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Kolandai K, Milne B, von Randow M, Bullen C, Marsh S, Crump JA. Public opinion on global COVID-19 vaccine procurement and distribution policies: A nationally representative survey in Aotearoa New Zealand 2022. Vaccine 2024; 42:1372-1382. [PMID: 38326132 DOI: 10.1016/j.vaccine.2024.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/13/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
The World Health Organisation and many health experts have regarded vaccine nationalism, a "my country first" approach to vaccines procurement, as a critical pandemic response failure. However, few studies have considered public opinion in this regard. This study gauged public support for vaccine nationalism and vaccine internationalism in a representative survey in New Zealand (N = 1,135). Support for vaccine internationalism (M (mean rating) = 3.64 on 5-point scales) was significantly stronger than for vaccine nationalism (M = 3.24). Additionally, support for openly sharing COVID-19 vaccine manufacturing knowledge and technology (M = 4.17 on 5-point scales) was significantly stronger than support for safeguarding vaccine manufacturers' intellectual property (M = 2.66). The public also supported a utilitarian approach that would see distributions based on need (M = 3.76 on 5-point scales) over an equal proportional international distribution (M = 3.16). Akin to the few preceding studies, the present observations suggest that the public is likely to be more supportive of pandemic responses that are globally equitable and long-term orientated. Our findings have substantial implications for pandemic preparedness as the congruence or lack thereof of public vaccine-related values with government policies can affect public trust, which, in turn, can affect public cooperation. It may pay for governments to invest in proactive public engagement efforts before and during a pandemic to discuss critical ethical issues and inequities in global vaccine procurement and distributions.
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Affiliation(s)
- Komathi Kolandai
- COMPASS Research Centre & Public Policy Institute, Faculty of Arts, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Barry Milne
- COMPASS Research Centre, Faculty of Arts, University of Auckland, New Zealand
| | - Martin von Randow
- COMPASS Research Centre, Faculty of Arts, University of Auckland, New Zealand
| | - Chris Bullen
- General Practice and Primary Healthcare, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Samantha Marsh
- General Practice and Primary Healthcare, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - John A Crump
- Centre for International Health & Otago Global Health Institute, University of Otago, New Zealand
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Licht A, Wetzker W, Scholz J, Scherag A, Weis S, Pletz MW, Bauer M, Dickmann P. Public health risk communication through the lens of a quarantined community: Insights from a coronavirus hotspot in Germany. PLoS One 2023; 18:e0292248. [PMID: 37824455 PMCID: PMC10569635 DOI: 10.1371/journal.pone.0292248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/17/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Quarantine is one of the most effective interventions to contain an infectious disease outbreak, yet it is one of the most disruptive. We investigated the quarantine of an entire village to better understand risk communication requirements for groups. METHODS We conducted a cross-sectional, mixed-methods survey study on a single cohort of adult residents in Neustadt am Rennsteig, Germany, six weeks after the removal of a 14-day mandatory community quarantine. The survey response rate was 33% (289/883 residents). FINDINGS Survey participants reported a lack of information on the quarantine implementation process. What authorities communicated was not necessarily what residents desired to know. While inhabitants used social media and telephones to communicate with each other, the official information sources were regional radio, television, newspapers and official websites. Public health authorities did not employ social media communication to engage with their communities. Despite a lack of information, the majority of respondents stated that they had complied with the quarantine and they expressed little sympathy for those who violated the quarantine. After lifting the quarantine, many respondents continued to avoid places where they suspected a significant risk of infection, such as family and friends' homes, doctor's offices and grocery stores. INTERPRETATION The survey participants utilised existing social networks to disseminate vital information and stabilise its group identity and behaviour (quarantine compliance). The authorities communicated sparsely in a unidirectional, top-down manner, without engaging the community. Despite the lack of official information, the social coherency of the group contributed to considerate and compliant conduct, but participants expressed dissatisfaction with official leadership and asked for more attention. CONCLUSION Public health risk communication must engage with communities more effectively. This necessitates a deeper comprehension of groups, their modes of communication and their social needs.
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Affiliation(s)
- Annika Licht
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Wibke Wetzker
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Juliane Scholz
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Sebastian Weis
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University, Jena, Germany
- Leibniz Institute for Infection Biology and Natural Product Research, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Jena, Germany
| | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Michael Bauer
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Petra Dickmann
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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Kemper S, Bongers M, Kupper F, De Vries M, Timen A. Preferences for public engagement in decision-making regarding four COVID-19 non-pharmaceutical interventions in the Netherlands: A survey study. PLoS One 2023; 18:e0292119. [PMID: 37796885 PMCID: PMC10553365 DOI: 10.1371/journal.pone.0292119] [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: 10/07/2022] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Worldwide, non-pharmaceutical interventions (NPIs) were implemented during the COVID-19 crisis, which heavily impacted the daily lives of citizens. This study considers public perspectives on whether and how public engagement (PE) can contribute to future decision-making about NPIs. METHODS An online survey was conducted among a representative sample of the public in the Netherlands from 27 October to 9 November 2021. Perceptions and preferences about PE in decision-making on NPIs to control COVID-19 were collected. Preferences regarding four NPIs were studied: Nightly curfew (NC); Digital Covid Certificate (DCC); Closure of elementary schools and daycares (CED); and physical distancing (1.5M). Engagement was surveyed based on the five participation modes of the IAP2 Spectrum of Public Participation, namely inform, consult, advice, collaborate and empower. RESULTS Of the 4981 respondents, 25% expressed a desire to engage in decision-making, as they thought engagement could improve their understanding and the quality of NPIs, as well as increase their trust in the government. Especially for the NPIs DCC and NC, respondents found it valuable to engage and provide their perspective on trade-offs in values (e.g. opening up society versus division in society by vaccination status). Respondents agreed that the main responsibility in decision-making should stay with experts and policy-makers. 50% of respondents did not want to engage, as they felt no need to engage or considered themselves insufficiently knowledgeable. Inform was deemed the most preferred mode of engagement, and empower the least preferred mode of engagement. CONCLUSION We reveal large variations in public preferences regarding engagement in NPI decision-making. With 25% of respondents expressing an explicit desire to engage, and considering the benefit of PE in other areas of (public) health, opportunities for PE in NPI decision-making might have been overlooked during the COVID-19 pandemic. Our results provide guidance into when and how to execute PE in future outbreaks.
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Affiliation(s)
- Sophie Kemper
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marloes Bongers
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Frank Kupper
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marion De Vries
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aura Timen
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
- Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Ziadni MS, Jaros S, Anderson SR, You DS, Darnall BD, Mackey SC. A Longitudinal Investigation of the Impact of COVID-19 on Patients With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:1830-1842. [PMID: 37225065 PMCID: PMC10201913 DOI: 10.1016/j.jpain.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
The COVID-19 pandemic prompted unexpected changes in the healthcare system. This current longitudinal study had 2 aims: 1) describe the trajectory of pandemic-associated stressors and patient-reported health outcomes among patients receiving treatment at a tertiary pain clinic over 2 years (May 2020 to June 2022); and 2) identify vulnerable subgroups. We assessed changes in pandemic-associated stressors and patient-reported health outcome measures. The study sample included 1270 adult patients who were predominantly female (74.6%), White (66.2%), non-Hispanic (80.6%), married (66.1%), not on disability (71.2%), college-educated (59.45%), and not currently working (57.9%). We conducted linear mixed effect modeling to examine the main effect of time with controlling for a random intercept. Findings revealed a significant main effect of time for all pandemic-associated stressors except financial impact. Over time, patients reported increased proximity to COVID-19, but decreased pandemic-associated stressors. A significant improvement was also observed in pain intensity, pain catastrophizing, and PROMIS-pain interference, sleep, anxiety, anger, and depression scores. Demographic-based subgroup analyses for pandemic-associated stressors revealed that younger adults, Hispanics, Asians, and patients receiving disability compensation were vulnerable groups either during the initial visit or follow-up visits. We observed additional differential pandemic effects between groups based on participant sex, education level, and working status. In conclusion, despite unanticipated changes in pain care services during the pandemic, patients receiving pain treatments adjusted to pandemic-related stressors and improved their health status over time. As the current study observed differential pandemic impacts on patient subgroups, future studies should investigate and address the unmet needs of vulnerable subgroups. PERSPECTIVE: Over a 2-year timeframe, the pandemic did not adversely influence physical and mental health among treatment-seeking patients with chronic pain. Patients reported small but significant improvements across indices of physical and psychosocial health. Differential impacts emerged among groups based on ethnicity, age, disability status, gender, education level, and working status.
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Affiliation(s)
- Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Sam Jaros
- Department of Epidemiology, Stanford University School of Medicine, Palo Alto, California
| | - Steven R Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Dokyoung S You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
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Ceccato I, Di Crosta A, La Malva P, Cannito L, Mammarella N, Palumbo R, Palumbo R, Di Domenico A. Public opinion in vaccine allocation priority: who comes first? Psychol Health 2023; 38:1194-1214. [PMID: 34822253 DOI: 10.1080/08870446.2021.2007914] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We investigated people's preferences in COVID-19 vaccine allocation priority, comparing different social categories based on age and occupation. Vaccine allocation preferences were related to perceived health vulnerability and economic backlash (economic negative consequences) endured by the different social groups during the pandemic. In-group favoritism in vaccine allocation preferences was analyzed. DESIGN Data were collected through an online survey in Italy (n = 506) before the start of the vaccination campaign. MAIN OUTCOME MEASURES Vaccine allocation preferences, health vulnerability, and economic backlash due to COVID-19, measured through ranking tasks. RESULTS The healthcare workers category was placed at the top of the ranking in vaccine allocation priority by 65% of the respondents. Vaccine allocation priority was related to perceived health vulnerability and not economic difficulties. Limited self-preference effects emerged. People who did not consider healthcare workers a priority (1/5 of the sample) had a lower education level, were more worried about COVID-19 infection risk, and did not trust vaccines. CONCLUSIONS A consensus emerged on who should be vaccinated first. Governments and policymakers should be aware of these preferences when designing and communicating vaccine allocation plans to predict and foster the public's acceptance of the COVID-19 vaccination programs created by experts.
