Scaling and sustaining COVID-19 vaccination through meaningful community engagement and care coordination for underserved communities: hybrid type 3 effectiveness-implementation sequential multiple assignment randomized trial

BACKGROUND

COVID-19 inequities are abundant in low-income communities of color. Addressing COVID-19 vaccine hesitancy to promote equitable and sustained vaccination for underserved communities requires a multi-level, scalable, and sustainable approach. It is also essential that efforts acknowledge the broader healthcare needs of these communities including engagement in preventive services.

METHODS

This is a hybrid type 3 effectiveness-implementation study that will include a multi-level, longitudinal, mixed-methods data collection approach designed to assess the sustained impact of a co-created multicomponent strategy relying on bidirectional learning, shared decision-making, and expertise by all team members. The study capitalizes on a combination of implementation strategies including mHealth outreach with culturally appropriate messaging, care coordination to increase engagement in high priority preventive services, and the co-design of these strategies using community advisory boards led by Community Weavers. Community Weavers are individuals with lived experience as members of an underserved community serving as cultural brokers between communities, public health systems, and researchers to co-create community-driven, culturally sensitive public health solutions. The study will use an adaptive implementation approach operationalized in a sequential multiple assignment randomized trial design of 300 participants from three sites in a Federally Qualified Health Center in Southern California. This design will allow examining the impact of various implementation strategy components and deliver more intensive support to those who benefit from it most. The primary effectiveness outcomes are COVID-19 vaccine completion, engagement in preventive services, and vaccine confidence. The primary implementation outcomes are reach, adoption, implementation, and maintenance of the multicomponent strategy over a 12-month follow-up period. Mixed-effects logistic regression models will be used to examine program impacts and will be triangulated with qualitative data from participants and implementers.

DISCUSSION

This study capitalizes on community engagement, implementation science, health equity and communication, infectious disease, and public health perspectives to co-create a multicomponent strategy to promote the uptake of COVID-19 vaccination and preventive services for underserved communities in San Diego. The study design emphasizes broad engagement of our community and clinic partners leading to culturally sensitive and acceptable strategies to produce lasting and sustainable increases in vaccine equity and preventive services engagement.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05841810 May 3, 2023.

How do we differentiate not demonise - Is there a role for healthier processed foods in an age of food insecurity? Proceedings of a roundtable event

The 'ultra-processed food' (UPF) concept, with classification of foods by 'level of processing' rather than nutrient profiles, and its relationship with health outcomes, is currently a topic of debate among academics and increasingly referred to in the media. The British Nutrition Foundation convened a virtual roundtable on 6th July 2022 to gather views on the use of the term (and current definitions of) UPF for public health messaging, seeking to establish areas of consensus and disagreement and identify topics for further research. A small group of invited expert stakeholders attended, including representatives from academia, policy, behavioural science, communications, health, food science, retail and consumer interests. Participants' discussions clustered into cogent themes which included: problems with the use of definitions for UPF, the lack of causal evidence and defined mechanisms linking processing per se with poor health outcomes, and advice that may result in consumer confusion. There was agreement that many foods classified as UPF are high in fat, sugars and/or salt and public health messages should continue to focus on reducing these in the diet since it is unclear whether reported associations between high intakes of UPF and poor health reflect poorer dietary patterns (defined by nutrient intakes), and nutrient-health relationships are well established. Examples of misalignment were also highlighted (i.e. some foods are classified as UPF yet recommended in food-based dietary guidelines [featuring in healthy dietary patterns]). This raises challenges for consumer communication around UPF. Concern was also expressed about potential unintended consequences, particularly for vulnerable groups, where advice to avoid UPF could create stigma and guilt due to lack of time or facilities to prepare and cook meals from scratch. It could also impact on nutrient intakes, as some foods classified as UPF represent more affordable sources of important nutrients (e.g. packaged wholemeal bread). Discordance between the concept of UPF and current strategies to improve public health, such as reformulation, was also discussed. The group concluded that the use of the concept of UPF in UK policy (e.g. dietary guidelines) would be unhelpful at present. Overall, participants felt that it was more important to focus on providing practical advice around selection of healthier processed foods and making healthier foods more accessible rather than promoting the avoidance of UPF. The latter may act to demonise all foods classified as UPF by current definitions, including some affordable nutrient-dense foods.

One Dose Is Not Enough: The Beneficial Effect of Corrective COVID-19 Information Is Diminished If Followed by Misinformation

The World Health Organization (WHO) released a series of mythbuster infographics to combat misinformation during the COVID-19 infodemic. While the corrective effects of such debunking interventions have typically been examined in the immediate aftermath of intervention delivery; the durability of these corrective effects and their resilience against subsequent misinformation remains poorly understood. To this end, we asked younger and older adults to rate the truthfulness and credibility of 10 statements containing misinformation about common COVID-19 myths, as well as their willingness to share the statements through social media. They did this three times, before and after experimental interventions within a single study session. In keeping with established findings, exposure to the WHO's myth-busting infographics-(a) improved participants' ratings of the misinformation statements as untruthful and uncredible and (b) reduced their reported willingness to share the statements. However, within-subject data revealed these beneficial effects were diminished if corrective information was presented shortly by misinformation, but the effects remained when further corrective information was presented. Throughout the study, younger adults rated the misinformation statements as more truthful and credible and were more willing to share them. Our data reveal that the benefit of COVID-19 debunking interventions may be short-lived if followed shortly by misinformation. Still, the effect can be maintained in the presence of further corrective information. These outcomes provide insights into the effectiveness and durability of corrective information and can influence strategies for tackling health-related misinformation, especially in younger adults.

