Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States.

In the United States, the coronavirus disease-2019 (COVID-19) pandemic has disproportionally affected Black, Latinx, and Indigenous populations, immigrants, and economically disadvantaged individuals. Such historically marginalized groups are more often employed in low-wage jobs without health insurance and have higher rates of infection, hospitalization, and death from COVID-19 than non-Latinx White individuals. Mistrust in the health care system, language barriers, and limited health literacy have hindered vaccination rates in minorities, further exacerbating health disparities rooted in structural, institutional, and socioeconomic inequities. In this article, we discuss the lessons learned over the last 2 years and how to mitigate health disparities moving forward.

How Trust in Cancer Information Has Changed in the Era of COVID-19: Patterns by Race and Ethnicity.

COVID-19 emerged during an era of heightened attention to systemic racism and the spread of misinformation. This context may have impacted public trust in health information about chronic diseases like cancer. Here, we examine data from the 2018 and 2020 Health Information National Trends Survey (N = 7,369) to describe how trust in cancer information from government health agencies, doctors, family and friends, charitable organizations, and religious organizations changed after COVID-19 became a pandemic, and whether that change varied by race/ethnicity. Statistical methods included chi-square tests and multiple logistic regression modeling. Overall, the proportion of respondents who reported a high degree of trust in cancer information from doctors increased (73.65% vs. 77.34%, p = .04). Trends for trust in information from government health agencies and family and friends varied significantly by race/ethnicity, with substantial declines observed among non-Hispanic Blacks (NHB) only. The odds of reporting a high degree of trust in cancer information from government health agencies and friends and family decreased by 53% (OR = 0.47, 95% CI = 0.24-0.93) and 73% (OR = 0.27, 95% CI = 0.09-0.82), respectively, among NHB, but were stable for other groups. Future studies should monitor whether recent declines in trust among NHB persist and unfavorably impact participation in preventive care.

COVID-19 infection induces higher trust in strangers.

How does the COVID-19 pandemic affect interpersonal trust? Most evidence shows that natural disasters reinforce trust and cooperation, but the COVID-19 virus differs from other calamities, since it spreads through contact with people, potentially increasing suspicion and distrust, as, according to contemporaneous writers' accounts, seems to have been the case with the Black Death, the London plague, and the Spanish influenza. We investigate the link between interpersonal trust and individuals exposed to COVID-19, either vicariously through their community or networks or directly by becoming infected. We rely on an original panel survey, including a survey experiment, with a representative sample of adults in Italy, one of the countries hardest struck by the pandemic. Our experimental findings reveal that priming people about the risk that the pandemic poses to their health leads to a substantial increase in their trust in strangers. Our panel data analysis of within-individual effects shows that those who become infected trust strangers more than those who are not infected. Our findings could be explained by people observing higher than expected altruistic behavior or becoming more dependent on other people's support, consistent with the "emancipation theory of trust." When people recover from COVID-19, however, they drop to trusting strangers as much as those who were not directly exposed to the virus, an indication that the positive effects on trust during the pandemic have an emotional source. Nonetheless, the evidence suggests that, in the aggregate, there has been a small but significant increase in trust among the general population relative to prepandemic levels.

The evolvement of trust in response to the COVID-19 pandemic among migrants in Norway.

BACKGROUND: The COVID-19 pandemic has had profound consequences for the world's population, particularly for vulnerable groups like migrants who face barriers to healthcare access. Trust in authorities is crucial to any crisis management strategy implemented by a government. However, trust in authorities is linked to trust in other areas of life and it evolves during a crisis. This study explores migrants' trust in the Norwegian government's response to the COVID-19 pandemic. METHODS: We conducted semi-structured interviews from April to May 2020 with migrants from Somalia (10), Syria (15), Sri Lanka (10), Chile (10) and Poland (10) who were living in Norway. Interviews were conducted via telephone and in participants' mother tongue. Data were analysed thematically using the systematic text condensation method. RESULTS: Trust was established at four levels: (i) in the personal sphere, (ii) in Norwegian society in general, (iii) in the Norwegian authorities' management of the pandemic, and (iv) in the transnational sphere. Trust was deeply rooted in relationships with individuals, groups and entities, across countries. High trust in authorities emerged in the accounts of participants who felt they were taken care of in the diverse relationships they established in Norway, particularly during the crisis. CONCLUSION: Pandemics create more vulnerability but also opportunities for trust-building. Trust-building can be fostered through relationships in the host country that provide the foundation for migrants to feel included. Healthcare providers are in a position from which they can nurture trust as they can build relationships with migrants over time.

