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(1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework. (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context. (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities. (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.

Vaccine hesitancy has been identified as one of the top 10 threats to global health. The causes of low vaccine uptake are many and vary at micro and macro levels. However, rural and remote coastal areas in the UK experience unique vaccine inequalities due to high levels of deprivation and their unique and complex access-related problems. This study aimed to explore community efforts to promote vaccine uptake during the COVID-19 pandemic and understand how the COVID-19 vaccination campaign was experienced by the public. We conducted an exploratory descriptive qualitative study using semi-structured interviews with decision-makers, health professionals and community members in Lincolnshire, a predominantly rural county with a long coastline, a large population of white minority ethnicities, and those living in caravan and temporary housing. Data were analysed using conventional content analysis. Overcoming the various access barriers to vaccination uptake involved working with local media stations, local communities and local community groups, translation of information, bringing vaccines closer to the people through pop-up and mobile clinics and provision of transport and ensuring confidentiality. There is a need to employ inclusive targeted non-conventional care interventions whilst dealing with complex problems as occur in rural and remote coastal regions.

Background: Debate on the burden of musculoskeletal (MSK) conditions in lower and middle income countries is intensifying; yet, little knowledge so far exists on patterns and impacts of such conditions among general or older adult populations in sub-Saharan Africa (SSA). The objectives of this study are to examine the prevalence, potential predictors, and sequelae of MSK among older adults residing in two low resource informal urban settlements or "slums" in Nairobi Kenya. Methods: Data on older adults aged 60 years and over from two unrelated cross-sectional surveys on the older slum populations are used: a 2006/7 survey on the social, health, and overall well-being of older people (sample N = 831), and a 2016 survey on realities and impacts of long-term care and social protection for older adults (sample n = 1026). Uni and multivariate regressions on the 2006/7 data are employed to examine relationships of back pain and symptoms of arthritis with sex, age, wealth, unemployment, diagnoses of hypertension, and diabetes; and with indicators of subjective well-being and functional ability. Descriptive frequencies and chi-squared tests of association are used on 2016 data to identify the overall prevalence and locations of activity limiting MSK pain, and sex differences in these. Results: Prevalence of past month back pain and past 2 week symptoms of arthritis was 44% and 42.6%, respectively. Respective prevalence of past month activity limiting back pain and joint pain was 13.9% and 22.7%. A total of 42.6% of slum residents with a current health problem report MSK as the most severe problem. In multivariate regressions, female sex, unemployment, and diagnosis of hypertension are predictive of back pain and symptoms of arthritis. Both conditions are associated with raised odds of having lower quality of life, poorer life satisfaction, and depressive symptoms, and with mobility impairments and self-care difficulties. Conclusions: MSK conditions are salient, and a likely

Background: Infectious diseases cause the majority of childhood deaths in low income settings. Integrated community case management (iCCM) is a health innovation relying on community health workers (CHWs) to diagnose and treat children with malaria, pneumonia and diarrhoea while referring children with severe disease. However, iCCM is a complex innovation and its perception by its intended users as well as the acceptability of its attributes and how these fit into the functions of the health system, are not well understood. Yet these factors are likely to affect adoption and effective coverage of the innovation. Objective: The studies sought to explore the uptake and impact of iCCM in Uganda, with a focus on community acceptability, perceived quality of care, appropriate treatment and access to referral care, in order to formulate recommendations for improved implementation at scale. Methods: Four studies (I-IV) were conducted among caregivers of children under-five and community members. Study I draws on diffusion of innovations and uses an explanatory qualitative approach with focus group discussions and interviews with community members, CHWs, and health facility supervisors to explore the acceptability and adoption of iCCM. In study II, a cross-sectional sample of caretakers of children aged 2-59 months who suffered an episode of malaria, pneumonia or diarrhoea and have been treated either by CHWs or primary health facility workers (PHFWs) were compared for perceived quality of care (PCQ) across quality domains specified in the Donabedian Model. Study III compares uptake of appropriate treatments for pneumonia and diarrhoea under iCCM and equity in use of CHWs. Study IV estimates the cost of referral and willingness to pay (WTP) for referral using a case-series study on children referred by CHWs to higher level health facilities. Findings: CHWs were seen as acceptable providers of child health services and the communities appreciated the treatment provided (stud

The COVID-19 pandemic has caused considerable disruption to cancer care and may have exacerbated existing challenges already faced by cancer survivors from rural areas. This has created a need for a rapid evidence synthesis to inform the development of tailored interventions that address the specific needs of rural cancer survivors who continue to be affected by the pandemic. The review was conducted following guidance from the Cochrane Rapid Review Methods Group. Database searches were performed via the EBSCOHost interface (includes MEDLINE, CINAHL, PsycINFO) on 25 May 2022 and supplemented with searches on Google Scholar. Peer-reviewed articles published after March 2020 that reported primary data on the experiences of cancer survivors residing in rural and remote settings during the pandemic were included. Findings were tabulated and written up narratively. Fourteen studies were included. The COVID-19 pandemic had a mostly detrimental impact on the experiences of rural cancer survivors. People’s individual coping mechanisms were challenging for a range of reasons. Specifically, the pandemic impacted on their ability to access testing, treatment, check-ups and supportive care, their ability to maintain and access social support with close friends and family, as well as negative consequences to their finances and emotional wellbeing with some reporting feelings of psychological distress including depression and anxiety. This review provides important insight into the experiences of rural cancer survivors that may help inform tailored support in line with the needs and challenges faced because of the pandemic.

