The science of trust: future directions, research gaps, and implications for health and risk communication.

'Trust is among the most important factors in human life, as it pervades' all domains of society [1] and related decision-making processes. This includes people's trust in science, and in clinical and public health solutions. Unequivocally, community and patient trust are foundational to the adoption and maintenance of health-related behaviors, social norms, and policies. Yet, trust has to be earned and developed over time and through multiple interactions. Trust is about dialogue and human connection. It's about listening and knowing that one interaction will not be enough to build trust. It is also influenced by a variety of social, economic, cultural, and political factors, past experiences, and the history of specific communities and patient groups. It should be at the core of the health and social systems with which people interact. More recently, trust in evidence-based information has also been affected by misinformation, not only on social media but also in a variety of community, institutional, and patient settings. Ultimately, we are in the midst of a global trust crisis that precedes the COVID-19 pandemic and is often rooted in the health, racial, and social inequities many groups experience [2].

Behavioral Communication Strategies for Global Epidemics: An Innovative Model for Public Health Education and Humanitarian Response.

In response to a number of growing global health challenges, New York University and UNICEF designed a Behavioral Communication Strategies for Global Epidemics course that brings together United Nations professionals, government staff, and MPH (Master of Public Health) students to design innovative social behavior change communication (SBCC) strategies that address disease outbreaks and humanitarian challenges around the world. Applying a systems approach, participants in the course work on interdisciplinary teams to design strategies, develop skills, and engage in global learning. At the culmination of the course, all teams present strategies to UNICEF country offices for implementation. This innovative model for disease outbreak, public health education, and humanitarian response provides professionals with an opportunity to develop a wide range of competencies, including systems thinking, behavior change, and human-centered design and equips them with the necessary tools to develop more novel approaches to SBCC. As the number of outbreaks and humanitarian challenges increase each year, this format for learning can serve as a model for how professionals can effectively address these complex crises.

Key Guidelines in Developing a Pre-Emptive COVID-19 Vaccination Uptake Promotion Strategy.

This paper makes the case for immediate planning for a COVID-19 vaccination uptake strategy in advance of vaccine availability for two reasons: first, the need to build a consensus about the order in which groups of the population will get access to the vaccine; second, to reduce any fear and concerns that exist in relation to vaccination and to create demand for vaccines. A key part of this strategy is to counter the anti-vaccination movement that is already promoting hesitancy and resistance. Since the beginning of the COVID-19 pandemic there has been a tsunami of misinformation and conspiracy theories that have the potential to reduce vaccine uptake. To make matters worse, sections of populations in many countries display low trust in governments and official information about the pandemic and how the officials are tackling it. This paper aims to set out in short form critical guidelines that governments and regional bodies should take to enhance the impact of a COVID-19 vaccination strategy. We base our recommendations on a review of existing best practice guidance. This paper aims to assist those responsible for promoting COVID-19 vaccine uptake to digest the mass of guidance that exists and formulate an effective locally relevant strategy. A summary of key guidelines is presented based on best practice guidance.

Vaccine Hesitancy and Demand for Immunization in Eastern Europe and Central Asia: Implications for the Region and Beyond.

Immunization is a global success story. It has saved millions of lives and prevented disease worldwide and millions more have been spared the permanent disabilities caused by diseases such as polio and the long-term morbidity caused by other diseases such as measles. Despite the compelling evidence of the public health and economic value of vaccines, vaccine hesitancy has become a growing concern globally. By calling into question the safety and efficacy of vaccines, vaccine hesitancy threatens the progress made in combating morbidity and mortality including efforts to introduce COVID-19 vaccines. This paper a) examines key factors that drive limited demand for vaccines and vaccine hesitancy, (b) highlights the role of demand promotion for immunization and of risk communication and community engagement to address those challenges, (c) discusses vaccine demand and hesitancy in Eastern Europe and Central Asia, and (d) makes recommendations for public health policy and programming for the introduction of the COVID-19 vaccine and beyond.Recommendations include strengthen social listening and digital engagement to address the concerns of caregivers and healthcare professionals, improve the availability and use of social data for evidence-based programming, reinforce public trust in health institutions and service providers, mainstream demand for immunization, strengthen the communication competencies of health service providers, test and apply solutions based on behavioral insights to reinforce demand, engage regularly with local governments and local actors, and strengthen resilience and response capacities for diseases outbreaks and public health emergencies.

Effects of Parent-Child Relationships on Child Marriage of Girls in Ethiopia, India, Peru, and Vietnam: Evidence From a Prospective Cohort.