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Affiliation(s)
- Irene Ceccato
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Adolfo Di Crosta
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Pasquale La Malva
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Loreta Cannito
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Nicola Mammarella
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Riccardo Palumbo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Rocco Palumbo
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Alberto Di Domenico
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
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Kemper S, van den Broek R, van Hameren S, Kupper JFH, Bongers MEJ, de Weger E, de Vries M, Timen A. Voices of society: the emergence of civil-society practices aiming to engage in the management of the COVID-19 pandemic in the Netherlands. BMJ Glob Health 2023; 8:e012875. [PMID: 37607772 PMCID: PMC10445389 DOI: 10.1136/bmjgh-2023-012875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
During the COVID-19 pandemic, public groups mobilised themselves in civil-society engagement practices (CSEPs) aiming to improve or suggest alternative epidemic management. This study explores the motivation to establish CSEPs and their perceived contributions to epidemic management, to gain insight whether integrating views of CSEPs could add value. A systematic online search was executed to identify CSEPs focused on COVID-19 management between January 2020 and January 2022 in the Netherlands. In order to create a comprehensible overview of the identified CSEPs, relevant characteristics were gathered and mapped, for example, local or national scope, subject of action and goals. A selection of CSEPs was interviewed between April and June 2022 to study their motivators to start the CSEPs and perceived contributions to management. The search resulted in the identification of 22 CSEPs, of which members of 14 CSEPs were interviewed. These members indicated several issues that motivated the start of their CSEP, namely; shortage of equipment, sense of solidarity, and a perceived lack of governmental action, lack of democratic values and lack in diversity of perspectives in epidemic management. All respondents believed to have contributed to policy or society, by influencing opinions, and occasionally by altering policy. However, respondents encountered obstacles in their attempts to contribute such as inability to establish contact with authorities, feeling unheard or undermined, and complications due to the interplay of political interests. In conclusion, CSEPs have fulfilled various roles such as providing alternative management policies, producing equipment, representing the needs of vulnerable populations, and supporting citizens and providing citizens with other viewpoints and information. The identified motivators to establish CSEPs in this study uncover room for improvements in policy. These insights, together with the identified perceived barriers of CSEPs, can be used to improve the connection between (future) epidemic management and public priorities and interests.
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Affiliation(s)
- Sophie Kemper
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Renate van den Broek
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sarah van Hameren
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - J Frank H Kupper
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marloes E J Bongers
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Esther de Weger
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marion de Vries
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aura Timen
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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Khazaee-Pool M, Pashaei T, Ponnet K. Social innovation in health and community-driven engagement as a key strategy for addressing COVID-19 crisis challenges: insights and reflections from the multicultural society of Iran. Front Public Health 2023; 11:1174385. [PMID: 37346112 PMCID: PMC10279867 DOI: 10.3389/fpubh.2023.1174385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
Background Social innovation is one of the strategies for appealing to people and encouraging social cooperation and engagement in interventions during crisis periods. In this regard, community engagement is an operative and innovative community health approach for achieving successful health outcomes. There is limited information about the role and operational impact of social innovation on community engagement during the challenges posed by the COVID-19 crisis. In this study, we aim to contribute to the understanding of innovative social strategies to attract social participation in crises such as the COVID-19 pandemic by highlighting the experience of social innovative strategies based on community-driven engagement in Iran. Methods This qualitative study was conducted in seven provinces of Iran-Mazandaran, Zanjan, Golestan, Lorestan, Tehran, Kurdistan, and Khuzestan-from 4 September 2021 to 1 March 2022. A sample of Iranians (15-71 years) was selected by purposeful and snowball sampling methods to participate in the study, and 187 semi-structured telephone interviews were conducted. Participants were recruited from three levels of the community: community leaders, healthcare providers, and laypeople. The data collection tool was an interview guide, which was designed based on a review of the literature. The data were analyzed using conventional content analysis. Exploratory analyses were performed to identify social innovative strategies based on community engagement used during the COVID-19 crisis in Iran. The interviews continued until data saturation was reached. Results Based on our findings, we distilled innovative strategies into 6 main themes and 37 categories: (1) information giving/sharing, (2) consultation, (3) involvement/collaboration, (4) health education and prevention, (5) empowering, and (6) advocacy. The results revealed that the participants were very driven to engage in the management and control of the COVID-19 crisis, even though they faced significant challenges. Conclusion The spread of the COVID-19 pandemic required social- and community-based responses. These reactions increased the possibility of fair access to health services, especially for vulnerable groups and minorities. As with other epidemics, applying the experience of the comprehensive participation of communities played an important and active role in the prevention and control of COVID-19. In this regard, giving and sharing information, consultation, involvement/collaboration, health education/prevention, empowerment, and advocacy are the most important innovative strategies that might encourage the community to perform COVID-19 crisis management and control.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Pashaei
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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Chebil D, Ben Hassine D, Melki S, Nouira S, Kammoun Rebai W, Hannachi H, Merzougui L, Ben Abdelaziz A. Place of distancing measures in containing epidemics: a scoping review. Libyan J Med 2022; 17:2140473. [DOI: 10.1080/19932820.2022.2140473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dhekra Chebil
- Infection Prevention Control Department, Ibn Al Jazzar University Hospital, Kairouan, Tunisia
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Donia Ben Hassine
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Information System Direction (DSI), Sahloul University Hospital, Sousse, Tunisia
| | - Sarra Melki
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Information System Direction (DSI), Sahloul University Hospital, Sousse, Tunisia
| | - Sarra Nouira
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Information System Direction (DSI), Sahloul University Hospital, Sousse, Tunisia
| | - Wafa Kammoun Rebai
- Regional Training Center supported by WHO-TDR for East Mediterranean Region (EMR), Pasteur Institute of Tunis, Tunisia
| | - Hajer Hannachi
- Infection Prevention Control Department, Ibn Al Jazzar University Hospital, Kairouan, Tunisia
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Latifa Merzougui
- Infection Prevention Control Department, Ibn Al Jazzar University Hospital, Kairouan, Tunisia
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Ahmed Ben Abdelaziz
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
- Information System Direction (DSI), Sahloul University Hospital, Sousse, Tunisia
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Lasseter G, Compston P, Robin C, Lambert H, Hickman M, Denford S, Reynolds R, Zhang J, Cai S, Zhang T, Smith LE, Rubin GJ, Yardley L, Amlôt R, Oliver I. Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation. BMC Public Health 2022; 22:2145. [PMID: 36418978 PMCID: PMC9685010 DOI: 10.1186/s12889-022-14368-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of "shielding" on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown. METHODS A two-stage mixed methods study, including a structured survey (7 August-23 October 2020) and semi-structured telephone interviews (26 August-30 September 2020) with a sample of individuals who had been identified as CEV and advised to "shield" by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG). RESULTS The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of 'official' communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety. CONCLUSIONS This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.
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Affiliation(s)
- Gemma Lasseter
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Polly Compston
- grid.515304.60000 0005 0421 4601Field Epidemiology Service, UK Health Security Agency, Cambridge, UK
| | - Charlotte Robin
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.515304.60000 0005 0421 4601Field Epidemiology, Field Service, National Infection Service, UK Health Security Agency, Liverpool, UK ,grid.10025.360000 0004 1936 8470NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK ,grid.10025.360000 0004 1936 8470NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Helen Lambert
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Matthew Hickman
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Sarah Denford
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, UK
| | - Rosy Reynolds
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Juan Zhang
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shenghan Cai
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tingting Zhang
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louise E. Smith
- grid.13097.3c0000 0001 2322 6764NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, King’s College London, London, UK
| | - G James Rubin
- grid.13097.3c0000 0001 2322 6764NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, King’s College London, London, UK
| | - Lucy Yardley
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, UK ,grid.5491.90000 0004 1936 9297Psychology Department, University of Southampton, Southampton, UK
| | - Richard Amlôt
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.515304.60000 0005 0421 4601Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, UK
| | - Isabel Oliver
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.515304.60000 0005 0421 4601Field Epidemiology Service, UK Health Security Agency, Cambridge, UK
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10
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Kemper S, Kupper F, Kengne Kamga S, Brabers A, De Jong J, Bongers M, Timen A. Public engagement in decision-making regarding the management of the COVID-19 epidemic: Views and expectations of the 'publics'. Health Expect 2022; 25:2807-2817. [PMID: 36148630 PMCID: PMC9538976 DOI: 10.1111/hex.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/23/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background In the management of epidemics, like COVID‐19, trade‐offs have to be made between reducing mortality and morbidity and minimizing socioeconomic and political consequences. Traditionally, epidemic management (EM) has been guided and executed attentively by experts and policymakers. It can, however, still be controversial in the public sphere. In the last decades, public engagement (PE) has been successfully applied in various aspects of healthcare. This leads to the question if PE could be implemented in EM decision‐making. Methods From June to October 2020, seven deliberative discussion focus groups were executed with 35 Dutch citizens between 19 and 84 years old. Their views on PE in COVID‐19 management were explored. The deliberative approach allows for the education of participants on the topic before the discussion. The benefits, barriers, timing and possible forms of PE in EM were discussed. Results Almost all participants supported PE in EM, as they thought that integrating their experiences and ideas would benefit the quality of EM, and increase awareness and acceptance of measures. A fitting mode for PE was consultation, as it was deemed important to provide the public with possibilities to share ideas and feedback; however, final authority remained with experts. The publics could particularly provide input about communication campaigns and control measures. PE could be executed after the first acute phase of the epidemic and during evaluations. Conclusions This paper describes the construction of an empirically informed framework about the values and conditions for PE in EM from the perspective of the public. Participants expressed support to engage certain population groups and considered it valuable for the quality and effectiveness of EM; however, they expressed doubts about the feasibility of PE and the capabilities of citizens. In future studies, these results should be confirmed by a broader audience. Patient or Public Contribution No patients or members of the public were involved in the construction and execution of this study. This study was very exploratory, to gain a first insight into the views of the public in the Netherlands, and will be used to develop engagement practices accordingly. At this stage, the involvement of the public was not yet appropriate.
