A FRAMEWORK FOR DIGITAL HEALTH EQUITY

BACKGROUND: The COVID-19 pandemic highlighted both the continued impact of long-standing systemic oppression on disparate health outcomes as well as the growing importance of healthcare provided through digital means. For example, an explosion in the use of telehealth for remote care noted significant disparities in use by minority groups. There is a growing recognition of the crucial importance of determinants in the digital environment and their impact on health outcomes. These digital determinants of health (DDoH) function independently as barriers to and facilitators of health as well as interact with social determinants of health (SDoH) to impact outcomes. A framework for digital health equity, detailing key DDoHs, is needed to support the work of developers in industry, health systems operations and academia. METHODS: The framework for digital health equity is an adaptation of the NIMHD Research Framework, which is the culmination of decades of work in the field of health disparities. The NIMHD framework is organized into several domains, including biological, behavioral, physical/built environment, sociocultural environment, and the health care system. Because of its particular importance at this time -we incorporate a digital environment domain with key DDoHs. RESULTS: Determinants at the individual level include digital literacy, readiness, interest, and self-efficacy. Readiness describes necessary technological equipment availability. Interest is used here to describe an individual's desire and willingness to use and trust in digital tools. Determinants at the interpersonal level include bias, interdependence, and relationship disruption. We use the term bias to describe the impact perceptions about an individual's digital literacy, readiness and interest have on clinician willingness to enroll and engage individuals with digital healthcare tools. Relationship disruption describes the complex cultural transformation encouraged by digital technologies. For disparity populations this has the potential to impact well documented relational determinants including medical mistrust and poor-quality communication. Determinants at the community level include cellular wireless and broadband access, quality and affordability as well as health system infrastructure. Determinants at the societal level include the impact of policy, data and design standards, algorithmic bias as well as social norms and ideologies in technical industry. Key examples of facilitators of positive health outcomes are provided at all levels. CONCLUSIONS: By adapting the leading health disparities research framework for digital health equity, we hope developers will benefit from decades of progress in the field of health disparities as well as see their work in the larger context of SDoHs so that we might work together towards meaningful progress in using digital means to achieve health equity for all.

Impact of COVID-19 vaccine-associated side effects on health care worker absenteeism and future booster vaccination.

BACKGROUND: Short-term side effects related to mRNA vaccines against SARS-CoV-2 are frequent and bothersome, with the potential to disrupt work duties and impact future vaccine decision-making. OBJECTIVE: To identify factors more likely to lead to vaccine-associated work disruption, employee absenteeism, and future vaccine reluctance among healthcare workers (HCWs). HYPOTHESIS: Side effects related to COVID vaccination: 1- frequently disrupt HCW duties, 2- result in a significant proportion of HCW absenteeism, 3- contribute to uncertainty about future booster vaccination, 4- vary based on certain demographic, socioeconomic, occupational, and vaccine-related factors. METHODS: Using an anonymous, voluntary electronic survey, we obtained responses from a large, heterogeneous sample of COVID-19-vaccinated HCWs in two healthcare systems in Southern California. Descriptive statistics and regression models were utilized to evaluate the research questions. RESULTS: Among 2,103 vaccinated HCWs, 579 (27.5%) reported that vaccine-related symptoms disrupted their professional responsibilities, and 380 (18.1%) missed work as a result. Independent predictors for absenteeism included experiencing generalized and work-disruptive symptoms, and receiving the Moderna vaccine [OR = 1.77 (95% CI = 1.33 - 2.36), p < 0.001]. Physicians were less likely to miss work due to side effects (6.7% vs 21.2% for all other HCWs, p < 0.001). Independent predictors of reluctance toward future booster vaccination included lower education level, younger age, having received the Moderna vaccine, and missing work due to vaccine-related symptoms. CONCLUSION: Symptoms related to mRNA vaccinations against SARS-CoV-2 may frequently disrupt work duties, lead to absenteeism, and impact future vaccine decision-making. This may be more common in Moderna recipients and less likely among physicians. Accordingly, health employers should schedule future booster vaccination cycles to minimize loss of work productivity.

Reducing Social Anxiety among Adolescents in the Covid-19 Era: Rational Emotive Behavior Therapy as a Counselling Approach

While the prioritization and rollout of vaccines against COVID-19 in most countries of the world remains the only means to save the world from the novel coronavirus pandemic, which has continued to disrupt the traditional way of life for everyone, the increased social anxiety that can help to reduce vaccine hesitancy has been spared, especially in the developing nations. Therefore, this study aimed to adopt the Rational Emotive Behavior Therapy (REBT) counselling approach to manage social anxiety among adolescents in the COVID-19 era. A quasi-experimental design (prepost-test and control group) was adopted. Using the multistage sampling technique, 88 adolescents were randomly assigned to REBT (n= 43) and control groups n= 45). The results indicated that REBT significantly reduced social anxiety with pre-test and post-test mean scores of 47.56 (47.56%) ± 6.58 and 30.23 (30.23%) ±14.29, respectively. The main effect of REBT treatment was found to be significant (F 2, 233= 41.82, p=.000). Conversely, the two-way interaction between treatment and gender was not statistically significant. It was concluded that REBT is an effective counselling approach in reducing social anxiety among school-going adolescents, and that the treatment was not gender specific. © 2022. IJP&PT & AAC. Unauthorized reproduction of this article is prohibited.