A pre- and post-intervention study testing the effect of exposure to languageless animated images communicating COVID-19 preventive behaviours on behavioural intentions and beliefs of Guatemalan adults

Background

Effective health communication to encourage participation in COVID-19 preventive behaviours is crucial in helping mitigate viral spread. Intentions and beliefs are known determinants of adherence to these behaviours, therefore, health communication interventions based on these constructs may be effective. Visual languageless messages can be particularly useful in multilingual countries, where text-based communications can limit message exposure. This pre- and post-intervention study sought to identify the effect of exposure to languageless animated messages, presented in the Graphic Interchange Format (GIF), communicating COVID-19 preventive behaviours (physical distancing, handwashing, and mask-wearing) on behavioural intentions and beliefs.

Methods

Between February and March 2021, a nationally representative sample of 308 Guatemalan adults completed this online survey experiment. Self-reported performance of preventive behaviours, understanding of COVID-19 transmission risk, as well as intentions, self-efficacy, and outcome expectancy beliefs about preventive behaviours were assessed at baseline. Participants were then exposed to a random combination of three of four possible GIFs in random presentation order. Following exposure to each GIF, intentions, self-efficacy, and outcome expectancy beliefs were reassessed.

Results

In terms of main effects, GIF exposure was significantly associated with improved intentions, self-efficacy, and outcome expectancy beliefs in relation to physical distancing; intentions and outcome expectancy beliefs in relation to handwashing; and intentions and self-efficacy in relation to mask-wearing. These associations were not dependent on the combination of the three of four possible GIFs presented. Pairwise comparisons revealed that observed improvements in scores were most pronounced from baseline to the first GIF exposure and reduced thereafter.

Conclusions

Exposure to languageless GIFs communicating COVID-19 preventive behaviours is associated with improvements in key social-cognitive determinants of those behaviours. Dosage of GIF exposure and durability of effects are issues that warrant further attention so we can better understand the conditions and point at which benefits are maximised. Moreover, the effect on behavioural adherence is yet to be determined. GIFs provide a valuable means to widely disseminate health messages via social media during public health crises, such as COVID-19. When these messages are languageless, the potential reach of dissemination can be maximised.

Narrative elaboration makes misinformation and corrective information regarding COVID-19 more believable

OBJECTIVE

People gather information about health topics from online channels oftentimes awash with misinformation. Investigating this problem during the COVID-19 pandemic is important, as the misinformation effect occurs when misleading details are embedded in narratives and questions. This pilot study investigated whether narrative elaboration increases believability in misinformation statements about COVID-19, and willingness to share these statements online.

RESULTS

Results from our online survey (n = 80) demonstrated that narrative elaboration increased believability in both misinformation and accurate statements, with a more pronounced effect on younger adults. Future research may investigate cognitive vulnerabilities imposed by elaborate narratives embedded in online health misinformation with increased attention on developing misinformation resilience among younger adults.

Postoperative respiratory depression caused by iatrogenic hypermagnesaemia

Hypermagnesaemia is an uncommon electrolyte disorder which can be fatal if not recognised and treated promptly. The signs and symptoms of hypermagnesaemia are non-specific, making it an under-diagnosed cause of cardiovascular dysfunction, hypocalcaemia, and neurological and respiratory depression. Since magnesium homeostasis is handled almost exclusively by the kidneys, symptomatic hypermagnesaemia seldom occurs in the context of normal renal function; when it does, it is usually iatrogenic. Here, we report a case of iatrogenic hypermagnesaemia which presented as respiratory depression, preventing weaning from mechanical ventilation following cardiac surgery in a patient in the early stages of chronic kidney disease. On investigation he was found to have isolated severe hypermagnesaemia, following an intravenous bolus of magnesium sulphate administered intra-operatively to treat tachyarrhythmia. Before administering intravenous magnesium therapeutically, it is important for clinicians to assess renal function and baseline serum magnesium along with other possible risk factors for hypermagnesaemia, and to actively look for signs and symptoms of magnesium toxicity when the patient is receiving therapeutic magnesium.

Dynamics of social corrections to peers sharing COVID-19 misinformation on WhatsApp in Brazil

OBJECTIVE

Online COVID-19 misinformation is a serious concern in Brazil, home to the second-largest WhatsApp user base and the second-highest number of COVID-19 deaths. We examined the extent to which WhatsApp users might be willing to correct their peers who might share COVID-19 misinformation.

MATERIALS AND METHODS

We conducted a cross-sectional online survey using Qualtrics among 726 Brazilian adults to identify the types of social correction behaviors (SCBs) and health and technological factors that shape the performance of these behaviors.

RESULTS

Brazil's WhatsApp users expressed medium to high levels of willingness to engage in SCBs. We discovered 3 modes of SCBs: correction to the group, correction to the sender only, and passive or no correction. WhatsApp users with lower levels of educational attainment and from younger age groups were less inclined to provide corrections. Lastly, the perceived severity of COVID-19 and the ability to critically evaluate a message were positively associated with providing corrections to either the group or the sender.

