Stigma and health inequality experienced by ethnic minorities during the COVID-19 pandemic in a Chinese community: an implication to health policymakers.

Introduction: Ethnic minorities are considered one of the most vulnerable groups during the COVID-19 pandemic. However, the explanatory pathway of how their disadvantaged experiences during epidemics are related to the embedded and longstanding stigmas against them and how these embedded stigmas can affect their resilience in disease outbreaks are not well understood. This study investigated the experiences of ethnic minorities in the COVID-19 pandemic, and how their experiences were related to the embedded stigma toward them. Methods: This study adopted a qualitative approach, interviewed 25 individuals (13 women and 12 men) from ethnic minority groups residing in Hong Kong from August 2021 to February 2022 in a semi-structured format. Thematic analysis was conducted to analyze the data. Results: The participants were isolated and stereotyped as infectious during the COVID-19 pandemic at community and institutional levels. Their experiences did not occur suddenly during the pandemic but were embedded in the longstanding segregation and negative stereotypes toward ethnic minorities in different aspects of life before the pandemic. These negative stereotypes affected their resilience in living and coping with the pandemic. Conclusion: The participants' experiences during the COVID-19 pandemic were mostly disadvantageous and predominantly initiated by the mainstream stigmatization toward them by the local Chinese residents and government. Their disadvantaged experiences in the pandemic should be traced to the embedded social systems, imposing structural disparities for ethnic minorities when accessing social and medical resources during a pandemic. Because of the preexisting stigmatization and social seclusion of ethnic minorities in Hong Kong, the participants experienced health inequality, which stemmed from social inequality and the power differential between them and the Chinese locals. The disadvantaged situation of the participants negatively affected their resilience to the pandemic. To enable ethnic minorities better cope with future epidemics, merely providing assistance to them during an epidemic is barely adequate, but a more supportive and inclusive social system should be established for them in the long run.

Using knowledge of, attitude toward, and daily preventive practices for COVID-19 to predict the level of post-traumatic stress and vaccine acceptance among adults in Hong Kong.

Introduction: COVID-19 has been perceived as an event triggering a new type of post-traumatic stress (PTSD) that can live during and after the pandemic itself. However, it remains unclear whether such PTSD is partly related to people's knowledge of, attitude toward and daily behavioral practices (KAP) for COVID-19. Methods: Through a telephone survey, we collected responses from 3,011 adult Hong Kong residents. Then using the Catboost machine learning method, we examined whether KAP predicted the participant's PTSD level, vaccine acceptance and participation in voluntary testing. Results: Results suggested that having good preventative practices for, poor knowledge of, and negative attitude toward COVID-19 were associated with greater susceptibility to PTSD. Having a positive attitude and good compliance with preventative practices significantly predicted willingness to get vaccinated and participate in voluntary testing. Good knowledge of COVID-19 predicted engagement in testing but showed little association with vaccine acceptance. Discussion: To maintain good mental health and ongoing vaccine acceptance, it is important to foster people's sense of trust and belief in health professionals' and government's ability to control COVID-19, in addition to strengthening people's knowledge of and compliance with preventative measures.

The Role of Social and Cultural Values in Pandemic Control in a Chinese Community: An Ethnographic Study on the Construction and Stigmatization of "Others" in Severe Acute Respiratory Syndrome (SARS) and COVID-19 in Hong Kong.

BACKGROUND: Studies have widely reported that social and cultural values serve as constraints in controlling the spread of an epidemic. However, I argue that a social and cultural value system is a double-edged sword and can motivate people's preventive health behaviors. Few studies have examined the positive role of social and cultural values in promoting epidemic control. METHODS: Using the severe acute respiratory syndrome outbreak in 2003 and the COVID-19 pandemic that began in 2020 in Hong Kong as examples, the present study performed participant observation in Hong Kong from January to June 2003 and from January 2020 to May 2022; in-depth individual semi-structured interviews were conducted with 70 participants between February 2021 and March 2022. RESULTS: Social and cultural values serve as informal social control mechanisms in manipulating people's adoption of preventive health behaviors that can assist in epidemic control. Specifically, the construction and stigmatization of the "others" groups and the traditional cultural values based on the capitalist ideology were noted to facilitate control measures against the two outbreaks in Hong Kong. CONCLUSION: These two outbreaks reinforced the embedded social and cultural values of the capitalist ideology of Hong Kong, which increased the vulnerability of disadvantaged social groups to stigmatization.

