"I Learned Myself": Using Structuration Theory to Uncover Korean Immigrants' Health Literacy Development in the U.S. as an Agentic Behavior During the COVID-19 Pandemic.

The health literacy of immigrants has been often viewed in a deficit model. By using structuration theory as a theoretical lens, this study aimed to uncover the health literacy development of Korean immigrants in the U.S. as an agentic behavior during the COVID-19 pandemic. A total of 20 semi-structured interviews were conducted with Korean immigrants in the U.S. Findings reveal how the participants' experience was shaped by structural forces such as conflicting but co-existing public health systems between the U.S. and Korea, information overload, and the uncertainty surrounding the pandemic. Participants also employed strategies such as constantly comparing the public health guidelines from the two countries, critically appraising the information, deliberately choosing which guideline to follow, combating misinformation, and regulating media consumption. These strategies enabled them to develop health literacy by leveraging their immigrant status as an advantage. Theoretical, practical, and policy implications are discussed.

From struggle to strength in African and Middle Eastern newcomers' integration stories to Canada: A participatory health equity research study.

BACKGROUND AND OBJECTIVES: Newcomers (immigrants, refugees, and international students) face many personal, gender, cultural, environmental and health system barriers when integrating into a new society. These struggles can affect their health and social care, reducing access to mental health care. This study explores the lived experiences of African and Middle Eastern newcomers to Ontario, Canada. An understanding of newcomer integration challenges, successes and social justice issues is needed to improve health equity and social services. METHODS: In this qualitative study, we used a participatory research approach to collect stories reflecting participants' integration perspectives and experiences. Beginning with our immigrant community network, we used snowball sampling to recruit newcomers, ages 18 to 30, originating from Africa or the Middle East. We used qualitative narrative analysis to interpret stories, identifying context themes, integrating related barriers and facilitators, and resolutions and learnings. We shared our findings and sought final feedback from our participants. FINDINGS: A total of 18 newcomers, 78% female and approximately half post-secondary students, participated in the study. Participants described an unknown and intimidating migration context, with periods of loneliness and isolation aggravated by cold winter conditions and unfamiliar language and culture. Amidst the struggles, the support of friends and family, along with engaging in schoolwork, exploring new learning opportunities, and participating in community services, all facilitated integration and forged new resilience. CONCLUSIONS: Community building, friendships, and local services emerged as key elements for future immigrant service research. Utilizing a participatory health research approach allowed us to respond to the call for social justice-oriented research that helps to generate scientific knowledge for promoting culturally adaptive health care and access for marginalized populations.

An Intersectional Approach to Understanding Beliefs and Attitudes Toward Mental Health Issues Among Muslim Immigrant Women in Canada.

Although addressing cultural and religious practices is important in providing mental health care, little research exists on understanding mental health issues of minority groups such as Muslim immigrant women. We employed an intersectional approach to examine beliefs and attitudes toward mental health issues among Muslim immigrant women in Canada. Four focus groups (21 participants) were conducted, and 101 surveys were collected in Ottawa, Canada. Three core themes emerged from thematic content analysis of focus group data that relate to participants' communication about: 1) stressors, 2) mental health care seeking, and 3) utilizing coping strategies. The survey data were analyzed using independent samples t-test and One-Way ANOVA, the results of which supported the qualitative findings that social stigma was an important obstacle preventing those women from seeking professional mental health services. Muslim women with South and Southeast Asian cultural/ethnic backgrounds were more likely to get help from professionals than those with African cultural/ethnic backgrounds. No group differences were found in age, family income, and employment status. Broadly, the findings underscore the importance of developing knowledge about the intersections among gender, religion, cultural identity, immigration status, and social stigma that influence beliefs and attitudes toward mental health issues. Specifically, the findings point to the need for an intersectional approach that offers a more nuanced understanding for tailoring mental health care to Muslim immigrant women's needs.

Predictors of COVID-19 Vaccine Uptake and Reasons for Vaccine Hesitancy Among New York State Refugees.

