Exploring key informants' perceptions of Covid-19 vaccine hesitancy in a disadvantaged urban community in Ireland: Emergence of a '4Cs' model.

AIM: The aim of this study was to explore key informants' views on and experiences with Covid-19 vaccine hesitancy in a Dublin community with a high concentration of economic and social disadvantage and to identify feasible, community-centred solutions for improving vaccination acceptance and uptake. METHODS: Qualitative, semi-structured interviews were carried out at a local community-centre and a central hair salon. Twelve key informants from the target community were selected based on their professional experience with vulnerable population groups: the unemployed, adults in recovery from addiction, the elderly, and Irish Travellers. Inductive thematic framework analysis was conducted to identify emergent themes and sub-themes. RESULTS: Drivers of vaccine hesitancy identified by key informants largely fell under the WHO '3Cs' model of hesitancy: lack of confidence in the vaccine and its providers, complacency towards the health risks of Covid-19, and inconvenient access conditions. Covid-19 Communications emerged as a fourth 'C' whereby unclear and negative messages, confusing public health measures, and unmet expectations of the vaccine's effectiveness exacerbated anti-authority sentiments and vaccine scepticism during the pandemic. Community-specific solutions involve the provision of accurate and accessible information, collaborating with community-based organizations to build trust in the vaccine through relationship building and ongoing dialogue, and ensuring acceptable access conditions. CONCLUSIONS: The proposed Confidence, Complacency, Convenience, Covid-19 Communications ('4Cs') model provides a tool for considering vaccine hesitancy in disadvantaged urban communities reacting to the rapid development and distribution of a novel vaccine. The model and in-depth key informants' perspectives can be used to compliment equitable vaccination efforts currently underway by public health agencies and non-governmental organizations.

Employee Mental Health During COVID-19 Adaptation: Observations of Occupational Safety and Health/Human Resource Professionals in Ireland

Objectives: This study aims to understand mental health issues among Irish employees arising from COVID-19 adaptation from the perspective of Occupational Safety and Health (OSH) and/or Human Resource (HR) professionals. Methods: Fifteen focus groups including 60 OSH/HR professionals from various sectors were conducted covering four predetermined themes. The data were transcribed verbatim, with transcripts entered into Nvivo for thematic analysis incorporating intercoder reliability testing. Results: The mental health impacts among employees are identified from three stages: pre-adaptation, during adaptation, and post-adaptation. Most issues were reported during the second stage when working conditions dramatically changed to follow emerging COVID-19 policies. The identified mental health support from participating organizations included providing timely and reliable information, Employee Assistance Programme (EAP), informal communication channels, hybrid work schedules and reinforcement of control measures. Conclusion: This study explores the challenges facing employees during the different stages of COVID-19 adaptation and the associated mental health impacts. Gender’s influence on mental health consultations should be considered when planning for public health emergencies, and further research conducted in male dominated industries.

'Communication, that is the key': a qualitative investigation of how essential workers with COVID-19 responded to public health information.

OBJECTIVES: To understand how essential workers with confirmed infections responded to information on COVID-19. DESIGN: Qualitative analysis of semistructured interviews conducted in collaboration with the national contact tracing management programme in Ireland. SETTING: Semistructured interviews conducted via telephone and Zoom Meetings. PARTICIPANTS: 18 people in Ireland with laboratory confirmed SARS-CoV-2 infections using real-time PCR testing of oropharyngeal and nasopharyngeal swabs. All individuals were identified as part of workplace outbreaks defined as ≥2 individuals with epidemiologically linked infections. RESULTS: A total of four high-order themes were identified: (1) accessing essential information early, (2) responses to emerging 'infodemic', (3) barriers to ongoing engagement and (4) communication strategies. Thirteen lower order or subthemes were identified and agreed on by the researchers. CONCLUSIONS: Our findings provide insights into how people infected with COVID-19 sought and processed related health information throughout the pandemic. We describe strategies used to navigate excessive and incomplete information and how perceptions of information providers evolve overtime. These results can inform future communication strategies on COVID-19.