Medical Mistrust in Perinatal Mental Health.

ABSTRACT: Despite the advancement of telemedicine and recent innovations in treatment, minoritized women continue to bear a disproportionate burden of pregnancy-related psychiatric conditions and complications, which the pandemic has further exacerbated. Research demonstrates that medical mistrust and systemic racism play central roles in the underutilization of services by racially and ethnically diverse women during pregnancy and postpartum. To effectively address these disparities, it is imperative to understand the drivers of medical mistrust in perinatal health care systems. This Perspectives article describes the historical context of medical mistrust in psychiatric and obstetric health systems and offers solutions to mitigate mistrust and the impact of systemic racism on perinatal care.

Older adults' perceptions of government handling of COVID-19: Predictors of protective behaviors from lockdown to post-lockdown.

BACKGROUND: Distrust, and more broadly, public perception of government's handling of a crisis, has been a widely studied topic within health crisis research and suggests that these perceptions are significantly associated with the behavior of its citizens. PURPOSE: To understand which aspects of the public's perception of government handling of the COVID-19 pandemic predicted engagement of protective behaviors among older adults, who are the most vulnerable to COVID-19. METHODS: Participants were recruited from an ongoing biopsychosocial study on aging amongst community-dwelling older adults. There were two rounds of data collection, during the national lockdown and post-lockdown. The average length of follow-up was 5.88 months. N = 421 completed the first round of data collection and N = 318 subsequently completed the second round of questionnaires. RESULTS: During the lockdown, perceptions that pandemic-related measures in place were sufficient, effective, timely, provided a sense of safety, important information was easily accessible, and government handling of the pandemic could be trusted, were found to significantly predict engagement in protective behaviors. During post-lockdown, only perceptions that measures in place were sufficient, provided a sense of safety, and important information was easily accessible, remained significant predictors. The perception that COVID-19 measures were clear and easy to understand now became a significant predictor. CONCLUSIONS: Public perceptions of government handling of the pandemic predicted engagement in protective behaviors but were less important during post-lockdown. To effectively engage older adults in protective behavior, our findings suggest for pandemic-related information to be accessible, introducing timely safety measures, and having easy-to-understand instructions for nuanced measures.

Examining the direct and indirect effects of trust in motivating COVID-19 vaccine uptake.

OBJECTIVES: This study aims to investigate how trust in healthcare providers, public health agencies, politicians, and pharmaceutical companies shaped people's attitudes and behavioral intention associated with COVID-19 vaccination, directly and indirectly via the mediation of vaccine evaluation and emotions. METHODS: A two-wave longitudinal survey (N = 534) was employed in late 2020 and early 2021 to assess the direct and indirect relationships between trust on people's attitude toward the COVID-19 vaccine, vaccination intention, and actual vaccine uptake. RESULTS: Results show that trust was positively associated with attitude toward the COVID-19 vaccines and vaccination intention, both directly and indirectly via the mediation of vaccine evaluation, hope, and anger. Vaccination intention also mediated trust's influence on vaccine uptake. CONCLUSION: Trust in health providers, vaccine manufacturers, and public health agencies are vital to public acceptance of the COVID-19 vaccine. PRACTICE IMPLICATIONS: Healthcare providers and vaccine manufacturers may serve as the most effective source to communicate COVID-19 vaccine-related information. Trusted health communicators need to highlight the effectiveness and safety of the vaccine while maintaining a positive tone.

'Us-Versus-Them': Othering in COVID-19 public health behavior compliance.

