Social and self-stigma during COVID-19 pandemic: Egyptians' perspectives.

BACKGROUND: Social stigma associated with infectious diseases existed throughout the history of pandemics due to fears of contagion and death. This study aims to assess social and self-stigma resulting from COVID-19 infection and other associated factors in Egypt during the pandemic. METHODS: A cross-sectional study was conducted on 533 adult Egyptians via an online questionnaire. The questionnaire included social stigma toward current and recovered COVID-19 patients and the negative self-image of being a COVID-19 patient. RESULTS: The mean calculated overall COVID-19-related stigma score for the studied sample was 4.7±3.1. The highest reported stigma category was mild stigma: Social stigma towards current COVID-19 patients (88.2%), Social stigma toward recovered COVID-19 patients (64.2%), Negative self-image for being a COVID-19 patient; perceived self-stigma (71.6%) and total stigma score (88.2%) respectively. The overall stigma score was negatively associated with a higher level of education and getting information from healthcare workers and positively associated with getting information from social networks. CONCLUSION: Social and self-stigma related to COVID-19 infection was mild from the Egyptian perspective but found in a large proportion of the population and mainly affected by getting information from healthcare workers or through social media and being more among those with lower education levels. The study recommends more legislative control on social media for disseminating health-related information and conducting awareness campaigns to counteract these adverse effects.

What Drives the Influence of Health Science Communication Accounts on TikTok? A Fuzzy-Set Qualitative Comparative Analysis.

Medical institutions face a variety of challenges as they seek to enhance their reputation and increase the influence of their social media accounts. Becoming a social media influencer in the health field in today's complex online environment requires integrated social and technical systems. However, rather than holistically investigating the mechanism of account influence, studies have focused on a narrow subset of social and technical conditions that drive online influence. We attribute this to the mismatch between complex causality problems and traditional symmetric regression methods. In this study, we adopted an asymmetric configurational perspective that allowed us to test a causally complex model of the conditions that create strong and not-strong account influence. We used fuzzy-set qualitative comparative analysis (fsQCA) to detect the effects of varying configurations of three social system characteristics (i.e., an oncology-related attribute, a public attribute, and comment interaction) and two technical system characteristics (i.e., telepresence and video collection) on the TikTok accounts of 63 elderly Chinese doctors (60 to 92 years old). Our results revealed two pathways associated with distinct sociotechnical configurations to strong account influence and three pathways associated with distinct sociotechnical configurations to not-strong account influence. Furthermore, the results confirmed that a single antecedent condition cannot, on its own, produce an outcome, i.e., account influence. Multiple inter-related conditions are required to produce an influential account. These results offer a more holistic picture of how health science communication accounts operate and reconcile the scattered results in the literature. We also demonstrate how configurational theory and methods can be used to analyze the complexities of social media platforms.

Acceptability of a standalone written leaflet for the National Health Service for England Targeted Lung Health Check Programme: A concurrent, think-aloud study.

BACKGROUND: Many countries are introducing low-dose computed tomography screening programmes for people at high risk of lung cancer. Effective communication strategies that convey risks and benefits, including unfamiliar concepts and outcome probabilities based on population risk, are critical to achieving informed choice and mitigating inequalities in uptake. METHODS: This study investigated the acceptability of an aspect of NHS England's communication strategy in the form of a leaflet that was used to invite and inform eligible adults about the Targeted Lung Health Check (TLHC) programme. Acceptability was assessed in terms of how individuals engaged with, comprehended and responded to the leaflet. Semi-structured, 'think aloud' interviews were conducted remotely with 40 UK screening-naïve current and former smokers (aged 55-73). The verbatim transcripts were analysed thematically using a coding framework based on the Dual Process Theory of cognition. RESULTS: The leaflet helped participants understand the principles and procedures of screening and fostered cautiously favourable intentions. Three themes captured the main results of the data analysis: (1) Response-participants experienced anxiety about screening results and further investigations, but the involvement of specialist healthcare professionals was reassuring; (2) Engagement-participants were rapidly drawn to information about lung cancer prevalence, and benefits of screening, but deliberated slowly about early diagnosis, risks of screening and less familiar symptoms of lung cancer; (3) Comprehension-participants understood the main principles of the TLHC programme, but some were confused by its rationale and eligibility criteria. Radiation risks, abnormal screening results and numerical probabilities of screening outcomes were hard to understand. CONCLUSION: The TLHC information leaflet appeared to be acceptable to the target population. There is scope to improve aspects of comprehension and engagement in ways that would support informed choice as a distributed process in lung cancer screening. PATIENT OR PUBLIC CONTRIBUTION: The insight and perspectives of patient representatives directly informed and improved the design and conduct of this study.

