From high hopes to disenchantment: A qualitative analysis of editorial cartoons on COVID-19 vaccines in Canadian newspapers.

In Canada, the first COVID-19 vaccine was approved for use in December 2020, marking the beginning of a large vaccination campaign. The campaign was not only unprecedented in terms of reach, but also with regards to the amount of information about vaccines that circulated in traditional and social media. This study's aim was to describe COVID-19 vaccine related discourses in Canada through an analysis of editorial cartoons. We collected 2172 cartoons about COVID-19 published between January 2020 and August 2022 in Canadian newspapers. These cartoons were downloaded and a first thematic analysis was conducted using the WHO-EPIWIN taxonomy (cause, illness, treatment, interventions, and information). From this, 389 cartoons related to COVID-19 vaccines were identified under the treatment category. These were subjected to a second thematic analysis to assess main themes (e.g., vaccine development, campaign progress, etc.), characters featured (e.g., politicians, public figures, public) and position with respect to vaccine (favorable, unfavorable, neutral). Six main themes emerged: Research and development of vaccines; Management of the vaccination campaign; Perceptions of and experiences with vaccination services; Measures and incentives to increase COVID-19 vaccine uptake; Criticism of the unvaccinated; and Effectiveness of vaccination. Our analysis revealed a shift in attitudes toward COVID-19 vaccination from high hopes to disenchantment, which may reflect some vaccine fatigue. In the future, public health authorities could face some challenges in maintaining confidence and high COVID-19 vaccine uptake.

Identifying H1N1 and COVID-19 vaccine hesitancy or refusal among health care providers: a scoping review.

OBJECTIVES: The objective of this review was to describe and map the evidence on COVID-19 and H1N1 vaccine hesitancy or refusal by physicians, nurses, and pharmacists in North America, the United Kingdom and the European Union, and Australia. INTRODUCTION: Since 2009, we have experienced two pandemics: H1N1 "swine flu" and COVID-19. While severity and transmissibility of these viruses varied, vaccination has been a critical component of bringing both pandemics under control. However, uptake of these vaccines has been affected by vaccine hesitancy and refusal. The vaccination behaviors of health care providers, including physicians, nurses, and pharmacists, are of particular interest as they have been priority populations to receive both H1N1 and COVID-19 vaccinations. Their vaccination views could affect the vaccination decisions of their patients. INCLUSION CRITERIA: Studies were eligible for inclusion if they identified reasons for COVID-19 or H1N1 vaccine hesitancy or refusal among physicians, nurses, or pharmacists from the included countries. Published and unpublished literature were eligible for inclusion. Previous reviews were excluded; however, the reference lists of relevant reviews were searched to identify additional studies for inclusion. METHODS: A search of CINAHL, MEDLINE, PsycINFO, and Academic Search Premier databases was conducted April 28, 2021, to identify English-language literature published from 2009 to 2021. Gray literature and citation screening were also conducted to identify additional relevant literature. Titles, abstracts, and eligible full-text articles were reviewed in duplicate by 2 trained reviewers. Data were extracted in duplicate using a structured extraction tool developed for the review. Conflicts were resolved through discussion or with a third team member. Data were synthesized using narrative and tabular summaries. RESULTS: In total, 83 articles were included in the review. Studies were conducted primarily across the United States, the United Kingdom, and France. The majority of articles (n=70) used cross-sectional designs to examine knowledge, attitudes, and uptake of H1N1 (n=61) or COVID-19 (n=22) vaccines. Physicians, medical students, nurses, and nursing students were common participants in the studies; however, only 8 studies included pharmacists in their sample. Across health care settings, most studies were conducted in urban, academic teaching hospitals, with 1 study conducted in a rural hospital setting. Concerns about vaccine safety, vaccine side effects, and perceived low risk of contracting H1N1 or COVID-19 were the most common reasons for vaccine hesitancy or refusal across both vaccines. CONCLUSIONS: With increased interest and attention on vaccines in recent years, intensified by the COVID-19 pandemic, more research that examines vaccine hesitancy or refusal across different health care settings and health care providers is warranted. Future work should aim to utilize more qualitative and mixed methods research designs to capture the personal perspectives of vaccine hesitancy and refusal, and consider collecting data beyond the common urban and academic health care settings identified in this review.

Global evidence of gender equity in academic health research: a scoping review.

