Health Communication in COVID-19 Era: Experiences from the Italian VaccinarSì Network Websites

Enhancing routine immunization efforts for older adults and frail individuals: Good practices during the SARS-CoV-2 pandemic in Italy

Infectious diseases pose a significant burden on the general population, particularly older adults who are more susceptible to severe complications. Immunization plays a crucial role in preventing infections and securing a healthier aging, but actual vaccination rates among older adults and frail individuals (OAFs) remains far from recommended targets. This study aims to collect and share good practices implemented in several Italian local health districts during the SARS-CoV-2 pandemic to ease routine immunization for OAFs. A 28-items questionnaire has been developed to collect information on organization aspect of immunization services and local good practices implemented before and during the SARS-CoV-2 pandemic. Twelve Public Health managers representative of 9 Italian Regions were further interviewed between January and March 2021. Despite literature suggests several effective interventions to increase vaccine demand, improve vaccine access, and enhance healthcare providers' performance, our survey highlighted substantial heterogeneity in their implementation at local level. Seven good local practices have been identified and described: mass vaccination centers; vaccination mobile units; drive-through vaccination; co-administration; tailored pathways; cooperation among providers involved in vaccination; digitization. Our survey pointed out valuable strategies for enhancing routine immunization for OAFs. Providers should combine effective interventions adequate to their specific context and share good practices.

The community nurse's role on the promotion of papillomavirus vaccination among young students: A study protocol

Vaccination is the principal strategy for primary prevention of infection by Human Papilloma Virus (HPV), which causes different pathological conditions, up to cancer, in both males and females. However, to date, knowledge among adolescents and their parents about the HPV vaccine is still low. The aim of this quasi-experimental, multicenter study is to assess the effectiveness of a digital educational intervention, conducted by a multidisciplinary health-care team including a Community Nurse, to increase adolescents' HPV vaccination uptake, their knowledge, self-efficacy, feelings and involvement in HPV vaccine decision-making, and parents' vaccination hesitancy. The study will be carried out among a population of students (and their parents), aged between 11 and 13, at secondary schools in Italy. Validated questionnaires will be administered to both students and parents at baseline (T0) and 3 months after a digital educational intervention (T1). The findings may be useful in evaluating and deepening a methodology for designing and implementing educational interventions, embedded in the school setting, that could promote the achievement of outcomes within the broader process of youth's health promotion.

Seroprevalence Assessment of Anti-Varicella Antibodies among Adults in the Province of Florence (Italy)

Background: Varicella infections follow a benign course in around 90% of cases, with more severe forms occurring in adults. To identify potential pockets of susceptibility and to improve targeted immunization strategies, this study aims to critically assess immunological status by evaluating varicella seroprevalence among adults (18-99 years) in the province of Florence (Italy), nearly a decade after Tuscany introduced the vaccination program. Methods: A convenience sample of 430 subjects aged 18 to 94 years (mean age 51.8 ± 18.8 years), stratified by age and sex (53.7% of subjects were female; N = 231), was collected between 2018 and 2019. Sero-analytical analyses were conducted utilizing EUROIMMUN Anti-VZV ELISA (IgG) kits. Results: Most of them were of Italian nationality (87.4%; N = 376). Among the 430 tested samples, 385 (89.5%) were positive and 39 (9.1%) were negative. The remaining six sera (1.4%), confirmed as equivocal, were excluded from further analysis. No significant differences were found based on sex (p-value = 0.706) or nationality (p-value = 0.112). The application of trend tests (Mantel-Haenszel; Kendall Tau-b) showed a significant trend (p < 0.024 and p < 0.032, respectively), with an increasing probability of finding a positive anti-varicella serological status passing from a lower age group (84.2%) to a higher one (93.0%). By considering the female population aged 18-49 years, the seroprevalence of anti-varicella antibodies was found to be 88.4%, with a susceptibility of 11.6%, highlighting the risk of acquiring infection during pregnancy. Conclusions: The introduction of varicella vaccination has had a significant impact on public health in Tuscany and in Italy more generally. However, further efforts should be made to reduce the number of individuals still susceptible in adulthood, with particular attention given to women of childbearing age and the promotion of vaccination through mass and social media and institutional websites.

Italy's Post-COVID-19 Stroke Network: Has It Returned to Pre-Pandemic Standards?

