Environmental determinants of infectious and chronic disease prevention behaviours: A systematic review and thematic synthesis of qualitative research.

Regulatory health policies facilitate desired health behaviours in communities, and among them, smoke-free policies and COVID-19 restrictions have been widely implemented. Qualitative research studies have explored how these measures and other environmental influences shape preventive behaviours. The objective of this systematic review was to synthesize previously published qualitative research, generate across-study themes, and propose recommendations for behaviour change interventions. We used a comprehensive search strategy, relevance screening and confirmation, data extraction, quality assessment, thematic synthesis, and quality-of-evidence assessment. In total, 87 relevant studies were identified. Findings were grouped under six overarching themes and mapped under three categories: (i) the political environment, (ii) the sociocultural environment, and (iii) the physical environment. These findings provide insights into the environmental influences of behaviour and indicate future interventions may be more effective by considering moral norms, community norms, policy support, and group identity.

Behind the Counter: Exploring Pharmacists' Stressors and Lessons Learned During the Pandemic in Ontario, Canada.

Background: The onset of the COVID-19 pandemic has contributed to increased stress among healthcare professionals. Among these healthcare providers are Ontario pharmacists, who are facing new and pre-existing challenges and new stressors since the pandemic. Objectives: This study aimed to understand the stressors and lessons learned by Ontario pharmacists during the pandemic through their lived experiences. Methods: In this descriptive qualitative study, we conducted semi-structured one-on-one interviews with Ontario pharmacists virtually to learn about their stressors and lessons learned during the pandemic. Interviews were transcribed verbatim, then analyzed using thematic analysis. Findings: We reached data saturation after 15 interviews and identified 5 main themes: (1) Communication/miscommunication with the public and other care providers; (2) high workload due to staff shortage and low appreciation/acknowledgement; (3) mismatch in market demand and supply; (4) informational gaps pertaining to the COVID-19 pandemic along with rapid protocol changes; and (5) lessons learned to improve the future of pharmacy practice in Ontario. Discussion: Our study helped us gain a better understanding of the stressors pharmacists faced, their contributions, and the opportunities that arose due to the pandemic. Conclusion: Drawing on these experiences, this study provides recommendations to improve pharmacy practice and increase preparedness for future emergencies.

A Cross-Sectional Study and Observational Assessment of Shoppers' COVID-19 Prevention Behaviors in Southwestern Ontario, Canada.

OBJECTIVE: The aim of this study was to observe the level of alcohol-based sanitizer, mask use, and physical distancing across indoor community settings in Guelph, ON, Canada, and to identify potential barriers to practicing these behaviors. METHODS: Shoppers were observed in June 2022 across 21 establishments. Discrete in-person observations were conducted and electronically recorded using smartphones. Multilevel logistic regression models were fitted to identify possible covariates for the 3 behavioral outcomes. RESULTS: Of 946 observed shoppers, 69% shopped alone, 72% had at least 1 hand occupied, 26% touched their face, 29% physically distanced ≥ 2 m, 6% used hand sanitizer, and 29% wore masks. Sanitizer use was more commonly observed among people who wore masks and in establishments with coronavirus disease (COVID-19) signage posted at the entrance. Mask use was more commonly observed during days without precipitation and in establishments with some or all touch-free entrances. Shoppers more commonly physically distanced ≥ 2 m when they were shopping alone. CONCLUSIONS: This supports evidence for environmental context influencing COVID-19 preventive behaviors. Intervention efforts aimed at visible signage, tailored messaging, and redesigning spaces to facilitate preventive behaviors may be effective at increasing adherence during outbreaks.

"I Can Sense When My Hands Need Washing": A Qualitative Study and Thematic Analysis of Factors Affecting Young Adults' Hand Hygiene.

Handwashing is one of the most effective and low-cost public health measures. However, it is often not practiced frequently enough or correctly by the public. Young adults in particular have poorer intentions to wash their hands, frequency of handwashing, and sanitizer use compared to other age groups. Therefore, there is a need to identify barriers and facilitators affecting hand hygiene within this group. The objective of this qualitative study was to apply the Theoretical Domains Framework to explore factors which influence hand hygiene among young adults aged 18 to 25 years old. An online questionnaire (n = 37) and thematic analysis were used to generate 3 overarching themes. The main findings indicated internal factors such as knowledge and intentions; interpersonal factors such as social norms; and environmental factors such as reminders, cues, accessibility, and cleanliness of handwashing facilities determined the level of hand hygiene practiced among young adults. The findings suggest that behavior change techniques such as social comparisons and tailored messaging to suit the needs of young adults may be more effective at increasing hand hygiene.