PURPOSE: Resettled refugees in the U.S. face a disproportionately high risk of COVID-19 exposure, infection, and death. This study examines COVID-19 vaccination status among adult participants and their minor children, reasons for vaccine hesitancy, and predictors of vaccine uptake, as well as sources of COVID-19 news and information and trust in those sources. METHOD: The data in this study were drawn from the Telehealth and COVID-19 Knowledge, Attitudes, and Practices in New York Refugee Communities Survey (N = 353), conducted March-May, 2022. RESULTS: The multivariate results indicate that in this sample of resettled refugees, those who reported higher levels of educational attainment, were from Afghanistan, and those who had fewer concerns about the vaccine were more likely to accept vaccination. The participants in this study identified local health workers, clinics, and community organizations - places where social workers are present - as both the largest source of nonsocial media COVID-19 news and information and the most trusted source of COVID-19 news and information. DISCUSSION: The implications from this study provide social workers with an understanding of the social and behavioral factors impacting vaccine uptake in refugee communities. CONCLUSION: According to the NASW Code of Ethics, social workers must challenge inequalities that persist against marginalized groups, such as racial and ethnic health disparities. Social work practitioners can play an essential role in decreasing unjust health disparities by providing accurate, culturally appropriate information on public health concerns such as COVID-19 to their refugee clients and within interprofessional collaboration.

Social Media and Black Maternal Health: The Role of Health Literacy and eHealth Literacy.

BACKGROUND: Black women experience greater maternal mortality and morbidity than White women. Although there are many causes of this disparity, providing more and better maternal health information to this population may be beneficial. Social media offers a way to easily and quickly disseminate information to empower and educate Black women about health during pregnancy. OBJECTIVE: This study sought to identify social media use patterns to determine what sources Black women used to obtain information about pregnancy and to explore whether health literacy/eHealth literacy influence those patterns. METHODS: This cross-sectional, nationally representative survey panel included 404 Black women. Health literacy was measured by the Single Item Literacy Screener, and eHEALS was used to measure eHealth literacy. We examined participants' social media activity, social media use, social media use for support, and sharing of pregnancy-related health information. Relationships between health literacy, eHealth literacy, and social media use were assessed. KEY RESULTS: Overall, 67.5% of participants had high health literacy, and the average eHealth literacy score was high (34.5). Most women (71.6%) reported using more than three social media accounts as a source for pregnancy information. Women with low health literacy searched social media for general and specific pregnancy health information, reported more social media use during pregnancy in general (p < .001), and more use of social media for giving and getting support (p = .003). Women with higher eHealth literacy were more likely to report more social media use (r = 0.107, p = .039) and often used social media to give and get support (r = 0.197, p = .0001). Women with high health literacy more often reported sharing the pregnancy information they found on social media with their nurse (χ2 = 7.068, p = .029), doula (χ2 = 6.878, p = .032), and childbirth educator (χ2 = 10.289, p = .006). Women who reported higher eHealth literacy also reported more often sharing the pregnancy information they found on social media with their doctor (r = 0.115, p = .030), nurse (r = 0.139, p = .001), coworkers (r = 0.160, p = .004), and family or friends (r = 0.201, p = .0001). CONCLUSION: Substantial numbers of Black women use social media to find pregnancy health information. Future studies should elicit more detailed information on why and how Black women use social media to obtain pregnancy information and support as well as what role health literacy and eHealth literacy may have on birth outcomes. [HLRP: Health Literacy Research and Practice. 2023;7(3):e119-e129.].

Advancing Community-Based Participatory Research During the COVID-19 Pandemic: A Methods Commentary on the Lessons Learned from Working with Community Data Collectors on a Refugee Health Disparities Study.

This methods commentary focuses on lessons learned from working with community data collectors on a refugee health disparities study during the COVID-19 pandemic. While there is a strong literature base for community health workers in refugee or migrant communities, there is less known about the procedural elements, challenges, and effectiveness of using community data collectors (CDCs) in research with refugee or migrant communities. Recognizing the cultural wealth and unique strengths of local stakeholders in the refugee community, the research team employed a robust collaborative approach by partnering with CDCs to design and administer the Telehealth and COVID-19 Knowledge, Attitudes, and Practices in New York Refugee Communities Survey. The study's success was largely due to the CDC partnership. This methods commentary highlights the utility of Community-Based Participatory Research as a culturally-responsive framework well-suited to exploring health disparities as part of a broader agenda of public health communication research.