PURPOSE: Parental influence over early marriage of girls is well-documented in qualitative research, but little quantitative work in this area has been conducted. This study assesses the effects of the parent-child relationship in early adolescence (aged 12 years) on early marriage of girls. METHODS: We analyzed survey data from a multicountry prospective cohort of girls (n = 1,648) followed over four rounds from age 8 to 19 years (2002-2013), as part of the Young Lives study in India, Ethiopia, Vietnam, and Peru. Multinomial logistic regression models assessed the effects of parent-child communication and parent-child relationship quality, as reported when girls were aged 12 years on child and early marriage (married <16 years, married 16-17 years, married 18-19 years, unmarried). Covariates were wealth, rural/urban residence, maternal education, parents' value of education, early menarche, and country. RESULTS: One in five girls (18.04%) reported marriage before 18 years of age, and 8.1% reported marrying before 16 years (8.3% and 13.7% in India and Ethiopia). Multinomial regression found that girls reporting good parent-child communication and high parent-child relationship quality at age 12 years were significantly less likely to marry before age 16 years (moderate relationship quality, adjusted relative risk ratio: .23, 95% confidence interval: .07-.72; high relationship quality, adjusted relative risk ratio: .34, 95% confidence interval: .11-.99). CONCLUSION: Parent-child relationship quality and communication in early adolescence are protective against very early marriage of girls cross-nationally, although communication may facilitate marriage soon on completion of school. Primary prevention interventions targeting child marriage may benefit from components focused on improving the parent-child relationship.

Community Engagement in Liberia: Routine Immunization Post-Ebola.

A national integrated polio, measles, and deworming campaign was implemented across Liberia May 8-14, 2015. The community engagement and social mobilization component of the campaign was based on structures that had been invested in during the Ebola response. This article provides an overview of the community engagement and social mobilization activities that were conducted and reports the key findings of a rapid qualitative assessment conducted immediately after the campaign that focused on community perceptions of routine immunization in the post-Ebola context. Focus group discussions and interviews were conducted across four counties in Liberia (Montserrado, Nimba, Bong, and Margibi). Thematic analysis identified the barriers preventing and drivers leading to the utilization of routine immunization. Community members also made recommendations and forwarded community-based solutions to encourage engagement with future health interventions, including uptake in vaccination campaigns. These should be incorporated in the development and implementation of future interventions and programs.

Placing Human Behavior at the Center of the Fight to Eradicate Polio: Lessons Learned and Their Application to Other Life-Saving Interventions.

Today, acceptance of oral polio vaccine is the highest ever. Reaching this level of acceptance has depended on decades of engaging with communities, building trust amid extraordinary social contexts, and responding to the complex variables that trigger behavioral and social change. Drawing on both the successes and setbacks in the 28 years of the Global Polio Eradication Initiative (GPEI), this article articulates what happened when the GPEI began to pay more attention to the dynamics of human and social behavior change. Three particular lessons for other health and immunization programs can be drawn from the experience of GPEI: change begins from within (ie, success needs institutional recognition of the importance of human behavior), good data are not enough for good decision-making, and health workers are important agents of behavior change. These lessons should be harnessed and put into practice to build demand and trust for the last stages of polio eradication, as well as for other life-saving health interventions.

Social Mobilization and Community Engagement Central to the Ebola Response in West Africa: Lessons for Future Public Health Emergencies.

Following the World Health Organization (WHO) declaration of a Public Health Emergency of International Concern regarding the Ebola outbreak in West Africa in July 2014, UNICEF was asked to co-lead, in coordination with WHO and the ministries of health of affected countries, the communication and social mobilization component-which UNICEF refers to as communication for development (C4D)-of the Ebola response. For the first time in an emergency setting, C4D was formally incorporated into each country's national response, alongside more typical components such as supplies and logistics, surveillance, and clinical care. This article describes the lessons learned about social mobilization and community engagement in the emergency response to the Ebola outbreak, with a particular focus on UNICEF's C4D work in Guinea, Liberia, and Sierra Leone. The lessons emerged through an assessment conducted by UNICEF using 4 methods: a literature review of key documents, meeting reports, and other articles; structured discussions conducted in June 2015 and October 2015 with UNICEF and civil society experts; an electronic survey, launched in October and November 2015, with staff from government, the UN, or any partner organization who worked on Ebola (N = 53); and key informant interviews (N = 5). After triangulating the findings from all data sources, we distilled lessons under 7 major domains: (1) strategy and decentralization: develop a comprehensive C4D strategy with communities at the center and decentralized programming to facilitate flexibility and adaptation to the local context; (2) coordination: establish C4D leadership with the necessary authority to coordinate between partners and enforce use of standard operating procedures as a central coordination and quality assurance tool; (3) entering and engaging communities: invest in key communication channels (such as radio) and trusted local community members; (4) messaging: adapt messages and strategies continually as patterns of the epidemic change over time; (5) partnerships: invest in strategic partnerships with community, religious leaders, journalists, radio stations, and partner organizations; (6) capacity building: support a network of local and international professionals with capacity for C4D who can be deployed rapidly; (7) data and performance monitoring: establish clear C4D process and impact indicators and strive for real-time data analysis and rapid feedback to communities and authorities to inform decision making. Ultimately, communication, community engagement, and social mobilization need to be formally placed within the global humanitarian response architecture with proper funding to effectively support future public health emergencies, which are as much a social as a health phenomenon.