The mental health of laboratory and rehabilitation specialists during COVID-19: A rapid review.

Backgrounds: Healthcare workers have experienced considerable stress and burnout during the COVID-19 pandemic. Among these healthcare workers are medical laboratory professionals and rehabilitation specialists, specifically, occupational therapists, and physical therapists, who all perform critical services for the functioning of a healthcare system. Purpose: This rapid review examined the impact of the pandemic on the mental health of medical laboratory professionals (MLPs), occupational therapists (OTs) and physical therapists (PTs) and identified gaps in the research necessary to understand the impact of the pandemic on these healthcare workers. Methods: We systematically searched "mental health" among MLPs, OTs and PTs using three databases (PsycINFO, MEDLINE, and CINAHL). Results: Our search yielded 8887 articles, 16 of which met our criteria. Our results revealed poor mental health among all occupational groups, including burnout, depression, and anxiety. Notably, MLPs reported feeling forgotten and unappreciated compared to other healthcare groups. In general, there is a dearth of literature on the mental health of these occupational groups before and during the pandemic; therefore, unique stressors are not yet uncovered. Conclusions: Our results highlight poor mental health outcomes for these occupational groups despite the dearth of research. In addition to more research among these groups, we recommend that policymakers focus on improving workplace cultures and embed more intrinsic incentives to improve job retention and reduce staff shortage. In future emergencies, providing timely and accurate health information to healthcare workers is imperative, which could also help reduce poor mental health outcomes.

Pharmacists' Mental Health during the First Two Years of the Pandemic: A Socio-Ecological Scoping Review.

Healthcare workers have been under a great deal of stress and have been experiencing burnout throughout the COVID-19 pandemic. Among these, healthcare workers are pharmacists who have been instrumental in the fight against the pandemic. This scoping review examined the impact of the pandemic on pharmacists' mental health and their antecedents using three databases (CINAHL, MEDLINE, and PsycINFO). Eligible studies included primary research articles that examined the mental health antecedents and outcomes among pharmacists during the first two years of the pandemic. We used the Social Ecological Model to categorize antecedents per outcome. The initial search yielded 4165 articles, and 23 met the criteria. The scoping review identified pharmacists experiencing poor mental health during the pandemic, including anxiety, burnout, depression, and job stress. In addition, several individual, interpersonal, organizational, community, and policy-level antecedents were identified. As this review revealed a general decline in pharmacists' mental health during the pandemic, further research is required to understand the long-term impacts of the pandemic on pharmacists. Furthermore, we recommend practical mitigation strategies to improve pharmacists' mental health, such as implementing crisis/pandemic preparedness protocols and leadership training to foster a better workplace culture.

Natural Resource Development and Well-Being in Inuit Nunangat: A Scoping Review

Natural resource developments have signifi cant positive and negative impacts on the health and well-being of communities in Inuit Nunangat (Inuit Homelands) in Canada. Mining, hydroelectric, and oil and gas developments signifi cantly alter the landscapes of communities and often an entire region. As climate change and global demand for natural resources increase, the four regions in Inuit Nunangat-Nunatsiavut, Nunavik, Nunavut, and the Inuvialuit Settlement Region-may experience an increase in development activity. The goal of this scoping review was to map trends in the extent, range, and nature of published research examining the relationship between natural resource development and health and well-being of communities in Inuit Nunangat. A total of 2,861 articles were screened for relevance, and 58 articles met the inclusion criteria and were analyzed in full. The results indicate that: 1) Nunavut was the most discussed region;2) mining and/or mineral exploration was the most commonly discussed resource development;3) communication between researchers and industry offi cials or health authorities was not frequently reported;4) there were numerous government policies discussed, suggesting policy is a signifi cant factor in the relationship between resource development and well-being;5) holistic health was the most common area of health discussed;6) Inuit inclusion in research varied, with nearly half of articles reporting Inuit involvement in the data collection and/or analysis;7) few articles discussed mine closures and the impacts on Inuit well-being;and, 8) no articles were published in 2020, therefore no articles discussed the impact of COVID-19.

