Supporting US healthcare providers for successful vaccine communication.

BACKGROUND: While many healthcare providers (HCPs) have navigated patients' vaccine concerns and questions prior to the rollout of the COVID-19 vaccines, sentiments surrounding the COVID-19 vaccines have presented new and distinct challenges. OBJECTIVE: To understand the provider experience of counseling patients about COVID-19 vaccinations, aspects of the pandemic environment that impacted vaccine trust, and communication strategies providers found supportive of patient vaccine education. METHODS: 7 focus groups of healthcare providers were conducted and recorded during December 2021 and January 2022, at the height of the Omicron wave in the United States. Recordings were transcribed, and iterative coding and analysis was applied. RESULTS: 44 focus group participants representing 24 US states with the majority (80%) fully vaccinated at the time of data collection. Most participants were doctors (34%) or physician's assistants and nurse practitioners (34%). The negative impact of COVID-19 misinformation on patient-provider communication at both intrapersonal and interpersonal levels as well as barriers and facilitators to patient vaccine uptake are reported. People or sources that play a role in health communication ("messengers") and persuasive messages that impact behavior or attitudes towards vaccination ("messages") are described. Providers expressed frustration in the need to continuously address vaccine misinformation in clinical appointments among patients who remained unvaccinated. Many providers found value in resources that provided up-to-date and evidence-based information as COVID-19 guidelines continued to change. Additionally, providers indicated that patient-facing materials designed to support vaccination education were not frequently available, but they were the most valuable to providers in a changing information environment. CONCLUSIONS: While vaccine decision-making is complex and hinges on diverse factors such as health care access (i.e., convenience, expense) and individual knowledge, providers can play a major role in navigating these factors with their patients. But to strengthen provider vaccine communication and promote vaccine uptake, a comprehensive communication infrastructure must be sustained to support the patient-provider dyad. The findings provide recommendations to maintain an environment that facilitates effective provider-patient communication at the community, organizational and policy levels. There is a need for a unified multisectoral response to reinforce the recommendations in patient settings.

Sophocles' Philoctetes and Moral Injury in the COVID-19 Pandemic.

Strong emotional responses of health-care professionals to the unusual stress of providing care during the COVID-19 pandemic may be consistent with the experience of moral injury. This term, originally used to explain the feelings of guilt, shame, and righteous anger resulting from trauma experienced by US soldiers who felt betrayed by their leaders in combat, has recently been applied to the experiences of health-care workers who know the right thing to do but lack the autonomy, latitude, or authority to do it. Ancient Greek tragedy, which often explores stories about moral challenges, can provide a fruitful context for communicating about this kind of traumatic experience. Sophocles' Philoctetes is particularly relevant for health care since it describes the psychological pain of a would-be caregiver who is ordered by a superior to deny care to someone suffering with chronic pain, providing a clear example of betrayal through failed leadership and lack of authority to do the right thing. A more detailed reading of Sophocles' Philoctetes demonstrates that it also describes the kind of moral distress that results from being forced to respond to an unsolvable ethical dilemma when there is no clear right thing to do or when doing the right thing requires violating personal moral values.

A Select Bibliography of Actions to Promote Vaccine Literacy: A Resource for Health Communication.

In this bibliography, the researchers provide an introduction to the available evidence base of actions to promote vaccine literacy. The research team organized interventions to create a tool that can inform health communicators and practitioners seeking a resource focused on strategy and implementation design for actions that support vaccine literacy. This scoping bibliography is honed specifically to respond to the urgency of the current pandemic, when supporting and increasing vaccine literacy offers promise for achieving the critically needed high levels of vaccination. Over the course of the coming months and year, this bibliography will be a dynamic and "living" document hosted and maintained on vaccineliteracy.com.

Passively Sensing SARS-CoV-2 RNA in Public Transit Buses (preprint)

Affordably tracking the transmission of respiratory infectious diseases in urban transport infrastructures can inform individuals about potential exposure to diseases and guide public policymakers to prepare timely responses based on geographical transmission in different areas in the city. Towards that end, we designed and tested a method to detect SARS-CoV-2 RNA in the air filters of public buses, revealing that air filters could be used as passive fabric sensors for the detection of viral presence. We placed and retrieved filters in the existing HVAC systems of public buses to test for the presence of trapped SARS-CoV-2 RNA using phenol-chloroform extraction and RT-qPCR. SARS-CoV-2 RNA was detected in 14% (5/37) of public bus filters tested in Seattle, Washington, from August 2020 to March 2021. These results indicate that this sensing system is feasible and that, if scaled, this method could provide a unique lens into the geographically relevant transmission of SARS-CoV-2 through public transit rider vectors, pooling samples of riders over time in a passive manner without installing any additional systems on transit vehicles.

