Experiences of physical therapists during the COVID-19 pandemic: an interpretive phenomenological analysis.

INTRODUCTION: The COVID-19 pandemic is the most fundamental challenge to the healthcare system in current generations. Physical therapists (PTs), as essential members of the healthcare team, were impacted substantially. Understanding their experiences during this unique and challenging time would help PTs manage the pandemic and future crises in healthcare. It may also reveal professional changes that may persist through the pandemic and beyond. PURPOSE: To describe the experiences of PTs in the New York metropolitan area during the initial wave of the pandemic. METHODS: This was an interpretive phenomenological study. Data were collected during 8 focus groups of 2-3 PTs each in August and September 2020 via videoconference. Audio recordings of the groups were transcribed, and data were coded in 3 rounds. RESULTS: Twenty-two PTs from a range of settings participated. Four themes were identified: (1) Everything was disrupted; (2) It was not safe; (3) It was overwhelming; and (4) There was a professional transformation. In hospitals, participants described chaos, poor communication, and unsafe working environments. In outpatient settings, participants described job instability and challenges adapting to telehealth. As the pandemic progressed inpatient PTs felt safer, gained confidence, and became critical members of interdisciplinary care teams. Outpatient therapists adapted to telehealth and experienced rising caseloads as patients returned to therapy. CONCLUSION: Physical therapists experienced a variety of challenges during the initial phases of the pandemic. As the pandemic progressed, they redefined practice.

Dialogic Health Education to Reduce COVID-19 Disparities and Increase Health Literacy in Community and Correctional Settings: Protocol for a Two-Pronged Health Education Program.

BACKGROUND: COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. OBJECTIVE: To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making. METHODS: Grounded in dialogic learning, the program entails training community-based "trusted messengers" and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff. RESULTS: Pre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete. CONCLUSIONS: Few studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19-specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37713.

Experiences of Physical Therapists During the COVID-19 Pandemic: An Interpretive Phenomenological Analysis

Research Objectives To describe the experiences of Physical Therapists (PTs) in the initial wave of the COVID-19 pandemic in an area where the pandemic was initially very intense. Design This was a qualitative study with an interpretive phenomenological approach. Data were collected during 8 focus groups of 2-3 physical therapists each (n=22). Setting Focus groups were conducted via videoconference. Participants A purposive sampling strategy was used. To be included, participants had to be licensed PTs, worked in facilities in the NY metro area at the onset of the pandemic (March 1, 2020), and had to have had direct patient-care responsibilities. Participant work settings included: acute care, inpatient rehabilitation, homecare, outpatient clinics, school systems, and skilled nursing facilities. Interventions This was a qualitative study without interventions. Main Outcome Measures An open, inductive coding process was used to identify codes, categories and themes. To improve trustworthiness the investigators took notes, debriefed, and maintained and audit trail. All 3 investigators participated in the coding process. Results Four themes emerged including: 1) Everything was disrupted;2) It was not safe;3) It was overwhelming;and 4) There was a professional transformation. In hospitals and skilled nursing, participants described chaos, inadequate communication, and unsafe working environments. In outpatient settings, participants experienced furloughs and layoffs along with challenges adapting to telehealth. As the pandemic progressed, inpatient PTs gained confidence and grew into new roles as essential members of interdisciplinary care teams. Outpatient therapists adapted to telehealth and and as patients returned to therapy. Conclusions Physical therapists experienced extreme challenges during the initial phases of the pandemic. As the pandemic progressed, they redefined practice in ways that will be instructive as the pandemic continues. Author(s) Disclosures The authors of this study have no disclosures to acknowledge.