The COVID-19 pandemic strongly transformed the healthcare system in the Lombardy region (Italy), forcing a rapid reorganization of hospital structures. The emergency medical service (EMS) system and emergency departments (EDs) were among the most affected departments. Several studies have shown a change in the epidemiology of time-dependent pathologies, such as stroke, during the pandemic's peak. However, there is little scientific evidence regarding the interpandemic phase. The regional register for ED accesses (EUOL) was analyzed, taking into consideration all accesses for stroke and stroke-like syndromes during the years 2019, 2020, and 2021. The analysis shows a significant difference in the average number of diagnoses per month [2092 vs. 1815 vs. 2015, respectively (p < 0.05)] and an increase in the percentage of transports carried out by EMS vehicles to EDs [17% vs. 25% vs. 22%, respectively (p < 0.05)]. The length of stay (LOS) increased for both discharged patients (9.0 vs. 10.1 vs. 11.2 h, respectively; p < 0.005) and hospitalized patients (7.5 vs. 9.7 vs. 10.6 h, respectively; p < 0.005). During the COVID-19 pandemic, the overall number of stroke diagnoses decreased, while the percentage of patients transported to EDs by EMS vehicles increased. Furthermore, an increased processing time in EDs was highlighted.

Development of a User-friendly Health Promotion Website to Spread Evidence-based Information in Italy

Introduction

Appropriate communication models and strategies are crucial in order to strengthen preventive and health promotion interventions via digital platforms. Today, 52.23% of the Italian population use the Internet as a source of health-related information. The aim of the "Insegna Salute" project was to create a website that would enable people to satisfy their knowledge health needs and increase their awareness in the field of prevention.

Methods

To develop the website, a qualitative literature research was carried out to collect an overview of effective online health communication strategies and tools before, during and after the COVID-19 pandemic. Further, we implemented the website insegnasalute.it according to the one-to-many (screen-to-face) communication model. The second part of the research focused on identifying tools to ensure the constant update of the platform. Finally, we proceeded with the creation of the visual identity.

Results

The research resulted in 28 sources regarding health communication, vaccine hesitancy, online health information seeking, visual identity, current digital and social trends and mis/disinformation. Many publications reported that healthcare professionals (HCPs) are the main providers of evidence-based information and the most effective agents against misinformation. Furthermore, most of the articles advocated the use of digital technologies, such as social media and websites, along with proactive and targeted communication strategies.

Conclusions

Vaccination hesitancy and other health prevention issues require accurate tools to build trust-based relationships between users and healthcare professionals. In line with the preventive guidelines issued by the Italian Ministry of Health, new tools, such as "Insegna Salute", integrate health knowledge with communication strategies. In the wake of the COVID-19 pandemic, preventive measures are essential to protect the population from misinformation spread and the probability of getting ill.

An evaluation of the quality of COVID-19 websites in terms of HON principles and using DISCERN tool

BACKGROUND

As many people relied on information from the Internet for official scientific or academically affiliated information during the COVID-19 pandemic, the quality of information on those websites should be good.

OBJECTIVE

The main purpose of this study was to evaluate a selection of COVID-19-related websites for the quality of health information provided.

METHOD

Using Google and Yahoo, 36 English language websites were selected, in accordance with the inclusion criteria. The two tools were selected for evaluation were the Health on the Net (HON) Code and the 16-item DISCERN tool.

RESULTS

Most websites (39%) were related to information for the public, and a small number of them (3%) concerned screening websites in which people could be informed of their possible condition by entering their symptoms. The result of the evaluation by the HON tool showed that most websites were reliable (53%), and 44% of them were very reliable. Based on the assessment results of the Likert-based 16-item DISCERN tool, the maximum and minimum values for the average scores of each website were calculated as 2.44 and 4.25, respectively.

CONCLUSION

Evaluation using two widely accepted tools shows that most websites related to COVID-19 are reliable and useful for physicians, researchers and the public.

Spreading of misinformation on mass media and digital platforms regarding vaccines. A systematic scoping review on stakeholders, policymakers, and sentiments/behavior of Italian consumers

Studies on traditional and social media have found that misinformation about vaccines has been widely spread over the last decade, negatively impacting public opinion and people's willingness to get vaccinated. We reviewed the sentiments of Italian users to define the characteristic of anti-vax and pro-vax contents and defined the strategies to deal with the misinformation. Scopus, MEDLINE/PubMed, Google Scholar (up to page 10), and ISI Web of Knowledge databases were systematically searched. Research articles, brief reports, commentaries, and letters published between January 1, 2010 and March 30, 2022 were included in the search. No-vax or ambiguous contents in Italian mass media are not prevalent compared to neutral and pro-vax content; the communication of no-vax groups is significantly simplified, favoring the understanding of the topics by users. Events related to vaccinations are associated with news coverage by media, search engine consultations, and user reactions on social networks. In this context, the activity of no-vax groups is triggered, and misinformation and fake news spread even further. A multifactorial approach is necessary to manage online user sentiment and use mass and social media as health promotion tools.

