Adapting Community Educational Programs During the COVID-19 Pandemic: Comparing the Feasibility and Efficacy of a Lung Cancer Screening Educational Intervention by Mode of Delivery.

Few eligible patients receive lung cancer screening. We developed the Lung AIR (awareness, information, and resources) intervention to increase community education regarding lung cancer screening. The intervention was designed as an in-person group intervention; however, the COVID-19 pandemic necessitated adapting the mode of delivery. In this study we examined intervention feasibility and efficacy overall and by mode of delivery (in-person group vs. one-on-one phone) to understand the impact of adapting community outreach and engagement strategies. Feasibility was examined through participant demographics. Efficacy was measured through pre/post knowledge, attitudes, and beliefs about lung cancer screening, and intention to complete screening. We reached N = 292 participants. Forty percent had a household income below $35,000, 58% had a high school degree or less, 40% were Hispanic, 57% were Black, and 84% reported current or past smoking. One-on-one phone sessions reached participants who were older, had lower incomes, more current smoking, smoked for more years, more cigarettes per day, lower pre-intervention lung cancer screening knowledge, and higher pre-intervention fear and worry. Overall pre/post test scores show significant increases in knowledge, salience, and coherence, and reduced fear and worry. Participants in the one-on-one phone sessions had significantly higher increases in salience and coherence and intention to complete screening compared to participants in the in-person group sessions. The Lung AIR intervention is a feasible and effective community-based educational intervention for lung cancer screening. Findings point to differences in reach and efficacy of the community-based intervention by mode of delivery.

Pandemic Through the Lens of Black Barbershops: COVID-19's Impact and Barbers' Potential Role as Public Health Extenders.

We examined the impact of COVID-19 on Black barbershops and their potential role as public health extenders. A 30-item survey was distributed to predominantly Black barbershop owners and barbers across 40 different states/territories in the US between June and October 2020. The survey addressed the impact of COVID-19 on Black barbershops, and barbers' interest in engaging in health outreach programs. The majority reported that stay-at-home orders had significant to severe impact on their business; few were prepared for the financial impact and less than half thought they qualified for government assistance. The majority were already providing health education and outreach to the Black community and showed interest in continuing to provide such services, like information on COVID-19. Barbers in Black-serving barbershops, a well-documented effective place for public health outreach to the Black community, show promise as public health extenders in the response to the COVID-19 pandemic.

University–Community Outreach as an Enabler for Integral Human Development During the COVID-19 Pandemic

This article examines how university–community outreach was an enabler for integral human development during the COVID-19 pandemic. Qualitative information about the University of Asia and the Pacific (UA&P) Community Outreach Program (COP) is described and analyzed. In particular, the Kabagis Aeta Projects succeeded in its initial implementation, moving from distribution of goods to capability building. It has improved family living conditions and instilled positive work values among the Aetas of Castillejos, Zambales, Philippines. The interventions served as enablers of integral human development in personal, economic, social, ecological, and spiritual life. Beyond physical, structural interventions and resources, values formation was integrated to achieve integral human development. Structures furnished through the COP—the study center, livelihood workshop, and training center—provide venues for trainings and continuous learning for the Aetas. Possible clients or markets can also be explored to absorb the products and outputs of their newly learned skills. © 2023 by the University of Georgia.

Strengthening primary care for diabetes and hypertension in Eswatini: study protocol for a nationwide cluster-randomized controlled trial.

BACKGROUND: Diabetes and hypertension are increasingly important population health challenges in Eswatini. Prior to this project, healthcare for these conditions was primarily provided through physician-led teams at tertiary care facilities and accessed by only a small fraction of people living with diabetes or hypertension. This trial tests and evaluates two community-based healthcare service models implemented at the national level, which involve health care personnel at primary care facilities and utilize the country's public sector community health worker cadre (the rural health motivators [RHMs]) to help generate demand for care. METHODS: This study is a cluster-randomized controlled trial with two treatment arms and one control arm. The unit of randomization is a primary healthcare facility along with all RHMs (and their corresponding service areas) assigned to the facility. A total of 84 primary healthcare facilities were randomized in a 1:1:1 ratio to the three study arms. The first treatment arm implements differentiated service delivery (DSD) models at the clinic and community levels with the objective of improving treatment uptake and adherence among clients with diabetes or hypertension. In the second treatment arm, community distribution points (CDPs), which previously targeted clients living with human immunodeficiency virus, extend their services to clients with diabetes or hypertension by allowing them to pick up medications and obtain routine nurse-led follow-up visits in their community rather than at the healthcare facility. In both treatment arms, RHMs visit households regularly, screen clients at risk, provide personalized counseling, and refer clients to either primary care clinics or the nearest CDP. In the control arm, primary care clinics provide diabetes and hypertension care services but without the involvement of RHMs and the implementation of DSD models or CDPs. The primary endpoints are mean glycated hemoglobin (HbA1c) and systolic blood pressure among adults aged 40 years and older living with diabetes or hypertension, respectively. These endpoints will be assessed through a household survey in the RHM service areas. In addition to the health impact evaluation, we will conduct studies on cost-effectiveness, syndemics, and the intervention's implementation processes. DISCUSSION: This study has the ambition to assist the Eswatini government in selecting the most effective delivery model for diabetes and hypertension care. The evidence generated with this national-level cluster-randomized controlled trial may also prove useful to policy makers in the wider Sub-Saharan African region. TRIAL REGISTRATION: NCT04183413. Trial registration date: December 3, 2019.

Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care.

Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a variety of prehospital settings. Traditional thinking holds that a trained user is required to obtain images, greatly handicapping the scale of potential improvements in individual health assessments. However, as the interpretation of ultrasound images can be accomplished remotely by experts, the paradigm wherein experts guide novices to obtain meaningful images that facilitate remote care is being embraced worldwide. The ultimate extension of this concept is for experts to guide patients to image themselves, enabling secondary disease prevention, home-focused care, and self-empowerment of the individual to manage their own health. This paradigm of remotely telementored self-performed ultrasound (RTMSPUS) was first described for supporting health care on the International Space Station. The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group has been investigating the utility of this paradigm for terrestrial use. The technique has particular attractiveness in enabling surveillance of lung health during pandemic scenarios. However, the paradigm has tremendous potential to empower and support nearly any medical question poised in a conscious individual with internet connectivity able to follow the directions of a remote expert. Further studies and development are recommended in all areas of acute and chronic health care.

Impacts of the COVID-19 pandemic on pregnant and postpartum women: Where is the village?

As the COVID-19 pandemic took hold of the United States, pregnant women and mothers of infants were among those most affected by fears of the virus, the disruption of health care systems, social isolation, and the collapse of social supports. This article describes how a group of psychoanalysts and psychoanalytic therapists in a community outreach initiative, the SPRING Project, worked to meet these mental health needs by providing affordable psychotherapy at this critical time. Two case reports highlight the ways the pandemic magnified postpartum distress as well as the relevance and efficacy of a psychodynamic clinical approach in resolving such distress. In addition, the author chronicles how early in the pandemic the SPRING Project launched support groups for pregnant women. Participants in this virtual village helped offset the painful isolation of these women and supported their emotional development during their pregnancies. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The Use of a SWOT Analysis to Evaluate a COVID-19 Mitigation Project in the Paso del Norte Region.

A SWOT (strengths, weaknesses, opportunities, and threats) analysis is a strategic planning and management technique used for project planning. It is sometimes called situational assessment or situational analysis. We applied this tool (with some adaptations) effectively in a health promotion/public health education intervention project in the Paso del Norte region. This region is composed of a predominantly Hispanic population and is marked by a dynamic flow of residents across the border. In this milieu, COVID-19 has disproportionately impacted communities of color and individuals who are economically and socially marginalized. The University of Texas at El Paso (UTEP) has partnered with the National COVID-19 Resilience Network (NCRN) to mitigate the impact of COVID-19 among farm and food production workers (i.e., farmworkers, dairy, and meat packing workers) in El Paso, Doña Ana, and Moore counties. Intervention strategies include: (1) providing culturally and linguistically appropriate COVID-19 information, (2) disseminating protective equipment, and (3) ensuring access to COVID-19 vaccines. After completing year 1 of the project, we conducted a multiple-level SWOT analysis to evaluate, gather insights, and develop actionable strategies that would allow better service delivery to our priority population. We provide this case study to illustrate how a SWOT analysis can be a useful tool for practitioners engaged in the practice of evaluating health promotion and disease prevention programs. Even when attention and energy is absorbed in the immediate course of action, a SWOT analysis can help to achieve positive and effective collaborations resulting in strong service levels.

Conducting remote materials education and outreach with in-person communities: implementation and reflections

The COVID-19 pandemic has greatly impacted educators all over the world and a major area of disruption has been the ability for higher education institutions to provide meaningful STEM education activities to the broader community. In this work, methods to adapt materials science outreach activities to meet the needs of students, teachers, and the community at large during the pandemic are explored and outcomes and recommendations are provided. This is accomplished through a focus on three efforts: fully-virtual classroom visits, remote visitation for in-person classrooms, and an innovative hybrid museum tour that showcases materials science in art for general community outreach. Results show that methods developed with restrictions on in-person interaction in place can have benefits in terms of the ability to reach broader audiences while also fostering more consistent interaction between those broader audiences and those conducting outreach. These methods also have the potential to remain effective even following a return to "normal" conditions and thus supplement and positively augment pre-pandemic methods. © American Society for Engineering Education, 2022.

