COVID-19 preparedness and response in rural and remote areas: A scoping review

The relationship between safety measures, preparedness, and mental health outcomes in New York City during the COVID-19 pandemic

Background

The COVID-19 pandemic necessitated strict safety measures and preparedness, potentially influencing mental well-being worldwide. This study investigated the impact of safety measures and preparedness levels on mental health outcomes during the COVID-19 pandemic in New York City, USA examining how sociodemographic characteristics modified these associations.

Method

A longitudinal study of 1,227 participants from three ongoing cohorts, provided data through telephone interviews across three waves from March 2020 to August 2021. Depression and anxiety were measured using Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7 (GAD-7). Logistic regression models were used to investigate associations between safety measures, preparedness, and mental health outcomes over time, adjusting for potential confounders and assessing the modification effect of demographic factors.

Results

At Wave 1, 18% of participants reported moderate to severe depression, while 20% had moderate to severe anxiety. Over time, these rates declined significantly, with depression dropping to 9% and anxiety to 10% by Wave 3. Safety measures practiced at Wave 1 showed a protective effect on depression at Wave 3 (OR=0.45, 95% CI: 0.22, 0.91). Higher preparedness levels were significantly associated with reduced odds of anxiety (aOR=0.72, 95% CI: 0.55, 0.93) in the concurrent wave. Age specific analysis revealed that individuals aged 26-35 experienced stronger protective effects from higher preparedness levels (OR=0.43, 95% CI: 0.2, 0.92) compared to younger age groups.

Conclusion

This study highlights the importance of safety measures and preparedness in mitigating mental health challenges during crises. Addressing age specific factors and preparedness levels can guide the public health strategies to better support diverse populations.

The impact of interprofessional collaboration between pharmacists and community health workers on medication adherence: a systematic review

BACKGROUND

There is increasing evidence to support the effectiveness of interventions involving community health workers (CHWs) in improving patient health outcomes, which reinforces their growing integration in healthcare teams. However, little is known about the interprofessional collaboration between pharmacists and CHWs. This systematic review aimed to explore the impact of interprofessional interventions involving pharmacists and CHWs on patient medication adherence.

METHODS

The English language scientific literature published in Embase, MEDLINE, Web of Science, CINAHL, Scopus, plus the grey literature were searched in October 2024. Using the software Covidence, two authors screened article titles and abstracts and assessed full-text articles for eligibility. Studies were included if (i) the intervention was delivered by pharmacists and CHWs and (ii) reported on medication adherence outcomes. Data were extracted using a customized template using Excel and synthetized narratively. The Effective Public Health Practice Project quality assessment tool was used to assess the studies' methodological quality.

RESULTS

Eight studies met the inclusion criteria, including a total of 1577 participants. Seven studies were conducted in the United States, and six were published since 2020. The interventions consisted of medication therapy management, medication reconciliation, and repeated education sessions. The CHW shared clinical and non-clinical patient information and ensured a culturally safe environment while the pharmacist delivered the clinical intervention. In five studies, medication adherence was evaluated solely through patient self-reported measures. One study used an objective measure (i.e., pharmacy refill records) to evaluate medication adherence. Only two studies assessed medication adherence using both self-reported and objective measures (i.e., pill count and proportion of days covered). A significant improvement in medication adherence was observed in three of the eight studies. Half of the studies were of weak quality and half of moderate quality.

CONCLUSIONS

There was a small number of studies identified which focused on the impact of interprofessional collaboration between pharmacists and CHWs on medication adherence. The impact of the interprofessional interventions on medication adherence was limited. Further studies of higher quality are needed to better evaluate the impact of such collaboration on patient health outcomes.

REGISTRATION

PROSPERO, ID CRD42024526969.

A scoping review and expert consensus on digital determinants of health

Objective

To map how social, commercial, political and digital determinants of health have changed or emerged during the recent digital transformation of society and to identify priority areas for policy action.

Methods

We systematically searched MEDLINE, Embase and Web of Science on 24 September 2023, to identify eligible reviews published in 2018 and later. To ensure we included the most recent literature, we supplemented our review with non-systematic searches in PubMed® and Google Scholar, along with records identified by subject matter experts. Using thematic analysis, we clustered the extracted data into five societal domains affected by digitalization. The clustering also informed a novel framework, which the authors and contributors reviewed for comprehensiveness and accuracy. Using a two-round consensus process, we rated the identified determinants into high, moderate and low urgency for policy actions.

Findings

We identified 13 804 records, of which 204 met the inclusion criteria. A total of 127 health determinants were found to have emerged or changed during the digital transformation of society (37 digital, 33 social, 33 commercial and economic and 24 political determinants). Of these, 30 determinants (23.6%) were considered particularly urgent for policy action.

Conclusion

This review offers a comprehensive overview of health determinants across digital, social, commercial and economic, and political domains, highlighting how policy decisions, individual behaviours and broader factors influence health by digitalization. The findings deepen our understanding of how health outcomes manifest within a digital ecosystem and inform strategies for addressing the complex and evolving networks of health determinants.

Interprofessional collaboration between pharmacists and community health workers: a scoping review

INTRODUCTION

Community health workers (CHWs) help bridge the cultural gap between health services and the communities they serve. CHWs work with physicians, nurses and social workers, but little is known about their collaboration with pharmacists. This scoping review aims to describe the interprofessional collaboration between CHWs and pharmacists, the types of interventions they deliver and CHWs' and pharmacists' specific roles within these interventions.

