5 results
Psychological reactance, misinformation, and distrust: A mixed methods analysis of COVID-19 vaccine uptake
- Lily Huang, Todd R. Huschka, Amelia K. Barwise, Jay-Sheree P. Allen, Wendy Wolfersteig, Kathryn Hamm, Lilliana D. Cardenas, Sean M. Phelan, Megan A. Allyse
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 30 January 2024, e48
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Background:
Assessing perceptions of the COVID-19 vaccines is essential for understanding vaccine hesitancy and for improving uptake during public health emergencies. In the complicated landscape of COVID-19 vaccine mandates and rampant misinformation, many individuals faced challenges during vaccination decision-making. The purpose of our mixed methods study is to elucidate factors affecting vaccine decision-making and to highlight the discourse surrounding the COVID-19 vaccines in diverse and underserved communities.
Methods:This mixed methods study was conducted in Arizona, Florida, Minnesota, and Wisconsin between March and November 2021, combining a cross-sectional survey (n = 3593) and focus groups (n = 47).
Results:The groups least likely to report receiving a vaccination were non-Hispanic Whites, Indigenous people, males, and those with moderate socioeconomic status (SES). Those indicating high and low SES reported similar vaccination uptake. Focus group data highlighted resistance to mandates, distrust, misinformation, and concerns about the rapid development surrounding the COVID-19 vaccines. Psychological reactance theory posits that strongly persuasive messaging and social pressure can be perceived as a threat to freedom, encouraging an individual to take action to restore that freedom.
Conclusion:Our findings indicate that a subsection of participants felt pressured to get the vaccine, which led to weaker intentions to vaccinate. These results suggest that vaccine rollout strategies should be reevaluated to improve and facilitate informed decision-making.
A multisite exploration of the association between critical care implementation factors and clinical outcomes during the COVID-19 pandemic
- Santana Silver, Sarah Redmond, Kayla Christine Jones, Emily George, Sarah Zornes, Amelia Barwise, Aaron Leppin, Yue Dong, Lori A. Harmon, Vishakha K. Kumar, Christina Kordik, Mari-Lynn Drainoni, Allan J. Walkey
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- Journal:
- Journal of Clinical and Translational Science / Volume 7 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 17 February 2023, e72
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Background:
Little is known about strategies to implement new critical care practices in response to COVID-19. Moreover, the association between differing implementation climates and COVID-19 clinical outcomes has not been examined. The purpose of this study was to evaluate the relationship between implementation determinants and COVID-19 mortality rates.
Methods:We used mixed methods guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured qualitative interviews were conducted with critical care leaders and analyzed to rate the influence of CFIR constructs on the implementation of new care practices. Qualitative and quantitative comparisons of CFIR construct ratings were performed between hospital groups with low- versus high-mortality rates.
Results:We found associations between various implementation factors and clinical outcomes of critically ill COVID-19 patients. Three CFIR constructs (implementation climate, leadership engagement, and engaging staff) had both qualitative and statistically significant quantitative correlations with mortality outcomes. An implementation climate governed by a trial-and-error approach was correlated with high COVID-19 mortality, while leadership engagement and engaging staff were correlated with low mortality. Another three constructs (needs of patient; organizational incentives and rewards; and engaging implementation leaders) were qualitatively different across mortality outcome groups, but these differences were not statistically significant.
Conclusions:Improving clinical outcomes during future public health emergencies will require reducing identified barriers associated with high mortality and harnessing salient facilitators associated with low mortality. Our findings suggest that collaborative and engaged leadership styles that promote the integration of new yet evidence-based critical care practices best support COVID-19 patients and contribute to lower mortality.
