Predictors of changing patterns of adherence to containment measures during the early stage of COVID-19 pandemic: an international longitudinal study.

BACKGROUND: Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitudinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (self-efficacy, perceived susceptibility and severity of COVID-19, perceived social support) predict the change in adherence to COVID-19 containment strategies. METHOD: In wave 1 of data collection, adults from eight geographical regions completed online surveys beginning in April 2020, and wave 2 began in June and ended in September 2020. Hypothesized predictors included prosociality, self-efficacy in following COVID-19 containment measures, perceived susceptibility to COVID-19, perceived severity of COVID-19 and perceived social support. Baseline covariates included age, sex, history of COVID-19 infection and geographical regions. Participants who reported adhering to specific containment measures, including physical distancing, avoidance of non-essential travel and hand hygiene, were classified as adherence. The dependent variable was the category of adherence, which was constructed based on changes in adherence across the survey period and included four categories: non-adherence, less adherence, greater adherence and sustained adherence (which was designated as the reference category). RESULTS: In total, 2189 adult participants (82% female, 57.2% aged 31-59 years) from East Asia (217 [9.7%]), West Asia (246 [11.2%]), North and South America (131 [6.0%]), Northern Europe (600 [27.4%]), Western Europe (322 [14.7%]), Southern Europe (433 [19.8%]), Eastern Europe (148 [6.8%]) and other regions (96 [4.4%]) were analyzed. Adjusted multinomial logistic regression analyses showed that prosociality, self-efficacy, perceived susceptibility and severity of COVID-19 were significant factors affecting adherence. Participants with greater self-efficacy at wave 1 were less likely to become non-adherence at wave 2 by 26% (adjusted odds ratio [aOR], 0.74; 95% CI, 0.71 to 0.77; P < .001), while those with greater prosociality at wave 1 were less likely to become less adherence at wave 2 by 23% (aOR, 0.77; 95% CI, 0.75 to 0.79; P = .04). CONCLUSIONS: This study provides evidence that in addition to emphasizing the potential severity of COVID-19 and the potential susceptibility to contact with the virus, fostering self-efficacy in following containment strategies and prosociality appears to be a viable public health education or communication strategy to combat COVID-19.

The role of psychological flexibility in the relationships between burnout, job satisfaction, and mental health among nurses in combatting COVID-19: A two-region survey.

BACKGROUND: A growing body of evidence suggests that the COVID-19 pandemic is adversely impacting the mental health and well-being of frontline nurses worldwide. It is therefore important to understand how such impact can be mitigated, including by studying psychological capacities that could help the nurses regulate and minimize the impact. AIM: To examine the role of psychological flexibility in mitigating the adverse impacts of burnout and low job satisfaction on mental health problems (i.e., anxiety, depression, and stress) and well-being among the frontline nurses in Hong Kong and Switzerland during the COVID-19 pandemic. DESIGN: Cross-sectional, two-region survey study. METHOD: Four hundred fifty-two nurses from Hong Kong (n = 158) and Switzerland (n = 294) completed an online survey. An adjusted structured equation model was used to examine the interrelationship of the constructs. RESULTS: Psychological flexibility was found to partially mediate the effects of job satisfaction on mental well-being (ß = 0.32, 95% CI [0.19, 0.57], p = 0.001) and mental health problems (ß = -0.79, 95% CI [-1.57, -0.44], p = 0.001), respectively. Similarly, this partial mediation was found in the effects of burnout on mental well-being (ß = -0.35, 95% CI [-0.89, -0.15], p = 0.002) and mental health problems (ß = 0.89, 95% CI [0.48, 3.65], p = 0.001). CONCLUSION: Psychological flexibility could be a crucial psychological resilience factor against the adverse impact of nurses' burnout on their mental health problems and well-being during COVID-19. CLINICAL RELEVANCE: Organizational measures should focus on fostering psychological flexibility in nurses through highly accessible, brief psychotherapeutic interventions, such as Acceptance and Commitment Therapy, to reduce the impact on mental health.

Factors Associated with COVID-19 Vaccine Acceptance among Healthcare Professionals and Community Stakeholders in Hong Kong: A Cross-Sectional Study.

