Behind the mask: What the eyes can't tell: Facial emotion recognition in a sample of Italian health care students

Wearing a facemask remains a pivotal strategy to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection even after vaccination, but one of the possible costs of this protection is that it may interfere with the ability to read emotion in facial expressions. We explored the extent to which it may be more difficult for participants to read emotions in faces when faces are covered with masks than when they are not, and whether participants' empathy, attachment style, and patient-centred orientation would affect their performance. Medical and nursing students (N = 429) were administered either a masked or unmasked set of 24 adult faces depicting anger, sadness, fear, or happiness. Participants also completed self-report measures of empathy, patient-centredness, and attachment style. As predicted, participants made more errors to the masked than the unmasked faces with the exception of the identification of fear. Of note, when participants missed happiness, they were most likely to see it as sadness, and when they missed anger, they were most likely to see it as happiness. A multiple linear regression analysis showed that more errors identifying emotions in faces was associated with faces being masked as opposed to unmasked, lower scores on the empathy fantasy scale, and higher scores on the fearful attachment style. The findings suggest that wearing facemasks is associated with a variety of negative outcomes that might interfere with the building of positive relationships between health care workers and patients. Those who teach student health care workers would benefit from bringing this finding into their curriculum and training.

Being an older hospitalized patient during the COVID-19 pandemic - A qualitative interview study

BACKGROUND

Older people hospitalized for COVID-19 are a vulnerable group due to the disease itself, aging and often loss of hearing and vision. Person-centered care, where patients have opportunities to communicate and participate in their own care, is important. However, because healthcare staff needed to wear personal protective equipment during the pandemic, to protect the patients and themselves, providing person-centered care was often difficult. This study aims to describe older hospitalized patients' experiences both of being cared for, while having COVID-19, and of the care provided by healthcare staff wearing PPE.

METHODS

Fourteen older patients, over 65 years of age, were interviewed, and the data were analyzed using qualitative content analysis. The study adhered to Consolidated criteria for reporting qualitative research guidelines.

RESULTS

Three subthemes and one overall theme, "The desire for survival overshadows difficulties", emerged in the analysis. The main findings revealed that the older hospitalized patients experienced the care they received from the healthcare staff as satisfactory. The older patients reported understanding and accepting that the pandemic situation meant that their ability to participate in their own care and communicate with healthcare staff were given lower priority.

CONCLUSIONS

Older hospitalized patients need to be provided person-centered care, and situations such as a pandemic are no exception. Care tasks that are not acute in nature, e.g., planning for patients' return home, could be conducted by healthcare staff not required to wear PPE.

Very small effects of an imagery-based randomised trial to promote adherence to wearing face coverings during the COVID-19 pandemic and identification of future intervention targets

OBJECTIVE

Mental imagery interventions are a cost-effective way of promoting health behaviour change. We tested a mental imagery intervention designed to promote adherence to wearing face coverings during the COVID-19 pandemic.Design: A four-arm randomised controlled trial to explore potential mechanisms of action. Main outcome measures: Measures of behaviour (frequency of self-reported face covering adherence), theory of planned behaviour constructs (i.e. intention, attitudes, subjective norms, and perceived behavioural control), personality traits, imagery ability and barrier self-efficacy were measured at baseline (T1). Behaviour was also assessed at four-week follow-up (T2).Results: Of 297 participants, a majority always wore face coverings (N = 216, 73% overall sample). Logistic regression analyses revealed no intervention effects on changes in adherence to wearing face coverings, though T1 wearing of face coverings and being male predicted T2 behaviour. Subgroup analysis of participants self-reporting 'suboptimal T1 adherence, revealed that T2 non-adherence was predicted by being a non-student and by subjective norms and lower T1 intention to wear face coverings.Conclusion: Imagery-based interventions to increase face covering wearing adherence may exert significant public health effects but only when conducted on a very large scale. Our findings suggest that interventions should target men and disrupt habitual past behaviour.

Nurse-Patient Communication and Relationship When Wearing Personal Protective Equipment: Nurses' Experience in a COVID-19 Ward

Little is known about which communication strategies nurses carried out and whether the nurse-patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse-patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme 'The in-out relationship: 'in here and out there' and 'inside me and out of me' included the main themes 'A closed system different from normal', 'Uncovering meaningful human gestures', and 'A deep experience to live''. The relational nature of nursing-where 'me and you' and the context are the main elements-leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care.