Teaching design thinking as a tool to address complex public health challenges in public health students: a case study.

BACKGROUND: Developing a public health workforce that can understand problems from a population perspective is essential in the design of impactful user-centred responses to current population health challenges. Design Thinking, a user-driven process for problem-defining and solution-finding, not only has utility in the field of public health but stands as a potential mechanism for developing critical skills -such as empathy, creativity and innovation- amongst future professionals. Though the literature reflects the use of DT across many health sciences disciplines, less research has been published on how students apply learned concepts using real-world challenges of their choice and what difficulties they face during the process. METHODS: This case study evaluates achieved learning outcomes after the introduction of a design thinking block into post-graduate public health curriculum at the University College Dublin. Two independent assessors evaluated student learning outcomes and observed difficulties during the process by assessing group presentations to identify and understand any learning difficulties using an ad-hoc designed tool. The tool consisted of twelve items scored using a 5-point Likert scale. Student feedback, in the form of an online survey, was also analysed to determine their level of enjoyment, perceived learning outcomes and opinions on the course content. RESULTS: The assessors evaluated thirteen DT group presentations and reports from 50 students. The groups chose a range of topics from socialization of college students during Covid-19 to mental health challenges in a low-income country. Independent assessment of assignments revealed that the highest scores were reached by groups who explored a challenge relevant to their own lives (more than 80% of total possible points versus 60% class average). The groups that explored challenges more distant to themselves struggled with problem finding with a mean score of 2.05 (SD ± 1.2) out of 5 in that domain. The greatest difficulties were observed in problem finding and ideation. Though most students found the design thinking block enjoyable and relevant to their education, they recommended that the DT block be a stand-alone module. Students recognized that groups who chose a familiar topic experienced fewer difficulties throughout the process. CONCLUSION: The study showed that DT learning outcomes were best achieved when students focused on challenges, they had either personally experienced or were familiar with. These findings provide insight for future iterations of DT workshops and support the teaching of user-centred approaches to future public health practitioners.

Development and validation of a multi-lingual online questionnaire for surveying the COVID-19 prevention and control measures used in global workplaces.

BACKGROUND: Despite widespread COVID-19 vaccination programs, there is an ongoing need for targeted disease prevention and control efforts in high-risk occupational settings. This study aimed to develop, pilot, and validate an instrument for surveying occupational COVID-19 infection prevention and control (IPC) measures available to workers in diverse geographic and occupational settings. METHODS: A 44-item online survey was developed in English and validated for face and content validity according to literature review, expert consultation, and pre-testing. The survey was translated and piloted with 890 workers from diverse industries in Canada, Ireland, Argentina, Poland, Nigeria, China, the US, and the UK. Odds ratios generated from univariable, and multivariable logistic regression assessed differences in 'feeling protected at work' according to gender, age, occupation, country of residence, professional role, and vaccination status. Exploratory factor analysis (EFA) was conducted, and internal consistency reliability verified with Cronbach's alpha. Hypothesis testing using two-sample t-tests verified construct validity (i.e., discriminant validity, known-groups technique), and criterion validity. RESULTS: After adjustment for occupational sector, characteristics associated with feeling protected at work included being male (AOR = 1.88; 95% CI = 1.18,2.99), being over 55 (AOR = 2.17; 95% CI = 1.25,3.77) and working in a managerial position (AOR = 3.1; 95% CI = 1.99,4.83). EFA revealed nine key IPC domains relating to: environmental adjustments, testing and surveillance, education, costs incurred, restricted movements, physical distancing, masking, isolation strategies, and areas for improvement. Each domain showed sufficient internal consistency reliability (Cronbach's alpha ≥0.60). Hypothesis testing revealed differences in survey responses by country and occupational sector, confirming construct validity (p < 0.001), criterion validity (p = 0.04), and discriminant validity (p < 0.001). CONCLUSIONS: The online survey, developed in English to identify the COVID-19 protective measures used in diverse workplace settings, showed strong face validity, content validity, internal consistency, criterion validity, and construct validity. Translations in Chinese, Spanish, French, Polish, and Hindi demonstrated adaptability of the survey for use in international working environments. The multi-lingual tool can be used by decision makers in the distribution of IPC resources, and to guide occupational safety and health (OSH) recommendations for preventing COVID-19 and future infectious disease outbreaks.

