 34872972 PMCID: PMC8764706 DOI: 10.1136/bmjgh-2021-006691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/17/2021] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic is an unprecedented global crisis in which governments had to act in a situation of rapid change and substantial uncertainty. The governments of Germany, Sweden and the UK have taken different paths allowing learning for future pandemic preparedness. To help inform discussions on preparedness, inspired by resilience frameworks, this paper reviews governance structures, and the role of science and the media in the COVID-19 response of Germany, Sweden and the UK in 2020. We mapped legitimacy, interdependence, knowledge generation and the capacity to deal with uncertainty. Our analysis revealed stark differences which were linked to pre-existing governing structures, the traditional role of academia, experience of crisis management and the communication of uncertainty—all of which impacted on how much people trusted their government. Germany leveraged diversity and inclusiveness, a ‘patchwork quilt’, for which it was heavily criticised during the second wave. The Swedish approach avoided plurality and largely excluded academia, while in the UK’s academia played an important role in knowledge generation and in forcing the government to review its strategies. However, the vivant debate left the public with confusing and rapidly changing public health messages. Uncertainty and the lack of evidence on how best to manage the COVID-19 pandemic—the main feature during the first wave—was only communicated explicitly in Germany. All country governments lost trust of their populations during the epidemic due to a mix of communication and transparency failures, and increased questioning of government legitimacy and technical capacity by the public.
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Affiliation(s)
- Claudia Hanson
- Global Public Health, Karolinska Institutet, Stockholm, Sweden .,Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Susanne Luedtke
- Institute for risk and disaster reduction, University College London, London, UK.,Gesundheitsamt Nuremberg, Nuremberg, Germany
| | - Neil Spicer
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | | | - Susannah Mayhew
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Sandra Mounier-Jack
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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El-Majzoub S, Narasiah L, Adrien A, Kaiser D, Rousseau C. Negotiating Safety and Wellbeing: The Collaboration Between Faith-Based Communities and Public Health During the COVID-19 Pandemic. JOURNAL OF RELIGION AND HEALTH 2021; 60:4564-4578. [PMID: 34559364 PMCID: PMC8475844 DOI: 10.1007/s10943-021-01434-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 05/27/2023]
Abstract
The COVID-19 pandemic led to lockdown measures where congregational faith-based activities were prohibited. With time, the collateral impacts of confinement emerged as priorities, and impositions had to be balanced with the collaboration of the population. In this process, faith-based organizations played a key role in encouraging their congregations to adhere to lockdown measures while fostering their mental wellbeing and resilience. This paper describes the process of establishing a collaborative negotiation among the Montreal Regional Public Health Unit, the police, and the Muslim and Jewish communities, examining the role of mediation in this context. Despite some obstacles, such as communication difficulties and decision-making limitations, the collaborative approach seems to buffer the escalation of intercommunity tension and to promote communities' commitment to physical distancing measures and should be considered in times of pandemic for a more inclusive public health approach.
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Affiliation(s)
- Salam El-Majzoub
- Department of Psychiatry, McGill University, Montreal, QC Canada
| | | | - Alix Adrien
- Department of Epidemiology, Biostatics and Occupational Health, McGill University, Montreal, QC Canada
| | - David Kaiser
- Public Health School- Department of Social and Preventative Medicine, Université de Montréal, Montreal, QC Canada
| | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montreal, QC Canada
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Kroese K, Porter K, Surridge H, Tembo D. Challenges and solutions: surveying researchers on what type of community engagement and involvement activities are feasible in low and middle income countries during the COVID-19 pandemic. BMJ Open 2021; 11:e052135. [PMID: 34706957 PMCID: PMC8551745 DOI: 10.1136/bmjopen-2021-052135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Measures to limit the spread of infection during the COVID-19 global pandemic have made engaging and involving members of the community in global health research more challenging. This research aimed to explore how global health researchers adapted to the imposed pandemic measures in low and middle income countries (LMICs) and how they overcame challenges to effective community engagement and involvement (CEI). DESIGN A qualitative two-stage mixed-methods study involving an online survey and a virtual round table. SETTING The survey and round table were completed online. PARTICIPANTS Of 53 participants, 43 were LMIC-based or UK-based global health researchers and/or CEI professionals, and 10 worked for the National Institute for Health Research or UK Government's Department of Health and Social Care. OUTCOME MEASURES This study aimed to capture data on: the number of CEI activities halted and adapted because of the COVID-19 pandemic; where CEI is possible; how it has been adapted; what the challenges and successes were; and the potential impact of adapted or halted CEI on global health research. RESULTS Pandemic control measures forced the majority of researchers to stop or amend their planned CEI activities. Most face-to-face CEI activities were replaced with remote methods, such as online communication. Virtual engagement enabled researchers to maintain already established relationships with community members, but was less effective when developing new relationships or addressing challenges around the inclusion of marginalised community groups. CONCLUSIONS COVID-19 has highlighted the need for contingency planning and flexibility in CEI. The redesigning and adopting of remote methods has come with both advantages and disadvantages, and required new skills, access to technology, funding, reliable services and enthusiasm from stakeholders. The methods suggested have the potential to augment or substitute previously preferred CEI activities. The effectiveness and impact of these remote CEI activities need to be assessed.