Motivations and deterrents of blood donation among blood donors during the COVID-19 pandemic in Hong Kong.

BACKGROUND: The COVID-19 pandemic has resulted in a reduction in blood donations and limited blood supply in many countries. The theory of planned behaviour has been widely used in past studies to understand the factors influencing blood donation. However, this theory limits analyses to the individual level. Furthermore, most research on the determinants of blood donation during the COVID-19 pandemic is quantitative in nature, with relevant qualitative research being rare. OBJECTIVES: To investigate the motivators and demotivators for donating blood among current blood donors during COVID-19 pandemic. DESIGN: Forty in-depth, individual semistructured interviews were conducted with current blood donors from December 2020 to March 2021 in Hong Kong. Thematic content analysis was adopted in the data analysis. RESULTS: The majority of the participants (n = 37) were demotivated from donating blood during the COVID-19 pandemic. Factors at the perceptual, social and institutional levels interacted to cause this reluctance. Only three participants felt more motivated to donate blood. The data revealed that sociocultural forces and government pandemic prevention policies strongly affected the participants' motivations to donate blood during the pandemic. CONCLUSION: This study presents a macro understanding of blood donation behaviour by investigating the institutional, social and perceptual factors influencing current blood donors during the COVID-19 pandemic. This adds a more comprehensive understanding of blood donation where the theory of planned behaviour is widely used in past studies. PUBLIC CONTRIBUTION: The participants shared their experiences in the interviews. Their experiences provide hints for explaining the decreasing blood donation during the pandemic times.

A Community-Based Participatory Research Approach to Developing and Testing Social and Behavioural Interventions to Reduce the Spread of SARS-CoV-2: A Protocol for the 'COPAR for COVID' Programme of Research with Five Interconnected Studies in the Hong Kong Context.

BACKGROUND: While a number of population preventive measures for COVID-19 exist that help to decrease the spread of the virus in the community, there are still many areas in preventative efforts that need improvement or refinement, particularly as new strains of the virus develop. Some of the key issues currently include incorrect and/or inconsistent use of face masks, low acceptance of early screening or vaccination for COVID-19, vaccine hesitance, and misinformation. This is particularly the case in some vulnerable populations, such as older people with chronic illnesses, ethnic minorities who may not speak the mainstream language well and children. The current protocol introduces a large programme of research through five interrelated studies that all focus on social and behavioural interventions to improve different aspects of community-related preventative indicators. Hence, the specific objectives of the overall programme are to (1) increase early testing for COVID-19 and promote the uptake of COVID-19 vaccines in the community (Study 1); (2) increase COVID-19-related health literacy and vaccine literacy and promote improved preventative measures in minority ethnic groups, chronically ill populations and caregivers (Study 2); (3) strengthen the public's motivation to stay at home and avoid nonessential high-risk activities (Study 3); (4) decrease COVID-19 vaccine hesitancy (Study 4); and (5) enhance the adherence to COVID-19-related hygiene practices and the uptake of early testing in school children (Study 5). METHODS: We will utilise a community-based participatory research (CBPR) approach in the proposed studies. All studies will incorporate an intervention development phase in conjunction with key community stakeholders, a feasibility study and an execution stage. A variety of self-reported and objective-based measures will be used to assess various outcomes, based on the focus of each study, in both the short- and long-term, including, for example, the 8-item self-reported eHealth Literacy Scale (eHEAL) and objective measures such as vaccine uptake. DISCUSSION: Theory-driven interventions will address each study's focus (e.g., social distancing, promotion of vaccine uptake, eHealth education, preventive measures and early detection). Improvements are expected to be seen in the outcomes of vulnerable and high-risk groups. Decreased infection rates are expected due to improved preventative behaviours and increased vaccine uptake. Long-term sustainability of the approach will be achieved through the CBPR model. The publication of this protocol can assist not only in sharing a large-scale and complex community-based design, but will also allow all to learn from this, so that we will have better insight in the future whether sharing of study designs can elicit timely research initiatives.

COVID-19 one year on: identification of at-risk groups for psychological trauma and poor health-protective behaviour using a telephone survey.