DISCUSSION

The demographic analyses point to the need to strengthen information literacy among population groups that are younger with lower levels of educational attainment. These efforts could facilitate individual-level contributions to the global fight against misinformation by the World Health Organization in collaboration with member states, social media companies, and civil society.

CONCLUSION

Our study suggests that Brazil's WhatsApp users might be willing to actively respond with feedback when exposed to COVID-19 misinformation by their peers on small-world networks like WhatsApp groups.

Prognostic significance of Troponin I in patients undergoing primary percutaneous coronary intervention

This observational study investigates the prognostic significance of troponin I in patients undergoing primary percutaneous intervention (pPCI). Sequential cardiac biomarker sampling of the enrolled patients (n = 167) was performed on admission and at 6,12,24 and 48 h. Clinical characteristics, major adverse cardiac and cerebrovascular events (MACCE) (death, reinfarction, stroke and new or worsening heart failure) and left ventricular ejection fraction (LVEF) were noted on admission and 30 day follow-up. A 24-h troponin I level >60 ng/ml predicted MACCE (OR 4.06, p = 0.023; adjusted OR 5.09, p = 0.034) and less than 10% improvement in LVEF on follow-up (OR 2.49, p = 0.007). Thus, in patients undergoing pPCI, 24-h cardiac Troponin I is a good non-invasive surrogate to predict MACCE and improvement in LVEF.

Themes, communities and influencers of online probiotics chatter: A retrospective analysis from 2009-2017

We build on recent examinations questioning the quality of online information about probiotic products by studying the themes of content, detecting virtual communities and identifying key influencers in social media using data science techniques. We conducted topic modelling (n = 36,715 tweets) and longitudinal social network analysis (n = 17,834 tweets) of probiotic chatter on Twitter from 2009–17. We used Latent Dirichlet Allocation (LDA) to build the topic models and network analysis tool Gephi for building yearly graphs. We identified the top 10 topics of probiotics-related communication on Twitter and a constant rise in communication activity. However the number of communities grew consistently to peak in 2014 before dipping and levelling off by 2017. While several probiotics industry actors appeared and disappeared during this period, the influence of one specific actor rose from a hub initially to an authority in the latter years. With multi-brand advertising and probiotics promotions mostly occupying the Twitter chatter, scientists, journalists, or policymakers exerted minimal influence in these communities. Consistent with previous research, we find that probiotics-related content on social media veers towards promotions and benefits. Probiotic industry actors maintain consistent presence on Twitter while transitioning from hubs to authorities over time; scientific entities assume an authoritative role without much engagement. The involvement of scientific, journalistic or regulatory stakeholders will help create a balanced informational environment surrounding probiotic products.

Barriers to older adults' uptake of mobile-based mental health interventions

Background

To address increasing demand of mental healthcare treatments for older adults and the need to reduce delivery costs, healthcare providers are turning to mobile applications. The importance of psychological barriers have been highlighted in the uptake of mobile-based mental health interventions and efforts have been made to identify these barriers in order to facilitate initial uptake and acceptance. However, limited research has focused on older adults’ awareness of these applications and factors that might be hindering their use.

Objective

The purpose of this study was to explore the perceived barriers that older adults experience in the uptake of mobile-based mental health interventions.

Methods

Semi-structured interviews were conducted with a sample of 10 older adults, 50 years or older (female = 7, mean age = 68 years), who experienced periods of low mood. National Health Service applications were demonstrated to facilitate conversation and explore participants’ understanding of mental health and mobile-based mental health interventions. Thematic analysis was used to analyse the interview transcripts.

Results

The social ecological model was adopted as an organising framework for the thematic analysis which identified six distinct barriers to older adults’ uptake of mobile-based mental health interventions: mental electronic-health (e-health) awareness, interaction with technology, discontinuation, ‘seeing’ facilitates therapeutic alliance, incongruent role of the general practitioner and privacy and confidentiality.

Conclusions

Older adults experience a number of barriers to uptake ranging from the individual level to a macro, organisational level. The practical implications of these barriers are discussed such as the need for increased awareness of mobile-based mental health interventions among older adults.

Enhancing organizational health literacy in a rural Missouri clinic: a qualitative case study

PURPOSE

The purpose of this paper is to evaluate a collaborative effort between a health care organization and academic institution to strengthen organizational health literacy.

DESIGN/METHODOLOGY/APPROACH

The intervention took place at a rural, federally qualified health clinic in Missouri between May 2009 and April 2011. Qualitative interviews of key informants were conducted before (n=35) and after (n=23) the intervention to examine program implementation and success in effecting organizational change.

FINDINGS

Intervention activities helped establish a comprehensive understanding of health literacy. The project achieved moderate, fundamental and sustainable organizational change. The program successfully integrated health literacy practices into clinic systems and garnered leadership and organizational commitment, helped the workforce improve interpersonal communication and embedded practices making health education materials more accessible.

ORIGINALITY/VALUE

The study points to programmatic, conceptual and methodological challenges that must be addressed for organizations to improve health literacy practices, and suggests change management strategies to advance organizational health literacy.

Virtual Zika transmission after the first U.S. case: who said what and how it spread on Twitter

BACKGROUND

This paper goes beyond detecting specific themes within Zika-related chatter on Twitter, to identify the key actors who influence the diffusive process through which some themes become more amplified than others.

