Adaptive reuse of closed malls for dementia programs and services: Community focus group feedback

The double societal hit of dementia and infectious disease outbreaks like COVID-19 have raised a convergence of concerns for the future of care settings for people living with dementia. Images of institutionalized older adults who are quarantined in closed settings have led developers, government agencies, and care administrators to search for innovative options to create more autonomy and quality of life in care settings while protecting the health of residents. This chapter describes the qualitative work being conducted by a Midwestern university research team, laying the groundwork for the conceptual adaptive reuse of an 800,000 square-foot closed mall site for centralized dementia programs, services, housing, and an on-site quarantine and medical center. Focus group outcomes from architects and developers highlighted five principle themes relating to the barriers and benefits of adaptive reuse for this model which include: mixed-use precedents, linking the old with the new, economic factors, development partnerships, and sustainable building practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Creating hospitable service systems for refugees during a pandemic: Leveraging resources for service inclusion

Purpose: The overarching goal of this paper is to increase awareness among researchers and practitioners that refugees are disproportionally impacted by COVID-19, which increases their suffering. Second, it extends a recently introduced transformative refugee service experience framework by integrating and conceptualizing refugees' resource and service inclusion during a pandemic. Third, it explores lessons learned and implications from the COVID-19 pandemic for the future of service research and practice. Design/methodology/approach: This study synthesizes approaches on refugees, resources and transformative service research to develop an extended framework for addressing one of society's pressing issues during and after pandemics. Findings: Recognizing refugees as providing resources rather than just needing or depleting resources can enable more inclusion. It facilitates refugees' integration into society by drawing on their skills and knowledge. This requires hospitable refugee service systems that enable service inclusion and opportunities for refugee resource integration.Research limitations/implications: This article focuses on one vulnerable group in society. However, the extended framework presented warrants broader application to other contexts, such as subsistence marketplaces. Practical implications: Managers of service businesses and public policymakers should create more inclusive and hospitable service systems for refugees. This may result in redesigning services, changing consumer behavior and reformulating public policy.Social implicationsBetter inclusion and integration of refugees and their resources should increase their individual well-being, reduce social issues in society, increase overall societal well-being and productivity. Originality/value: This article presents a novel extended framework for service scholars and service providers to increase resource and service inclusion of refugees in a disaster context. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Balancing burdens of infection control: Norwegian district medical officers' ethical challenges during the COVID-19 pandemic.

BACKGROUND: In several countries, district medical officers (DMOs) are public health experts with duties including infection control measures. The Norwegian DMOs have been key actors in the local handling of the COVID-19 pandemic. METHODS: The aim of the study was to explore the ethical challenges experienced by Norwegian DMOs during the COVID-19 pandemic, and how the DMOs have handled these challenges. 15 in-depth individual research interviews were performed and analyzed with a manifest approach. RESULTS: Norwegian DMOs have had to handle a large range of significant ethical problems during the COVID-19 pandemic. Often, a common denominator has been the need to balance burdens of the contagion control measures for different individuals and groups. In another large set of issues, the challenge was to achieve a balance between safety understood as effective contagion prevention on the one hand, and freedom, autonomy and quality of life for the same individuals on the other. CONCLUSIONS: The DMOs have a central role in the municipality's handling of the pandemic, and they wield significant influence. Thus, there is a need for support in decision-making, both from national authorities and regulations, and from discussions with colleagues.

The Use of a Single-Time Sit-To-Stand Test in Ambulatory Individuals With Spinal Cord Injury by Primary Health Care Providers.