Family Medicine and Primary Healthcare: The Past, Present and Future

As defined by the World Health Organisation in the conference held in Alma Ata, Kazakhstan, in 1978, "Primary health care is essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination" [...].

Artificial Intelligence and Public Health: Evaluating ChatGPT Responses to Vaccination Myths and Misconceptions

Artificial intelligence (AI) tools, such as ChatGPT, are the subject of intense debate regarding their possible applications in contexts such as health care. This study evaluates the Correctness, Clarity, and Exhaustiveness of the answers provided by ChatGPT on the topic of vaccination. The World Health Organization's 11 "myths and misconceptions" about vaccinations were administered to both the free (GPT-3.5) and paid version (GPT-4.0) of ChatGPT. The AI tool's responses were evaluated qualitatively and quantitatively, in reference to those myth and misconceptions provided by WHO, independently by two expert Raters. The agreement between the Raters was significant for both versions (p of K < 0.05). Overall, ChatGPT responses were easy to understand and 85.4% accurate although one of the questions was misinterpreted. Qualitatively, the GPT-4.0 responses were superior to the GPT-3.5 responses in terms of Correctness, Clarity, and Exhaustiveness (Δ = 5.6%, 17.9%, 9.3%, respectively). The study shows that, if appropriately questioned, AI tools can represent a useful aid in the health care field. However, when consulted by non-expert users, without the support of expert medical advice, these tools are not free from the risk of eliciting misleading responses. Moreover, given the existing social divide in information access, the improved accuracy of answers from the paid version raises further ethical issues.

First Year of Special Issue "New Insights in Vaccination and Public Health": Opinions and Considerations

Disease prevention and control is the foundation of public health [...].

“Before Dawn,” Listening to the Voices of Social Media: A Study on the Public’s Response to the COVID-19 Vaccine

The COVID-19 pandemic is a worldwide catastrophe. In the absence of an effective drug, one effective measure to pull the pandemic to the end is herd immunity by taking vaccines, while the hesitation and anti-attitude from social media affect the vaccination. This makes it crucial to evaluate the text data about the COVID-19 vaccine from tweets. The period for data used in this study is 1 Aug to 31 Oct, 2020, since it is just before promoting the use when public reactions to the COVID-19 vaccine can influence their subsequent vaccination behavior. In this study, we used the latent Dirichlet allocation (LDA) topic model and sentiment analysis to explore public reactions to the COVID-19 vaccine. The results indicate that the public discussion could be divided into 11 topics, which could be further summarized into four different themes: (1) concerns about COVID-19; (2) concerns about vaccine development, production, and distribution; (3) how to control the COVID-19 before obtaining the vaccine; and (4) concerns about information of vaccine safety and efficacy. It can be concluded that to a large extent, public reactions to vaccines are dominated by positive sentiment. Specifically, the politicization of the vaccine approval process, suspension of vaccine trials, and measures to control COVID-19 tend to trigger negative public sentiment; whereas information related to successful vaccine development and availability enhances positive public sentiment. These findings help us understand public reactions to the COVID-19 vaccine, uncover potential factors that may influence vaccination behavior, and help policymakers understand public opinion about the COVID-19 vaccine and develop rational and effective policies.

Knowledge, Attitudes, and Behaviors towards Proper Nutrition and Lifestyles in Italian Diabetic Patients during the COVID-19 Pandemic

Prevention of diabetes mellitus is mainly based on a healthy lifestyle. The lockdown measures imposed during the COVID-19 pandemic resulted in major changes in daily life and social behavior, which may have an influence on diabetes self-management and glycemic control. The present work aims to assess the relationship between diabetic patients' knowledge, attitudes, and behaviors towards proper nutrition and lifestyles in order to plan strategies for educational intervention from a health literacy perspective. Attitudes, behaviors, and knowledge of diabetic patients attending the Diabetes and Metabolic Diseases Department of the Local Health Authority of Sassari (ASL1-SS) were assessed with a cognitive survey conducted from April to July 2022. Three hundred twenty-one questionnaires were administered during the survey period. Fifty-two percent of diabetic patients were female and 48% male, with a mean age of 61.1 ± 18.5 years and 62.0 ± 15.1 years, respectively. The overall level of knowledge about the role of food and proper nutrition with respect to the risk of diabetes and its complications appeared to be generally unsatisfactory and inadequate. Nonetheless, females showed a significantly higher level of knowledge than males (p < 0.0001). Moreover, knowledge was seen to decrease according to the age of the patients (p = 0.035). As for the possible impact played by the COVID-19 pandemic on lifestyles, it should be noted that about 70% of the respondents stated that they had maintained a reasonable dietary standard or even improved it throughout. Thus, the study underlines the need to improve the knowledge of diabetic subjects about nutrition and, in particular, their self-management, positively influencing behaviors and attitudes.

