Social Media, Public Health Research, and Vulnerability: Considerations to Advance Ethical Guidelines and Strengthen Future Research.

The purpose of this article is to build upon prior work in social media research and ethics by highlighting an important and as yet underdeveloped research consideration: how should we consider vulnerability when conducting public health research in the social media environment? The use of social media in public health, both platforms and their data, has advanced the field dramatically over the past 2 decades. Applied public health research in the social media space has led to more robust surveillance tools and analytic strategies, more targeted recruitment activities, and more tailored health education. Ethical guidelines when using social media for public health research must also expand alongside these increasing capabilities and uses. Privacy, consent, and confidentiality have been hallmarks for ethical frameworks both in public health and social media research. To date, public health ethics scholarship has focused largely on practical guidelines and considerations for writing and reviewing social media research protocols. Such ethical guidelines have included collecting public data, reporting anonymized or aggregate results, and obtaining informed consent virtually. Our pursuit of the question related to vulnerability and public health research in the social media environment extends this foundational work in ethical guidelines and seeks to advance research in this field and to provide a solid ethical footing on which future research can thrive.

Assessing the Mental Health Impact of the COVID-19 Pandemic on US Fire-Based Emergency Medical Services Responders: A Tale of Two Samples (The RAPID Study I).

OBJECTIVE: This study aimed to examine the COVID-19 pandemic's impact on fire service safety culture, behavior and morale, levers of well-being, and well-being outcomes. METHODS: Two samples (Stress and Violence against fire-based EMS Responders [SAVER], consisting of 3 metropolitan departments, and Fire service Organizational Culture of Safety [FOCUS], a geographically stratified random sample of 17 departments) were assessed monthly from May to October 2020. Fire department-specific and pooled scores were calculated. Linear regression was used to model trends. RESULTS: We observed concerningly low and decreasing scores on management commitment to safety, leadership communication, supervisor sensegiving, and decision-making. We observed increasing and concerning scores for burnout, intent to leave the profession, and percentage at high risk for anxiety and depression. CONCLUSIONS: Our findings suggest that organizational attributes remained generally stable but low during the pandemic and impacted well-being outcomes, job satisfaction, and engagement. Improving safety culture can address the mental health burden of this work.

Model Policies to Protect U.S. Fire-Based EMS Responders From Workplace Stress and Violence.

The stress and violence to fire-based emergency medical service responders (SAVER) Systems-Level Checklist is an organizational-level intervention to address stress and violence in emergency medical service (EMS), focused on the development of policy and training. Fire and EMS leadership, first responders, dispatchers, and labor union representatives participated in the SAVER Model Policy Collaborative to develop model policies that resulted from the most feasible checklist items. ThinkLets technology was employed to achieve consensus on the model policies, and an Action SWOT analysis was then conducted to assess facilitators and barriers to policy implementation. The resultant model policies are a systems-level workplace violence intervention for the U.S. fire and rescue service that is ready for implementation. Expected improvements to organizational outcomes such as burnout, job engagement, and job satisfaction are anticipated, as are decreasing assaults and injuries. The SAVER Model Policies have the potential to inform national standards and regulations on workplace violence in EMS.

Development of Personas to Communicate Narrative-Based Information About the HPV Vaccine on Twitter.

Introduction: Personas are based on real-life typologies of people that can be used to create characters and messages to communicate important health information through relatable narrative storylines. Persona development is data-driven and can involve multiple phases of formative research and evaluation; however, personas are largely underutilized in digital health research. The purpose of this study was to create and document persona development to deliver narrative-focused health education for parents on Twitter with the goal of increasing uptake of HPV vaccination among adolescents. Methods: Leveraging data from a mixed-method study conducted in the U.S. with a diverse population of parents with adolescents ages 9-14, we used both qualitative and quantitative data (e.g., the National Immunization Survey-Teen, focus groups, and social media) to create personas. These data sources were used to identify and develop key characteristics for personas to reflect a range of parents and their diverse understandings and experiences related to HPV vaccination. A parent advisory board provided insight and helped refine persona development. Results: Four personas emerged and were characterized as the (1) Informed Altruist, (2) Real Talker, (3) Information Gatherer, and (4) Supporter. Characteristics differed across personas and provided insights into targeted narrative strategies. Described attributes included demographics, psychographics, communication style, vaccine goals and aspirations, vaccine challenges and frustrations, and vaccine hesitancy. Discussion: This work demonstrates how multiple data sources can be used to create personas to deliver social media messages that can address the diverse preferences and needs of parents for HPV vaccine information. With increasing usage of social media for health information among parents, it is important for researchers to consider marketing and design thinking to create health communication messages that resonate with audiences.