Background: The uncertain health care situations, such as that created by the COVID-19 pandemic, has limited hospital access and facilitated a paradigm shift in health care toward an increased demand for standard home visits and community-based rehabilitation services, including by ambulatory individuals with spinal cord injury (SCI). Objectives: This 6-month prospective study explored the validity and reliability of a single-time sit-to-stand (STSTS) test when used by primary health care (PHC) providers, including a village health volunteer, caregiver, individual with SCI, and health professional. Methods: Eighty-two participants were assessed for the STSTS using four arm placement conditions (arms on a walking device, arms on knees, arms free by the sides, and arms crossed over the chest) and standard measures, with prospective fall data follow-up over 6 months. Thirty participants involved in the reliability study were also assessed and reassessed for the ability to complete the STSTS conditions by PHC providers. Results: Outcomes of the STSTS test, except the condition with arms on a walking device, could significantly discriminate lower extremity muscle strength (LEMS) and mobility of the participants (rpb = -0.58 to 0.69) with moderate concurrent validity. Outcomes of the tests without using the arms also showed moderate to almost-perfect reliability (kappa = 0.754-1.000) when assessed by PHC raters. Conclusion: The findings suggest the use of an STSTS with arms free by the sides as a standard practical measure by PHC providers to reflect LEMS and mobility of ambulatory individuals with SCI in various clinical, community, and home-based settings.

Emerging fields of practice in American social work

Since its beginnings, American social work has evolved in response to social injustices and human needs confronting our society. Social workers have assisted immigrants in resettlement and developed policy for financial assistance and alleviation of poverty for millions of Americans. They engaged in the fight for civil rights;worked to combat stigma;and gained services for many disenfranchised groups, including those afflicted with HIV, the mentally ill, the addicted, the homeless, and survivors of violence. Increasingly, social workers are moving into spaces where they can provide help and support more readily and with less stigma than more traditional practice settings have afforded. And although social workers have long been involved in disasters as first responders, the COVID-19 pandemic is a strong impetus for the profession to reconceptualize the practice of social work in the face of a health crisis that requires a multidimensional response to needed social care. On the micro level, social workers who are skilled in trauma-based work will also find their skills and expertise in greater demand as many first responders, health care providers, and families who experienced the loss of loved ones will require mental health services. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Examining the care of noncommunicable diseases at the first level of providing services during the COVID-19 pandemic.

Aim: Providing services for patients with noncommunicable diseases is one of the main responsibilities of health systems. During the COVID-19 pandemic, the care of these patients faced problems. This study investigates the ways of providing optimal care to patients during pandemics like COVID-19. Subject and methods: This study was conducted in 2021 in Tehran province using an analytical cross-sectional method. Six hundred participants were selected for the study. In order to examine the challenges and solutions for receiving services, a questionnaire was completed and its reliability and validity were checked; finally, a telephone interview was completed over a period of 3 months. Results: Among study participants, 68.2% were female, and the highest percentage was in the age group of 50-60 years. Fifty-four percent were illiterate or had primary education, 48.8% had diabetes, 42.8% had high blood pressure, and 8.3% had both diseases. Forty-three percent of the interviewees had not used health care services during the COVID-19 pandemic, the main reason for which was the fear of contracting COVID-19. The outbreak of coronavirus disease had affected the care of noncommunicable diseases for 63% of the interviewees. Conclusion: The fundamental need for changes in the health system was revealed by the COVID-19 pandemic. The need for flexibility in the health system will inevitably arise when similar cases occur, and policymakers and managers should consider necessary measures in this regard. The use of new technologies is one of the ways to replace traditional models.

COVID-19 emergency operator support: Bologna Local Health Unit Prevention and Protection Service

At the start of the Covid-19 pandemic, the Bologna Local Health Unit Prevention and Protection Service began to receive a number of various requests. From this, the idea of setting up a programme for colleagues emerged, and a phone number was established to address the needs of operators. After an initial evaluation, operators were referred to specific professional figures. The service's psychologists dealt with the requests received by offering different types of interventions. This report presents and discusses the results of this experience regarding the operators who used the service, the interventions implemented and the feedback received. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) All'inizio della pandemia da COVID-19 sono iniziate a pervenire numerose richieste di diversa natura presso il Servizio Prevenzione e Protezione dell'AUSL di Bologna. Da questi elementi e nata l'idea di pianificare un percorso dedicato ai colleghi attraverso l'istituzione di un numero telefonico per l'accoglienza dei bisogni degli operatori. A una prima accoglienza si rimandava a figure professionali specifiche. Gli psicologi del Servizio hanno preso in carico le richieste pervenute offrendo diverse tipologie di interventi. Nel presente elaborato sono presentati e discussi i risultati di questa esperienza relativi ai lavoratori che hanno usufruito del servizio, gli interventi attuati e i feedback ricevuti. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