METHOD

The scientific literature published in PubMed, Embase, MEDLINE, Scopus, Web of Science, PsycInfo, CINAHL and the grey literature were searched. Inclusion criteria were that the research (i) involved pharmacists and CHWs working collaboratively and (ii) included an intervention, service or program. One researcher screened all articles, and two reviewers screened 6% of articles (20/340) assessed for eligibility, using the software Covidence. After the discrepancies were resolved, data from the included articles were extracted using a customized template for data extraction and synthesized narratively.

RESULTS

Eighteen studies met the inclusion criteria. Most were conducted in the USA (14/18) and were published since 2020 (12/18). Most interventions involved medication reviews, support for medication adherence, disease prevention or addressing the social determinants of health. Pharmacists had primarily clinical roles (i.e., medication reconciliation and patient education), while the CHWs' roles consisted of collecting patient information, supporting patient self-management, bridging the cultural gap by translating information in the patient's language and ensuring patient follow-up. The collaborative practice occurred via interprofessional referral, ranging from the CHW facilitating the link between the patient and the pharmacist, and information sharing between the CHW and the pharmacist, to an interprofessional collaborative practice where CHWs and pharmacists delivered the intervention together.

CONCLUSION

While CHWs and pharmacists had independent roles as part of the interventions, they also collaborated at various levels to deliver services to patients. CHWs have an important role to play in bridging the cultural gap between the patient and the pharmacist, in improving patient referral so that more patients can benefit from pharmaceutical services, and in identifying patients' social determinants of health. CHWs and pharmacists can work synergistically and collaboratively to tailor an intervention to the patient's needs, which can improve and optimize pharmaceutical services, and may ultimately positively impact health outcomes.

The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review

BACKGROUND

Rural community health workers [CHWs] play a critical role in improving health outcomes during non-pandemic times, but evidence on their effectiveness during the COVID-19 pandemic is limited. There is a need to focus on rural CHWs and rural health systems as they have limited material and human resources rendering them more vulnerable than urban health systems to severe disruptions during pandemics.

OBJECTIVES

This systematic review aims to describe and appraise the current evidence on the effectiveness of rural CHWs in improving access to health services and health outcomes during the COVID-19 pandemic in low-and middle-income countries [LMICs].

METHODS

We searched electronic databases for articles published from 2020 to 2023 describing rural CHW interventions during the COVID-19 pandemic in LMICs. We extracted data on study characteristics, interventions, outcome measures, and main results. We conducted a narrative synthesis of key results.

RESULTS

Fifteen studies from 10 countries met our inclusion criteria. Most of the studies were from Asia [10 of 15 studies]. Study designs varied and included descriptive and analytical studies. The evidence suggested that rural CHW interventions led to increased household access to health services and may be effective in improving COVID-19 and non-COVID-19 health outcomes. Overall, however, the quality of evidence was poor due to methodological limitations; 14 of 15 studies had a high risk of bias.

CONCLUSION

Rural CHWs may have improved access to health services and health outcomes during the COVID-19 pandemic in LMICs but more rigorous studies are needed during future pandemics to evaluate their effectiveness in improving health outcomes in different settings and to assess appropriate support required to ensure their impact at scale.

COVID-19 Resilience and Risk Reduction Intervention in Rural Populations of Western India: Retrospective Evaluation

BACKGROUND

Globally, especially in the low- and middle-income countries (LMICs), rural populations were more susceptible to the negative impact of the COVID-19 pandemic due to lower levels of community awareness, poor hygiene, and health literacy accompanying pre-existing weak public health systems. Consequently, various community-based interventions were engineered in rural regions worldwide to mitigate the COVID-19 pandemic by empowering people to mount both individual and collective public health responses against the pandemic. However, to date, there is paucity of information on the effectiveness of any large-scale community intervention in controlling and mitigating the effects of COVID-19, especially from the perspective of LMICs.

OBJECTIVE

This retrospective impact evaluation study was conducted to evaluate the effect of a large-scale rural community-based intervention, the COVID-Free Village Program (CFVP), on COVID-19 resilience and control in rural populations in Maharashtra, India.

METHODS

The intervention site was the rural areas of the Pune district where CFVP was implemented from August 2021 to February 2022, while the adjoining district, Satara, represented the control district where the COVID-Free Village Scheme was implemented. Data were collected during April-May 2022 from 3500 sample households in villages across intervention and comparison arms by using the 2-stage stratified random sampling through face-to-face interviews followed by developing a matched sample using propensity score matching methods.

RESULTS

The participants in Pune had a significantly higher combined COVID-19 awareness index by 0.43 (95% CI 0.29-0.58) points than those in Satara. Furthermore, the adherence to COVID-appropriate behaviors, including handwashing, was 23% (95% CI 3%-45%) and masking was 17% (0%-38%) higher in Pune compared to those in Satara. The probability of perception of COVID as a serious illness in patients with heart disease was 22% (95% CI 1.036-1.439) higher in Pune compared to that in Satara. The awareness index of COVID-19 variants and preventive measures were also higher in Pune by 0.88 (95% CI 0.674-1.089) points. In the subgroup analysis, when the highest household educational level was restricted to middle school, the awareness about the COVID-control program was 0.69 (95% CI 0.36-1.021) points higher in Pune, while the awareness index of COVID-19 variants and preventive measures was higher by 0.45 (95% CI 0.236-0.671) points. We did not observe any significant changes in the overall COVID-19 vaccination coverage due to CFVP implementation. Furthermore, the number of COVID-19 deaths in both the sampled populations were very low. The probability of observing COVID-19-related stigma or discrimination in Pune was 68% (95% CI 0.133-0.191) lower than that in Satara.

CONCLUSIONS

CFVP contributed to improved awareness and sustainability of COVID-appropriate behaviors in a large population although there was no evidence of higher COVID-19 vaccination coverage or reduction in mortality, signifying potential applicability in future pandemic preparedness, especially in resource-constrained settings.