Identifying features of source and message that influence the retweeting of health information on social media during the COVID-19 pandemic.

BACKGROUND: Social media has become an essential tool to implement risk communication, giving health information could gain more exposure by retweeting during the COVID-19 pandemic. METHODS: Content analysis was conducted to scrutinize the official (national and provincial) public health agencies' Weibo posts (n = 4396) to identify features of information sources and message features (structure, style content). The Zero-Inflated Negative Binomial (ZINB) model was adopted to analyze the association between these features and the frequency of the retweeted messages. RESULTS: Results indicated that features of source and health information, such as structure, style, and content, were correlated to retweeting. The results of IRR further suggested that compared to provincial accounts, messages from national health authorities' accounts gained more retweeting. Regarding the information features, messages with hashtags#, picture, video have been retweeted more often than messages without any of these features respectively, while messages with hyperlinks received fewer retweets than messages without hyperlinks. In terms of the information structure, messages with the sentiment (!) have been retweeted more frequently than messages without sentiment. Concerning content, messages containing severity, reassurance, efficacy, and action frame have been retweeted with higher frequency, while messages with uncertainty frames have been retweeted less often. CONCLUSIONS: Health organizations and medical professionals should pay close attention to the features of health information sources, structures, style, and content to satisfy the public's information needs and preferences to promote the public's health engagement. Designing suitable information systems and promoting health communication strategies during different pandemic stages may improve public awareness of the COVID-19, alleviate negative emotions, and promote preventive measures to curb the spread of the virus.

Community-Engaged Bidirectional Crisis and Emergency Risk Communication With Immigrant and Refugee Populations During the COVID-19 Pandemic.

OBJECTIVES: This study was conducted to assess an intervention that was created by a community-academic partnership to address COVID-19 health inequities. We evaluated a community-engaged bidirectional pandemic crisis and emergency risk communication (CERC) framework with immigrant and refugee populations during the COVID-19 pandemic. METHODS: A 17-year community-engaged research partnership adopted a CERC framework in March 2020 to address COVID-19 prevention, testing, and socioeconomic impacts with immigrant and refugee groups in southeast Minnesota. The partnership used bidirectional communication between communication leaders and their social networks to refine messages, leverage resources, and advise policy makers. We conducted a mixed-methods evaluation for intervention acceptability, feasibility, reach, adaptation, and sustainability through multisource data, including email communications, work group notes, semistructured interviews, and focus groups. RESULTS: The intervention reached at least 39 000 people in 9 months. It was implemented as intended and perceived efficacy was high. Frequent communication between community and academic partners allowed the team to respond rapidly to concerns and facilitated connection of community members to resources. Framework implementation also led to systems and policy changes to meet the needs of immigrant and refugee populations. CONCLUSIONS: Community-engaged CERC is feasible and sustainable and can reduce COVID-19 disparities through shared creation and dissemination of public health messages, enhanced connection to existing resources, and incorporation of community perspectives in regional pandemic mitigation policies.

Static vs. dynamic methods of delivery for science communication: A critical analysis of user engagement with science on social media.

Science communication has been increasingly viewed as a necessity and obligation of scientists in recent years. The rise of Web 2.0 technologies, such as social media, has made communication of science to the public more accessible as a whole. While one of the primary goals of science communication is to increase public engagement, there is very little research to show the type of communication that fosters the highest levels of engagement. Here we evaluate two social medial platforms, Instagram and TikTok, and assess the type of educational science content (ESC) that promotes user awareness and overall engagement. Specifically, we measured the level of engagement between static and dynamic posts on Instagram, and lecture-style and experimental videos on TikTok. User engagement is measured through the analysis of relative number of likes, comments, shares, saves, and views of each post in the various categories. We found that users interact with ESC significantly more (p<0.05) when the content is presented in dynamic ways with a component of experimentation. Together, we took the findings of this study and provided a series of suggestions for conducting science communication on social media, and the type of ESC that should be used to promote better user outcomes.

Colonial Virus": COVID-19, creative arts and public health communication in Ghana.