3095 Perceived Knowledge of Palliative Care among Immigrants: A Secondary Data Analysis from the Health Information National Trends Survey
- Amelia Barwise, Andrea Cheville, Mark Wieland, Ognjen Gajic, Alexandra Greenberg-Worisek
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- Journal:
- Journal of Clinical and Translational Science / Volume 3 / Issue s1 / March 2019
- Published online by Cambridge University Press:
- 26 March 2019, pp. 136-137
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OBJECTIVES/SPECIFIC AIMS: Immigrants to North America receive more interventions at end of life.The reasons for this are not entirely clear but may potentially be due to knowledge gaps. The primary objective of this study was to measure and describe levels of perceived knowledge about palliative care among immigrants to the US compared to those born in the US. Our secondary objective was to identify trusted sources for seeking information about palliative care among immigrants and compare these trusted sources with those born in the US. We hypothesized that immigrants would have less knowledge of palliative care than those born in US and would trust different sources for information about palliative care. METHODS/STUDY POPULATION: We analyzed data from the nationally representative 2018 Health Information National Trends Survey (HINTS 5, cycle 2). Questionnaires were administered via mail between January and May 2018 to a population-based sample of adults. The primary outcome of interest was assessed using the item “How would you describe your level of knowledge about palliative care?” The secondary outcome of interest was determined using the item “Imagine you had a strong need to get information about palliative care, which of the following would you most trust as a source of information about palliative care?” All analyses were complete case analyses and conducted with survey commands using SAS 9.3 (SAS Institute Inc, Cary, NC, USA). Descriptive statistics were calculated, and bivariate analyses run between the outcomes of interest and sociodemographic characteristics (age, sex, education, race/ethnicity, nativity, English language proficiency). Multivariable logistic regressions were conducted to assess the role of nativity, controlling for statistically significant and relevant sociodemographic variables. Jackknife weighting was used to generate population-level estimates. RESULTS/ANTICIPATED RESULTS: The response rate was 33% (n=3384) and included 2846 (85.3% weighted) born in the US and 492 (14.7% weighted) not born in the USA. About 70% of those born in the US and 77% of immigrants (weighted) responded that they had “never heard of palliative care.” Trusted sources of palliative care were very similar between the groups (all p > 0.05). Both groups’ preferred trusted source of palliative care knowledge was “health care provider,” with over 80% of respondents in each group selecting this option. Printed materials and social media were the least popular trusted sources among both groups. After adjusting for relevant sociodemographic characteristics, we found no association between poor knowledge of palliative care and nativity (p=0.22). Female respondents had 2.5-fold increased odds of reporting low levels of perceived knowledge of palliative care (OR = 2.58, 95% CI = 1.76-3.78; p<0.001). Education was an important predictor of perceived knowledge of palliative care; as education level increased, so did perceived knowledge of palliative care (p < 0.001). DISCUSSION/SIGNIFICANCE OF IMPACT: Perceived knowledge of palliative care is poor generally, regardless of birthplace. Trusted sources for palliative care are similar between immigrants and those born in the US. Education is important and is a strong predictor of perceived knowledge of palliative care. Women perceive they have lower levels of knowledge of PC than men. Differences in end of life care between immigrants and non-immigrants cannot be explained by knowledge differences. Further research is needed to examine the potential factors including suboptimal communication between providers and immigrant patients to understand why these differences are noted. Future strategies for improving knowledge of palliative care should target health care providers as the key trusted source of information to help address deficits noted in this study.
3235 Acceptability of Robotic-Assisted Exercise Coaching in Diverse Youth
- Amelia Barwise, Martha Bock, Christine Hughes, Joyce Balls-Berry, Christi Patten, James Levine, Chung-Il, Tabetha Brockman, Miguel Valdez Soto, Young Juhn
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- Journal:
- Journal of Clinical and Translational Science / Volume 3 / Issue s1 / March 2019
- Published online by Cambridge University Press:
- 26 March 2019, p. 81
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OBJECTIVES/SPECIFIC AIMS: Approximately 80% of adolescents do not meet the current national guidelines of engaging in 60 minutes or more of physical activity daily. Physical activity is widely recognized as being beneficial for healthy growth as well as important for good mental health and fitness. Interventions are needed that promote and encourage physical activity among this population to reduce the risk of obesity and to encourage maintenance of a healthy weight. Since adolescents enjoy digital technologies, robotic-assisted platforms might be a novel, innovative and engaging mechanism to deliver physical activity interventions. The objective of this study was to assess the potential acceptability of robotic-assisted exercise coaching among diverse youth. METHODS/STUDY POPULATION: This was a pilot study that used a cross-sectional survey design. Adolescents ages 12-17 were recruited at 3 community-based sites. We obtained written informed consent from participants’ parents and guardians as well as assent from participants. We demonstrated the robotic system human interface (also