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Affiliation(s)
- Sophie Kemper
- National Coordination Centre for Communicable Disease Control, The National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Frank Kupper
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Sandra Kengne Kamga
- National Coordination Centre for Communicable Disease Control, The National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Anne Brabers
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, 3513 CR, The Netherlands
| | - Judith De Jong
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, 3513 CR, The Netherlands.,Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marloes Bongers
- National Coordination Centre for Communicable Disease Control, The National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aura Timen
- National Coordination Centre for Communicable Disease Control, The National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, 1081 HV, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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11
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Berner-Rodoreda A, Bärnighausen T, Eyal N, Sarker M, Hossain P, Leshabari M, Metta E, Mmbaga E, Wikler D, McMahon SA. “Thought provoking”, “interactive”, and “more like a peer talk”: Testing the deliberative interview style in Germany. SSM - QUALITATIVE RESEARCH IN HEALTH 2021; 1:None. [PMID: 34977853 PMCID: PMC8688150 DOI: 10.1016/j.ssmqr.2021.100007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
Proponents of the newly-developed “deliberative interview” argue that examining complex issues requires more dynamic and engaging interview exchanges. Unlike traditional qualitative interviews, deliberative interviewing champions opinion sharing, active debates and similar speaking times by both sides throughout the interview. Drawing on 20 interviews with health experts in Germany, we examined the process and outcome of deliberative versus conventional interviews on the topic of informed consent. The deliberative interview expedited clarity on the issue, led to more nuanced discussion and generated more knowledge overall, but was challenging because it broke the mold for traditional interviewing. Alignment in terms of gender, age, personality and professional background facilitated rapport, regardless of interview style. To manage expectations, we recommend a thorough, perhaps video-based explanation of the deliberative style prior to the interview. Deliberative interviews can bolster knowledge generation for complex issues and can be applied in public health and beyond.
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Affiliation(s)
- Astrid Berner-Rodoreda
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Corresponding author. Institute of Global Health, Heidelberg University, Germany.
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, USA
| | - Nir Eyal
- Department of Health, Behavior, Society and Policy, Rutgers University, Piscataway, USA
- Center for Population-Level Bioethics, New Brunswick, USA
| | - Malabika Sarker
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Puspita Hossain
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- McMaster University, Hamilton, Canada
| | - Melkizedeck Leshabari
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmy Metta
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia Mmbaga
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Daniel Wikler
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, USA
| | - Shannon A. McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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12
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Kemper S, Bongers M, Slok E, Schoonmade LJ, Kupper J, Timen A. Patient and public engagement in decision-making regarding infectious disease outbreak management: an integrative review. BMJ Glob Health 2021; 6:bmjgh-2021-007340. [PMID: 34824137 PMCID: PMC8627369 DOI: 10.1136/bmjgh-2021-007340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Worldwide, people experience the effects of infectious disease outbreaks on a regular basis. These effects vary from direct impact of the virus on health, to indirect impact of control measures on day-to-day life. Yet, incorporating the experiences, views and ideas of patients and the public in decision-making in managing outbreaks does not take place on a structural basis. However, this might be beneficial. We examined the current incorporation of patient and public engagement (PPE) in decision-making regarding outbreak management (OM). Methods A systematic search was executed in PubMed, Embase, APA PsycInfo, Web of Science, Scopus and other literature sources. Papers describing PPE in decision-making regarding OM on a collective level (group-level) were included. Relevant information about study characteristics, methods, impact and embedment of PPE in decision-making in OM was collected. Results The search yielded 4186 papers of which 13 were included. The papers varied in study context and design. Remarkably, no substantial patient engagement was identified. Overall, public engagement (PE) in decision-making regarding OM was mostly executed by a mix of methods, for example, workshops, interviews and surveys. Knowledge and idea sharing between the public and experts was deemed beneficial for establishing well-informed discussions. The efforts resulted in either direct implications for practice or recommendations in policy papers. Most papers described their efforts as a first step. No structural embedment of collective PE in decision-making regarding OM was identified. Furthermore, the quality of most papers was low to moderate due to insufficient description. Conclusion Overall, various practices for PE can be potentially valuable, but structural embedment in OM decision-making on a collective level was low. Before PPE can be permanently embedded in OM, more evidence on its impact needs to be collected. Furthermore, reporting on the engagement process and used terminology needs to be harmonised to ensure reproducibility and transparency.
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Affiliation(s)
- Sophie Kemper
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands .,Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Mej Bongers
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ene Slok
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - L J Schoonmade
- Medical Library, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jfh Kupper
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - A Timen
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
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13
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Sadjadi M, Mörschel KS, Petticrew M. Social distancing measures: barriers to their implementation and how they can be overcome - a systematic review. Eur J Public Health 2021; 31:1249-1258. [PMID: 34508629 PMCID: PMC8499970 DOI: 10.1093/eurpub/ckab103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite their central role in the global response to the COVID-19 pandemic and previous infectious disease outbreaks, factors influencing the acceptability and implementation of social distancing measures are poorly understood. This systematic review aims to identify such factors drawing on qualitative literature. METHODS A systematic search was carried out in eleven databases. Papers were included in the review if they reported on qualitative studies of factors influencing the implementation of social distancing measures in potentially epidemic infectious diseases. An adapted meta-ethnographical approach was used for synthesis. Review findings were assessed for strength and reliability using GRADE-CERQual. RESULTS Twenty-nine papers were included from the systematic search that yielded 5620 results, and supplementary methods. The review identifies two broad categories of barriers to social distancing measures: individual- or community-level psychosocial phenomena, and shortcomings in governmental action or communication. Based on this, 25 themes are identified that can be addressed to improve the implementation of social distancing. CONCLUSION Among other findings, the review identifies the need for good communication as well as the need for authorities to provide comprehensive support as two key opportunities to increase acceptability and adherence. Further important enablers of adherence are adequate preparedness and appropriate legislation, the presence of community involvement, solidarity within communities and trust in governments and authorities.
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Affiliation(s)
- Mahan Sadjadi
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Katharina S Mörschel
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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14
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Homaie Rad E, Hajizadeh M, Yazdi-Feyzabadi V, Delavari S, Mohtasham-Amiri Z. How Much Money Should be Paid for a Patient to Isolate During the COVID-19 Outbreak? A Discrete Choice Experiment in Iran. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:709-719. [PMID: 34312818 PMCID: PMC8313371 DOI: 10.1007/s40258-021-00671-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Isolation of COVID-19 patients is a vital strategy for preventing the spread of the virus. Isolation without any incentive or compensation for the patients cannot be effective. We sought to find the monetary value of the willingness to accept (WTA) being isolated for COVID-19 in Iran. METHODS In this discrete choice experiment, scenarios were designed by reviewing the literature and semi-structural interviews. Fourteen choice sets with two scenarios were included in an internet-based questionnaire that was sent to the Telegram Social Network. A total of 617 individuals completed the questionnaire. A random-effects logistic regression model was used for the main analysis. RESULTS The average monetary value of a WTA 7 days of isolation was US$51.71 (95% confidence interval [CI] 43.09-60.33). The WTA for one day of isolation was US$1.48 (95% CI 1.11-1.85) for unemployed groups, US$1.49 (95% CI 1.18-1.79) for office employees and US$1.36 (95% CI 0.73-2.01) for manual workers. The WTA was 0.44 (95% CI 0.35-0.53) US$ for low-income groups, US$0.68 (95% CI 0.52-0.84) for middle-income groups and US$0.77 (95% CI 0.35-1.18) for high-income groups. CONCLUSIONS Our findings suggested that financial preferences for being isolated vary widely across individuals within different socioeconomic groups. Policymakers should consider these differences when designing effective intervention to increase compliance with the isolation protocols during infectious disease outbreaks.
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Affiliation(s)
- Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | - Sajad Delavari
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Mohtasham-Amiri
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
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15
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Chiam AL, Cheng NWI, Larson H. Community engagement for outbreak preparedness and response in high-income settings: A systematic review. Glob Public Health 2021; 17:1113-1135. [PMID: 33938368 DOI: 10.1080/17441692.2021.1919734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND This review aims to (i) identify and critique existing methods of community engagement for outbreak preparedness and response in high-income settings, and (ii) understand community members' experiences of community engagement, and their views and concerns towards pandemic planning/response. METHODS Following the PRISMA guidelines, a systematic review was conducted by searching Medline, Embase, PubMed, Global Health, CINAHL Plus and Scopus for publications from 2004 to June 2019. Potential literature was screened using explicit inclusion and exclusion criteria. Included studies were appraised using the Critical Appraisal Skills Programme Qualitative Research checklist. Those using deliberative approaches were appraised using additional criteria for judging deliberation quality. Thematic synthesis was then conducted. RESULTS Primary studies employed participatory research approaches, deliberative forums, interviews/focus groups to engage community members on pandemic planning/response with varying degrees of involvement and methodological rigour. This review indicates such endeavours must take into account instrumental and relational considerations: socioeconomic pressures; agency and capacity; diversity and divergent views; educate, communicate and engage; trust and transparency. CONCLUSION Community engagement for pandemic planning/response requires clear methods, processes and who 'community' constitutes. Instrumental and relational considerations must be addressed concurrently in pandemic planning/response to enhance preparedness for public health emergencies.