The Impact of the COVID-19 Pandemic on Ophthalmic Outpatient Care in a Tertiary Care Center in Riyadh

In this paper, we measured the impact of a full COVID-19 lockdown on ophthalmic patients after a period of lockdown in Saudi Arabia, from March to September 2020. A cross-sectional analytical study was carried out on 180 patients who had their appointments delayed or canceled due to the lockdown. Data was collected from electronic medical records and patients via voice calls using a validated questionnaire that were analyzed using a multivariable binary regression analysis. The results show no statistically significant mean difference in visual acuity when comparing pre- and post-lockdown measurements. The median number of appointment cancellations/delays per patient was two, and the estimated delay for the first canceled appointments was equal to 178.8 days. Of the cohort studied, 15.4% of patients faced delays in necessary surgical and therapeutic interventions; 22.1% of patients sought eye care at other institutions due to the delay, and 15% of those were seen by doctors unspecialized in ophthalmology. The odds of dissatisfaction with care were higher in patients who experienced cancellations in a surgical procedure and patients who experienced difficulty in obtaining medications. In conclusion, the pandemic hampered ophthalmic patients' access to medications. Subjective visual outcomes of patients were also negatively affected; however, the change in objective visual parameters was not statistically significant.

Did Italy Really Need Compulsory Vaccination against COVID-19 for Healthcare Workers? Results of a Survey in a Centre for Maternal and Child Health

Since its early spread, the COVID-19 pandemic has become a health threat globally. Due to their crucial role in the pandemic, Italy declared compulsory vaccination for healthcare workers. Vaccine hesitancy was observed among the healthcare workers and an ethical debate arose about Italian legal statement D.L. n. 44/2021. In this article, we present the results of a survey performed in an Italian center for maternal and infant care and assess the attitudes towards the COVID-19 pandemic and the mandatory COVID-19 vaccination of healthcare workers. Since March 2022, 91.5% of healthcare workers have been vaccinated with an additional dose. Only 2.3% of the respondents refused to take vaccination: the reasons behind this refusal were distrust, doubts over safety, and lack of information. Despite the high rate of response to vaccination, 17.7% of HCWs did not agree with its mandatory nature. In addition, 5.4% stated that they agreed to be vaccinated exclusively because of the sanctions provided for by the legislation. In conclusion, adequate vaccination coverage has been achieved in the hospital under consideration. However, it is still very important to continue to persuade HCWs of vaccine efficacy and safety, considering their social role.

COVID-19 and Digital Health: Evolution, Perspectives and Opportunities

Health Communication is key to establishing an empathic relationship between health professionals and their patients. Indeed, the ability to motivate and reassure the patient often determines the success of the therapies proposed. In the past, the relationship between health professionals and patients was centred on treatment and assistance, and health information came in the form of education campaigns based on signage (large posters, etc.). Subsequently, social and cultural changes gave rise to new ways of communicating science: from signage to magazines and television programmes devoted to health issues, through the use of social networks. In particular, fast and cheap access to the Internet and the vast number of app users have made the Web an effective communication tool. Given the potential of technology in the information-seeking process, the use of online channels by health institutions is a valuable tool for divulging medical and scientific knowledge. As a consequence, prompted by the need to provide fast and reliable information to the population, public institutions have adopted such innovative methods as the use of Information and Communication Technologies (ICTs) to convey health-related content. This practice, known as digital health or e-health, provides healthcare information using digital tools (e.g., Websites and social networks), delivered in an easy-to-understand language in order to reach various population groups and bring about better health conditions for all, hence the importance of acquiring and reinforcing communication skills in the healthcare field, where correct and effective communication immediately translates into a benefit for the professionals themselves and for their patients.

COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis

INTRODUCTION

Pregnant and breastfeeding women are at an increased risk of severe illness from COVID-19. Despite this, low vaccination coverages are reported in this population sub-group.

AREAS COVERED

The purpose of this study is to estimate the proportion of pregnant and breastfeeding women expressing hesitation to the COVID-19 vaccine worldwide. Forty-six studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar, and Scopus databases between January 1, 2020 and February 6, 2022. The vaccine hesitation rate among pregnant and breastfeeding women was 48.4% (95%CI= 43.4-53.4%). In a sub analysis by study period, it was 40.0% (95%CI=31.6-46.6%) considering surveys administered in 2020, 58.0% (95%CI=48.9-66.9%) considering surveys administered in the first semester of 2021, and 38.1% (95%CI=25.9-51.2%) considering surveys administered in the second semester of 2021. The main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events.

