Ebola Virus Disease Sensitization: Community-Driven Efforts in Sierra Leone

The 2014-2016 West Africa Ebola outbreak was the largest in history, resulting in approximately 11,000 deaths. Despite the outbreak's eventual end, national and international health sensitization and containment efforts were subject to criticism. This study investigates disease-related knowledge and beliefs, as well as trusted sources of health information among EVD-survivors and their family members, highlighting the importance of community-informed public health responses. Participants (n = 134) were adults who were either EVD-infected, affected families/caregivers, or community leaders. In-depth interviews and focus groups explored EVD-related experiences, including health effects, stigma, and community relationships. Using a grounded theory and thematic content analysis approach, transcripts were coded for evidence of health sensitization, as well as compliance with mitigation measures and trusted sources of information. Participants displayed a high level of knowledge around EVD and reported compliance with mandated and personal prevention measures. Levels of health sensitization and subsequent reintegration of survivors were reported to be largely the products of community-based efforts, rather than the top-down, national public health response. Primary sources of trusted information included EVD survivors acting as peer educators; local leaders; and EVD sensitization by community health workers. This study highlights the importance of a community-based response for increasing the effectiveness of public health campaigns. Participants expressed that relying on the experiences of trusted cultural insiders led to a deeper understanding of Ebola compared to top-down public health campaigns, and helped infected and affected community members reintegrate. Future public health efforts should incorporate community-based participatory approaches to address infectious disease outbreaks.

Assessing Mental Healthcare Worker Experiences of Workplace Fairness and Organizational Value: A National Survey of Peer-Support Specialists

BACKGROUND

Peer-support specialists-individuals with diagnosed mental illnesses who provide support services to other adults with diagnosed mental health issues-often feel stigmatized and undervalued at work, leading to negative personal- and job-related outcomes. Given their important link to positive service user outcomes, this study assessed how peer-support specialists perceive fairness and feel valued in the workplace.

METHODS

Peer-support specialists (N = 274) were recruited online from peer-support specialist listservs, social media groups, and patient-run organizations to take a cross-sectional survey that included a 14-item scale on how workplace fairness relates to job satisfaction and four questions on how valued they felt by administrators, clinicians, the people they serve, and fellow peer-support specialists. Descriptive and bivariate statistics were used to assess total scores and differences by gender and race.

FINDINGS

Ranging in age from 20 to 77 years and identifying predominantly as White (81.0%) and female (62.9%), respondents noted that fair practices in the workplace would increase their job satisfaction, with no significant differences observed by gender or race. Most peer-support specialists felt valued by the people they serve (97.1%) and fellow peer-support specialists (92.7%). However, fewer reported feeling valued by administrators (64.6%) and clinicians (60.6%).

CONCLUSIONS/APPLICATION TO PRACTICE

Peer-support specialists value fairness at the workplace and feel undervalued by some staff. This study highlights peer-support specialists' important role in behavioral health services and suggests that healthcare professionals, including occupational health specialists, are important stakeholders in creating fairer workplaces and increasing peer-support specialists' sense of being valued, leading to improved personal and organizational outcomes.

SciComm Optimizer for Policy Engagement: a randomized controlled trial of the SCOPE model on state legislators' research use in public discourse

BACKGROUND

While prior work has revealed conditions that foster policymakers' use of research evidence, few studies have rigorously investigated the effectiveness of theory-based practices. Specifically, policymakers are most apt to use research evidence when it is timely, relevant, brief, and messaged appropriately, as well as when it facilitates interactive engagement. This study sought to experimentally evaluate an enhanced research dissemination intervention, known as the SciComm Optimizer for Policy Engagement (SCOPE), implemented during the COVID-19 pandemic among US state legislators.

METHODS

State legislators assigned to health committees and their staff were randomized to receive the SCOPE intervention. This involved providing academic researchers with a pathway for translating and disseminating research relevant to current legislative priorities via fact sheets emailed directly to officials. The intervention occurred April 2020-March 2021. Research language was measured in state legislators' social media posts.

RESULTS

Legislators randomized to receive the intervention, relative to the control group, produced 24% more social media posts containing research language related to COVID-19. Secondary analyses revealed that these findings were driven by two different types of research language. Intervention officials produced 67% more COVID-related social media posts referencing technical language (e.g., statistical methods), as well as 28% more posts that referenced research-based concepts. However, they produced 31% fewer posts that referenced creating or disseminating new knowledge.

CONCLUSIONS

This study suggests that strategic, targeted science communication efforts may have the potential to change state legislators' public discourse and use of evidence. Strategic science communication efforts are particularly needed in light of the role government officials have played in communicating about the pandemic to the general public.