BACKGROUND: Acceptance of vaccination in both healthcare professionals and the general public in the community is vital for efficacious control of the virus. Vaccine acceptance associates with many factors. Little research has been dedicated to examining attitudes and behaviors of healthcare professionals and community stakeholders regarding COVID-19 vaccine acceptance in Hong Kong. METHODS: An online cross-sectional survey was sent between February and April 2021 (N = 512). Multivariable regression modeling was used to identify associated variables with outcomes using adjusted odds ratios (AOR) and 95% of confidence intervals (CI). RESULTS: Two demographic variables-age group of over 40 years old (40-59: ORm = 3.157, 95% CI = 2.090-4.467; 60 or over: ORm = 6.606, 95% CI = 2.513-17.360) and those who had previously received a flu vaccination (ORm = 1.537, 95% CI = 1.047-2.258)-were found to be associated with high vaccine intent. Adjusting for these two variables, the results showed that five factors on knowledge variables as perceived benefits for vaccine intent were statistically significant: "Closed area and social gathering are the major ways of SAR-CoV-2 transmission" (AOR = 4.688, 95% CI = 1.802-12.199), "The vaccine can strengthen my immunity against COVID-19, so as to reduce the chance of being infected with it" (AOR = 2.983, 95% CI = 1.904-4.674), "The vaccine can lower the risk of transmitting the viruses to my family and friends" (AOR = 2.276, 95% CI = 1.508-3.436), "The benefits of COVID-19 vaccination outweigh its harm" (AOR = 3.913, 95% CI = 2.618-5.847) and "Vaccination is an effective way to prevent COVID-19" (AOR = 3.810, 95% CI = 2.535-5.728). CONCLUSIONS: High vaccine intent was associated with age and having previously received a flu vaccination. Knowledge and attitudes of healthcare professionals and community stakeholders were associated with high vaccine intent. Training and continuing education programs for healthcare providers and community stakeholders focusing on the delivery of evidence-based data on the benefits of vaccination campaigns for populations to increase the vaccination rates is recommended.

Ethical challenges experienced by care home staff during COVID-19 pandemic.

BACKGROUND: Care homes have been disproportionately affected during the COVID-19 pandemic. Practical challenges of enacting infection control measures in care home settings have been widely reported, but little is known about the ethical concerns of care home staff during the implementation of such measures. . OBJECTIVES: To understand the ethical challenges perceived by care home staff during the early months of the COVID-19 pandemic. RESEARCH DESIGN: An exploratory qualitative study. PARTICIPANTS AND RESEARCH CONTEXT: A purposive sample of 15 care home staff in different roles and ranks in Hong Kong was recruited to take part in semi-structured interviews between June and August 2020. ETHICAL CONSIDERATIONS: Ethical approval for this study was obtained. Participation was voluntary and anonymous. Participants had the right to withdraw from the study at any time without reprisal. FINDINGS: Three themes were identified: unclear legitimacy regarding infection control measures, limited autonomy in choices over infection control measures and inevitable harms to residents' well-being. While the participants expected that they would have legitimated power to implement infection control measures, they were resistant when their right to self-determination of testing and vaccination was infringed. They also felt trapped between ethical duties to protect care home residents from infection risk and the anticipated detrimental effects of infection control measures. CONCLUSIONS: The findings of this study reveal tensions among the ethical obligations of care home staff in response to a public health emergency. They highlight the importance of strengthening ethical sensitivity and ethical leadership in identifying and resolving the challenges of pandemic responses.

To Help or Not to Help? Prosocial Behavior, Its Association With Well-Being, and Predictors of Prosocial Behavior During the Coronavirus Disease Pandemic.

The coronavirus disease (COVID-19) pandemic fundamentally disrupted humans' social life and behavior. Public health measures may have inadvertently impacted how people care for each other. This study investigated prosocial behavior, its association well-being, and predictors of prosocial behavior during the first COVID-19 pandemic lockdown and sought to understand whether region-specific differences exist. Participants (N = 9,496) from eight regions clustering multiple countries around the world responded to a cross-sectional online-survey investigating the psychological consequences of the first upsurge of lockdowns in spring 2020. Prosocial behavior was reported to occur frequently. Multiple regression analyses showed that prosocial behavior was associated with better well-being consistently across regions. With regard to predictors of prosocial behavior, high levels of perceived social support were most strongly associated with prosocial behavior, followed by high levels of perceived stress, positive affect and psychological flexibility. Sociodemographic and psychosocial predictors of prosocial behavior were similar across regions.

