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1.
Am J Public Health ; 112(S2): S199-S205, 2022 04.
Article in English | MEDLINE | ID: covidwho-1779826

ABSTRACT

Objectives. To characterize the effects of the onset of the COVID-19 pandemic on the risk environment of people who use drugs (PWUD) in Tijuana, Mexico. Methods. We used intensive participant-observation ethnography among street-based PWUD and key informants, such as frontline physicians and harm reductionists. Results. PWUD described an unprecedented cessation of police violence and extortion during the initial pandemic-related lockdown, though this quickly reversed and police violence worsened. Government-provided housing and medical treatment with methadone were temporarily provided to PWUD in a dedicated clinic, yet only for PWUD with COVID-19 symptoms. Concurrently, non‒COVID-19‒related hospital care became virtually inaccessible, and many PWUD died of untreated, chronic illnesses, such as hepatitis C, and soft-tissue infections. Border closures, decreases in social interaction, and reduced drug and sex tourism resulted in worsening food, income, and housing insecurity for many PWUD. By contrast, potent illicit drugs remained easily accessible in open-air drug markets. Conclusions. The pandemic exacerbated health risks for PWUD but also offered profound glimpses of beneficial structural changes. Efforts are needed in Tijuana and elsewhere to institutionalize positive pandemic-related shifts and ameliorate novel harms for PWUD. (Am J Public Health. 2022;112(S2):S199-S202. https://doi.org/10.2105/AJPH.2022.306796).


Subject(s)
COVID-19 , Drug Users , Anthropology, Cultural , COVID-19/epidemiology , Communicable Disease Control , Humans , Mexico/epidemiology , Pandemics
2.
Health Place ; 74: 102741, 2022 03.
Article in English | MEDLINE | ID: covidwho-1664951

ABSTRACT

This ethnographic study in two socio-economically contrasting areas employed geo-ethnography, underpinned by a relational approach, to understand inequalities in gastrointestinal infections in families with young children. In our 'relatively disadvantaged' area, gastrointestinal infections spread to multiple households within a small radius, whereas in our 'relatively advantaged' area, illness was confined to one household or dispersed long distances. These differences were shaped by historical, social and economic contrasts in: housing; social networks and childcare arrangements; employment and household income. Our findings show how linking places, pathogens and people helps us understand inequalities in gastrointestinal infections and may be pertinent to other infectious diseases such as COVID-19.


Subject(s)
COVID-19 , Communicable Diseases , Anthropology, Cultural , COVID-19/epidemiology , Child , Child, Preschool , Communicable Diseases/epidemiology , Humans , Socioeconomic Factors , United Kingdom
3.
Int J Environ Res Public Health ; 19(1)2021 12 30.
Article in English | MEDLINE | ID: covidwho-1623724

ABSTRACT

There is increasing evidence of the psychological impact of COVID-19 on various population groups, with concern particularly focused on young people's mental health. However, few papers have engaged with the views of young people themselves. We present findings from a study into young people's discussions on social media about the impact of COVID-19 on their mental health. Real-time, multi-platform online ethnography was used to collect social media posts by young people in the United Kingdom (UK), March 2020-March 2021, 1033 original posts and 13,860 associated comments were analysed thematically. Mental health difficulties that were described as arising from, or exacerbated by, school closures, lost opportunities or fraught family environments included depression, anxiety and suicidality. Yet, some also described improvements to their mental health, away from prior stressors, such as school. Young people also recounted anxiety at the ramifications of the virus on others. The complexities of the psychological impact of COVID-19 on young people, and how this impact is situated in their pre-existing social worlds, need recognising. Forging appropriate support necessitates looking beyond an individualised conceptualisation of young people's mental health that sets this apart from broader societal concerns. Instead, both research and practice need to take a systemic approach, recognising young people's societal belonging and social contexts.


