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Frontiers in Public Health 2023Reevaluating response plans is essential to ensuring consistent readiness and resilience to the COVID-19 pandemic. The "During Action Review" and Tabletop (DART)... (Review)
Review
BACKGROUND
Reevaluating response plans is essential to ensuring consistent readiness and resilience to the COVID-19 pandemic. The "During Action Review" and Tabletop (DART) methodology provides a retrospective and prospective assessment to inform the adaptive response. Israel introduced COVID-19 vaccinations in December 2020 and was the first country to implement booster vaccination to address waning immunity and surges caused by new variants. We assessed Israel's readiness and resilience related to COVID-19 response while capturing the pre-vaccination and vaccination periods.
METHODS
A DART analysis was conducted between December 2020 and August 2021 among experts involved in the management of the COVID-19 pandemic in Israel. During the retrospective stage, a role-based questionnaire and discussions were undertaken in a participant-led review of the response, focusing on epidemiology and surveillance, risk communication, and vaccines. The prospective stage included tabletop exercises to evaluate short to long-term simulated scenarios.
RESULTS
Participants emphasized the pivotal role of Israel globally by sharing experiences with the pandemic, and vaccination. Perceived strengths included multi-sectoral collaboration between the Ministry of Health, healthcare providers, academia, military, and others, stretching capacities, expanding laboratory workload, and establishing/maintaining surveillance. The vaccine prioritization plan and strong infrastructure, including computerized databases, enabled real-life assessment of vaccine uptake and impact. Challenges included the need to change case definitions early on and insufficient staffing. Quarantine of patients and contacts was particularly challenging among underprivileged communities. Risk communication approaches need to focus more on creating norms in behavior. Trust issues and limited cooperation were noted, especially among ethnic and religious minorities. To ensure readiness and resiliency, participants recommended establishing a nationally deployed system for bringing in and acting upon feedback from the field, especially concerning risk communication and vaccines.
CONCLUSION
Our study appraised strengths and weaknesses of the COVID-19 pandemic response in Israel and led to concrete recommendations for adjusting responses and future similar events. An efficient response comprised multi-sectoral collaboration, policy design, infrastructure, care delivery, and mitigation measures, including vaccines, while risk communication, trust issues, and limited cooperation with minority groups were perceived as areas for action and intervention.
Topics: Humans; COVID-19; Israel; Pandemics; Prospective Studies; Resilience, Psychological; Retrospective Studies; Vaccines
PubMed: 38328537
DOI: 10.3389/fpubh.2023.1308267 -
Israel Journal of Health Policy Research Apr 2023COVID-19 is disproportionately affecting disadvantaged populations, with greater representation and worse outcomes in low socioeconomic and minority populations, and in...
BACKGROUND
COVID-19 is disproportionately affecting disadvantaged populations, with greater representation and worse outcomes in low socioeconomic and minority populations, and in persons from marginalized groups. General health care system approaches to inequity reduction (i.e., the minimization of differences in health and health care which are considered unfair or unjust), address the major social determinants of health, such as low income, ethnic affiliation or remote place of residents. Yet, to effectively reduce inequity there is a need for a multifactorial consideration of the aspects that intersect and generate significant barriers to effective care that can address the unique situations that people face due to their gender, ethnicity and socioeconomic situation.
MAIN BODY
To address the health equity challenges of diverse population groups in Israel, we propose to adopt an intersectional approach, allowing to better identify the needs and then better tailor the infection prevention and control modalities to those who need them the most. We focus on the two main ethnic - cultural-religious minority groups, that of Arab Palestinian citizens of Israel and Jewish ultra-orthodox (Haredi) communities. Additionally, we address the unique needs of persons with severe mental illness who often experience an intersection of clinical and sociodemographic risks.
CONCLUSIONS
This perspective highlights the need for responses to COVID-19, and future pandemic or global disasters, that adopt the unique lens of intersectionality and equity. This requires that the government and health system create multiple messages, interventions and policies which ensure a person and community tailored approach to meet the needs of persons from diverse linguistic, ethnic, religious, socioeconomic and cultural backgrounds. Under-investment in intersectional responses will lead to widening of gaps and a disproportionate disease and mortality burden on societies' most vulnerable groups.
