Evaluating the impact of the COVID-19 related public health restrictions on access to digital sexually transmitted and blood borne infection testing in British Columbia, Canada: An interrupted time series analysis.

BACKGROUND: Evidence of long-term impacts of COVID-19 related public health restrictions on digital sexually transmitted and blood borne infection (STBBI) testing utilization is limited. We assessed these impacts on GetCheckedOnline (a digital testing resource for STBBIs) relative to all STBBI tests in British Columbia (BC). METHODS: Interrupted time series analyses were conducted using GetCheckedOnline program data comparing monthly test episodes (STBBI tests per requisition) among BC residents, stratified by BC region, testers' sociodemographic and sexual risk profiles, for the pre-pandemic (March 2018-February 2020) and pandemic periods (March 2020-October 2021). Trends in GetCheckedOnline testing per 100 STBBI tests in BC regions with GetCheckedOnline were analysed. Each outcome was modelled using segmented generalized least squared regression. RESULTS: Overall, 17,215 and 22,646 test episodes were conducted in the pre-pandemic and pandemic periods. Monthly GetCheckedOnline test episodes reduced immediately after restrictions. By October 2021(end of pandemic period), monthly GetCheckedOnline testing increased 21.24 test episodes per million BC residents (95%CI: -11.88, 54.84) and GetCheckedOnline tests per 100 tests in corresponding BC regions increased 1.10 (95%CI: 0.02, 2.17) above baseline trends. After initial increases among users at higher STBBI risk (symptomatic testers/testers reporting sexual contacts with STBBIs), testing decreased below baseline trends later in the pandemic, while monthly GetCheckedOnline testing increased among people ≥40 years, men who have sex with men, racialized minorities, and first-time testers via GetCheckedOnline. CONCLUSIONS: Sustained increases in utilization of digital STBBI testing during the pandemic suggest fundamental changes in STBBI testing in BC, highlighting the need for accessible and appropriate digital testing, especially for those most affected by STBBIs.

Culture Change in Long-Term Care-Post COVID-19: Adapting to a New Reality Using Established Ideas and Systems.

The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic's persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents' quality of life, while ensuring the well-being of staff and residents' families.

Developmental evaluation during the COVID-19 pandemic: Practice-based learnings from projects in British Columbia, Canada

In this article, we explore experiences and learnings from adapting to challenges encountered in implementing three Developmental Evaluations (DE) in British Columbia, Canada within the evolving context of the COVID-19 pandemic. We situate our DE projects within our approach to the DE life cycle and describe challenges encountered and required adaptations in each phase of the life cycle. Regarding foundational aspects of DEs, we experienced challenges with relationship building, assessing and responding to the context, and ensuring continuous learning. These challenges were related to suboptimal embeddedness of the evaluators within the evaluated projects. We adapted by leveraging online channels to maintain communications and securing stakeholder engagement by assuming non-traditional DE roles based on our knowledge of the context to support project goals. Additional challenges experienced with mapping the rationale and goals of the projects, identifying domains for assessment, collecting data, making sense of the data and intervening were adapted to by facilitating online workshops, collecting data online and through proxy evaluators, while sharing methodological insights within the evaluation team. During evolving crises, like the COVID-19 pandemic, evaluators must embrace flexibility, leverage, and apply their knowledge of the evaluation context, lean on their strengths, purposefully reflect and share knowledge to optimise their DEs.

Defining Digital Public Health and the Role of Digitization, Digitalization, and Digital Transformation: Scoping Review.

BACKGROUND: The recent proliferation and application of digital technologies in public health has spurred interest in digital public health. However, as yet, there appears to be a lack of conceptual clarity and consensus on its definition. OBJECTIVE: In this scoping review, we seek to assess formal and informal definitions of digital public health in the literature and to understand how these definitions have been conceptualized in relation to digitization, digitalization, and digital transformation. METHODS: We conducted a scoping literature search in Ovid MEDLINE, Embase, Google Scholar, and 14 government and intergovernmental agency websites encompassing 6 geographic regions. Among a total of 409 full articles identified, we reviewed 11 publications that either formally defined digital public health or informally described the integration of digital technologies into public health in relation to digitization, digitalization, and digital transformation, and we conducted a thematic analysis of the identified definitions. RESULTS: Two explicit definitions of digital public health were identified, each with divergent meanings. The first definition suggested digital public health was a reimagination of public health using new ways of working, blending established public health wisdom with new digital concepts and tools. The second definition highlighted digital public health as an asset to achieve existing public health goals. In relation to public health, digitization was used to refer to the technical process of converting analog records to digital data, digitalization referred to the integration of digital technologies into public health operations, and digital transformation was used to describe a cultural shift that pervasively integrates digital technologies and reorganizes services on the basis of the health needs of the public. CONCLUSIONS: The definition of digital public health remains contested in the literature. Public health researchers and practitioners need to clarify these conceptual definitions to harness opportunities to integrate digital technologies into public health in a way that maximizes their potential to improve public health outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/preprints.27686.