[Barriers and facilitators to confronting HIV/aids and syphilis experienced by Venezuelan women living in BrazilFactores facilitadores y barreras que tienen las mujeres venezolanas residentes en Brasil respecto de la infección por el VIH/sida y la sífilis]. / Barreiras e facilitadores do enfrentamento de HIV/aids e sífilis por venezuelanas residentes no Brasil.

Objective: To describe the perception of Venezuelan women regarding access to health care, diagnosis, and treatment of HIV/aids and syphilis in Brazil. Method: This is a descriptive, exploratory study employing a qualitative approach, performed from February to May 2021 in the municipalities of Manaus, state of Amazonas, and Boa Vista, state of Roraima. The interviews with participants were fully transcribed, with identification of themes based on content analysis. Results: Forty women were interviewed (20 in Manaus and 20 in Boa Vista). Following transcription and translation of the accounts, two analytical categories were identified: barriers to healthcare access, with four subcategories - language, cost, adverse drug reactions, and COVID-19 pandemic; and facilitators of healthcare access, again with four subcategories - Unified Health System (SUS), National Policy of Comprehensive Women's Health, National Social Assistance Policy, and relationship between healthcare professionals and SUS users. Conclusion: The results showed the need to design strategies to mitigate the difficulties faced by migrant women from Venezuela living in Brazil regarding the diagnosis and treatment of HIV/aids and syphilis, going beyond the healthcare support guaranteed by law.

Objetivo: Describir la percepción de las mujeres venezolanas sobre el acceso a los servicios de salud, al diagnóstico y al tratamiento de la infección por el VIH/sida y la sífilis en Brasil. Métodos: Se trata de un estudio descriptivo y exploratorio, con enfoque cualitativo, realizado entre febrero y mayo del 2021 en los municipios de Manaos, estado de Amazonas, y Boa Vista, estado de Roraima. Las entrevistas con las participantes se transcribieron en su totalidad, y se exploraron los puntos de interés según el análisis del contenido. Resultados: Se entrevistaron 40 mujeres (20 en Manaos y 20 en Boa Vista). A partir de la transcripción y la traducción de las conversaciones, se establecieron dos categorías para el análisis del contenido: las barreras de acceso a los servicios de salud (subcategorías: idioma, costos relacionados con la salud, reacciones adversas a los medicamentos y pandemia de COVID-19); y los factores facilitadores del acceso (cuatro subcategorías: Sistema Único de Salud, Política nacional de Atención Integral a la Salud de la Mujer, Política Nacional de Asistencia Social y relación entre los profesionales de salud y las usuarias del Sistema Único de Salud). Conclusión: Los resultados mostraron la necesidad de formular estrategias para mitigar las dificultades que enfrentan las mujeres migrantes de Venezuela residentes en Brasil en relación con el diagnóstico y el tratamiento de la infección por el VIH/sida y la sífilis, más allá de la protección de la salud garantizada por la ley.