Subject(s)
COVID-19 , Social Media , Adolescent , Anthropology, Cultural , Humans , Mental Health , SARS-CoV-2
4.
J Med Internet Res ; 23(12): e29071, 2021 12 02.
Article in English | MEDLINE | ID: covidwho-1592118

ABSTRACT

BACKGROUND: Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and impact. OBJECTIVE: This study aims to evaluate the implementation and effectiveness of the electronic Patient-Reported Outcome (ePRO) mobile app and portal system, designed to enable goal-oriented care delivery in interprofessional primary care practices. The research questions driving this study are as follows: Does ePRO improve quality of life and self-management in older adults with complex needs? What mechanisms are likely driving observed outcomes? METHODS: A multimethod, pragmatic randomized controlled trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrollment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the midpoint and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data were analyzed using qualitative description and framework analysis methods. RESULTS: Recruitment challenges resulted in fewer sites and participants than expected; of the 176 target, only 142 (80.6%) patients were identified as eligible to participate because of lower-than-expected provider participation and fewer-than-expected patients willing to participate or perceived as ready to engage in goal-setting. Of the 142 patients approached, 45 (32%) participated. Patients set a variety of goals related to self-management, mental health, social health, and overall well-being. Owing to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however, the intervention group, ePRO plus usual care (mean 15.28, SD 18.60) demonstrated a nonsignificant decrease in quality of life (t24=-1.20; P=.24) when compared with usual care only (mean 21.76, SD 2.17). The ethnographic data reveal a complex implementation process in which the meaningfulness (or coherence) of the technology to individuals' lives and work acted as a key driver of adoption and tool appraisal. CONCLUSIONS: This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinical settings, dynamic goal-oriented care process, and readiness of provider and patient participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954.


Subject(s)
Quality of Life , Research Design , Aged , Anthropology, Cultural , Electronics , Humans , Patient Reported Outcome Measures
5.
Front Public Health ; 9: 768624, 2021.
Article in English | MEDLINE | ID: covidwho-1581114

ABSTRACT

The COVID-19 pandemic coincided with a multi-national federally funded research project examining the potential for health and care services in small rural areas to identify and implement innovations in service delivery. The project has a strong focus on electronic health (eHealth) but covers other areas of innovation as well. The project has been designed as an ethnography to prelude a realist evaluation, asking the question under what conditions can local health and care services take responsibility for designing and implementing new service models that meet local needs? The project had already engaged with several health care practitioners and research students based in Canada, Sweden, Australia, and the United States. Our attention is particularly on rural communities with fewer than 5,000 residents and which are relatively isolated from larger service centres. Between March and September 2020, the project team undertook ethnographic and auto-ethnographic research in their own communities to investigate what the service model responses to the pandemic were, and the extent to which local service managers were able to customize their responses to suit the needs of their communities. An initial program theory drawn from the extant literature suggested that "successful" response to the pandemic would depend on a level of local autonomy, "absorptive capacity,*" strong service-community connections, an "anti-fragile†" approach to implementing change, and a realistic recognition of the historical barriers to implementing eHealth and other innovations in these types of rural communities. The field research in 2020 has refined the theory by focusing even more attention on absorptive capacity and community connections, and by suggesting that some level of ignorance of the barriers to innovation may be beneficial. The research also emphasized the role and power of external actors to the community which had not been well-explored in the literature. This paper will summarize both what the field research revealed about the capacity to respond well to the COVID-19 challenge and highlight the gaps in innovative strategies at a managerial level required for rapid response to system stress. *Absorptive Capacity is defined as the ability of an organization (community, clinic, hospital) to adapt to change. Organizations with flexible capacity can incorporate change in a productive fashion, while those with rigid capacity take longer to adapt, and may do so inappropriately. †Antifragility is defined as an entities' ability to gain stability through stress. Biological examples include building muscle through consistent use, and bones becoming stronger through subtle stress. Antifragility has been used as a guiding principle in programme implementation in the past.