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Affiliation(s)
- Karolin Kroese
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, UK
| | - Katie Porter
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Heidi Surridge
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Doreen Tembo
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
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Haberer JE, van der Straten A, Safren SA, Johnson MO, Amico KR, del Rio C, Andrasik M, Wilson IB, Simoni JM. Individual health behaviours to combat the COVID-19 pandemic: lessons from HIV socio-behavioural science. J Int AIDS Soc 2021; 24:e25771. [PMID: 34339113 PMCID: PMC8327691 DOI: 10.1002/jia2.25771] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/12/2021] [Accepted: 06/21/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION COVID-19 parallels HIV in many ways. Socio-behavioural science has been critical in elucidating the context and factors surrounding individual levels of engagement with known effective prevention and treatment tools for HIV, thus offering important lessons for ongoing efforts to combat the COVID-19 pandemic. DISCUSSION Non-adherence to effective disease mitigation strategies (e.g. condoms for HIV and masks for COVID-19) can be attributed in part to prioritizing comfort, convenience and individual autonomy over public health. Importantly, misinformation can fuel denialism and conspiracies that discredit scientific knowledge and motivate nonadherence. These preferences and the extent to which individuals can act on their preferences may be constrained by the structures and culture in which they live. Both HIV and COVID-19 have been politicized and influenced by evolving recommendations from scientists, clinicians, policymakers and politically motivated organizations. While vaccines are vital for ending both pandemics, their impact will depend on availability and uptake. Four decades of experience with the HIV epidemic have shown that information alone is insufficient to overcome these challenges; interventions must address the underlying, often complex factors that influence human behaviour. This article builds from socio-behavioural science theory and describes practical and successful approaches to enable and support adherence to prevention and treatment strategies, including vaccine adoption. Key methods include reframing tools to enhance motivation, promoting centralized sources of trusted information, strategic development and messaging with and within key populations (e.g. through social media) and appealing to self-empowerment, altruism and informed decision making. Orchestrated evidence-based activism is needed to overcome manipulative politicization, while consistent transparent messaging around scientific discoveries and clinical recommendations are critical for public acceptance and support. Ultimately, the effectiveness of COVID-19 vaccines will depend on our ability to engender trust in the communities most affected. CONCLUSIONS Many lessons learned from socio-behavioural science in the HIV pandemic are applicable to the COVID-19 pandemic. Individual behaviour must be understood within its interpersonal and societal context to address the current barriers to adherence to disease-mitigating strategies and promote an effective response to the COVID-19 pandemic, which is likely to be endured for the foreseeable future.
