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1.
Prev Chronic Dis ; 19: E15, 2022 03 31.
Article in English | MEDLINE | ID: covidwho-1771674

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has prevented many adolescents from receiving their vaccines, including the human papillomavirus (HPV) vaccine, on time. However, little is known about the impact of the pandemic on implementation of clinic-level evidence-based interventions (EBIs) that help to improve HPV vaccine uptake. In this qualitative study, we explored the pandemic's impact on EBI implementation and HPV vaccine delivery. METHODS: During August-November 2020, we interviewed clinic managers in a rural, midwestern state about their experiences implementing EBIs for HPV vaccination during the COVID-19 pandemic. We used a multipronged sampling approach with both stratified and purposive sampling to recruit participants from Vaccines for Children clinics. We then conducted a thematic analysis of transcripts. RESULTS: In interviews (N = 18), 2 primary themes emerged: decreased opportunities for HPV vaccination and disruption to HPV-related implementation work. Most participants reported decreases in opportunities to vaccinate caused by structural changes in how they delivered care (eg, switched to telehealth visits) and patient fear of exposure to COVID-19. Disruptions to EBI implementation were primarily due to logistical challenges (eg, decreases in staffing) and shifting priorities. CONCLUSION: During the pandemic, clinics struggled to provide routine care, and as a result, many adolescents missed HPV vaccinations. To ensure these adolescents do not fall behind on this vaccine series, providers and researchers will need to recommit to EBI implementation and use existing strategies to promote vaccination. In the long term, improvements are needed to make EBI implementation more resilient to ensure that progress does not come to a halt in future pandemic events.


Subject(s)
COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Evidence-Based Medicine , Humans , Pandemics/prevention & control , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Vaccination
3.
JMIR Ment Health ; 8(5): e25528, 2021 May 27.
Article in English | MEDLINE | ID: covidwho-1249615

ABSTRACT

BACKGROUND: Initial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet. OBJECTIVE: The objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet. METHODS: A systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet. RESULTS: The systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3). CONCLUSIONS: The 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support.

4.
Global Health ; 16(1): 90, 2020 09 25.
Article in English | MEDLINE | ID: covidwho-795506

ABSTRACT

BACKGROUND: A recent editorial urged those working in global mental health to "change the conversation" on coronavirus disease (Covid-19) by putting more focus on the needs of people with severe mental health conditions. UPSIDES (Using Peer Support In Developing Empowering mental health Services) is a six-country consortium carrying out implementation research on peer support for people with severe mental health conditions in high- (Germany, Israel), lower middle- (India) and low-income (Tanzania, Uganda) settings. This commentary briefly outlines some of the key challenges faced by UPSIDES sites in low- and middle-income countries as a result of Covid-19, sharing early lessons that may also apply to other services seeking to address the needs of people with severe mental health conditions in similar contexts. CHALLENGES AND LESSONS LEARNED: The key take-away from experiences in India, Tanzania and Uganda is that inequalities in terms of access to mobile technologies, as well as to secure employment and benefits, put peer support workers in particularly vulnerable situations precisely when they and their peers are also at their most isolated. Establishing more resilient peer support services requires attention to the already precarious situation of people with severe mental health conditions in low-resource settings, even before a crisis like Covid-19 occurs. While it is essential to maintain contact with peer support workers and peers to whatever extent is possible remotely, alternatives to face-to-face delivery of psychosocial interventions are not always straightforward to implement and can make it more difficult to observe individuals' reactions, talk about emotional issues and offer appropriate support. CONCLUSIONS: In environments where mental health care was already heavily medicalized and mostly limited to medications issued by psychiatric institutions, Covid-19 threatens burgeoning efforts to pursue a more holistic and person-centered model of care for people with severe mental health conditions. As countries emerge from lockdown, those working in global mental health will need to redouble their efforts not only to make up for lost time and help individuals cope with the added stressors of Covid-19 in their communities, but also to regain lost ground in mental health care reform and in broader conversations about mental health in low-resource settings.


Subject(s)
Coronavirus Infections , Developing Countries , Mental Health , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Germany , Humans , India , SARS-CoV-2 , Tanzania , Uganda
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