COVID-19 related messaging, beliefs, information sources, and mitigation behaviors in Virginia: a cross-sectional survey in the summer of 2020.

Background: Conflicting messages and misleading information related to the coronavirus (COVID-19) pandemic (SARS-CoV-2) have hindered mitigation efforts. It is important that trust in evidence-based public health information be maintained to effectively continue pandemic mitigation strategies. Officials, researchers, and the public can benefit from exploring how people receive information they believe and trust, and how their beliefs influence their behaviors. Methods: To gain insight and inform effective evidence-based public health messaging, we distributed an anonymous online cross-sectional survey from May to July, 2020 to Virginia residents, 18 years of age or older. Participants were surveyed about their perceptions of COVID-19, risk mitigation behaviors, messages and events they felt influenced their beliefs and behaviors, and where they obtained information that they trust. The survey also collected socio-demographic information, including gender, age, race, ethnicity, level of education, income, employment status, occupation, changes in employment due to the pandemic, political affiliation, sexual orientation, and zip code. Analyses included specific focus on the most effective behavioral measures: wearing a face mask and distancing in public. Results: Among 3,488 respondents, systematic differences were observed in information sources that people trust, events that impacted beliefs and behaviors, and how behaviors changed by socio-demographics, political identity, and geography within Virginia. Characteristics significantly associated (p < 0.025) with not wearing a mask in public included identifying as non-Hispanic white, male, Republican political identity, younger age, lower income, not trusting national science and health organizations, believing one or more non-evidence-based messages, and residing in Southwest Virginia in logistic regression. Similar, lesser in magnitude correlations, were observed for distancing in public. Conclusions: This study describes how information sources considered trustworthy vary across different populations and identities, and how these differentially correspond to beliefs and behaviors. This study can assist decision makers and the public to improve and effectively target public health messaging related to the ongoing COVID-19 pandemic and future public health challenges in Virginia and similar jurisdictions.

Qualitative analysis of small animal veterinarian-perceived barriers to nutrition communication.

OBJECTIVE: Nutrition is important in preventing and managing disease. Veterinarians are an important source of nutrition information; however, nutrition communication between veterinarians and pet owners is relatively infrequent. The purpose of this study was to conduct a qualitative review of barriers to nutrition communication and possible solutions, reported by small animal veterinarians. SAMPLE: 18 veterinarians from Maryland, Michigan, Virginia, Washington DC, and West Virginia. METHODS: In a qualitative focus group study, 5 virtual focus groups using the Zoom platform were conducted from February 3, 2021, to April 2, 2021. Each focus group was audio recorded, and transcripts were created using Otter.ai software. Transcripts were analyzed in Atlas.ti qualitative data analysis software using a hybrid of inductive and deductive thematic analysis. RESULTS: The 4 barriers to nutrition communication identified by veterinarians were as follows: (1) time, (2) misinformation and information overload, (3) pet owners' apprehension toward new information, and (4) veterinarians' confidence in nutrition knowledge and communication skills. Potential solutions include (1) improving communication and nutrition education, (2) improving and increasing access to client-friendly resources, and (3) empowering credentialed veterinary technicians and support staff to discuss nutrition. CLINICAL RELEVANCE: This study provides guidance for how to focus efforts to break down barriers to nutrition communication in small animal veterinary practice.

Implementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in rural communities in Virginia.

INTRODUCTION: Adult onset diabetes is a significant health issue in rural communities that are disproportionately suffering from the health, social and financial costs of the disease. Despite this, over half of rural counties in the USA lack access to diabetes self-management programs, which are effective at improving diabetes management. The Cooperative Extension System (CES) is a nationwide education network that provides research-based information and programs in nearly 3000 counties in the USA to improve the health and wellbeing of rural and urban communities. This study evaluated the implementation and outcomes of a lifestyle management program, Balanced Living with Diabetes (BLD) conducted by community-based educators who are part of the CES in rural Virginia, to address the gap in diabetes education in these communities. BLD is grounded in social cognitive theory and has shown efficacy to modify dietary and physical activity behaviors resulting in improved glycemic control in people with type 2 diabetes. METHODS: The study evaluated the implementation and effectiveness of BLD programs conducted by the CES in 16 rural counties over 2 years. Program adoption, reach, context, and barriers and facilitators to implementation were evaluated through program outcome data and extension educator interviews. Program outcomes included change in weight, glycosylated hemoglobin (A1C), diabetes knowledge, self-management practices, diet and physical activity behaviors, and self-efficacy from baseline to 12-week assessment. RESULTS: Extension educators conducted 30 programs, reaching 290 residents, with a 58% mean retention rate. The program resulted in a significant increase in diabetes and food knowledge, fruit, vegetable, and whole grain intake, use of the plate method, exercise, and diabetes management self-efficacy. A1C decreased significantly in participants with diabetes (mean reduction=0.345±1.013; p=0.001). The program was conducted twice in 11 counties, and once in five counties. Barriers to program adoption in the five counties included limited community interest, competing program priorities of the extension educator, and loss of extension personnel to conduct the program. Participant communication materials and systems to enhance program sustainability were developed in response to educator feedback. Process evaluation indicated that the program was highly acceptable to extension educators and program participants. CONCLUSION: The CES is an effective network for implementation of diabetes lifestyle-management programs in underserved communities, and the BLD program is effective at increasing lifestyle behaviors and self-efficacy that improve glycemic control in people with type 2 diabetes. Collaboration by Virginia's CES with a variety of community partners, including healthcare and social service providers, increases the reach and sustainability of extension diabetes programs. The CES in the USA is well positioned to fill the gap in diabetes education in rural communities as part of a chronic care model.