OBJECTIVE: We explored public perceptions about the COVID-19 pandemic to learn how those attitudes may affect compliance with health behaviors. METHODS: Participants were Central Pennsylvania adults from diverse backgrounds purposively sampled (based on race, gender, educational attainment, and healthcare worker status) who responded to a mixed methods survey, completed between March 25-31, 2020. Four open-ended questions were analyzed, including: "What worries you most about the COVID-19 pandemic?" We applied a pragmatic, inductive coding process to conduct a qualitative, descriptive content analysis of responses. RESULTS: Of the 5,948 respondents, 538 were sampled for this qualitative analysis. Participants were 58% female, 56% with ≥ bachelor's degree, and 50% from minority racial backgrounds. Qualitative descriptive analysis revealed four themes related to respondents' health and societal concerns: lack of faith in others; fears of illness or death; frustration at perceived slow societal response; and a desire for transparency in communicating local COVID-19 information. An "us-versus-them" subtext emerged; participants attributed non-compliance with COVID-19 behaviors to other groups, setting themselves apart from those Others. CONCLUSION: Our study uncovered Othering undertones in the context of the COVID-19 pandemic, occurring between groups of like-minded individuals with behavioral differences in 'compliance' versus 'non-compliance' with public health recommendations. Addressing the 'us-versus-them' mentality may be important for boosting compliance with recommended health behaviors.

Exploratory attitude survey of homeless persons regarding telecare services in shelters providing mid- and long-term accommodation: The importance of trust.

BACKGROUND: With the expansion of digital health, it is imperative to consider intervention techniques in order not to be the cause of even more social health inequalities in underserved populations struggling with chronic diseases. Telemedicine solutions for homeless persons might compensate for shortcomings in access to valuable health services in different settings. The main aim of our research was to examine the attitudes and openness of homeless persons regarding telecare on a Hungarian sample. METHODS: Quantitative survey among homeless people (n = 98) was completed in 4 shelters providing mid- and long-term accommodation in Budapest, Hungary. Attitudes regarding healthcare service accessibility and telecare were measured by a self-developed questionnaire of the research team. Telecare attitude comparison was made with data of a Hungarian weighted reference group of non-homeless persons recruited from 2 primary care units (n = 110). RESULTS: A significant fraction of homeless people with mid- or long-term residency in homeless shelters did not oppose the use of telecare via live online video consultation and there was no difference compared to the national reference group (averages of 3.09 vs. 3.15, respectively). Results of the homeless group indicate that those more satisfied with healthcare services, in general, manifest more openness to telecare. It is clearly demonstrated by the multivariate analysis that those participants in the homeless group who had problems getting health care in the last year definitely preferred in-person doctor-patient consultations. CONCLUSION: Digital health technologies offer a potentially important new pathway for the prevention and treatment of chronic conditions among homeless persons. Based on the attitudes towards telecare, initiating an on-site telecare program for mid- and long-term residents of homeless shelters might enable better care continuity. Our results draw attention to the key factors including building trust in the implementation of such programs among underserved and other vulnerable patient groups.

Trust in science, social consensus and vaccine confidence.

While scholarly attention to date has focused almost entirely on individual-level drivers of vaccine confidence, we show that macro-level factors play an important role in understanding individual propensity to be confident about vaccination. We analyse data from the 2018 Wellcome Global Monitor survey covering over 120,000 respondents in 126 countries to assess how societal-level trust in science is related to vaccine confidence. In countries with a high aggregate level of trust in science, people are more likely to be confident about vaccination, over and above their individual-level scientific trust. Additionally, we show that societal consensus around trust in science moderates these individual-level and country-level relationships. In countries with a high level of consensus regarding the trustworthiness of science and scientists, the positive correlation between trust in science and vaccine confidence is stronger than it is in comparable countries where the level of social consensus is weaker.

A social norms approach intervention to address misperceptions of anti-vaccine conspiracy beliefs amongst UK parents.