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Affiliation(s)
| | | | - Heidi Larson
- London School of Hygiene & Tropical Medicine, London, UK
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16
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Quarantine acceptance and adherence: qualitative evidence synthesis and conceptual framework. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2021; 30:2091-2101. [PMID: 33898163 PMCID: PMC8051932 DOI: 10.1007/s10389-021-01544-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/05/2021] [Indexed: 01/15/2023]
Abstract
Aim Emergent infectious diseases often lack medical treatment or preventive vaccines, thus requiring non-pharmaceutical interventions such as quarantine to reduce disease transmission. Quarantine, defined as the separation and restriction of movement of healthy people who have potentially been exposed to the disease, remains contentious especially when the risks and benefits are not fully discussed and not effectively communicated to the people by the organizations who impose this public health measure. Subject and methods A qualitative evidence synthesis was conducted to examine the phenomenon of adherence to quarantine focused on the following questions: What strategies affect adherence to quarantine? What are the barriers and facilitators to quarantine acceptance? What benefits and harms of quarantine have been described or measured? Results The evidence synthesis produced 18 findings assessed with high confidence. The findings were used to construct a conceptual framework for inter- and within-organization coordination and public communication that includes the following topics for consideration: desired orientation for implementation; population demographics; perceptions of messages; prior acceptance of quarantine; likelihood of impacts of quarantine; perceptions of health infrastructure; and perceptions of policy importance. Conclusion The findings and conceptual framework can guide development of effective non-pharmaceutical interventions and as such have direct relevance to public health policy and decision-making for intervening in emergent infectious diseases outbreak such as the ongoing COVID-19 pandemic.
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17
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Dal-Ré R, Camps V. Who should be vaccinated against COVID-19 first? MEDICINA CLINICA (ENGLISH ED.) 2021; 156:177-179. [PMID: 33521292 PMCID: PMC7825832 DOI: 10.1016/j.medcle.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rafael Dal-Ré
- Unidad de Epidemiología, Instituto de Investigación Sanitaria, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Victoria Camps
- Departamento de Filosofía, Universidad Autónoma de Barcelona, Barcelona, Spain
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18
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Dal-Ré R, Camps V. [Who should be vaccinated against COVID-19 first?]. Med Clin (Barc) 2021; 156:177-179. [PMID: 33279207 PMCID: PMC7670930 DOI: 10.1016/j.medcli.2020.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Rafael Dal-Ré
- Unidad de Epidemiología, Instituto de Investigación Sanitaria, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España.
| | - Victoria Camps
- Departamento de Filosofía, Universidad Autónoma de Barcelona, Barcelona, España
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19
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Hruschak V, Flowers KM, Azizoddin DR, Jamison RN, Edwards RR, Schreiber KL. Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic. Pain 2021; 162:619-629. [PMID: 33230007 PMCID: PMC7808279 DOI: 10.1097/j.pain.0000000000002128] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 12/23/2022]
Abstract
ABSTRACT The COVID-19 pandemic has had a tremendous impact, including on individuals with chronic pain. The social distancing policies necessary to slow the spread of SARS-CoV-2 have involved increased levels of social isolation. This cross-sectional survey study examined pain severity and interference among individuals with chronic pain during an early phase of social distancing mandates and identified characteristics of individuals who were most impacted. Approximately 4 to 8 weeks after social distancing mandates commenced in the state of Massachusetts, 150 patients with fibromyalgia, chronic spine, and postsurgical pain completed demographic, pain, social distancing, and validated psychosocial questionnaires. Patients self-reported an overall significant increase in pain severity and pain interference, compared with before social distancing, although both pain severity and interference were quite variable among individuals under conditions of social distancing. Several demographic, socioeconomic, and psychosocial factors were associated with greater pain severity and interference during social distancing. Multivariable linear regression demonstrated that female sex, nonwhite race, lower education, disability, fibromyalgia, and higher pain catastrophizing were independently associated with greater pain severity, while female sex and pain catastrophizing were independently associated greater pain interference. The findings suggest that individual differences among patients with chronic pain should be considered in the planning, development, and prioritization of interventions to improve pain care and to prevent worsening of symptoms during the continuing COVID-19 pandemic.
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Affiliation(s)
- Valerie Hruschak
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital Boston, MA, United States
| | - K. Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital Boston, MA, United States
| | - Desiree R. Azizoddin
- Department of Emergency Medicine, Brigham and Women's Hospital Boston, MA, United States
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Robert N. Jamison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital Boston, MA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital Boston, MA, United States
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital Boston, MA, United States
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20
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Degeling C, Williams J, Carter SM, Moss R, Massey P, Gilbert GL, Shih P, Braunack-Mayer A, Crooks K, Brown D, McVernon J. Priority allocation of pandemic influenza vaccines in Australia - Recommendations of 3 community juries. Vaccine 2021; 39:255-262. [PMID: 33317870 PMCID: PMC7733601 DOI: 10.1016/j.vaccine.2020.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pandemic planning has historically been oriented to respond to an influenza virus, with vaccination strategy being a key focus. As the current COVID-19 pandemic plays out, the Australian government is closely monitoring progress towards development of SARS-CoV2 vaccines as a definitive intervention. However, as in any pandemic, initial supply will likely be exceeded by demand due to limited manufacturing output. METHODS We convened community juries in three Australian locations in 2019 to assess public acceptability and perceived legitimacy of influenza pandemic vaccination distribution strategies. Preparatory work included literature reviews on pandemic vaccine allocation strategies and on vaccine allocation ethics, and simulation modelling studies. We assumed vaccine would be provided to predefined priority groups. Jurors were then asked to recommend one of two strategies for distributing remaining early doses of vaccine: directly vaccinate people at higher risk of adverse outcomes from influenza; or indirectly protect the general population by vaccinating primary school students, who are most likely to spread infection. RESULTS Thirty-four participants of diverse backgrounds and ages were recruited through random digit dialling and topic-blinded social media advertising. Juries heard evidence and arguments supporting different vaccine distribution strategies, and questioned expert presenters. All three community juries supported prioritising school children for influenza vaccination (aiming for indirect protection), one by 10-2 majority and two by consensus. Justifications included that indirect protection benefits more people and is likely to be more publicly acceptable. CONCLUSIONS In the context of an influenza pandemic, informed citizens were not opposed to prioritising groups at higher risks of adverse outcomes, but if resources and epidemiological conditions allow, achieving population benefits should be a strategic priority. These insights may inform future SARS-CoV-2 vaccination strategies.
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Affiliation(s)
- C Degeling
- Australian Centre for Health Engagement, Evidence and Values, School of Health & Society, University of Wollongong, Wollongong, Australia.
| | - J Williams
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, Australia
| | - S M Carter
- Australian Centre for Health Engagement, Evidence and Values, School of Health & Society, University of Wollongong, Wollongong, Australia
| | - R Moss
- Modelling and Simulation Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - P Massey
- Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - G L Gilbert
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, Australia; Marie Bashir Institute for Emerging Infections, University of Sydney, Sydney, Australia
| | - P Shih
- Australian Centre for Health Engagement, Evidence and Values, School of Health & Society, University of Wollongong, Wollongong, Australia
| | - A Braunack-Mayer
- Australian Centre for Health Engagement, Evidence and Values, School of Health & Society, University of Wollongong, Wollongong, Australia
| | - K Crooks
- Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia; Menzies School of Health Research, Charles Darwin University, Casuarina, Darwin, Australia
| | - D Brown
- Modelling and Simulation Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Victorian Infectious Diseases Laboratory Epidemiology Unit at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - J McVernon
- Modelling and Simulation Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Victorian Infectious Diseases Laboratory Epidemiology Unit at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
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21
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Ashikkali L, Carroll W, Johnson C. The indirect impact of COVID-19 on child health. PAEDIATRICS AND CHILD HEALTH 2020; 30:430-437. [PMID: 32959000 PMCID: PMC7494255 DOI: 10.1016/j.paed.2020.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Since the detection of COVID-19 in December 2019, the rapid spread of the disease worldwide has led to a new pandemic, with the number of infected individuals and deaths rising daily. Early experience shows that it predominantly affects older age groups with children and young adults being generally more resilient to more severe disease.1, 2, 3 From a health standpoint, children and young people are less directly affected than adults and presentation of the disease has shown different characteristics. Nonetheless, COVID-19 has had severe repercussions on children and young people. These indirect, downstream implications should not be ignored. An understanding of the issues is essential for those who hope to advocate effectively for children to prevent irreversible damage to the adults of the future. This article reviews some of the evidence of harm to children that may accrue indirectly as a result of pandemics. It explores the physical and psychological effects, discusses the role of parenting and education, offering practical advice about how best to provide support as a healthcare professional.