Living in a Limited World: Experience of Lipreaders When Society Is Masked

The goal of the current interpretive phenomenological study grounded in Heidegger's philosophies was to explore the experience of lipreaders when society was masked during the coronavirus disease 2019 pandemic. Participants were prelingually deafened English-speaking adults who predominantly relied on lip-reading and speaking for communication. Twelve in-depth email interviews were conducted with respondents recruited via social media. Thematic techniques of Benner were employed, and six themes emerged: Limiting of World Resulting in Negative Emotions, Increased Prominence of Deafness, Balancing Safety and Communication Access, Creative Resourcefulness, Resilience and Personal Growth, and Passage of Time to Bittersweet Freedom. Insights from this study clarify the need for psychosocial support of lipreaders during times of restricted communication access and awareness of accommodations to facilitate inclusion. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 18-26.].

Using Principles of Therapeutic Communication to Enhance Trauma-Informed Care in the Critical Care Setting to Promote Positive Encounters

Traumatic events such as hospitalization of family members in the intensive care setting can influence communication interactions between health-care workers and family members not just because of the acute situation but because it brings feelings resulting from past traumatic events to the surface. Providing trauma-informed care to all patients and families in the critical care setting improves communication and results in encounters that are less likely to result in an escalation of negative emotions and outbursts and provides an environment that is conducive to interprofessional communication between families, patients, and health-care workers.

Assessment of Patient Retention of Inpatient Care Information Post-Hospitalization

BACKGROUND

Patient understanding of medical care improves readmission rates and patient satisfaction, yet the literature suggests patients often have poor retention of care information post-hospitalization. Although multiple interventions have been implemented to facilitate this process, the cumulative durability of their benefit remains unclear. The authors conducted this study to more objectively understand how well patients retain care information after hospital discharge and to assess patient perspectives on facilitators of this process (for example, whiteboards and patient portals).

METHODS

Semistructured phone interviews of patients admitted to general medicine resident teaching services were performed within 24 to 48 hours post-hospitalization. Recall of four key domains of care (diagnoses addressed, inpatient treatment, postdischarge treatment plans, and medication changes) was elicited. Chart review was performed to verify patient responses. Responses were then categorized by independent reviewers as correct, partially correct, or incorrect. Patient perspectives on facilitators to help with information retention were also assessed.

RESULTS

Fifty-three patients participated. The vast majority (> 90%) were confident in their knowledge of their diagnoses and treatment, yet independent review revealed only 58.5%, 64.2%, 50.9%, and 43.4% of patients correctly recalled each respective key domain. Whiteboards were the most frequently used facilitator (96.2%), yet their content was rated least helpful for retaining care information. Patients suggested several areas for improvement, including prioritizing bedside pen and paper along with updating whiteboards with diagnostic and therapeutic information.

CONCLUSION

Patient recall of their inpatient care after discharge, despite modern facilitators, remains poor. Further efforts are needed to enhance or implement facilitators based on patient feedback.

The impact of facemasks on blood donation process: The professionals' perspective

Facemasks represent an essential measure of prevention against the spread of COVID-19; however, they lessen the ability to convey and understand emotions through facial expressions. In blood donation settings, facemasks may interfere with professionals' tasks. This qualitative study aims to describe healthcare staff's experiences, beliefs, and attitudes toward facemask wearing and strategies used to overcome communication and relational barriers along the blood donation process. Semistructured qualitative interviews were conducted with 25 healthcare professionals (14 physicians and 11 nurses) working in Italian blood donation centers. The framework analysis method was used to organize the data and identify emerging themes. More than 70% of participants reported discomfort and a negative impact on communicating effectively with donors and building empathic relationships. The difficulty to detect early signs of adverse reactions was reported by almost all nurses, and physicians were concerned that facemasks limited the identification of donors and the detection of deferral criteria. Facemasks have changed the blood donation process, reducing the healthcare professionals' ability to build empathic relationships and communicate with donors effectively. New strategies should be developed to overcome these limitations.

