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Ziebart C, Kfrerer ML, Stanley M, Austin LC. A Digital First Healthcare Approach to Managing Pandemics: A Scoping Review of Pandemic Self-Triage Tools. J Med Internet Res 2023; 25:e40983. [PMID: 37018543 DOI: 10.2196/40983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, many patient-facing digital self-triage tools were designed and deployed to alleviate demand for pandemic virus triage in hospitals and doctors' offices by providing a way for people to self-assess health status and get advice on whether to seek care. These tools, provided via websites, apps, or patient portals allow people to answer questions, e.g., about symptoms and contact history, and receive guidance to appropriate care, which might be self-care. OBJECTIVE The purpose of this scoping review was to explore the state of literature on digital self-triage tools that direct or advise care for adults during a pandemic, and to explore what has been learned about intended purpose, use, and quality of guidance, tool usability, impact on providers, and ability to forecast health outcomes or care demand. METHODS A literature search was conducted in July 2021 using MEDLINE, Embase, Scopus, PsycINFO, CINAHL and Cochrane databases. Using Covidence, 1227 titles and abstracts were screened by two researchers, with 83 reviewed via full text screening. 22 articles met inclusion criteria: they allowed adults to self-assess for pandemic virus and directed to care. Using Microsoft Excel, we extracted and charted the following data: authors, publication year and country, country the tool was used in, whether the tool was integrated into a healthcare system, research question/purpose, direction of care provided, and key findings. RESULTS All but two studies reported on tools developed since early 2020 during the COVID-19 pandemic. Studies reported on tools were developed in 17 countries. Direction of care advice included directing to an ER, seek urgent care, contact/see a doctor, be tested, or to stay at home/self-isolate. Only two studies evaluated tool usability. One used 52 use-cases to evaluate quality of advice by tools in four countries, finding advice varied, e.g., tools in the US and UK often advising staying home when clinical assessment was warranted, while tools in Japan and Singapore advised seeking care. No study demonstrated that the tools reduce demand on the health care system, although at least one suggests data can predict demand for care and data allows monitoring public health. CONCLUSIONS While self-triage tools developed and used around the world have similarities in directing to care (ER, physician, self-care), they also differ in important ways. Some collect data to predict healthcare demand. Some are for use when concerned about health status; others are intended to be used repeatedly by users to monitor public health. Quality of triage may vary. The high use of such tools during the COVID-19 pandemic suggests research is needed to assess and ensure quality of advice given by self-triage tools, and to assess intended or unintended consequences on public health and health care systems. CLINICALTRIAL
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Affiliation(s)
| | | | | | - Laurel C Austin
- Western University, 1201 Western Rd, London, CA
- Ivey Business School, London, CA
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2
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Villius Zetterholm M, Nilsson L, Jokela P. Using a Proximity-Detection Technology to Nudge for Physical Distancing in a Swedish Workplace During the COVID-19 Pandemic: Retrospective Case Study. JMIR Form Res 2022; 6:e39570. [PMID: 36343202 DOI: 10.2196/39570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/19/2022] [Accepted: 09/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The recent COVID-19 pandemic has contributed to the emergence of several technologies for infectious disease management. Although much focus has been placed on contact-tracing apps, another promising new tactic is proximity tracing, which focuses on health-related behavior and can be used for primary prevention. Underpinned by theories on behavioral design, a proximity-detection system can be devised that provides a user with immediate nudges to maintain physical distance from others. However, the practical feasibility of proximity detection during an infectious disease outbreak has not been sufficiently investigated. OBJECTIVE We aimed to evaluate the feasibility of using a wearable device to nudge for distance and to gather important insights about how functionality and interaction are experienced by users. The results of this study can guide future research and design efforts in this emerging technology. METHODS In this retrospective case study, a wearable proximity-detection technology was used in a workplace for 6 weeks during the production of a music competition. The purpose of the technology was to nudge users to maintain their physical distance using auditory feedback. We used a mixed methods sequential approach, including interviews (n=8) and a survey (n=30), to compile the experiences of using wearable technology in a real-life setting. RESULTS We generated themes from qualitative analysis based on data from interviews and open-text survey responses. The quantitative data were subsequently integrated into these themes: feasibility (implementation and acceptance-establishing a shared problem; distance tags in context-strategy, environment, and activities; understanding and learning; and accomplishing the purpose) and design aspects (a purposefully annoying device; timing, tone, and proximity; and additional functions). CONCLUSIONS This empirical study reports on the feasibility of using wearable technology based on proximity detection to nudge individuals to maintain physical distance in the workplace. The technology supports attention to distance, but the usability of this approach is dependent on the context and situation. In certain situations, the audio signal is frustrating, but most users agree that it needs to be annoying to ensure sufficient behavioral adaption. We proposed a dual nudge that involves vibration followed by sound. There are indications that the technology also facilitates learning how to maintain a greater distance from others, and that this behavior can persist beyond the context of technology use. This study demonstrates that the key value of this technology is that it places the user in control and enables immediate action when the distance to others is not maintained. This study provides insights into the emerging field of personal and wearable technologies used for primary prevention during infectious disease outbreaks. Future research is needed to evaluate the preventive effect on transmission and investigate behavioral changes in detail and in relation to different forms of feedback.