Equipping Small Businesses to Navigate Health Orders and Occupational Safety During the COVID-19 Pandemic

From July 2020 to June 2021, the UC San Diego COVID-19 Small Business Outreach Project conducted COVID-19-related educational outreach to small businesses in high-risk communities of San Diego County and distributed over 1,200 toolkits containing COVID-19-related safety tips, best practices, and a summary of pertinent guidelines and COVID-19 vaccine information.

Addressing Food Insecurity during the COVID-19 Pandemic: Intervention Outcomes and Lessons Learned from a Collaborative Food Delivery Response in South Florida's Underserved Households.

BACKGROUND: The COVID-19 pandemic highlighted underlying disparities in health, healthcare access, and other social factors that have been documented for racial/ethnic minorities. The social-distancing mandate exacerbated the impact of social determinants of health, such as unemployment and food insecurity, particularly among underserved minority populations. We highlight intervention outcomes and lessons learned from the Florida International University (FIU) Herbert Wertheim College of Medicine (HWCOM) NeighborhoodHELP's response to pandemic-related food insecurity among Miami Dade County's underserved population. METHODS: Following the stay-at-home mandate, a weekly needs assessment of program households was conducted by the NeighborhoodHELP team, during which food insecurity emerged as a pandemic-related urgent need, rising from three percent of program Households in March 2020 to 36.9 percent six months later. Consequently, the program staff collaborated with another FIU department, community partners, and a benefactor to develop a food donation and delivery project. RESULTS: Fifteen hundred and forty-three culturally appropriate food boxes were delivered to 289 participating households, comprising 898 household members, over a 14-month period. CONCLUSION: This project underscores the importance of leveraging community assets to address their needs during a crisis and the significance of sustained community engagement for researchers and service providers who work in underserved communities.

Project COALESCE-An Example of Academic Institutions as Conveners of Community-Clinic Partnerships to Improve Cancer Screening Access.

In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative to nL-White people in Virginia, but preventable with equitable screening access and timely diagnostic follow-up. However, structural barriers, such as fractured referral systems and extended time between medical visits, remain. Because Federally Qualified Health Centers (FQHCs) care for a large proportion of racial and ethnic minorities, and underserved communities, regardless of ability to pay, they are ideal partners to tackle structural barriers to cancer screenings. We piloted a quality improvement initiative at five FQHCs in southcentral Virginia to identify and address structural, race-related barriers to CRC, as well as CCa screening and diagnostic follow-up using evidence-based approaches. Uniquely, FQHCs were paired with local community organizations in a didactic partnership, to elevate the community's voice while together, increase support, acceptance, uptake, and intervention sustainability. We report on project development, and share preliminary data within the context of project goals, namely, to increase cancer screenings by 5-10%, improve knowledge and diagnostic follow-up processes, and build longitudinal partnerships.

Disparities in telemedicine during COVID-19.

BACKGROUND: Oncology rapidly shifted to telemedicine in response to the COVID-19 pandemic. Telemedicine can increase access to healthcare, but recent research has shown disparities exist with telemedicine use during the pandemic. This study evaluated health disparities associated with telemedicine uptake during the COVID-19 pandemic among cancer patients in a tertiary care academic medical center. METHODS: This retrospective cohort study evaluated telemedicine use among adult cancer patients who received outpatient medical oncology care within a tertiary care academic healthcare system between January and September 2020. We used multivariable mixed-effects logistic regression models to determine how telemedicine use varied by patient race/ethnicity, primary language, insurance status, and income level. We assessed geospatial links between zip-code level COVID-19 infection rates and telemedicine use. RESULTS: Among 29,421 patient encounters over the study period, 8,541 (29%) were delivered via telemedicine. Several groups of patients were less likely to use telemedicine, including Hispanic (adjusted odds ratio [aOR] 0.86, p = 0.03), Asian (aOR 0.79, p = 0.002), Spanish-speaking (aOR 0.71, p = 0.0006), low-income (aOR 0.67, p < 0.0001), and those with Medicaid (aOR 0.66, p < 0.0001). Lower rates of telemedicine use were found in zip codes with higher rates of COVID-19 infection. Each 10% increase in COVID-19 infection rates was associated with an 8.3% decrease in telemedicine use (p = 0.002). CONCLUSIONS: This study demonstrates racial/ethnic, language, and income-level disparities with telemedicine use, which ultimately led patients with the highest risk of COVID-19 infection to use telemedicine the least. Additional research to better understand actionable barriers will help improve telemedicine access among our underserved populations.