Since March 2020, Ghana's creative arts communities have tracked the complex facets of the COVID-19 pandemic through various art forms. This paper reports a study that analysed selected 'COVID art forms' through arts and health and critical health psychology frameworks. Art forms produced between March and July 2020, and available in the public sphere - traditional media, social media and public spaces - were collated. The data consisted of comedy, cartoons, songs, murals and textile designs. Three key functions emerged from analysis: health promotion (comedy, cartoons, songs); disease prevention (masks); and improving the aesthetics of the healthcare environment (murals). Textile designs performed broader socio-cultural functions of memorialising and political advocacy. Similar to earlier HIV/AIDS and Ebola arts interventions in other African countries, these Ghanaian COVID art forms translated public health information on COVID-19 in ways that connected emotionally, created social awareness and improved public understanding. However, some art forms had limitations: for example, songs that edutained using fear-based strategies or promoting conspiracy theories on the origins and treatment of COVID-19, and state-sponsored visual art that represented public health messaging decoupled from socio-economic barriers to health protection. These were likely to undermine the public health communication goals of behaviour modification. We outline concrete approaches to incorporate creative arts into COVID-19 public health interventions and post-pandemic health systems strengthening in Ghana. FUNDING: None declared.

The Effect of a Wordless, Animated, Social Media Video Intervention on COVID-19 Prevention: Online Randomized Controlled Trial.

BACKGROUND: Innovative approaches to the dissemination of evidence-based COVID-19 health messages are urgently needed to counter social media misinformation about the pandemic. To this end, we designed a short, wordless, animated global health communication video (the CoVideo), which was rapidly distributed through social media channels to an international audience. OBJECTIVE: The objectives of this study were to (1) establish the CoVideo's effectiveness in improving COVID-19 prevention knowledge, and (2) establish the CoVideo's effectiveness in increasing behavioral intent toward COVID-19 prevention. METHODS: In May and June 2020, we enrolled 15,163 online participants from the United States, Mexico, the United Kingdom, Germany, and Spain. We randomized participants to (1) the CoVideo arm, (2) an attention placebo control (APC) arm, and (3) a do-nothing arm, and presented 18 knowledge questions about preventive COVID-19 behaviors, which was our first primary endpoint. To measure behavioral intent, our second primary endpoint, we randomized participants in each arm to five list experiments. RESULTS: Globally, the video intervention was viewed 1.2 million times within the first 10 days of its release and more than 15 million times within the first 4 months. Knowledge in the CoVideo arm was significantly higher (mean 16.95, 95% CI 16.91-16.99) than in the do-nothing (mean 16.86, 95% CI 16.83-16.90; P<.001) arm. We observed high baseline levels of behavioral intent to perform many of the preventive behaviors featured in the video intervention. We were only able to detect a statistically significant impact of the CoVideo on one of the five preventive behaviors. CONCLUSIONS: Despite high baseline levels, the intervention was effective at boosting knowledge of COVID-19 prevention. We were only able to capture a measurable change in behavioral intent toward one of the five COVID-19 preventive behaviors examined in this study. The global reach of this health communication intervention and the high voluntary engagement of trial participants highlight several innovative features that could inform the design and dissemination of public health messages. Short, wordless, animated videos, distributed by health authorities via social media, may be an effective pathway for rapid global health communication during health crises. TRIAL REGISTRATION: German Clinical Trials Register DRKS00021582; https://tinyurl.com/6r4zkbbn. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-020-04942-7.

The COVID-19 Vaccine and the Black Community: Addressing the Justified Questions.

Established in 2019, the Roundtable on Black Men and Black Women in STEM convenes a broad array of stakeholders that focus on the barriers and opportunities encountered by Black men and Black women as they navigate the pathways from K-12 and postsecondary education to careers in science, engineering, and medicine. Through meetings, public workshops, and publications, the Roundtable advances discussions that raise awareness and/or highlight promising practices for increasing the representation, retention, and inclusiveness of Black men and Black women in STEM. In keeping with the charge of the Roundtable, Roundtable leadership and leaders of the COVID-19 action group conducted an informational video in January 2021 to provide an in-depth discussion around common, justified questions in the Black community pertaining to the COVID-19 vaccine. The manuscript addresses selected questions and answers relating to the different types of COVID-19 vaccines and their development, administration, and effectiveness. Discussion focuses on addressing vaccine misconceptions, misinformation, mistrust, and hesitancy; challenges in prioritizing vaccinations in diverse populations and communities; dealing with racism in medicine and public health; optimizing communication and health education; and offering practical strategies and recommendations for improving vaccine acceptance by clinicians, health care workers, and the Black community. This manuscript summarizes the content in the YouTube video ( https://www.youtube.com/watch?v=wdEC9c48A_k ).

Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial.