BACKGROUND: This study examined the profiles and correlates of psychological trauma, compliance with preventative measures, vaccine acceptance and participation in voluntary testing during the novel coronavirus disease 2019 (COVID-19) pandemic among the adult population in Hong Kong (n = 3,011). METHODS: Data were collected through a telephone survey between December 2020 and February 2021, using measures of psychological trauma, compliance with preventative measures, reading news reports on COVID-19, vaccine acceptance and willingness to participate in voluntary testing. RESULTS: The prevalence of possible post-traumatic stress disorder was found to be 12.4%. Respondents were generally compliant with routine preventative measures, and approximately half had accepted vaccination and voluntary testing. Participants who had lower levels of education, were unemployed or had no income showed greater psychological trauma symptoms, whereas female, older and more educated participants showed greater compliance with preventative measures. Participants who spent more time watching news reports of COVID-19 had greater psychological trauma, but also greater compliance. Participants who were male, older, had lower education levels or were married showed greater acceptance of vaccination and participation in voluntary testing. CONCLUSIONS: Socio-demographic factors affected both psychological trauma and engagement in health-protective measures at one year after the onset of the pandemic. The theoretical and practical implications of these findings are discussed.

Perceptions of and hesitancy toward COVID-19 vaccination in older Chinese adults in Hong Kong: a qualitative study.

BACKGROUND: COVID-19 vaccination is recommended for older adults by the World Health Organization. However, by July 15, 2021, only 26% of individuals over 60 years old in Hong Kong had received a first dose of the vaccine. The health belief model and the theory of planned behavior have been used to understand the determinants for COVID-19 vaccination in past literature. However, vaccination determinants can be complex and involve social and cultural factors that cannot be explained by micro-individual factors alone; hence, the health belief model and the theory of planned behavior cannot provide a complete understanding of vaccine hesitancy. Few studies on the barriers to, hesitancy toward, and motivations for COVID-19 vaccination among older Chinese adults have been performed. The aim of this study is to fill this gap by conducting a comprehensive analysis of this subject using the critical medical anthropology framework, extending the health belief model and the theory of planned behavior in understanding vaccination determinants among the older adult population. METHODS: Between November 2020 and February 2021, 31 adults (24 women and 7 men) over the age of 65 took part in semi-structured, one-on-one interviews. The data we gathered were then analyzed through a phenomenological approach. RESULTS: Two major themes in the data were examined: barriers to vaccination and motivations for vaccination. The participants' perceptions of and hesitancy toward vaccination demonstrated a confluence of factors at the individual (trust, confidence, and social support networks), microsocial (stigma toward health care workers), intermediate-social (government), and macrosocial (cultural stereotypes, civic and collective responsibility, and economic considerations) levels according to the critical medical anthropology framework. CONCLUSIONS: The decision to receive a COVID-19 vaccination is a complex consideration for older adults of low socioeconomic status in Hong Kong. Using the critical medical anthropology framework, the decision-making experience is a reflection of the interaction of factors at different layers of social levels. The findings of this study extend the health belief model and the theory of planned behavior regarding the understanding of vaccination perceptions and relevant behaviors in an older adult population.

Health inequality experienced by the socially disadvantaged populations during the outbreak of COVID-19 in Hong Kong: An interaction with social inequality.

Health inequality creates conditions for the transmission of infectious diseases, and existing health disparities can contribute to unequal burdens of morbidity and mortality. In Hong Kong, low socioeconomic districts were the epicentres of third-wave outbreak of COVID-19 in July and August 2020, suggesting that people from low socioeconomic class are vulnerable groups. Socially disadvantaged people are relatively more vulnerable to the physical, mental, and social impacts of infectious diseases. To achieve more effective infection control, the social determinants of health and existing health inequalities should be identified, and understanding the experiences of socially disadvantaged groups in the COVID-19 outbreak will be beneficial to health authorities in formulating a responsive infection control policy targeting the needs of the socially disadvantaged. This article investigates the experiences of economically disadvantaged groups during the COVID-19 outbreak and examines how they were further disadvantaged in the outbreak by delineating how health inequality intersected with social inequality. In-depth, semistructured interviews were conducted from February to April 2020 with 35 participants from the poverty class in Hong Kong. The high prices of surgical face masks and disinfecting products as well as the economic impacts induced by COVID-19-related social distancing policies imposed severe economic burden on the participants. In addition to economic and housing deprivation, social inequality was closely associated with health inequality, which made the participants more vulnerable to infection. Social inequality is associated with and can worsen health inequality. Here, the participants, who were of low socioeconomic status were more disadvantaged in health and in the attainment of social resources such as employment, education, face masks, disinfection products and right to use public facilities, during the COVID-19 outbreak. All these elements may have interrelated effects and in turn limit accessibility to healthcare and lead to less positive health outcomes and consequently to health inequality.