A qualitative study exploring healthcare providers' and trainees' barriers to COVID-19 and influenza vaccine uptake.

Background: Vaccines are effective biological interventions which reduce health burdens and protect healthcare providers from vaccine-preventable diseases. However, there are concerns about varying levels of vaccination coverage of influenza and COVID-19 vaccines among those working in healthcare. The aim of this study was to identify barriers and facilitators to COVID-19 and influenza vaccinations among healthcare providers and trainees using the Theoretical Domains Framework (TDF). Methods: Semi-structured interviews (n = 18) were carried out with healthcare providers and trainees in Canada. A thematic analysis approach was used to code interview transcripts and match findings to TDF domains and broader categories. Results: Three overarching themes were generated from six TDF domains and three inductively generated categories: (1) making informed health decisions with an added responsibility to protect oneself and patients; (2) a pro-vaccine social network, widespread accessibility, and pursuing a sense of normalcy; and (3) seeking a more nuanced, respectful, and calculated approach to vaccine communication and policy implementation. Conclusion: These findings help to identify factors associated with influenza and COVID-19 vaccine uptake among individuals in the healthcare field. Addressing these factors may improve healthcare provider sentiments surrounding vaccines, lead to better patient education, and increased uptake of vaccinations with the potential for seasonal booster doses.

Canadian COVID-19 Crisis Communication on Twitter: Mixed Methods Research Examining Tweets from Government, Politicians, and Public Health for Crisis Communication Guiding Principles and Tweet Engagement.

To foster trust on social media during a crisis, messages should implement key guiding principles, including call to action, clarity, conversational tone, compassion and empathy, correction of misinformation, and transparency. This study describes how crisis actors used guiding principles in COVID-19 tweets, and how the use of these guiding principles relates to tweet engagement. Original, English language tweets from 10 federal level government, politician, and public health Twitter accounts were collected between 11 March 2020 and 25 January 2021 (n = 6053). A 60% random sample was taken (n = 3633), and the tweets were analyzed for guiding principles. A tweet engagement score was calculated for each tweet and logistic regression analyses were conducted to model the relationship between guiding principles and tweet engagement. Overall, the use of guiding principles was low and inconsistent. Tweets that were written with compassion and empathy, or conversational tone were associated with greater odds of having higher tweet engagement. Across all guiding principles, tweets from politicians and public health were associated with greater odds of having higher tweet engagement. Using a combination of guiding principles was associated with greater odds of having higher tweet engagement. Crisis actors should consistently use relevant guiding principles in crisis communication messages to improve message engagement.

Trust and Engagement on Twitter During the Management of COVID-19 Pandemic: The Effect of Gender and Position.

During the COVID-19 pandemic, health and political leaders have attempted to update citizens using Twitter. Here, we examined the difference between environments that social media has provided for male/female or health/political leaders to interact with people during the COVID-19 pandemic. The comparison was made based on the content of posts and public responses to those posts as well as user-level and post-level metrics. Our findings suggest that although health officers and female leaders generated more contents on Twitter, political leaders and male authorities were more active in building networks. Offensive language was used more frequently toward males than females and toward political leaders than health leaders. The public also used more appreciation keywords toward health leaders than politicians, while more judgmental and economy-related keywords were used toward politicians. Overall, depending on the gender and position of leaders, Twitter provided them with different environments to communicate and manage the pandemic.

A content analysis of Canadian influencer crisis messages on Instagram and the public's response during COVID-19.

Successful mitigation of emerging infectious disease requires that the public adopt recommended behaviours, which is directly influenced by effective crisis communication. Social media has become an important communication channel during COVID-19 where official actors, influencers, and the public are co-creating crisis messages. Our research examined COVID-19-related crisis messages across Canadian influencer accounts within news media, politicians, public health and government, science communicators, and brand influencer and celebrities, posted on Instagram between December 2019 and March 2021 for Health Belief Model and Extended Parallel Processing Model constructs and the corresponding public comment sentiment and engagement. Thirty-three influencer accounts resulted in a total of 2,642 Instagram posts collected, along with 461,436 comments, which showed overall low use of constructs in both captions and images. Further, most posts used no combinations (n = 0 or 1 construct per post) of constructs in captions and images and very infrequently used captions that combined threat (severity and susceptibility) with cues to action and efficacy. Brand influencers and celebrities, politicians, and science communicators had above average post engagement while public health and government and news media had lower. Finally, most influencers saw the largest proportion of neutral sentiment comments. Crisis messages must be designed to include combinations of constructs that increase message acceptance and influence risk perception and efficacy to increase the adoption of recommended and mandated behaviours.