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Affiliation(s)
- Jessica E Haberer
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Ariane van der Straten
- ASTRA ConsultingKensingtonCAUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Steven A Safren
- Department of Psychology and Center for HIV and Research in Mental HealthUniversity of MiamiFLUSA
| | - Mallory O Johnson
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - K Rivet Amico
- Health Behavior & Health EducationUniversity of Michigan School of NursingAnn ArborMIUSA
| | - Carlos del Rio
- Department of Global HealthRollins School of Public HealthAtlantaGAUSA
- Division of Infectious DiseasesEmory University School of MedicineAtlantaGAUSA
| | - Michele Andrasik
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Ira B Wilson
- Department of Health Services, Policy and PracticeBrown UniversityProvidenceRIUSA
| | - Jane M Simoni
- Departments of Psychology and Global HealthUniversity of WashingtonSeattleWAUSA
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Simpson N, Angland M, Bhogal JK, Bowers RE, Cannell F, Gardner K, Gheewala Lohiya A, James D, Jivraj N, Koch I, Laws M, Lipton J, Long NJ, Vieira J, Watt C, Whittle C, Zidaru-Bărbulescu T, Bear L. 'Good' and 'Bad' deaths during the COVID-19 pandemic: insights from a rapid qualitative study. BMJ Glob Health 2021; 6:bmjgh-2021-005509. [PMID: 34078630 PMCID: PMC8174027 DOI: 10.1136/bmjgh-2021-005509] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/12/2021] [Indexed: 01/19/2023] Open
Abstract
Dealing with excess death in the context of the COVID-19 pandemic has thrown the question of a ‘good or bad death’ into sharp relief as countries across the globe have grappled with multiple peaks of cases and mortality; and communities mourn those lost. In the UK, these challenges have included the fact that mortality has adversely affected minority communities. Corpse disposal and social distancing guidelines do not allow a process of mourning in which families and communities can be involved in the dying process. This study aimed to examine the main concerns of faith and non-faith communities across the UK in relation to death in the context of the COVID-19 pandemic. The research team used rapid ethnographic methods to examine the adaptations to the dying process prior to hospital admission, during admission, during the disposal and release of the body, during funerals and mourning. The study revealed that communities were experiencing collective loss, were making necessary adaptations to rituals that surrounded death, dying and mourning and would benefit from clear and compassionate communication and consultation with authorities.
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Affiliation(s)
- Nikita Simpson
- Anthropology, London School of Economics and Political Science, London, UK
| | - Michael Angland
- Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Jaskiran K Bhogal
- Anthropology, London School of Economics and Political Science, London, UK
| | - Rebecca E Bowers
- Anthropology, London School of Economics and Political Science, London, UK
| | - Fenella Cannell
- Anthropology, London School of Economics and Political Science, London, UK
| | - Katy Gardner
- Anthropology, London School of Economics and Political Science, London, UK
| | | | - Deborah James
- Anthropology, London School of Economics and Political Science, London, UK
| | - Naseem Jivraj
- Anthropology, London School of Economics and Political Science, London, UK
| | - Insa Koch
- Anthropology, London School of Economics and Political Science, London, UK
| | - Megan Laws
- Anthropology, London School of Economics and Political Science, London, UK
| | - Jonah Lipton
- Anthropology, London School of Economics and Political Science, London, UK
| | - Nicholas J Long
- Anthropology, London School of Economics and Political Science, London, UK
| | - Jordan Vieira
- Anthropology, London School of Economics and Political Science, London, UK
| | - Connor Watt
- Anthropology, London School of Economics and Political Science, London, UK
| | - Catherine Whittle
- Anthropology, London School of Economics and Political Science, London, UK
| | | | - Laura Bear
- Anthropology, London School of Economics and Political Science, London, UK
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13
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Ohta R, Ryu Y, Sano C. Fears Related to COVID-19 among Rural Older People in Japan. Healthcare (Basel) 2021; 9:healthcare9050524. [PMID: 33946911 PMCID: PMC8146122 DOI: 10.3390/healthcare9050524] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has affected people’s social lives by inhibiting their movement; this seriously impacts the lives of older people in particular. Rural older people may have been particularly affected because they live dispersedly and in isolation. This study explored rural older people’s perceptions of how COVID-19 has impacted their social lives. This qualitative study assessed participants who were 65 years and older and residing in rural Japanese communities. Five focus group discussions were conducted with 53 participants to explore their perceptions and challenges during COVID-19. Data were analyzed using thematic analysis, and four themes were developed: the beginning of suffering, social cognitive suppression, reflection on rural contexts, and critical approaches to the pandemic based on rural standards. The daily activities of rural older people were suppressed due to social norms and pandemic-related standard precautionary measures based on urban areas. Specific infection control standards for rural areas and the provision of direct information to individuals in the community to sustain social support are needed. To effectively maintain rural social support, as well as the trust and accountability of rural citizens, constant dialog among local governments and rural citizens is required.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane, Japan;
- Correspondence: or ; Tel.: +81-90-5060-5330
| | - Yoshinori Ryu
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Shimane, Japan;
