Innovative strategies to remotely sample hard-to-reach populations: Assessing phone versus Internet respondent driven sampling approaches among Venezuelan refugees and migrants in Colombia.

It is challenging to quantitatively measure vulnerability and risk factors of refugees and migrants residing outside of formal settlement settings. For hard-to-reach populations without available sampling frames, researchers have increasingly turned to novel sampling and statistical methods, like respondent-driven sampling (RDS). 'Standard' RDS is typically conducted face-to-face at fixed sites. However, during the COVID-19 pandemic, face-to-face survey methods and recruitment approaches posed high potential risk of virus transmission and infection, making remote RDS approaches optimal. This paper explores the feasibility of implementing phone and Internet RDS strategies to assess challenges faced by Venezuelan refugees and migrants in the city of Bogotá, Colombia's capital, and the department of Norte de Santander, the main Venezuelan-Colombian border crossing site. The authors describe RDS assumptions, survey design, formative research, and the implementation of both strategies and present diagnostics to determine whether assumptions are met. Phone-based recruitment strategies in both locations and the Internet strategy in Bogotá achieved their calculated sample size, however the Internet strategy in Norte de Santander did not. Most RDS assumptions were sufficiently met in sites where sample sizes were reached. These surveys provide valuable lessons learned for implementing innovative remote strategies to study hard-to-reach populations such as refugees and migrants.

COVID-19-related mental health challenges and opportunities perceived by mental health providers in the Philippines.

This paper outlines the psychosocial impacts of the COVID-19 pandemic as reported by 145 licensed mental health providers in the Philippines in an online survey. Respondents perceived an increase in observed mental health disorders in their beneficiaries and an overall decrease in stigma associated with receiving mental health care services during the pandemic. Respondents further identified specific stigma-related help-seeking barriers during the pandemic. Positive impacts of telehealth and importance of increased public education of mental health were highlighted, with implications for improving the landscape of mental health care for Philippines post-pandemic.

Leveraging interactive voice response technology to mitigate COVID-19 risk in refugee settlements in Uganda: Lessons learned implementing "Dial-COVID" a toll-free mobile phone symptom surveillance and information dissemination tool.

BACKGROUND: Persons living in refugee settlements in sub-Saharan Africa may be at increased risk for COVID-19 and experience barriers to accessing COVID-19 information. We aimed to evaluate the implementation of "Dial-COVID" a multi-lingual, toll free, telephone platform that uses interactive voice response (IVR) to track COVID-19 symptoms/exposure and disseminate COVID-19 health information in refugee settlements in Uganda. We hypothesized that IVR could provide an alternative way to screen for COVID-19 and communicate public health information to humanitarian populations when physical access and testing capacity were limited. METHODS: The Dial-COVID IVR platform was created in ten languages and advertised by community health workers in refugee settlements for participants to call into toll free. In a recorded IVR symptom survey, participants were screened for COVID-19 symptoms/exposures and based on their responses, received tailored public health messages about COVID-19 risk mitigation in accordance with Uganda Ministry of Health guidelines. Here we report the challenges and lessons learned implementing this research during the pandemic. RESULTS: Between February 2021 and March 2022, 15,465 calls were received by the Dial-COVID platform from all 31 refugee settlements in Uganda through which 6,913 symptom surveys were completed and 10,411 public health messages were disseminated in all study languages. Uptake of Dial-COVID fluctuated with the national COVID-19 caseload and was impacted by phone ownership and connectivity in refugee settlements. Intensified advertising efforts promoted Dial-COVID uptake. Flexibility to adapt IVR messages was contingent on translation capacity. CONCLUSION: Refugees living in refugee settlements across Uganda accessed Dial-COVID to share and obtain COVID-19 information suggesting that IVR holds potential for rapid information dissemination and screening of humanitarian populations during future infectious disease outbreaks and may be a valuable tool for routine public health programs. IVR adaptation flexibility and reach are influenced by language constraints and by contextual factors related to platform access. REGISTRATION DETAILS: World Pandemic Research Network- 490652.

