Religiosity and COVID-19: Impact on Use of Remote Worship and Changes in Self-Reported Social Support.

Objective: This study examines associations between changes in the use of remote worship services and changes in the types of social support among religious adults during the COVID-19 pandemic. Materials and Methods: Cross-sectional, web survey data (n = 461; 15 May to 6 July 2020) were collected during the COVID-19 pandemic. Multinomial logistic regression models calculated unadjusted odds of increases and decreases of three types of perceived social support from before to during COVID-19 based on remote worship use. Results: Adults who initiated use of remote worship had lower odds of gaining social support for personal problems (OR: 0.38; 95% CI: 0.19, 0.79) and greater odds of reporting less ease of getting practical help from neighbors (OR: 1.77; 95% CI: 1.04, 3.02) compared to adults who never used or stopped using remote worship. Adults who continued using remote worship services were more likely to report less ease of getting practical help from their neighbors (OR: 2.23; 95% CI: 1.17, 4.25) and decreased interest and concern felt from other people (OR: 2.62; 95% CI: 1.24, 5.51) than adults who never used or stopped using remote worship. Conclusions: Adults who initiated and continued using remote worship during the COVID-19 pandemic had poorer perceived social support outcomes relative to adults who never used or stopped using remote services. Despite continued engagement with their religious communities, adults participating in worship remotely may have had residual personal, emotional, and instrumental social support needs that remote worship did not mitigate.

"We figured it out as we went along": Staff perspectives of COVID-19 response efforts at a large North American syringe services programme.

Syringe services programmes face operational challenges to provide life-sustaining services to people who use substances and those who have substance use disorders. COVID-19 has disrupted operations at these programmes and is a threat to people with substance use disorder because of severe poverty, de-prioritisation of COVID-19 safety and high prevalence of comorbidities. This phenomenological qualitative study describes 16 in-depth interviews with staff of one of the largest syringe services programme in North America-Prevention Point Philadelphia, located in the Kensington neighbourhood of Philadelphia, Pennsylvania. Interviews were conducted from December 2020 to February 2021, audio-recorded, transcribed and coded to develop a thematic framework. Participants were mostly white (71.4%) and female (68.8%) with a median age of 31.5. Three main and four sub-themes related to the impact of COVID-19 on the syringe services programme were identified: (1) COVID-19 altered services provision (sub-theme: select service changes should be retained); (2) unclear or absent COVID-19 response guidance which compromised mitigation (sub-themes: COVID-19 messaging was difficult to translate to practice, learn-as-we-go); and (3) staff and clients experienced elevated mental anguish during the pandemic (sub-theme: already limited resources were further strained). COVID-19 presented complex challenges to an organisation normally strained in pre-pandemic times. A staff culture of resourcefulness and resiliency aided the syringe services programme to balance client needs and staff safety. However, staff experienced a serious psychological impact, largely attributable to being unable to find reprieve from the stressors of COVID-19 and the difficulties associated with navigating and acting-on contradictory public health messaging. Staff also shared a belief that the relaxing of some pre-pandemic barriers allowed staff to link clients more readily with services. Syringe services programmes should embrace the potential for lasting changes to health services delivery brought about by wide-scale changes in service provisions because of COVID-19.

Barriers and poor telephone counseling experiences among patients receiving medication for opioid use disorders.

OBJECTIVE: The COVID-19 pandemic catalyzed the relaxation of regulations surrounding Medication for Opioid Use Disorders (MOUD) treatment, including a shift from in-person to telehealth counseling services adjunct to MOUD treatment. We examine how patient-level barriers impact their counseling experiences. METHODS: We examine data from n = 264 participants who completed a cross-sectional survey regarding their experiences with telephone counseling adjunct to MOUD between July to November 2020. Variables examined include: convenience and satisfaction with telephone counseling, comfort and change in relationship with counselor, and how telephone counseling helped with anxiety, depression, anger, substance use, and recovery. Participants also listed the barriers they faced when using telephone counseling. RESULTS: Thirty-one percent of the sample (n = 81) reported experiencing one or more barriers to telephone counseling. Satisfaction with counseling, perceived convenience, comfort, and beneficial effects of counseling on substance use were associated with increased odds of reporting no barriers (range of p.038 to <0.001). CONCLUSIONS: Many participants reported barriers to telehealth counseling, and these barriers were in turn associated with poorer counseling experiences. PRACTICE IMPLICATIONS: Many treatment providers plan to integrate telehealth service provision in their healthcare delivery model, but more research on patient-level barriers and its impact on treatment is needed.