Topics: Humans; COVID-19; Health Equity; Israel; Intersectional Framework; Minority Groups
PubMed: 37098624
DOI: 10.1186/s13584-023-00567-8 -
Frontiers in Public Health 2021As the rates of infection and mortality from COVID-19 have been higher in minority groups, the communication of health information in a way that is understood and... (Review)
Review
As the rates of infection and mortality from COVID-19 have been higher in minority groups, the communication of health information in a way that is understood and accepted is of particular importance. To provide health professionals with a clinical practice guideline for clear and culturally sensitive communication of health information about COVID-19 to people of Indigenous and culturally and linguistically diverse (CALD) backgrounds. The authors conducted a review of the literature on health communication, and the guidelines were developed with particular reference to the SPIKES protocol of "breaking bad news" in oncology and the use of the DSM-5 Cultural Formulation Interview (CFI). The guideline combines two approaches, the Cultural Formulation Interview, developed for DSM-5, and the SPIKES protocol used for delivering "bad news" in oncology. The combined CFI-SPIKES protocol is a six-step clinical practice guideline that includes the following: (1) Set up (S) the interview; (2) Determine how the patient perceives the problem (P) using the Cultural Formulation Interview (CFI) to elicit the patient's cultural perception of the problem; (3) Obtain an invitation (I) from the patient to receive a diagnosis; (4) Provide the patient knowledge (K) of diagnosis in a non-technical way; (5) Address the patient's emotional reaction (E) to diagnosis; and (6) Provide the patient a summary (S) of healthcare and treatment. This article presents guidelines for assessing the cultural dimensions of patients' understanding of COVID-19 and delivering diagnostic and treatment recommendations in ways that are culturally safe and responsive, such as: (a) suspending the clinician's own cultural biases to understand the explanatory models and cultural values of their CALD or Indigenous patients; (b) encouraging the use of interpreters or cultural brokers to ensure that that the message is delivered in a way that the patient can understand; and (c) encouraging CALD or Indigenous patient to take an active part in the solution and treatment adherence, to minimize transmission of COVID-19 in CALD and Indigenous communities.
Topics: COVID-19; Cultural Diversity; Health Personnel; Humans; Minority Groups; SARS-CoV-2
PubMed: 34249822
DOI: 10.3389/fpubh.2021.584000 -
European Journal of Public Health Apr 2021While many studies focus on specific aspects of Unaccompanied Migrant Minors' (UMMs) health, especially mental well-being, there is a lack of tools comprehensively... (Review)
Review
BACKGROUND
While many studies focus on specific aspects of Unaccompanied Migrant Minors' (UMMs) health, especially mental well-being, there is a lack of tools comprehensively assessing their needs. To fill this gap, we developed and validated a questionnaire to thoroughly assess unAccompaniEd miGrant mInorS' physical, psychological, legal, spiritual, social and educational needs (AEGIS-Q).
METHODS
This work consisted of three stages. The first one involved an extensive literature review. Given the results of the review, a first draft of the questionnaire was developed and submitted to a panel of experts for validation (Delphi method-second stage). During the third stage, the final version of the questionnaire was pilot-tested in a sample of 18 UMMs.
RESULTS
The questionnaire, drafted based on the results of the review, consisted of sections covering personal data, migration profile, physical health needs and access to healthcare, psychological needs, legal needs, spiritual needs and educational and social needs of UMMs. After two Delphi rounds, the final version of the questionnaire, consisting of 83 questions, was structured. The pilot study had a response rate of 89-100%. We found substantial reliability for most of the sections in the questionnaire, including physical health (α=0.652), legal (α=0.781), and educational and social (α=0.614) needs. The questions regarding psychological needs had very high reliability (α=0.860).
CONCLUSIONS
The questionnaire offers a useful sharable tool to assess and monitor UMMs' needs, helping the reception system to better know and meet their needs and implement the taking in charge.
Topics: Humans; Minors; Pilot Projects; Reproducibility of Results; Surveys and Questionnaires; Transients and Migrants
PubMed: 33176357
DOI: 10.1093/eurpub/ckaa184 -
Disability and Rehabilitation Sep 2021We completed a scoping review to: (1) identify strategies that have been used to engage hard-to-reach populations in childhood disability research, and (2) synthesize... (Review)
Review
PURPOSE
We completed a scoping review to: (1) identify strategies that have been used to engage hard-to-reach populations in childhood disability research, and (2) synthesize information as to whether and how these strategies were evaluated.
METHODS
Systematic search of six electronic databases and grey literature to identify articles published in the last 10 years. Studies published in English, French, and Spanish reporting on strategies used to engage hard-to-reach populations in childhood disability research were eligible for inclusion.
RESULTS
Out of 106 articles selected for full text review, 16 were included. Engagement was more common in earlier stages of research. The populations included in studies were children with disabilities and their parents. Engagement strategies were reported but rarely evaluated. Anecdotal outcomes of engagement were reported in 14/16 studies and included positive outcomes for the children and parents such as empowerment. The challenges with engagement included the increased time needed to engage children with disabilities or their parents.
