Cognitive Security and Resilience: A Social Ecological Model of Disinformation and other Harms with Applications to COVID-19 Vaccine Information Behaviors

Access to and discovery of credible information is the product of numerous, interacting factors including individual characteristics and behaviors as well as features of the information environment, social, cultural, and institutional norms, policies and regulations, and more. To date, most research on information disorder has focused either on the individual or on the information environment (or on the technology that allows an individual to access the information environment), but there is a lack of systematic, theory-driven research on the dynamic relationship between the individual and their environment. In this study, we propose a novel application of Brofenbrenner's social ecological model to the study of cognitive security and resilience in the context of information disorder. First, we describe the refitting of the model from public health and human development to cognitive security. Using extant literature in the field, we identify the key factors at each level of influence - including individual-level factors such as attitudes/beliefs, knowledge/experience, and demographic characteristics, as well as higher-level factors at the interpersonal-, organizational/institutional-, community-, and policy/culture-levels - that shape susceptibility and resilience to information disorder. We also consider the dynamic interactions between individuals, groups, societies, and characteristics of the technological environment, including how algorithms and artificial intelligence interact with individual behaviors, policies, and organizational decision-making to shape access to and discoverability of credible information. Finally, we describe an application of the model to a use case involving COVID-19-related information behaviors. To our knowledge, this is the first time Brofenbrenner's social ecological model has been applied in full as a conceptual foundation for the study of cognitive security and resilience. Our findings provide important new insight into the social, cultural, and structural factors that shape information behaviors and access to credible information, as well as the impact of information disorder. The results can be used to identify vulnerabilities and targets for future information-related initiatives and interventions (such as fact-checking and journalism initiatives) and to inform evaluations of such initiatives, as well as to better understand variation in susceptibility and resilience to information disorder. Further, this study lays an important conceptual foundation for future research to expand on this use case and refine the application of the social ecological model to the information domain. © 2022 Copyright for this paper by its authors.

Cost Analysis of Providing Overtime to Current Nurses Versus Hiring a Dedicated Nurse for COVID-19 Management in a Processing Plant.

BACKGROUND: U.S. meat and poultry processing workers experienced a disproportionate burden of COVID-19 illness following the declaration of the COVID-19 pandemic. Managing prevention and surveillance activities for COVID-19 prevention required additional work for occupational health nurses. The purpose of this project was to conduct a cost analysis for two staffing options to address the increased workload for occupational health nurses. METHODS: An economic quality improvement design was used for this study. The project was performed at a meat and poultry processing plant with 1,800 employees and six occupational health nurses. Two staffing options were considered. Option 1 was to continue to pay current occupational health nurses overtime, and Option 2 was to hire a COVID-dedicated nurse to manage the increased workload. A cost analysis was conducted for wages per hour plus benefits at three time points: 3 months, 1 year, and 3 years. FINDINGS: Costs for Option 1 (continuing overtime) at 3 months, 1 year, and 3 years were estimated at US$27,370, US$109,517, and US$328,550, respectively. Costs for Option 2 (hiring a COVID-dedicated nurse) at 3 months, 1 year, and 3 years were estimated at US$44,279, US$94,979, and US$230,179, respectively. CONCLUSIONS/APPLICATION TO PRACTICE: Hiring a dedicated COVID nurse would save the processing plant extensive salary costs by Year 3. Reducing overtime had the potential to decrease the COVID-19-related workload and potential experiences of fatigue and burnout in occupational health nurses.

Primary care education during a global pandemic:implementation of telemedicine

Program Goals: Facing the COVID-19 pandemic and the need for social distancing, our residency programremoved residents from certain clinical settings including the resident continuity clinic. This created aneducational gap in resident training and dramatically affected the way we deliver healthcare to our patients.To facilitate medical care in the safest way possible, our clinic implemented virtual visits via phone and videobeginning in mid-March. Whenever appropriate, sick and well care visits were completed via virtualencounters preceded by nurse-only visits for vaccines when indicated. Initially attendings performed thesevisits to develop virtual skills, build provider condence, and ensure that proper infrastructure was in place.Recognizing that telemedicine represented an important educational opportunity for residents, we laterincorporated residents into clinic. Residents were rst asked to observe a virtual encounter performed by anattending, and then they were observed conducting a virtual encounter. Residents then conducted encountersindependently, precepting with attendings via videoconference (including the family) or by putting the family on hold. Evaluation: 15 residents participated in telemedicine clinics within the rst 3 weeks of initiating thisprogram. 11 respondents from all years of training provided feedback. Residents reported completing 2-5telemedicine visits per half-day session. When asked about the educational value of a telemedicine clinicsession, 82% of residents reported this was similar or more educational as compared to a usual continuityclinic session. Educational benets included the opportunity to improve phone triage skills and increaseexperience with a technology that residents expect to use in the future. Educational challenges includedfeeling “rushed trying to navigate the technology' and discomfort with an unfamiliar process for precepting.All participants reported increased level of comfort with providing care via telemedicine after these sessions,and 91% of residents agreed or strongly agreed with the statement “I feel comfortable with providing care viatelemedicine now.” Although residents felt challenged by the inefficiency of reading screening tools aloud, bydelays due to connectivity problems, and by limited physical exam capabilities, they noted many strengthsincluding improved visit attendance rates and convenience for patients. Discussion: Innovative care deliverymodels are necessary to protect the community and the healthcare workforce while also providing neededmedical care and educational opportunities for our residents. As we move forward, we will continue to solicitfeedback to effectively meet new and evolving educational needs. We anticipate a role for virtual visits wellbeyond the COVID-19 pandemic. As such, we will continue to train our residents through virtual visits and willsoon be engaging medical students in telemedicine electives. We will continue to identify innovative ways toengage learners in telemedicine and streamline processes for determining which visits are appropriate for avirtual visit.