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Affiliation(s)
- My Villius Zetterholm
- Department of Informatics, Faculty of Technology, Linnaeus University, Kalmar, Sweden
| | - Lina Nilsson
- eHealth Institute, Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Päivi Jokela
- Department of Informatics, Faculty of Technology, Linnaeus University, Växjö, Sweden
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3
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Schmieding ML, Kopka M, Schmidt K, Schulz-Niethammer S, Balzer F, Feufel MA. Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation. J Med Internet Res 2022; 24:e31810. [PMID: 35536633 PMCID: PMC9131144 DOI: 10.2196/31810] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/19/2021] [Accepted: 01/30/2022] [Indexed: 12/16/2022] Open
Abstract
Background Symptom checkers are digital tools assisting laypersons in self-assessing the urgency and potential causes of their medical complaints. They are widely used but face concerns from both patients and health care professionals, especially regarding their accuracy. A 2015 landmark study substantiated these concerns using case vignettes to demonstrate that symptom checkers commonly err in their triage assessment. Objective This study aims to revisit the landmark index study to investigate whether and how symptom checkers’ capabilities have evolved since 2015 and how they currently compare with laypersons’ stand-alone triage appraisal. Methods In early 2020, we searched for smartphone and web-based applications providing triage advice. We evaluated these apps on the same 45 case vignettes as the index study. Using descriptive statistics, we compared our findings with those of the index study and with publicly available data on laypersons’ triage capability. Results We retrieved 22 symptom checkers providing triage advice. The median triage accuracy in 2020 (55.8%, IQR 15.1%) was close to that in 2015 (59.1%, IQR 15.5%). The apps in 2020 were less risk averse (odds 1.11:1, the ratio of overtriage errors to undertriage errors) than those in 2015 (odds 2.82:1), missing >40% of emergencies. Few apps outperformed laypersons in either deciding whether emergency care was required or whether self-care was sufficient. No apps outperformed the laypersons on both decisions. Conclusions Triage performance of symptom checkers has, on average, not improved over the course of 5 years. It decreased in 2 use cases (advice on when emergency care is required and when no health care is needed for the moment). However, triage capability varies widely within the sample of symptom checkers. Whether it is beneficial to seek advice from symptom checkers depends on the app chosen and on the specific question to be answered. Future research should develop resources (eg, case vignette repositories) to audit the capabilities of symptom checkers continuously and independently and provide guidance on when and to whom they should be recommended.
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Affiliation(s)
- Malte L Schmieding
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marvin Kopka
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Cognitive Psychology and Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Germany, Jena, Germany.,Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sven Schulz-Niethammer
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus A Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
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Yang X, Wang J, Liu RD, Ding Y, Hong W, Yang Y, Hwang J. Home Quarantine Behavior in College Students: The Internal Mechanism and Cross-National Differences. Psychol Res Behav Manag 2022; 15:823-837. [PMID: 35411196 PMCID: PMC8994652 DOI: 10.2147/prbm.s359983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 pandemic motivated people to stay at home to reduce the risk of COVID-19 infection and community transmission, but limited research has investigated the behavioral mechanisms underlying home quarantine. Methods Based on the theory of planned behavior (TPB), this study explored the mediating role of intention toward home quarantine and the moderating role of nationality among attitude, subjective norms, and perceived behavioral control. A total of 827 college students from the United States and China were recruited to complete an online survey. Results The results of structural equation modeling showed that antecedents (ie, attitude, subjective norms, and perceived behavioral control) could predict actual home-quarantine behavior through the role of intention. Notably, the relation between both attitude and intention and perceived behavioral control and intention were moderated by nationality. Specifically, attitude was a stronger predictor of intention for American participants than for Chinese participants; however, perceived behavioral control was a stronger predictor of intention for Chinese participants. Conclusion These findings reveal the internal mechanism of home-quarantine behavior and the heterogeneous explanations attributed to cultural diversity during the pandemic, which not only expands the application of TPB but also provides a reference for infectious disease mitigation in the field of public health policy.