COVID-19 mitigation for high-risk populations in Springfield Massachusetts USA: a health systems approach.

BACKGROUND: Numerous reports have demonstrated the disproportionate impact that COVID-19 has had on vulnerable populations. Our purpose is to describe our health care system's response to this impact. METHODS: We convened a Workgroup with the goal to mitigate the impact of COVID-19 on the most medically vulnerable people in Springfield, Massachusetts, USA, particularly those with significant social needs. We did this through (1) identifying vulnerable patients in high-need geographic areas, (2) developing and implementing a needs assessment/outreach tool tailored to meet cultural, linguistic and religious backgrounds, (3) surveying pharmacies for access to medication delivery, (4) gathering information about sources of food delivery, groceries and/or prepared food, (5) gathering information about means of travel, and (6) assessing need for testing. We then combined these six elements into a patient-oriented branch and a community outreach/engagement branch. CONCLUSIONS: Our highly intentional and methodical approach to patient and community outreach with a strong geographic component has led to fruitful efforts in COVID-19 mitigation. Our patient-level outreach engages our health centers' clinical teams, particularly community health workers, and is providing the direct benefit of material and service resources for our at-risk patients and their families. Our community efforts leveraged existing relationships and created new partnerships that continue to inform us-healthcare entities, healthcare employees, and clinical teams-so that we can grow and learn in order to authentically build trust and engagement.

Implementing a Service Project During the COVID-19 Pandemic.

This brief report describes our experiences and the holiday service project that was safely conducted at the height of the COVID-19 resurgence in Michigan. As COVID-19 resurgence emerged in the United States and Europe, many establishments were forced to decrease their services and or cease functioning altogether. While other organizations faltered, our chapter found the means to continue to work during the pandemic.

Adapting Medical Education Initiatives Through Team-Based e-Learning, Telemedicine Objective Structured Clinical Exams, and Student-Led Community Outreach During the COVID-19 Pandemic.

Although the COVID-19 pandemic has quickly prompted medical schools and students around the world to transition from their traditional classrooms to web-based learning, the global crisis has inspired the development of innovative e-learning solutions that use existing technology and other web-based tools to continue nurturing the education of medical students while ensuring the public health and safety of both students and faculty members alike. Through the perspective of medical students, we share how the COVID-19 pandemic has impacted and transformed small team-based learning in medical education; changed objective structured clinical exam evaluations and the practice of clinical skills through telemedicine; and nurtured nationwide, web-based, student-led initiatives for community outreach, telehealth, and medical services.

Detecting COVID-19 Clusters at High Spatiotemporal Resolution, New York City, New York, USA, June-July 2020.

A surveillance system that uses census tract resolution and the SaTScan prospective space-time scan statistic detected clusters of increasing severe acute respiratory syndrome coronavirus 2 test percent positivity in New York City, NY, USA. Clusters included one in which patients attended the same social gathering and another that led to targeted testing and outreach.

Influenza vaccine community outreach: Leveraging an interprofessional healthcare student workforce to immunize marginalized populations.

Vulnerable populations such as the uninsured, unemployed, and unhoused face significant morbidity and mortality from influenza but are less likely to receive the annual vaccine and have limited access to medical care. We describe an interprofessional, student-run vaccine outreach program (VOP) in Davidson County, Tennessee that lowers barriers to vaccination through free vaccination events in nontraditional community locations. We provide this framework as a model to expand novel, seasonal, or outbreak-oriented vaccine outreach to resource-poor populations. Demographic data were collected from the patients who received an influenza vaccine between 2015 and 2019 through an optional survey to determine whether these events were reaching unhoused, uninsured, and/or unemployed individuals. Of 1,803 patients, 1,733 (96.1%) completed at least one field of the demographic form. Overall, 481 (27.8%) were individuals without homes or living in temporary housing and 673 (38.8%) were unemployed. Most patients, 1,109 (64.0%), did not have health insurance at any point during the prior two years. With the addition of a nurse practitioner student to VOP leadership, the 2018-2019 VOP reached the most unhoused or temporarily-housed (228, 32.3%), unemployed (313, 18.5%), and disabled (60, 8.5%) patients. The VOP can be adapted to meet community needs, funding, and volunteer interest. The VOP model may be applicable to a SARS-CoV-2 vaccine, especially since the economic impact of COVID-19 has increased unemployment rates and housing instability. Healthcare students serve as an eager, underutilized resource who can be leveraged to disseminate vaccines to individuals with limited access to care.