Subject(s)
COVID-19 , Pandemics , Anthropology, Cultural , Australia/epidemiology , Canada/epidemiology , Humans , Pandemics/prevention & control , Rural Health , SARS-CoV-2 , Sweden , United States/epidemiology
6.
Pan Afr Med J ; 38: 348, 2021.
Article in French | MEDLINE | ID: covidwho-1547772

ABSTRACT

INTRODUCTION: since its appearance, the COVID-19 has exhausted global health systems. It was predictable that countries with weak health systems will be severly wiped out by the pandemic. Countries across Europe faced severe human loses and it was foreseable that Africa will experience an even worse tragedy. Suprisingly, since the evolution of the pandemic, there has been remarkable resistance from African countries, including Cameroon. METHOD: the study was phenomenographic. The data were collected successively from media observations (in particular the WHO site, national TV (CRTV) programs 'Parlons COVID'), social networks - Facebook and Whatsapp) and direct observations of some quarters of Garoua (Roumdé-Adjia, Foulbéré, Kakataré) and Mora for the Far North and the southern zone of Yaoundé (Ngoa-Ekelé, Nkolondom, Mokolo). These observations were associated with individual interview, reviews and note-taking around places of public circulation (places of worship, markets and discussion sites (Faada). The theory of functionalism was mobilized in this study. RESULTS: the results show that Cameroonians perceive the pandemic as an eminently metasocial phenomenon which explains their tendency to use prayers, nature to counter this attack. CONCLUSION: the study suggests that a multidimensional approach is capable of offering avenues of « liberation ¼. Also, the study once again raises the place of traditional medecine in health systems and shows the close link that exists between traditional medicine and spirituality.


Subject(s)
Attitude to Health , COVID-19/epidemiology , Anthropology, Cultural , Cameroon/epidemiology , Humans , Poverty , Religion , Sociological Factors , Urban Health
7.
Glob Health Res Policy ; 6(1): 47, 2021 Dec 02.
Article in English | MEDLINE | ID: covidwho-1546805

ABSTRACT

COVID-19 has brought about political, economic, cultural, and interspecies problems far from medical areas, which challenges academia to rethink global health. For holism principle, anthropology offers valuable insights into these health issues, including the political economy of inequality, cultural diversity, and cultural adaptations, as well as the study of multispecies ethnography. These perspectives indicate that unequal political and economic systems contribute to health problems when people acknowledge disease and illness mechanisms. Moreover, cultural diversity and cultural adaptation are essential for providing appropriate medical solutions. Lastly, as a research method of studying interspecies relationships, multispecies ethnography promotes one health and planetary health from the ultimate perspective of holism. In conclusion, global health is not only a bio-medical concept but also involves political economy, culture, and multispecies factors, for which anthropology proffers inspiring theories and methods.


Subject(s)
COVID-19 , Global Health , Anthropology , Anthropology, Cultural , Humans , SARS-CoV-2
8.
Subst Abuse Treat Prev Policy ; 16(1): 85, 2021 11 12.
Article in English | MEDLINE | ID: covidwho-1526649

ABSTRACT

BACKGROUND: E-cigarettes are increasing in popularity, particularly among young adults. With public health organisations contesting the possible benefits of e-cigarettes, research is required to explore young adults' use of e-cigarettes as a smoking cessation and recreational tool. This study examined existing qualitative data to understand how transition into adulthood and issues of identity affect young adults' perceptions and experiences of e-cigarette use. METHODS: A meta-ethnography was conducted to examine how young adults perceive and use e-cigarettes. Data were synthesised using Noblit and Hare's (1988) meta-ethnographic approach. Bronfenbrenner's socio-ecological model (1979) was used to conceptualise themes and map findings. RESULTS: A total of 34 studies were included in the review. Young adults viewed e-cigarettes as a safer alternative to traditional cigarette smoking and perceived e-cigarettes as an effective cessation tool. Users were able to personalise their e-cigarette use due to the variety of flavours and devices available. E-cigarettes were found to be a sociable tool as they allowed users to align themselves with their peers who used e-cigarettes and facilitated use within smoke-free environments. Young adults demonstrated high levels of self-efficacy with regards to obtaining e-cigarettes from various retailers and were active consumers of e-cigarette marketing. CONCLUSION: This meta-ethnography provides an in-depth insight into social norms around e-cigarette use and beliefs that e-cigarettes could be a safer alternative to traditional cigarettes. As young adults increasingly engage with e-cigarettes, there is a need for informed policy decisions regarding appropriate use. Engagement with e-cigarettes is often reflected within social media, so this medium could be a key platform for creating tailored interventions which inform young adults about the appropriate use of these products.