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Mayhew SH, Kyamusugulwa PM, Kihangi Bindu K, Richards P, Kiyungu C, Balabanova D. Responding to the 2018-2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches. Risk Manag Healthc Policy 2021; 14:1731-1747. [PMID: 33953623 PMCID: PMC8092619 DOI: 10.2147/rmhp.s219295] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/20/2021] [Indexed: 11/23/2022] Open
Abstract
The Democratic Republic of Congo (DRC) presents a challenging context in which to respond to public health crises. Its 2018-2020 Ebola outbreak was the second largest in history. Lessons were known from the previous West African outbreak. Chief among these was the recognition that local action and involvement are key to establishing effective epidemic-response. It remains unclear whether and how this was achieved in DRC's Ebola response. Additionally, there is a lack of scholarship on how to build resilience (the ability to adapt or transform under pressure) in crisis-response. In this article, we critically review literature to examine evidence on whether and how communities were involved, trust built, and resilience strengthened through adaptation or transformation of DRC's 2018-2020 Ebola response measures. Overall, we found limited evidence that the response adapted to engage and involve local actors and institutions or respond to locally expressed concerns. When adaptations occurred, they were shaped by national and international actors rather than enabling local actors to develop locally trusted initiatives. Communities were "engaged" to understand their perceptions but were not involved in decision-making or shaping responses. Few studies documented how trust was built or analyzed power dynamics between different groups in DRC. Yet, both these elements appear to be critical in building effective, resilient responses. These failures occurred because there was no willingness by the national government or international agencies to concede decision-making power to local people. Emergency humanitarian response is entrenched in highly medicalized, military style command and control approaches which have no space for decentralizing decision-making to "non-experts". To transform humanitarian responses, international responders can no longer be regarded as "experts" who own the knowledge and control the response. To successfully tackle future humanitarian crises requires a transformation of international humanitarian and emergency response systems such that they are led, or shaped, through inclusive, equitable collaboration with local actors.
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Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Patrick Milabyo Kyamusugulwa
- Bukavu Medical University College/Institut Supérieur des Techniques Médicales de Bukavu (ISTM-Bukavu), Bukavu, Eastern Democratic Republic of Congo
| | - Kennedy Kihangi Bindu
- Centre de Recherche sur la Démocratie et le Développement en Afrique (CREDDA), Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo
| | - Paul Richards
- School of Environmental Sciences, Njala University, Freetown, Sierra Leone
| | - Cyrille Kiyungu
- Hygiene, State Administration, Kikwit, Democratic Republic of Congo
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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15
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Enria L, Waterlow N, Rogers NT, Brindle H, Lal S, Eggo RM, Lees S, Roberts CH. Trust and transparency in times of crisis: Results from an online survey during the first wave (April 2020) of the COVID-19 epidemic in the UK. PLoS One 2021; 16:e0239247. [PMID: 33591985 PMCID: PMC7886216 DOI: 10.1371/journal.pone.0239247] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background The success of a government’s COVID-19 control strategy relies on public trust and broad acceptance of response measures. We investigated public perceptions of the UK government’s COVID-19 response, focusing on the relationship between trust and perceived transparency, during the first wave (April 2020) of the COVID-19 pandemic in the United Kingdom. Methods Anonymous survey data were collected (2020-04-06 to 2020-04-22) from 9,322 respondents, aged 20+ using an online questionnaire shared primarily through Facebook. We took an embedded-mixed-methods approach to data analysis. Missing data were imputed via multiple imputation. Binomial & multinomial logistic regression were used to detect associations between demographic characteristics and perceptions or opinions of the UK government’s response to COVID-19. Structural topic modelling (STM), qualitative thematic coding of sub-sets of responses were then used to perform a thematic analysis of topics that were of interest to key demographic groups. Results Most respondents (95.1%) supported government enforcement of behaviour change. While 52.1% of respondents thought the government was making good decisions, differences were apparent across demographic groups, for example respondents from Scotland had lower odds of responding positively than respondents in London. Higher educational levels saw decreasing odds of having a positive opinion of the government response and decreasing household income associated with decreasing positive opinion. Of respondents who thought the government was not making good decisions 60% believed the economy was being prioritised over people and their health. Positive views on government decision-making were associated with positive views on government transparency about the COVID-19 response. Qualitative analysis about perceptions of government transparency highlighted five key themes: (1) the justification of opacity due to the condition of crisis, (2) generalised mistrust of politics, (3) concerns about the role of scientific evidence, (4) quality of government communication and (5) questions about political decision-making processes. Conclusion Our study suggests that trust is not homogenous across communities, and that generalised mistrust, concerns about the transparent use and communication of evidence and insights into decision-making processes can affect perceptions of the government’s pandemic response. We recommend targeted community engagement, tailored to the experiences of different groups and a new focus on accountability and openness around how decisions are made in the response to the UK COVID-19 pandemic.