Engagement Analysis of Canadian Public Health and News Media Facebook Posts and Sentiment Analysis of Corresponding Comments during COVID-19

During the COVID-19 pandemic, key stakeholders have used social media to rapidly disseminate essential information to the public to help them make informed health-related decisions. Our research examined how the public responded to official actors’Facebook posts during COVID-19 and examined the comment sentiment and post engagement rates. CBC News and CTV News received a greater proportion of negative comments and a lower average post engagement rate compared with Healthy Canadians. Additionally, the proportion of negative and positive comments varied over time for all sources;however, over 30% of the comments for all three actors were consistently negative. Key stakeholders should monitor the public’s response to their social media posts and adapt their messages to increase the effectiveness of their crisis communication efforts to encourage the adoption of protective measures.

How Did the Media Report the Mining Industry's Initial Response to COVID-19 in Inuit Nunangat? A Newspaper Review.

Mining in Inuit Nunangat relies on a southern Canada fly-in/fly-out (FIFO) and local workforce. The FIFO workforce, combined with existing social determinants of health, can create health risks to Inuit Nunangat. These risks were increased with COVID-19. As newspaper reporting can shape public opinion and policy actions regarding these COVID-19 risks, we systematically searched databases to identify newspaper articles during the initial phase of COVID-19 (i.e., articles published from 1 January to 30 June 2020). Descriptive statistics and qualitative thematic analysis were used to analyze the nature, range, and extent of included articles. Most included articles were published by Inuit Nunangat-based newspapers. Half the sources quoted were mining companies and most reported reactions to their initial response were negative. The most frequent topic was concern that an infected FIFO employee could transmit COVID-19 to a worksite and subsequently infect Inuit employees and communities. Inuit Nunangat-based newspapers were crucial in shaping the narrative of the initial response. National newspapers mainly focused on the takeover of TMAC™ during the pandemic, while Inuit Nunangat-based newspapers provided timely and locally-relevant pandemic information. Without Inuit Nunangat-based newspapers, the reporting would be from national and southern newspapers, which was less in-depth, less frequent, and less relevant to Inuit.

Exploration of Factors Affecting Post-Secondary Students' Stress and Academic Success: Application of the Socio-Ecological Model for Health Promotion.

OVERVIEW: There has been an increase in the frequency and severity of stress experienced by Canadian post-secondary students, which has adverse implications on their academic success. This work applied the socio-ecological model for health promotion to explore the contextual factors that influence this relationship at the individual, interpersonal, institutional, community, and public policy levels. METHODS: Using a qualitative, phenomenological approach, we conducted 38 semi-structured interviews with undergraduate students and on-campus staff who provide services to this population at a post-secondary institution in Southwestern Ontario, Canada. Thematic analysis inductively identified overarching themes among participants' perspectives. RESULTS: Several positive and negative factors were identified at each socio-ecological model level, demonstrating the complex interplay of demographic, psychological, emotional, social, physical, and academic factors impacting students' academic stress. CONCLUSIONS: A lack of communication and knowledge seems to underlie many factors, highlighting the need to strengthen communication strategies to promote awareness, accessibility, and availability of services and programs on campus. Results also pointed to focusing on proactive, resilience-focused, upstream mental health promotion efforts at post-secondary institutions to reduce stress and improve academic success. This knowledge can help Canadian campuses better address students' needs.

Examining Social Media Crisis Communication during Early COVID-19 from Public Health and News Media for Quality, Content, and Corresponding Public Sentiment.