Engaging With Aging: A Qualitative Study of Age-Related Changes and Adaptations

Background and Objectives

In the context of global aging, there is a need to better understand how older adults adapt to their changing health status. Engaging with aging (EWA) is an emerging framework proposed by Carnevali, which provides a new lens to understand an active, conscious daily-living process of managing age-related changes (ARCs) taken on by older adults. Study aims were to (a) describe the ARCs experienced by community-dwelling older adults and (b) identify the strategies and resources used by older adults to accommodate the daily-living challenges caused by the associated ARCs.

Research Design and Methods

We conducted semistructured interviews using a virtual card sort to gather qualitative data about ARCs and strategies to manage ARCs. Interviews were conducted virtually due to coronavirus disease 2019 (COVID-19) restrictions.

Results

Participants included 19 females and 10 males. The mean age was 77.45 years old (range from 64 to 98). Sixteen ARCs (e.g., changes in hearing, changes in stability, changes in sleep, etc.) were mentioned by participants, and their corresponding adaptations were discussed. Participants linked their adaptations to their ARCs based on their changing capacities and needs. Examples of commonly used adaptations included, for example, conserving energy, utilizing tools or technology, and being more conscious before and while taking actions. The challenges caused by COVID-19 in implementing the adaptations were also discussed.

Discussion and Implications

Findings from this study demonstrate how older adults explore, generate, and utilize adaptive behaviors to address their ARCS. This study substantiates the EWA framework by showing common patterns among older adults in linking ARCs with adaptations. Implications for clinicians include using EWA to help older adults identify personalized health solutions that fit their capacities. Researchers may use EWA to design and test interventions by considering the specific ARCs older adults encounter and the attitudes they hold towards the ARCs.

The Impact of Amplification on Cognitive Screening Test Scores

Hearing loss is associated with cognitive decline in older adults. Research has shown that hearing loss negatively affects cognitive screening test measures as patients may mishear verbally administered questions. The purpose of the current study was to investigate the impact of amplification on performance on a commonly used cognitive screening test. Thirty older adults with hearing loss underwent testing with the Mini-Mental State Examination (MMSE) in three conditions: without hearing aids, with hearing aids, and with a personal listening device (PLD). Performance on the MMSE significantly improved with the use of hearing aids or a PLD. Amplification and the use of communication strategies should be considered when administering cognitive screening measures to older adults. Failure to account for hearing status may lead to invalid results and can increase the likelihood of over-referral for further assessment. [Journal of Gerontological Nursing, 48(7), 31-37.].

Masking care: A qualitative investigation of the impact of face masks on the experience of stroke rehabilitation from the perspective of staff and service users with communication difficulties

BACKGROUND

Face mask use has become widespread as a means of reducing transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Research suggests face coverings can impact speech discrimination, therapeutic alliance and the interpretation of non-verbal cues. However, there is little research into the impact of face masks on people with communication difficulties (pwCD) post-stroke.

AIMS

To explore the perspectives of service users and staff on a stroke rehabilitation unit in order to understand the impact of staff wearing face masks on the experience of rehabilitation for pwCD. Strategies that might improve the experience of rehabilitation for pwCD were also explored.

METHODS & PROCEDURES

Semi-structured interviews and a focus group were conducted with six pwCD and five health professionals (HPs) on a stroke rehabilitation unit. The data were analysed using reflexive thematic analysis.

OUTCOMES & RESULTS

Four main interacting themes were identified from the data: (1) face masks as a barrier to effective communication; (2) face masks as a barrier to human connection and therapeutic relationships; (3) the impact of face masks on an individual is influenced by multiple internal and external factors; and (4) there is a need for service provision to evolve to meet pwCD's needs when using face masks.

CONCLUSIONS & IMPLICATIONS

Findings shed light on how face masks can act as a barrier for pwCD within the rehabilitative process, and emphasize that each individual with communication difficulties is likely to be affected to a differing extent, as a result of multiple interacting factors. HPs are encouraged to consider the individual holistically, tailor strategies and adapt to each individual's needs. Further research is required to understand how to optimize rehabilitation outcomes when face masks are used.

