Health-Seeking Behavior and Its Associated Technology Use: Interview Study Among Community-Dwelling Older Adults.

BACKGROUND: Understanding older people's health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people's health-seeking activities. OBJECTIVE: This study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs. METHODS: This paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ≥50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the individual as the unit of analysis to understand the patterns of behaviors. RESULTS: In total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services; information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults' well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants' observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype. CONCLUSIONS: Unlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults' health seeking. Our findings have implications for the design and implementation of health services and policies.

Education and Rehabilitation of Incarcerated Youth during COVID-19: Views of State-Level Administrators

The present study addresses the complexities of providing education and rehabilitation to incarcerated youth during the COVID-19 crisis. A total of three state-level administrators, one supervisor for juvenile residential services health care, and one medical director of state detention centers from three states completed a survey focusing on the key domains of education, physical safety, mental health support, social support, support for physical health, and information sharing. With each domain, respondents were queried on the adequacy and basis of policies, as well as monitoring of compliance with policies and barriers to compliance. The state officials then each participated in two 45-minute interviews. Results indicate that the survey respondents found policies to be adequate across domains. Interview findings yielded across-state themes of learned capability and collaboration and/or cooperation. Additional results, as well as implications for research and practices, are discussed.

Analyzing Access to Health Facilities by Road Using Unconventional Data Sources

The COVID-19 pandemic has led to an urgent need in emerging economies to quickly identify vulnerable populations that do not live within access of a health facility for testing and vaccination. This access information is critical to prioritize investments in mobile and temporary clinics. To meet this need, the World Bank team sought to develop an open-source methodology that could be quickly and easily implemented by government health departments, regardless of technical and data collection capacity. The team explored use of readily available open-source and licensable data, as well as non-intensive computational methodologies. By bringing together population data from Facebook's Data for Good program, travel-time calculations from Mapbox, road network and point-of-interest data from the OpenStreetMap (OSM), and the World Bank's open-source GOSTNets network routing tools, we created a computational framework that supports efficient and granular analysis of road-based access to health facilities in two pilot locations—Indonesia and the Philippines. Our findings align with observed health trends in these countries and support identification of high-density areas that lack sufficient road access to health facilities. Our framework is easy to replicate, allowing health officials and infrastructure planners to incorporate access analysis in pandemic response and future health access planning. © National Academy of Sciences: Transportation Research Board 2022.

Confronting Disparities: Race, Ethnicity, and Immigrant Status as Intersectional Determinants in the COVID-19 Era.

The COVID-19 (coronavirus disease-2019) pandemic has exposed long-standing inequalities in U.S. health care. Historically, racial and ethnic minorities have been the most likely to suffer from inadequate health care access and insurance coverage. With the spread of COVID-19, these disparities have dramatically increased. Focusing on native and foreign-born racial/ethnic minorities, this article discusses how entrenched health inequities and structural discrimination have led to COVID-19 morbidities and mortalities. Considering that "essential" frontline workers are disproportionately native and foreign-born racial/ethnic minorities, this work evaluates the impact(s) of social exclusion and the lack of support systems for these workers. Using the framework of intersectionality, this work also examines how race and immigrant status affect COVID-19 spread in prisons and immigration detention centers-facilities that often lack effective health and sanitary conditions and where inmates are also likely to be racial/ethnic minorities.

A Qualitative Evaluation of a Health Access Card for Refugees and Asylum Seekers in a City in Northern England.

Refugees and asylum seekers residing in the UK face multiple barriers to accessing healthcare. A Health Access Card information resource was launched in Newcastle upon Tyne in 2019 by Newcastle City Council, intended to guide refugees and asylum seekers living in the city, and the professional organisations that support them, to appropriate healthcare services provided locally. The aim of this qualitative evaluation was to explore service user and professional experiences of healthcare access and utilisation in Newcastle and perspectives on the Health Access Card. Eleven semi-structured interviews took place between February 2020 and March 2021. Participants provided diverse and compelling accounts of healthcare experiences and described cultural, financial and institutional barriers to care. Opportunities to improve healthcare access for these population groups included offering more bespoke support, additional language support, delivering training and education to healthcare professionals and reviewing the local support landscape to maximise the impact of collaboration and cross-sector working. Opportunities to improve the Health Access Card were also described, and these included providing translated versions and exploring the possibility of developing an accompanying digital resource.