METHODS

We collected all Zika-related tweets during the 3 months immediately after the first U.S. case of Zika. After the tweets were categorized into 12 themes, a cross-section were grouped into weekly datasets, to capture 12 amplifier/user groups, and analyzed by 4 amplification modes: mentions, retweets, talkers, and Twitter-wide amplifiers.

RESULTS

We analyzed 3,057,130 tweets in the United States and categorized 4997 users. The most talked about theme was Zika transmission (~58%). News media, public health institutions, and grassroots users were the most visible and frequent sources and disseminators of Zika-related Twitter content. Grassroots users were the primary sources and disseminators of conspiracy theories.

CONCLUSIONS

Social media analytics enable public health institutions to quickly learn what information is being disseminated, and by whom, regarding infectious diseases. Such information can help public health institutions identify and engage with news media and other active information providers. It also provides insights into media and public concerns, accuracy of information on Twitter, and information gaps. The study identifies implications for pandemic preparedness and response in the digital era and presents the agenda for future research and practice.

Zika reveals India's risk communication challenges and needs

India's approach to disseminating information about the first three cases of the Zika virus was criticised nationally and internationally after the issue came to light in May 2017 through a World Health Organization news release. We analyse the incident from a risk communication perspective. This commentary recaps the events and synthesises key arguments put forth by the news media and public health stakeholders. We use Peter Sandman's risk = hazard + outrage framework - also adopted by India's risk communication planners - to analyse India's risk communication response and contextualise it against the mandate of the National Risk Communication Plan and Integrated Disease Surveillance Programme. We conclude with recommendations for India's risk communication policymakers, including the need to develop capacity for risk communication research and scholarship in the country.

What's buzzing on your feed? Health authorities' use of Facebook to combat Zika in Singapore

In 2016, Singapore grappled with one of the largest Zika outbreaks in Southeast Asia. This study examines the use of Facebook for Zika-related outreach by the Ministry of Health (MOH) and the National Environmental Agency (NEA) from March 1, 2015, to September 1, 2016, and public response to this effort. Despite nearly equivalent outreach, MOH's Facebook posts received more likes (µ = 3.49) and shares (µ = 30.11), whereas NEA's posts received more comments (µ = 4.55), with NEA posting mostly on prevention (N = 30) and MOH on situational updates (N = 24). Thematic analyses identified prevention-related posts as garnering the most likes (N = 1277), while update-related posts were most shared (N = 1059) and commented upon (N = 220). Outreach ceased briefly for 2 months after Singapore's first imported case of Zika, but increased following the outbreak of locally transmitted cases in August 2016. Public engagement was significantly higher during Zika compared with prior haze and dengue outbreaks. The results indicate the value of Facebook as a tool for rapid outreach during infectious disease outbreaks, and as a "listening" platform for those managing the situation. We discuss implications for public health communication research and policy.

Comparing State Legislative Aides’ Perspectives on Tobacco Policymaking in States With Strong and Weak Policies: A Qualitative Study

Purpose:

The study compared perceptions of state legislative aides about tobacco policymaking in states with strong and weak tobacco control policies.

Approach:

Qualitative in-depth interviews carried out in 2009.

Setting:

The US states were ranked on a combination of tobacco prevention funding, taxes, and presence of smoke-free policies. States at the top and bottom of the rankings were chosen.

Participants:

Interviews were conducted with 10 legislative aides in 5 states with strong tobacco control policies and 10 aides in 7 states with weak policies.

Method:

Twenty semistructured interviews were conducted, coded, and analyzed using a consensus coding process.

Results:

Tobacco control was a lower priority in states with weak policies, and respondents from these states listed more barriers to tobacco control policymaking than those from states with strong policies. Successful arguments for tobacco control emphasized operational applications, for example, enhanced revenue from tobacco taxes or safety of children and employees.

Conclusion:

Our findings support propositions posited in the Advocacy Coalition Framework. They point to the preeminence of contextual factors, notably political leanings and economic climate on success of policy change efforts. Lessons learned from participants from states with strong policy nonetheless show promise for success in states with weak policy.

A Social Media mHealth Solution to Address the Needs of Dengue Prevention and Management in Sri Lanka

Background

Sri Lanka has witnessed a series of dengue epidemics over the past five years, with the western province, home to the political capital of Colombo, bearing more than half of the dengue burden. Existing dengue monitoring prevention programs are exhausted as public health inspectors (PHIs) cope with increasing workloads and paper-based modes of surveillance and education, characterizing a reactive system unable to cope with the enormity of the problem. On the other hand, the unprecedented proliferation and affordability of mobile phones since 2009 and a supportive political climate have thus far remained unexploited for the use of mobile-based interventions for dengue management.

Objective

To conduct a needs assessment of PHIs in Colombo with respect to their dengue-related tasks and develop a new mobile-based system to address these needs while strengthening existing systems.

Methods

One-on-one in-depth interviews were conducted with 29 PHIs to a) gain a nuanced, in-depth understanding of the current state of surveillance practices, b) understand the logistical, technological and social challenges they confront, and c) identify opportunities for mobile-based interventions. Quantitative analysis included simple descriptive statistics while qualitative analysis comprised textual analysis of 209 pages of transcripts (or nearly 600 minutes of conversations) using grounded theory approaches.