BACKGROUND: The effectiveness of the COVID-19 vaccination programme depends on mass participation: the greater the number of people vaccinated, the less risk to the population. Concise, persuasive messaging is crucial, particularly given substantial levels of vaccine hesitancy in the UK. Our aim was to test which types of written information about COVID-19 vaccination, in addition to a statement of efficacy and safety, might increase vaccine acceptance. METHODS: For this single-blind, parallel-group, randomised controlled trial, we aimed to recruit 15 000 adults in the UK, who were quota sampled to be representative. Participants were randomly assigned equally across ten information conditions stratified by level of vaccine acceptance (willing, doubtful, or strongly hesitant). The control information condition comprised the safety and effectiveness statement taken from the UK National Health Service website; the remaining conditions addressed collective benefit, personal benefit, seriousness of the pandemic, and safety concerns. After online provision of vaccination information, participants completed the Oxford COVID-19 Vaccine Hesitancy Scale (outcome measure; score range 7-35) and the Oxford Vaccine Confidence and Complacency Scale (mediation measure). The primary outcome was willingness to be vaccinated. Participants were analysed in the groups they were allocated. p values were adjusted for multiple comparisons. The study was registered with ISRCTN, ISRCTN37254291. FINDINGS: From Jan 19 to Feb 5, 2021, 15 014 adults were recruited. Vaccine hesitancy had reduced from 26·9% the previous year to 16·9%, so recruitment was extended to Feb 18 to recruit 3841 additional vaccine-hesitant adults. 12 463 (66·1%) participants were classified as willing, 2932 (15·6%) as doubtful, and 3460 (18·4%) as strongly hesitant (ie, report that they will avoid being vaccinated for as long as possible or will never get vaccinated). Information conditions did not alter COVID-19 vaccine hesitancy in those willing or doubtful (adjusted p values >0·70). In those strongly hesitant, COVID-19 vaccine hesitancy was reduced, in comparison to the control condition, by personal benefit information (mean difference -1·49, 95% CI -2·16 to -0·82; adjusted p=0·0015), directly addressing safety concerns about speed of development (-0·91, -1·58 to -0·23; adjusted p=0·0261), and a combination of all information (-0·86, -1·53 to -0·18; adjusted p=0·0313). In those strongly hesitant, provision of personal benefit information reduced hesitancy to a greater extent than provision of information on the collective benefit of not personally getting ill (-0·97, 95% CI -1·64 to -0·30; adjusted p=0·0165) or the collective benefit of not transmitting the virus (-1·01, -1·68 to -0·35; adjusted p=0·0150). Ethnicity and gender were found to moderate information condition outcomes. INTERPRETATION: In the approximately 10% of the population who are strongly hesitant about COVID-19 vaccines, provision of information on personal benefit reduces hesitancy to a greater extent than information on collective benefits. Where perception of risk from vaccines is most salient, decision making becomes centred on the personal. As such, messaging that stresses the counterbalancing personal benefits is likely to prove most effective. The messaging from this study could be used in public health communications. Going forwards, the study highlights the need for future health campaigns to engage with the public on the terrain that is most salient to them. FUNDING: National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and NIHR Oxford Health Biomedical Research Centre.

The Saudi Ministry of Health's Twitter Communication Strategies and Public Engagement During the COVID-19 Pandemic: Content Analysis Study.

BACKGROUND: During a public health crisis such as the current COVID-19 pandemic, governments and health authorities need quick and accurate methods of communicating with the public. While social media can serve as a useful tool for effective communication during disease outbreaks, few studies have elucidated how these platforms are used by the Ministry of Health (MOH) during disease outbreaks in Saudi Arabia. OBJECTIVE: Guided by the Crisis and Emergency Risk Communication model, this study aimed to explore the MOH's use of Twitter and the public's engagement during different stages of the COVID-19 pandemic in Saudi Arabia. METHODS: Tweets and corresponding likes and retweets were extracted from the official Twitter account of the MOH in Saudi Arabia for the period of January 1 through August 31, 2020. Tweets related to COVID-19 were identified; subsequently, content analysis was performed, in which tweets were coded for the following message types: risk messages, warnings, preparations, uncertainty reduction, efficacy, reassurance, and digital health responses. Public engagement was measured by examining the numbers of likes and retweets. The association between outbreak stages and types of messages was assessed, as well as the effect of these messages on public engagement. RESULTS: The MOH posted a total of 1393 original tweets during the study period. Of the total tweets, 1293 (92.82%) were related to COVID-19, and 1217 were ultimately included in the analysis. The MOH posted the majority of its tweets (65.89%) during the initial stage of the outbreak. Accordingly, the public showed the highest level of engagement (as indicated by numbers of likes and retweets) during the initial stage. The types of messages sent by the MOH significantly differed across outbreak stages, with messages related to uncertainty reduction, reassurance, and efficacy being prevalent among all stages. Tweet content, media type, and crisis stage influenced the level of public engagement. Engagement was negatively associated with the inclusion of hyperlinks and multimedia files, while higher level of public engagement was associated with the use of hashtags. Tweets related to warnings, uncertainty reduction, and reassurance received high levels of public engagement. CONCLUSIONS: This study provides insights into the Saudi MOH's communication strategy during the COVID-19 pandemic. Our results have implications for researchers, governments, health organizations, and practitioners with regard to their communication practices during outbreaks. To increase public engagement, governments and health authorities should consider the public's need for information. This, in turn, could raise public awareness regarding disease outbreaks.