Subject(s)
Electronic Nicotine Delivery Systems , Smoking Cessation , Vaping , Adult , Anthropology, Cultural , Humans , Perception , Young Adult
9.
PLoS One ; 16(10): e0258252, 2021.
Article in English | MEDLINE | ID: covidwho-1480449

ABSTRACT

BACKGROUND: Vaccine hesitancy is a complex, contested social phenomenon and existing research highlights the multifaceted role of trust in strengthening vaccine confidence. However, understanding public engagement with vaccination through the lens of (mis)trust requires more contextual evidence on trust's qualitative determinants. This includes expanding the geographic focus beyond current studies' focus on High Income Countries. Furthermore, obstacles remain in effectively integrating social science findings in the design of vaccine deployment strategies, and in ensuring that those who implement interventions and are affected by them are directly involved in producing knowledge about vaccination challenges. METHODS: We piloted a community-led ethnographic approach, training Community Health Workers (CHWs) in Kambia District, Sierra Leone, in qualitative social science methods. Methods included participant observation, participatory power mapping and rumour tracking, focus group discussions and key stakeholder interviews. CHWs, with the support of public health officials and professional social scientists, conducted research on vaccination challenges, analysed data, tested new community engagement strategies based on their findings and elicited local perspectives on these approaches. RESULTS: Our findings on vaccine confidence in five border communities highlighted three key themes: the impact of prior experiences with the health system on (mis)trust; relevance of livelihood strategies and power dynamics for vaccine uptake and access; and the contextual nature of knowledge around vaccines. Across these themes, we show how expressions of trust centered on social proximity, reliability and respect and the role of structural issues affecting both vaccine access and confidence. The pilot also highlighted the value and practical challenges to meaningfully co-designed research. CONCLUSION: There is scope for broader application of a community-led ethnographic approach will help redesign programming that is responsive to local knowledge and experience. Involving communities and low-cadre service providers in generating knowledge and solutions can strengthen relationships and sustain dialogue to bolster vaccine confidence.


Subject(s)
Anthropology, Cultural , Biomedical Research , Immunization Programs , Residence Characteristics , Social Behavior , Trust , Vaccination , Focus Groups , Health Personnel , Humans , Sierra Leone , Vaccines/immunology
10.
J Med Internet Res ; 23(10): e31374, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1477711

ABSTRACT

BACKGROUND: Scotland-a country of 5.5 million people-has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. OBJECTIVE: To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland's video consultation services both before and during the pandemic. METHODS: Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. RESULTS: By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations' general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. CONCLUSIONS: The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.


Subject(s)
COVID-19 , Remote Consultation , Anthropology, Cultural , Humans , Pandemics , SARS-CoV-2
11.
BMC Health Serv Res ; 21(1): 1131, 2021 Oct 21.
Article in English | MEDLINE | ID: covidwho-1477418