OBJECTIVES: To chart the global literature on gender equity in academic health research. DESIGN: Scoping review. PARTICIPANTS: Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support. RESULTS: Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%). CONCLUSIONS: Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/8wk7e/.

Using a learning health system framework to examine COVID-19 pandemic planning and response at a Canadian Health Centre.

BACKGROUND: The COVID-19 pandemic has presented a unique opportunity to explore how health systems adapt under rapid and constant change and develop a better understanding of health system transformation. Learning health systems (LHS) have been proposed as an ideal structure to inform a data-driven response to a public health emergency like COVID-19. The aim of this study was to use a LHS framework to identify assets and gaps in health system pandemic planning and response during the initial stages of the COVID-19 pandemic at a single Canadian Health Centre. METHODS: This paper reports the data triangulation stage of a concurrent triangulation mixed methods study which aims to map study findings onto the LHS framework. We used a triangulation matrix to map quantitative (textual and administrative sources) and qualitative (semi-structured interviews) data onto the seven characteristics of a LHS and identify assets and gaps related to health-system receptors and research-system supports. RESULTS: We identified several health system assets within the LHS characteristics, including appropriate decision supports and aligned governance. Gaps were identified in the LHS characteristics of engaged patients and timely production and use of research evidence. CONCLUSION: The LHS provided a useful framework to examine COVID-19 pandemic response measures. We highlighted opportunities to strengthen the LHS infrastructure for rapid integration of evidence and patient experience data into future practice and policy changes.

Nova Scotia Strong: why communities joined to embrace COVID-19 public health measures.

OBJECTIVE: To explore Nova Scotian experiences, barriers, and facilitators associated with pandemic public health measures (PHM), including COVID-19 vaccination. METHODS: We conducted semi-structured, individual interviews with Nova Scotians between May and August 2021, during the third wave of COVID-19 cases and provincial lockdown. Participants were recruited across the province from three sectors: decision makers, community leaders, and community members using purposive and snowball sampling. Direct content analysis and thematic analysis were used to identify key themes via the Theoretical Domains Framework. RESULTS: The experiences of 30 Nova Scotian interviewees clustered around four themes: Communication of PHM, Responsibly Observing PHM: A Community Coming Together, Navigating PHM, and Vaccine Confidence & Hesitancy. Consistent communication of PHM through briefings with the chief medical officer of health and provincial channels reduced misinformation and encouraged PHM compliance. While adherence was high throughout the province, inconsistent enforcement of these measures proved challenging to individuals navigating PHMs. A high level of COVID-19 vaccine confidence and acceptance was identified, and a strong sense of provincial pride prevailed in keeping COVID-19 numbers and transmission low. CONCLUSION: This study provides insights into Nova Scotians' unique experiences with COVID-19 PHM. Provincial public health experts and government leaders communicated PHM with various levels of success, Nova Scotia Strong, a sentiment of unity and communitarianism that sprang from public response to tragic events. Future work should aim to include under-represented communities to facilitate broader inclusion.

RéSUMé: OBJECTIF: Explorer les expériences des Néo-Écossais et les éléments qui entravent ou qui favorisent les mesures sanitaires pandémiques (MSP), dont la vaccination contre la COVID-19, en Nouvelle-Écosse. MéTHODE: Nous avons mené des entretiens individuels semi-directifs avec des Néo-Écossais entre mai et août 2021, au cours de la troisième vague de cas de COVID-19 et de confinement dans la province. Des participants de trois groupes (décideurs, responsables locaux et résidents) ont été recrutés dans toute la province à l'aide de sondages intentionnels et cumulatifs. Nous avons utilisé l'analyse directe de contenu et l'analyse thématique pour cerner les principaux thèmes à l'aide du cadre des domaines théoriques (cadre TDF). RéSULTATS: Les expériences des 30 Néo-Écossais interrogés s'articulaient autour de quatre thèmes : Communication des MSP, Observance responsable des MSP : une communauté qui se rassemble, S'y retrouver dans le dédale des MSP et Confiance envers les vaccins et hésitation vaccinale. La communication cohérente des MSP lors des breffages du médecin-hygiéniste en chef et par les canaux provinciaux a réduit la mésinformation et encouragé l'observance des MSP. Cette observance était élevée à l'échelle de la province, mais l'application incohérente des mesures a rendu difficile pour les gens de s'y retrouver dans le dédale des MSP. Un niveau élevé de confiance et d'acceptation des vaccins contre la COVID-19 a été observé, et un profond sentiment de fierté provinciale a pris le dessus pour réduire le nombre de cas et la transmission de la COVID-19. CONCLUSION: Cette étude vient éclairer les expériences uniques des Néo-Écossais face aux MSP liées à la COVID-19. Les spécialistes provinciaux de la santé publique et les chefs du gouvernement ont communiqué les MSP de façon coordonnée et ont bénéficié du sentiment d'unité et de l'esprit communautaire (Nova Scotia Strong) qui ont émergé dans la population à la suite d'autres tragédies. Les démarches futures devraient chercher à inclure les communautés sous-représentées.