The Oregon Wellness Program: Serving Healthcare Professionals in Distress from Burnout and COVID-19

Clinicians are reluctant to seek mental health services. They fear loss of livelihood and disciplinary action. The Oregon Wellness Program (OWP) is a state-wide consolidated mental health initiative formally established in 2018 as a physician, physician assistant, acupuncturist, and podiatrist program. OWP is self-referral, not-mandated, strictly confidential, and free. Reporting to oversight bodies is forbidden. Utilization increased from 228 clients to 349 clients (a 53% increase) and 405 visits to 625 visits (a 54% increase) from 2019 to 2020 respectively, coinciding with the first COVID-19 pandemic surge. Between April 2019 and the end of August 2020, 41 of 433 (9.5%) individuals who were provided mental health services returned 77 program evaluation surveys, indicating satisfaction with the program (96%), its helpfulness to them personally (99%), and changes made in their personal lives (80%). The burnout response rate fell with increased visits and reallocation of activities within their practices increased (39%). A survey of mental health professionals corroborated positive results of their clients. The OWP can serve as a model for healthcare professional support programs. Collaboration among healthcare organizations, professional, and oversight bodies is essential. Increasing sustainable funding to pay for expanding services for dentists and nurses, assuring access for rural clinicians, and developing research tools to capture a more robust sample of responses remain priorities. Copyright 2022 Federation of State Medical Boards. All Rights Reserved.

COVID-19 pandemic and contagion laws and policies in international and national perspectives

There is a settled statute concerning health rights and qualifications in emergency and normalcy. The current dash of legal advancement addresses novelty in the comprehension of India's epidemic and disaster administration. India has crossed 43,144,820 positive cases and 524,525 deceased persons due to COVID-19 until May 26, 2022. India has never spent over 2% of its gross domestic product on medical services. The probability of a principal statute of general health under these conditions needs a new generation of public laws and policies. The pre-constitution vintage of the Epidemic Diseases Act, 1897, contradicts Entry 29 of the accompanying rundown of the Constitution of India, 1950, and fighting the bordering nature of COVID-19 in India. Therefore an investigation into the legal approach to the scourge of pandemic in the global and national purview appears to be entrancing in extending our comprehension of contagion control, the State's role, and citizen's freedom. The privilege of health and life is a vital concern of the State, particularly amid pestilence and pandemics. The cross-country lockdown and COVID-19 have seen a progression of legal intervention in health rights and entitlement in broader goals of COVID-19 pandemic and contagion laws and policies in India. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.

Exploring social determinants of health: COVID-19 vaccine challenges and solutions

The Coronavirus (COVID-19) pandemic has negatively shifted the foundations of human health and the well-being of humanity on a global scale. Its contagiousness and lethal symptoms pose a threat to everyone, especially seniors over 65 years, immunocompromised individuals, and people with preexisting health conditions. The factors of the social determinants of health had great influence on the vaccination status for Black and Brown communities. Access to life-saving treatment and resources was hindered by the poor social determinants and socioeconomic status, which led to slow vaccination numbers. This article examines that equitable vaccination access, distribution, and health literacy in Black and Brown communities are all supported by careful analysis of the notion of dignity.

Financing vaccine equity: funding for day-zero of the next pandemic

A lack of timely financing for purchases of vaccines and other health products impeded the global response to the Covid-19 pandemic. Based on analysis of contract signature and delivery dates in Covid-19 vaccine advance purchase agreements, this paper finds that 60-75 per cent of the delay in vaccine deliveries to low- and middle-income countries is attributable to their signing purchase agreements later than high-income countries, which placed them further behind in the delivery line. A pandemic Advance Commitment Facility with access to a credit line on day-zero of the next pandemic could allow low- and middle-income countries to secure orders earlier, ensuring a much faster and equitable global response than during Covid-19. The paper outlines four options for a financier to absorb some or all of the risk associated with the credit line and discusses how the credit would complement other proposals to strengthen the financing architecture for pandemic preparedness, prevention, and response.