Rising COVID-19 cases in Canada in early 2021, coupled with pervasive mis- and disinformation, demonstrate the critical relationship between effective crisis communication, trust, and risk protective measure adherence by the public. Trust in crisis communication is affected by the communication's characteristics including transparency, timeliness, empathy, and clarity, as well as the source and communication channels used. Crisis communication occurs in a rhetorical arena where various actors, including public health, news media, and the public, are co-producing and responding to messages. Rhetorical arenas must be monitored to assess the acceptance of messaging. The quality and content of Canadian public health and news media crisis communication on Facebook were evaluated to understand the use of key guiding principles of effective crisis communication, the focus of the communication, and subsequent public emotional response to included posts. Four hundred and thirty-eight posts and 26,774 anonymized comments were collected and analyzed. Overall, the guiding principles for effective crisis communication were inconsistently applied and combined. A limited combination of guiding principles, especially those that demonstrate trustworthiness, was likely driving the negative sentiment uncovered in the comments. Public health and news media should use the guiding principles consistently to increase positive sentiment and build trust among followers.

An analysis of COVID-19 vaccine sentiments and opinions on Twitter.

OBJECTIVE: We identified public sentiments and opinions toward the COVID-19 vaccines based on the content of Twitter. MATERIALS AND METHODS: We retrieved 4,552,652 publicly available tweets posted within the timeline of January 2020 to January 2021. Following extraction, we identified vaccine sentiments and opinions of tweets and compared their progression by time, geographical distribution, main themes, keywords, posts engagement metrics and accounts characteristics. RESULTS: We found a slight difference in the prevalence of positive and negative sentiments, with positive being the dominant polarity and having higher engagements. The amount of discussion on vaccine rejection and hesitancy was more than interest in vaccines during the course of the study, but the pattern was different in various countries. We found the accounts producing vaccine opposition content were partly Twitter bots or political activists while well-known individuals and organizations generated the content in favour of vaccination. CONCLUSION: Understanding sentiments and opinions toward vaccination using Twitter may help public health agencies to increase positive messaging and eliminate opposing messages in order to enhance vaccine uptake.

Strengthening collaborations at the public health system-academic interface: a call to action.

In Canada and globally, the COVID-19 pandemic has highlighted the importance of reliable and responsive public health systems. The pandemic has required decisive leadership and collaboration across all sectors of society informed by the best available evidence. In this commentary, we argue that in order to create a robust public health system equipped to address current and future public health challenges, we must prioritize and invest in stronger relationships between public health practice and academia. We briefly review key recommendations following the SARS outbreak, particularly those calling for stronger linkages between public health academia and practice settings in Canada. We then propose key actions for strengthening these linkages. Echoing other COVID-19-related calls, which request long-term reinvestment in public health education and training, we recommend the following actions: (1) Improve collaboration between education programs and public health agencies to address system needs (e.g., surge capacity) and persisting health inequities; (2) Fund a pan-Canadian public health training initiative that builds on a renewed set of public health competencies to address priority training needs (e.g., equity-oriented leadership); and (3) Prepare a cadre of certified public health leaders who can progress along public health career pathways, including those already in practice.

RéSUMé: Au Canada et ailleurs dans le monde, la pandémie de COVID-19 a montré qu'il est important d'avoir des systèmes de santé publique fiables et réactifs. La pandémie nécessite un leadership décisif et une collaboration entre tous les secteurs de la société, éclairés par les meilleures preuves disponibles. Dans ce commentaire, nous faisons valoir que pour créer un système de santé publique robuste capable de relever les défis actuels et futurs, il faut privilégier des liens plus forts entre les praticiens de la santé publique et les milieux universitaires et y consacrer les investissements nécessaires. Nous passons brièvement en revue les principales recommandations qui ont suivi la crise du SRAS, en particulier celles qui réclamaient le renforcement des liens entre les facultés de santé publique et les milieux de pratique au Canada. Nous proposons ensuite des mesures clés pour renforcer ces liens. Faisant écho à d'autres appels à l'action liés à la COVID-19, qui préconisent un réinvestissement à long terme dans l'enseignement et la formation en santé publique, nous recommandons les mesures suivantes: 1) Améliorer la collaboration entre les programmes d'enseignement et les organismes de santé publique pour aborder les besoins des systèmes (p. ex. leur capacité d'appoint) et les inégalités persistantes en santé; 2) Financer une initiative pancanadienne de formation en santé publique qui s'appuie sur un ensemble renouvelé de compétences en santé publique pour répondre aux besoins prioritaires en matière de formation (p. ex. le leadership axé sur l'équité); et 3) Préparer un groupe de dirigeants de santé publique agréés pouvant progresser dans les carrières de la santé publique, y compris des personnes qui exercent déjà la profession.