Implementation During a Pandemic: Findings, Successes, and Lessons Learned from Community Grantees.

Funding communities through mini-grant programs builds community capacity by fostering leadership among community members, developing expertise in implementing evidence-based practices, and increasing trust in partnerships. The South Carolina Cancer Prevention and Control Research Network (SC-CPCRN) implemented the Community Health Intervention Program (CHIP) mini-grants initiative to address cancer-related health disparities among high-risk populations in rural areas of the state. One community-based organization and one faith-based organization were funded during the most recent call for proposals. The organizations implemented National Cancer Institute evidence-based strategies and programs focused on health and cancer screenings and physical activity and promotion of walking trails. Despite the potential for the COVID-19 pandemic to serve as a major barrier to implementation, grantees successfully recruited and engaged community members in evidence-based activities. These initiatives added material benefits to their local communities, including promotion of walking outdoors where it is less likely to contract the virus when socially distanced and provision of COVID-19 testing and vaccines along with other health and cancer screenings. Future mini-grants programs will benefit from learning from current grantees' flexibility in program implementation during a pandemic as well as their intentional approach to modifying program aspects as needed.

Elements for successful implementation of a clinic-based health literacy intervention.

Improving health literacy is a national public health priority. Given the context of the COVID-19 pandemic, it is even more critical for health and medical information to be clear and understandable for patients and their families. Clinic-based programs to improve health literacy need to be pragmatic, feasible, and helpful for the implementing clinic and patients. This paper describes the development, implementation, and evaluation of a pragmatic, clinic-based health literacy intervention in a safety-net clinic that serves uninsured and indigent patients. Study methods are guided by a previous pilot study and components recommended for pragmatic interventions. An electronic readiness assessment was distributed to out-patient clinics affiliated with a statewide hospital association. The AskMe3 tool was used for the intervention as it is evidence informed and relatively easy to implement. Implementation included ongoing dialogue between the clinic and the academic research team. Within the implementing clinic, data collected from patients via verbally administered questionnaires was analyzed using descriptive statistics and chi-squares. Interview data collected from the clinic director was analyzed qualitatively for themes. The implementing clinic had some of the lowest average scores of the 34 clinics who participated in the initial readiness assessment. Despite this, they were able to successfully implement the health literacy intervention during a global pandemic. Eighty-eight participants completed patient questionnaires at this clinic. Most patients (96%) agreed the AskMe3 questions helped them talk with the doctor or nurse at their current appointment. Most (99%) also perceived the AskMe3 tool to be very helpful when used in a clinical setting. The clinic director offered that the staff initially thought the intervention would be difficult to implement. However, implementation by clinic volunteers with encouragement and prioritization of health literacy by the clinic director contributed to success. When considering interventions for clinical settings, a pragmatic approach can help with selection and implementation of a program that fits with the realities on the ground. Further, frequent technical assistance can help resolve implementation barriers. Interventions utilizing tools such as AskMe3, because of their simplicity, allow creative solutions to capacity issues for clinics who see a need for health literacy improvements.

In the Words of My Mother: "I'm fighting hard for me but mostly for you".

I have always been interested in health information-what it is, where people get it, how they interpret it, talk about it with others, and use it-if at all. It has been overwhelming to stay abreast of the evolving science during the COVID-19 global pandemic when it is often quite complicated in nature and when we are exposed to individuals' and group's spreading of misinformation and disinformation. During this pandemic, I have been reflecting a lot on my childhood during which my mother was suffering with cancer and frustrated and confused about the information she received regarding her diagnosis and treatment plan. This is not the kind of journal article I am used to writing and these are probably the most difficult few pages I have ever drafted. My observations during COVID-19 led me to want to share the aspects of my mother's situation that motivate me and guide my work in cancer education with a focus on health literacy and communication. This piece describes my mother's experiences with illness and medical information in her own words. It is brief and personal and reminds me clearly why I chose this field and why it is important now more than ever for cancer educators to focus our efforts on communication.

Examining Social Determinants of Health During a Pandemic: Clinical Application of Z Codes Before and During COVID-19.