CONCLUSIONS
Our results can guide others who wish to engage a diverse group of children with disabilities and their parents in research. Research on how to engage other hard-to-reach populations within the childhood disability umbrella and evaluation of engagement strategies and outcomes is needed.IMPLICATIONS FOR REHABILITATION• Service providers should be concerned when the research informing their practices does not include families that represent their clients (e.g., families who are low income, Indigenous, ethnic minority, or LGBTQI parents of children with disabilities).• Strategies used to include children with disabilities in research, such as offering varied response methods that include story telling or photography, may also be used to promote participation in clinical services.• Service providers and teachers may have a role in facilitating the recruitment of 'hard-to-reach' families in research and advising researchers on methods to create a comfortable environment with accessible means of data collection for children with disabilities.
Topics: Data Collection; Ethnicity; Humans; Minority Groups; Parents; Poverty
PubMed: 31999495
DOI: 10.1080/09638288.2020.1717649 -
Health & Social Care in the Community Jan 2020Studies show that women are more vulnerable to human immunodeficiency virus (HIV) transmission than men because of biological and sociocultural risk factors. Israeli...
Studies show that women are more vulnerable to human immunodeficiency virus (HIV) transmission than men because of biological and sociocultural risk factors. Israeli Arab-Palestinians are the largest ethnic minority group in Israel. Unofficial data suggest that merely one percent of the tests conducted in Israel to diagnose HIV/acquired immune deficiency syndrome (AIDS) are conducted by this population and that Israeli Arab-Palestinians are typically diagnosed late. Arab communities in Israel were found to be predominately patriarchal, characterised by conservative gender roles and structures, and the policing of overt sexual behaviours, particularly those of women. In order to advance our understanding of the HIV/AIDS phenomenon in different sociocultural contexts, as well as to design effective cultural-sensitive interventions, we must first understand how HIV/AIDS is constructed in different cultural sites. Against this backdrop, this exploratory study examines HIV/AIDS-related beliefs among non-infected, Israeli Arab-Palestinian women. We conducted semi-structured interviews with 12 women. Thematic content analysis was used in order to analyse the data. Five themes emerged from the analysis, in the first, personal responsibility and blame were assigned to people with HIV/AIDS for their illness. In the second theme, HIV/AIDS was constructed as a sexually transmitted disease, associated with 'deviant' sexuality and sexual conduct in the Arab culture. In the third theme, HIV/AIDS was believed to be transmitted by multiple, mostly mistaken, modes of contact. In the fourth theme, people with HIV/AIDS were believed to be subjected to severe negative social responses. In the fifth theme, individuals with HIV/AIDS were depicted as a symbol of physical and psychological malaise. In conclusion, the findings imply that Israeli Arab-Palestinian women hold negative beliefs concerning people with HIV/AIDS and are misinformed regarding HIV transmission. This suggests a need to design culturally appropriate interventions to address stigma-related beliefs and misconceptions concerning transmission, among Israeli Arab-Palestinian women.
Topics: Adult; Arabs; Cultural Characteristics; Family Characteristics; Female; HIV Infections; Humans; Israel; Male; Minority Groups; Social Stigma; Women's Health
PubMed: 31515884
DOI: 10.1111/hsc.12855 -
Clinical Pharmacology and Therapeutics Aug 2019Health disparities exist among minorities in the United States, with differences seen in disease prevalence, mortality, and responses to medications. These differences... (Review)
Review
Health disparities exist among minorities in the United States, with differences seen in disease prevalence, mortality, and responses to medications. These differences are multifactorial with genetic variation explaining a portion of this variability. Pharmacogenomics aims to find the effect of genetic variations on drug response, with the goal of optimizing drug therapy and development. Although genome-wide association studies have been useful in unbiasedly surveying the genome for genetic drivers of clinically relevant phenotypes, most of these studies have been conducted in mainly participants of European and Asian descent, contributing to a growing health disparity in precision medicine. Diversity is important to pharmacogenomic studies, and there may be real advantages to the use of these complex genomes in pharmacogenomics. In this review we will outline some of the advantages and confounders of pharmacogenomics in minorities, describe the role of genetic variation in pharmacologic pathways, and highlight a number of population-specific findings.
