Readiness to Implement a Doula-Hospital Partnership Program.

OBJECTIVE: To assess obstetric clinicians' and leaders' baseline knowledge, attitudes, and experience with doulas and their readiness to implement a novel doula-hospital partnership program. DESIGN: Survey of obstetric clinicians and leaders before implementation of the doula program. SETTING/LOCAL PROBLEM: Academic medical center in Western Massachusetts that was preparing to pilot a doula-hospital partnership program with Black doulas for Black women to address racial disparities in maternal morbidity and mortality. PARTICIPANTS: Obstetric clinicians and leaders (N = 48). INTERVENTION/MEASUREMENTS: We used established questions from the Organizational Readiness for Implementing Change (ORIC) scale and original questions to assess participants' knowledge, attitudes, and experiences with doulas and their readiness to implement the planned doula program. We distributed the questionnaire to 103 potential respondents. We conducted descriptive and bivariate analyses and analyzed open-ended responses using content analysis. RESULTS: Forty-eight participants responded to the survey. Of those who provided intrapartum care (n = 45), all were familiar with doula roles. Respondents who reported having experience working with a doula, 47.3% (n = 18/38) had at least one prior negative experience with a doula and 76.3% (n = 29/38) reported positive experiences with doulas. However, there was a mean score of 12.62 on the attitude toward doulas (scale range: 3-15). The mean score on the ORIC change commitment subscale was 20.65 (range: 15-25) and on the ORIC change efficacy subscale, mean score was 29.31 (range: 19-35). Results did not differ by participants characteristics. CONCLUSION: Our findings suggested strong support for and readiness to implement the doula-hospital partnership program.

Communication of COVID-19 Misinformation on Social Media by Physicians in the US.

Importance: Approximately one-third of the more than 1 100 000 confirmed COVID-19-related deaths as of January 18, 2023, were considered preventable if public health recommendations had been followed. Physicians' propagation of misinformation about COVID-19 on social media and other internet-based platforms has raised professional, public health, and ethical concerns. Objective: To characterize (1) the types of COVID-19 misinformation propagated by US physicians after vaccines became available, (2) the online platforms used, and (3) the characteristics of the physicians spreading misinformation. Design, Setting, and Participants: Using US Centers for Disease Control and Prevention guidelines for the prevention and treatment of COVID-19 infection during the study window to define misinformation, structured searches of high-use social media platforms (Twitter, Facebook, Instagram, Parler, and YouTube) and news sources (The New York Times, National Public Radio) were conducted to identify COVID-19 misinformation communicated by US-based physicians between January 2021 and December 2022. Physicians' state of licensure and medical specialty were identified. The number of followers for each physician on 4 major platforms was extracted to estimate reach and qualitative content analysis of the messages was performed. Main Outcomes and Measures: Outcome measures included categories of COVID-19 misinformation propagated, the number and traits of physicians engaged in misinformation propagation, and the type of online media channels used to propagate misinformation and potential reach. Results: The propagation of COVID-19 misinformation was attributed to 52 physicians in 28 different specialties across all regions of the country. General misinformation categories included vaccines, medication, masks, and other (ie, conspiracy theories). Forty-two physicians (80.8%) posted vaccine misinformation, 40 (76.9%) propagated information in more than 1 category, and 20 (38.5%) posted misinformation on 5 or more platforms. Major themes identified included (1) disputing vaccine safety and effectiveness, (2) promoting medical treatments lacking scientific evidence and/or US Food and Drug Administration approval, (3) disputing mask-wearing effectiveness, and (4) other (unsubstantiated claims, eg, virus origin, government lies, and other conspiracy theories). Conclusions and Relevance: In this mixed-methods study of US physician propagation of COVID-19 misinformation on social media, results suggest widespread, inaccurate, and potentially harmful assertions made by physicians across the country who represented a range of subspecialties. Further research is needed to assess the extent of the potential harms associated with physician propagation of misinformation, the motivations for these behaviors, and potential legal and professional recourse to improve accountability for misinformation propagation.

A Qualitative Study of Health Workers' Experiences During Early Surges in the COVID-19 Pandemic in the U.S.: Implications for Ongoing Occupational Health Challenges.

Background: Health workers (HWs) have faced significant threats to physical and psychological health during the COVID-19 pandemic. The recent surges associated with the spread of the delta variant in the U.S., coupled with political resistance to effective public health mitigation strategies, indicate that the risks experienced early in the pandemic are not likely to abate soon. This study sought to better understand the experiences, thoughts, concerns, and recommendations of HWs during one of the first major surges in the U.S. and to explore how these experiences might inform efforts to mitigate potential ongoing COVID-related negative health and psychological impacts on HWs. Methods: HWs were recruited using a multi-faceted approach tailored to public health mitigation guidelines. Semi-structured interviews were conducted via video conference with front line HWs, support staff, and opioid use disorder service organization providers between April 1 and July 9, 2020 using the Social-Ecological Model as a framework. Interviews were audio-recorded and professionally transcribed; transcripts were analyzed inductively and deductively using thematic analytic methods, generating major themes and subthemes. Results: A total of 22 HWs participated in the study; 14 were female; 3 identified as a member of a racial or ethnic minority population. Major themes identified included: (1) Institutions, Infrastructure, and the Pandemic; (2) Working Under Fire; (3) The Political Becomes Personal and (4) Hope. Themes and subthemes explicated the ways in which phenomena at personal, interpersonal, community, organizational, and societal levels affected HWs experiences and suggested potential mechanisms through which negative effects on HW mental health and health may be mitigated. Conclusions: Previous global infectious disease epidemics have had profound negative effects on HWs' health and mental health. This study suggests the potential for similar negative impacts that may be exacerbated by the U.S.'s current sociopolitical milieu. Efforts to systematically describe and quantify these effects and to intervene to mitigate them are warranted.

Community Perspectives on the Creation of a Hospital-Based Doula Program.

Objective: Racial and ethnic inequities in perinatal health outcomes are pervasive. Doula support is an evidence-based practice for improving maternal outcomes. However, women in lower-income populations often do not have access to doulas. This study explored community perspectives on doula care to inform the development of a hospital-based doula program to serve primarily low-income women of color. Methods: Four focus groups and four individual interviews were conducted with: (1) women who were pregnant or parenting a child under age 2 (n=20); (2) people who had provided support during a birth in the previous 2 years (n=5); and (3) women who had received doula training (n=4). Results: Participants had generally positive perceptions of doula services. Many aspects of doula support desired by participants are core to birth doula services. Participants identified ways that doulas could potentially address critical gaps in health care services known to impact outcomes (e.g., continuity of care and advocacy), and provide much-needed support in the postpartum period. Responses also suggested that doula training and hospital-based doula programs may need to be adapted to address population-specific needs (e.g., women with substance use disorder and younger mothers). Novel program suggestions included "on call" informational doulas. Conclusions: Findings suggested that women in racial/ethnic minority and lower income groups may be likely to utilize a hospital-based doula program and identified adaptations to traditional doula care that may be required to best meet the needs of women in groups with higher risk of poor maternal health and birth outcomes.