Perceived Benefits and Barriers to Implementing Occupational Health Recommendations Among Immigrant-Owned Nail Salons in the Greater Philadelphia Region

Introduction. Immigrant nail salon owners and employees face multiple barriers to accessing occupational health training and services. We formed an academic-community-based organization-business owner partnership-unique in that all partners were culturally congruent-to develop a pilot intervention program for the nail salon community. Methods. Eighteen individuals (nine salon owners and nine employees) from the Greater Philadelphia region received the training in their native language and provided feedback through in-depth qualitative interviews. Interview guide was developed using the Consolidated Framework for Implementation Research (CFIR). Themes of perceived benefits and barriers were identified and aligned with relevant CFIR constructs to gain better understanding of the implementation challenges. Results. Reported benefits of program were improved knowledge of the workplace hazards and safety practices, and the potential to attract more customers and retain employees. Perceived barriers to implementing recommended practices were limited availability of safer products and high cost, challenges communicating with customers, lack of engagement from some owners, organizational management practices affecting employees' motivation, and limited partnership with local government to assist small immigrant-owned businesses. Conclusions. Our study revealed multiple factors that pit long-term health protection of nail salon workers against the economic viability of the businesses that employ them. Our research highlights the need to (1) advocate for federal policies making safer products to be more accessible to the masses, (2) establish local policy and culturally appropriate technical support programs that engage community-based organizations, and (3) develop economic opportunities and mentorship for immigrant entrepreneurs to operate profitable healthy salons.

In Search of a Value Proposition for COVID-19 Testing in the Work Environment: A Social Marketing Analysis

BACKGROUND

This study examined employer experience with SARS-CoV-2 (COVID-19) asymptomatic testing through a social marketing lens. Social marketing uses commercial marketing principles to achieve socially beneficial ends including improved health and safety behavior.

METHOD

Twenty employers across 11 occupational sectors were interviewed about implementation of COVID-19 testing from January through April 2021. Recorded transcripts were coded and analyzed using marketing's "Four P's": "product," "price," "place," "promotion."

RESULTS

COVID-19 tests (product) were uncomfortable, were easily confused, and didn't solve problems articulated by employers. Testing was not widely available or didn't line up with shifts or locations (place). The perceived price, which included direct and associated costs (e.g., laboratory fees, productivity loss, logistical challenges) was high. Most crucially, the time to receive (PCR) results negated the major benefit of less time spent in quarantine and challenged employer trust. A potential audience segmentation strategy based on perceptions of exposure risk also emerged.

CONCLUSIONS

This social marketing analysis suggests ways to improve the value proposition for asymptomatic testing through changes in product, price, and placement features in line with employers' expressed needs. Study findings can also inform creation of employee communication materials that balance perceived rewards of testing against perceived risks of exposure.

Barriers to SARS-CoV-2 Testing among U.S. Employers in the COVID-19 Pandemic: A Qualitative Analysis Conducted January through April 2021

During the first year of the COVID-19 pandemic, U.S. companies were seeking ways to support their employees to return to the workplace. Nonetheless, the development of strategies to support the access, use, and interpretation of SARS-CoV-2 testing was challenging. In the present study, we explore, from the perspective of owners and company leadership, the barriers to SARS-CoV-2 testing among U.S. companies. Key informant interviews with company representatives were conducted during January-April 2021 about SARS-CoV-2 testing. A pre-interview survey assessed respondent socio-demographic and organizational characteristics. Interview sessions were transcribed, coded, and analyzed using MaxQDA. A total of twenty interviews were completed with at least two interviews conducted in each major U.S. industry sector. Ninety percent of participants represented companies in business >10 years, comprising both small and large workforces. Using a grounded theory approach, six themes emerged: (1) access to and knowledge of SARS-CoV-2 tests; (2) strategies for symptomatic and asymptomatic testing of workers; (3) type/availability of personal protective equipment to mitigate coronavirus exposures; (4) return-to-work policies; (5) guidance and communication of SARS-CoV-2 Testing; and (6) use of contact tracing and SARS-CoV-2 vaccination. Various modifiable and non-modifiable challenges for SARS-CoV-2 testing among U.S. companies were identified and can inform work-related SARS-CoV-2 testing strategies.

