Community Care Research Articles

Integrating AI·IoT-OAHPs with existing elderly care systems.

This letter addresses the integration of artificial intelligence and the Internet of Things-based older adult healthcare programs with existing community and institutional elderly care systems. It highlights the current disconnect leading to service duplication and resource inefficiencies, proposes multifaceted integration approaches, and underscores the importance of supportive policies. International examples are referenced to demonstrate successful models, emphasizing the need for coordinated care to enhance service delivery and optimize resource use.

Abstract TP90: Outpatient stroke care quality in VA Teleneurology and Community Care Neurology Consults

Abstract TP90: Outpatient stroke care quality in VA Teleneurology and Community Care Neurology Consults

Determinants of Familiarity and Experience with HIV Pre-Exposure Prophylaxis in Primary Care Providers in Ontario, Canada.

Despite increased access to HIV pre-exposure prophylaxis (PrEP) in Canada, familiarity and experience among primary care providers (PCPs)-including family doctors and those working with key populations-remains limited. To understand the barriers and facilitators of PrEP familiarity and experience, we conducted a situational analysis in PCPs in sub-urban and rural Ontario. We surveyed a non-probabilistic sample of PCPs using an online questionnaire, designed with the Consolidated Framework for Implementation Research (CFIR). Poisson regressions with robust variance were used to assess the relationship between CFIR domains, sociodemographic, and practice characteristics on both PrEP familiarity and experience. A total of 54 PCPs participated (6% response rate), comprising 80% physicians and 20% nurses. Nearly 30% of the sample worked with key populations, including sexual health clinics and community care centers, 18% of respondents reported high familiarity with PrEP, and 44% reported PrEP experience (referred, started a conversation, or prescribed). PrEP familiarity and experience were associated with working in an organization serving key populations, working with gender minorities, and having colleagues providing PrEP. Providers with a positive perception of PrEP and its necessity for populations at risk were more likely to have PrEP-related experience. Higher familiarity and experience were reported by PCPs with specific clinical skills related to PrEP, and with the perception that PrEP was compatible with their practice as primary provider. Our findings suggest that organizational support, and additional training and education would facilitate PrEP provision by PCPs in suburban/rural Ontario.

Clinicians Perspectives on Effective Suicide Prevention in Secondary Care Adult Mental Health Services: An Appreciative Inquiry Approach.

Suicide is a major health issue with devastating consequences for individuals, families and communities. In New Zealand, the latest confirmed suicide rates show an increase, with young adults, males and members of the indigenous Māori and LGBTQIA+ communities particularly affected. Until recently, most of the suicide research in New Zealand focused on the general population, rather than clinical populations such as those accessing mental health services. This evidence gap is especially important in New Zealand where almost half of those who die by suicide have known involvement with mental health services. The present qualitative study explored the question: What strategies and approaches do clinicians consider effective for preventing suicide in people accessing adult secondary care community mental health services? Eleven clinicians from a large metropolitan service were interviewed individually and in a focus group. Appreciative inquiry and thematic analysis were used. This report is adherent with COREQ. Four themes were identified for suicide prevention: Understanding who the person is, and for Indigenous Māori, this included use of cultural practices; providing a range of evidence-based prevention strategies; having an effective service structure that is part of a wider system; and suicide prevention work is important and staff need effective support. Clinicians identified strategies at the individual, family and service level for preventing suicide, most of which aligned with those recommended in the literature. There is a need for more suicide prevention research in secondary care mental health services and the effectiveness of suicide prevention in high-rate groups such as Māori and LGBTQIA+.

