Undergraduate Learning in the COVID-19 Pandemic: Lessons Learned and Ways Forward.

The SARS-CoV-2 coronavirus (COVID-19) pandemic is in constant evolution, much like the virus, and we must learn to adapt our undergraduate education and learning strategies to enable students to complete their studies. This narrative review focuses on what is currently known about the face-to-face and e-learning strategies of undergraduate medical students in resource-limited settings during the COVID-19 pandemic. The majority of studies, involving health professional students, took place in 2020. Few involved educators. Students have faced challenges with the transition to remote learning, for which a couple of interventions have been devised. Bridging the gap in access and utilisation of remote learning might have required more time, however, the COVID-19 pandemic has accelerated the learning curve and the transition from in-person to online learning.

Implementing Psychological First Aid for Healthcare Workers During the COVID-19 Pandemic: A Feasibility Study of the ICARE Model.

Maintaining the resilience of healthcare workers (HCWs) during the protracted COVID-19 pandemic is critical as chronic stress is associated with burnout, inability to provide high-quality care, and decreased attentiveness to infection prevention protocols. Between May and July 2020, we implemented the ICARE model of psychological first aid (PFA) in a novel online (i.e., telehealth) format to address the psychological support needs of HCWs during the COVID-19 pandemic. We found that HCWs needed psychological support related to obtaining clear information about pandemic policies and guidelines, navigating new rules and responsibilities, and processing overwhelming and conflicting emotions. The HCWs in our program repeatedly expressed appreciation for the support we provided. Future directions include establishing online discussion forums, increasing opportunities for individual support, and training HCWs to provide peer support using PFA. This program has far-reaching potential benefit to HCWs and to society at large in the context of a pandemic.

Utilizing Digital Storytelling to Develop a Public Health Professions Pathway for Native American High School Students.

Digital storytelling is a decentering methodology in health promotion that positions the storyteller as an expert to create a narrative of their lived experiences. This article describes using a two-phase digital storytelling process within the Diné (Navajo) Educational Philosophy framework to guide the development of a culturally grounded curriculum plan that actively engages Diné youth in exploring health professions pathways in their community. The first phase consisted of developing a high school digital storytelling team by training three Diné youth attending high school on the Navajo Nation located in southwest United States, in digital storytelling. In the second phase, the high school digital storytelling team worked collaboratively with seven Diné students enrolled at the local tribal college to develop digital stories about navigating from high school to college. Data from seven completed digital stories were analyzed with assistance from a community advisory board to identify asset-based themes that contributed to positively transitioning from high school to a tribal college. The results revealed several strategies for successful transitions from high school to a public health college major. The culturally relevant strategies and stories were incorporated into a school-based health professions pathway curriculum plan for Diné youth.

Getting to the Emergency Department in time: Interviews with patients and their caregivers on the challenges to emergency care utilization in rural Uganda.

OBJECTIVES: Karoli Lwanga Hospital and Global Emergency Care, a 501(c)(3) nongovernmental organization, operate an Emergency Department (ED) in Uganda's rural Rukungiri District. Despite available emergency care (EC), preventable death and disability persist due to delayed patient presentations. This study seeks to understand the emergency care seeking behavior of community members utilizing the established ED. METHODS: We purposefully sampled and interviewed patients and caregivers presenting to the ED more than 12 hours after onset of chief complaint in January-March 2017 to include various ages, genders, and complaints. Semistructured interviews addressing actions taken before seeking EC and delays to presentation once the need for EC was recognized were conducted until a diverse sample and theoretical saturation were obtained. An interdisciplinary and multicultural research team conducted thematic analysis based on descriptive phenomenology. RESULTS: The 50 ED patients for whom care was sought (mean age 33) had approximately even distribution of gender, as well as occupation (none, subsistence farmers and small business owner). Interviews were conducted with 13 ED patients and 37 caregivers, on the behalf of patients when unavailable. The median duration of patients' chief complaint on ED presentation was 5.5 days. On average, participants identified severe symptoms necessitating EC 1 day before presentation. Four themes of treatment delay before and after severity were recognized were identified: 1) Cultural factors and limited knowledge of emergency signs and initial actions to take; 2) Use of local health facilities despite perception of inadequate services; 3) Lack of resources to cover the anticipated cost of obtaining EC; 4) Inadequate transportation options. CONCLUSIONS: Interventions are warranted to address each of the four major reasons for treatment delay. The next stage of formative research will generate intervention strategies and assess the opportunities and challenges to implementation with community and health system stakeholders.

Engaging Native American High School Students in Public Health Career Preparation Through the Indigenous Summer Enhancement Program.