Face Value: Remote facial expression analysis adds predictive power to perceived effectiveness for selecting anti-tobacco PSAs

Perceived effectiveness (PE) is a validated tool for predicting the potential impact of anti-tobacco public service announcements (PSAs). We set out to evaluate the added predictive value of facial expression analysis when combined with PE in a remote (online) survey. Each of 302 tobacco users watched 3 PSAs and allowed transmission of webcam videos from which metrics for "attention" (head position) and "facial action units" (FAU) were computed. The participants completed scales for their subjective emotions, willingness to share on social media, and intention to quit smoking using the Tobacco Free Florida website. Based on PE, both ready to quit (RTQ) and not ready (NR) respondents favored the same PSAs but RTQs assigned higher PE scores. Negative PSAs ("sad" or "frightening") were more compelling overall but RTQs also favored surprising ads and were more willing to share them on social media. Logistic regression showed that the combination of Attention + FAU+ PE (AUC = .816, p < .0001) outperformed single factors or factor combinations in distinguishing RTQ from NR. This study demonstrates that on-line assessment of facial expressions enhances the predictive value of PE and can be deployed on large remote samples.

Competencies for Health Communication Specialists: Survey of Health Communication Educators and Practitioners

For more than two decades, health communication educators and practitioners have been working toward establishing a competency model to guide health communication education. This article reports the results of a survey to identify competencies for health communication specialists with master's degrees. To prepare the survey, a working group drafted a competency list through reviewing the literature and soliciting feedback from attendees at a professional society meeting, resulting in lists of items reflecting 18 knowledge domains, 11 skill sets, and 14 application bundles labeled "abilities." The survey asked participants to rate the 43 items in terms of their importance and provide their opinions about the preparation of health communication specialists. The survey was disseminated online through professional associations and completed by 142 participants (74 educators and 68 practitioners). Nearly all of the 43 items were rated "somewhat important" or higher. The lists were reduced to 10 knowledge domains, three skill sets, and five abilities through factor analyses. Replication of the findings and triangulation with studies employing different research methods will help advance this line of inquiry.

Food Is Medicine: Providing Medically Tailored Meals to Community Members with Disease-associated Nutritional Risk Supports Stable BMI and Decreased Hospitalization (P12-005-19)

Objectives

MANNA, a Food is Medicine organization in Philadelphia, provides nutritional support for community members at nutritional risk from serious illness. MANNA's program of medically-tailored meals and nutrition counseling have been associated with lower healthcare utilization and costs, however the specific health outcomes that contribute to these effects are unknown. The objective of this research is to analyze change in body mass index (BMI) and proportion of recent hospitalizations in association with MANNA's program.

Methods

A retrospective chart review was conducted for 103 clients who answered a 2016 Client Satisfaction Survey and received at least six months of MANNA's program between Jan. 2015 and Dec. 2016. Data from the start of services and at 6-months follow-up were entered into Research Electronic Database Capture (REDCap) and analyzed using Statistical Analysis Software (SAS).

Results

The median age of clients in the sample was 66.0 years (interquartile range (IQR) 58.0—72.0). Primary diagnoses were cancer (53%), renal disease (15.7%), diabetes (7.8%), HIV/AIDS (3.9%), heart disease (3.9%) and “other” (16.7%). Half of the sample (52.0%) reported having insufficient money to buy food. Per weight history, two-thirds (63.3%) of clients had decreasing weight before program enrollment, 28.9% had stable weight and 7.8% had increasing weight. Change in BMI between initial intake and recertification was: median = 0.04; IQR (−0.84,−1.02). Analysis of variance followed by a multiple comparisons with a Bonferroni adjustment found no evidence of any difference in BMI change between diagnoses. Bivariate analysis with t-tests found no evidence of any difference in BMI change between clients with enough money for food and those without (P = 0.4277). McNemar's Test found evidence of a significant decrease in the proportion of clients who had recent hospitalizations at follow-up compared to the start of services (P = 0.0077).

Conclusions

Manna's program was associated with stable BMI. Change in BMI was not significantly different based on primary diagnosis or insufficient money to buy food. The proportion of client hospitalizations was significantly less after MANNA's program. Stabilization of BMI is a possible health outcome that contributes to lower healthcare utilization and cost savings in MANNA's clients.

Funding Sources

None.

How Do Low-Literacy Populations Perceive "Dirty Bombs"? Implications for Preparedness Messages

Potential terror events such as "dirty bombs" could have significant public health effects, but little is known about how low-literacy populations perceive dirty bombs, their trust in public health or government officials to provide credible information, and their willingness to comply with recommended actions. We surveyed 50 low-literacy adults from a large urban center; they were mostly members of ethnic minority groups. We used unique social marketing methods-perceptual mapping and vector message modeling-to create 3-dimensional models that reflected respondents' knowledge of what a dirty bomb is, their intended behaviors should one occur, and their concerns about complying with "shelter in place" recommendations. To further understand individual variations in this at-risk group, a k-means cluster analysis was used to identify 3 distinct segments, differing on trust of local authorities and their emergency response, willingness to comply with emergency directives, and trust of information sources. Message strategies targeting each segment were developed to focus on concepts important to moving the groups toward a "shelter in place" behavior, revealing key differences in how best to communicate with risk communication. We discuss how these methods helped elucidate specific differences in each segment's understanding of and likely response during the event of a "dirty bomb" and how these techniques can be used to create more effective message strategies targeted to these groups.