Hospital at Home: Paying for What It's Worth

Am J Manag Care. 2021;27(9):369-371. https://doi.org/10.37765/ajmc.2021.88739 _____ Takeaway Points A framework centered around cost, quality, and equity is essential to define the value of hospital-at-home programs. * Validated disease-specific tools should be consistently used to measure process metrics, outcome metrics, quality-of-life measures, and caregiver satisfaction measures. * Equity-focused process metrics, care utilization measures, and risk-adjusted outcome metrics should be reported. * Total costs of care for hospital-at-home programs should be consistently measured through a time-driven activity-based costing method. * Personal, societal, technical, and allocative value should be considered when determining the value of hospital-at-home programs. _____ In recent years, home health care has grown to 3% of overall US health care spending.1 Investment in home health care delivery including telemedicine grew considerably during the COVID-19 pandemic.2 One area that has lagged in terms of growth has been the hospital-at-home model. For home health agencies (different from hospital-at-home programs, which provide more acute care services), CMS uses a more comprehensive Home Health Quality Reporting process to assess risk-adjusted process measures, outcomes measures, occurrences of adverse events, utilization of care measures, and cost measures.9 After the COVID-19 pandemic, similar reporting processes should be implemented for measuring the quality and outcomes of hospital-at-home programs. Because hospital-at-home programs share features of both inpatient hospital admissions and home health agencies, they are uniquely positioned to both treat the patient acutely and improve the living conditions and resources that led to the acute illness. The American Heart Association's Get With the Guidelines – Heart Failure, an in-hospital program, describes a comprehensive, robust set of quality measurements including process and outcome measurements for heart failure management.11 Process metrics include assessment of left ventricular ejection fraction, adherence to guideline-recommended medical therapy at discharge, and scheduled follow-up;process metrics correlate well to high-quality heart failure care.12 Outcome metrics include 30-day mortality and 30-day readmission rates.12 Although hospital-at-home programs have been associated with lower costs, these cost reductions are mostly due to reduced length of hospitalization,13 number of consultations,14 and clinical testing.13 It is yet unclear if the reduction in services utilized also leads to a reduction in value for the patient—either through fewer completed process metrics or significantly increased caregiver burden. Of 34 studies included in a meta-analysis comparing the costs of hospital at home with those of hospitalizations, 32 studies found hospital at home to cost less.3 For example, in a recent randomized controlled trial evaluating patients treated in a hospital-at-home program compared with those treated in a traditional hospital, the risk-adjusted cost reduction of home care management was 19%.15 In this trial, costs were calculated by summing the costs of labor, equipment, medications, laboratory tests, imaging tests, and transport during the period of hospitalization.15 In hospital-at-home models, cost savings are thought to be achieved due to reduced length of hospitalization,13 decreased number of consultations,14 reduced nursing labor costs,15 and decreased clinical testing.13 However, no uniform method exists to track and assess costs,16 and there is worry that the costs of hospital-at-home programs are underestimated.17 To fill this gap, these programs should report and analyze the total costs of care—including costs incurred by patients and their caregivers—rather than simply the reimbursement rates for care.

Telemedicine Use by Age in Louisiana Medicaid During COVID-19: Claims-Based Longitudinal Analysis.

BACKGROUND: Limited availability of in-person health care services and fear of contracting COVID-19 during the pandemic promoted an increased reliance on telemedicine. However, long-standing inequities in telemedicine due to unequal levels of digital literacy and internet connectivity among different age groups raise concerns about whether the uptake of telemedicine has exacerbated or alleviated those inequities. OBJECTIVE: The aim of this study is to examine changes in telemedicine and in-person health service use during the COVID-19 pandemic across age groups for Medicaid beneficiaries in the state of Louisiana. METHODS: Interrupted time series models were used on Louisiana Medicaid claims data to estimate trends in total, in-person, and telemedicine monthly office visit claims per 1000 Medicaid beneficiaries between January 2018 and December 2020. Changes in care pattern trends and levels were estimated around the infection peaks (April 2020 and July 2020) and for an end-of-year infection leveling off period (December 2020). Four mutually exclusive age categories (0 to 17, 18 to 34, 35 to 49, and 50 to 64 years) were used to compare the differences. RESULTS: Prior to the COVID-19 pandemic, telemedicine services accounted for less than 1% of total office visit claim volume across the age groups. Each age group followed similar patterns of sharp increases in April 2020, downward trends until sharp increases again in July 2020, followed by flat trends thereafter until December 2020. These sharp increases were most pronounced for older patients, with those aged 50 to 64 years seeing increases of 184.09 telemedicine claims per 1000 Medicaid beneficiaries in April 2020 (95% CI 172.19 to 195.99) and 120.81 in July 2020 (95% CI 101.32 to 140.31) compared with those aged 18 to 34 years, seeing increases of 84.47 (95% CI 78.64 to 90.31) and 57.00 (95% CI 48.21 to 65.79), respectively. This resulted in overall changes from baseline to December 2020 levels of 123.65 (95% CI 112.79 to 134.51) for those aged 50 to 64 years compared with 59.07 (95% CI 53.89 to 64.24) for those aged 18 to 34 years. CONCLUSIONS: Older Medicaid beneficiaries in Louisiana had higher rates of telemedicine claim volume during the COVID-19 pandemic compared with younger beneficiaries.