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Parsons Leigh J, Fiest K, Brundin-Mather R, Plotnikoff K, Soo A, Sypes EE, Whalen-Browne L, Ahmed SB, Burns KEA, Fox-Robichaud A, Kupsch S, Longmore S, Murthy S, Niven DJ, Rochwerg B, Stelfox HT. A national cross-sectional survey of public perceptions of the COVID-19 pandemic: Self-reported beliefs, knowledge, and behaviors. PLoS One 2020; 15:e0241259. [PMID: 33095836 PMCID: PMC7584165 DOI: 10.1371/journal.pone.0241259] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Abstract
Introduction Efforts to mitigate the global spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing Corona Virus Disease-19 (COVID-19) have largely relied on broad compliance with public health recommendations yet navigating the high volume of evolving information can be challenging. We assessed self-reported public perceptions related to COVID-19 including, beliefs (e.g., severity, concerns, health), knowledge (e.g., transmission, information sources), and behaviors (e.g., physical distancing) to understand perspectives in Canada and to inform future public health initiatives. Methods We administered a national online survey aiming to obtain responses from 2000 adults in Canada. Respondent sampling was stratified by age, sex, and region. We used descriptive statistics to summarize responses and tested for regional differences using chi-squared tests, followed by weighted logistic regression. Results We collected 1,996 eligible questionnaires between April 26th and May 1st, 2020. One-fifth (20%) of respondents knew someone diagnosed with COVID-19, but few had tested positive themselves (0.6%). Negative impacts of pandemic conditions were evidenced in several areas, including concerns about healthcare (e.g. sufficient equipment, 52%), pandemic stress (45%), and worsening social (49%) and mental/emotional (39%) health. Most respondents (88%) felt they had good to excellent knowledge of virus transmission, and predominantly accessed (74%) and trusted (60%) Canadian news television, newspapers/magazines, or non-government news websites for COVID-19 information. We found high compliance with distancing measures (80% reported self-isolating or always physical distancing). We identified associations between region and self-reported beliefs, knowledge, and behaviors related to COVID-19. Discussion We found that information about COVID-19 is largely acquired through domestic news sources, which may explain high self-reported compliance with prevention measures. The results highlight the broader impact of a pandemic on the general public’s overall health and wellbeing, outside of personal infection. The study findings should be used to inform public health communications during COVID-19 and future pandemics.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Kara Plotnikoff
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Emma E. Sypes
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Liam Whalen-Browne
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B. Ahmed
- Department of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Karen E. A. Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto–St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia, Vancouver British Columbia, Canada
| | - Daniel J. Niven
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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23
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Silva DS. COVID-19 in the public housing towers of Melbourne: upholding social justice when invoking precaution. Aust N Z J Public Health 2020; 44:430. [PMID: 32955775 PMCID: PMC7537280 DOI: 10.1111/1753-6405.13041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Diego S. Silva
- Sydney Health Ethics, The University of Sydney, New South Wales,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, New South Wales,Correspondence to: Dr Diego S. Silva, Sydney Health Ethics, The University of Sydney, 92‐94 Parramatta Rd, Sydney, NSW 2006
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24
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Annand EJ, Reid PA, Johnson J, Gilbert GL, Taylor M, Walsh M, Ward MP, Wilson A, Degeling C. Citizens' juries give verdict on whether private practice veterinarians should attend unvaccinated Hendra virus suspect horses. Aust Vet J 2020; 98:273-279. [PMID: 32529687 DOI: 10.1111/avj.12957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/26/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hendra virus (HeV) is endemic in Australian flying foxes, posing a threat to equine and human health. Equine vaccination remains the most effective risk mitigation strategy. Many horses remain unvaccinated - even in higher-risk regions. Debate surrounding the vaccine's use is characterised by conflicting perspectives, misunderstanding and mistrust. Private veterinary practitioners are critical to early identification of public health risk through recognition, sampling and management of suspect-equine-HeV-cases. However, managing such cases can be burdensome, with some veterinarians opting not to attend unvaccinated horses or to abandon equine practice because of risk posed by HeV disease and liability. OBJECTIVE Ascertain the perspectives of informed citizens on what obligations (if any) private veterinarians have to attend unvaccinated horses with HeV or HeV-like disease. METHODS Three citizens' juries were tasked with considering approaches to managing HeV risk in Australia, including (reported here) roles and obligations of private veterinarians in responding to HeV-suspect-cases. RESULTS Jurors acknowledged that HeV management posed an important challenge for private veterinarians. A clear majority (27 of 31 jurors) voted that veterinarians should not be obliged to attend unvaccinated horses. All recognised that greater support for veterinarians should be a priority. CONCLUSIONS When informed of HeV risks and strategies for control and management, citizens appreciated the need to support veterinarians performing this critical 'One Health' role for public benefit. The current governance framework within which zoonotic disease recognition and response operates limits the contingency and scope for increasing support and efficacy of these important veterinary public health practices.
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Affiliation(s)
- E J Annand
- The University of Sydney, School of Veterinary Science, Sydney, New South Wales, Australia.,The University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia.,CSIRO, Health and Biosecurity, Canberra, Australian Capital Territory, Australia.,Equine Veterinary and Epidemiology Services, EquiEpiVet, Berrima, New South Wales, Australia
| | - P A Reid
- Private Equine Veterinary Practice, Brisbane, Queensland, Australia
| | - J Johnson
- The University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia.,The University of Sydney, Sydney Health Ethics, Sydney, New South Wales, Australia.,Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - G L Gilbert
- The University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia.,The University of Sydney, Sydney Health Ethics, Sydney, New South Wales, Australia
| | - M Taylor
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - M Walsh
- The University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia.,The University of Sydney, Sydney Health Ethics, Sydney, New South Wales, Australia
| | - M P Ward
- The University of Sydney, School of Veterinary Science, Sydney, New South Wales, Australia.,The University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia
| | - A Wilson
- The University of Sydney, Menzies Centre for Health Policy, Sydney, New South Wales, Australia
| | - C Degeling
- University of Wollongong, Australian Centre for Health Engagement, Evidence and Values, Wollongong, New South Wales, Australia
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25
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Dalton CB, Corbett SJ, Katelaris AL. COVID-19: implementing sustainable low cost physical distancing and enhanced hygiene. Med J Aust 2020; 212:443-446.e1. [PMID: 32356573 PMCID: PMC7267378 DOI: 10.5694/mja2.50602] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Stephen J Corbett
- Centre for Population HealthWestern Sydney Local Health DistrictSydneyNSW
| | - Anthea L Katelaris
- Centre for Population HealthWestern Sydney Local Health DistrictSydneyNSW
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26
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Motta Zanin G, Gentile E, Parisi A, Spasiano D. A Preliminary Evaluation of the Public Risk Perception Related to the COVID-19 Health Emergency in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3024. [PMID: 32349253 PMCID: PMC7246845 DOI: 10.3390/ijerph17093024] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023]
Abstract
Governments faced with the spread of COVID-19 pandemic are adopting strict and severe mitigation measures to influence people's behaviors. Public perception of health risk plays a key role in the adoption of these actions, in people's feelings, and in their daily habits. To support decision makers from international to local levels to face with future sanitary emergencies, this study aims at investigating Italian public perceptions of health risk. To this purpose, a questionnaire was designed and administered within the period of Italian COVID-19 lockdown and quarantine to almost 9000 citizens in Italy and abroad. The obtained results highlight a significative influence that mass media play on both the level of knowledge and the feelings of the respondents. The findings also point out future variations of some perceived behaviors consequent to the COVID-19 outbreak.
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Affiliation(s)
- Giulia Motta Zanin
- Department of Civil, Environmental, Land, Building Engineering and Chemistry (DICATECh), Polytechnic University of Bari, 70100 Bari, Italy; (G.M.Z.); (D.S.)
| | - Eleonora Gentile
- Department of Basic Medical Sciences, Neuroscience and Sense Organs (SMBNOS), University of Bari “Aldo Moro”, 70100 Bari, Italy;
| | - Alessandro Parisi
- Department of Civil, Environmental, Land, Building Engineering and Chemistry (DICATECh), Polytechnic University of Bari, 70100 Bari, Italy; (G.M.Z.); (D.S.)
| | - Danilo Spasiano
- Department of Civil, Environmental, Land, Building Engineering and Chemistry (DICATECh), Polytechnic University of Bari, 70100 Bari, Italy; (G.M.Z.); (D.S.)
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27
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Schoch-Spana M, Brunson EK, Gwon H, Regenberg A, Toner ES, Daugherty-Biddison EL. Influence of Community and Culture in the Ethical Allocation of Scarce Medical Resources in a Pandemic Situation: Deliberative Democracy Study. J Particip Med 2020; 12:e18272. [PMID: 33064107 PMCID: PMC7141421 DOI: 10.2196/18272] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Stark gaps exist between projected health needs in a pandemic situation and the current capacity of health care and medical countermeasure systems. Existing pandemic ethics discussions have advocated to engage the public in scarcity dilemmas and attend the local contexts and cultural perspectives that shape responses to a global health threat. This public engagement study thus considers the role of community and culture in the ethical apportionment of scarce health resources, specifically ventilators, during an influenza pandemic. It builds upon a previous exploration of the values and preferences of Maryland residents regarding how a finite supply of mechanical ventilators ought to be allocated during a severe global outbreak of influenza. An important finding of this earlier research was that local history and place within the state engendered different ways of thinking about scarcity. OBJECTIVE Given the intrastate variation in the themes expressed by Maryland participants, the project team sought to examine interstate differences by implementing the same protocol elsewhere to answer the following questions. Does variation in ethical frames of reference exist within different regions of the United States? What practical implications does evidence of sameness and difference possess for pandemic planners and policymakers at local and national levels? METHODS Research using the same deliberative democracy process from the Maryland study was conducted in Central Texas in March 2018 among 30 diverse participants, half of whom identified as Hispanic or Latino. Deliberative democracy provides a moderated process through which community members can learn facts about a public policy matter from experts and explore their own and others' views. RESULTS Participants proposed that by evenly distributing supplies of ventilators and applying clear eligibility criteria consistently, health authorities could enable fair allocation of scarce lifesaving equipment. The strong identification, attachment, and obligation of persons toward their nuclear and extended families emerged as a distinctive regional and ethnic core value that has practical implications for the substance, administration, and communication of allocation frameworks. CONCLUSIONS Maryland and Central Texas residents expressed a common, overriding concern about the fairness of allocation decisions. Central Texas deliberants, however, more readily expounded upon family as a central consideration. In Central Texas, family is a principal, culturally inflected lens through which life and death matters are often viewed. Conveners of other pandemic-related public engagement exercises in the United States have advocated the benefits of transparency and inclusivity in developing an ethical allocation framework; this study demonstrates cultural competence as a further advantage.