WHAT THIS PAPER ADDS

What is already known on the subject There is evidence face masks can affect speech discrimination, therapeutic alliance and interpretation of non-verbal cues. The existing literature predominantly considers people with hearing impairments, mental health needs or the general public. The potential for face masks to impact pwCD post-stroke is high, given pre-existing communication barriers and evidence of increased social isolation. What this paper adds to existing knowledge This study is the first of its kind to explore how face mask use by HPs impacts the experience of rehabilitation for pwCD post-stroke. The authors consider the need to tailor compensatory strategies to each individual and adapt them to meet service users' needs. What are the potential or actual clinical implications of this work? HPs should monitor closely the impact of face mask use on pwCD with whom they are working, and consider what adaptations to delivery are required. It would be helpful for clinicians to have a discussion with pwCD post-stroke to understand the impact of face mask use on them personally and what strategies they would find most helpful within rehabilitation. Additional training by speech and language therapists on supporting effective communication and successful interaction with pwCD may be indicated in the context of face mask use.

Acoustic characteristics of fricatives, amplitude of formants and clarity of speech produced without and with a medical mask

BACKGROUND

Previous research has found that high-frequency energy of speech signals decreased while wearing face masks. However, no study has examined the specific spectral characteristics of fricative consonants and vowels and the perception of clarity of speech in mask wearing.

AIMS

To investigate acoustic-phonetic characteristics of fricative consonants and vowels and auditory perceptual rating of clarity of speech produced with and without wearing a face mask.

METHODS & PROCEDURES

A total of 16 healthcare workers read the Rainbow Passage using modal phonation in three conditions: without a face mask, with a standard surgical mask and with a KN95 mask (China GB2626-2006, a medical respirator with higher barrier level than the standard surgical mask). Speech samples were acoustically analysed for root mean square (RMS) amplitude (A_RMS ) and spectral moments of four fricatives /f/, /s/, /ʃ/ and /z/; and amplitude of the first three formants (A1, A2 and A3) measured from the reading passage and extracted vowels. Auditory perception of speech clarity was performed. Data were compared across mask and non-mask conditions using linear mixed models.

OUTCOMES & RESULTS

The A_RMS of all included fricatives was significantly lower in surgical mask and KN95 mask compared with non-mask condition. Centre of gravity of /f/ decreased in both surgical and KN95 mask while other spectral moments did not show systematic significant linear trends across mask conditions. None of the formant amplitude measures was statistically different across conditions. Speech clarity was significantly poorer in both surgical and KN95 mask conditions.

CONCLUSIONS & IMPLICATIONS

Speech produced while wearing either a surgical mask or KN95 mask was associated with decreased fricative amplitude and poorer speech clarity.

WHAT THIS PAPER ADDS

What is already known on the subject Previous studies have shown that the overall spectral levels in high frequency ranges and intelligibility are decreased for speech produced with a face mask. It is unclear how different types of the speech signals that is, fricatives and vowels are presented in speech produced with wearing either a medical surgical or KN95 mask. It is also unclear whether ratings of speech clarity are similar for speech produced with these face masks. What this paper adds to existing knowledge Speech data collected using a real-world, clinical and non-laboratory-controlled settings showed differences in the amplitude of fricatives and speech clarity ratings between non-mask and mask-wearing conditions. Formant amplitude did not show significant differences in mask-wearing conditions compared with non-mask. What are the potential or actual clinical implications of this work? Wearing a surgical mask or a KN95 mask had different effects on consonants and vowels. It appeared from the findings in this study that these masks only affected fricative consonants and did not affect vowel production. The poorer speech clarity in these mask-wearing conditions has important implications for speech perception in communication between clinical staff and between medical officers and patients in clinics, and between people in everyday situations. The impact of these masks on speech perception may be more pronounced in people with hearing impairment and communication disorders. In voice evaluation and/or therapy sessions, the effects of wearing a medical mask can occur bidirectionally for both the clinician and the patient. The patient may find it more challenging to understand the speech conveyed by the clinician while the clinician may not perceptually assess patient's speech and voice accurately. Given the significant correlation between clarity ratings and fricative amplitude, improving fricative signals would be useful to improve speech clarity while wearing these medical face masks.