Building Commons in the Wasteocene: Empowerment and the Struggles of Injured Workers in South China

ABSTRACT Response: Drawing on the concept of “the Wasteocene,” this paper explores how workers dealing with occupational health and safety injuries have overcome the barriers of self-blame and discrimination to become active subjects who fight back against the capitalist logic of endless accumulation. Against the alleged neutrality of the Anthropocene, the Wasteocene draws attention to how socioecological relationships under capitalism lead to the production of disposable humans such as injured workers. However, since the revolutionary subject is not a pre-constituted entity, workers can become empowered only through the “commoning” practices of community caring and solidarity building. With the help of social work organizations, injured workers launch both individual struggles for legal compensation as well as collective action for the improvement of workplace safety. The workers' actions have proven that the practice of commoning is an important way to sabotage the Wasteocene. Their experience will help us reconceptualize possibilities for red-green alliances beyond the Anthropocene.

A qualitative study exploring the feasibility and acceptability of computerised adaptive testing to assess and monitor children and young people’s mental health in primary care settings in the UK

BackgroundThe increasing prevalence of mental health disorders among adolescents highlights the importance of early identification and intervention. Artemis-A is a web-based application of computerised adaptive testing (CAT), originally developed for...

Topical review: Challenges and solutions for eye care in long-term care.

The prevalence of visual impairment among individuals living in long-term care (LTC) is substantial, yet eye care is often disregarded and inadequately addressed. This neglect contributes to a decline in quality of life for residents. Thus, understanding the challenges faced by stakeholders in providing eye care for residents might suggest opportunities to improve eye health outcomes. This study aimed to identify factors influencing access to eye care services in LTC, focusing on key stakeholders including residents, family members, aged care staff, and eye care professionals. We included studies on vision/eye care-related challenges and/or management of eye conditions for people living in LTC facilities. We performed literature searches using Cochrane Database of Systematic Reviews, PubMed, CINAHL/EBSCO, EMBASE, APA PsycINFO, and Web of Science database. The search was limited to articles in English language, published between January 2013 and September 2023. Factors influencing the vision/eye care for residents were mapped to respective stakeholders, and we visualized how they interacted within the LTC system in providing eye care. Eleven studies were included in the review. We found that the challenges to appropriate eye care in LTC are present across all stakeholder groups. These challenges include limited awareness of eye health, logistical difficulties in coordinating and managing eye care within LTC settings, and negative beliefs and attitudes toward prioritizing eye care for residents. This review highlights that barriers to eye care in LTC communities exist at multiple levels and involve a range of stakeholders. In order to improve eye care, interventions should be at the system level, considering the influence of all key stakeholders rather than employing a targeted approach.

Geriatric medicine in Spain's healthcare system: Past and future

Geriatrics is the medical specialty that cares for health problems of older persons, including acute care, chronic care and rehabilitation, in various settings such as the community, hospitals and long-term care. This article analyzes the situation of geriatric medicine in Spain before and after the COVID-19 pandemic, highlighting the challenges and changes needed to improve geriatric care in the future. The first part of this paper describes the main landmarks of the Spanish health system. In 1986, a key law (Ley General de Sanidad) was approved by the Spanish Parliament, launching the development of the national health care system. In parallel, we describe and comment the development of geriatrics in Spain along this period is described. Later, the interactions between the health system and geriatrics along the next decades is reported, using 2020 (when started the COVID-19 pandemic started) as deadline of our past history. In the second part, the most important characteristics of the current situation of Spanish and European geriatric medicine are described, in order to propose ideas on how geriatric care can be designed and reimagined in the future.

Factors influencing the utilization, and perceived benefits of complementary and alternative medicine in the management of common childhood diseases among residents of Makun community, Sagamu, Ogun State Nigeria.