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Affiliation(s)
- Luisa Enria
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Naomi Waterlow
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nina Trivedy Rogers
- UCL Research Department of Epidemiology & Public Health, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Hannah Brindle
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sham Lal
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rosalind M. Eggo
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shelley Lees
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chrissy h. Roberts
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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16
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MacDonald NE, Comeau J, Dubé È, Graham J, Greenwood M, Harmon S, McElhaney J, Meghan McMurtry C, Middleton A, Steenbeek A, Taddio A. Royal society of Canada COVID-19 report: Enhancing COVID-19 vaccine acceptance in Canada. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
COVID-19 vaccine acceptance exists on a continuum from a minority who strongly oppose vaccination, to the “moveable middle” heterogeneous group with varying uncertainty levels about acceptance or hesitancy, to the majority who state willingness to be vaccinated. Intention for vaccine acceptance varies over time. COVID-19 vaccination decisions are influenced by many factors including knowledge, attitudes, and beliefs; social networks; communication environment; COVID-19 community rate; cultural and religious influences; ease of access; and the organization of health and community services and policies. Reflecting vaccine acceptance complexity, the Royal Society of Canada Working Group on COVID-19 Vaccine Acceptance developed a framework with four major factor domains that influence vaccine acceptance (people, communities, health care workers; immunization knowledge; health care and public health systems including federal/provincial/territorial/indigenous factors)—each influencing the others and all influenced by education, infection control, extent of collaborations, and communications about COVID-19 immunization. The Working Group then developed 37 interrelated recommendations to support COVID vaccine acceptance nested under four categories of responsibility: 1. People and Communities, 2. Health Care Workers, 3. Health Care System and Local Public Health Units, and 4. Federal/Provincial/Territorial/Indigenous. To optimize outcomes, all must be engaged to ensure co-development and broad ownership.
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Affiliation(s)
- Noni E. MacDonald
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Jeannette Comeau
- Division of Infectious Diseases, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Ève Dubé
- Scientific Group on Immunization at the Quebec National Institute of Public Health, Québec, Canada
- Department of Anthropology, Université Laval, Québec, QC G1V 0A6, Canada
| | - Janice Graham
- Department of Pediatrics, Division of Infectious Diseases, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Margo Greenwood
- School of Education, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada
- Department of First Nations Studies, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada
- National Collaborating Centre for Indigenous Health, Prince George, BC V2N 4Z9, Canada
| | - Shawn Harmon
- Department of Pediatrics, Technoscience and Regulation Research Unit, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Janet McElhaney
- Medical Sciences Division, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
| | - C. Meghan McMurtry
- Pediatric Pain, Health and Communication Lab (PPHC), University of Guelph, Guelph, ON N1G 2W1, Canada
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
- Clinical and Health Psychologist with the Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Alan Middleton
- Schulich Executive Education Centre, York University, North York, ON M3J 1P3, Canada
| | - Audrey Steenbeek
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Anna Taddio
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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17
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Bagheri Lankarani K, Honarvar B, Kalateh Sadati A, Rahmanian Haghighi MR. Citizens' Opinion on Governmental Response to COVID-19 Outbreak: A Qualitative Study from Iran. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211024906. [PMID: 34166135 PMCID: PMC8239969 DOI: 10.1177/00469580211024906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023]
Abstract
Studying the people's expectations of government measures to control and manage the coronavirus disease 2019 (COVID-19) can help to prepare for future crises. This study aimed to investigate the opinion of the Iranian people on authorities' management during a crisis, such as the COVID-19 pandemic. This qualitative study was conducted on 70 Iranian citizens in Shiraz to explore their opinion about the government response to the COVID-19 outbreak in February and March 2020. Based on saturation criteria, the data was collected by 1 open-end question: "What is your attitude toward the readiness of the officials and government in this epidemic?" Thematic analysis was conducted to explore themes. At the first step of the outbreak, people had critical opinions on their authorities' management. Four themes were studied, including trust and responsiveness, policymaking during a health crisis, economic management, and epidemic management. Although the citizens' expectation is dynamic, our study showed that there are still high demands from citizens toward the authorities, even in a new crisis that was not perceived before. One of the best ways to respond to these demands is appropriate risk communication.