ABSTRACT

BACKGROUND: The emergence of the Coronavirus disease has heightened the experience of emotional burden among healthcare staff. To guide the development of support programmes, this review sought to aggregate and synthesise qualitative studies to establish a comparative understanding of the experiences of healthcare staff caring for persons with the disease. DESIGN: A meta-ethnography approach was used to aggregate and synthesise primary qualitative studies. Database search was undertaken from January to November 2020. A standardised tool was used to extract data from the identified primary studies. The studies were translated into each other to formulate overarching concepts/ metaphors which formed the basis of undertaking a narrative synthesis. RESULTS: Eight qualitative studies met the inclusion criteria. Two overarching metaphors/ concepts were formulated from the primary studies: 1) surviving to thriving in an evolving space and 2) support amid the new normal. The initial phase of entering the space of caring during the outbreak was filled with psychological chaos as healthcare staff struggled to survive within the context of an illness which was not fully understood. Gradually, healthcare staff may transition to a thriving phase characterised by resilience but still experienced heavy workload and physical/ emotional exhaustion predisposing them to burnout and compassion fatigue. Fear persisted throughout their experiences: fear of contracting the disease or infecting one's family members/ loved ones remained a key concern among healthcare staff despite infection precaution measures. Healthcare staff who contracted the disease felt isolated with additional fears of dying alone. The sources of support were varied with a strong emphasis on peer support. CONCLUSIONS: Healthcare staff caring for persons infected with the Coronavirus disease are at risk of burnout and compassion fatigue and require ongoing mental health support commensurate to their needs. Staff who contract the disease may require additional support to navigate through the illness and recovery. Policies and concerted efforts are needed to strengthen support systems and build resilience among healthcare staff.


Subject(s)
COVID-19 , Anthropology, Cultural , Delivery of Health Care , Health Facilities , Humans , SARS-CoV-2
12.
BMJ Open ; 11(10): e048212, 2021 10 13.
Article in English | MEDLINE | ID: covidwho-1467703

ABSTRACT

INTRODUCTION: German government regulations such as physical distancing and limited group numbers, designed to curb the spread of COVID-19, have had far-reaching consequences for the very foundations of social life. They have, to name only a few, transformed greetings and goodbyes, blurred private and public worlds, and complicated basic communication with mandatory mask wearing. The ethnographic study CoronaCare investigates how these sociopolitical measures affect social health, a form of health which unfolds through and across social relations. It explores how caring as a fundamental human activity and one integral to sustaining social health is impacted when in-person and person-to-person contacts are restricted and everyone is radically redefined as at risk from others and a risk to others. It explores care relationships, relationships involving the giving or receiving of care in everyday life, institutional settings such as an assisted living facility, and informal settings, such as a housing block. Inside of the pandemic, relationships are a pivotal site at which the negotiation of caring and risk is intensified and where the consequences for social health and social life more generally are pronounced. METHODS AND ANALYSIS: This ethnographic project aims to understand the tensions that arise in the lives of individuals and communities living under the sociopolitical regulations and to analyse the tacit forms of practice that individuals and communities develop to uphold social health. Fueled by citizen science, the ethnography uses a variety of methods namely telephone and video interviews with 60-70 research participants, the collection of ethnographic material including video and audio diaries, storyboards, first-person camera footage, photographs and a survey to enrich the sample description based on the Copenhagen Psychosocial Questionnaire. The analysis will draw on elements of grounded theory and through the aid of the qualitative software MAXQDA it will rigorously document and explain how the social regulations are (re)shaping our ability to be cared for and to care for one another. The survey data will be analysed through the use of the quantitative software programme R. ETHICS AND DISSEMINATION: The ethics committee of the Brandenburg Medical School Theodor Fontane has approved the project (E-01-20200605). The dissemination strategy includes publications in medical, sociological and research methods journals, as well as a stakeholder discussion with political and civil society leaders where the research team will present its recommendations for future pandemic preparedness.


Subject(s)
COVID-19 , Pandemics , Anthropology, Cultural , Humans , SARS-CoV-2 , Surveys and Questionnaires
13.
Women Birth ; 34(2): 128-135, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1454573