Results

Current paper-based data collection practices for dengue surveillance involved a circuitous, time consuming process that could take between 7-10 days to officially report and record a single case. PHIs confronted challenges in terms of unreliable, standalone GIS devices, delays in registering mosquito breeding sites and lack of engagement from communities while delivering dengue education. These findings, in concert with a high motivation to use mobile-based systems, informed the development of Mo-Buzz, a mobile-based system that integrates three components – digitized surveillance, dynamic disease mapping and digitized dengue education – on a common platform. The system was developed through an iterative, evolutionary, collaborative process, consistent with the Spiral model of software development and is currently being used by all 55 PHIs in the CMC system.

Conclusions

Given the entrenched nature of existing paper-based systems in PHIs’ work habits, we expect a gradual adoption curve for Mo-Buzz in the future. Equally, we expect variable adoption of the system with respect to its specific components, and specific PHI sub-groups (younger versus older). The Mo-Buzz intervention is a response to multiple calls by the global mHealth community for collaborations in the area of mobile interventions for global health. Our experience revealed that the benefits of this paradigm lies in alleviating country-specific public health challenges through a commonly shared understanding of cultural mores, and sharing of knowledge and technologies. We call upon future researchers to further dissect the applicability of the Spiral Model of software development to mHealth interventions and contribute to the mHealth evidence debate from theoretical and applied perspectives.

Social media-based civic engagement solutions for dengue prevention in Sri Lanka: results of receptivity assessment

This article focuses on a novel social media-based system that addresses dengue prevention through an integration of three components: predictive surveillance, civic engagement and health education. The aim was to conduct a potential receptivity assessment of this system among smartphone users in the city of Colombo, the epicenter of the dengue epidemic in the island country of Sri Lanka. Grounded in Protection Motivation Theory (PMT) and using a convenience sampling approach, the cross-sectional survey assessed perceived severity (PSe), perceived susceptibility (PSu), perceived response efficacy (PRE), perceived self-efficacy (PSE) and intention-to-use (IU) among 513 individuals. The overall receptivity to the system was high with a score of >4.00 on a five-point scale. Participants belonging to younger, better educated and higher income groups reported significantly better perceptions of the efficaciousness of the system, were confident in their ability to use the system, and planned to use it in the future. PMT variables contributed significantly to regression models predicting IU. We concluded that a social media-based system for dengue prevention will be positively received among Colombo residents and a targeted, strategic health communication effort to raise dengue-related threat perceptions will be needed to encourage greater adoption and use of the system.

Baseline Evaluation of a Participatory Mobile Health Intervention for Dengue Prevention in Sri Lanka

Challenges posed by infectious disease outbreaks have led to a range of participatory mobile phone-based innovations that use the power of crowdsourcing for disease surveillance. However, the dynamics of participatory behavior by crowds in such interventions have yet to be examined. This article reports results from a baseline evaluation of one such intervention called Mo-Buzz, a mobile-based crowdsource-driven socially mediated system developed to address gaps in dengue surveillance and education in Colombo, Sri Lanka. We conducted a 30-minute cross-sectional field survey (N = 404) among potential users of Mo-Buzz in Colombo. We examined individual, institutional, and cultural factors that influence their potential intention-to-use Mo-Buzz and assessed if these factors varied by demographic factors. Descriptive analysis revealed high perceived ease-of-use (PEOU; M = 3.81, SD = 0.44), perceived usefulness (PU; M = 4.01, SD = 0.48), and intention-to-use (PI; M = 3.91, SD = 0.46) among participants. Analysis of variance suggested participants in the 31 to 40 years age group reported highest PEOU, whereas the oldest group reported high perceived institutional efficacy (M = 3.59, SD = 0.64) and collectivistic tendencies. Significant differences (at the p < .05 level) were also found by education and income. Regression analysis demonstrated that PU, behavioral control, institutional efficacy, and collectivism were significant predictors of PI. We concluded that despite high overall PI, future adoption and use of Mo-Buzz will be shaped by a complex mix of factors at different levels of the public health ecology. Implications of study findings from theoretical and practical perspectives related to the future adoption of mobile-based participatory systems in public health are discussed and ideas for a future research agenda presented.

'It's effective but should I bother?' A study of personal protection measures against Malaria in urban India

OBJECTIVES

Malaria affects millions of people in urban and rural India every year. This study addresses two main gaps in current research: 1) attitudes towards personal protective strategies against Malaria among urban populations; and 2) understanding of the extent to which urban health information seeking preferences shape preventive behaviours.

STUDY DESIGN

Cross-sectional face-to-face surveys using stratified sampling design.

METHODS

A 60-min survey was carried out to 1000 middle-of-pyramid (MOP) population in five main cities in India by trained interviewers. Variables assessed included perceived effectiveness and actual practice of 14 scientific and indigenous personal protection methods, Malaria-related attitudes (susceptibility, severity and response efficacy) and health information seeking preferences.

RESULTS

Actual practice of Malaria preventive behaviours was found to be significantly lower than the perceived effectiveness of each of the fourteen scientific and indigenous methods. Television, newspapers, and mobile phones were reported as the top three preferred media for seeking public health information. Lastly, perceived susceptibility, response efficacy, and health-related media use were found to play significant roles in predicting actual practice behaviours.

CONCLUSIONS

Our study highlights a need for health authorities to focus on translating positive attitudes to actual practice of preventive behaviours. Communication efforts may focus on the use of TV, newspapers and mobile phones for greater reach and efficacy. Other implications for Malaria prevention programs are discussed.