EXPERT OPINION

Available evidence in the literature has shown that fighting vaccine resistance is harsh and too slow as a process, considering the rapidity and unpredictability of a pandemic. Health education should be provided in order to improve the willingness of the community, especially for those with lower levels of education.

Ten Actions to Counteract Vaccine Hesitancy Suggested by the Italian Society of Hygiene, Preventive Medicine, and Public Health

Vaccine hesitancy (VH) is one of the main causes of the widespread decline in vaccination coverage and has become the subject of ongoing debate among public health professionals. The present commentary is a “decalogue” of strategic actions to counteract vaccine hesitancy for public health professionals that comes from the cognitive and formative path put in place by the “Communication in Public Health” working group (WG) of the Italian Society of Hygiene, Preventive Medicine, and Public Health. From the establishment of a national, multidisciplinary WG on VH to the activation of a national monitoring/surveillance system on vaccine hesitancy, several proposals are discussed. The identification and dissemination of good practices and tools to counteract and understand vaccine hesitancy, interdisciplinary training on vaccine hesitancy and on risk communication, community engagement and infodemiology, the inclusion of effective interventions to counteract vaccine hesitancy within the National Immunization Plan (NIP), the promotion and growth of a community of practice and research in the field of vaccine hesitancy, collaborations between scientific societies, and knowledge from the behavioral sciences represent other actions recommended in the present commentary. The present document suggests ten undeferrable strategies that could be implemented at the national and local levels in Italy, and that could be borrowed by other European countries in order to counteract vaccines hesitancy with a systematic and organic approach.

COVID-19 vaccination hesitancy in Italian healthcare workers: a systematic review and meta-analysis

INTRODUCTION

As for other vaccines, vaccination hesitancy may be a determining factor in the success (or otherwise) of the COVID-19 immunization campaign in healthcare workers (HCWs).

AREAS COVERED

To estimate the proportion of HCWs in Italy who expressed COVID-19 vaccine hesitancy, we conducted a systematic review of the relevant literature and a meta-analysis. Determinants of vaccine compliance and options suggested by these studies to address vaccine hesitancy among HCWs were also analyzed. Seventeen studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases between January 1, 2020 and January 25, 2022. The vaccine hesitancy rate among HCWs was 13.1% (95%CI: 6.9-20.9%). The vaccine hesitancy rate among HCWs investigated before and during the vaccination campaign was 18.2% (95%CI=12.8-24.2%) and 8.9% (95%CI=3.4-16.6%), respectively. That main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events.

EXPERT OPINION

Despite strategies to achieve a greater willingness to immunize in this category, mandatory vaccination appears to be one of the most important measures that can guarantee the protection of HCWs and the patients they care for.

Vaccine and Vaccination: On Field Research

Historically, vaccinations have enabled the eradication, elimination, and control of many debilitating diseases [...]

From Survey Results to a Decision-Making Matrix for Strategic Planning in Healthcare: The Case of Clinical Pathways

Background: It is a well-known fact that the information obtained from a survey can be used in a healthcare organizational analysis; however, it is very difficult to compare the different results found in the literature to each other, even through the use of metanalysis, as the methodology is often not consistent. Methods: Data from a survey analyzing the organizational and managerial responses adopted in pathology-specific clinical pathways (CPs) during the first two waves of the COVID-19 pandemic were used for constructing a decisional matrix, a tool called SPRIS system, consisting of four different sheets. The first sheet reports the results of the survey and, using a streetlight color system, identifies strengths and weaknesses; the second one, by assigning a priority score, establishes the priority of intervention on each of the strengths and weaknesses identified; the third sheet reports the subjective items of the questionnaire in order to identify threats and opportunities and their probability of happening; in the last sheet, a SWOT Analysis is used to calculate the performance index of the whole organization. Results: The SPRIS system, applied to data concerning the adaptation of four CPs to the COVID-19 pandemic, showed that, whereas all the CPs had a good performance index, some concerns remained unsolved and need be addressed. Conclusions: The SPRIS system showed to be an easily constructed tool that is able to give an overview of the organization analyzed by the survey and to produce an index that can be used in a direct quality comparison between different services or organizations.