Mapping Perceptual Differences to Understand COVID-19 Beliefs in Those with Vaccine Hesitancy.

Thirty percent of US adults are COVID-19 vaccine hesitant, but little is known about them beyond demographics. We used segmentation and perceptual mapping techniques to assess perceptual differences in unvaccinated, vaccine hesitant adults in Philadelphia, PA (n = 110) who answered a cross-sectional survey in-person or online. The sample was 54% ethnic minority, 65% female, 55% earned less than $25,000 with a mean age of 44. K-means cluster analysis identified three audience segments based on reported trust of healthcare providers and personal COVID-19 impact (High Trust/Low impact [n = 34], Moderate Trust/High impact [n = 39], Low Trust/Low impact [n = 23]). Multidimensional scaling analysis created three-dimensional perceptual maps to understand differences in COVID-19 and vaccine perceptions. The Low Trust/Low Impact group showed higher agreement with items related to COVID-19 being a hoax (p = .034) and that minorities should be suspicious of government information (p = .009). Maps indicate vaccine messaging for all groups would need to acknowledge these items, but added messaging about trust of pharmaceutical companies, belief that COVID messages keep changing or that vaccines are not safe would also need to be addressed to reach different segments. This may be more effective than current messaging that highlights personal responsibility or protection of others.

Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach.

Using quantitative and qualitative evidence, this study triangulates counselors' perspectives on the use of telemedicine in the context of Opioid Use Disorder (OUD) treatment. A concurrent mixed-methods design examined counselors' experiences with telephone counseling during the COVID-19 pandemic. N = 42 counselors who provided OUD counseling services completed a close-ended, quantitative survey examining their experiences in addressing clients' anxiety, depression, anger, substance use, therapeutic relationship, and substance use recovery using telephone counseling. The survey also assessed comfort, convenience, and satisfaction with telephone counseling. Counselors also completed open-ended responses examining satisfaction, convenience, relationship with patients, substance use, and general feedback with telephone counseling. The synthesis of quantitative and qualitative evidence indicated that a majority of counselors had positive experiences with using telephone counseling to provide services to clients undergoing OUD treatment. Convenience, greater access to clients, and flexibility were among the reasons cited for their positive experience. However, counselors also expressed that the telephone counseling was impersonal, and that some clients may have difficulties accessing appropriate technology for telehealth adoption. Findings suggest that further research with counselors is needed to identify the key elements of an effective integration of telephone counseling with traditional in-person treatment approaches in the post-pandemic era.

Patient Experiences with the Transition to Telephone Counseling during the COVID-19 Pandemic.

Background: To identify and document the treatment experiences among patients with opioid use disorder (OUD) in the context of the rapid move from in-person to telephone counseling due to the COVID-19 pandemic. Methods: Participants (n = 237) completed a survey with open-ended questions that included the following domains: (1) satisfaction with telephone counseling, (2) perceived convenience, (3) changes to the therapeutic relationship, (4) perceived impact on substance use recovery, and (5) general feedback. Responses were coded using thematic analysis. Codes were subsequently organized into themes and subthemes (covering 98% of responses). Interrater reliability for coding of participants' responses ranged from 0.89 to 0.95. Results: Overall, patients reported that telephone counseling improved the therapeutic experience. Specifically, 74% of respondents were coded as providing responses consistently indicating "positive valency". "Positive valency" responses include: (1) feeling supported, (2) greater comfort and privacy, (3) increased access to counselors, and (4) resolved transportation barriers. Conversely, "negative valency" responses include: (1) impersonal experience and (2) reduced privacy. Conclusions: Telephone counseling presents its own set of challenges that should be investigated further to improve the quality of care and long-term patient outcomes.