The effect of COVID-19 on the home behaviours of people affected by dementia.

The COVID-19 pandemic has dramatically altered the behaviour of most of the world's population, particularly affecting the elderly, including people living with dementia (PLwD). Here we use remote home monitoring technology deployed into 31 homes of PLwD living in the UK to investigate the effects of COVID-19 on behaviour within the home, including social isolation. The home activity was monitored continuously using unobtrusive sensors for 498 days from 1 December 2019 to 12 April 2021. This period included six distinct pandemic phases with differing public health measures, including three periods of home 'lockdown'. Linear mixed-effects modelling is used to examine changes in the home activity of PLwD who lived alone or with others. An algorithm is developed to quantify time spent outside the home. Increased home activity is observed from very early in the pandemic, with a significant decrease in the time spent outside produced by the first lockdown. The study demonstrates the effects of COVID-19 lockdown on home behaviours in PLwD and shows how unobtrusive home monitoring can be used to track behaviours relevant to social isolation.

Change in nurses' psychosocial characteristics pre- and post-electronic medical record system implementation coinciding with the SARS-CoV-2 pandemic: pre- and post-cross-sectional surveys.

BACKGROUND: The impacts of electronic medical record implementation on nurses, the largest healthcare workforce, have not been comprehensively examined. Negative impacts on nurses have implications for quality of patient care delivery and workforce retention. OBJECTIVE: To investigate changes in nurses' well-being, intention to stay, burnout, work engagement, satisfaction, motivation and experience using technology pre- and post-implementation of an organisation-wide electronic medical record in Victoria, Australia. METHODS: The natural experiment comprised an electronic medical record system implementation across six hospitals of a large tertiary healthcare organisation. Cross-sectional surveys were collected pre-electronic medical record implementation prior to the SARS-CoV-2 pandemic in 2019, and 18-months post-electronic medical record implementation during the pandemic in 2020, and findings compared. RESULTS: A total of 942 surveys were analysed (550 pre-electronic medical record (response rate 15.52%) and 392 post-electronic medical record (response rate 9.50%)). Post-electronic medical record, nurses' work satisfaction (r = 0.23, p=<0.001), intention to stay (r = 0.11, p = 0.001) and well-being (r = 0.17, p=<0.001) decreased. Nurses' perceived competence increased (r = 0.10, p = 0.002) despite decreased autonomy (r = 0.10, p = 0.003). Two of three dimensions of work engagement worsened (vigour r = 0.13, p=<0.001; dedication r = 0.13, p=<0.001) and all dimensions of burnout increased (exhaustion r = 0.08, p = 0.012, cynicism r = 0.07, p = 0.04 and reduced efficiency r = 0.32, p=<0.001). Nurses reported more burnout symptoms (95% CI 4.6-4.7%, p = 0.036), were less engaged (95% CI 49.6-49.9%, p=<0.001) and career trajectory satisfaction decreased (r = 0.15, p=<0.001). Matched data from 52 nurses showed changes in the same direction for all items except career trajectory satisfaction, hence validated findings from the larger unmatched sample. CONCLUSIONS: Implementation of an electronic medical record immediately followed by the SARS-CoV-2 pandemic was associated with negative changes in nurses' well-being, intention to stay, burnout, work engagement and satisfaction.

"Vaccine Passports" May Backfire: Findings from a Cross-Sectional Study in the UK and Israel on Willingness to Get Vaccinated against COVID-19.

Domestic "vaccine passports" are being implemented across the world as a way of increasing vaccinated people's freedom of movement and to encourage vaccination. However, these vaccine passports may affect people's vaccination decisions in unintended and undesirable ways. This cross-sectional study investigated whether people's willingness and motivation to get vaccinated relate to their psychological needs (autonomy, competence and relatedness), and how vaccine passports might affect these needs. Across two countries and 1358 participants, we found that need frustration-particularly autonomy frustration-was associated with lower willingness to get vaccinated and with a shift from self-determined to external motivation. In Israel (a country with vaccine passports), people reported greater autonomy frustration than in the UK (a country without vaccine passports). Our findings suggest that control measures, such as domestic vaccine passports, may have detrimental effects on people's autonomy, motivation, and willingness to get vaccinated. Policies should strive to achieve a highly vaccinated population by supporting individuals' autonomous motivation to get vaccinated and using messages of autonomy and relatedness, rather than applying pressure and external controls.

Public Health and Risk Communication During COVID-19-Enhancing Psychological Needs to Promote Sustainable Behavior Change.

Background: The current COVID-19 pandemic requires sustainable behavior change to mitigate the impact of the virus. A phenomenon which has arisen in parallel with this pandemic is an infodemic-an over-abundance of information, of which some is accurate and some is not, making it hard for people to find trustworthy and reliable guidance to make informed decisions. This infodemic has also been found to create distress and increase risks for mental health disorders, such as depression and anxiety. Aim: To propose practical guidelines for public health and risk communication that will enhance current recommendations and will cut through the infodemic, supporting accessible, reliable, actionable, and inclusive communication. The guidelines aim to support basic human psychological needs of autonomy, competence, and relatedness to support well-being and sustainable behavior change. Method: We applied the Self-Determination Theory (SDT) and concepts from psychology, philosophy and human computer interaction to better understand human behaviors and motivations and propose practical guidelines for public health communication focusing on well-being and sustainable behavior change. We then systematically searched the literature for research on health communication strategies during COVID-19 to discuss our proposed guidelines in light of the emerging literature. We illustrate the guidelines in a communication case study: wearing face-coverings. Findings: We propose five practical guidelines for public health and risk communication that will cut through the infodemic and support well-being and sustainable behavior change: (1) create an autonomy-supportive health care climate; (2) provide choice; (3) apply a bottom-up approach to communication; (4) create solidarity; (5) be transparent and acknowledge uncertainty. Conclusion: Health communication that starts by fostering well-being and basic human psychological needs has the potential to cut through the infodemic and promote effective and sustainable behavior change during such pandemics. Our guidelines provide a starting point for developing a concrete public health communication strategy.