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Affiliation(s)
- Monica Schoch-Spana
- Johns Hopkins Center for Health Security, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Emily K Brunson
- Department of Anthropology, Texas State University, San Marcos, TX, United States
| | - Howard Gwon
- Department of Environmental Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Alan Regenberg
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
| | - Eric S Toner
- Johns Hopkins Center for Health Security, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Elizabeth L Daugherty-Biddison
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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28
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Degeling C, Gilbert GL, Annand E, Taylor M, Walsh MG, Ward MP, Wilson A, Johnson J. Managing the risk of Hendra virus spillover in Australia using ecological approaches: A report on three community juries. PLoS One 2018; 13:e0209798. [PMID: 30596719 PMCID: PMC6312203 DOI: 10.1371/journal.pone.0209798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hendra virus (HeV) infection is endemic in Australian flying-fox populations. Habitat loss has increased the peri-urban presence of flying-foxes, increasing the risk of contact and therefore viral 'spillovers' into horse and human populations. An equine vaccine is available and horse-husbandry practices that minimize HeV exposure are encouraged, but their adoption is suboptimal. Ecological approaches-such as habitat creation and conservation-could complement vaccination and behavioural strategies by reducing spillover risks, but these are controversial. METHODS We convened three community juries (two regional; one metropolitan) to elicit the views of well-informed citizens on the acceptability of adding ecological approaches to current interventions for HeV risk. Thirty-one participants of diverse backgrounds, mixed genders and ages were recruited using random-digit-dialling. Each jury was presented with balanced factual evidence, given time to ask questions of expert presenters and, after deliberation, come to well-reasoned conclusions. RESULTS All juries voted unanimously that ecological strategies should be included in HeV risk management strategies but concluded that current interventions-including vaccination and changing horse-husbandry practices-must remain the priority. The key reasons given for adopting ecological approaches were: (i) they address underlying drivers of disease emergence, (ii) the potential to prevent spillover of other bat-borne pathogens, and (iii) there would be broader community benefits. Juries differed regarding the best mechanism to create/conserve flying-fox habitat: participants in regional centres favoured direct government action, whereas the metropolitan jury preferred to place the burden on landholders. CONCLUSIONS Informed citizens acknowledge the value of addressing the drivers of bat-borne infectious risks but differ substantially as to the best implementation strategies. Ecological approaches to securing bat habitat could find broad social support in Australia, but disagreement about how best to achieve them indicates the need for negotiation with affected communities to co-develop fair, effective and locally appropriate policies.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement Evidence and Values, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
- * E-mail:
| | - Gwendolyn L. Gilbert
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, NSW, Australia
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Edward Annand
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, NSW, Australia
- Sydney School of Veterinary Science, University of Sydney, Camden, NSW, Australia
- EquiEpiVet, Picton, NSW, Australia
| | - Melanie Taylor
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Michael G. Walsh
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, NSW, Australia
- Westmead Clinical School, Sydney Medical School, University of Sydney, Westmead, NSW, Australia
| | - Michael P. Ward
- Sydney School of Veterinary Science, University of Sydney, Camden, NSW, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Jane Johnson
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, NSW, Australia
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, NSW, Australia
- Westmead Clinical School, Sydney Medical School, University of Sydney, Westmead, NSW, Australia
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29
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Bahri P, Castillon Melero M. Listen to the public and fulfil their information interests - translating vaccine communication research findings into guidance for regulators. Br J Clin Pharmacol 2018; 84:1696-1705. [PMID: 29573274 PMCID: PMC6046478 DOI: 10.1111/bcp.13587] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 11/27/2022] Open
Abstract
Regulatory authorities have a crucial role in communicating about the vaccines they license. In terms of content and timing, their communication to the public is usually driven by data on quality, safety and efficacy. However, concerns over safety and vaccine hesitancy have emerged in some communities in various countries, and this demands a new approach to communication, starting with listening to the public debate. Reviewing communication research findings, coming in particular from the cognitive, decision‐making and media sciences, constitutes one mechanism of listening and has led the European Union (EU) regulatory network to developing guidance about which common concerns and information needs of the public to address through proactive and prepared communication. The guidance has been welcomed by EU and international fora. The current article summarizes the recommendations and shares the underlying research findings, as well as a proof of concept that communication research can be valuable for regulators. It is critical that regulators integrate the communication process with product risk assessment in the framework of pharmacovigilance, to ensure that public concerns are addressed in the assessments and that information about evidence and uncertainty relating to safety is provided to the public and vaccination policy makers in a specific, clear and accurate manner. Additionally, information from regulatory authorities should support healthcare professionals in their communication with patients. Meeting the information interests of the public is the principal prerequisite for informed decisions as well as safe and effective use of vaccines and medicines overall. This is also fundamental for trust in the authorities' commitment to patient and population health.
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Affiliation(s)
- Priya Bahri
- Surveillance & Epidemiology Service, Pharmacovigilance Department, European Medicines Agency, London, UK
| | - Mireia Castillon Melero
- Surveillance & Epidemiology Service, Pharmacovigilance Department, European Medicines Agency, London, UK
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30
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Feeney O, Borry P, Felzmann H, Galvagni L, Haukkala A, Loi M, Nordal S, Rakic V, Riso B, Sterckx S, Vears D. Genuine participation in participant-centred research initiatives: the rhetoric and the potential reality. J Community Genet 2018; 9:133-142. [PMID: 29064073 PMCID: PMC5849703 DOI: 10.1007/s12687-017-0342-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/09/2017] [Indexed: 11/14/2022] Open
Abstract
The introduction of Web 2.0 technology, along with a population increasingly proficient in Information and Communications Technology (ICT), coupled with the rapid advancements in genetic testing methods, has seen an increase in the presence of participant-centred research initiatives. Such initiatives, aided by the centrality of ICT interconnections, and the ethos they propound seem to further embody the ideal of increasing the participatory nature of research, beyond what might be possible in non-ICT contexts alone. However, the majority of such research seems to actualise a much narrower definition of 'participation'-where it is merely the case that such research initiatives have increased contact with participants through ICT but are otherwise non-participatory in any important normative sense. Furthermore, the rhetoric of participant-centred initiatives tends to inflate this minimalist form of participation into something that it is not, i.e. something genuinely participatory, with greater connections with both the ICT-facilitated political contexts and the largely non-ICT participatory initiatives that have expanded in contemporary health and research contexts. In this paper, we highlight that genuine (ICT-based) 'participation' should enable a reasonable minimum threshold of participatory engagement through, at least, three central participatory elements: educative, sense of being involved and degree of control. While we agree with criticisms that, at present, genuine participation seems more rhetoric than reality, we believe that there is clear potential for a greater ICT-facilitated participatory engagement on all three participatory elements. We outline some practical steps such initiatives could take to further develop these elements and thereby their level of ICT-facilitated participatory engagement.
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Affiliation(s)
- Oliver Feeney
- Centre of Bioethical Research and Analysis, National University of Ireland (Galway), Galway, Republic of Ireland.
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Leuven Institute for Genomics and Society, KU Leuven, Leuven, Belgium
| | - Heike Felzmann
- Centre of Bioethical Research and Analysis, National University of Ireland (Galway), Galway, Republic of Ireland
| | | | - Ari Haukkala
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Michele Loi
- Institute for Biomedical Ethics and the History of Medicine and Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Salvör Nordal
- Centre for Ethics, University of Iceland, Reykjavik, Iceland
| | - Vojin Rakic
- Center for the Study of Bioethics, University of Belgrade, Belgrade, Serbia
| | - Brígida Riso
- Instituto Universitário de Lisboa (ISCTE-IUL), CIES-IUL, Lisbon, Portugal
| | - Sigrid Sterckx
- Bioethics Institute Ghent, Department of Philosophy & Moral Sciences, Ghent University, Ghent, Belgium
| | - Danya Vears
- Leuven Institute for Genomics and Society, KU Leuven, Leuven, Belgium
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Degeling C, Rychetnik L, Street J, Thomas R, Carter SM. Influencing health policy through public deliberation: Lessons learned from two decades of Citizens'/community juries. Soc Sci Med 2017; 179:166-171. [PMID: 28285232 DOI: 10.1016/j.socscimed.2017.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 03/01/2017] [Indexed: 01/15/2023]
Abstract
Citizens'/community juries [CJs] engage members of the public in policy decision-making processes. CJs can be employed to develop policy responses to health problems that require the consideration of both community values and scientific evidence. Based on the principles of deliberative democracy, recent reviews indicate that findings from CJs have successfully been used to influence health policy decision-making. Despite this evidence of success, there appears to be a gap between the goals of health researchers who organize CJs and the needs of policy actors and decision makers. Drawing on our experiences working with CJs and recent research on CJ methods, we describe a synopsis of the current state of the art organized around four key questions, and informed by insights from deliberative theory and critical policy studies. Our intention is to stimulate further discussion as to the types of health policy questions that can be usefully addressed through public deliberation, and provide guidance on the methodological and political dimensions that need to be considered in deciding whether a CJ is an appropriate approach for informing a policy decision-making process.
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Affiliation(s)
- Chris Degeling
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, K25, University of Sydney, NSW, 2006, Australia.
| | - Lucie Rychetnik
- School of Medicine Sydney, The University of Notre Dame, Broadway, NSW, 2077, Australia; Centre for Values, Ethics and the Law in Medicine, School of Public Health, K25, University of Sydney, NSW, 2006, Australia.
| | - Jackie Street
- School of Public Health, North Terrace Tower, The University of Adelaide, SA, 5005, Australia.
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4229 QLD, Australia.
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, K25, University of Sydney, NSW, 2006, Australia.
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32
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Thomas R, Sims R, Degeling C, Street JM, Carter SM, Rychetnik L, Whitty JA, Wilson A, Ward P, Glasziou P. CJCheck Stage 1: development and testing of a checklist for reporting community juries - Delphi process and analysis of studies published in 1996-2015. Health Expect 2016; 20:626-637. [PMID: 27704684 PMCID: PMC5513001 DOI: 10.1111/hex.12493] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 12/25/2022] Open
Abstract
Background Opportunities for community members to actively participate in policy development are increasing. Community/citizen's juries (CJs) are a deliberative democratic process aimed to illicit informed community perspectives on difficult topics. But how comprehensive these processes are reported in peer‐reviewed literature is unknown. Adequate reporting of methodology enables others to judge process quality, compare outcomes, facilitate critical reflection and potentially repeat a process. We aimed to identify important elements for reporting CJs, to develop an initial checklist and to review published health and health policy CJs to examine reporting standards. Design Using the literature and expertise from CJ researchers and policy advisors, a list of important CJ reporting items was suggested and further refined. We then reviewed published CJs within the health literature and used the checklist to assess the comprehensiveness of reporting. Results CJCheck was developed and examined reporting of CJ planning, juror information, procedures and scheduling. We screened 1711 studies and extracted data from 38. No studies fully reported the checklist items. The item most consistently reported was juror numbers (92%, 35/38), while least reported was the availability of expert presentations (5%, 2/38). Recruitment strategies were described in 66% of studies (25/38); however, the frequency and timing of deliberations was inadequately described (29%, 11/38). Conclusions Currently CJ publications in health and health policy literature are inadequately reported, hampering their use in policy making. We propose broadening the CJCheck by creating a reporting standards template in collaboration with international CJ researchers, policy advisors and consumer representatives to ensure standardized, systematic and transparent reporting.