Understanding the role of mHealth and other media interventions for behavior change to enhance child survival and development in low- and middle-income countries: an evidence review.

Given the high morbidity and mortality among children in low- and middle-income countries as a result of preventable causes, the U.S. government and the United Nations Children's Fund convened an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change on June 3-4, 2013, in Washington, D.C. This article summarizes evidence for technological advances associated with population-level behavior changes necessary to advance child survival and healthy development in children under 5 years of age in low- and middle-income countries. After a rigorous evidence selection process, the authors assessed science, technology, and innovation papers that used mHealth, social/transmedia, multiplatform media, health literacy, and devices for behavior changes supporting child survival and development. Because of an insufficient number of studies on health literacy and devices that supported causal attribution of interventions to outcomes, the review focused on mHealth, social/transmedia, and multiplatform media. Overall, this review found that some mHealth interventions have sufficient evidence to make topic-specific recommendations for broader implementation, scaling, and next research steps (e.g., adherence to HIV/AIDS antiretroviral therapy, uptake and demand of maternal health service, and compliance with malaria treatment guidelines). While some media evidence demonstrates effectiveness in changing cognitive abilities, knowledge, and attitudes, evidence is minimal on behavioral endpoints linked to child survival. Population level behavior change is necessary to end preventable child deaths. Donors and low- and middle-income countries are encouraged to implement recommendations for informing practice, policy, and research decisions to fully maximize the impact potential of mHealth and multimedia for child survival and development.

The complexity of social mobilization in health communication: top-down and bottom-up experiences in polio eradication.

The Polio Eradication Initiative (PEI) has been one of the most ambitious global health efforts in recent times. Social mobilization (SM) has been a strategic component of the PEI. Yet, a close-up analysis of SM dynamics seems to be lacking in the health communication literature. We examine critical aspects of the PEI experience in an attempt to move from dominant informational perspectives to a focus on emerging challenges in polio eradication efforts and new levels of complexity to SM. We examine available literature on communication and public health, available data on SM experiences that support polio eradication in Africa and Asia, and field work conducted by the authors where polio eradication efforts are ongoing. Our analysis suggests that (1) SM should not be casually approached as a top-down informational strategy to advance pre-established health goals; (2) centralized strategies hardly amount to SM; and (3) hybrid options that combine both activist and pragmatic SM are concrete possibilities for global health initiatives. In the context of renewed global democratization and persistent conflicts rooted in ethnicity, religion, and economics, it cannot be assumed that communities will either diligently espouse global goals or necessarily oppose them. Communication and SM strategies should rely on a clear understanding of the motives and agendas of involved actors. Resistance or opposition are important analytical dimensions as they may uncover new opportunities for effective health interventions. Further studies using these perspectives should be a priority for global health programs, including studies of the trust level, or lack thereof, among social actors.

La enseñanza de la salud infantil en las escuelas y facultades de enfermería de América Latina

Presenta guía acerca de la enseñanza de la salud infantil en las escuelas y facultades de enfermería de América Latina. Presenta un conocimiento basal que permitirá generar y orientar la educación y la práctica de la enfermería en la Región. A través deello se intenta fortalecer lineamientos de acción en salud pública y atención primaria, dos campos de acción que siempre han constituido un componente esencial en las preocupaciones de las enfermeras. Document in PDF format, required Acrobat Reader.

Achieving polio eradication: a review of health communication evidence and lessons learned in India and Pakistan.

Since 1988, the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which communication interventions have played a consistently central role. Mass media and information dissemination approaches used in immunization efforts worldwide have contributed to this success. However, reaching the hardest-to-reach, the poorest, the most marginalized and those without access to health services has been challenging. In the last push to eradicate polio, Polio Eradication Initiative communication strategies have become increasingly research-driven and innovative, particularly through the introduction of sustained interpersonal communication and social mobilization approaches to reach unreached populations. This review examines polio communication efforts in India and Pakistan between the years 2000 and 2007. It shows how epidemiological, social and behavioural data guide communication strategies that have contributed to increased levels of polio immunity, particularly among underserved and hard-to-reach populations. It illustrates how evidence-based and planned communication strategies - such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy combined - have contributed to reducing polio incidence in these countries. Findings show that communication strategies have contributed on several levels by: mobilizing social networks and leaders; creating political will; increasing knowledge; ensuring individual and community-level demand; overcoming gender barriers and resistance to vaccination; and reaching out to the poorest and marginalized populations. The review concludes with observations about the added value of communication strategies in polio eradication efforts and implications for global and local public health communication interventions.