Disparities in mental health access before and after transitioning to telehealth

Telehealth implementation has potential to reduce disparities in access to mental health care. We examined the number of mental health visits accessed and the visit format used (office, phone, or virtual) by patient demographics before and after a large health system's shift to telehealth during the COVID-19 pandemic. Patients ages 6-17 accessed relatively fewer and female patients accessed relatively more mental health visits after the telehealth transition. Demographic variables were associated with visit format used, with rural residents, older adults, females, and White and Black/African American patients using a higher proportion of phone visits. Implications are discussed for the future implementation of telehealth. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement This study found changes in the gender and age of patients accessing mental health services before and after a large health system began providing services remotely in response to the COVID-19 pandemic. It also found that phone calls were relatively preferred by certain demographic groups. These groups may be adversely affected by limitations on reimbursement for mental health services provided by phone. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Financial assessment of the community-based dental education program at the Indiana University School of Dentistry.

BACKGROUND: There is a gap in access to oral health services for millions of Americans residing in health professional shortage areas. The community-based dental education program at the Indiana University School of Dentistry is an innovative model that aims to improve access to oral health services in rural underserved Indiana. OBJECTIVE: With this study, our goal was to assess the financial implications of the program over a period of 3 years (2018-2021). METHODS: Proxy estimates for the revenue generated by students at the community clinic sites were calculated and compared against the implementation costs of the program as well as revenue lost by the school during the rotation period. Descriptive statistics were used to assess the quantitative impact of the program over the 3 years. RESULTS: The total of 7460 patients who were offered care as part of this program were mostly from the uninsured group or were covered under Medicaid. According to our cost-benefit analysis which was conducted during the peak of the coronavirus disease 2019 (COVID-19) pandemic, the total revenue of $1,777,097 was generated by students at the community sites through the 3-year period. The revenue generated was still more than the dollar amount invested in running the program, given the timeline of the study was when elective services were mostly suspended. CONCLUDE: We conclude community programs like these have an impact beyond the dollar value; they can be modeled to be cost-effective, improve access to oral health services for millions of Americans in underserved settings and at the same time provide a great learning experience for dental students.

Movement Pandemic Adaptability: Health Inequity and Advocacy among Latinx Immigrant and Indigenous Peoples.

The COVID-19 pandemic exacerbated longstanding inequities in resources and healthcare, stacked on top of historical systems that exploit immigrants and communities of color. The range of relief, mutual aid, and advocacy responses to the pandemic highlights the role of social movement organizations in addressing the ways that immigration status creates systemic barriers to adequate health and wellbeing. This paper conceptualizes what I call, "movement pandemic adaptability," drawing from a decolonial-inspired study including participant-observation (September 2018-September 2020), interviews (n = 31), and focus groups (n = 12) with community members and health advocates. Data collection began before the COVID-19 pandemic (September 2018-February 2019) and continued during its emergence and the initial shelter-in-place orders (March 2019-September 2020). Movement pandemic adaptability emerged as a strategy of drawing from pre-existing networks and solidarities to provide culturally relevant resources for resilience that addressed vulnerabilities created by restrictions against undocumented people and language barriers for communities that speak Spanish and a range of Indigenous languages. This paper presents how the relationship between immigration status and health is influenced by the local context, as well as the decisions of advocates, policymakers, and community members.

A path toward disability-inclusive health in Zimbabwe Part 2: A qualitative study on the national response to COVID-19.

Background: People with disabilities are at higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes. Additionally, measures to mitigate COVID-19 transmission have impacted health service provision and access, which may particularly disadvantage people with disabilities. Objectives: To explore the perspectives and experiences of people with disabilities in accessing health services in Zimbabwe during the pandemic, to identify perceived challenges and facilitators to inclusive health and key actions to improve accessibility. Methods: We used in-depth interviews with 24 people with disabilities (identified through purposive sampling) and with 10 key informants (from expert recommendation) to explore the impact of COVID-19 on access to health care. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health 'Missing Billion' framework to map and inform barriers to inclusive health care during COVID-19 and disparities in outcomes faced by people with disabilities. Results: People with disabilities demonstrated good awareness of COVID-19 mitigation strategies, but faced difficulties accessing COVID-19 information and health services. Challenges to the implementation of COVID-19 guidelines related to a person's functional impairment and financial ability to do so. A key supply-side constraint was the perceived de-prioritisation of rehabilitation services. Further restrictions on access to health services and rehabilitation decreased an individual's functional ability and exacerbated pre-existing conditions. Conclusion: The immediate health and financial impacts of the COVID-19 pandemic on people with disabilities in Zimbabwe were severe. Government departments should include people with disabilities in all communications and activities related to the pandemic through a twin-track approach, meaning inclusion in mainstream activities and targeting with specific interventions where necessary.