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Affiliation(s)
- Xiantong Yang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, 100875, People’s Republic of China
| | - Jia Wang
- Teachers’ College, Beijing Union University, Beijing, 100874, People’s Republic of China
| | - Ru-De Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, 100875, People’s Republic of China
- Correspondence: Ru-De Liu, Email
| | - Yi Ding
- Graduate School of Education, Fordham University, New York, NY, 10023, USA
| | - Wei Hong
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, 100875, People’s Republic of China
| | - Yi Yang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, 100875, People’s Republic of China
| | - Jacqueline Hwang
- Graduate School of Education, Fordham University, New York, NY, 10023, USA
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5
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Kemp D, King AJ, Upshaw SJ, Mackert M, Jensen JD. Applying harm reduction to COVID-19 prevention: The influence of moderation messages and risk infographics. PATIENT EDUCATION AND COUNSELING 2022; 105:269-276. [PMID: 34600777 PMCID: PMC8806114 DOI: 10.1016/j.pec.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 05/16/2023]
Abstract
OBJECTIVE We propose that harm reduction messages advocating moderation versus abstinence from social interaction will be seen as less threatening and increase intentions to follow COVID-19 guidelines. We also examine two important moderators: the influence of risk framing and willingness to risk infection. METHOD A 2 × 2 between-participants, randomized experiment (N = 476) varied infographics portraying low-risk behaviors, like going camping, versus high-risk behaviors, like attending a concert, followed by either moderation or abstinence guidelines. Participants in two additional control groups saw an infographic displaying either a full range of risk behaviors or behaviors that pose no risk, each followed by generic guidelines. RESULTS Regression analyses show moderation messages are less freedom-threatening only when presenting low-risk behaviors. Persons more willing to risk infection found all messages more freedom-threatening; however, for these individuals, moderation messages increased behavioral intentions when risks were presented as high. CONCLUSION This study suggests harm reduction may be applied effectively in a pandemic, where the behavior of risk-tolerant individuals, at a population level, could have suboptimal effects on curbing virus transmission. PRACTICE IMPLICATIONS Health educators should communicate harm reduction with certain populations but also test to ensure messaging, including visuals communicating relative risks, are received as intended.
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Affiliation(s)
- Deena Kemp
- Stan Richards School of Advertising & Public Relations, University of Texas at Austin, Austin, USA.