Cups for COVID: rapid implementation of a harm reduction initiative to support populations experiencing homelessness during the COVID-19 pandemic.

SETTING: As of June 10, 2020, 37 people experiencing homelessness or unstable housing in Calgary, Alberta, had developed lab-confirmed COVID-19. Spread occurred despite standard outbreak controls at affected shelter and supportive housing sites. Among these 37 cases, drink sharing was frequently identified as a modifiable mode of possible transmission. We collaborated with emergency shelters, a supportive housing site, and street and encampment outreach groups, using mixed service delivery by health staff, non-profits, and peers with lived experience with homelessness. INTERVENTION: To empower individuals to decrease COVID-19 transmission using a harm reduction approach, we provided disposable paper cups to service providers for distribution to clients. Service providers tracked the number of cups distributed. To assess effectiveness, we interviewed staff and peers who distributed the cups. OUTCOMES: Cup distribution was highest among populations with higher rates of alcohol use, and the intervention was well received by people who drink alcohol regularly, providing unique opportunities to promote COVID-19 awareness and safer drinking practices. Providers to these populations reported enthusiastic client engagement and repeat requests for cups for safer drinking. Intervention usefulness was limited in contexts with low alcohol consumption and in the absence of paired COVID-19 education. Provider reports suggest appropriate disposal of these cups after use. IMPLICATIONS: Disposable cups are a novel, rapidly implementable, low-cost harm reduction tool to empower people experiencing homelessness to reduce the risk of COVID-19 transmission due to drink sharing, ideally as part of a larger harm reduction and community education strategy.

RéSUMé: LIEU: Au 10 juin 2020, trente-sept (37) personnes sans abri ou vivant en logement instable à Calgary (Alberta) avaient contracté une infection par la COVID-19 confirmée en laboratoire. La maladie s'est propagée malgré les mesures types de contrôle des éclosions dans les refuges et les logements supervisés touchés. Parmi ces 37 cas, le partage de boissons a souvent été défini comme un mode de transmission modifiable possible. En collaboration avec des refuges d'urgence, un complexe de logements supervisés et des groupes menant des activités de proximité dans la rue et les campements, nous avons assuré une prestation de services mixte par des personnels de santé, des organisations sans but lucratif et des pairs ayant une expérience vécue de sans-abrisme. INTERVENTION: Pour donner à chaque personne les moyens de réduire la transmission de la COVID-19 selon une approche de réduction des méfaits, nous avons fourni aux dispensateurs de services des gobelets en papier jetables à distribuer à leurs usagers. Les dispensateurs ont fait un suivi du nombre de gobelets distribués. Pour évaluer l'efficacité de l'initiative, nous avons interviewé le personnel et les pairs ayant distribué les gobelets. RéSULTATS: Le nombre de gobelets distribués a été le plus élevé dans les populations ayant des taux élevés de consommation d'alcool, et l'intervention a été bien accueillie par les personnes qui consomment régulièrement de l'alcool; elle a offert des occasions uniques de faire de la sensibilisation à la COVID-19 et de promouvoir une pratique de consommation de boissons à moindre risque. Les intervenants auprès de ces populations ont fait état d'une participation enthousiaste des usagers et de demandes répétées de gobelets pour boire sans s'exposer au risque de contracter la maladie. L'utilité de l'intervention a été limitée dans les contextes de faible consommation d'alcool et en l'absence d'une sensibilisation conjointe à la COVID-19. Selon les rapports des dispensateurs de services, les gobelets ont été correctement éliminés après usage. CONSéQUENCES: Les gobelets jetables sont un nouvel outil de réduction des méfaits à prix abordable qui peut être mis en œuvre rapidement pour donner aux personnes aux prises avec le sans-abrisme les moyens de réduire le risque de transmission de la COVID-19 lorsqu'elles partagent des boissons, idéalement dans le cadre d'une stratégie de réduction des méfaits et de sensibilisation de proximité.

COVID-19: Emergency Medicine Physician Empowered to Shape Perspectives on This Public Health Crisis.

COVID-19 (Coronavirus Disease 2019) has sparked a remarkable public response in the United States. The following publication highlights the integral role that Emergency Medicine (EM) providers are afforded as a result of the public health circumstances. By embracing the unique outlet of direct patient coordination of care, EM providers can correct public misconceptions and promote more appropriate social distancing practices to the greater community.