The utilization of Complementary and Alternative Medicine (CAM) has been on the rise, despite the expansion of conventional medicine across populations. The choice and utilization of CAM are informed by individuals' health-care-seeking behavior and the derived benefits. This study examined the factors responsible for the choice and utilization of CAM in the management of common childhood diseases among residents of Makun community, Sagamu, Ogun state Nigeria. A descriptive cross-sectional design was adapted for this study, using an interview-administered questionnaire to elicit data on respondents' socio-demographic characteristics, knowledge, utilization, and factors influencing the utilization of CAM and perceived effects and satisfaction. Multi-stage sampling technique was used to select a total of 332 respondents comprising 129 males and 203 females. Data were analyzed with the Statistical Package for Social Sciences and presented using tables, percentages, and frequencies. The findings revealed the following as the most influencing factors for the choice and utilization of CAM: Effectiveness (75.9%), affordability (82.9%), accessibility (81.7%), and tolerance for children (44.6%). CAM therapies that are always utilized in the management of common childhood diseases include herbal medicine (36.7%), natural supplements (21.4%), dietary therapy (13.3%), and chiropractic (10.2%). Perceived benefits include satisfaction (71.1%), effectiveness (45.8%), safety (37.3%), and minimal side effects (46.7%). The study concludes that despite the popularity of conventional or orthodox medicine in Nigeria, there is still a significant percentage of the population who actively utilize complementary and alternative medicine therapies in the management of common childhood diseases. CAM therapies are mostly used in communities as either primary or adjunct therapy, due to high perceived safety and effectiveness. It is pertinent for Nurses to be aware of the knowledge of CAM and It is pertinent for Nurses to be aware of the growing popularity and utilization of Complementary and Alternative Medicine in managing common childhood diseases. Nurses need to develop solid strategies to ensure there is an open conversation regarding CAM use by clients towards improving the care of communities and mitigating the uncontrolled utilization of complementary and alternative medicine in the care of children.

P-803. A 10-year Retrospective Analysis of Staphylococcus aureus Bacteremia in a Philippine Tertiary Hospital

Abstract Background Staphylococcus aureus is a frequent cause of bacteremia in community and health care settings. There is limited data on S. aureus bacteremia (SAB) in the Philippines. This study describes the demographic profile and clinical characteristics of adult patients with SAB and their association with in-hospital mortality. Methods Patients aged ≥ 18 years with SAB from 1/1/2013 to 12/31/2023 were reviewed for study inclusion. SAB was defined as at least one blood culture result positive for S. aureus. Clinical characteristics, comorbidities, sources of infection, and clinical outcomes were recorded. Stepwise regression analysis was performed using STATA 13.1. Results 314 patients with SAB were included; over half were male (185/314, 59%) and majority (62.5%) had Methicillin Susceptible Staphylococcus aureus (MSSA) bacteremia. The most common comorbidities were diabetes mellitus (146/314, 46.5%) and end stage renal disease (92/314, 29.3%). Mortality was high at 24.5% (77/314). Deceased patients were significantly older than survivors (65.7 years vs 59.0 years, p = 0.004). Among deceased patients, pleuropulmonary and intravascular catheter-related infections were the most common sources of infection comprising 29/77 (37.7%) and 12/77 (15.6%), respectively. Most patients (252/314, 80.3%) were referred to infectious diseases (ID) specialists. Clinical factors significantly associated with in-hospital mortality in the bivariate analysis included older age (OR=1.02, 95% CI 1.01-1.04), active malignancy (OR=3.25, 95% CI 1.68-6.26), hepatic failure (OR=3.25, 95% CI 1.01-10.51), hospital-acquired SAB (OR=3.97, 95% CI 2.09-7.53), septic shock (OR=54.0, 95% CI 7.2-404), and ICU admission (OR=22.17, 95% CI 9.16-53.69). In the multivariate regression model, hospital-acquired SAB (OR = 3.79, 95% CI 1.05 – 13.72, p = 0.002) and septic shock (OR = 1972.07, 95% CI 120.25 – 32339.3, p = < 0.001) increased the odds of in-hospital mortality, while referral to ID was protective (OR=0.11, 95% CI 0.01 – 0.90, p = 0.40). Conclusion The high mortality rate of SAB in this study is comparable to published data. Hospital-acquired SAB and the presence of septic shock significantly affect in-hospital mortality. Referral to ID specialist is associated with improved survival. Disclosures Karl Evans R. Henson, MD, FIDSA, BSV Biosciences: Honoraria|Cathay Drug Company, Inc: Grant/Research Support|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria

P-1952. SARS-CoV-2 Self-Testing Modalities Demonstrate Concerning Inaccuracies Among Rural, Minority Populations: The ALL-IN SC Study

Abstract Background At-home, diagnostic self-test assays provide a unique opportunity to reduce healthcare disparities by providing low-cost, immediate access to disease testing. Despite their utility, their real-world accuracy is unknown. Therefore, this study aimed to evaluate multiple testing modalities among diverse, marginalized populations in a large, multi-year, state-wide randomized controlled trial. Methods From 2022 to 2023, 2,195 individuals participated in testing events across South Carolina, USA. Participants provided medical personnel collected samples for gold standard laboratory comparison and were assigned to one of three groups for a matching self-test comparison. These groups were 1) no assistance self-test (only provided manufacturer self-test instructions), 2) unassisted hybrid (collected their own samples according to manufacturer instructions and mailed-in samples to laboratory), and 3) assisted (medical personnel verbally explained the manufacturer’s instructions). A robust statistical analysis plan was executed; however, only the results from multivariate regression are described here. Results Participants in the unassisted groups were significantly more likely to have an incorrect self-test result. Conversely, participants with assistance were 32% more likely to have a correct self-test result, regardless of testing modality (saliva, dried blood spot, nasal swab). Self-collection of saliva samples to send to a laboratory for testing had the highest odds of inaccuracy (OR=9.21, p-value < 0.001). Self-collection of dried blood spot samples sent for laboratory testing had the lowest odds of inaccuracy (OR=1.52, p-value< 0.021). Demographic risk factors varied by testing modality, with females, black, and lower income participants statistically more likely to have inaccurate testing results. Select infection symptoms at the time of testing also increased the odds of inaccuracy. Conclusion This study provides critical evidence that self-tests are a viable option for addressing health care access disparities, but telemedicine and/or community assistance programs must also be provided to ensure tests are conducted and interpreted correctly. Disclosures All Authors: No reported disclosures

P-969. Antibiotic Prescribing Patterns for Surgical Prophylaxis Before and After an Educational Campaign about Penicillin Allergies

Abstract Background Patients with a documented penicillin allergy often do not receive first-line antibiotics for surgical prophylaxis due to the concern for allergic cross-reactivity between cefazolin and penicillins. Receiving suboptimal antibiotics unnecessarily may contribute to increased risk of adverse drug reactions and undesirable clinical outcomes. This study evaluated the rate of first-line antibiotic regimen utilization for surgical prophylaxis in penicillin allergy-labeled patients before and after a prescriber-facing educational campaign about penicillin allergies.Figure 1.WINK Educational Document Methods This was a single-center retrospective cohort study conducted at a tertiary care community hospital. Education was provided over one month in-person by infectious diseases and surgical services pharmacists to surgeons and anesthesiologists, including review of an educational handout detailing current penicillin allergy label literature, cefazolin side-chain dissimilarity, and when cefazolin should be considered or avoided (Figure 1). This content was also provided to pharmacists and posted to the system intranet. Patients were included if they had a documented penicillin allergy and received an antibiotic during admission for procedural prophylaxis. Patients receiving systemic antibiotics or with an infection within three days of procedure were excluded. The primary outcome was rate of first-line pre-operative antibiotic regimen utilization for surgical prophylaxis pre-education versus post-education. Secondary outcomes included all-cause hospital readmission within 90 days, acute care length of stay, surgical site infection rate, and safety outcomes. This study was approved by the local Institutional Review Board.Table 1.Baseline Patient Characteristics Results 340 patients were included in the study, evenly split into the pre- and post-groups. Patient demographics are shown in Table 1. First-line pre-operative antibiotic regimen utilization occurred in 89 patients in the pre-education group (52.4%), and in 113 patients in the post-education group (66.5%) (P = 0.011). Secondary outcomes are listed in Table 2.Table 2.Results for Secondary Outcomes Conclusion An educational campaign focusing on reasonable use of cefazolin in the setting of a penicillin allergy label may improve use of first-line antibiotics, which may positively influence clinical outcomes. Disclosures Timothy Gauthier, PharmD, BCPS, BCIDP, AbbVie Pharma: Advisor/Consultant|Antimicrobial Therapy, Inc: Advisor/Consultant|Ferring Pharma: Advisor/Consultant|Firstline Mobile Health: Advisor/Consultant|Gilead Pharma: Advisor/Consultant|GoodRx: Advisor/Consultant|GSK Pharma: Advisor/Consultant|Melinta Pharma: Advisor/Consultant|Pattern Biosciences: Advisor/Consultant|Pfizer Pharma: Advisor/Consultant|ProCE: Honoraria|WWW.LearnAntibiotics.com: Ownership Interest