Youth, new media, and HIV/AIDS: determinants of participation in an online health social movement

Abstract This paper focuses on the Global Youth Coalition for HIV/AIDS (GYCA), a collaboration of young people who utilize the Internet to organize and inform the global youth HIV/AIDS social movement. We used a trans-disciplinary conceptual framework guided by the diffusion of innovations approach to explore factors that influence online participation among the coalition's members and to explain perceived effects of participation. We used a randomized stratified sampling strategy to conduct an online 7 week survey of GYCA's members (n=275). Descriptive statistics revealed that the majority of participants were from Africa (∼54%) and Asia (∼24%), with an average age of 27 years. Multiple linear regression analyses showed that participation in the e-consultations (R(2)=0.39, p<0.001) was influenced by a greater number of factors compared to the listserv (R(2)=0.20, p<0.001). Online participation significantly influenced perceptions about the coalition's social networking utility (R(2)=0.21, p<0.001). Perceived social networking utility significantly explained perceived effects on program areas such as knowledge sharing (R(2)=0.49, p<0.001), capacity building (R(2)=0.48, p<0.001), and political advocacy (R(2)=0.44, p<0.001). We concluded that a range of factors shapes participation in online health social movements. Initiatives such as GYCA need regular, intensive assessments to understand these factors for better tailoring their online activities to members' needs and for greater impact.

A 21st century approach to tackling dengue: Crowdsourced surveillance, predictive mapping and tailored communication

This paper describes a social media system to prevent dengue in Sri Lanka and potentially in the rest of the South and Southeast Asia regions. The system integrates three concepts of public health prevention that have thus far been implemented only in silos. First, the predictive surveillance component uses a computer simulation to forewarn health authorities and the general public about impending disease outbreaks. The civic engagement component allows the general public to use social media tools to interact and engage with health authorities by aiding them in surveillance efforts by reporting symptoms, mosquito bites and breeding sites using smartphone technologies. The health communication component utilizes citizen data gathered from the first two components to disseminate customized health awareness messages to enhance knowledge and increase preventive behaviors among citizens. The system, known as "Mo-Buzz," will be made available on a host of digital platforms like simple mobile phones, smart phones and a website. We present challenges and lessons learnt including content validation, stakeholder collaborations and applied trans-disciplinary research.

Prostate cancer survivors as community health educators: implications for informed decision making and cancer communication

Recent evidence questioning the effectiveness of prostate-specific antigen testing leave community-based prostate cancer (CaP) outreach programs with a dilemma between promoting screening and highlighting screening risks. CaP survivors are uniquely positioned to address this problem by drawing upon real-life experiences to share nuanced information and perspectives. While CaP survivors have historically been incorporated into outreach programs, little is known about their impact on psychosocial outcomes and their effectiveness compared to professional health educators. This study addressed these gaps through a quasi-experimental design where African American men attended a CaP screening session conducted by a health educator (HE) or survivor educator (SV). The presentation included prostate cancer statistics, CaP information, and descriptions of CaP screening tests. SV were encouraged to bolster their presentations with personal stories whereas HE maintained fidelity to the curriculum content. All participants completed pre- and post-test questionnaires. Our sample comprised a total of 63 participants (HE group = 32; SV group = 31) with an age range of 40-70 years. Decision self-efficacy increased significantly in the SV group (p = 0.01) whereas perceived screening risks reduced significantly in the HE group (p < 0.001). No significant changes were found in knowledge, subjective norms, outcome expectancies, and screening benefits. Survivor educators were found to have significantly greater appeal (p = 0.03), identification with audience (p = 0.01), and liking (p = 0.03). Training CaP survivors as health educators might be a viable strategy for community-based cancer communication efforts confronted by the CaP screening controversy. We discuss conceptual and programmatic implications of our findings and present directions for future research.

Determinants of food label use among supermarket shoppers: a Singaporean perspective

OBJECTIVE

Examining factors influencing food label use among Singapore's supermarket shoppers using the Theory of Planned Behavior.

DESIGN

A point-of-purchase survey among general shoppers in 2 supermarkets.

SETTING

Singapore, a country whose population is exposed to a wide range of food labeling formats because of the import-dependent nature of the food industry.

PARTICIPANTS

A total of 200 shoppers (Chinese [75.5%], Malays [8.5%], and Indians [7.0%]) participated in the survey.

MAIN OUTCOME MEASURES

Independent variables composed of attitudes and subjective norms (both 5-point Likert); perceived behavioral control and diet-health concern (both 5-point semantic differential); and knowledge (18-item index). Dependent variables were intention to use food labels (5-point differential scale) and actual use of food labels (19-item index).

ANALYSIS

Data were analyzed using descriptive statistics, mean analysis, and multivariate linear regression.

RESULTS

Low levels of knowledge and health literacy were found. Attitudes, subjective norms, and behavioral control differed significantly by age and ethnicity. Subjective norms and diet-health concern were significant predictors of intention to use food labels.

CONCLUSIONS AND IMPLICATIONS

Lack of knowledge but positive attitudes toward food labels make Singapore's consumers vulnerable to misusing or being misled by food label information. Demographic differences demonstrate the need to develop targeted educational interventions and enhance awareness of and ability to use food labels.

Individual and community influences on adherence to directives in the event of a plague attack: survey results

OBJECTIVES

  During a public health emergency, public health officials issue directives with actions people need to take to protect themselves. Past research has shown that adherence to these directives depends on individual beliefs and circumstances. This report presents new research about the effects of community factors on adherence.