How the COVID-19 Pandemic Affects Risk Awareness in Dentists: A Scoping Review

Dentists are on the frontline of infection, especially when it comes to respiratory viruses like the new coronavirus. The purpose of this paper is to conduct a scoping review to better understand dentists’ risk awareness, awareness of COVID-19 symptoms, preventive measures, and effective methods of COVID-19 infection prevention and management. This paper systematically assesses the published literature on dentistry and COVID-19. Various electronic databases including Ovid MEDLINE, Scopus, Embase, and MEDLINE via PubMed were searched up to 9 September 2021. Overall, 39 papers were included. Almost the entirety of dentists (94.5%) reported awareness of the three most common COVID-19 symptoms, and a risk awareness score of about 90% was shown, while 88.2% of dentists reported adopting preventive measures. More than 50% did not want to treat infected people. While 70.3% of dentists recommended usage of N95 masks, the rate of dentists using them was below 40%. Sufficient awareness of risks during the pandemic was found in dentists. Although they were using preventive measures, there remains upside potential for adopting all recommended measures. Further, the usage of N95 masks is improvable, even though the benefit of wearing them could not be confirmed.

Knowledge and Behaviours towards Immunisation Programmes: Vaccine Hesitancy during the COVID-19 Pandemic Era

Assessing knowledge, attitudes and behaviours towards vaccination is a key strategy when implementing national and international immunisation programmes aimed at improving compliance among the population and thereby increasing vaccination coverage. While vaccination's role as a powerful life-saving weapon in the fight against infectious diseases has been further highlighted following the introduction of the Coronavirus Disease 2019 (COVID-19) vaccine, there is still a discrepancy between the scientific evidence on the effectiveness of vaccines and the perception of the risk attributed to them. Known as "Vaccine Hesitancy" (VH), this phenomenon is the delay in acceptance or refusal of vaccines, despite the availability of services. VH can be found in at least 15% of the worldwide population, and even professional groups tasked with promoting vaccination as a primary prevention measure, e.g., healthcare workers (HCWs), sometimes have doubts regarding vaccination. Since 2014, this Public Health problem has been increasing in 90% of countries worldwide, to the extent that in 2019 it was listed as one of the ten greatest threats to global health by the World Health Organization (WHO). VH has also affected COVID-19 vaccination, hampering the achievement of desired vaccination coverage. Monitoring this trend by studying people's behaviour and attitudes could be a useful tool to aid Public Health, in orienting vaccination policies and designing new health education and continuous training interventions, aimed at both the general public and accountable cohorts, such as HCWs.

Prevalence and Motives of Social Media Use among the Iranian Population

Background

Around the world, people are using social media (SM) for different purposes following a wide range of patterns. There is a paucity of studies addressing the issue in the Eastern Mediterranean region. In this population-based study, the frequency and patterns of SM use in Iran were investigated.

Materials and Methods

To explore the prevalence and motives of SM use, a sample of 1800 Iranian people aged 10-65 years old (53.5% female) were surveyed. Social media addiction (SMA) was assessed using the Bergen Social Media Addiction Scale.

Results

The results revealed that 88.5% (n = 1593) of the participants were SM users, and the average time spent by them in SM was 4.0 ± 3.9 hours. The most common motivations for SM use were communication with others (48.9%), receiving news (40.7%), and surfing the net (40.6%). Besides, burning eyes (31.0%), headache (26.8%), and sleep disturbance (25.1%) were the most common health problems experienced by SM users. The SMA prevalence was 23.1% (95% CI: 21.2, 25.1) (males: 23.8%; females: 22.5%), with a higher rate (26.0%) among adolescents and young people.

Conclusion

SM use and SMA appear to be real health challenges in Iran, particularly among youth. Consequently, to decrease the negative impacts of excessive SM use, exploring the motives behind SM use and designing population-based interventions are recommended.

An Analysis of the Willingness to the COVID-19 Vaccine Booster Shots among Urban Employees: Evidence from a Megacity H in Eastern China

Many studies have shown that urban workers may have a higher acceptance rate of coronavirus disease (COVID-19) vaccine uptake compared to their rural counterparts. As Omicron spreads globally, the COVID-19 booster vaccination has been acknowledged as the primary strategy against this variant. In this study, we identify factors related to the willingness of workers in megacities to take the vaccine booster shots and their main reasons accounting for their booster willingness. This research survey was conducted in megacity H in eastern China, and a total of 1227 employees from different industries were interviewed. The study at hand examines the relationship between various characteristics (including both economic and non-economic factors) of urban employees and their intention/desire to accept the COVID-19 booster shoots. The survey results show that some characteristics, namely work organization, vaccine knowledge, and social network, affect their intention to take COVID-19 vaccine booster shots. Urban employees with a strong work organization, a high degree of vaccine knowledge, and a dense social capital are more likely to receive booster injections than other employees. Therefore, work organization, vaccine knowledge, and social networks provide fundamental entry points for designing enhanced injection strategies to increase the acceptance of COVID-19 vaccines among employees in megacities.