Social distancing, community stigma, and implications for psychological distress in the aftermath of Ebola virus disease

Background

The 2013–2016 Ebola virus disease (EVD) epidemic resulted in more infections and deaths than all prior outbreaks in the 40-year history of this virus combined. This study examines how experiences of EVD infection, and preventive measures such as social distancing, were linked to experiences of stigma and social exclusion among those reintegrating into their communities.

Methods

Key informant interviews (n = 42) and focus group discussions (n = 27) were conducted in districts with a high prevalence of EVD and representing geographical and ethnic diversity (n = 228 participants). The final sample was composed of adults (52%) and children (48%) who were EVD-infected (46%) and -affected (42%) individuals, and community leaders (12%). Data were coded using a Grounded Theory approach informed by Thematic Content Analysis, and analyzed using NVivo. Interrater reliability was high, with Cohen’s κ = 0.80 or higher.

Findings

Participants described two main sources of EVD-related stress: isolation from the community because of social distancing and other prevention measures such as quarantine, and stigma related to infected or affected status. Participants linked experiences of social isolation and stigma to significant distress and feelings of ostracization. These experiences were particularly pronounced among children. Sources of support included community reintegration over time, and formal community efforts to provide education and establish protection bylaws.

Interpretation

This study found that social distancing and EVD-related stigma were each prominent sources of distress among participants. These results suggest that isolation because of infection, and the enduring stigmatization of infected individuals and their families, demand coordinated responses to prevent and mitigate additional psychosocial harm. Such responses should include close engagement with community leaders to combat misinformation and promote community reintegration.

The social epidemiology of Zika: stigma, transmission, and prevention in Brazil

Zika Virus continues to pose a threat to public health in Brazil. In the absence of an infrastructure-focused approach to eradication, it is crucial to understand points of intervention that may increase preventative action in the population. There has been a lack of studies on how socioeconomic and demographic factors relate to attitudes and behaviors surrounding Zika. The purpose of this study was to investigate factors influencing stigma, transmission knowledge, and prevention method use in Brazil.

This study relied on nationally-representative data collected for the 2016/2017 AmericasBarometer survey. A multi-stage national probability sample design was used, yielding 1,532 participants. Items were selected representing three thematic categories: stigmatizing attitudes, accuracy of transmission knowledge, and the frequency of prevention method use. Multi-level modeling was used to assess the relationship between each item and gender, urban/rural living, income, and education, nested by region.

Education level was the strongest and most common predictor overall in this study. Higher levels of education were associated with less stigma against those with Zika, t(677)= 3.41, p < 0.01, and more accurate transmission knowledge, t(1326)=5.31, p < 0.001. For prevention method use, female gender was the strongest predictor, t(1408)=4.85, p < 0.001. These relationships did not differ significantly by region. 

The governmental response to Zika thus far has focused primarily on vector control. This has had limited success and placed the burden of prevention primarily on women and girls. The results of this study suggest that, in the absence of structural change, targeted interventions may be necessary to increase the accuracy of Zika-related knowledge and prevention method use. In addition to community-level interventions, advocacy for equitable access to education and increased availability of comprehensive family planning are critical.

Key messages

There are multi-level barriers to Zika knowledge and prevention use that will require structural, community, and individual-level interventions. Severe weather events driven by climate change will further damage fragile water/sanitation infrastructures in Brazil. Multi-sector collaboration is needed for environmental and population health.

Explanatory variables for women's increased risk for mental health problems in Vietnam

PURPOSE

The United Nations Sustainable Development Goals include gender equality for women, including health, as one of seventeen targets. Within this broad domain, a wide range of research indicates that being female is associated with increased risk for mental health problems, particularly in low- and middle-income countries (LMIC). What is less clear are the trans-diagnostic demographic and environmental risk factors in LMIC that may underlie this increased risk. The purpose of the present study was to identify socio-economic and related disadvantages potentially underlying increased risk for women for mental health-related problems in the Southeast Asian LMIC of Vietnam.

METHODS

Nine hundred and seventy-seven adults were randomly selected from five provinces in central coastal Vietnam. Individuals were assessed cross-sectionally for depression (PHQ-9), anxiety (GAD-7), post-traumatic stress disorder symptoms (PDS), somatic syndrome (SCL-90-R), alcohol dependence (ICD-10), functional impairment (PDS life functioning section), and self-perceived general physical health (SF-36). Trans-diagnostic risk factors assessed included financial stress, education level, exposure to traumatic events, and others.

RESULTS

At the multivariate level, gender explained approximately 5% of the variance in mental health symptoms, with women significantly higher in all mental health domains except alcohol dependency. The trans-diagnostic risk factors explained slightly over half of this variance, with financial stress and lower education levels the two strongest individual explanatory variables for women's increased risk for mental health problems.

CONCLUSIONS

These results suggest that support for gender equality including in regard to economic stability and education may be critical for reducing broad gender disparities in mental health functioning.