Assessment of Environmental and Occupational Risk Factors for the Mitigation and Containment of a COVID-19 Outbreak in a Meat Processing Plant.

Throughout the COVID-19 pandemic, meat processing plants have been vulnerable to outbreaks of SARS-CoV-2 infection. Transmission of the virus is difficult to control in these settings because of a combination of factors including environmental conditions and the specific nature of the work. This paper describes a retrospective outbreak investigation in a meat processing plant, a description of the measures taken to prevent or contain further outbreaks, and insights on how those with specific knowledge of the working environment of these plants can collaborate with public health authorities to ensure optimal outbreak control. The plant experienced 111 confirmed positive asymptomatic cases in total with an estimated attack rate of 38% during a five-week period. 4 weeks after the first case, mass screening of all workers was conducted by the public health authorities. Thirty-two workers tested positive, of which 16 (50%) worked in one particular area of the plant, the boning hall (n = 60). The research team prepared and carried out semi-structured interviews with the plant personnel who were charged with COVID control within the plant. They carried out assessments of operational risk factors and also undertook air quality monitoring in the boning hall and abattoir. The air quality measurements in the boning hall showed a gradual build-up of carbon dioxide and aerosol particles over the course of a work shift, confirming that this poorly ventilated area of the plant had an environment that was highly favorable for aerosol transmission of SARS-CoV-2. Assessment of operational conditions incorporated visual surveys of the plant during the working day. Prior to and during the first 2 weeks of the outbreak, multiple measures were introduced into the plant by management, including physical distancing, provision of educational material to workers, visitor restrictions, and environmental monitoring. After the implementation of these measures and their progressive refinement by plant management, the factory had no further linked cases (clusters) or outbreaks for the following 198 days. The tailored approach to risk mitigation adopted in this meat processing plant shows that generic risk mitigation measures, as recommended by public health authorities, can be successfully adapted and optimized by designated plant emergency response teams.

General practice attendances among patients attending a post-COVID-19 clinic: a pilot study.

BACKGROUND: About 10-35% of people with COVID-19 need medical care within 3 weeks of infection. However, the prevalence of ongoing care needs among those experiencing severe COVID-19 illness is unclear. AIM: This pilot study aimed to address this knowledge gap by examining GP attendance trends among patients attending a post-COVID-19 hospital follow-up clinic, 3-6 months after an initial clinic visit. DESIGN & SETTING: Data were collected from adult patients attending a post-COVID-19 follow-up clinic at the Mater Misericordiae University Hospital (MMUH), Dublin, Ireland. METHOD: Participants completed questionnaires outlining their demographics; medical histories; emergency hospital admissions and readmissions where applicable; and, where relevant, GP attendances following hospital discharge. Analyses were conducted using descriptive and inferential statistics. RESULTS: Participants' (n = 153) median age was 43.5 years (interquartile range [IQR] = 30.9-52.1 years). There were 105 females (68.6%, 95% confidence interval [CI] = 61.3% to 75.9%). Various medical histories were reported among participants. Sixty-seven (43.2%, 95% CI = 35.9% to 51.6%) received emergency COVID-19 hospital care. Older adults, males, intensive care unit [ICU] admissions, and readmissions were common among hospital attendees. Of the hospital attendees, 16 (24%, 95% CI = 13.7% to 34.2%) attended GPs within 7 days of hospital discharge, and 26 (39%, 95% CI = 27.3% to 50.7%) within 30 days. Older adults, people with pre-existing medical conditions, and individuals admitted to ICU and/or readmitted to hospital were common among general practice attendees. CONCLUSION: Persistent health issues appear to be common among patients with severe COVID-19, particularly those who are older adults, have pre-existing health problems, and who had been in ICU and/or readmission care. Larger scale studies of ongoing COVID-19 care needs in primary care and general practice are required.