METHODS

  A random digit-dial survey of 936 residents in the St Louis, Missouri, area was conducted in 2008 to assess barriers to and facilitators of adherence to directives issued in response to a hypothetical scenario involving the intentional release of the bacterium that causes plague. Community factors were assessed using characteristics of census tracts for individual respondents. Multilevel modeling was used to understand how individual and community factors contributed to the likelihood of adherence.

RESULTS

  The majority of participants indicated that they would adhere to 3 distinct directives. Community poverty and ethnic homogeneity as well as individual-level barriers were negatively associated with adherence to a 6-day quarantine. Having children younger than 18 years and being away from home when the directive was called were negatively associated with adherence to a 10-hour quarantine. Logistical concerns were negatively associated with visiting a point of dispensing for prophylactic antibiotics.

CONCLUSIONS

  Our findings establish an empirical basis for the influence of community factors on adherence to public health directives. The influence of community and individual factors on adherence varies across directives. Consequently, communication strategies to disseminate directives and organizational strategies to support them must vary according to the nature of the directives.

Mo-Buzz: Socially-Mediated Collaborative Platform for Ubiquitous Location Based Service

This paper describes a middleware platform for user-generated multimedia contents which facilitates visualization and communication of vector-borne diseases (dengue, malaria, etc.). It acts as a community platform, where diverse users from geographically distributed locations can collaborate to seek and contribute multimedia contents of such diseases and related issues (breeding sites, etc.). Some of the essential services supported by the system are display of live hotspots, timeline, multimedia and Twitter-feed visualization, and location based services for both users and authorities. As a proof-of-concept, dengue disease was selected to build services using this platform to observe its capabilities.

Young adults' perceptions about established and emerging tobacco products: results from eight focus groups

INTRODUCTION

In order to sustain their market, tobacco producers target young adults through novel product design and marketing strategies. Public health professionals need to understand young adults' risks perceptions about and use of new tobacco products to best inform tobacco control interventions.

METHODS

In 2009, researchers conducted 8 focus groups with 67 young adults stratified by self-reported tobacco use and nonuse, residence in rural and urban areas, and living in a state with or without a statewide smoking restriction policy. Participants provided feedback about their knowledge and risk perceptions about and use of tobacco products and marketing.

RESULTS

Participants reported a high level of familiarity with a wide range of novel tobacco products. A great deal of confusion and disagreement appeared with regard to absolute and relative risk of different tobacco products. Participants readily discussed using smokeless tobacco products as alternatives to smoking when smoking is prohibited. Fewer differences in tobacco-related knowledge risk perceptions and use were found between urban and rural participants and those in smoke-free policy and nonpolicy states than between user and nonuser groups. Both users and nonusers were familiar with and skeptical about tobacco marketing and prevention efforts.

CONCLUSIONS

Young adults are familiar with many tobacco products, but they convey little understanding of relative risks of new or trendy tobacco products, such as snus or hookah. Mindful of industry innovation, tobacco control advocates must continuously update prevention efforts, seeking new strategies to limit promotion, marketing, and use of new and conventional products.

Addressing the challenge of informed decision making in prostate cancer community outreach to African American men

African American men are disproportionately affected by prostate cancer. This project adopted a community-based participatory approach to design and pilot test an educational outreach strategy that promotes informed decision making about screening among African American men in community settings in St. Louis, Missouri. Interviews with local subject matter experts informed the design of the strategy. The revised curriculum was pilot tested in 2009 with 63 men who completed pre- and posttest surveys that measured knowledge, norms, beliefs, decision self-efficacy, and screening intention. The intervention resulted in statistically significant improvement in prostate cancer knowledge, decreased perceived risks and barriers, and increased screening decision self-efficacy. The educational outreach strategy offered in community settings was effective in improving knowledge, beliefs, and decision self-efficacy related to prostate cancer screening. This project sought to devise a screening outreach strategy that struck a balance between the imperatives of informed decision-making goals and the pragmatics of community settings. The findings suggest the need for further research to assess the effectiveness of community-based outreach efforts in enhancing engagement of men in decision making related to screening, diagnostics, and treatment.

Conservative Management of Dens Evaginatus: Report of Two Unusual Cases

Dens evaginatus (DE) is a rare developmental anomaly characterized by presence of an extra cusp arising from occlusal or lingual surfaces. Isolated occurrence or concomitant presence of DE with other dental anomalies has been reported. DE commonly affects permanent teeth and is rarely seen in primary dentition. Treatment may be conservative or radical. This article presents two unusual cases of concomitant occurrence of a supernumerary tooth and DE affecting maxillary deciduous lateral incisor and conservative management of DE occurring concurrently with a possible Oehler’s type I invagination in maxillary permanent lateral incisor.

Changing the conversation about prostate cancer among African Americans: results of formative research

OBJECTIVES

To understand obstacles to and opportunities for improving prostate cancer communication to and within African American communities.

DESIGN

Researchers conducted interviews with 19 community leaders and five focus groups with healthy men and survivors. The team also conducted process evaluations of two outreach projects in which survivors spoke to African American men about prostate cancer and screening.