A path toward disability-inclusive health in Zimbabwe Part 1: A qualitative study on access to healthcare.

Background: On average, people with disabilities have greater healthcare needs, yet face a range of barriers in accessing care. Objectives: Our objectives were to explore the experiences of people with disabilities in accessing care and identify opportunities for the health system to be designed for inclusion in Zimbabwe. Methods: In-depth qualitative interviews were conducted between May and June 2021 with 24 people with disabilities (identified through purposive sampling) and with 10 key informants from local and national health authorities (identified through expert recommendations). Interviews explored the experience of accessing healthcare prior to the coronavirus disease 2019 (COVID-19) pandemic. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health 'Missing Billion' framework to map and inform barriers to inclusive healthcare and disparities in outcomes faced by people with disabilities. Results: People with disabilities experienced difficulties accessing health services in Zimbabwe prior to COVID-19. These experiences were shaped by health literacy, self-stigma and affordability of services, which limited demand. Supply of health services was constrained by the perceived poor capacity of health workers to treat people with disabilities and discrimination. Inclusion was facilitated by clinic staff support of people with disabilities' access to medication through referral to mission hospitals and private clinics, and the lobbying of organisations of people with disabilities. Conclusion: Strategies to promote disability inclusion in healthcare include meaningfully engaging people with disabilities, investing in organisations of people with disabilities, protecting funding for disability inclusion, collecting and analysing disability-disaggregated data and strengthening a twin-track approach to health service provision.

How the COVID-19 Pandemic Alters the Landscapes of the HIV and Tuberculosis Epidemics in South Africa: A Case Study and Future Directions.

South Africa has long grappled with one of the highest HIV and tuberculosis (TB) burdens in the world. The COVID-19 pandemic poses challenges to the country's already strained health system. Measures to contain COVID-19 virus may have further hampered the containment of HIV and TB in the country and further widened the socioeconomic gap. South Africa's handling of the pandemic has led to disruptions to HIV/TB testing and treatment. It has, furthermore, influenced social risk factors associated with increased transmission of these diseases. Individuals living with HIV and/or TB also face higher risk of developing severe COVID-19 disease. In this case study, we contextualize the HIV/TB landscape in South Africa and analyze the direct and indirect impact of the COVID-19 pandemic on the country's efforts to combat these ongoing epidemics.

The impact of COVID-19 on migrant women in son Gotleu (Palma) and the development of outreach tools to improve health and social care.

AIMS: The objectives of this research protocol are as follows: to examine the influence of the COVID-19 pandemic on health and social care for migrant women in the Son Gotleu district of Palma de Mallorca, Spain, and to develop outreach tools to target this specific group. DESIGN: This is a qualitative study that uses content analysis to obtain in-depth knowledge of personal experience (manifest content) and contextual experience (latent content) in a specific social setting. METHODS: The study population are migrant women living in Son Gotleu district, who are segmented by their age and experience of COVID-19, defined as positive or negative according to whether or not they have been infected with the disease. RESULTS: The shortcomings and needs relating to communication and health care that affect this group's current and future quality of life will be identified. CONCLUSION: The study of migrant women offers a gateway allowing vulnerability in health care to be detected. An awareness of their needs will allow prototype tools to be developed to facilitate communication and care for general and acute health needs between the scientific community and the vulnerable population.

Households' basic needs satisfaction during the Coronavirus disease 19 (COVID-19) pandemic in Burkina Faso.