COVID-19 risk perception among residents of seven sub-Saharan African countries: socio-demographic correlates and predicted probabilities.

INTRODUCTION: as the COVID-19 pandemic rages on, sub-Saharan Africa remains at high risk given the poor adherence to pandemic control protocols. Misconceptions about the contagion may have given rise to adverse risk behaviours across population groups. This study evaluates risk perception among 2,244 residents of seven countries in sub-Saharan Africa (Botswana, Kenya, Malawi, Nigeria, Tanzania, Zambia and Zimbabwe) in relation to socio-demographic determinants. METHODS: an online survey was conducted via social media platforms to a random sample of participants. Risk perception was evaluated across six domains: loss of income, food scarcity, having a relative infected, civil disorder, criminal attacks, or losing a friend or relative to COVID-19. A multivariable ordinal logistic regression was conducted to assess socio-demographic factors associated with the perceived risk of being affected by COVID-19. RESULTS: 595 (27%) respondents did not consider themselves to be at risk, while 33% perceived themselves to be at high risk of being affected by the pandemic with respect to the six domains evaluated. Hospital-based workers had the highest proportional odds (3.5; 95%CI: 2.3-5.6) high perceived risk. Teenage respondents had the highest predictive probability (54.6%; 95% CI: 36.6-72.7%) of perceiving themselves not to be at risk of being affected by COVID-19, while Zambia residents had the highest predictive probability (40.7%; 95% CI: 34.3-47.0%) for high-risk perception. CONCLUSION: this study reveals the need to increase awareness of risks among socio-demographic groups such as younger people and the unemployed. Targeted risk communication strategies will create better risk consciousness, as well as adherence to safety measures.

On the imperative of thinking through the ethical, health equity, and social justice possibilities and limits of digital technologies in public health.

The COVID-19 pandemic has demonstrated both the positive and negative use, usefulness, and impact of digital technologies in public health. Digitalization can help advance and sustain the core functions of public health, including health promotion and prevention, epidemiological surveillance, and response to emergent health issues. Digital technologies are thus-in some areas of public discourse-presented as being both necessary and inevitable requirements to address routine and emergency public health issues. However, the circumstances, ways, and extent to which they apply remain a subject of critical reflection and empirical investigation. In this commentary, we argue that we must think through the use of digital technologies in public health and that their usefulness must be assessed in relation to their short- and long-term ethical, health equity, and social justice implications. Neither a sense of digital technological optimism and determinism nor the demands of addressing pressing public health issues should override critical assessment before development and implementation. The urgency of addressing public health emergencies such as the ongoing COVID-19 pandemic requires prompt and effective action, including action facilitated by digital technologies. Nevertheless, a sense of urgency cannot be an excuse or a substitute for a critical assessment of the tools employed.

RéSUMé: La pandémie de COVID-19 a montré les aspects positifs et négatifs de l'utilisation, de l'utilité et de l'impact des technologies numériques en santé publique. La numérisation peut contribuer à promouvoir et à soutenir les fonctions de base de la santé publique, dont la promotion de la santé, la prévention, la surveillance épidémiologique et la riposte aux nouvelles crises sanitaires. Les technologies numériques sont donc­dans certaines parties du discours public­présentées comme étant à la fois nécessaires et inévitables pour résoudre les problèmes de santé publique ordinaires ou urgents. Par contre, les circonstances, les moyens et la mesure dans laquelle elles s'appliquent font encore l'objet d'une réflexion critique et d'une investigation empirique. Dans ce commentaire, nous faisons valoir qu'il faut bien réfléchir à l'utilisation des technologies numériques en santé publique, et que leur utilité doit être analysée par rapport à leurs conséquences à court et à long terme sur l'éthique, l'équité en santé et la justice sociale. Ni les sentiments d'optimisme et de déterminisme à l'égard des technologies numériques, ni la nécessité de résoudre les problèmes de santé publique pressants ne devraient prendre le dessus sur l'analyse critique avant leur développement et leur mise en œuvre. L'urgence de résoudre des crises sanitaires comme la pandémie actuelle de COVID-19 nécessite une action rapide et efficace, et cette action peut être facilitée par les technologies numériques. Néanmoins, le sentiment d'urgence ne doit pas être une excuse et ne peut pas remplacer une analyse critique des outils employés.