A Community-Led Approach to Understanding How Service Providers Can Support ‘Ageing well’ for Older Aboriginal People in Australia

ABSTRACT Supporting older people to age well is a global policy priority, however the development and implementation of strategies to support ageing well for older Aboriginal people must be determined by the communities affected. This is necessary in colonial contexts, where socio-political structures impinge on Aboriginal rights and mainstream policy and practice creates and maintains health and social inequities. This article reports on research conducted in partnership with the Dharriwaa Elders Group, an Aboriginal Community Controlled Organisation. The research focus was how service provision can support Aboriginal people to age well in a remote community in New South Wales, Australia. Interviews were conducted with 11 staff members from health, aged care, and Aboriginal Community Controlled services. The analysis produced four themes: Ageing well is collective and a shared responsibility; Racism and discrimination are pervasive in mainstream services; Intersectional barriers and enablers to ageing in place; Trust and cultural safety are integral to service accessibility. Our discussion explores the cultural and socio-political context of these findings and highlights implications for policy and practice.

Multi-level Factors to Build Confidence and Support in Active Surveillance for Low-Risk Prostate Cancer: A Qualitative Study.

Active surveillance (AS) is the guideline-recommended treatment for low-risk prostate cancer and involves routine provider visits, lab tests, imaging, and prostate biopsies. Despite good uptake, adherence to AS, in terms of receiving recommended follow-up testing and remaining on AS in the absence of evidence of cancer progression, remains challenging. We sought to better understand urologist, primary care providers (PCPs), and patient experiences with AS care delivery to identify opportunities to improve adherence. A qualitative study involving patients, PCPs, and urologists with experience of AS. PCPs (19), urologists (15), and patients (15) in Michigan. Participants were recruited through a statewide quality improvement collaborative. Semi-structured interviews were conducted virtually from June 2020 to April 2021. The Theoretical Domains Framework and the Behavior Change Wheel's Capability, Opportunity, and Motivation model guided interviews and coding. Thematic analysis was used to identify shared perspectives on AS care delivery. Three main themes emerged from the PCP, urologist, and patient data collected related to AS care delivery that were needed to improve AS adherence: (1) building patient confidence in AS by leveraging provider roles and expertise and creating connection through communication across the care team and with patients; (2) building confidence in AS through psychosocial support by involving families and peers, and addressing anxiety and uncertainty; (3) building AS support within healthcare processes and electronic health record systems. These themes reflect opportunities for interventions at the care team, community (family and peers), and health system levels that could better support individualized care and overcome challenges to AS adherence through team-based approaches.