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18
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Molavi Vardanjani H, Bagheri Lankarani K, Hassani AH. What Was the Starting Date of the COVID-19 Epidemic in Iran? Rumors against Management of Public Health Emergencies. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:2431-2432. [PMID: 34178754 PMCID: PMC8215072 DOI: 10.18502/ijph.v49i12.4836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The article's abstract is not available.
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Affiliation(s)
- Hossein Molavi Vardanjani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Hossein Hassani
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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The Unlikely Saviour: Portugal's National Health System and the Initial Impact of the COVID-19 Pandemic? ACTA ACUST UNITED AC 2020; 63:291-297. [PMID: 33288975 PMCID: PMC7710772 DOI: 10.1057/s41301-020-00268-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
What is the impact of COVID-19 on Portugal’s Serviço Nacional de Saúde (SNS), the country’s national health service? The story, still unfolding, has all the elements of a recipe for disaster: one of the most elderly populations in the world; a weakened SNS, the result of a litany of policies and interventions by the ‘Troika’ (the European Commission, the European Central Bank and the International Monetary Fund); a health care delivery system focused on non-communicable diseases and long-term care; the growing public distrust in public services, compared to private, hotel-like health care facilities. We are aware that these are still the early days of the epidemic, yet it is safe to say that algorithmic scenarios of doom and gloom have so far been averted. In the past six months of the pandemic, the level of trust of the Portuguese population in the SNS and its health personnel has significantly improved, while the government has started to provide additional funding and to work for the expansion of the public system. At the very inception of the pandemic, private hospitals practically closed their doors to COVID-19 patients. Unexpectedly a new disease, COVID-19, by definition the foe of any health system, has granted the opportunity for a rare consensus amongst different key political and/or corporate actors in a long-called-for reform of the SNS. Social science and humanities, with their analytical tools and theoretical-conceptual frameworks, are mandatory in providing well-funded answers to such riddles and better grasping the reasons for the twist and turns.
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20
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Lees S, Enria L. Comparative ethnographies of medical research: materiality, social relations, citizenship and hope in Tanzania and Sierra Leone. Int Health 2020; 12:575-583. [PMID: 33165554 PMCID: PMC7650898 DOI: 10.1093/inthealth/ihaa071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/30/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
In this paper we bring together ethnographic research carried out during two clinical prevention trials to explore identities, relations and political imaginations that were brought to life by these different technologies. We highlight the ways in which critical anthropological engagement in clinical trials can help us radically reconsider the parameters and standards of medical research. In the paper we analyse the very different circumstances that made these two trials possible, highlighting the different temporalities and politics of HIV and Ebola as epidemics. We then describe four themes revealed by ethnographic research with participants and their communities but mediated by the specific sociopolitical contexts in which the trials were taking place. In both countries we found materiality and notions of exchange to be important to participants’ understanding of the value of medical research and their role within it. These dynamics were governed through social relations and moral economies that also underpinned challenges to Western notions of research ethics. The clinical trials offered a language to express both disaffection and disillusionment with the political status quo (often through rumours and anxieties) while at the same time setting the foundations for alternative visions of citizenship. Attached to these were expressions of ‘uncertainty and hope’ steeped in locally distinctive notions of destiny and expectations of the future.