Programmes to support transitions in community care for children with complex care needs: a scoping review.

OBJECTIVE: This scoping review aimed to map the range of programmes in the literature to support children and youth with complex care needs and their families during transitions in care in the community. DESIGN: A scoping review of the literature. CONTEXT: This review included programmes that supported the transition in care to home and between settings in the community. DATA SOURCES: We implemented our strategy to search five databases: (1) PubMed; (2) CINAHL; (3) ERIC; (4) PyscINFO and (5) Social Work Abstracts. The search was last implemented on 29 April 2021. STUDY SELECTION: Our search results were imported into Covidence Systematic Review Software. First, two reviewers assessed titles and abstracts against our eligibility criteria. Relevant articles were then retrieved in full and reviewed by two reviewers for inclusion. Disagreements were resolved by a third reviewer. DATA EXTRACTION: Relevant data were extracted related to population, concept, context, methods and key findings pertinent to our review objective. RESULTS: A total of 2482 records were identified. After our two-stage screening process, a total of 27 articles were included for analysis. Articles ranged in the type of transitions being supported and target population. The most common transition reported was the hospital-to-home transition. Intervention components primarily consisted of care coordination using a teams-based approach. The most reported barriers and enablers to implementing these transition care programmes were related to physical opportunities. LIMITATIONS: Included articles were limited to English and French. CONCLUSIONS: This review identified important gaps within the literature, as well as areas for future consideration to ensure the effective development and implementation of programmes to support children and youth with complex care needs during transitions in care.

Health system impacts of SARS-CoV - 2 variants of concern: a rapid review.

BACKGROUND: As of November 25th 2021, four SARS-CoV - 2 variants of concern (VOC: Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2)) have been detected. Variable degrees of increased transmissibility of the VOC have been documented, with potential implications for hospital and health system capacity and control measures. This rapid review aimed to provide a synthesis of evidence related to health system responses to the emergence of VOC worldwide. METHODS: Seven databases were searched up to September 27, 2021, for terms related to VOC. Titles, abstracts, and full-text documents were screened independently by two reviewers. Data were extracted independently by two reviewers using a standardized form. Studies were included if they reported on at least one of the VOC and health system outcomes. RESULTS: Of the 4877 articles retrieved, 59 studies were included, which used a wide range of designs and methods. Most of the studies reported on Alpha, and all except two reported on impacts for capacity planning related to hospitalization, intensive care admissions, and mortality. Most studies (73.4%) observed an increase in hospitalization, but findings on increased admission to intensive care units were mixed (50%). Most studies (63.4%) that reported mortality data found an increased risk of death due to VOC, although health system capacity may influence this. No studies reported on screening staff and visitors or cohorting patients based on VOC. CONCLUSION: While the findings should be interpreted with caution as most of the sources identified were preprints, evidence is trending towards an increased risk of hospitalization and, potentially, mortality due to VOC compared to wild-type SARS-CoV - 2. There is little evidence on the need for, and the effect of, changes to health system arrangements in response to VOC transmission.

Barriers to and strategies to address COVID-19 testing hesitancy: a rapid scoping review.