“Me Llamo Luchadora Social”: Trans Latina Immigrants as Nepantleras Generating Change in the Southern United States

Abstract Many trans Latina immigrants have utilized their individual and collective strengths to resist oppression and generate change in their communities; however, their efforts remain largely invisible to those outside of their communities. The current study aimed to explore the meaning trans Latinas make of their experiences as agents of change in the southern United States. Informed by Chicana feminisms, authors used interpretive phenomenology to explore the testimonios of six trans Latina immigrants living in Georgia, Louisiana, North Carolina, and Texas. Three themes were constructed: (1) the burden of discrimination, violence, and unmet needs; (2) luchadoras being and doing social change; and (3) finding strength in caring for each other. Anzaldúa’s nepantlera concept informed how authors situated findings as acts of resistance to societal violence, discrimination, and struggles at the micro, mezzo, and macro levels. The participants’ sense of agency was a response to the complexity of their identities within hostile contexts, and their resilience and resistance hinged upon building caring communities and becoming luchadoras sociales to affect empowerment and change. The authors offer suggestions for guiding social work researchers, practitioners, and educators to engage in strengths-based approaches to advocate for the human rights, needs, and strengths of trans Latina immigrants and their communities.

Health disparities among youth admitted for an eating disorder in an inpatient hospital setting

ABSTRACT The rise of eating disorders (EDs) in youth has become increasingly studied and understood among the health care community in recent years. With the frequency at which these youths are requiring medical stabilization, the importance of further examining factors that may contribute to these rates, such as health disparities, has become of primary concern for prevention and treatment efforts. Health disparities and related factors among youth hospitalized for medical stabilization secondary to an ED are examined to expand provider knowledge about this population and identify areas for improvement. Electronic medical record (EMR) retrospective (2017–2022) review was conducted within a southeast metropolitan children’s hospital (N = 91, ages 9–19 years) examining comparisons between Latinx and non-Latinx youth, insurance type, previous admissions for similar presentation, and ED-related characteristics. Results show Latinx patients were found to be admitted (p = .013, p = .002) and discharged (p = .003, p < .001) with higher scores on measures of body composition than non-Latinx patients. Additionally, higher rates of public insurance among Latinx patients (p < .001) and higher readmission rates among patients with public insurance (p < .001) were observed. Authors provide suggestions for improving screening practices and advocacy efforts to help increase ED treatment options for youth that may have limited access.

A New Agenda for Optimizing Roles and Infrastructure in a Mental Health Service Model for South Korea.

As the demand for community mental health services continues to grow, the need for well-equipped and organized services has become apparent. This study aimed to optimize the roles and infrastructure of mental health services, by establishing, among other initiatives, standardized operating models. The study was conducted in multiple phases from May 12, 2021, to December 29, 2021. Stakeholders within South Korea and metropolitan mental health welfare centers were targeted, but addiction management support centers, including officials, patients, and their families, were integrated as well. A literature review and survey, focus group interviews, a Delphi survey, and expert consultation contributed to comprehensive revisions and improvements of the mental health service model. The proposed model for community mental health welfare centers emphasizes the expansion of personnel and infrastructure, with a focus on severe mental illnesses and suicide prevention. The model for metropolitan mental health welfare centers delineates essential tasks in areas such as project planning and establishment, community research, and education about severe mental illnesses. The establishment of a 24-hour emergency intervention center was a crucial feature. In the integrated addiction support center model, the need to promote addiction management is defined as an essential task and the establishment of national governance for addiction policies is recommended. This study proposed standard operating models for three types of mental health service centers. To meet the increasing need for community care, robust mental health service delivery systems are of primary importance.

Willingness and determinants of elder care modes among elderly individuals: insights from underdeveloped regions in Western China.