| | - Andy J King
- Greenlee School of Journalism and Communication, Iowa State University, Ames, USA
| | - Sean J Upshaw
- Stan Richards School of Advertising & Public Relations, University of Texas at Austin, Austin, USA
| | - Mike Mackert
- Stan Richards School of Advertising & Public Relations, University of Texas at Austin, Austin, USA
| | - Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, USA
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6
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Abstract
Thomas Rouyard and colleagues discuss use of the boosting approach as an alternative to nudging in developing non-coercive interventions to promote health
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Affiliation(s)
- Thomas Rouyard
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo, Japan
| | - Bart Engelen
- Tilburg Center for Moral Philosophy, Epistemology and Philosophy of Science (TiLPS), Tilburg University, Tilburg, Netherlands
| | - Andrew Papanikitas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ryota Nakamura
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo, Japan
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7
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Röbbelen A, Schmieding ML, Kopka M, Balzer F, Feufel MA. Interactive versus static decision support tools for COVID-19: An experimental comparison. JMIR Public Health Surveill 2021; 8:e33733. [PMID: 34882571 PMCID: PMC9015012 DOI: 10.2196/33733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background During the COVID-19 pandemic, medical laypersons with symptoms indicative of a COVID-19 infection commonly sought guidance on whether and where to find medical care. Numerous web-based decision support tools (DSTs) have been developed, both by public and commercial stakeholders, to assist their decision making. Though most of the DSTs’ underlying algorithms are similar and simple decision trees, their mode of presentation differs: some DSTs present a static flowchart, while others are designed as a conversational agent, guiding the user through the decision tree’s nodes step-by-step in an interactive manner. Objective This study aims to investigate whether interactive DSTs provide greater decision support than noninteractive (ie, static) flowcharts. Methods We developed mock interfaces for 2 DSTs (1 static, 1 interactive), mimicking patient-facing, freely available DSTs for COVID-19-related self-assessment. Their underlying algorithm was identical and based on the Centers for Disease Control and Prevention’s guidelines. We recruited adult US residents online in November 2020. Participants appraised the appropriate social and care-seeking behavior for 7 fictitious descriptions of patients (case vignettes). Participants in the experimental groups received either the static or the interactive mock DST as support, while the control group appraised the case vignettes unsupported. We determined participants’ accuracy, decision certainty (after deciding), and mental effort to measure the quality of decision support. Participants’ ratings of the DSTs’ usefulness, ease of use, trust, and future intention to use the tools served as measures to analyze differences in participants’ perception of the tools. We used ANOVAs and t tests to assess statistical significance. Results Our survey yielded 196 responses. The mean number of correct assessments was higher in the intervention groups (interactive DST group: mean 11.71, SD 2.37; static DST group: mean 11.45, SD 2.48) than in the control group (mean 10.17, SD 2.00). Decisional certainty was significantly higher in the experimental groups (interactive DST group: mean 80.7%, SD 14.1%; static DST group: mean 80.5%, SD 15.8%) compared to the control group (mean 65.8%, SD 20.8%). The differences in these measures proved statistically significant in t tests comparing each intervention group with the control group (P<.001 for all 4 t tests). ANOVA detected no significant differences regarding mental effort between the 3 study groups. Differences between the 2 intervention groups were of small effect sizes and nonsignificant for all 3 measures of the quality of decision support and most measures of participants’ perception of the DSTs. Conclusions When the decision space is limited, as is the case in common COVID-19 self-assessment DSTs, static flowcharts might prove as beneficial in enhancing decision quality as interactive tools. Given that static flowcharts reveal the underlying decision algorithm more transparently and require less effort to develop, they might prove more efficient in providing guidance to the public. Further research should validate our findings on different use cases, elaborate on the trade-off between transparency and convenience in DSTs, and investigate whether subgroups of users benefit more with 1 type of user interface than the other. Trial Registration Deutsches Register Klinischer Studien DRKS00028136; https://tinyurl.com/4bcfausx (retrospectively registered)
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Affiliation(s)
- Alice Röbbelen
- Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, DE
| | - Malte L Schmieding
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, DE
| | - Marvin Kopka
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, DE
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, DE
| | - Markus A Feufel
- Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, DE
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Nowicka A, Jaszczak J, Szymanek Pasternak A, Simon K. Application of self-assessment triage tool in COVID-19 pandemic: descriptive study (Preprint). JMIR Hum Factors 2021; 9:e34134. [PMID: 35168192 PMCID: PMC8982648 DOI: 10.2196/34134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/30/2021] [Accepted: 02/13/2022] [Indexed: 01/08/2023] Open