The Evaluation of Health Care Services for Children and Adolescents With Post-COVID-19 Condition: Protocol for a Prospective Longitudinal Study.

BACKGROUND: Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite a frequently mild course of the disease. Nevertheless, extensive care for post-COVID-19 condition, also known as post-COVID-19 syndrome, in children and young people is not yet available. A comprehensive care network, Post-COVID Kids Bavaria (PoCo), for children and adolescents with post-COVID-19 condition has been set up as a model project in Bavaria, Germany. OBJECTIVE: The aim of this study is to evaluate the health care services provided within this network structure of care for children and adolescents with post-COVID-19 condition in a pre-post study design. METHODS: We have already recruited 117 children and adolescents aged up to 17 years with post-COVID-19 condition who were diagnosed and treated in 16 participating outpatient clinics. Health care use, treatment satisfaction, patient-reported outcomes related to health-related quality of life (the primary endpoint), fatigue, postexertional malaise, and mental health are being assessed at different time points (at baseline and after 4 weeks, 3 months, and 6 months) using routine data, interviews, and self-report questionnaires. RESULTS: The study recruitment process ran from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after follow-up assessment is completed, and the results will be published. CONCLUSIONS: The results will contribute to the evaluation of therapeutic services provided for post-COVID-19 condition in children and adolescents, and avenues for optimizing care may be identified. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41010.

Identification of Key Factors for Optimized Health Care Services: Protocol for a Multiphase Study of the Dubai Vaccination Campaign.

BACKGROUND: Mass vaccination of the global population against the novel COVID-19 outbreak posed multiple challenges, including effectively administering millions of doses in a short period of time while ensuring public safety and accessibility. The government of Dubai launched a mass campaign in December 2020 to vaccinate all its citizens and residents, targeting the population aged >18 years against COVID-19. The vaccination campaign involved a transformation of multiple commercial spaces into mass vaccination centers across the city of Dubai, the largest of which was the Dubai One Central (DOC) vaccination center. It was operational between January 17, 2021, and 27 January 27, 2022. OBJECTIVE: The multiphase research study aims to empirically explore the opinions of multiple health care stakeholders, elicit the key success factors that can influence the effective delivery of emergency health care services such as a COVID-19 mass vaccination center, and explore how these factors relate to one another. METHODS: To understand more about the operations of the DOC vaccination center, the study follows a multiphase design divided into 2 phases. The study is being conducted by the Institute for Excellence in Health Professions Education at Mohammed Bin Rashid University of Medicine and Health Sciences between December 2021 and January 2023. To elicit the key success factors that contributed to the vaccination campaign administered at DOC, the research team conducted 30 semistructured interviews (SSIs) with a sample of staff and volunteers who worked at the DOC vaccination center. Stratified random sampling was used to select the participants, and the interview cohort included representatives from the management team, team leaders, the administration and registration team, vaccinators, and volunteers. A total of 103 people were invited to take part in the research study, and 30 agreed to participate in the SSIs. To validate the participation of various stakeholders, phase 2 will analytically investigate one's subjectivity through Q-methodology and empirically investigate the opinions obtained from the research participants during phase 1. RESULTS: As of July 2022, 30 SSIs were conducted with the research participants. CONCLUSIONS: The study will provide a comprehensive 2-phase approach to obtaining the key success factors that can influence the delivery of high-quality health care services such as emergency services launched during a global pandemic. The study's findings will be translated into key factors that could support designing future health care services utilizing evidence-based practice. In line with future plans, a study will use data, collected through the DOC vaccination center, to develop a simulation model outlining the process of the customer journey and center workflow. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42278.