The aim of the present study was to investigate the willingness of elderly individuals regarding their choice of elderly care modes in underdeveloped regions of Western China and to identify the key factors influencing the willingness. We distributed a total of 20 000 questionnaires using the multistage stratified cluster random sampling method, and successfully collected 19 460 of them. After conducting quality checks, we deemed 19 040 questionnaires valid for analysis. The survey covered seven cities, 24 counties, and 255 villages in Gansu Province. We conducted statistical analyses, including univariate χ2 test, Kruskal-Wallis test and multivariate logistic regression, to assess the willingness of elderly individuals regarding care modes and the factors influencing these choices. Among the 19 040 valid responses, 88.55% preferred home care, 5.01% opted for community care, 5.01% chose institutional care, 1.08% preferred mutual care, and 0.36% selected smart care. Elderly individuals who have a lower level of education, residence within a 15-minute walking distance to the nearest health care facility, and believe that elder care should rely on themselves or their children, etc. exhibit a higher willingness for choosing the home care mode (P < 0.05). Elderly individuals who believe that elderly care should be reliant on their children, and possess a greater knowledge for the combination of medical and elderly care, etc. exhibit a stronger willingness for choosing the community care (P < 0.05). Elderly individuals with lower educational level and lack endowment insurance, etc. exhibit a higher willingness for choosing the mutual care (P < 0.05). Elderly individuals who are not afflicted with chronic illnesses and reside within a 15-minute distance from the nearest medical centre exhibit a higher willingness for choosing the smart care mode (P < 0.05). In underdeveloped regions in China, home care continues to be the predominant choice among elderly individuals. However, the growing demand for diverse elderly care modes warrants attention. Multiple factors influence the willingness of elderly individuals when selecting care modes. This study offers valuable insights for policymakers, enabling government departments to implement targeted strategies and interventions to meet the diverse service needs of the elderly population effectively.

Development of a Navigator-Delivered Health Insurance Education Program for Hispanic and Latine Communities.

Equitable access to health care services for Hispanic and Latine populations requires that systems go beyond working to increase enrollment in health insurance but also addressing health insurance literacy-the knowledge, ability, and confidence to find and use health insurance. In collaboration with a local health policy organization, individual interviews were conducted with Hispanic and Latine community members. Group engagement sessions were conducted with key professionals. Interviews and engagement sessions focused on the adaptation of an existing health insurance education program (HIEP) to Spanish-speaking Hispanic and Latine individuals. An outline of the proposed HIEP content was provided prior to each interview or engagement session. Qualitative content was analyzed using an inductive thematic analysis guided by the intervention adaptation literature. A total of N = 20 professionals participated in an engagement session, while N = 21 community members took part in an interview. Professionals worked in both health care systems (55%) and community organizations (45%). Community members were on average 41 years of age (SD = 13), 81% female, and 100% Hispanic or Latine. Qualitative analysis revealed that participants overwhelmingly supported the adaptation of the HIEP and approved of the proposed topics. Participants also provided recommendations to improve the intervention content and characteristics including a focus on controlling costs, tailoring to the population, ensuring accessibility of content, and specifics regarding the HIEP delivery and facilitator. Overall participants were supportive of the proposed HIEP adaptation and provided a variety of recommendations. Health insurance literacy was perceived as an important next step to enrollment in health insurance.

Impacts of State COVID-19 Vaccine Mandates for Health Care Workers on Health Sector Employment in the United States.

Objectives. To assess the impact of state COVID-19 vaccine mandates for health care workers (HCWs) on health sector employment in the United States. Methods. Using monthly state-level employment data from the Quarterly Census of Employment and Wages between January and October 2021, we employed a partially pooled synthetic control method that accounted for staggered mandate adoption and heterogeneous treatment effects. We conducted analyses separately for the 4 health care subsectors-ambulatory health care services, hospitals, nursing and residential care, and social assistance-with an additional analysis of 2 industry groups-skilled nursing care and community care for the elderly-under the nursing and residential care subsector. We further explored possible heterogeneous impacts according to the test-out option availability. Results. Mandate impact estimates were statistically indistinguishable from zero. Results further ruled out a mandate-associated decrease in employment larger than 2.1% of premandate employment levels for the 6 health care domains examined and for states with no test-out option. Conclusions. State COVID-19 vaccine mandates for HCWs were not found to be associated with significant adverse impacts on health sector employment even in states without a testing alternative to vaccination. The findings support vaccine mandates as a viable preventive measure without material disruption to the health care workforce, including in times of public health emergencies. (Am J Public Health. Published online ahead of print January 23, 2025:e1-e5. https://doi.org/10.2105/AJPH.2024.307906).