Abstract
Background The COVID-19 pandemic has sped up the implementation of telehealth solutions in medicine. A few symptom checkers dedicated for COVID-19 have been described, but it remains unclear whether and how they can affect patients and health systems. Objective This paper demonstrates our experiences with the COVID-19 risk assessment (CRA) tool. We tried to determine who the user of the web-based COVID-19 triage app is and compare this group with patients in the infectious diseases ward’s admission room to evaluate who could benefit from implementing the COVID-19 online symptom checker as a remote triage solution. Methods We analyzed the answers of 248,862 people interacting with an online World Health Organization–based triage tool for assessing the probability of SARS-CoV-2 infection. These users filled in an online questionnaire between April 7 and August 6, 2020. Based on the presented symptoms, risk factors, and demographics, the tool assessed whether the user’s answers were suggestive of COVID-19 and recommended appropriate action. Subsequently, we compared the sociodemographic and clinical characteristics of tool users with patients admitted to the Infectious Diseases Admission Room of J. Gromkowski Hospital in Wrocław. Results The CRA tool tended to be used by asymptomatic or oligosymptomatic individuals (171,226 [68.80%] of all users). Most users were young (162,432 [65.27%] were below 40 years of age) and without comorbidities. Only 77,645 (31.20%) of the self-assessment app users were suspected of COVID-19 based on their reported symptoms. On the contrary, most admission room patients were symptomatic—symptoms such as fever, cough, and dyspnea were prevalent in both COVID-19-positive and COVID-19-negative patients. COVID-19-suspected patients in the CRA tool group presented similar COVID-19 symptoms as those who presented to the admission room. These were cough (25,062/40,007 [62.64%] in the CRA tool group vs 138/232 [59.48%] in the admission room group), fever (23,123/40,007 [57.80%] in the CRA tool group vs 146/232 [62.93%] in the admission room group), and shortness of breath (15,157/40,007 [37.89%] in the CRA tool group vs 87/232 [37.50%] in the admission room group). Conclusions The comparison between the symptomatology of the users interacting with the CRA tool and those visiting the admission room revealed 2 major patient groups who could have benefited from the implementation of the self-assessment app in preclinical triage settings. The primary users of the CRA tool were young, oligosymptomatic individuals looking for screening for COVID-19 and reassurance early in the COVID-19 pandemic. The other group were users presenting the typical symptoms suggestive of COVID-19 at that time. The CRA tool recognized these individuals as potentially COVID-19 positive and directed them to the proper level of care. These use cases fulfil the idea of preclinical triage; however, the accuracy and influence on health care must be examined in the clinical setting.
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Affiliation(s)
- Anna Nowicka
- Provincial Specialist Hospital them. J. Gromkowski, Wrocław, Poland
- Infermedica, Wrocław, Poland
| | | | - Anna Szymanek Pasternak
- Provincial Specialist Hospital them. J. Gromkowski, Wrocław, Poland
- Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Wrocław, Poland
| | - Krzysztof Simon
- Provincial Specialist Hospital them. J. Gromkowski, Wrocław, Poland
- Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Wrocław, Poland
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Cardwell K, O'Neill SM, Tyner B, Broderick N, O'Brien K, Smith SM, Harrington P, Ryan M, O'Neill M. A rapid review of measures to support people in isolation or quarantine during the Covid-19 pandemic and the effectiveness of such measures. Rev Med Virol 2021; 32:e2244. [PMID: 33989440 PMCID: PMC8209933 DOI: 10.1002/rmv.2244] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
This rapid review aimed to identify measures available to support those in isolation or quarantine during the coronavirus disease 2019 (Covid‐19) pandemic, and determine their effectiveness in improving adherence to these recommendations and or reducing transmission. The rapid review consisted of two elements, the first was a review of guidance published by national and international agencies relating to measures to support those in isolation (due to case status) or quarantine (due to close contact status) during the Covid‐19 pandemic. Five categories of support measures were identified in the international guidance, they were: Psychological, addiction and safety supports, Essential supplies, Financial aid, Information provision and Enforcement. The second element was a rapid literature review of the effectiveness of measures used to support individuals in isolation or quarantine during any pandemic or epidemic setting, due to respiratory pathogens. A systematic search of published peer‐reviewed articles and nonpeer‐reviewed pre‐prints was undertaken from 1 January 2000 to 26 January 2021. Two Australian publications met the inclusion criteria, both based on data from a survey undertaken during the 2009 H1N1 pandemic. The first reported that 55% of households were fully compliant with quarantine recommendations, and that there was increased compliance reported in households that understood what they were meant to do compared with those who reported that they did not (odds ratio [OR]: 2.27, 95% confidence interval [CI]: 1.35–3.80). The second reported that access to paid sick and or carer's leave did not predict compliance with quarantine recommendations (OR: 2.07, 95% CI: 0.82–5.23). Neither reported on reduction in transmission.