The COVID-19 pandemic: Reorganisation of health services and coping of health care workers in primary healthcare

Background: The COVID-19 pandemic has forced the reorganisation of healthcare services, and the implementation of contingency plans impacted Primary Health Care (PHC) workers' daily demands. The training and support of health workers staff, its clinical, psychological and social support are additional challenges. Research question: How have PHC services responded to the pandemic and how has this impacted PHC workers regarding anxiety levels? Methods: We conducted a cross-sectional survey with a convenience sample of Primary Care Services workers from 7 European countries (Portugal, Spain, Bosnia, Italy, Turkey, Ukraine and France) using an online questionnaire. Ethical aspects were guaranteed. We collected information on gender, age, professional group, perceived support, access to personal protective equipment (PPE), overall pressure felt by professionals and their anxiety levels by March 2020 and May 2021. The association between each variable and anxiety were estimated through multivariate logistic regression. Result(s): Our sample comprised 1045 PHC workers (73.8% female, mean age 44.8 years;49.6% doctors). Almost 70% of participants claimed to monitor suspected COVID-19 patients and 66.5% reported a risk management protocol was in place. In March 2020, 54% of participants reported little/no PPEs availability, whereas in May 2021 76% stated PPEs were available/very available. About 65% of the participants feel high/extreme pressure at their work. High/extreme anxiety levels were reported by 54.1% in March 2020 and 38.3% in May 2021. Multivariate logistic regression analysis showed that feeling supported regarding personal problems and encouraged to maintain social interactions was associated with lower anxiety levels (adjusted OR =0.292, p=0.009;adjusted OR =0.390, p=0.012). Conclusion(s): Despite perceived high work-related pressure levels, PHC services adapted to the pandemic demands by implementation of risk management plans. PHC workers anxiety levels reduced from March 2020 to May 2021. Feeling encouraged to maintain social interactions and supported regarding personal problems decreased the likelihood of anxiety.

The impact of the COVID-19 pandemic on LGBT individuals

The COVID-19 pandemic and the strategies used to cope with the outbreak intensified health, social and economic inequities within society. In particular, psychological problems of different types were experienced by the LGBT community. Previous research has shown that sexual minorities often have more limited access to health care services due to discrimination resulting from lack of cultural responsiveness among health care professionals to the special needs of this sub-group. Pandemic officials failed to recognize the unique needs and concerns of LGBT individuals. As such, it is recommended that, in the future, LGBT persons should be provided with online work, education, and mental health services, as well as mental health services. In particular, emphasis needs to be placed on social support which is a major problem for a minority group during a major crisis affecting a large swath of the population. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Effects of posttraumatic stress disorder for U.S. women veterans

The purpose of this qualitative phenomenological study was to explore the lived postdeployment experiences of U.S. women veterans with posttraumatic stress disorder (PTSD) and their perception of the impact their diagnosis had on their immediate families. The theoretical framework was Heider's causal attribution theory. The first two research questions directly addressed the purpose of the study, and the third research question addressed each participant's experience with accessing mental healthcare services. NVivo was used to transcribe, code, and analyze data derived from semistructured interviews with six U.S. women veterans who were diagnosed with PTSD by a licensed mental health professional postdeployment. Findings emerged PTSD diagnosis, U.S. women veterans experienced effects of PTSD on themselves and their immediate family members, access challenges to mental health care services. Eight subordinate themes (codes) also emerged history of traumatic events during active duty (i.e., sexual assault);communicative challenges, elevated verbal exchanges/angry outbursts with immediate family members;lengthy process of claims to begin Veterans Affairs mental health services, prescription medication to treat PTSD symptoms;denied mental health care services due to peacetime service;desire for improved U.S. women veterans' mental health care services;anxiety/panic attacks;and difficulty rescheduling therapy sessions and/or distractible teletherapy sessions due to Covid-19 pandemic. The positive social change implications include increasing awareness for the need of rapid response and access to mental health care services for U.S. women veterans living with PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