ABSTRACT

PROBLEM: Limited literature is available about women who wish to breastfeed but experience unexpected feelings of aversion in reaction to their infant suckling at the breast while breastfeeding. BACKGROUND: Breastfeeding benefits mothers, infants and society yet breastfeeding rates continue to fall below recommendations in part due to inadequate tailored support after hospital discharge. Influences on breastfeeding are complex and include many physiological, psychosocial and cultural factors. AIM: To better understand the experience of women who have feelings of aversion during breastfeeding by synthesising the existing literature. METHODS: MEDLINE, CINAHL, PsycINFO, Maternity and Infant Care databases were searched for relevant literature published between 2000 to 2019. Using Covidence software, five qualitative research studies were identified. Studies were then analysed using meta-ethnographic qualitative synthesis. FINDINGS: Feelings of aversion during breastfeeding were described as visceral and overwhelming; leading to feelings of shame and inadequacy. This synthesis identified five findings; a central conceptual category of "it's such a strong feeling of get away from me" with four key metaphors translated from this central conceptual category: "I do it because I feel it is best for my baby", "I can't control those feelings", "I should be able to breastfeed my son and enjoy it", and "I'm glad I did it". This phenomenon may negatively affect a women's sense of self and impact on the mother-infant relationship. CONCLUSION: Some women who want to breastfeed can experience feelings of aversion while breastfeeding. The feelings of 'aversion' while breastfeeding can inhibit women from achieving their personal breastfeeding goals.


Subject(s)
Breast Feeding/psychology , Maternal Behavior/ethnology , Mothers/psychology , Adult , Affect , Anthropology, Cultural , Breast Feeding/ethnology , Emotions , Female , Humans , Infant , Infant, Newborn , Interviews as Topic , Maternal Behavior/psychology , Mother-Child Relations , Pregnancy , Qualitative Research , Self Concept
14.
Glob Public Health ; 16(8-9): 1396-1410, 2021.
Article in English | MEDLINE | ID: covidwho-1364688

ABSTRACT

The COVID-19 pandemic has overwhelmed health systems around the globe, and intensified the lethality of social and political inequality. In the United States, where public health departments have been severely defunded, Black, Native, Latinx communities and those experiencing poverty in the country's largest cities are disproportionately infected and disproportionately dying. Based on our collective ethnographic work in three global cities in the U.S. (San Francisco, Los Angeles, and Detroit), we identify how the political geography of racialisation potentiated the COVID-19 crisis, exacerbating the social and economic toll of the pandemic for non-white communities, and undercut the public health response. Our analysis is specific to the current COVID19 crisis in the U.S, however the lessons from these cases are important for understanding and responding to the corrosive political processes that have entrenched inequality in pandemics around the world.


Subject(s)
COVID-19 , Pandemics , Politics , Anthropology, Cultural , COVID-19/epidemiology , Cities/epidemiology , Health Status Disparities , Humans , Los Angeles/epidemiology , Michigan/epidemiology , San Francisco/epidemiology
15.
Adm Policy Ment Health ; 49(2): 157-167, 2022 03.
Article in English | MEDLINE | ID: covidwho-1328625

ABSTRACT

A rapid ethnographic assessment of delivery of mental health services to patients at a Level I trauma center in a major metropolitan hospital undergoing a COVID-19 surge was conducted to assess the challenges involved in services delivery and to compare the experience of delivering services across time. Study participants were patients and providers who interacted with or otherwise were observed by three clinicians engaged in the delivery of care within the Emergency Department (ED) and Trauma Center at Harborview Medical Center from the COVID-19-related "surge" in April to the end of July 2020. Data were collected and analyzed in accordance with the Rapid Assessment Procedures-Informed Clinical Ethnography (RAPICE) protocol. Community and institutional efforts to control the spread of the coronavirus created several challenges to providing mental health services in an acute care setting during the April surge. Most of these challenges were successfully addressed by standardization of infection control protocols, but new challenges emerged including an increase in expenses for infection control and reduction in clinical revenues due to fewer patients, furloughs of mental health services providers and peer specialists in the ED, services not provided or delayed, increased stress due to fear of furloughs or increased workload of those not furloughed, and increases in patients seen with injuries due to risky behavior, violence, and substance use. These findings illustrate the rapidly shifting nature of the pandemic, its impacts on mental health services, and the mitigation efforts of communities and healthcare systems.