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Affiliation(s)
- Karen Cardwell
- Health Information and Quality Authority, Dublin 7, Ireland.,Department of General Practice, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | - Barrie Tyner
- Health Information and Quality Authority, Dublin 7, Ireland
| | | | - Kirsty O'Brien
- Health Information and Quality Authority, Dublin 7, Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | - Mairin Ryan
- Health Information and Quality Authority, Dublin 7, Ireland.,Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Health Sciences, Dublin 8, Ireland
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Cross-Country Differences in Stay-at-Home Behaviors during Peaks in the COVID-19 Pandemic in China and the United States: The Roles of Health Beliefs and Behavioral Intention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042104. [PMID: 33670078 PMCID: PMC7927070 DOI: 10.3390/ijerph18042104] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/24/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) rapidly escalated to a global pandemic. To control the rate of transmission, governments advocated that the public practice social distancing, which included staying at home. However, compliance with stay-at-home orders has varied between countries such as China and the United States, and little is known about the mechanisms underlying the national differences. Based on the health belief model, the theory of reasoned action, and the technology acceptance model, health beliefs and behavioral intention are suggested as possible explanations. A total of 498 Chinese and 292 American college students were recruited to complete an online survey. The structural equation modeling results showed that health beliefs (i.e., perceived susceptibility, severity, and barriers) and behavioral intention played multiple mediating roles in the association between nationality and actual stay-at-home behaviors. Notably, the effect via perceived barriers → behavioral intention was stronger than the effects via perceived susceptibility and severity → behavioral intention. That is, American participants perceived high levels of susceptibility whereas Chinese participants perceived high levels of severity, especially few barriers, which further led to increased behavioral intention and more frequent stay-at-home behaviors. These findings not only facilitate a comprehensive understanding of cross-country differences in compliance with stay-at-home orders during peaks in the COVID-19 pandemic but also lend support for mitigation of the current global crisis and future disease prevention and health promotion efforts.
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Lin HC, Chen CC. Disease Prevention Behavior During the COVID-19 Pandemic and the Role of Self-Esteem: An Extended Parallel Process Model. Psychol Res Behav Manag 2021; 14:123-135. [PMID: 33603513 PMCID: PMC7882452 DOI: 10.2147/prbm.s291300] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/31/2020] [Indexed: 12/20/2022] Open
Abstract
Objective The COVID-19 outbreak has become a serious public health problem worldwide. The purpose of this study was to use an extended parallel process model (EPPM) to understand factors in COVID-19 prevention behaviors. Methods This cross-sectional and analytical study was conducted on 1012 participants in Taiwan. A structured questionnaire and an online survey were used to collect data. Results The EPPM revealed that the severity of the COVID-19 threat perceived by respondents directly affected the arousal of fear in the respondents (β=0.268, t=9.007, p<0.001), but perceived efficacy did not (β=−0.019, t=−0.619, p>0.05); additionally, fear arousal was significantly associated with COVID-19 prevention behaviors (β=0.119, t=4.603, p<0.001). Regarding personal characteristics, self-esteem moderated the relationship between perceived threat and fear arousal. However, the moderating effect of self-esteem was stronger in people with low self-esteem compared to those with high self-esteem (β=0.606, −0.472; t=26.303, −17.694; p<0.001, p<0.001; respectively). The results of this study also indicated that two demographic characteristics (age and gender) affect COVID-19 prevention behaviors. Conclusion When developing healthcare policies and community interventions for improving COVID-19 prevention behaviors during an outbreak, healthcare administrators should carefully consider the main constructs of the EPPM, particularly personal characteristics (ie, self-esteem) and demographic characteristics (ie, age and gender).
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Affiliation(s)
- Hsien-Cheng Lin
- Business College, Taizhou University, Taizhou, Zhejiang Province, People's Republic of China
| | - Chia-Chen Chen
- Department of Anesthesiology, China Medical University Hsinchu Hospital, Zhubei, Taiwan, Republic of China
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Abstract
This paper offers the perspective of a behavioural scientist advising and providing evidence for Ireland's government during the coronavirus pandemic. It describes how behavioural research informed the public response in the early months of the crisis, but lost influence as political conflict increased. It proposes some broader lessons for managing public health crises, one of which is to recognise the potential wisdom of crowds.
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Affiliation(s)
- Peter D. Lunn
- Behavioural Research Unit, Economic and Social Research Institute (ESRI), Sir John Rogerson’s Quay, Dublin, D02 K138 Ireland
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