Predictors of COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers in Southern California: Not Just "Anti" vs. "Pro" Vaccine.

In this study, we evaluated the status of and attitudes toward COVID-19 vaccination of healthcare workers in two major hospital systems (academic and private) in Southern California. Responses were collected via an anonymous and voluntary survey from a total of 2491 participants, including nurses, physicians, other allied health professionals, and administrators. Among the 2491 participants that had been offered the vaccine at the time of the study, 2103 (84%) were vaccinated. The bulk of the participants were middle-aged college-educated White (73%), non-Hispanic women (77%), and nursing was the most represented medical occupation (35%). Political affiliation, education level, and income were shown to be significant factors associated with vaccination status. Our data suggest that the current allocation of healthcare workers into dichotomous groups such as "anti-vaccine vs. pro-vaccine" may be inadequate in accurately tailoring vaccine uptake interventions. We found that healthcare workers that have yet to receive the COVID-19 vaccine likely belong to one of four categories: the misinformed, the undecided, the uninformed, or the unconcerned. This diversity in vaccine hesitancy among healthcare workers highlights the importance of targeted intervention to increase vaccine confidence. Regardless of governmental vaccine mandates, addressing the root causes contributing to vaccine hesitancy continues to be of utmost importance.

Can HbA1c levels be used as an independent marker of mortality and morbidity risk in patients with COVID-19 positive swabs?

Background: Diabetes mellitus has been considered a significant risk factor for morbidity and mortality for COVID-19.1 HbA1c levels are often used as a marker of poor glycaemic control and are one way of diagnosing pre-diabetes as well as diabetes.2,3 We tried to explore whether HbA1c levels could be an independent risk factor for mortality and morbidity in patients with positive coronavirus (SARS-COv-2) swabs. Methods: This was a retrospective multicentre study of coronavirus swab positive patients who had a recent HbA1c test. Their demographic data, medical history, COVID-19 swab and laboratory results, and final outcomes were analysed. Patients were divided into three groups;HbA1c in normal (group 1), pre-diabetic (group 2) and diabetic (group 3) ranges. Data were analysed using JASP and statistical computation using a χ2 test. Results: A total of 1,226 patients had SARS-CoV-2 RNA identification swabs between 10 February 2020 and 1 May 2020. A cohort of 120 of these patients had positive swab results and recent HbA1c results. Mortality rates for group 1 (normal HbA1c) and 3 (diabetic HbA1c) were relatively higher than group 2 (pre-diabetic HbA1c). Among group 2, female patients had greater mortality, perhaps because of fewer male patients, although overall co-morbidity was less (4/120 (3.33%) in group 2 compared with 18/120 (15%) in group 1 and 14/120 (11.66%) in group 3. Overall, 36/120 (30%) patients died and 84/120 (70%) survived. Survival curves after analysis of data showed that increasing HbA1c levels were associated with poorer outcomes across all groups. Analysis was significant with p=0.003. Conclusions: HbA1c levels in this study were an independent marker of increased risk of mortality in COVID-19 swab positive patients. The findings are statistically significant (p=0.003). Increased co-morbidities at normal HbA1c seem to have a contributing role in enhanced mortality.

Parental involvement, learning participation and online learning commitment of adolescent learners during the COVID-19 lockdown

During the escalating coronavirus disease-2019 (COVID-19) pandemic, attempting to contain its spread, a large number of educational institutions shut down face-to-face teaching and learning activities globally due to a complete lockdown. This lockdown revealed emerging vulnerabilities of education systems in the low-and middle-income countries of the world, with Nigeria being no exception. Given these concerns, this research study assessed parental involvement, learning participation and the commitment to online learning of adolescent learners during the COVID-19 lockdown in Nigeria. Au online survey questionnaire was employed to examine the level of online learning commitment and the contributory roles of each of the factors to online learning commitment of adolescent learners. In total, 1407 adolescents (male = 38.8%;female 61.2%) aged between 12 and 20 years (mean = 15: SD = 4.24) responded to the online survey, which was open for 2 months. Data were analysed using descriptive statistics of frequency distribution and inferential statistics of multiple regression. The findings revealed that the commitment level of adolescent learners to online learning was high. The findings further yielded a coefficient of R= 0.439 and R-2 = 0.192 variance in the prediction of the outcome measure. Parental involvement contributed 32% (beta = 0.322, p < 0.05) and learning participation contributed 23% (beta = 0.234, p < 0.05) towards online learning. The study concludes that parental involvement and learning participation played a significant and positive role in the commitment of adolescent learners towards online learning during the COVID-19 lockdown in Nigeria. The authors suggest that parents be encouraged to synergise with the digitalised revolution, while the need for further in-depth research on the subject is emphasised in the suggestions for future research.