The Coronavirus disease 19 (COVID-19) pandemic has profoundly affected economic and health systems around the world. This paper aims to assess household access to basic foods and health care and food security attainment during the COVID-19 pandemic in Burkina Faso. We use the COVID-19 High-Frequency Phone Survey 2020 panel data supported by the World Bank and conducted by Institut National de la Statistique et de la Démographie (INSD). The pooled multinomial logistic, the panel logistic, and the panel ordered logistic regressions are used to analyse the access to basic foods, the access to health care and the food security of the households, respectively. The results show that during COVID-19, female-headed households, poor households and farm households remain the most vulnerable in terms of access to basic foods, health services and food insecurity. Furthermore, the results indicate that households living outside the capital, particularly in the other urbans, experience fewer difficulties obtaining basic foods than those residing in the capital and are also unlikely to experience food insecurity. For more effective policy responses to the COVID-19 or similar shocks, the interventions should focus on household socioeconomic conditions and distinguish between urban and rural areas.

Social Determinants of Health and COVID-19 Behaviors and Beliefs Toward Immunizations Among Latinxs.

INTRODUCTION: Sixty million Latinxs make up 26.4% of all COVID-19 cases in the United States. It is uncertain whether behaviors and beliefs of immunizations among Latinxs is influenced by social determinants of health. The purpose of this study was to examine how social determinants of health predict COVID-19 behaviors and beliefs toward immunization among Latinxs. METHODS: In this exploratory study, 11 chapters from the National Association of Hispanic Nurses collaborated to recruit participants. The CDC National 2009 H1N1 Flu Survey was adapted to measure behaviors and beliefs about immunizations of COVID-19. The Health Access Survey was used to measure social determinants of health. Instruments were available in both Spanish and English. RESULTS: Participants (n=228) with higher education and health insurance tended to have less worry about taking the vaccine. Access to resources and practicing COVID-19 protective factors was positively associated. Alternative medicine and use of COVID-19 protective factors were negatively associated. Exposure to drugs and violence was associated with a decrease in likelihood to pursue a vaccine. CONCLUSIONS: Latinx need education about COVID-19 and vaccinations. Access to health care services must be available. Results highlight the importance of careful measurement when assessing social determinants of health among Latinx.

The uneven impacts of avoiding public transit on riders' access to healthcare during COVID-19.

Background: During the COVID-19 pandemic, many urban residents stopped riding public transit despite their reliance on it to reach essential services like healthcare. Few studies have examined the implications of public transit reliance on riders' ability to reach healthcare when transit is disrupted. To understand how shocks to transportation systems impact healthcare access, this study measures the impact of avoiding public transit on the ability of riders to access healthcare and pharmacy services during lockdowns. Methods: We deployed a cross-sectional survey of residents of Toronto and Vancouver in May 2020 through Facebook advertisements and community list-serves. Eligibility criteria included riding transit at least weekly prior to the pandemic and subsequent cessation of transit use during the pandemic. We applied multivariable modified Poisson models to identify socio-demographic, transportation, health-related, and neighborhood predictors of experiencing increased difficulty accessing healthcare and getting prescriptions while avoiding public transit. We also predicted which respondents reported deferring medical care until they felt comfortable riding transit again. Results: A total of 4367 former transit riders were included (64.2% female, 56.1% Toronto residents). Several factors were associated with deferring medical care including: being non-White (Toronto, APR, 1.14; 95% CI, 1.00-1.29; Vancouver, APR, 1.52; 95% CI, 1.26-1.84), having a physical disability (Toronto, APR, 1.20; 95% CI, 1.00-1.45; Vancouver, APR, 1.42; 95% CI, 1.08-1.87), having no vehicle access (Toronto, APR, 1.74; 95% CI, 1.51-2.00; Vancouver, APR, 2.74; 95% CI, 2.20-3.42), and having low income (Toronto, APR, 1.77; 95% CI, 1.44-2.17; Vancouver, APR, 1.51; 95% CI, 1.06-2.14). Discussion: During COVID-19 in two major Canadian cities, former transit riders from marginalized groups were more likely to defer medical care than other former riders. COVID-19 related transit disruptions may have imposed a disproportionate burden on the health access of marginalized individuals. Policymakers should consider prioritizing healthcare access for vulnerable residents during crises.