Anti-vaccine conspiracy beliefs among parents can reduce vaccination intentions. Parents' beliefs in anti-vaccine conspiracy theories are also related to their perceptions of other parents' conspiracy beliefs. Further, research has shown that parents hold misperceptions of anti-vaccine conspiracy belief norms: UK parents over-estimate the anti-vaccine conspiracy beliefs of other parents. The present study tested the effectiveness of a Social Norms Approach intervention, which corrects misperceptions using normative feedback, to reduce UK parents' anti-vaccine conspiracy beliefs and increase vaccination intentions. At baseline, 202 UK parents of young children reported their personal belief in anti-vaccine conspiracy theories, future intentions to vaccinate, and their perceptions of other UK parents' beliefs and intentions. Participants were then randomly assigned to a normative feedback condition (n = 89) or an assessment-only control condition (n = 113). The normative feedback compared participants' personal anti-vaccine conspiracy beliefs and perceptions of other UK parents' beliefs with actual normative belief levels. Parents receiving the normative feedback showed significantly reduced personal belief in anti-vaccine conspiracy beliefs at immediate post-test. As hypothesised, changes in normative perceptions of anti-vaccine conspiracy beliefs mediated the effect of the intervention. The intervention, did not directly increase vaccination intentions, however mediation analysis showed that the normative feedback increased perceptions of other parents' vaccination intentions, which in turn increased personal vaccination intentions. No significant effects remained after a six-week follow-up. The current research demonstrates the potential utility of Social Norms Approach interventions for correcting misperceptions and reducing anti-vaccine conspiracy beliefs among UK parents. Further research could explore utilising a top-up intervention to maintain the efficacy.

Experimental evidence that changing beliefs about mask efficacy and social norms increase mask wearing for COVID-19 risk reduction: Results from the United States and Italy.

In the absence of widespread vaccination for COVID-19, governments and public health officials have advocated for the public to wear masks during the pandemic. The decision to wear a mask in public is likely affected by both beliefs about its efficacy and the prevalence of the behavior. Greater mask use in the community may encourage others to follow this norm, but it also creates an incentive for individuals to free ride on the protection afforded to them by others. We report the results of two vignette-based experiments conducted in the United States (n = 3,100) and Italy (n = 2,659) to examine the causal relationship between beliefs, social norms, and reported intentions to engage in mask promoting behavior. In both countries, survey respondents were quota sampled to be representative of the country's population on key demographics. We find that providing information about how masks protect others increases the likelihood that someone would wear a mask or encourage others to do so in the United States, but not in Italy. There is no effect of providing information about how masks protect the wearer in either country. Additionally, greater mask use increases intentions to wear a mask and encourage someone else to wear theirs properly in both the United States and Italy. Thus, community mask use may be self-reinforcing.

COVID-19 Vaccine Decision-making Factors in Racial and Ethnic Minority Communities in Los Angeles, California.

Importance: The COVID-19 pandemic has had disproportionate effects on racial and ethnic minority communities, where preexisting clinical and social conditions amplify health and social disparities. Many of these communities report lower vaccine confidence and lower receipt of the COVID-19 vaccine. Understanding factors that influence the multifaceted decision-making process for vaccine uptake is critical for narrowing COVID-19-related disparities. Objective: To examine factors that members of multiethnic communities at high risk for COVID-19 infection and morbidity report as contributing to vaccine decision-making. Design, Setting, and Participants: This qualitative study used community-engaged methods to conduct virtual focus groups from November 16, 2020, to January 28, 2021, with Los Angeles County residents. Potential participants were recruited through email, video, and telephone outreach to community partner networks. Focus groups were stratified by self-identified race and ethnicity as well as age. Transcripts were analyzed using reflexive thematic analysis. Main Outcomes and Measures: Themes were categorized by contextual, individual, and vaccine-specific influences using the World Health Organization's Vaccine Hesitancy Matrix categories. Results: A total of 13 focus groups were conducted with 70 participants (50 [71.4%] female) who self-identified as American Indian (n = 17 [24.3%]), Black/African American (n = 17 [24.3%]), Filipino/Filipina (n = 11 [15.7%]), Latino/Latina (n = 15 [21.4%]), or Pacific Islander (n = 10 [14.3%]). A total of 39 participants (55.7%) were residents from high-poverty zip codes, and 34 (48.6%) were essential workers. The resulting themes included policy implications for equitable vaccine distribution: contextual influences (unclear and unreliable information, concern for inequitable access or differential treatment, references to mistrust from unethical research studies, accessibility and accommodation barriers, eligibility uncertainty, and fears of politicization or pharmaceutical industry influence); social and group influences (inadequate exposure to trusted messengers or information, altruistic motivations, medical mistrust, and desire for autonomy); and vaccination-specific influences (need for vaccine evidence by subpopulation, misconceptions on vaccine development, allocation ambiguity, vaccination safety preferences, the importance of perceiving vaccine equity, burden of vaccine scheduling, cost uncertainty, and desire for practitioner recommendation). Conclusions and Relevance: In this qualitative study, participants reported a number of factors that affected their vaccine decision-making, including concern for inequitable vaccine access. Participants endorsed policy recommendations and strategies to promote vaccine confidence. These results suggest that support of informed deliberation and attainment of vaccine equity will require multifaceted, multilevel policy approaches that improve COVID-19 vaccine knowledge, enhance trust, and address the complex interplay of sociocultural and structural barriers to vaccination.