Topics: Biotransformation; Health Status Disparities; Humans; Minority Groups; Pharmacogenetics; Pharmacogenomic Variants
PubMed: 31038731
DOI: 10.1002/cpt.1491 -
Journal of General Internal Medicine Apr 2023Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and... (Review)
Review
Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and ethnic minority group in the United States (US). Many members of this group report limited English proficiency, experience discrimination, feel distrust in the healthcare setting, and face poorer health outcomes than non-Latinx Whites. As healthcare systems assess internal structures of care, understanding the experiences of Latinx patients may inform strategies to improve care. This narrative review describes studies that assessed the experiences of Latinx patients with limited English proficiency (LEP) in the inpatient and outpatient settings in the US. We searched PubMed for studies published between January 1, 1990, and March 2021. We reviewed all citations and available abstracts (n = 429). We classified study titles (n = 156) as warranting detailed consideration of the original article. Limited English proficiency is a well-documented challenge reported by Latinx patients seeking care in the outpatient setting, resulting in mistrust of healthcare organizations and clinicians. The effects of LEP overlap substantially with challenges related to patients' immigration status, cultural traditions, and socioeconomic needs. Use of professional interpretation rather than ad hoc interpretation improves trust and satisfaction. There is no consensus about the most effective mode of delivering professional interpretation (in person, telephonic, video conferencing), although rapid simultaneous telephone translation is a promising modality. Increasing awareness of the barriers to effective communication, improving skills in communicating through translators, and increasing the amount of time spent with patients may improve communication and trust more than structural changes like mode of translation or bedside rounding. Cultural fluency training, standardized language training for providers, and incentive pay for fluency are also deserving of further consideration.
Topics: Humans; United States; Ethnicity; Limited English Proficiency; Minority Groups; Delivery of Health Care; Communication; Communication Barriers
PubMed: 36720766
DOI: 10.1007/s11606-022-07995-3 -
Psychology Research and Behavior... 2022Intergroup contact is an effective strategy to improve intergroup relationships. Although intergroup relationships have been studied extensively, the individual roles of...
PURPOSE
Intergroup contact is an effective strategy to improve intergroup relationships. Although intergroup relationships have been studied extensively, the individual roles of quantity and quality of contact in relationships with cognition, emotion, and intention of behavior toward other ethnic minority groups are not fully understood. This study explores the situation via network analysis among Zhuang and Yao ethnic minorities in Southwest China.
METHODS
We investigated the quantity and quality of intergroup contact and cognition, emotion, and intention of behavior among a sample of 543 Zhuang and 490 Yao ethnic group members. Data were analyzed using the R-package. Network structures were analyzed via the Qgraph package, and the accuracy and stability of the network were measured via the Bootnet package; communities were detected via the Igraph package; bridge analyses were conducted via the Networktools package; and the network difference was compared via the Network Comparison Test package.
RESULTS
The results indicated perceived intimacy is the central node. Quantity of contact constructed a community with "perceived connection," "sense of community," "knowledge about out-group," and "perceived similarity." Meanwhile, quality of contact constructed a community with "intergroup attitude" and a "feeling thermometer." The remainder of the nodes constructed two additional communities. The network global connectivity and structure between the two ethnic groups were highly similar.
CONCLUSION
The study examined the quantity and quality of intergroup contact via network analysis for two ethnic minority groups. It was shown that the two groups' global network structures of intergroup contact and their effects are highly similar. Specifically, quantity and quality of contact produce different effects on intergroup relations. Quantity of contact has proximal effects, including instant cognitive and emotional response without depth cognition, while quality of contact has proximal effects that may change deep-seated cognition and subsequently improve intergroup relations.
PubMed: 35027853
DOI: 10.2147/PRBM.S336740 -
Disaster Medicine and Public Health... Mar 2023Coronavirus disease 2019 (COVID-19) and future pandemics have become a reality, and planners must understand how attitudes during COVID-19 may influence future...
OBJECTIVE
Coronavirus disease 2019 (COVID-19) and future pandemics have become a reality, and planners must understand how attitudes during COVID-19 may influence future preparedness activities. This study explores how personal experiences of Americans during the pandemic, attitudes about institutions, and views of social change could either pose challenges or help with planning for the next pandemic.
METHODS
A longitudinal survey capturing health attitudes and COVD-19-related experiences was fielded 3 times over the course of the pandemic among historically underserved individuals in US society (racial/ethnic minority and low-income populations).
RESULTS
COVID-19-related experiences increased over time. Attitudes about federal and state government and businesses' ability to respond to the pandemic varied by COVID-19-related experience and having any COVID-19-related experience was associated with a lower likelihood of reporting positive attitudes about institutions. Respondents generally perceived that COVID-19 presented an opportunity for positive social change, and those with COVID-19-related experiences had the greatest likelihood of selecting "reduce income inequality" as their top prioritized change. Those with COVID-19-related experiences were less likely to endorse other policy priorities such as protecting freedoms.
CONCLUSIONS
Anticipating potential backlash or other sentiments could improve pandemic responsiveness. Strengthening public institutions is crucial to ensuring their effectiveness during a pandemic. Pandemic planning could exploit opportunities to take other social policy actions where views seem to converge.
Topics: Humans; United States; COVID-19; Pandemics; Ethnicity; Minority Groups; Social Media; Attitude to Health
PubMed: 36927518
DOI: 10.1017/dmp.2023.38