Recognition of the impact of social determinants of health (SDoH) on healthcare outcomes, healthcare service utilization, and population health has prompted a global shift in focus to patient social needs and lived experiences in assessment and treatment. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provides a list of non-billable "Z codes" specific to SDoH for use in electronic health records. Using population-level analysis, this study aims to examine clinical application of Z codes in South Carolina before and during the COVID-19 pandemic. The study population consists of South Carolina residents who had a healthcare visit and had their COVID-19 test result reported to the state's Department of Health and Environmental Control before January 14, 2021. Of the 1,190,531 individuals in the overall sample, Z codes were used only for 14,665 (1.23%) of the patients, including 2,536 (0.97%) COVID-positive patients and 12,129 (1.30%) COVID-negative patients. Compared with hospitals that did not use Z codes, those that did were significantly more likely to have higher bed capacity (p = 0.017) and to be teaching hospitals (p = 0.03), although this was significant only among COVID-19 positive individuals. Those at inpatient visits were most likely to receive Z codes (OR: 5.26; 95% CI: 5.14, 5.38; p < 0.0001) compared to those at outpatient visits (OR: 0.07; 95%CI: 0.06, 0.07; p < 0.0001). There was a slight increase of Z code use from 2019 to 2020 (OR: 1.33, 95% CI: 1.30, 1.36; p < 0.0001), which was still significant when stratified by facility type across time. As one of the first studies to examine Z code use among a large patient population, findings clearly indicate underutilization by providers. Additional study is needed to understand the potentially long-lasting health effects related to SDoH among underserved populations.

COVID-19 vaccine acceptance among college students in South Carolina: do information sources and trust in information matter?

BACKGROUND: For college students who are exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play a role in shaping the vaccine acceptance spectrum (refusal, hesitancy, and acceptance). METHODS: Based on an online survey among 1,062 college students in South Carolina, we investigated vaccine information sources among college students and examined how COVID-19 vaccine acceptance was associated with information source and trust level in each source. RESULTS: The top three sources of COVID-19 vaccine information were health agencies, mass media, and personal social networks. Trust in mass media, health agencies, scientists, and pharmaceutical companies was negatively associated with vaccine refusal. Trust in government and scientists was negatively associated with vaccine hesitancy. DISCUSSION: Our findings highlight the importance of restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era.

Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research.

Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.

Information uncertainty: a correlate for acute stress disorder during the COVID-19 outbreak in China.

BACKGROUND: Individuals' stress in responding to the current COVID-19 pandemic may be exacerbated by information uncertainty driven by inconsistent, unverified, and conflicting news from various sources. The current study aims to test if information uncertainty during the COVID-19 outbreak was related to acute stress disorder (ASD) over and above other psychosocial stressors. METHODS: An anonymous online survey was conducted with 7800 college students throughout China from January 31 through February 11, 2020. Existing scales were modified to measure ASD and six potential stressors including information uncertainty during the COVID-19 outbreak. Hierarchical regression analysis was conducted to assess the unique association of information uncertainty with ASD. To minimize the effect of large sample size and also to get a sense of whether the effects of information uncertainty were similar to people at the center of the epidemic, we repeated the hierarchical regression among 10% of the students who were randomly selected from the entire sample ("10% random sample"; n = 780) and 226 students from Hubei Province where the outbreak started. RESULTS: Information uncertainty was highly prevalent among the respondents (64%). It was significantly associated with ASD beyond other key variables and potential stressors across three samples. In the hierarchical regression among the entire sample, demographic variables accounted for 9.4% of the variance in ASD. The other five stressors added 5.1% of the variance. The information uncertainty (ß = .159; p < .001) explained an additional 2.1% of the variance. Likewise, the information uncertainty explained an additional 2.1 and 3.4% of the variance in ASD beyond all other variables among the 10% random sample (ß = .165; p < .001) and the Hubei sample (ß = .196; p < .01), respectively. CONCLUSION: Information uncertainty is a unique correlate of psychological stress during the COVID-19 outbreak. Reducing information uncertainty is essential not only for halting virus transmission but also for mitigating negative impacts of the pandemic on people's psychosocial wellbeing. Transparent, timely, and accurate communication can reduce public confusion, fear, and stress. Capacity building in governments, communities, and media outlets to prevent, reduce and manage information uncertainty should be a critical part of the response to an emerging global health crisis such as the COVID-19 pandemic.