Building Vaccine Literacy in a Pandemic: How One Team of Public Health Students Is Responding.

Students at schools and programs of public health will enter a workforce during the greatest public health crisis in the past century. The potential COVID-19 vaccine-one of the most promising tools to return to a new 'normal'-is held in doubt by many Americans. Vaccine literacy in the United States is a pressing issue that students of public health need to consider. We describe how a long-standing public health student crisis response team at Emory University is helping to address this challenge, and describe key principles we identify as worthy of study and focus for current public health students today. Schools and programs of public health have a timely opportunity to adapt their curricula to meet training needs of emerging public health students to equip them to address vaccine literacy while maintaining accreditation standards.

Inequalities in general practice remote consultations: a systematic review.

BACKGROUND: COVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown. AIM: To explore the impact of remote consultations in general practice, compared to face-to-face consultations, on utilisation and clinical outcomes across socioeconomic and disadvantaged groups. DESIGN & SETTING: Systematic review. METHOD: The authors undertook an electronic search of MEDLINE, EMBASE, and Web of Science from inception to June 2020. The study included studies that compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data were synthesised narratively. RESULTS: Based on 13 studies that explored telephone and internet-based consultations, this review found that telephone consultations were used by younger people of working age, the very old, and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socioeconomic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes. CONCLUSION: Remote consultations in general practice are likely to be used more by younger, working people, non-immigrants, older patients, and women, with internet-based consultations more by younger, affluent, and educated groups. Widespread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.

Face Masks: Their History and the Values They Communicate.

Masks, now recommended and worn by a growing proportion of the world's population, have reflected various perceived meaning across time. This paper provides a brief history of the socio-cultural perceptions attached to wearing a mask by surveying how masks were perceived in ancient Greece and Rome, the origins of medical masks, and the ascribed socio-cultural meaning of masks during the COVID-19 pandemic. The use of a mask has historically diverse perceived meanings; currently, wearing a mask communicates a bipolar socio-cultural meaning and a nuanced, divisive symbology. To some, masks communicate a belief in medical science and a desire to protect one's neighbor from contagion. To others, a mask communicates oppression, government overreach, and a skepticism toward established scientific principles. It is the mask's ability to signal a deception, or extrapolated more broadly, a value system, that is highly relevant to current public health guidelines encouraging mask use to decrease the transmission of SARS-CoV-2, the novel coronavirus responsible for the COVID-19 pandemic. Public health officials and providers should utilize evidence-based health communication strategies when findings warrant a reversed recommendation of a symbol (such as masks) with a legacy of socio-cultural underpinnings that are deep-seated, complex, and emotional.

Development and Usability Testing of a Web-based COVID-19 Self-triage Platform.

INTRODUCTION: The development and deployment of a web-based, self-triage tool for severe respiratory syndrome coronavirus 2 (COVID-19 disease) aimed at preventing surges in healthcare utilization could provide easily understandable health guidance with the goal of mitigating unnecessary emergency department (ED) and healthcare visits. We describe the iterative development and usability testing of such a tool. We hypothesized that adult users could understand and recall the recommendations provided by a COVID-19 web-based, self-triage tool. METHODS: We convened a multidisciplinary panel of medical experts at two academic medical schools in an iterative redesign process of a previously validated web-based, epidemic screening tool for the current COVID-19 pandemic. We then conducted a cross-sectional usability study over a 24-hour period among faculty, staff, and students at the two participating universities. Participants were randomly assigned a pre-written health script to enter into the self-triage website for testing. The primary outcome was immediate recall of website recommendations. Secondary outcomes included usability measures. We stratified outcomes by demographic characteristics. RESULTS: A final sample of 877 participants (mean age, 32 years [range, 19-84 years]; 65.3% female) was used in the analysis. We found that 79.4% of the participants accurately recalled the recommendations provided by the website. Almost all participants (96.9%) found the website easy to use and navigate. CONCLUSION: Adult users of a COVID-19 self-triage website, recruited from an academic setting, were able to successfully recall self-care instructions from the website and found it user-friendly. This website appears to be a feasible way to provide evidence-based health guidance to adult patients during a pandemic. Website guidance could be used to reduce unnecessary ED and healthcare visits.