RESULTS

Three levels of obstacles to prostate cancer screening and treatment were identified. Individual-level obstacles included limited knowledge about the condition, about prevention and treatment, and fear of cancer. Socio-cultural barriers included distrust of the medical system, lack of a provider for routine and preventive care, reluctance to talk about cancer, and aversion to aspects of screening. Institutional deficits included the scarcity of educational efforts targeting prostate cancer. Outreach project evaluations suggested that survivors can be effective in building prostate cancer knowledge, promoting positive attitudes toward screening, and fostering conversations about prostate cancer. Educational efforts included little information about screening risks and decision-making however.

CONCLUSIONS

The findings suggest that most potent interventions may combine survivor-led education with mass media and institution-based outreach. Such comprehensive programs could shift social norms that inhibit conversation and foster fear, leading in turn to more informed decisions and better treatment outcomes.

The Minimization of Public Health Risks in Newspapers after Hurricane Katrina

During natural disasters, mass media facilitate the timely provision of accurate information about health risks to the public. This study informs our understanding of such public health discourse utilizing content-analysis of 235 newspaper articles in four major metropolitan newspapers published in the five weeks after Hurricane Katrina hit the Gulf coast in August 2005. These data reveal a small and diminishing number of articles included public health information over time, detailed the hurricane impact on affected communities, and used reliable health sources. The implications for future research from a public health and media relations perspective are discussed.

A comparison of communication models of traditional and video-mediated health care delivery

BACKGROUND

While there may be benefits that accrue to the use of telemedicine technology in patient care, such as decreased costs and improved access, it has yet to be determined how telemedicine impacts patients' ability to express themselves and accordingly, how it impacts health care providers' communication of instructions or expressions of empathy.

AIM

The aim of this study was to examine the effect of telemedicine technology on communication by comparing the style and content of communication between actual (i.e., face to face) and virtual (i.e., non-face to face, telemedical) dermatology visits. The hypothesis was that there is no difference in the content and style of communication between actual and virtual visits in dermatology.

METHODS

Face-to-face and video-mediated dermatology sessions were observed and also audiotaped, timed and transcribed. A content analysis was performed.

RESULTS

Average duration of a face-to-face session was 11 min (S.D. 0.08) and of a telemedical session 9 min (S.D. 0.002). Small talk occurred in 20% of all face-to-face and 29.6% of all telemedical visits. Clinical assessment occurred in all sessions. Patient education occurred in 90% of face-to-face and 78% of telemedical visits. Other themes were also identified (e.g., discussion of treatment, promotion of compliance, psychosocial issues). In 14.8% of telemedical sessions technical issues were raised. Findings indicate that communication patterns in the two modes of care delivery are comparable.

Phase I dose-escalation study of tumor necrosis factor-alpha and concomitant radiation therapy

PURPOSE

Tumor necrosis factor-alpha enhances x-ray killing of human tumor cells in vitro and enhances tumor control when combined with radiation in animal tumor models. To determine the toxicity and maximal tolerated dose of tumor necrosis factor-alpha given daily during radiotherapy, we conducted a phase I dose-escalation study combining tumor necrosis factor-alpha and radiation.

PATIENTS AND METHODS

Thirty-one patients, including 14 patients with locally advanced primary tumors and 17 patients with metastatic sites, were entered into this study. Recombinant human tumor necrosis factor-alpha was administered intravenously at doses ranging from 10 microg/m2 to 150 microg/m2 4 hours prior to each radiation therapy session, which was given on consecutive days for a minimum of 2 weeks. Radiation was prescribed to localized fields, with dose fractions ranging from 150 to 300 cGy/day for palliation or control of locally advanced tumors.

RESULTS

Major toxicity requiring withdrawal from the study was independent of tumor necrosis factor-alpha dose and occurred in seven patients. Symptoms included angina in two patients, and hypotension, respiratory distress, atrial fibrillation, allergic reaction, and progressive leukopenia in one patient each. A tumor necrosis factor-alpha dose of 150 microg/m2 was the maximum dose administered. No single dose-limiting toxicity was observed and a maximal tolerated dose could not be defined. There was no obvious increase in in-field toxicity. Response to treatment was assessed in 20 patients. Complete regression within the irradiated field was achieved in four patients, partial regression in four, and a minimal response in four. A trend toward a greater response rate at higher doses of tumor necrosis factor-alpha was observed.

CONCLUSIONS

The maximal tolerated dose of tumor necrosis factor-alpha when given with radiotherapy is at least 150 microg/m2 and a dose-limiting toxicity was not observed. Future studies will show whether responses to treatment are increased over those expected with radiation alone. Tumor localization of tumor necrosis factor-alpha by gene therapy combined with radiation therapy may eliminate the systemic toxicity we observed.

The normal preterm foetal heart rate pattern

A longitudinal study was carried out on 38 women with low risk pregnancies. These women had cardiotocography at 27-28 wk initially, at fortnightly intervals thereafter until 36 wk and at weekly intervals thereafter until delivery. All cardiotocographs were analyzed by one investigator who was not aware of the individual clinical situation. Of the 232 cardiotocographs, 12 (0.5%) of poor quality were excluded from analyses. The mean base-line heart rate decreased from 142.5 (SD 6.03) beats per min at 27-30 wk to 138.2 (SD 7.4) at term. Analysis of variance for repeated measures showed that the decrease in foetal heart rate with gestation was statistically significant (P < 0.001). The number of accelerations increased with gestation (P = 0.002). There were no significant changes in variability and decelerations with increasing gestation.