Communication Dimensions of Healthcare Engagement and Patient Health Literacy for Immigrant Populations: A Systematic Review.

Health literacy is an important social determinant of health. Achieving health literacy of immigrants can be critical to empower this disadvantaged population in healthcare communication. However, to achieve this goal, it is a prerequisite to examine the relationship between health literacy and patient engagement in healthcare communication. This systematic review conceptualizes behavioral, emotional, and cognitive dimensions of patient engagement in healthcare communication and examines how health literacy and patient engagement among immigrants shape each other. A systematic review was conducted to identify relevant articles from five databases between 2010 and 2020. The reviewers synthesized findings from 15 articles that met the inclusion criteria. The results indicate that communication researchers should be more attentive to the emotional dimension of patient engagement in healthcare communication and that more empirical studies are needed to evaluate the relationship between health literacy and patient engagement among immigrants. Practical implications and recommendations for future research are discussed.

Identifying Health Equity Factors That Influence the Public's Perception of COVID-19 Health Information and Recommendations: A Scoping Review.

The COVID-19 pandemic has impacted global public health and public trust in health recommendations. Trust in health information may waver in the context of health inequities. The objective of this scoping review is to map evidence on public perceptions of COVID-19 prevention information using the PROGRESS-Plus health equity framework. We systematically searched the MEDLINE, Cochrane Central Register of Controlled Trials, PsycInfo, and Embase databases from January 2020 to July 2021. We identified 792 citations and 31 studies published in 15 countries that met all inclusion criteria. The majority (30/31; 96.7%) of the studies used an observational design (74.2% cross-sectional, 16.1% cohort, 6.5% case study, 3.2% experimental trials). Most studies (61.3%) reported on perception, understanding, and uptake, and 35.5% reported on engagement, compliance, and adherence to COVID-19 measures. The most frequently reported sources of COVID-related information were social media, TV, news (newspapers/news websites), and government sources. We identified five important equity factors related to public trust and uptake of recommendations: education and health literacy (19 studies; 61.3%), gender (15 studies; 48.4%), age (15 studies; 48.4%), socioeconomic status (11 studies; 35.5%), and place of residence (10 studies; 32.3%). Our review suggests that equity factors play a role in public perception of COVID-19 information and recommendations. A future systematic review could be conducted to estimate the impact of equity factors on perception and behavior outcomes.

Weight Communication: How Do Health Professionals Communicate about Weight with Their Patients in Primary Care Settings?

This study aimed to investigate how health professionals (HPs) communicate about weight with their patients. Semi-structured interviews were conducted with 33 health professionals (7 family physicians, 13 nurse practitioners, and 13 dietitians) working in multidisciplinary healthcare settings in Canada. Thematic analysis revealed four main approaches used by HPs to communicate about weight: 1) Analyzing patient perspectives, 2) focusing on overall health rather than weight, 3) directly addressing the topic, and 4) avoiding the topic. The approach chosen was influenced by HPs' outlook on obesity; for example, those who believed obesity to be a chronic disease did not hesitate to communicate about weight. However, some HPs who reported having obesity mentioned avoiding the topic of weight with their patients and emphasized the importance of establishing a trusting relationship with patients before addressing the topic. The approach chosen by HPs also seemed to be influenced by patient receptiveness, level of readiness, and motivation. Weight communication can be sensitive and the approach used to begin the topic of weight may differ based on patient- and HP factors. Future clinical practice guidelines may benefit from shifting toward communicating about modifiable risk factors rather than weight.

Communicating Scientific Uncertainty in an Age of COVID-19: An Investigation into the Use of Preprints by Digital Media Outlets.