Second Edition of Special Issue "Strategies and Evidence in Health Communication: Evidence and Perspectives"

The second edition of this Special Issue "Strategies and Evidence in Health Communication", published in the International Journal of Environmental Research and Public Health aims primarily to increase international literature evidence and observations in the field regarding: (i) health communication strategies and crisis communication, (ii) health education and health advocacy, and (iii) the fight against the phenomenon of Vaccine Hesitancy (VH) through training and communication activities targeting the general public and health professionals. This Special Issue builds on the premise that, despite the fact that theoretical and experimental research has contributed to an increase in knowledge and evidence about the importance of communication in healthcare, communication professionals in this field still face great challenges when trying to develop messages that effectively change the behavior of large groups of people. The need to relay fast and reliable information to the general public has therefore led public institutions to seek out new and innovative ways of transmitting health-related content. In particular, for some time now, Public Health has also been making use of the Internet and Information and Communication Technologies (ICT) to reach various population groups and achieve better health conditions for all. This practice, known as Digital Health or E-health, provides healthcare using digital tools (e.g., websites and social media networks) and easy-to-understand language. This is particularly important in the current pandemic context, where Public Health continues to face many problems and difficulties in persuading people to adhere to the guidelines issued for the containment of COVID-19, with particular reference to vaccination programs, hence the importance of acquiring and strengthening communication skills in healthcare, where correct and effective communication is immediately beneficial both to professionals and patients.

New Insight in Vaccination and Public Health: A Commentary from Special Issue Editors

Vaccination is a key component of primary health care and an indisputable human right [...].

A Knowledge, Attitude, and Perception Study on Flu and COVID-19 Vaccination during the COVID-19 Pandemic: Multicentric Italian Survey Insights

In January 2020, Chinese health authorities identified a novel coronavirus strain never before isolated in humans. It quickly spread across the world, and was eventually declared a pandemic, leading to about 310 million confirmed cases and to 5,497,113 deaths (data as of 11 January 2022). Influenza viruses affect millions of people during cold seasons, with high impacts, in terms of mortality and morbidity. Patients with comorbidities are at a higher risk of acquiring severe problems due to COVID-19 and the flu—infections that could impact their underlying clinical conditions. In the present study, knowledge, attitudes, and opinions of the general population regarding COVID-19 and influenza immunization were evaluated. A multicenter, web-based, cross-sectional study was conducted between 10 February and 12 July 2020, during the first wave of SARS-CoV-2 infections among the general population in Italy. A sample of 4116 questionnaires was collected at the end of the study period. Overall, 17.5% of respondents stated that it was unlikely that they would accept a future COVID-19 vaccine (n = 720). Reasons behind vaccine refusal/indecision were mainly a lack of trust in the vaccine (41.1%), the fear of side effects (23.4%), or a lack of perception of susceptibility to the disease (17.1%). More than 50% (53.8%; n = 2214) of the sample participants were willing to receive flu vaccinations in the forthcoming vaccination campaign, but only 28.2% of cases had received it at least once in the previous five seasons. A higher knowledge score about SARS-CoV-2/COVID-19 and at least one flu vaccination during previous influenza seasons were significantly associated with the intention to be vaccinated against COVID-19 and influenza. The continuous study of factors, determining vaccination acceptance and hesitancy, is fundamental in the current context, in regard to improve vaccination confidence and adherence rates against vaccine preventable diseases.

Impact of the COVID-19 Pandemic on Clinical Pathways for Non-SARS-CoV-2 Related Diseases in the Lazio Region, Italy

Clinical pathways (CPs) are multidisciplinary clinical governance tools necessary for the care management of the patients, whose aim is to outline the best practicable path within a health organization related to an illness or to a complex clinical situation. The COVID-19 pandemic emergency has created the need for an organizational renewal of care pathways based on the principles of “primary health care” recommended by the WHO. In Italy, the Hospitals and Local Health Authorities (ASL) have tried to guarantee the continuity of non-deferrable treatments and the maximum safety of both patients and health professionals. This study analyzes the organizational and managerial responses adopted in pathology-specific care pathways to assess how CPs as diagnostic tools responded to the COVID-19 pandemic in the first two waves. Twenty-four referents of Operational Units (UU OO) from Hospitals (AO) and Local Health Authorities (ASL) of the Lazio Region (Central Italy) that apply four different CPs responded to a survey, which analyzes the managerial and organizational responses of CPs in regard to different contexts. Results show that the structural and organizational adjustments of the CPs have made it possible to maintain an adequate level of care for specific treatment processes, with some common critical aspects that require improvement actions. The adjustments found could be useful for dealing with new outbreaks and/or new epidemics in order to try to mitigate the potential negative impact, especially on the most vulnerable patient categories.