Community-based Strategies to Engage Pastors Can Help Address Vaccine Hesitancy and Health Disparities in Black Communities.

In an era of Freddie Gray and Black Lives Matter, a long history of structural racism, combined with disproportionate rates of COVID-19, the African American community has seen a lot of reasons to demand social justice, equal treatment and immediate access to solutions to health disparities. Despite the promise of COVID-19 vaccines, the community is highly distrustful of the vaccine and institutions given a history of mistreatment and many other current concerns. Trusted messengers such as Black pastors are crucial to protecting the community that faces a disproportionate amount of disease. We present a framework to build trust and acceptance including understanding history and context; listening and empathy; engaging pastors as trusted messengers; creating partnerships with shared responsibility and power; and co-creation of solutions with faith leaders and their community, governments and institutions to create sustainable, long-term change. Efforts to support vaccine acceptance must be customized to the variety of needs and realities of the African American community, not just the topic of concern to the institution. Evaluations are needed to help ensure the community is engaged and feeling heard. Pastors and other religious leaders can work with government and institutions to bring information, facilitate discussion, build trust and develop measurable improvement efforts. Although acceptance of COVID-19 vaccines may not be achieved overnight, the process of focusing on issues that are important to the community is an important step in laying the foundation for both COVID-19 vaccines and future interventions.

Building Vaccine Literacy in a Pandemic: How One Team of Public Health Students Is Responding.

Students at schools and programs of public health will enter a workforce during the greatest public health crisis in the past century. The potential COVID-19 vaccine-one of the most promising tools to return to a new 'normal'-is held in doubt by many Americans. Vaccine literacy in the United States is a pressing issue that students of public health need to consider. We describe how a long-standing public health student crisis response team at Emory University is helping to address this challenge, and describe key principles we identify as worthy of study and focus for current public health students today. Schools and programs of public health have a timely opportunity to adapt their curricula to meet training needs of emerging public health students to equip them to address vaccine literacy while maintaining accreditation standards.

Which Beliefs Predict Intention to Get Vaccinated against COVID-19? A Mixed-Methods Reasoned Action Approach Applied to Health Communication.

This research examined the underlying beliefs and psychological determinants of COVID-19 vaccination intention in order to inform effective health promotion efforts. We utilized the reasoned action framework in a mixed-methods, two-study approach. Study 1, an open-ended belief elicitation survey (N = 197), explored the underlying beliefs associated with intention to get vaccinated against COVID-19 once a vaccine becomes available. In a quantitative survey with a representative sample of U.S. adults, study 2 (N = 1656) tested the psychological determinants of intention to get vaccinated. Results revealed (1) the most common attitudinal, normative, and control beliefs about COVID-19 vaccination; (2) instrumental attitude as the strongest determinant of COVID-19 vaccination intention; and (3) 'achieving peace of mind' as an effective target for health promotion efforts. Further implications and directions are discussed.

Health Communication and Decision Making about Vaccine Clinical Trials during a Pandemic.

The COVID-19 pandemic has magnified the importance of clinical trials for finding a safe and effective vaccine to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Although communication about vaccines and vaccine hesitancy were challenges long before COVID-19, the twin facts of a pandemic and an "infodemic" of health information, misinformation, and disinformation have raised new challenges for vaccine-related communication and decision-making. The goal of this commentary is to highlight strategies to improve communication and decision-making for adults considering participation in COVID-19 vaccine clinical trials. First, I present a general conceptual model for clinical trial participation that can be applied to various vaccine and other clinical trial contexts. Next, I introduce the ASK (Assume, Seek, Know) approach for enhancing clinical trial participation: (1) assume that all patients will want to know their options, (2) seek the counsel of stakeholders, and (3) know your numbers. The ideas presented in this commentary are intended to enhance vaccine-specific clinical trial communication, decision-making, and literacy, while dually offering strategies and resources that may help reduce vaccine hesitancy and increase vaccine uptake over time.