Using eye tracking and gaze pattern analysis to test a "dirty bomb" decision aid in a pilot RCT in urban adults with limited literacy

Background

Eye tracking is commonly used in marketing to understand complex responses to materials, but has not been used to understand how low-literacy adults access health information or its relationship to decision making.

Methods

This study assessed how participants use a literacy appropriate “dirty bomb” decision aid. Participants were randomized to receive a CDC “factsheet” (n = 21) or literacy-appropriate aid (n = 29) shown on a computer screen. Using 7 content similar slides, gaze patterns, mean pupil fixation time and mean overall time reading and looking at slides were compared. Groups were also compared by literacy level and effect on 'confidence of knowledge' and intended behavior.

Results

Results revealed differing abilities to read densely written material. Intervention participants more precisely followed text on 4 of 7 content-similar slides compared to control participants whose gaze patterns indicated unread text, or repeated attempts at reading the same text, suggesting difficulty in understanding key preparedness messages. Controls had significantly longer pupil fixations on 5 of 7 slides and spent more overall time on every slide. In those with very low literacy, intervention participants were more likely than controls to say they understood what a “dirty bomb” is and how to respond if one should occur.

Conclusions

Results indicate limited- literacy adults, especially those with very low literacy, may not be able to understand how to respond during a “dirty bomb” using available materials, making them vulnerable to negative health events. This study provides insights into how individuals perceive and process risk communication messages, illustrating a rich and nuanced understanding of the qualitative experience of a limited literacy population with written materials. It also demonstrates the feasibility of using these methods on a wider scale to develop more effective health and risk communication messages designed to increase knowledge of and compliance with general health guidelines, and enhance decision making. This has application for those with learning disabilities, those with limited media-literacy skills, and those needing to access the diverse array of assistive technologies now available. Eye tracking is thus a practical approach to understanding these diverse needs to ensure the development of cogent and salient communication.

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-016-0304-5) contains supplementary material, which is available to authorized users.

Crowdsourcing 101: a few basics to make you the leader of the pack

Crowdsourcing is a problem-solving approach that taps the knowledge, energy, and creativity of a global, online community. Like marketing, crowdsourcing originated and continues to evolve in the private sector. Health communicators and social marketers can use crowdsourcing across the research-development-dissemination process. This article provides an overview of crowdsourcing and how it can be used to speed up and enhance social marketing and health communication. Nielsen's 1/9/90% model is presented as a guide for engaging appropriate crowds for tasks throughout the development process. The four Fs that motivate online contributors--Fun, Feeling good (fulfillment), Fame, and Fortune--are also presented as ways of incentivizing crowd engagement and matching the incentive to the task at hand. Crowdsourcing resources, such as curating agencies, websites, and crowd labor markets, can be tremendous force multipliers. If done strategically, crowdsourcing has the promise of giving well-researched and creative social marketing results for less money and in less time than traditional methods.

The impact of anthrax attacks on the American public

CONTEXT

Incidents involving anthrax (Bacillus anthracis) through the mail in 4 metropolitan areas have raised concerns about the public's response nationally and locally.

OBJECTIVE

To examine public response to these incidents and what it reveals about the demand placed on health professionals and public health officials nationally, in affected areas, and by affected people.

DESIGN

Random-digit-dialed telephone surveys of samples of households nationally and in 3 specific metropolitan areas where cases of anthrax were reported: the District of Columbia; Trenton/Princeton, New Jersey; and Boca Raton, Florida.

OUTCOME MEASURE

Respondents were asked a series of questions measuring their level of concern and their behavior in response to threats of anthrax and potential bioterrorist acts.

RESULTS

The lives of a large share of people were affected in 3 metropolitan areas where anthrax incidents occurred. Residents of those 3 areas and people there who were affected by the incidents expressed a higher level of concern and took more precautions handling their mail. However, these incidents did not lead to great demands on the health system.

CONCLUSIONS

The incidents of anthrax created anxieties, especially in areas where incidents occurred. There was some increased demand on the health system, but the demands were not large-scale. In the event of a major outbreak of disease, most Americans will rely heavily on their own physician for advice. Both national and local systems of population-based information gathering about the public's response to bioterrorist attacks are needed.