“What Is Hidden behind the Mask?” Facial Emotion Recognition at the Time of COVID-19 Pandemic in Cognitively Normal Multiple Sclerosis Patients

Social cognition deficits have been described in people with multiple sclerosis (PwMS), even in absence of a global cognitive impairment, affecting predominantly the ability to adequately process emotions from human faces. The COVID-19 pandemic has forced people to wear face masks that might interfere with facial emotion recognition. Therefore, in the present study, we aimed at investigating the ability of emotion recognition in PwMS from faces wearing masks. We enrolled a total of 42 cognitively normal relapsing–remitting PwMS and a matched group of 20 healthy controls (HCs). Participants underwent a facial emotion recognition task in which they had to recognize from faces wearing or not surgical masks which of the six basic emotions (happiness, anger, fear, sadness, surprise, disgust) was presented. Results showed that face masks negatively affected emotion recognition in all participants (p < 0.001); in particular, PwMS showed a global worse accuracy than HCs (p = 0.005), mainly driven by the “no masked” (p = 0.021) than the “masked” (p = 0.064) condition. Considering individual emotions, PwMS showed a selective impairment in the recognition of fear, compared with HCs, in both the conditions investigated (“masked”: p = 0.023; “no masked”: p = 0.016). Face masks affected negatively also response times (p < 0.001); in particular, PwMS were globally hastier than HCs (p = 0.024), especially in the “masked” condition (p = 0.013). Furthermore, a detailed characterization of the performance of PwMS and HCs in terms of accuracy and response speed was proposed. Results from the present study showed the effect of face masks on the ability to process facial emotions in PwMS, compared with HCs. Healthcare professionals working with PwMS at the time of the COVID-19 outbreak should take into consideration this effect in their clinical practice. Implications in the everyday life of PwMS are also discussed.

Students’ Perceptions of Verbal and Non-Verbal Communication Behaviors during and after the COVID-19 Pandemic

Aiming at shedding light on the implications the COVID-19 pandemic has had on the students’ social and personal lives, this study has focused on the verbal and non-verbal communication and on the surveyees’ personal lives during the pandemic as well as on the perspective of changing their communication behaviors after the pandemic. The 409 respondents, students at Politehnica University of Timisoara, took part in a survey, conducted between 1 April and 30 May 2021, that was posted on isondaje.ro, a Romanian online survey platform. The research has suggested the following results: the adjustment of the verbal communication by speaking in a more articulated manner or more loudly; the overuse of the upper part of the face to compensate for the concealed parts of the face due to face mask wearing; the analysis of the factors underlying the respondents’ actions, i.e., relational attitudes, various greeting forms, various non-verbal reactions, which are aspects that are likely to change even after the pandemic. The results have also presented the changes that interpersonal communication could go through under the pressure of the restrictions imposed by the pandemic, but also the ways through which people try to protect their most valuable asset, i.e., communication, which defines humanity and makes us unique as human beings.

Ensuring communication access for all during the COVID-19 pandemic and beyond: supporting patients, providers, and caregivers in hospitals

The COVID-19 pandemic has revealed substantial gaps in communication access for patients across hospital settings. With the rise in positive cases globally, the need for communication enhancement strategies, including augmentative and alternative communication (AAC), has emerged as a critical need. Many resources exist that describe AAC assessment and intervention processes in the acute care setting; however, AAC service provision in the COVID-19 pandemic is fraught with many unanticipated challenges. Patients, providers, and caregivers have encountered significant communication strain both at the bedside and beyond hospital walls, resulting in a communication crisis induced by many COVID-19 related variables. This article describes the sequelae of symptoms a person with COVID-19 may experience, progression of communication needs, and evidence-based solutions to supporting communication access. Barriers related to the COVID-19 pandemic are outlined (e.g., evolving infection control practices, personal protective equipment requirements, visitor policies, and more) along with response recommendations to support communication enhancement efforts for people with and without COVID-19 benefiting from access to AAC.

Behind the Mask: Emotion Recognition in Healthcare Students

Current widespread facemask usage profoundly impacts clinical practice and healthcare education where communicational dimensions are essential to the care and teaching processes. As part of a larger study, 208 medical and nursing students were randomly assigned to a masked vs unmasked version of the standardized facial emotion recognition task DANVA2. A significantly higher number of errors existed in the masked vs unmasked condition. Differences for happy, sad, and angry faces, but not for fearful faces, existed between conditions. Misinterpretation of facial emotions can severely affect doctor-patient and inter-professional communication in healthcare. Teaching communication in medical education must adapt to the current universal use of facemasks in professional settings.

COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection

Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk ("Emmentaler cheese model"), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.