Educational Interventions on Pregnancy Vaccinations during Childbirth Classes Improves Vaccine Coverages among Pregnant Women in Palermo's Province

Maternal immunization is considered the best intervention in order to prevent influenza infection of pregnant women and influenza and pertussis infection of newborns. Despite the existing recommendations, vaccination coverage rates in Italy remain very low. Starting from August 2018, maternal immunization against influenza and diphtheria-tetanus-pertussis were strongly recommended by the Italian Ministry of Health. We conducted a cross sectional study to estimate the effectiveness of an educational intervention, conducted during childbirth classes in three general hospitals in the Palermo metropolitan area, Italy, on vaccination adherence during pregnancy. To this end, a questionnaire on knowledge, attitudes, and immunization practices was structured and self-administered to a sample of pregnant women attending childbirth classes. Then, an educational intervention on maternal immunization, followed by a counseling, was conducted by a Public Health medical doctor. After 30 days following the interventions, the adherence to the recommended vaccinations (influenza and pertussis) was evaluated. At the end of the study 326 women were enrolled and 201 responded to the follow-up survey. After the intervention, among the responding pregnant women 47.8% received influenza vaccination (+44.8%), 57.7% diphtheria-tetanus-pertussis vaccination (+50.7%) and 64.2% both the recommended vaccinations (+54.8%). A significant association was found between pregnant women that received at least one vaccination during pregnancy and higher educational level (graduation degree/master’s degree), employment status (employed part/full-time) and influenza vaccination adherence during past seasons (at least one during last five years). The implementation of vaccination educational interventions, including counseling by healthcare professionals (HCPs), on maternal immunization during childbirth courses improved considerably the vaccination adherence during pregnancy.

Influenza Vaccination Strategies in Healthcare Workers: A Cohort Study (2018-2021) in an Italian University Hospital

Vaccinating healthcare workers (HCWs) is the most effective intervention for preventing nosocomial influenza infection. However, influenza vaccination coverage (VC%) among HCWs remains low. The aim of the study was to analyse the trend of VC% among healthcare workers in an Italian hospital through a three-year vaccination project covering three influenza seasons (2018-2019, 2019-2020, and 2020-2021). A gap analysis was performed at the case base (2018-2019), on-site vaccination was trialled in the 2019-2020 season, and an integrated vaccination offer (on-site vaccination and the classic offer at a vaccination clinic) was implemented for the 2020-2021 season. For each unit of vaccinated HCWs, the following variables were recorded: main demographic details, area of affiliation (medical/surgical/services), and professional category. Logistic regression analyses were performed to assess the relationship between outcome (undergoing vaccination in 2020-2021) and other variables related to the healthcare workers' characteristics. In the three seasons, VC% values of 13.2%. 27.7%, and 58.9% were recorded, respectively (p < 0.005). The highest VC% was recorded among physicians (94.93%), in the medical area (63.27%), and males (62.59%) and in general among the youngest HCWs. Comparison of the coverage values recorded in the three seasons showed that in the last season considered (2020-2021) about 80% of health workers preferred to be vaccinated in the workplace instead of using the standard vaccination delivery method (invitation to attend the vaccination clinic). Our study suggests that the integrated vaccination offer may lead to an increase in VC% among HCWs compared to the classical offer modalities.

Willingness to Get the COVID-19 Vaccine among Residents of Slum Settlements

Slum residents are more vulnerable to COVID-19 infection. Without a specific treatment, vaccination became the main strategy against COVID-19. In this study, we determined the rate and factors associated with the willingness to get vaccinated against COVID-19 among slum residents and their main reasons associated with the vaccine intention. The study was conducted in Pau da Lima, a slum community in Salvador Brazil. In total, 985 residents were interviewed. Among them 66.0% (650/985) were willing to get vaccinated, 26.1% (257/985) were hesitant to take the vaccine and 7.9% (78/285) were not sure. The main reasons cited for vaccine hesitancy or being unsure were concerns about vaccine efficacy and potential side effects. In contrast, the main reasons cited for wanting the vaccine were the high incidence of COVID-19 cases and participants’ self-perception of their own health history. Multivariate analysis identified that COVID-19 vaccine hesitancy was associated with younger age and low social capital, summarized as low perceived importance of vaccination to protect one’s family, friends and community. Slum residents have been less willing to vaccinate than the general population. Social capital presents a critical opportunity in the design of communication campaigns to increase COVID-19 vaccine acceptance in slum settings.