Subject(s)
COVID-19 , Mental Health Services , Anthropology, Cultural , Delivery of Health Care , Emergency Service, Hospital , Humans , Pandemics , SARS-CoV-2 , Trauma Centers
16.
Int J Environ Res Public Health ; 18(14)2021 07 16.
Article in English | MEDLINE | ID: covidwho-1323242

ABSTRACT

(1) Background: Health professionals play an important role in addressing parents who are hesitant or reluctant to immunise their children. Despite the importance of this topic, gaps remain in the literature about these experiences. This meta-ethnography aimed to synthesise the available body of qualitative work about the care experiences of community and hospital health professionals in encounters with parents hesitant or reluctant to vaccinate their children. The aim is to provide key information for the creation of strategies that address vaccine hesitancy or refusal and ensure public trust in vaccination programs, which are required in a pandemic context such as the current one. (2) Methods: Noblit and Hare's interpretive meta-ethnography of 12 studies was followed. A line of argument synthesis based on a metaphor was developed. (3) Results: The metaphor "The stone that refuses to be sculpted", accompanied by three themes, symbolises the care experiences of health professionals in their encounters with parents that hesitate or refuse to vaccinate their children. (4) Conclusions: The creation of clearer communication strategies, the establishment of a therapeutic alliance, health literacy and the empowerment of parents are recommended. The incorporation of health professionals in decision making and the strengthening of multidisciplinary teams interacting with such parents are also included.


Subject(s)
Vaccination , Vaccines , Anthropology, Cultural , Child , Communication , Health Knowledge, Attitudes, Practice , Health Personnel , Humans
17.
Res Social Adm Pharm ; 18(1): 2157-2163, 2022 01.
Article in English | MEDLINE | ID: covidwho-1199057

ABSTRACT

Video-reflexive ethnography (VRE) is a qualitative methodology that explores the complex nature of healthcare 'as it really is'. Its collaborative and reflexive process invites stakeholders (e.g. pharmacists and pharmacy support staff) to participate in analysing their everyday work practices as captured on video footage. Through close collaboration with practitioners and attention to their work contexts, VRE may be a useful methodology to engage a time-poor pharmacy workforce in research about themselves, encouraging more practitioner involvement in practice-based research. Aside from research, VRE has also been used effectively as an intervention to facilitate learning and change in healthcare settings, and could be effective in provoking change in otherwise resistant pharmacy environments. Much like traditional ethnographic approaches, VRE researchers have relied on being present 'in the field' to observe, record and make sense of practices with participants. The COVID-19 pandemic however, has introduced restrictions around travel and physical distancing, which has required researchers to contemplate the conduct of VRE 'at a distance', and to imagine new ways in which the methodological 'closeness' to stakeholders and their workplace contexts can be maintained when researchers cannot be on site. In this commentary, we outline the rationale for participatory methods, in the form of VRE, in pharmacy research. We describe the underlying principles of this innovative methodology, and offer examples of how VRE can be used in pharmacy research. Finally, we offer a reflexive account of how we have adapted the method for use in community pharmacy research, to adapt to physical distancing, without sacrificing its methodological principles. This paper offers not only a new methodology to examine the complexity of pharmacy work, but demonstrates also the responsiveness of VRE itself to complexity, and the potential breadth of future research applications in pharmacy both during and beyond the current pandemic.


Subject(s)
COVID-19 , Pharmacies , Pharmacy Research , Anthropology, Cultural , Community-Based Participatory Research , Humans , Pandemics , Pharmacists , SARS-CoV-2
18.
Health Sociol Rev ; 29(2): 113-121, 2020 07.
Article in English | MEDLINE | ID: covidwho-1153013

ABSTRACT

On 19 March 2020, I last met with a group of women from a neighbourhood of Monterrey, Mexico where I have spent the past year conducting ethnographic research. They had scheduled a meeting to decide whether to continue our weekly talks on health-related topics. 'Is this coronavirus real?' was the question guiding the meeting. Women shared their thoughts on their feelings on the threat that predominates in biomedical discourse. An air of resignation pervaded their speech. Nearly all of them suffer from chronic diseases and they clearly perceive the risk of their own death. However, the material conditions of their lives limit the scope of their strategies to protect themselves. A dialogue emerged between the women's request for clarity regarding the pandemic and me, a researcher called on as a physician. This article seeks to reflect on the political and moral aspects of everyday life that configure risk perception in the context of the WHO-declared pandemic. I analyse the dialogue sustained in the meeting as part of an ethnographic research I am conducting in this neighbourhood. Most of its residents live under precarious circumstances, which is a fundamental element in understanding their responses to the current COVID-19 crisis.