Assessing the impact of the COVID-19 pandemic among Venezuelan refugees and migrants in Colombia using respondent-driven sampling (RDS).

OBJECTIVES: To determine factors associated with adherence to COVID-19 mitigation measures, related symptoms and testing, as well as pandemic-related income loss among Venezuelan refugee and migrant adults in urban and border areas of Colombia. DESIGN: Phone-based respondent-driven sampling SETTING: Bogotá and Norte de Santander, Colombia. PARTICIPANTS: 605 adult Venezuelan refugees and migrants residing in Bogotá (n=305) and Norte de Santander (n=300), who arrived in Colombia after 2014 and completed the survey in August and September 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: Full COVID-19 compliance (vs incomplete or no compliance), any COVID-19-related symptoms (vs none) and income loss due to isolation measures in Colombia (vs no income change or increase in income). RESULTS: Older age was associated with lower odds of compliance with physical distancing measures (0.94, 0.90-0.99; p=0.01) for those in Bogotá. Nearly 15% of refugees and migrants in both locations (81 of 605) experienced at least one symptom consistent with COVID-19. Having a health condition was associated with higher odds of experiencing COVID-19-related symptoms in Bogotá (4.00, 1.22-13.06; p=0.02) and Norte de Santander (6.99, 1.95-24.99; p=0.003). Around 8% in both locations (48 of 605) were tested for COVID-19. Around 90% in both locations (537 of 605) had trouble earning an income after the introduction of isolation measures, and the median reported monthly income decreased by half in Bogotá and by 30% in Norte de Santander. A higher level of education (3.46, 1.02-11.75; p=0.05) was associated with higher odds of income loss among participants in Norte de Santander. CONCLUSIONS: Results indicate high compliance with COVID-19 mitigation measures, low testing rates and high pandemic-related income loss among Venezuelan refugees and migrants in Colombia. This study provides insights into a hard-to-reach refugee and migrant population in Colombia; additional study on the effects of the pandemic on hidden populations is warranted.

Fear, distress, and perceived risk shape stigma toward Ebola survivors: a prospective longitudinal study.

BACKGROUND: During the 2014-15 Ebola Virus Disease (EVD) epidemic, thousands of people in Sierra Leone were infected with the devastating virus and survived. Years after the epidemic was declared over, stigma toward EVD survivors and others affected by the virus is still a major concern, but little is known about the factors that influence stigma toward survivors. This study examines how key personal and ecological factors predicted EVD-related stigma at the height of the 2014-2015 epidemic in Sierra Leone, and the personal and ecological factors that shaped changes in stigma over time. METHODS: Using three waves of survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines factors associated with self-reported personal stigma toward Ebola survivors (11 items, α = 0.77) among 1008 adults (74.6% retention rate) from 63 census enumeration areas of the Western Rural and Western Urban districts of Sierra Leone. Participants were randomly sampled at the height of the EVD epidemic and followed up as the epidemic was waning and once the epidemic had been declared over by the WHO. Three-level mixed effects models were fit using Stata 16 SE to examine cross-sectional associations as well as predictors of longitudinal changes in stigma toward EVD survivors. RESULTS: At the height of the EVD epidemic, female sex, household wealth, post-traumatic stress, EVD-related fear and perceived infection risk are a few of the factors which predicted higher levels of stigma toward survivors. On average, stigma toward EVD survivors decreased significantly as the epidemic declined in Sierra Leone, but female sex, EVD fear, and risk perceptions predicted a slower rate of change. CONCLUSION: This study identified key individual and psychosocial characteristics which may predict higher levels of stigma toward infectious disease survivors. Future studies should pursue a better understanding of how personal characteristics and perceptions, including psychosocial distress, fear, and perceived infection risk serve as pathways for stigma in communities affected by infectious disease.

Find Your Side Gig: Extra Income Opportunities for Family Physicians

Traditional offerings still abound, but advances in technology have also opened up new possibilities.