Meeting science meets public health: Results from the "Stress and Violence in fire-based EMS Responders (SAVER)" Systems Checklist Consensus Conference (SC3).

INTRODUCTION: In order to implement a systems-level Emergency Medical Services (EMS) workplace violence intervention, input from end users was critically needed. We convened the two-day Stress and Violence in fire-based EMS Responders (SAVER)" Systems Checklist Consensus Conference (SC3) using methods from meeting science (i.e., ThinkLets) to comprehensively and efficiently gather feedback from stakeholders on the completeness and utility of the draft checklist that would comprise the intervention. METHODS: ThinkLets, a codified facilitation technique was used to aid brainstorming, convergence, organization, evaluation, and consensus building activities on the SAVER Systems Checklist among 41 national stakeholders during a two-day conference. A qualitative and quantitative process evaluation was conducted to measure the effectiveness of conference procedures. To verify checklist feasibility results from the conference, a second feasibility assessment was conducted with the four implementation sites. CONCLUSIONS: The quantitative conference evaluation results indicated most participants viewed the conference process favorably. Emergent themes reflecting on conference effectiveness and suggestions for improvements are described. The re-evaluation of the checklist's feasibility completed by the SAVER study sites confirmed prior feasibility findings. SAVER study sites cast 45.5% of votes on checklist items to be most feasible, 34.9% as less feasible, and 19.6% as extremely difficult. Practical Applications: Multidisciplinary collaboration between public health, occupational health psychology, and meeting science led to the development of the SAVER Systems Checklist. The checklist underscores important needs for EMS policy and training development critical to responder safety as identified and supported by over 41 diverse subject matter experts. The incorporation of a widely used meeting science method, ThinkLets, into public health intervention design proved an effective and well-received approach to bring assessment, evaluation, and consensus to the SAVER Systems Checklist. These methods may hold benefit for other industries and disciplines that may not be familiar with such facilitation and consensus-building techniques.

Creation of a Systems-Level Checklist to Address Stress and Violence in Fire-Based Emergency Medical Services Responders.

Between 57 and 93% of Emergency Medical Services (EMS) responders reported having experienced verbal or physical violence at least once in their career. Therefore, the primary goal of this study was to develop a systems-level checklist for violence against fire-based EMS responders using findings from a systematic literature review and outcomes from a national stakeholder meeting. First, a literature review of violence against EMS responders resulted in an extensive list of 162 academic and industrial publications. Second, from these sources, 318 potential candidate items were developed. Third, Q-methodology was employed to categorize, refine, and de-duplicate the items. Fourth, ThinkLet systems facilitated consensus-building, collaboration, and evaluation of the checklist with diverse subject matter experts representing 27 different EMS organizations, government, academia, labor unions, and fire departments during a two-day consensus conference. The final SAVER checklist contains 174 items organized by six phases of EMS response: pre-event, traveling to the scene, scene arrival, patient care, assessing readiness to return to service, and post-event. So called pause points for the individual EMS responder were incorporated at the end of each of phase. Overall, 47.5% of votes across all phases rated items as most feasible, 33.7% as less feasible, and 11.6% as extremely difficult. The SAVER systems-level Checklist is an innovative application of traditional checklists, designed to shift the onus of safety and health from that of the individual first responder to the organization by focusing on actions that leadership can institute through training, policy, and environmental modifications.