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Affiliation(s)
- Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Luisa Enria
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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21
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MacDonald NE, Comeau J, Dubé E, Bucci L, Graham JE. A public health timeline to prepare for COVID-19 vaccines in Canada. Canadian Journal of Public Health 2020; 111:945-952. [PMID: 33151510 PMCID: PMC7643523 DOI: 10.17269/s41997-020-00423-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022]
Abstract
For control of COVID-19, community immunity is required, necessitating widespread immunization. COVID-19 vaccines are coming to Canada, with the government announcing in August 2020 agreements with four different companies for their COVID-19 vaccine if their trials are successful. Never before has public health had to rapidly develop a vaccine introduction program for multiple new but differing vaccines with the added pressure that the program is needed across all ages and in all Canadian communities and there is high probability of not enough vaccine to go around at the start. Traditional public health vaccine introduction planning will need to be both accelerated and more comprehensive to ensure optimal uptake across the country. This overview highlights a number of points for consideration by public health in their planning for COVID-19 vaccines before these COVID-19 vaccines are available, once they are available, once supplies are plentiful, and throughout the vaccine program. Targeted and tailored communications are key elements needed to reach and positively influence diverse communities, regions, ages, languages, education levels and lived experiences.
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Affiliation(s)
- Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Jeannette Comeau
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec and Université Laval, Québec, Québec, Canada
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada
| | - Janice E Graham
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
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22
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Abstract
Vaccine trials for infectious diseases take place in a milieu of trust in which scientists, regulatory institutions, and volunteers trust each other to play traditional roles. This milieu of trust emerges from a combination of preexisting linkages embedded in the local and national political context. Using the case of failed vaccine trials in Hohoe, Ghana, we explore this milieu of trust by employing the concept of tandems of trust and control, with a particular focus on the perceived characteristics of the disease and the linkages formed. An analysis of qualitative interviews collected in Hohoe following the West Africa Ebola outbreak of 2014-2016 shows that the trust/control nexus in vaccine trials precedes the implementation of those trials, while both the characteristics of Ebola and the political context shaped the formation and breakdown of relationships in the trial network.
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23
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Han Q, Curtis DR. Suspicious minds: cinematic depiction of distrust during epidemic disease outbreaks. MEDICAL HUMANITIES 2020; 47:medhum-2020-011871. [PMID: 32467302 PMCID: PMC7299651 DOI: 10.1136/medhum-2020-011871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
One key factor that appears to be crucial in the rejection of quarantines, isolation and other social controls during epidemic outbreaks is trust-or rather distrust. Much like news reporting and social media, popular culture such as fictional novels, television shows and films can influence people's trust, especially given that the information provided about an epidemic disease is sometimes seen as grounded in 'scientific fact' by societies. As well as providing information on the 'correct science' behind disease transmission, spread and illness in films and literature, popular culture can also inform societies about how to feel and how to react during epidemics-that is to say create some expectations about the kinds of societal responses that could potentially occur. In this article we closely analyse three films that centre around epidemic diseases-Contagion (Steven Soderbergh, 2011), Blindness (Fernando Meirelles, 2008) and The Painted Veil (John Curran, 2006)-in order to highlight three categories of distrust that have recently been identified and conceptualised in broader discussions regarding trust and health: institutional, social and interpersonal. These films raise two key issues about trust and social responses during epidemics. First, while certain aspects of trust are badly diminished during epidemic disease outbreaks, epidemics can also interact with pre-existing structural inequalities within society-based on race, gender or wealth-to create mixed outcomes of discord, prejudice and fear that coexist with new forms of cohesion. Second, the breakdown in trust seen at certain levels during epidemics, such as at the institutional level between communities and authorities or elites, might be mediated or negotiated, perhaps even compensated for, by heightened solidity of trust at the social level, within or between communities.