New graduate nursing retention in 2020: A multifactorial analysis

The issue of new graduates prematurely exiting the profession has a long- standing, complicated history in nursing. Current retention is further complicated by the COVID-19 pandemic. The state of the global workforce and transition shock theory situate this issue. Ray's theory of bureaucratic caring frames the analysis with proposed recommendations for individual nurses, healthcare organizations, and academia. The sociocultural and political domains of Ray's theory offer guidance for nurse leaders in academic and practice settings. The importance of a collaborative relationship between academic and practice settings is vital to mitigate the phenomenon of early exit of new graduates. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Black American experiences in healthcare: Past, present, and (improving the) future

Black Americans presently and have historically faced disproportionately negative experiences in the U.S. healthcare system, as spotlighted by the COVID-19 pandemic. In my dissertation, I employ diverse methodologies, including quantitative analyses of nationally representative data, qualitative analyses of focus groups, and experimental methods aiming to understand and illuminate potential ways to address Black Americans' experiences of injustice in healthcare. The introduction (Chapter 1) builds upon previous research to illustrate a model which emphasizes the importance of individuals and systems (and the histories of individuals and systems) to better understand racial injustice in healthcare. In Chapter 2, I provide a narrative review of the present and historical experiences of Black Americans in the healthcare system. Next, in Chapter 3, across two studies (N=13,054), including a nationally representative sample of Black and White Americans during the COVID-19 pandemic, Black (relative to White) Americans reported less positive experiences in healthcare, which explained early COVID-19 vaccination hesitancy and lower medical system trust. Current knowledge of the Tuskegee Syphilis Study was not related significantly to medical trust or vaccination intention, however. In Chapter 4, qualitative data and thematic analysis were used to interrogate the quality of healthcare provider-Black patient interactions in a sample of 37 Black American women who had been diagnosed with breast cancer. In a community-academic collaboration, three focus groups were conducted across California. Results demonstrated that participants experienced discrimination, stereotyping, and hostility from healthcare providers and within the healthcare system which undermined their medical trust. Further, participants offered suggestions for improving the healthcare experiences of Black women diagnosed with breast cancer. A critical step toward dismantling racial injustice is acknowledging its existence. Thus, in Chapter 5, I tested specific ways to shift dominant group members' perceptions to recognize both individual and systemic racism and how to increase behavioral intentions to combat injustice in healthcare. Results from this online experiment conducted with 1853 adults suggested that when White Americans learned about critical Black history in healthcare (i.e., history of injustice) vs. celebratory Black history (i.e., history of achievement) or control information, they reported significantly more perspective-taking with Black Americans, which in turn predicted more individual and systemic racism recognition and support for anti-racist policies in healthcare. Ultimately, my dissertation studies highlight specific experiences of injustice that Black Americans face in healthcare and identifies a mechanism to increase White Americans' recognition of and support for addressing injustices toward Black Americans. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Why are they still here: A look at employee retention amidst the COVID-19 pandemic