Subject(s)
Anthropology, Cultural , COVID-19/epidemiology , Quarantine/psychology , Risk Assessment , Female , Humans , Mexico/epidemiology , Poverty , SARS-CoV-2 , Uncertainty
19.
J Adv Nurs ; 77(5): 2429-2436, 2021 May.
Article in English | MEDLINE | ID: covidwho-1093744

ABSTRACT

AIM: To explore how the media and socially established hero narrative, affected the nursing staff who worked in the frontline during the first round of the COVID19-pandemic. BACKGROUND: During the COVID19-pandemic, both media, politicians and the public have supported and cheered on the frontline healthcare workers around the world. We have found the hero narrative to be potentially problematic for both nurses and other healthcare workers. This paper presents an analysis and discussion of the consequences of being proclaimed a hero. DESIGN: Hospital ethnography including fieldwork and focus groups. METHOD: Empirical data was collected in a newly opened COVID19-ward in a university hospital in the urban site of Copenhagen, Denmark. Fieldwork was performed from April until the ward closed in the end of May 2020. Succeeding focus group interviews with nursing staff who worked in the COVID19-ward were conducted in June 2020. The data were abductively analysed. RESULTS: The nursing staff rejected the hero narrative in ways that show how the hero narrative leads to predefined characteristics, ideas of being invincible and self-sacrificing, knowingly and willingly working in risk, transcending duties and imbodying a boundless identity. Being proclaimed as a hero inhibits important discussions of rights and boundaries. CONCLUSION: The hero narrative strips the responsibility of the politicians and imposes it onto the hospitals and the individual heroic health care worker. IMPACT: It is our agenda to show how the hero narrative detaches the connection between the politicians, society and healthcare system despite being a political apparatus. When reassessing contingency plans, it is important to incorporate the experiences from the health care workers and include their rights and boundaries. Finally, we urge the media to cover a long-lasting pandemic without having the hero narrative as the reigning filter.


Subject(s)
COVID-19 , Pandemics , Anthropology, Cultural , Denmark , Hospitals , Humans , SARS-CoV-2
20.
Health Commun ; 36(1): 109-115, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-939495

ABSTRACT

Aotearoa New Zealand's public health crisis communication approach amidst the COVID-19 pandemic effectively mobilized the nation into swift lockdown, significantly reducing community transmission. This communication approach has been applauded around the world. How did communities situated amongst the "margins of the margins" in Aotearoa New Zealand navigate through the existing structural barriers to health during the pandemic? In this study, we use a culture-centered analysis to foreground the structural context of disenfranchisement amidst the COVID-19 lockdown. Drawing on in-depth interviews with participants in a larger ethnographic project on poverty and health across three communities in Aotearoa New Zealand, we attend to the ways in which health is negotiated amidst the COVID-19 outbreak and lockdown response at the "margins of the margins." The narratives point out that health communication interventions to prevent COVID-19 in the context of Aotearoa New Zealand furthered the marginalization of communities at the margins, and community voices were largely erased from the enactment of interventions. With the extant structures failing to recognize these aspects of everyday struggles of health at the margins, the health and access challenges were further magnified during COVID-19. Our attention to communication situated in relationship to structures builds a register for health communication scholarship in the context of COVID-19 that is committed to disrupting the behaviorally based hegemonic health communication literature and transforming the unequal terrains of health experiences.


Subject(s)
COVID-19/ethnology , COVID-19/psychology , Communicable Disease Control/methods , Poverty/psychology , Poverty/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Anthropology, Cultural , Communication , Cultural Competency , Female , Humans , Interviews as Topic , Male , Middle Aged , Negotiating , New Zealand/epidemiology , Pandemics , SARS-CoV-2 , Socioeconomic Factors , Vulnerable Populations , Young Adult
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