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Affiliation(s)
- Rae Thomas
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
| | - Rebecca Sims
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
| | - Chris Degeling
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Jackie M Street
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jennifer A Whitty
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Paul Ward
- Discipline of Public Health, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
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Degeling C, Johnson J, Kerridge I, Wilson A, Ward M, Stewart C, Gilbert G. Implementing a One Health approach to emerging infectious disease: reflections on the socio-political, ethical and legal dimensions. BMC Public Health 2015; 15:1307. [PMID: 26715066 PMCID: PMC4696140 DOI: 10.1186/s12889-015-2617-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/16/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND 'One Health' represents a call for health researchers and practitioners at the human, animal and environmental interfaces to work together to mitigate the risks of emerging and re-emerging infectious diseases (EIDs). A One Health approach emphasizing inter-disciplinary co-operation is increasingly seen as necessary for effective EID control and prevention. There are, however, socio-political, ethical and legal challenges, which must be met by such a One Health approach. DISCUSSION Based on the philosophical review and critical analysis of scholarship around the theory and practice of One Health it is clear that EID events are not simply about pathogens jumping species barriers; they are comprised of complex and contingent sets of relations that involve socioeconomic and socio-political drivers and consequences with the latter extending beyond the impact of the disease. Therefore, the effectiveness of policies based on One Health depends on their implementation and alignment with or modification of public values. Despite its strong motivating rationale, implementing a One Health approach in an integrated and considered manner can be challenging, especially in the face of a perceived crisis. The effective control and prevention of EIDs therefore requires: (i) social science research to improve understanding of how EID threats and responses play out; (ii) the development of an analytic framework that catalogues case experiences with EIDs, reflects their dynamic nature and promotes inter-sectoral collaboration and knowledge synthesis; (iii) genuine public engagement processes that promote transparency, education and capture people's preferences; (iv) a set of practical principles and values that integrate ethics into decision-making procedures, against which policies and public health responses can be assessed; (v) integration of the analytic framework and the statement of principles and values outlined above; and (vi) a focus on genuine reform rather than rhetoric.
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Affiliation(s)
- Chris Degeling
- Centre for Values, Ethics and the Law in Medicine, K25 Level 1, Medical Foundation Building, University of Sydney, Sydney, NSW, 2006, Australia.
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.
| | - Jane Johnson
- Centre for Values, Ethics and the Law in Medicine, K25 Level 1, Medical Foundation Building, University of Sydney, Sydney, NSW, 2006, Australia.
- Faculty of Veterinary Medicine, University of Sydney, Sydney, Australia.
| | - Ian Kerridge
- Centre for Values, Ethics and the Law in Medicine, K25 Level 1, Medical Foundation Building, University of Sydney, Sydney, NSW, 2006, Australia.
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia.
| | - Michael Ward
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.
- Faculty of Veterinary Medicine, University of Sydney, Sydney, Australia.
| | | | - Gwendolyn Gilbert
- Centre for Values, Ethics and the Law in Medicine, K25 Level 1, Medical Foundation Building, University of Sydney, Sydney, NSW, 2006, Australia.
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.
- Centre for Infectious Disease and Microbiology - Public Health, Westmead Hospital, Sydney, Australia.
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Street JM, Callaghan P, Braunack-Mayer AJ, Hiller JE. Citizens' Perspectives on Disinvestment from Publicly Funded Pathology Tests: A Deliberative Forum. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:1050-1056. [PMID: 26686790 DOI: 10.1016/j.jval.2015.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/09/2015] [Accepted: 05/29/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Deliberative forums can be useful tools in policy decision making for balancing citizen voice and community values against dominant interests. OBJECTIVE To describe the use of a deliberative forum to explore community perspectives on a complex health problem-disinvestment. METHODS A deliberative forum of citizens was convened in Adelaide, South Australia, to develop criteria to support disinvestment from public funding of ineffective pathology tests. The case study of potential disinvestment from vitamin B12/folate pathology testing was used to shape the debate. The forum was informed by a systematic review of B12/folate pathology test effectiveness and expert testimony. RESULTS The citizens identified seven criteria: cost of the test, potential impact on individual health/capacity to benefit, potential cost to society, public good, alternatives to testing, severity of the condition, and accuracy of the test. The participants not only saw these criteria as an interdependent network but also questioned "the authority" of policymakers to make these decisions. CONCLUSIONS Coherence between the criteria devised by the forum and those described by an expert group was considerable, the major differences being that the citizens did not consider equity issues and the experts neglected the "cost" of social and emotional impact of disinvestment on users and the society.
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Affiliation(s)
- Jackie M Street
- School of Public Health, University of Adelaide, Adelaide, Australia.
| | - Peta Callaghan
- School of Public Health, University of Adelaide, Adelaide, Australia
| | | | - Janet E Hiller
- School of Public Health, University of Adelaide, Adelaide, Australia; Swinburne University of Technology, Hawthorn, Australia
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Hodgetts K, Hiller JE, Street JM, Carter D, Braunack-Mayer AJ, Watt AM, Moss JR, Elshaug AG. Disinvestment policy and the public funding of assisted reproductive technologies: outcomes of deliberative engagements with three key stakeholder groups. BMC Health Serv Res 2014; 14:204. [PMID: 24885716 PMCID: PMC4016640 DOI: 10.1186/1472-6963-14-204] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background Measures to improve the quality and sustainability of healthcare practice and provision have become a policy concern. In addition, the involvement of stakeholders in health policy decision-making has been advocated, as complex questions arise around the structure of funding arrangements in a context of limited resources. Using a case study of assisted reproductive technologies (ART), deliberative engagements with a range of stakeholder groups were held on the topic of how best to structure the distribution of Australian public funding in this domain. Methods Deliberative engagements were carried out with groups of ART consumers, clinicians and community members. The forums were informed by a systematic review of ART treatment safety and effectiveness (focusing, in particular, on maternal age and number of treatment cycles), as well as by international policy comparisons, and ethical and cost analyses. Forum discussions were transcribed and subject to thematic analysis. Results Each forum demonstrated stakeholders’ capacity to understand concepts of choice under resource scarcity and disinvestment, and to countenance options for ART funding not always aligned with their interests. Deliberations in each engagement identified concerns around ‘equity’ and ‘patient responsibility’, culminating in a broad preference for (potential) ART subsidy restrictions to be based upon individual factors rather than maternal age or number of treatment cycles. Community participants were open to restrictions based upon measures of body mass index (BMI) and smoking status, while consumers and clinicians saw support to improve these factors as part of an ART treatment program, as distinct from a funding criterion. All groups advocated continued patient co-payments, with measures in place to provide treatment access to those unable to pay (namely, equity of access). Conclusions Deliberations yielded qualitative, socially-negotiated evidence required to inform ethical, accountable policy decisions in the specific area of ART and health care more broadly. Notably, reductionist, deterministic characterizations of stakeholder ‘self-interest’ proved unfounded as each group sought to prioritise universal values (in particular, ‘equity’ and ‘responsibility’) over specific, within-group concerns. Our results - from an emotive case study in ART - highlight that evidence-informed disinvestment decision-making is feasible, and potentially less controversial than often presumed.
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Affiliation(s)
| | | | | | | | | | | | | | - Adam G Elshaug
- Menzies Centre for Health Policy, Sydney School of Public Health, Sydney Medical School, The University of Sydney, Coppleson Building D02, Sydney, NSW 2006, Australia.
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The use of citizens' juries in health policy decision-making: A systematic review. Soc Sci Med 2014; 109:1-9. [DOI: 10.1016/j.socscimed.2014.03.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 01/30/2014] [Accepted: 03/06/2014] [Indexed: 11/22/2022]
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Kavanagh AM, Mason KE, Bentley RJ, Studdert DM, McVernon J, Fielding JE, Petrony S, Gurrin L, LaMontagne AD. Leave entitlements, time off work and the household financial impacts of quarantine compliance during an H1N1 outbreak. BMC Infect Dis 2012; 12:311. [PMID: 23164090 PMCID: PMC3533824 DOI: 10.1186/1471-2334-12-311] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 11/08/2012] [Indexed: 11/24/2022] Open
Abstract
Background The Australian state of Victoria, with 5.2 million residents, enforced home quarantine during a H1N1 pandemic in 2009. The strategy was targeted at school children. The objective of this study was to investigate the extent to which parents’ access to paid sick leave or paid carer’s leave was associated with (a) time taken off work to care for quarantined children, (b) household finances, and (c) compliance with quarantine recommendations. Methods We conducted an online and telephone survey of households recruited through 33 schools (85% of eligible schools), received 314 responses (27%), and analysed the subsample of 133 households in which all resident parents were employed. Results In 52% of households, parents took time off work to care for quarantined children. Households in which no resident parent had access to leave appeared to be less likely to take time off work (42% vs 58%, p=0.08) although this difference had only borderline significance. Among parents who did take time off work, those in households without access to leave were more likely to lose pay (73% vs 21%, p<0.001). Of the 26 households in which a parent lost pay due to taking time off work, 42% experienced further financial consequences such as being unable to pay a bill. Access to leave did not predict compliance with quarantine recommendations. Conclusions Future pandemic plans should consider the economic costs borne by households and options for compensating quarantined families for income losses.
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Affiliation(s)
- Anne M Kavanagh
- Centre for Women's Health, Gender and Society, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia.