Mental Health and Adherence to COVID-19 Protective Behaviors among Cancer Patients during the COVID-19 Pandemic: An International, Multinational Cross-Sectional Study.

A population-based cross-sectional study was conducted during the first COVID-19 wave, to examine the impact of COVID-19 on mental health using an anonymous online survey, enrolling 9565 individuals in 78 countries. The current sub-study examined the impact of the pandemic and the associated lockdown measures on the mental health, and protective behaviors of cancer patients in comparison to non-cancer participants. Furthermore, 264 participants from 30 different countries reported being cancer patients. The median age was 51.5 years, 79.9% were female, and 28% had breast cancer. Cancer participants reported higher self-efficacy to follow recommended national guidelines regarding COVID-19 protective behaviors compared to non-cancer participants (p < 0.01). They were less stressed (p < 0.01), more psychologically flexible (p < 0.01), and had higher levels of positive affect compared to non-cancer participants. Amongst cancer participants, the majority (80.3%) reported COVID-19, not their cancer, as their priority during the first wave of the pandemic and females reported higher levels of stress compared to males. In conclusion, cancer participants appeared to have handled the unpredictable nature of the first wave of the pandemic efficiently, with a positive attitude towards an unknown and otherwise frightening situation. Larger, cancer population specific and longitudinal studies are warranted to ensure adequate medical and psychological care for cancer patients.

Experiences of the COVID-19 pandemic in care home settings in Hong Kong and Nanjing

Purposes: To understand the strategies used in care home settings during the COVID-19 pandemic and to identify contextual factors for developing sustainable pandemic responses. Methods: Qualitative interviews were conducted with a purposive sample of staff members between June and July 2020. The staff members were in different disciplines and ranks and worked for at least one month in any of the three care homes in Hong Kong and three care homes in Nanjing. The interviews were audio recorded and transcribed verbatim. Inductive data-driven thematic analysis was conducted. Results: 20 staff were included who were personal care workers (n=7), nurses (n=7), social workers (n=2), home administrator (n=1), and home managers (n=3). Three major challenges to provision of care home services during the pandemic were identified: how to implement measures to prevent an outbreak in the care home, how to minimise the detrimental effects of these control measures on the residents' psychosocial well-being, and how to prepare for the reopening of the care home. Three themes related to these care challenges were identified: libertarian paternalism versus paternalism, emerging versus established telecommunication, and selective versus blanket testing. Conclusions: Care home staff in both cities encountered similar challenges when providing care during the pandemic. The pandemic responses are complex interventions shaped by the social context, and thus the ways the staff addressed these challenges vary, affected by government policies on infection control measures, readiness of telecommunications infrastructure, and availability of testing facility to prevent another wave in post-peak period.

Can psychological flexibility and prosociality mitigate illness perceptions toward COVID-19 on mental health? A cross-sectional study among Hong Kong adults.

BACKGROUND: The negative impact of COVID-19 pandemic on public mental health can be persistent and substantial over a long period of time, but little is known regarding what psychological factors or processes can buffer such impact. The present study aimed to examine the mediating roles of coping, psychological flexibility and prosociality in the impacts of perceived illness threats toward COVID-19 on mental health. METHOD: Five-hundred and fourteen Hong Kong citizens (18 years or above) completed an online survey to measure illness perceptions toward COVID-19, coping, psychological flexibility, prosociality, and mental health, together with their socio-demographic variables. Structural equation modelling was used to explore the explanatory model that was the best-fit to illustrate the relationships between these constructs. RESULTS: Serial mediation structural equation model showed that only psychological flexibility (unstandardised beta coefficient, ß = - 0.12, 95% CI [- 0.20, - 0.02], p = 0.031) and prosociality (unstandardised ß = 0.04, 95% CI [0.01, 0.08], p = 0.001) fully mediated the relationship between illness perceptions toward COVID-19 and mental health. In addition, psychological flexibility exerted a direct effect on prosociality (standardised ß = 0.22, 95% CI [0.12, 0.32], p < 0.001). This best-fit model explained 62% of the variance of mental health. CONCLUSIONS: Fostering psychological flexibility and prosocial behaviour may play significant roles in mitigating the adverse effects of COVID-19 and its perceived threats on public mental health.