BACKGROUND: Testing is a foundational component of any COVID-19 management strategy; however, emerging evidence suggests that barriers and hesitancy to COVID-19 testing may affect uptake or participation and often these are multiple and intersecting factors that may vary across population groups. To this end, Health Canada's COVID-19 Testing and Screening Expert Advisory Panel commissioned this rapid review in January 2021 to explore the available evidence in this area. The aim of this rapid review was to identify barriers to COVID-19 testing and strategies used to mitigate these barriers. METHODS: Searches (completed January 8, 2021) were conducted in MEDLINE, Scopus, medRxiv/bioRxiv, Cochrane and online grey literature sources to identify publications that described barriers and strategies related to COVID-19 testing. RESULTS: From 1294 academic and 97 grey literature search results, 31 academic and 31 grey literature sources were included. Data were extracted from the relevant papers. The most cited barriers were cost of testing; low health literacy; low trust in the healthcare system; availability and accessibility of testing sites; and stigma and consequences of testing positive. Strategies to mitigate barriers to COVID-19 testing included: free testing; promoting awareness of importance to testing; presenting various testing options and types of testing centres (i.e., drive-thru, walk-up, home testing); providing transportation to testing centres; and offering support for self-isolation (e.g., salary support or housing). CONCLUSION: Various barriers to COVID-19 testing and strategies for mitigating these barriers were identified. Further research to test the efficacy of these strategies is needed to better support testing for COVID-19 by addressing testing hesitancy as part of the broader COVID-19 public health response.

Stigma and blame related to COVID-19 pandemic: A case-study of editorial cartoons in Canada.

The COVID-19 pandemic represents not only the spread of a highly contagious and potentially fatal virus, but also an outbreak of theories, rumors, discourses and representations trying to make sense of a crisis. In this article, we explore the issue of blame and stigma in the context of the COVID-19 pandemic in Canada. We do so by studying editorial cartoons published about COVID-19 in ten mainstream Canadian newspapers between January 2020 and March 2021. We identified 203 editorial cartoons that highlight common discourses which blame or stigmatize specific groups of people for the origin or transmission of COVID-19, or for their behavior during the pandemic. The cartoons focused on four groups: 1) people of Chinese origin or descent and of other national/geographic provenance (Americans, Canadians from specific provinces, urban residents); 2) international travelers; 3) people who do not respect the preventive measures to contain the pandemic; and 4) people who question or criticize the scientific discourses about COVID-19. Our analysis revealed an "othering process" common in times of pandemic. Our analysis of editorial cartoons in Canada also uncovered a moralization around the respect of the counter measures against COVID-19. These editorial cartoons largely divide the population into two groups: 1) "virtuous" people who are "selfless" and "smart" and who respect the public health preventive measures; 2) those who are "immoral", "self-centered", "silly" and even "stupid", who do not respect the recommended measures to prevent the transmission of COVID-19. While negatively portraying these individuals may help promote adherence to the recommended measures, it also can exacerbate polarization. Analyzing editorial cartoons can be a useful approach to rapidly gather information on attitudes and feelings in the public at a specific time and place.

Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review.

OBJECTIVE: The aim of this study was to identify knowledge translation (KT) strategies aimed at improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) and well-being. DESIGN: Rapid scoping review. SEARCH STRATEGY: A comprehensive and peer-reviewed search strategy was developed and applied to four electronic databases: MEDLINE ALL, Embase, CINAHL and Web of Science. Additional searches of grey literature were conducted to identify KT strategies aimed at supporting SRMNCAH. KT strategies and policies published in English from January 2000 to May 2020 onwards were eligible for inclusion. RESULTS: Only 4% of included 90 studies were conducted in low-income countries with the majority (52%) conducted in high-income countries. Studies primarily focused on maternal newborn or child health and well-being. Education (81%), including staff workshops and education modules, was the most commonly identified intervention component from the KT interventions. Low-income and middle-income countries were more likely to include civil society organisations, government and policymakers as stakeholders compared with high-income countries. Reported barriers to KT strategies included limited resources and time constraints, while enablers included stakeholder involvement throughout the KT process. CONCLUSION: We identified a number of gaps among KT strategies for SRMNCAH policy and action, including limited focus on adolescent, sexual and reproductive health and rights and SRMNCAH financing strategies. There is a need to support stakeholder engagement in KT interventions across the continuum of SRMNCAH services. Researchers and policymakers should consider enhancing efforts to work with multisectoral stakeholders to implement future KT strategies and policies to address SRMNCAH priorities. REGISTRATION: The rapid scoping review protocol was registered on Open Science Framework on 16 June 2020 (https://osf.io/xpf2k).

Using the Theoretical Domains Framework to Identify Barriers and Enablers to Implementing a Virtual Tertiary-Regional Telemedicine Rounding and Consultation for Kids (TRaC-K) Model: Qualitative Study.