In this article, we investigate the surge in use of COVID-19-related preprints by media outlets. Journalists are a main source of reliable public health information during crises and, until recently, journalists have been reluctant to cover preprints because of the associated scientific uncertainty. Yet, uploads of COVID-19 preprints and their uptake by online media have outstripped that of preprints about any other topic. Using an innovative approach combining altmetrics methods with content analysis, we identified a diversity of outlets covering COVID-19-related preprints during the early months of the pandemic, including specialist medical news outlets, traditional news media outlets, and aggregators. We found a ubiquity of hyperlinks as citations and a multiplicity of framing devices for highlighting the scientific uncertainty associated with COVID-19 preprints. These devices were rarely used consistently (e.g., mentioning that the study was a preprint, unreviewed, preliminary, and/or in need of verification). About half of the stories we analyzed contained framing devices emphasizing uncertainty. Outlets in our sample were much less likely to identify the research they mentioned as preprint research, compared to identifying it as simply "research." This work has significant implications for public health communication within the changing media landscape. While current best practices in public health risk communication promote identifying and promoting trustworthy sources of information, the uptake of preprint research by online media presents new challenges. At the same time, it provides new opportunities for fostering greater awareness of the scientific uncertainty associated with health research findings.

Surgery for heart failure: Treatment options and implications.

Heart failure is considered one of the leading causes of death worldwide. Over the years, etiological risk factors, diagnostic criteria, and classifications have been revised to create guide management needed to alleviate the global health burden caused by heart failure. Pharmacological treatments have progressed over time but are insufficient in reducing mortality. This leads to many patients developing advanced heart failure who will require surgical intervention often in the form of the gold standard, a heart transplant. However, the number of patients requiring a transplant far exceeds the number of donors. Other surgical inventions have been utilized, yet the rate of patients being diagnosed with heart failure is still increasing. Future developments in the surgical field of heart failure include the 77SyncCardia and atrial shunting but long-term clinical trials involving larger cohorts of patients have not yet taken place to view how effective these approaches can be.

Piperaquine Pharmacokinetics during Intermittent Preventive Treatment for Malaria in Pregnancy.

Dihydroartemisinin-piperaquine (DP) is a long-acting artemisinin combination treatment that provides effective chemoprevention and has been proposed as an alternative antimalarial drug for intermittent preventive therapy in pregnancy (IPTp). Several pharmacokinetic studies have shown that dose adjustment may not be needed for the treatment of malaria in pregnancy with DP. However, there are limited data on the optimal dosing for IPTp. This study aimed to evaluate the population pharmacokinetics of piperaquine given as IPTp in pregnant women. Pregnant women were enrolled in clinical trials conducted in Kenya and Indonesia and treated with standard 3-day courses of DP, administered in 4- to 8-week intervals from the second trimester until delivery. Pharmacokinetic blood samples were collected for piperaquine drug measurements before each treatment round, at the time of breakthrough symptomatic malaria, and at delivery. Piperaquine population pharmacokinetic properties were investigated using nonlinear mixed-effects modeling with a prior approach. In total, data from 366 Kenyan and 101 Indonesian women were analyzed. The pharmacokinetic properties of piperaquine were adequately described using a flexible transit absorption (n = 5) followed by a three-compartment disposition model. Gestational age did not affect the pharmacokinetic parameters of piperaquine. After three rounds of monthly IPTp, 9.45% (95% confidence interval [CI], 1.8 to 26.5%) of pregnant women had trough piperaquine concentrations below the suggested target concentration (10.3 ng/ml). Translational simulations suggest that providing the full treatment course of DP at monthly intervals provides sufficient protection to prevent malaria infection. Monthly administration of DP has the potential to offer optimal prevention of malaria during pregnancy. (This study has been registered at ClinicalTrials.gov under identifier NCT01669941 and in the ISRCTN under number ISRCTN34010937.).

Cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine versus single screening and treatment for the control of malaria in pregnancy in Papua, Indonesia: a provider perspective analysis from a cluster-randomised trial.