A qualitative exploration of the experiences of school nurses during COVID-19 pandemic as the frontline primary health care professionals.

BACKGROUND: It is widely acknowledged that the experiences of frontline primary health care professionals during COVID-19 are important to understand how they respond and act under situations of pandemic as the gatekeepers in primary health care system. School nurses are primary health care professionals who lead health care in schools and practice in a holistic manner to address the needs of schoolchildren and school personnel. There are rising mental health concerns of frontline health care professionals with anxiety and panic disorders, somatic symptoms, and feeling isolated. No studies use a qualitative study approach to document community frontline school nursing professionals' experiences and challenges during the COVID-19 pandemic. Hence, understanding the school nurses' experiences and challenges to fight against COVID-19 in the communities is important. PURPOSE: This study aims to explore the experiences of school nurses during the COVID-19 pandemic in Hong Kong. METHODS: A qualitative study design adopted the principles of thematic analysis. Nineteen school nurses were recruited to participate in individual semistructured interviews and shared their roles and responsibilities during the COVID-19 pandemic. FINDINGS: Three themes indicated the school nurses' expand professional responsibilities to fight against COVID-19 emerged from the data analysis. These were "Managing Stress," "Navigating the School Through the Pandemic," and "Raising the Profile of the School Nurse Professional," DISCUSSION: Findings reveal the important role of school nursing professionals in minimizing the community-wide risk posed by pandemics and the need to integrate them into planning and implementation of school health policies and guidelines in the primary health care system. This essential role in schools is necessary to assess, implement, monitor, prevent, and reduce the spread of virus in school communities and to minimize the burden to and extra health care resources utilized in the acute care setting during COVID-19 pandemic.

Impact of COVID-19 pandemic on mental health: An international study.

BACKGROUND: The COVID-19 pandemic triggered vast governmental lockdowns. The impact of these lockdowns on mental health is inadequately understood. On the one hand such drastic changes in daily routines could be detrimental to mental health. On the other hand, it might not be experienced negatively, especially because the entire population was affected. METHODS: The aim of this study was to determine mental health outcomes during pandemic induced lockdowns and to examine known predictors of mental health outcomes. We therefore surveyed n = 9,565 people from 78 countries and 18 languages. Outcomes assessed were stress, depression, affect, and wellbeing. Predictors included country, sociodemographic factors, lockdown characteristics, social factors, and psychological factors. RESULTS: Results indicated that on average about 10% of the sample was languishing from low levels of mental health and about 50% had only moderate mental health. Importantly, three consistent predictors of mental health emerged: social support, education level, and psychologically flexible (vs. rigid) responding. Poorer outcomes were most strongly predicted by a worsening of finances and not having access to basic supplies. CONCLUSIONS: These results suggest that on whole, respondents were moderately mentally healthy at the time of a population-wide lockdown. The highest level of mental health difficulties were found in approximately 10% of the population. Findings suggest that public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Interventions that promote psychological flexibility may mitigate the impact of the pandemic.

The Role of Illness Perceptions, Coping, and Self-Efficacy on Adherence to Precautionary Measures for COVID-19.

As the novel coronavirus disease 2019 (COVID-19) pandemic continues, engaging the public in adherence to precautionary measures for preventing COVID-19 spread or infection becomes difficult. The present study aims to extend our understanding of how illness perceptions, coping, and self-efficacy affect adherence to precautionary measures among the public. An online survey was administered between April and June 2020 to a sample of 514 Hong Kong citizens. Variables considered were illness perceptions toward COVID-19, problem-solving, avoidance-based coping, self-efficacy, as well as adherence to precautionary measures including physical distancing, limiting unnecessary travelling, and washing hands regularly with soap and water. Adjusted structural equation model showed that illness perceptions toward COVID-19 had significant direct effect on their adherence to precautionary measures (unstandardized ß = 0.50, [95% CI, 0.28, 0.80], p = 0.001), and indirect effects through avoidance-based coping (ß = -0.10 [95% CI, -0.26, -0.01], p = 0.016) and self-efficacy (ß = -0.10, [95% CI, -0.18, -0.01], p = 0.025). These results imply that apart from emphasizing the health hazards of a novel infectious disease, an effective public health intervention and crisis communication should address avoidance-based coping and self-efficacy of the public in adherence to precautionary measures for COVID-19.