BACKGROUND: Inequities in access to health services are a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children's hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The 2 tertiary pediatric hospitals in Alberta, Canada, have already been operating above capacity, but the pediatric beds at regional hospitals are underused. Such imbalance could lead to poor patient safety and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric health care providers, erode their confidence, and compel health systems to further reduce the capacity at regional sites. A Telemedicine Rounding and Consultation for Kids (TRaC-K) model was proposed to enable health care providers at Alberta Children's Hospital to partner with their counterparts at Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site. OBJECTIVE: The aim of this study is to identify perceived barriers and enablers to implementing the TRaC-K model. METHODS: This study was guided by the Theoretical Domains Framework (TDF) and used qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semistructured interviews and 2 focus groups. These data were thematically analyzed to identify major subthemes within each TDF domain. These subthemes were further aggregated and categorized into barriers or enablers to implementing the TRaC-K model and were tabulated separately. RESULTS: Our study identified 31 subthemes in 14 TDF domains, ranging from administrative issues to specific clinical conditions. We were able to merge these subthemes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that the barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, unclear processes and resources to support TRaC-K, and concerns about clear roles and responsibilities. The enablers were health care providers' motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary-regional relationships. CONCLUSIONS: This systematic inquiry into the perceived barriers and enablers to the implementation of TRaC-K helped us to gain insights from various health care providers' and family members' perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12913-018-3859-2.

Public health implications of SARS-CoV-2 variants of concern: a rapid scoping review.

OBJECTIVES: The four SARS-CoV-2 variants of concern (VOC; Alpha, Beta, Gamma and Delta) identified by May 2021 are highly transmissible, yet little is known about their impact on public health measures. We aimed to synthesise evidence related to public health measures and VOC. DESIGN: A rapid scoping review. DATA SOURCES: On 11 May 2021, seven databases (MEDLINE, Embase, the Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Epistemonikos' L-OVE on COVID-19, medRxiv, bioRxiv) were searched for terms related to VOC, public health measures, transmission and health systems. No limit was placed on date of publication. ELIGIBILITY CRITERIA: Studies were included if they reported on any of the four VOCs and public health measures, and were available in English. Only studies reporting on data collected after October 2020, when the first VOC was reported, were included. DATA EXTRACTION AND SYNTHESIS: Titles, abstracts and full-text articles were screened by two independent reviewers. Data extraction was completed by two independent reviewers using a standardised form. Data synthesis and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS: Of the 37 included studies, the majority assessed the impact of Alpha (n=32) and were conducted in Europe (n=12) or the UK (n=9). Most were modelling studies (n=28) and preprints (n=28). The majority of studies reported on infection control measures (n=17), followed by modifying approaches to vaccines (n=13), physical distancing (n=6) and either mask wearing, testing or hand washing (n=2). Findings suggest an accelerated vaccine rollout is needed to mitigate the spread of VOC. CONCLUSIONS: The increased severity of VOC requires proactive public health measures to control their spread. Further research is needed to strengthen the evidence for continued implementation of public health measures in conjunction with vaccine rollout. With no studies reporting on Delta, there is a need for further research on this and other emerging VOC on public health measures.

Identifying COVID-19 and H1N1 vaccination hesitancy or refusal among health care providers across North America, the United Kingdom, Europe, and Australia: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to describe and map the evidence on COVID-19 and H1N1 vaccination hesitancy or refusal among physicians, nurses, and pharmacists across North America, the United Kingdom, Europe, and Australia. INTRODUCTION: When global pandemics occur, including the coronavirus (COVID-19) pandemic, which originated in 2020, and the swine flu influenza pandemic (H1N1) of 2009, there is increased pressure for pharmaceutical companies and government agencies to develop safe and effective vaccines against these highly contagious illnesses. Following development and approvals, it then becomes essential that priority populations, including frontline health care providers, opt to receive these vaccinations to prevent illness and potential transmission to their patients. However, vaccine hesitancy or refusal has played a significant role in suboptimal vaccination rates globally. As health care providers, including physicians, nurses, and pharmacists, often administer vaccines, their vaccination views and behaviors are of great importance because they can directly affect the vaccination decisions of their patients. INCLUSION CRITERIA: The review will identify factors affecting COVID-19 and H1N1 vaccine hesitancy or refusal among physicians, nurses, and pharmacists across a range of countries. Published and unpublished evidence, including quantitative, qualitative, mixed methods research, and gray literature, will be eligible for inclusion. METHODS: This scoping review protocol will follow JBI methodology. The search strategy will be developed with support from a health sciences librarian scientist to identify relevant evidence. Screening and data extraction will be conducted by two reviewers, with findings summarized and presented through narrative descriptions, tables, and figures.