BACKGROUND: Malaria infection during pregnancy is associated with serious adverse maternal and birth outcomes. A randomised controlled trial in Papua, Indonesia, comparing the efficacy of intermittent preventive treatment with dihydroartemisinin-piperaquine with the current strategy of single screening and treatment showed that intermittent preventive treatment is a promising alternative treatment for the reduction of malaria in pregnancy. We aimed to estimate the incremental cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine compared with single screening and treatment with dihydroartemisinin-piperaquine. METHODS: We did a provider perspective analysis. A decision tree model was analysed from a health provider perspective over a lifetime horizon. Model parameters were used in deterministic and probabilistic sensitivity analyses. Simulations were run in hypothetical cohorts of 1000 women who received intermittent preventive treatment or single screening and treatment. Disability-adjusted life-years (DALYs) for fetal loss or neonatal death, low birthweight, moderate or severe maternal anaemia, and clinical malaria were calculated from trial data and cost estimates in 2016 US dollars from observational studies, health facility costings and public procurement databases. The main outcome measure was the incremental cost per DALY averted. FINDINGS: Relative to single screening and treatment, intermittent preventive treatment resulted in an incremental cost of US$5657 (95% CI 1827 to 9448) and 107·4 incremental DALYs averted (-719·7 to 904·1) per 1000 women; the average incremental cost-effectiveness ratio was $53 per DALY averted. INTERPRETATION: Intermittent preventive treatment with dihydroartemisinin-piperaquine offers a cost-effective alternative to single screening and treatment for the prevention of the adverse effects of malaria infection in pregnancy in the context of the moderate malaria transmission setting of Papua. The higher cost of intermittent preventive treatment was driven by monthly administration, as compared with single-administration single screening and treatment. However, acceptability and feasibility considerations will also be needed to inform decision making. FUNDING: Medical Research Council, Department for International Development, and Wellcome Trust.

How refugee youth use social media: what does this mean for improving their health and welfare?

How do refugee youth use social media and Information and Communication Technologies (ICTs)? Is ICT use relevant to refugee health and well-being? We conducted a systematic scoping review to identify current social media use behaviors. We examined impacts of social media and information sharing applications on health, well-being, inclusion, and integration of refugees into host countries. Review findings reveal that refugee youth commonly use ICTs for social networking, presentation of self, health information consumption, and political rights. Studies suggest that uptake of social media through personal mobile devices, such as smartphones, positively enhanced interactions of newly arrived refugees. Our review identifies policy opportunities to enable social media to facilitate delivery of resettlement and health information, to foster integration for refugees, and to improve their health.

Use of a highly-sensitive rapid diagnostic test to screen for malaria in pregnancy in Indonesia.

BACKGROUND: The sensitivity of rapid diagnostic tests (RDTs) for malaria is inadequate for detecting low-density, often asymptomatic infections, such as those that can occur when screening pregnant women for malaria. The performance of the Alere™ Ultra-sensitive Malaria Ag Plasmodium falciparum RDT (uRDT) was assessed retrospectively in pregnant women in Indonesia. METHODS: The diagnostic performance of the uRDT and the CareStart™ Malaria HRP2/pLDH VOM (Plasmodium vivax, Plasmodium ovale and Plasmodium malariae) Combo RDT (csRDT) were assessed using 270 stored red blood cell pellets and plasma samples from asymptomatic pregnant women. These included 112 P. falciparum negative and 158 P. falciparum positive samples detected by a composite test (qPCR, LAMP, nPCR) as reference standard. Diagnostic indicators: sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), diagnostic odds ratio (DOR) and the level of agreement (kappa) were calculated for comparison. RESULTS: Compared with the reference test, the uRDT had a sensitivity of 19.6% (95% CI 13.9-26.8) and specificity of 98.2% (93.1-99.7%). The csRDT was 22.8% (16.7-30.3) sensitive and 95.5% (89.4-98.3) specific for P. falciparum infections. Performance of the uRDT was non-significantly different to the csRDT (p = 0.169). RDT outcome was stratified by qPCR cycling threshold (Ct), and performance of the RDTs was found to be comparable across parasite loads. CONCLUSION: The uRDT performed similarly to the currently used csRDTs in detecting P. falciparum infections in asymptomatic pregnant women. In these settings, molecular diagnostics are currently the most sensitive for malaria.