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Affiliation(s)
- Qijun Han
- Foreign Studies, Nanjing University of Science and Technology, Nanjing, Jiangsu, China
| | - Daniel R Curtis
- History, Erasmus University Rotterdam Erasmus School of History, Culture and Communication, Rotterdam, The Netherlands
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24
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Challenges to Ebola preparedness during an ongoing outbreak: An analysis of borderland livelihoods and trust in Uganda. PLoS One 2020; 15:e0230683. [PMID: 32214381 PMCID: PMC7098638 DOI: 10.1371/journal.pone.0230683] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/05/2020] [Indexed: 11/19/2022] Open
Abstract
Ebola Virus Disease in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern on July 17, 2019. The first case to cross the border into Uganda in June 2019 demonstrates the importance of better understanding border dynamics in a context of Ebola. This paper adopts a political economy approach to contextualize epidemic response programs conducted in moderate- and high-risk border districts in Uganda, through a qualitative study with 287 participants. To that end, our aim was to describe the historical underpinnings of the borderlands context; the role of livelihood strategies in constraining risk avoidance decisions; and the dynamics of trust in authority figures, including health workers. This paper reports that border communities are highly connected, for a variety of social and economic reasons. These daily realities are in direct opposition to guidance to limit travel during an active Ebola epidemic. We argue that an ability to limit movement is constrained by the economic need to seek livelihood strategies wherever that may be. Moreover, border regions are populated by communities with long-standing distrust in authority figures, particularly in fishing areas. This distrust spills over with consequences for Ebola prevention and control activities. This research indexes the importance of tailoring Ebola programming and policies to consider the political and economic dynamics of borderlands.
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Gentili D, Bardin A, Ros E, Piovesan C, Ramigni M, Dalmanzio M, Dettori M, Filia A, Cinquetti S. Impact of Communication Measures Implemented During a School Tuberculosis Outbreak on Risk Perception among Parents and School Staff, Italy, 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030911. [PMID: 32024183 PMCID: PMC7037209 DOI: 10.3390/ijerph17030911] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
Risk perception has a significant impact on decisions people make when facing a threat: a mismatch between actual hazard and perceived risk can lead to inappropriate behaviours and suboptimal compliance to recommended public health measures. The present study was conducted in the aftermath of a tuberculosis (TB) outbreak that occurred in 2019 in a primary school in Italy. The aim was to evaluate the impact of communication measures implemented by local health authorities (including face-to-face meetings between LHAs and the local population, weekly press announcements, implementation of a telephone hotline and of an information desk, and social media communication), on risk perception among parents of schoolchildren and school staff, and to identify factors related to a change in risk perception before and after the said activities. An anonymous questionnaire was administered to parents of schoolchildren (n = 846) and to school staff (n = 70). Participants were asked about the level of risk they had perceived at two distinct times: when they first became aware of the outbreak and following implementation of communication activities. A significant reduction of perceived risk was found in both groups (p < 0.001) following the communication activities. The largest reduction was found among participants who reported having appreciated the meetings with the LHA healthcare staff. Our findings suggest that keeping an open approach, explaining the actual threat to the population and adapting communication to different listening skills, are essential for health authorities to successfully manage a public health emergency.
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Affiliation(s)
- Davide Gentili
- Public Health Office, Local Health Unit 2 Marca Trevigiana, 31100 Treviso, Italy; (E.R.); (M.D.); (S.C.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
- Correspondence:
| | - Andrea Bardin
- Department of Cardiac, Thoracic and Vascular Sciences, Public Health Unit, University of Padua, 35100 Padua, Italy;
| | - Elisa Ros
- Public Health Office, Local Health Unit 2 Marca Trevigiana, 31100 Treviso, Italy; (E.R.); (M.D.); (S.C.)
| | - Cinzia Piovesan
- Epidemiology Office, Local Health Unit 2 Marca Trevigiana, 31100 Treviso, Italy; (C.P.); (M.R.)
| | - Mauro Ramigni
- Epidemiology Office, Local Health Unit 2 Marca Trevigiana, 31100 Treviso, Italy; (C.P.); (M.R.)
| | - Maria Dalmanzio
- Public Health Office, Local Health Unit 2 Marca Trevigiana, 31100 Treviso, Italy; (E.R.); (M.D.); (S.C.)
| | - Marco Dettori
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Antonietta Filia
- Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), 00100 Rome, Italy;
| | - Sandro Cinquetti
- Public Health Office, Local Health Unit 2 Marca Trevigiana, 31100 Treviso, Italy; (E.R.); (M.D.); (S.C.)
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Affiliation(s)
- Janice E. Graham
- Department of Pediatrics (Infectious Diseases), Dalhousie University, Halifax, Canada
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