The purpose of this mixed methods study was to examine the impact of unplanned change, driven by the COVID-19 pandemic, on organizational culture and employee retention among essential workers in a growing healthcare organization. The research addresses the importance of employee retention, including factors related to retention, consequences of retentions, and the financial impact of employee attrition. Additionally, the research addresses employer strategies to increase retention, such as organizational culture, job satisfaction, employer brand, and generational differences in the workplace. The conceptual framework used for this research is an adaptation of the Burke-Litwin model of organizational performance and change (BLMOPC). The study sought to examine the change to the organization caused by the external environment factor of the COVID-19 pandemic by exploring the transactional factors of work unit climate and individual needs and values. Data collection consisted of a survey instrument and interviews with survey participants. The findings and results support the conceptual framework suggesting that the transformational factor of organizational culture is influenced by the transactional factors which can be leveraged to inform leaders and turn the COVID-19 crisis into an opportunity to create a stronger organizational culture. Recommendations to address the impact of the COVID-19 on organizational culture and employee retention are discussed and include a quantified and transparent approach to compensation and developing an organizational culture that promotes work-life balance and leadership presence. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

An NLP analysis of health advice giving in the medical research literature

Health advice - clinical and policy recommendations - plays a vital role in guiding medical practices and public health policies. Whether or not authors should give health advice in medical research publications is a controversial issue. The proponents of "actionable research" advocate for the more efficient and effective transmission of science evidence into practice. The opponents are concerned about the quality of health advice in individual research papers, especially that in observational studies. Arguments both for and against giving advice in individual studies indicate a strong need for identifying and accessing health advice, for either practical use or quality evaluation purposes. However, current information services do not support the direct retrieval of health advice. Compared to other natural language processing (NLP) applications, health advice has not been computationally modeled as a language construct either. A new information service for directly accessing health advice should be able to reduce information barriers and to provide external assessment in science communication.This dissertation work built an annotated corpus of scientific claims that distinguishes health advice according to its occurrence and strength. The study developed NLP-based prediction models to identify health advice in the PubMed literature. Using the annotated corpus and prediction models, the study answered research questions regarding the practice of advice giving in medical research literature. To test and demonstrate the potential use of the prediction model, it was used to retrieve health advice regarding the use of hydroxychloroquine (HCQ) as a treatment for COVID-19 from LitCovid, a large COVID-19 research literature database curated by the National Institutes of Health. An evaluation of sentences extracted from both s and discussions showed that BERT-based pre-trained language models performed well at detecting health advice. The health advice prediction model may be combined with existing health information service systems to provide more convenient navigation of a large volume of health literature. Findings from the study also show researchers are careful not to give advice solely in s. They also tend to give weaker and non-specific advice in s than in discussions. In addition, the study found that health advice has appeared consistently in the s of observational studies over the past 25 years. In the sample, 41.2% of the studies offered health advice in their conclusions, which is lower than earlier estimations based on analyses of much smaller samples processed manually. In the s of observational studies, journals with a lower impact are more likely to give health advice than those with a higher impact, suggesting the significance of the role of journals as gatekeepers of science communication.For the communities of natural language processing, information science, and public health, this work advances knowledge of the automated recognition of health advice in scientific literature. The corpus and code developed for the study have been made publicly available to facilitate future efforts in health advice retrieval and analysis. Furthermore, this study discusses the ways in which researchers give health advice in medical research articles, knowledge of which could be an essential step towards curbing potential exaggeration in the current global science communication. It also contributes to ongoing discussions of the integrity of scientific output.This study calls for caution in advice-giving in medical research literature, especially in s alone. It also calls for open access to medical research publications, so that health researchers and practitioners can fully review the advice in scientific outputs and its implications. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Delaying or avoiding medical care due to the COVID-19 pandemic

Delaying or avoiding medical treatment is a common and possibly dangerous consequence of the COVID-19 pandemic. Certain demographic, medical or social groups were found reporting higher rates of avoiding medical care. Patients should be specifically targeted in advertising and interactions that encourage people to return to their previous behavior concerning their health maintenance. Technology advances, especially telemedicine, should be implemented widely to overcome pandemic fears and provide a new platform for treating patients in this complex era. (PsycInfo Database Record (c) 2022 APA, all rights reserved)