Global adoption of personal and social mitigation behaviors during COVID-19: The role of trust & confidence.

What influences the adoption of SARS-CoV-2 mitigation behaviors-both personal, such as mask wearing and frequent handwashing, and social, such as avoiding large gatherings and physical contact-across countries? Understanding why some individuals are more willing to change their behavior to mitigate the spread of a pandemic will not only help us to address the current SARS-CoV-2 pandemic but also to respond to future ones. Researchers have pointed to a variety of factors that may influence individual adoption of personal and social mitigation behaviors, including social inequality, risk perception, personality traits, and government policies. While not denying the importance of these factors, we argue that the role of trust and confidence has received insufficient attention to date. Our study explores whether there is a difference in the way trust and confidence in particular leaders and organizations affect individual compliance and whether this effect is consistent across different types of mitigation behaviors. Specifically, we utilize an original cross-national survey conducted during the first wave of the SARS-CoV-2 pandemic (May-June 2020) to investigate how trust in scientists, medical professionals, politicians, and religious leaders and confidence in global, national, and local health organizations affects individual compliance in 16 countries/territories across five world regions. Our analyses, which control for the aforementioned factors as well as several others, suggest that trust in politicians and confidence in national health ministries have the most consistent influence on whether individuals adopt both personal and social mitigation behaviors. Across our sample, we find that greater trust in politicians is associated with lower levels of individual compliance with public health directives, whereas greater confidence in the national health ministry is associated with higher levels of individual compliance. Our findings suggest the need to understand trust and confidence as among the most important individual level characteristics driving compliance when developing and delivering messaging about the adoption of mitigation behaviors. The content of the message, it seems, will be most effective when citizens across countries trust its source. Trusted sources, such as politicians and the national health ministry, should thus consider working closely together when determining and communicating recommended health behaviors to avoid contradicting one another.

Skepticism and defiance: Assessing credibility and representations of science.

Since the 1970s, there has been a growing interest in how individuals appropriate scientific knowledge, which has recently been reinforced by societal issues such as vaccine releases and skepticism about global warming. Faced with the health and social consequences of the mistrust of scientific knowledge, there is an urgent need for tools to measure the acceptance or rejection of scientific knowledge, while at the same time gaining a more detailed understanding of the processes involved. This is the purpose of this article. Thus, we conducted 4 empirical studies to provide a validation of the Credibility of Science Scale from the perspective of a French population, which aims to assess the credibility that individuals attribute to science and to empirically evaluate the link that may exist between the different levels of credibility attributed to science and the social representations of science. Studies 1a and 1b demonstrated good structural validity, the good fidelity (homogeneity and temporal stability), and the good criterion validity of the French version of the scale. In Study 2, we observed the same psychometric qualities of the French version of the scale. We also noted a structuring of the social representation of science based on age (Factor 1) and on the credibility attributed to science (Factor 2). Our results also raise the question of possible means of intervention to promote a better perception of science.