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Watt AM, Hiller JE, Braunack-Mayer AJ, Moss JR, Buchan H, Wale J, Riitano DE, Hodgetts K, Street JM, Elshaug AG. The ASTUTE Health study protocol: deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment. Implement Sci 2012; 7:101. [PMID: 23088222 PMCID: PMC3520863 DOI: 10.1186/1748-5908-7-101] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 10/17/2012] [Indexed: 11/10/2022] Open
Abstract
Background Governments and other payers are yet to determine optimal processes by which to review the safety, effectiveness, and cost-effectiveness of technologies and procedures that are in active use within health systems, and rescind funding (partially or fully) from those that display poor profiles against these parameters. To further progress a disinvestment agenda, a model is required to support payers in implementing disinvestment in a transparent manner that may withstand challenge from vested interests and concerned citizens. Combining approaches from health technology assessment and deliberative democratic theory, this project seeks to determine if and how wide stakeholder engagement can contribute to improved decision-making processes, wherein the views of both vested and non-vested stakeholders are seen to contribute to informing policy implementation within a disinvestment context. Methods/design Systematic reviews pertaining to illustrative case studies were developed and formed the evidence base for discussion. Review findings were presented at a series of deliberative, evidence-informed stakeholder engagements, including partisan (clinicians and consumers) and non-partisan (representative community members) stakeholders. Participants were actively facilitated towards identifying shared and dissenting perspectives regarding public funding policy for each of the case studies and developing their own funding models in response to the evidence presented. Policy advisors will subsequently be invited to evaluate disinvestment options based on the scientific and colloquial evidence presented to them, and to explore the value of this information to their decision-making processes with reference to disinvestment. Discussion Analysis of the varied outputs of the deliberative engagements will contribute to the methodological development around how to best integrate scientific and colloquial evidence for consideration by policy advisors. It may contribute to the legitimization of broad and transparent stakeholder engagement in this context. It is anticipated that decision making will benefit from the knowledge delivered through informed deliberation with engaged stakeholders, and this will be explored through interviews with key decision makers.
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Affiliation(s)
- Amber M Watt
- School of Population Health, The University of Adelaide, North Terrace, Adelaide, SA, Australia
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News and social media: windows into community perspectives on disinvestment. Int J Technol Assess Health Care 2012; 27:376-83. [PMID: 22004780 DOI: 10.1017/s026646231100033x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study, in the context of disinvestment related health technology assessment, is to examine whether analysis of Web 2.0--commercial media output, blogs, and discussion forums--can provide an understanding of media framing, community perspectives, and the sociopolitical aspects of an entrenched technology. METHODS Thematic analysis of relevant data from fifty-nine media articles, thirty-nine discussion forums, thirteen blogs, and three Facebook pages relating to our case study: public funding for assisted reproductive technology services. Mainstream media and community-based social media responses were compared. RESULTS Media responses were narrow, primarily describing emotive individual narratives or the political nexus of interests. Community (including patient) responses were broader including discussion of opportunity cost and vested interests but mostly reflected the polar ends of the debate, diverging strongly for or against disinvestment from public funding. CONCLUSION Web2.0 and media analysis offers an inexpensive method to capture media portrayal, divergent community responses both to that portrayal and independent of it, and insight into the sociopolitical aspects of an entrenched technology undergoing disinvestment debate.
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Street JM, Delany TN. Guidelines in disrepute: a case study of influenza vaccination of healthcare workers. Aust N Z J Public Health 2012. [DOI: 10.1111/j.1753-6405.2012.00896.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Charania NA, Tsuji LJS. A community-based participatory approach and engagement process creates culturally appropriate and community informed pandemic plans after the 2009 H1N1 influenza pandemic: remote and isolated First Nations communities of sub-arctic Ontario, Canada. BMC Public Health 2012; 12:268. [PMID: 22472012 PMCID: PMC3434059 DOI: 10.1186/1471-2458-12-268] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 04/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health emergencies have the potential to disproportionately impact disadvantaged populations due to pre-established social and economic inequalities. Internationally, prior to the 2009 H1N1 influenza pandemic, existing pandemic plans were created with limited public consultation; therefore, the unique needs and characteristics of some First Nations communities may not be ethically and adequately addressed. Engaging the public in pandemic planning can provide vital information regarding local values and beliefs that may ultimately lead to increased acceptability, feasibility, and implementation of pandemic plans. Thus, the objective of the present study was to elicit and address First Nations community members' suggested modifications to their community-level pandemic plans after the 2009 H1N1 influenza pandemic. METHODS The study area included three remote and isolated First Nations communities located in sub-arctic Ontario, Canada. A community-based participatory approach and community engagement process (i.e., semi-directed interviews (n = 13), unstructured interviews (n = 4), and meetings (n = 27)) were employed. Participants were purposively sampled and represented various community stakeholders (e.g., local government, health care, clergy, education, etc.) involved in the community's pandemic response. Collected data were manually transcribed and coded using deductive and inductive thematic analysis. The data subsequently informed the modification of the community-level pandemic plans. RESULTS The primary modifications incorporated in the community-level pandemic plans involved adding community-specific detail. For example, 'supplies' emerged as an additional category of pandemic preparedness and response, since including details about supplies and resources was important due to the geographical remoteness of the study communities. Furthermore, it was important to add details of how, when, where, and who was responsible for implementing recommendations outlined in the pandemic plans. Additionally, the roles and responsibilities of the involved organizations were further clarified. CONCLUSIONS Our results illustrate the importance of engaging the public, especially First Nations, in pandemic planning to address local perspectives. The community engagement process used was successful in incorporating community-based input to create up-to-date and culturally-appropriate community-level pandemic plans. Since these pandemic plans are dynamic in nature, we recommend that the plans are continuously updated to address the communities' evolving needs. It is hoped that these modified plans will lead to an improved pandemic response capacity and health outcomes, during the next public health emergency, for these remote and isolated First Nations communities. Furthermore, the suggested modifications presented in this paper may help inform updates to the community-level pandemic plans of other similar communities.
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Affiliation(s)
- Nadia A Charania
- Department of Environment and Resource Studies, University of Waterloo, Waterloo, ON, Canada.
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Leask J, Braunack-Mayer A, Kerridge I. Consent and public engagement in an era of expanded childhood immunisation. J Paediatr Child Health 2011; 47:603-7. [PMID: 21951441 DOI: 10.1111/j.1440-1754.2011.02160.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Childhood immunisation programmes have seen well-heralded successes in disease control. An increasing number of scheduled vaccines, narrowing risk-benefit ratios and public attention to vaccine safety raise new questions about consent. We first explore the challenges that this highly dynamic environment poses for valid consent. Then, we broaden this discussion to wider public engagement by suggesting how the public - the bearers of vaccine risk and benefit - can be better involved in immunisation policy.
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Affiliation(s)
- Julie Leask
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney, Sydney, New South Wales, Australia.
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Ishola DA, Phin N. Could influenza transmission be reduced by restricting mass gatherings? Towards an evidence-based policy framework. J Epidemiol Glob Health 2011; 1:33-60. [PMID: 23856374 PMCID: PMC7104184 DOI: 10.1016/j.jegh.2011.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/20/2011] [Accepted: 06/20/2011] [Indexed: 12/21/2022] Open
Abstract
Introduction: Mass gatherings (MG) may provide ideal conditions for influenza transmission. The evidence for an association between MG and influenza transmission is reviewed to assess whether restricting MG may reduce transmission. Methods: Major databases were searched (Pubmed, EMBASE, Scopus, CINAHL), producing 1706 articles that were sifted by title, abstract, and full-text. A narrative approach was adopted for data synthesis. Results: Twenty-four papers met the inclusion criteria, covering MG of varying sizes and settings, and including 9 observational studies, 10 outbreak reports, 4 event reports, and a quasi-experimental study. There is some evidence that certain types of MG may be associated with increased risk of influenza transmission. MG may also “seed” new strains into an area, and may instigate community transmission in a pandemic. Restricting MGs, in combination with other social distancing interventions, may help reduce transmission, but it was not possible to identify conclusive evidence on the individual effect of MG restriction alone. Evidence suggests that event duration and crowdedness may be the key factors that determine the risk of influenza transmission, and possibly the type of venue (indoor/outdoor). Conclusion: These factors potentially represent a basis for a policy-making framework for MG restrictions in the event of a severe pandemic.
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Affiliation(s)
- David A. Ishola
- Pandemic Influenza and Legionnaires’ Disease Section, Health Protection Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
- Centre for Infectious Disease Epidemiology, Department of Infection and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Nick Phin
- Pandemic Influenza and Legionnaires’ Disease Section, Health Protection Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
- Faculty of Health and Social Care, University of Chester, Riverside Campus, Castle Drive, Chester CH1 1SL, United Kingdom
- Corresponding author at: Pandemic Influenza and Legionnaires’ Disease Section, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom. Tel.: +44 2083276661; fax: +44 2082007868
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Docter SP, Street J, Braunack-Mayer AJ, van der Wilt GJ. Public perceptions of pandemic influenza resource allocation: a deliberative forum using Grid/Group analysis. J Public Health Policy 2011; 32:350-66. [PMID: 21228887 DOI: 10.1057/jphp.2010.49] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The emergence of virulent avian influenza A subtypes with potential to evolve into novel human subtypes prompted directives from the World Health Organisation recommending that countries prepare for a pandemic. In response the Australian government developed the Australian Health Management Plan for Pandemic Influenza (AHMPPI), which includes strategies to contain and/or manage a pandemic. To implement these strategies successfully, community compliance is necessary. Our qualitative study investigated, through a deliberative forum, the extent to which the antiviral drug and vaccine allocation of the AHMPPI corresponds with community views about the priority groups. We used Mary Douglas' Grid/Group analysis to analyse the results, which suggested that the AHMPPI's allocation strategy corresponds well with community views with both based on a hierarchical structure. There are some differences concerning community involvement in the decision process and information provision to the public, for which our study provides recommendations.
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Affiliation(s)
- Stynke P Docter
- Faculty of Earth and Life Sciences, The Athena Institute, VU University, De Boelelaan 1081, Amsterdam, The Netherlands.
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