Native American populations are systematically marginalized in the healthcare and public health workforce. One effective approach to reduce health disparities and improve health care delivery among Indigenous populations is to train more Native American health professionals who integrate academic and cultural knowledge to understand and influence health behaviors and perspectives. Diné College partnered with Northern Arizona University to develop the Navajo Native American Research Center for Health (NARCH) Partnership, funded by the National Institutes of Health. The high school component of the Navajo NARCH Partnership created the Indigenous Summer Enhancement Program (ISEP), a 1-week summer training program providing exposure to health careers and mentorship in pursuing public health careers for Native American high school students. ISEP utilizes the Diné Educational Philosophy (DEP), a Navajo conceptual framework to serve as the foundation of the program. In 2020-2021, due to COVID-19 restrictions, the DEP model had to be incorporated in the Navajo NARCH high school virtual program activities. ISEP used 2018 and 2019 past program evaluation data to inform the virtual programming. Students' perception of the program was collected using an online Qualtrics evaluation questionnaire. Students stated appreciation for program staff, fellow students, peer mentors and culturally relevant learning experiences in both virtual and in-person environments. Recommendations included: expanding the length of ISEP and continuing the hands-on activities and Public Health Leadership series.

Organizational Readiness for Community Health Worker Workforce Integration Among Medicaid Contracted Health Plans and Provider Networks: An Arizona Case Study.

Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona - which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff.

Adapting Summer Education Programs for Navajo Students: Resilient Teamwork.

In May 2020, the Navajo Native American Research Center for Health Partnership (Navajo NARCH) was scheduled to launch two summer programs: a 10 weeks-long Summer Research Enhancement Program (SREP) for undergraduate students to learn and practice health research methods and participate in a practicum experience, and a week-long Indigenous Summer Enhancement Program (ISEP) for high school students that introduces a range of health professions and develops leadership qualities. Students accepted into the programs are predominantly Navajo and live within Navajo Nation (NN) during the summer. Due to NN restrictions and CDC guidelines for physically distancing in response to the coronavirus (COVID-19) pandemic, the Navajo NARCH team organized to offer both programs entirely online via Zoom™. This paper explores the instructional teams' adaptation process to maintain a commitment to preserve the programs' supportive environment for exploring and developing strong multicultural approaches in public health and health research. In preparation for online instruction, the team developed and offered workshops for staff and instructors to address anticipated challenges. The team identified the following challenges: technological difficulties, social disconnectedness, consistent student engagement, and facilitation of a practicum research experience. Results showed that program adaptations were successful as the team applied collaborative and holistic approaches, and established social connections remotely with students to offer meaningful research and practicum experiences.

Association between Measures of Women's Empowerment and Use of Modern Contraceptives: An Analysis of Nigeria's Demographic and Health Surveys.

BACKGROUND: Women's empowerment is hypothesized as a predictor of reproductive health outcomes. It is believed that empowered girls and women are more likely to delay marriage, plan their pregnancies, receive prenatal care, and have their childbirth attended by a skilled health provider. The objective of this study was to assess the association between women's empowerment and use of modern contraception among a representative sample of Nigerian women. METHODS: This study used the 2003, 2008, and 2013 Nigeria Demographic and Health Survey data. The analytic sample was restricted to 35,633 women who expressed no desire to have children within 2 years following each survey, were undecided about timing for children, and who reported no desire for more children. Measures of women's empowerment included their ability to partake in decisions pertaining to their healthcare, large household purchases, and visit to their family or relatives. Multivariable regression models adjusting for respondent's age at first birth, religion, education, wealth status, number of children, and geopolitical region were used to measure the association between empowerment and use of modern contraceptives. RESULTS: The proportion of women who participated in decisions to visit their relatives increased from 42.5% in 2003 to 50.6% in 2013. The prevalence of women involved in decision-making related to large household purchases increased from 24.3% in 2003 to 41.1% in 2013, while the proportion of those who partook in decision related to their health care increased from 28.4% in 2003 to 41.9% in 2013. Use of modern contraception was positively associated with women's participation in decisions related to large household purchases [2008: adjusted OR (aOR) = 1.15; 95% CI = 1.01-1.31] and (2013; aOR = 1.60; 1.40-1.83), health care [2008: (aOR = 1.20; 1.04-1.39) and (2013; aOR = 1.39; 1.22-1.59)], and visiting family or relatives [2013; aOR = 1.58; 1.36-1.83]. The prevalence of modern contraceptive use among women with need for contraception increased marginally from 11.1% in 2003 to 12.8% in 2013. CONCLUSION: Although there were marked improvements in all measures of women's empowerment between 2003 and 2013 in Nigeria, the use of modern contraceptives increased only marginally during this period. Beyond women's participation in household decision-making, further research is needed to elucidate how measures of women's empowerment interact with cultural values and health system factors to influence women's uptake of contraceptives.