Patient Factors and Hospital Outcomes Associated With Atypical Presentation in Hospitalized Older Adults With COVID-19 During the First Surge of the Pandemic

Background

Literature indicates an atypical presentation of COVID-19 among older adults (OAs). Our purpose is to identify the frequency of atypical presentation and compare demographic and clinical factors, and short-term outcomes, between typical versus atypical presentations in OAs hospitalized with COVID-19 during the first surge of the pandemic.

Methods

Data from the inpatient electronic health record were extracted for patients aged 65 and older, admitted to our health systems’ hospitals with COVID-19 between March 1 and April 20, 2020. Presentation as reported by the OA or his/her representative is documented by the admitting professional and includes both symptoms and signs. Natural language processing was used to code the presence/absence of each symptom or sign. Typical presentation was defined as words indicating fever, cough, or shortness of breath; atypical presentation was defined as words indicating functional decline or altered mental status.

Results

Of 4 961 unique OAs, atypical presentation characterized by functional decline or altered mental status was present in 24.9% and 11.3%, respectively. Atypical presentation was associated with older age, female gender, Black race, non-Hispanic ethnicity, higher comorbidity index, and the presence of dementia and diabetes mellitus. Those who presented typically were 1.39 times more likely than those who presented atypically to receive intensive care unit–level care. Hospital outcomes of mortality, length of stay, and 30-day readmission were similar between OAs with typical versus atypical presentations.

Conclusion

Although atypical presentation in OAs is not associated with the same need for acute intervention as respiratory distress, it must not be dismissed.

Communication during the COVID-19 pandemic: evaluation study on self-perceived competences and views of health care professionals

PURPOSE

The aims of this study were to describe communication experiences while wearing a mask during COVID-19 pandemic in 2020, to identify possible mask-related barriers to COVID-19-adapted communications and to investigate whether the ABC mnemonic (A: attend mindfully; B: behave calmly; C: communicate clearly) might address these.

METHODS

This study was a cross-sectional, voluntary, web-based survey between January and February 2021. A 22-item survey was developed using the Surveymonkey platform and question styles were varied to include single choice and Likert scales. The respondents were also asked to view a short video presentation, which outlined the ABC mnemonic. CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure completeness of reporting. Diverging stacked bar charts were created to illustrate Likert scale responses.

RESULTS

We received 226 responses. The respondents were mostly women (60.2%) and the majority worked in a teaching hospital (64.6%). The majority of the respondents indicated issues related to lack of time during clinical encounters, uncertainty about how to adapt communication, lack of personal protective equipment, lack of communication skills and lack of information about how to adapt their own communication skills. In addition, the participants indicated acknowledging emotions and providing information using clear, specific, unambiguous, and consistent lay language while wearing a mask were among the main communication challenges created during the COVID-19 pandemic. Finally, the study showed significantly improved self-perceived competency regarding key communication after watching the short video presentation.

CONCLUSION

Effective communication in medical encounters requires both verbal and nonverbal skills.

Masks and Face Coverings for the Lay Public : A Narrative Update

Whether and when to mandate the wearing of facemasks in the community to prevent the spread of coronavirus disease 2019 remains controversial. Published literature across disciplines about the role of masks in mitigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is summarized. Growing evidence that SARS-CoV-2 is airborne indicates that infection control interventions must go beyond contact and droplet measures (such as handwashing and cleaning surfaces) and attend to masking and ventilation. Observational evidence suggests that masks work mainly by source control (preventing infected persons from transmitting the virus to others), but laboratory studies of mask filtration properties suggest that they could also provide some protection to wearers (protective effect). Even small reductions in individual transmission could lead to substantial reductions in population spread. To date, only 1 randomized controlled trial has examined a community mask recommendation. This trial did not identify a significant protective effect and was not designed to evaluate source control. Filtration properties and comfort vary widely across mask types. Masks may cause discomfort and communication difficulties. However, there is no evidence that masks result in significant physiologic decompensation or that risk compensation and fomite transmission are associated with mask wearing. The psychological effects of masks are culturally shaped; they may include threats to autonomy, social relatedness, and competence. Evidence suggests that the potential benefits of wearing masks likely outweigh the potential harms when SARS-CoV-2 is spreading in a community. However, mask mandates involve a tradeoff with personal freedom, so such policies should be pursued only if the threat is substantial and mitigation of spread cannot be achieved through other means.