Shutdowns Associated with Covid during Pandemic, Impact on the Healthcare

​Short Summary  
Shutdowns associated with the COVID-19 pandemic significantly worsened health conditions for many populations and altered the delivery and outreach of public health programs, particularly those aimed at chronic disease prevention and management. This project partnered with academics at the University of Technology, Sydney and health promotion practitioners via a nation-wide collaboration in Indigenous health called the Centre for Research Excellence - STRengthening systems for InDigenous health care Equity (STRIDE) to develop the research questions, approach, and recruit participants. This international comparative study aimed to explore and compare the approaches and experiences of Health Promotion practitioners during COVID-19 in Australia and the United States. Research questions included: 

• Explore how the COVID-19 pandemic has affected priorities, resources, activities and staffing in health promotion 
• Explore how COVID has impacted health inequities and minority populations 
• Identify possible threats and opportunities available to health promotion practice as a result of COVID 19 

 
In 2021, students enrolled in MPH 512: Research Methods conducted interviews with 30 health promotion practitioners, 15 from each country. In 2022, students in MPH 512: Research Methods and in MPH 558: Qualitative Methods undertook in-depth analyses of qualitative data and presented findings to an international audience of stakeholders and participants. Subsequently, this work has been presented at the National Rural Health Conference, Australia, the Community Health Planning and Policy Development Section of the American Public Health Association Mid-Year meeting, and by students at the Health Equity and Social Justice Conference, Chicago. Two presentations have been accepted to the American Public Health Association conference for presentation by students in Fall 2022. 

Work-to-Date 
Overall, we're pleased to report that this project examining the impacts of COVID-19 on the Health Promotion workforce has met all projected goals and is on track to meet the final deliverable of a published manuscript in the 2^nd year of the fellowship.  

Graduate Students  
Two graduate students were supported on this project. Bianca Alvarez was supported by funding from the Steans Fellowship and Erin Augustine was supported by the Department of Public Health at DePaul. Their contributions were invaluable in developing the initial codebook and coding all of the transcripts from data collected in Spring 2021. They each identified a research question of interest and undertook their own analysis. These questions became the research questions that students explored in Spring 2022 (see below) so that the analysis was triangulated, and that Bianca and Erin could provide support to students by being a “guide" to the data. Bianca and Erin both developed an abstract for submission to the American Public Health Association annual meeting, and both were accepted for presentation to occur in November. 
 
Collaboration with CRE-STRIDE and A/Prof Percival 

In 2021- early 2022, after the initial phase of our study, Australia experienced its most severe shutdowns and COVID infections of the pandemic. This presented added hardships on our partners and planned Community of Practice (CoP) meetings were canceled. However, this also increased interest in the data that we had collected in early 2021. In partnership with Dr Percival, we identified 3 research questions for in-depth analysis from the data already collected and the initial analyses conducted by the graduate students. They were: 

1. How have priorities in health promotion been impacted by COVID-19 response? 

1. From the perspective of health promotion practitioners, explore how health inequities have been impacted by COVID-19 

1. What does “community engagement" look like during the COVID-19 response? 
   
   Dr Percival provided lectures to the students about the Australian health context and COVID-19 response, and feedback on the results prior to dissemination. In addition, Dr Tessa Benveniste and Kristy Clancy, an Indigenous woman and CRE=STRIDE research fellow, provided a presentation on culturally appropriate dissemination. 
   
   In May 2022, the students presented their findings to the CRE-STRIDE CoP in two zoom presentations. Approximately 30 people attended and participated in subsequent breakout rooms to discuss the findings in detail. 
   
   DePaul Course Integration 
   
   Students in MPH512: Research Methods conducted in-depth analysis of the qualitative data as the service-learning component of the course. In two large teams of about 6 students, each led by one of the graduate students, they learned about data collection, analysis, and dissemination using this project as a case study.  
   
   While I planned to integrate the service-learning project into MPH512: Research Methods, another opportunity arose to also integrate it into MPH558: Qualitative Methods. This project provided a natural fit because of its qualitative design. Further, many of the students in MPH558 had collected the data when they were enrolled in MPH512 in 2021 and had interest in looking at the data again and presenting it to STRIDE. As a small group, they undertook an analysis of research question 3 and presented these findings to a small group of CRE-STRIDE investigators. 
   
   Both courses received strong scores for the service-learning component. In addition, qualitative feedback indicated that some students have now become interested in a research career as a result of their experience in the course. 
   
   Dissemination and Future Plans 
   
   In addition to the dissemination meetings to CRE-STRIDE, 3 professional presentations have already occurred, one led by one of the student groups in MPH 512, and 2 presentations have been accepted to for presentation this fall. See citations below. In addition, I met with partners during my trip to Australia in July 2022 to identify next steps for the project and the dissemination of this work. 
   
   A manuscript on the data is in development and is anticipated to be submitted by the end of 2022.  
   
   CRE-STRIDE, Dr Percival and I are moving forward with plans to revise the structure and implementation of the CoP to better fit practitioners' needs as we move into a post-COVID world. With Australia opening back up, there are more opportunities to meet in-person and so the online zoom meetings may be discontinued. However, the findings from this study have already informed next steps for CoP topics and future work by CRE-STRIDE on reinvesting in Health Promotion, understanding new ways of engaging with community members and ongoing advocacy to address enduring inequities. 
   
    
   
   Timeline 

 
Presentations 

Bly, E., Torralba, R., King, R., Urrea, J., Delavega, S., Lazarski, I., Muslimovic, M., Augustine, E., Alvarez, E., Percival, N., Conte, K. “Examining the impact of COVID-19 on Health Promotion Priorities in the United States and Australia." Health Equity and Social Justice Conference, Chicago, IL, August 26 2022. 

Conte, K., Percival, N., Alvarez, B. Augustine, E. “Opportunities through COVID to strengthen Health Promotion practice in Australia and abroad: learning from practitioners and extending the discussion for Indigenous Health Promotion." National Rural Health Conference, Brisbane, August 2022.  

Conte, K, Augustine, E., Alvarez, B. Percival, N. “Responding to COVID: Shifts and adaptations in Health Promotion priorities." Community Health Planning and Policy Development Section of the American Public Health Association Mid-Year meeting, June 16, 2022. 

Conte, K. Alvarez, B. Augustine, E., Percival, N, and Master of Public Health Student in Research Methods Course. “Student-based learning in a collaborative research project examining impacts of COVID-19 on health promotion in Australia and the USA." Research Capacity Strengthening Seminar, Centre for Research Excellence in Strengthening Systems for Indigenous Health Care [online], May 2022. 

Accepted Presentations 

Augustine, E., Alvarez, B., Percival, N., Conte, K. “Rising to meet the challenge of COVID19: Health promotion professionals report innovations in health messaging and community engagement." American Public Health Association Annual Meeting, Boston, November 2022. 

Alvarez, B., Augustine, E. Percival, N., Conte, K. “Guilt in health promotion: A comparative international study to understand health practitioner challenges with health inequities during the COVID-19 pandemic." American Public Health Association Annual Meeting, Boston, November 2022. ​