Contraceptive Needs Among Women Recently Incarcerated at a Rural Appalachian Jail.

Background: Incarceration is associated with negative sexual and reproductive health outcomes. We examined contraceptive needs among women incarcerated at a rural Appalachian jail with emphasis on pregnancy history, recent contraceptive use, and current and near-future contraceptive needs. Materials and Methods: A survey was administered to newly incarcerated women at a jail in Southwest Virginia. It included questions about (1) prior pregnancies; (2) pregnancy intentions, contraceptive use, and sexual activity in the 3 months before jail; (3) unprotected sex in the 5 days before jail; (4) interest in contraceptive education and access during incarceration; and (5) post-release sexual activity, pregnancy, and contraceptive plans. Results: One hundred ninety-three women completed surveys. Analyses focused on the 95 at risk for pregnancy. Fifty-eight percent of prior pregnancies on which women provided intention information were unintended, with 74% of respondents reporting at least 1 such pregnancy. Ninety-four percent of women reported vaginal intercourse during the 3 months before jail. Only 46% of those who did not want to get pregnant reported consistent contraceptive use. Condoms and withdrawal were the most common methods used. Forty percent of women were eligible for emergency contraception (EC). Most (78%) participants anticipated sex with a man within 6 months of release, and most (63%) did not want to become pregnant within a year of release. Almost half (47%) expressed interest in receiving birth control while in jail. Conclusions: Results support the need to offer women EC on incarceration, family planning education during confinement, and effective birth control before release.

Providing comprehensive contraceptive services in primary care at a rural Federally Qualified Health Center in the USA: adapting to patient need in a culturally conservative, rural environment.

INTRODUCTION: In the USA, approximately 45% of pregnancies are unintended. Accessing quality contraceptives can be a barrier for some individuals, especially low-income, uninsured, minority or younger women. These problems are exacerbated in rural areas{1}. Integrating contraceptive services into primary care is an approach to ensure that sexually active women receive access to contraceptives. This study documented how one rural Federally Qualified Health Center (FQHC) adapted to their culturally conservative environment by offering contraceptive counseling, comprehensive education on birth control, and access to contraceptive services directly through primary care. METHODS: Twenty-one semi structured interviews were conducted and analyzed in Atlas.ti®. All women patients who had received contraceptive services through primary care in the previous 6 months were invited to participate in a semi-structured interview. A sample of current and past board members were invited to participate in semi-structured interviews. A sample of five primary care providers and nurses who interact with women receiving contraceptive services was invited to participate in a semi-structured, in-person interview. In addition, the executive director, the clinic manager, and the current and past medical directors were interviewed. A hybrid of inductive and deductive coding methods was used for theme generation. RESULTS: Interviews helped to highlight some of the barriers to accessing contraceptives currently experienced by women in this rural area, and showcased how this FQHC is adapting their approach and their services to be able to meet patient needs. The following themes emerged: lack of knowledge about services offered, lack of knowledge about birth control, misinformation and misconceptions, education on birth control, and care model. CONCLUSION: The cultural context of Southwest Virginia, including the cultural conservatism and stigma associated with talking about sex, has a big impact on people's willingness to access contraceptive services. Stigma limits educational opportunities being offered in schools, therefore limiting people's knowledge about services and birth control methods. This FQHC has adapted to their surrounding culture by ensuring that every woman seeking primary care at the FQHC is screened for contraceptive need, offered contraceptive counseling and comprehensive contraceptive methods. This FQHC's integration of contraceptive services is a model that can be replicated by other FQHCs, by local health departments, and by private physicians.