ABSTRACT
Policies designed to contain the COVID-19 pandemic have impacted food systems worldwide. How impacts played out in local food systems, and how these affected the lived experiences of different people is only just coming to light. We conducted a structured analysis of the impacts of COVID-19 containment policies on the food systems of small-scale fishing communities in Kenya, Papua New Guinea, and Saint Lucia, based on interviews with men and women fishers, fish traders, and community leaders. Participants reported that containment policies lead indirectly to reduced volumes of food, lower dietary diversity, increased consumption of traditional foods, and reduced access to fish for food and income. Although the initiating policy and food and nutrition security outcomes often appeared similar, we found that the underlying pathways and feedbacks causing these impacts were different based on local context. Incorporating knowledge of how context-specific factors shape food system outcomes may be key to tailoring strategies to mitigate the ongoing impacts of COVID-19 and designing timely, strategic interventions for future systemic shocks. © 2023, Resilience Alliance. All rights reserved.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: In early 2021, only 14% of vaccine eligible patients of two academic outpatient practices had received at least one COVID-19 vaccine dose;Black patients comprised 16% of all vaccine eligible patients, but only 10% of those vaccinated, while Hispanic patients comprised 13% of all vaccine eligible patients, but only 7% of those vaccinated. DESCRIPTION OF PROGRAM/INTERVENTION: The objective of this study was to rapidly develop and implement an equity-focused outreach intervention that facilitated COVID-19 vaccine appointments in patients who qualified for a vaccine. The intervention aimed to contact Black and Latino adults ≥65 years old, or ≥18 years old with qualifying chronic conditions, who had at least one visit at the practices within the past three years and who had not received or scheduled a COVID-19 vaccination per electronic health records. Using the Plan-Do-Study-Act model, we developed and executed a multipronged outreach intervention consisting of (1) a mailed letter from the patient's physician endorsing the COVID-19 vaccine, (2) a phone call/recall system to remind patients about their eligibility to receive the vaccine, (3) discussions with a vaccine ambassador to answer questions or address hesitancies regarding the vaccines, and (4) real-time facilitation with scheduling a vaccine appointment and information about where in the community to receive or schedule a vaccine. Volunteer callers were recruited and trained in executing all components of the intervention. MEASURES OF SUCCESS: Bi-weekly focus groups were held with callers to identify challenges with implementation. The number of calls made, patients reached and vaccinations scheduled were analyzed weekly. FINDINGS TO DATE: From March 15 to May 28, 2021, 38 callers were recruited and 5058 calls were made as part of our outreach intervention. Of 2794 total patients attempted, 1519 were successfully reached, 746 of whom had already scheduled or received a vaccine (without documentation in the electronic health record). Of the 750 patients who were reached and eligible for the intervention, 129 (17.2%) had a vaccine scheduled by the caller, 72 (9.6%) planned to self- schedule a vaccine and were instructed on how to do so by the callers, and 549 (73.2%) did not want nor planned to have the vaccine scheduled. The weekly proportion of eligible patients scheduled for vaccine decreased over time, starting at 30% and ending at 0% in the 11th week of the intervention, at which point the intervention was stopped. “Low confidence in the vaccine” and “Still contemplating whether to receive the vaccine” were the two reasons most cited for declining or being unsure about receiving the vaccine. KEY LESSONS FOR DISSEMINATION: An equity-focused outreach program to facilitate vaccination scheduling can be rapidly developed and implemented in outpatient primary care practices, but may need to further consider inaccuracies in vaccination status as documented in the electronic records and increase access to accessible vaccinations sites.