known as the robotic human trainer) to groups of adolescents. We delivered the exercise coaching in real time via an iPad tablet placed atop a mobile robotic wheel base and controlled remotely by the coach using an iOS device or computer. After the demonstration participants were asked to complete a 28- item survey that included questions about socio demographics, smoking history, weight, exercise habits, and depression history. The survey also included the 8- item Technology Acceptance Scale (TAS). RESULTS/ANTICIPATED RESULTS: Participants (N = 190) were 55% (103/189) male, 43% (81/190) racial minority, 6% (11/190) Hispanic, and 28% (54/190) lived in a lower-income community. The mean age of participants was 15.0 years (SD=2.0). Approximately 25% (47/190) of participants met national recommendations for physical activity. Their mean body mass index (BMI) was 21.8(SD_4.0) kg/m2. Of note, 18% (35/190) had experienced depression now or in the past. The mean Technology Acceptance Scale (TAS) total score was 32.8 (SD 7.8) of a possible score of 40, indicating high potential receptivity to the technology. No significant associations were detected between TAS score and gender, age, racial minority status, median income of participant’s neighborhood, BMI, meeting national recommendations for physical activity levels, or depression history. Of interest, 68% (129/190) of participants agreed that they and their friends were likely to use the robot to help them exercise. DISCUSSION/SIGNIFICANCE OF IMPACT: This pilot survey study demonstrated that among a racially and socioeconomically diverse group of adolescents, robotic-assisted exercise coaching is likely acceptable. The discovery that all demographic groups represented in this sample had similarly high receptivity to the robotic human exercise trainer is encouraging for ultimate considerations of intervention scalability and reach among diverse adolescent populations. Next steps include a study to assess the impact of robotic-assisted exercise coaching on adolescents’ exercise and health outcomes.
2378 Addressing challenges from missing data in a global quality improvement study
- Amelia Barwise, Lisha Yi, Jun Guo, Ognjen Gajic, Moldovan Sabov, Yue Dong, Rahul Kashyap
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, pp. 37-38
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OBJECTIVES/SPECIFIC AIMS: Missing data is a common problem in research studies that may lead to inconclusive or inaccurate results. It may even lead to harm secondary to wrong research conclusions. The purpose of this ancillary study is to measure the differences in missing data following implementation of a variety of mechanisms to improve data quality and documentation in a global quality improvement study. Many of the sites involved in the study were in low-income or middle-income countries with minimal research infrastructure. Missing data is defined as “values that are not available that would be meaningful for analysis if they were observed” (The prevention and treatment of missing data, New Engl J Med 367; 14, nejm.org, October 4, 2012). METHODS/STUDY POPULATION: All study sites used REDCap software to enter various data points including hospital and ICU admission and discharge dates as well as whether items on a Checklist relevant to processes of care in the ICU were reviewed. After initial general data collection phase, we categorized data as “must have” and “good to have.” “Must have” variables were defined as data variables that were essential for the study outcomes. “Good to have” variables would not affect the main outcomes of the study if missing. We measured completeness of data using the in-built REDCap data quality check feature. We used several strategies to encourage reduction of missing data. We initially did random data checks but noted that the amount of missing data was substantial and could not be adequately addressed this way. Second, we created excel sheets highlighting missing data for each site and notified sites. This proved onerous to create and made it burdensome for sites to identify easily where data was missing. Third, we built a custom report form in REDCap specifically able to identify which “must have” data points were missing. This could be easily accessed by the principal investigator at each site and made completing the data forms more straightforward. We encouraged all sites to complete their data collection by sending weekly data reports to each site highlighting the patients with missing data. An instructional YouTube tutorial was also created and the link was shared with all sites to demonstrate how to use the custom built report form in REDCap and how to appropriately fill in the missing data. Since this was a global study, we communicated with sites using a variety of locally favored mechanisms including Zoom, FaceTime, WeChat, WhatsApp as well as email. By harnessing the buy-in of local champions our approach was successful. RESULTS/ANTICIPATED RESULTS: The total number of patients recruited for the CERTAIN study is 4843. The rate of all missing variables improved with the efforts described above. Hospital admission dates were missing in 8.4% pre efforts and 4.2% post efforts (p<0.01). ICU admission dates were missing in 5.5% pre and 2.0% post (p<0.01). Documentation of completion of processes of care (including central line review, urinary catheter review, consideration for blood transfusion) improved significantly from pre to post (p<0.01). DISCUSSION/SIGNIFICANCE OF IMPACT: Missing data can be a problem in all types of research studies. This study provides some preliminary evidence for effective approaches that can reduce the problem of missing data when conducting a global study at sites with limited research infrastructure in place. By addressing the concern about missing data, we can be more confident that our results can be accurately analyzed and interpreted, improving the quality of the research.