The review question is: What type of practitioner led online Telehealth interventions that use psychological therapies are being delivered to support mental health and how effective are they? The review objectives are: 1. To identify and describe practitioner led online Telehealth interventions that use psychological therapies to support mental health. 2. To assess the utility and effectiveness of practitioner led online Telehealth interventions that use psychological therapies to support mental health. 3. What are the barriers and facilitators of implementing and engagement with practitioner led online Telehealth interventions that use psychological therapies to support mental health.

Background The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. Methods Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. Results Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. Conclusions Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities’ access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.

Background Telehealth usage has been promoted in all settings but has been identified as a panacea to issues of access and equity in the rural context. However, uptake and widespread integration of telehealth across all parts of the health system has been slow, with a myriad of barriers documented, including in rural settings. The crisis of the COVID-19 pandemic, saw barriers rapidly overturned with the unprecedented and exponential rise in telehealth usage. The uniqueness of the crisis forced telehealth adoption, but as the urgency stabilises, pandemic learnings must be captured, utilised, and built upon in a post-pandemic world. The aim of this study was to document staff experiences and perceptions of delivering rural psychological therapies via telehealth during the pandemic and to capture learnings for future rural telehealth delivery. Methods An online cross-sectional survey that explored mental health professional’s experiences, use, and perceptions of telehealth before and after pandemic-enforced changes to service delivery. Results Sixty-two respondents completed the questionnaire (response rate 68%). Both the delivery of telehealth via telephone and online video conferencing significantly increased during the pandemic (66% vs 98%, p < .001 for telephone and 10% vs 89%, p < 0.001 for online video). Respondents indicated that client’s access to services and attendance had improved with telehealth use but their attention and focus during sessions and non-verbal communication had been negatively affected. The challenges for older adults, people with learning and sensory disabilities, and residents in remote areas with poorer mobile/internet connectivity were identified. Despite these challenges, none of the respondents indicated a preference to return to fully face-to-face service delivery with most (86%) preferring to deliver psychological therapies fully or mostly via telehealth. Conclusions This study addresses three major gaps in knowledge: the experience

Over the course of the COVID-19 pandemic, the virus has undergone many mutations. Governments must continually update their health policies – often in seemingly contradictory terms – to protect the public from illness and death, and health systems from collapsing. This means persuading millions of people, not just once, but twice and three times each, to be vaccinated, while the virus and the messaging about it are in flux. The purpose of our ongoing research, in Canada and the United Kingdom (UK), is to learn what methods to date have worked to improve COVID-19 vaccine confidence among the public throughout the pandemic and to share this information with policymakers, public health officials, community decision-makers and contributors to public discourse. Our goal is to better understand how policy changes and mis/disinformation are experienced in communities with low vaccine confidence and to identify community level interventions that can be used to develop vaccine confidence. For this multiple methods study, our teams analysed and compared societal reception to COVID-19 vaccination policies, in particular the communication of those policies, across two distinct areas and populations, one in the UK and the other in Canada. Both areas studied had areas with lower vaccination rates and similar kinds of demographic subpopulations. We have characterized the evolution of relevant public health policies in terms of their content, context, actors and processes, seeking to learn more about how people understood and acted – or not – on COVID-19 health policy changes over time. We wanted to study which communication channels were used and how various populations responded to public health information and regulations; what other “unofficial” channels they may have used, for better or worse; and what community efforts might have built vaccine confidence among rural and urban communities. We, firstly, examined the policy evolution through a desk review. Our data sources inclu

COVID-19 infections are over-represented in ethnic minority groups and other deprived communities while low uptake levels for COVID-19 vaccines are observed in the same groups. The uptake of a vaccine depends not only on its perceived safety and effectiveness profile but also on how well vaccination policies are communicated by policy makers and subsequently implemented by practitioners. Scarcity of what was known about COVID-19 and its novel vaccines meant COVID-19 vaccination policies evolved quickly. We analysed how changes in government policies on COVID-19 vaccination in the UK (England) and Canada (Ontario) were communicated and experienced by diverse communities.

Vaccine hesitancy has been identified as one of the top 10 threats to global health. The causes of low vaccine uptake are many and vary at micro and macro levels. However, rural and remote coastal areas in the UK experience unique vaccine inequalities due to high levels of deprivation and their unique and complex access-related problems. This study aimed to explore community efforts to promote vaccine uptake during the COVID-19 pandemic and understand how the COVID-19 vaccination campaign was experienced by the public. We conducted an exploratory descriptive qualitative study using semi-structured interviews with decision-makers, health professionals and community members in Lincolnshire, a predominantly rural county with a long coastline, a large population of white minority ethnicities, and those living in caravan and temporary housing. Data were analysed using conventional content analysis. Overcoming the various access barriers to vaccination uptake involved working with local media stations, local communities and local community groups, translation of information, bringing vaccines closer to the people through pop-up and mobile clinics and provision of transport and ensuring confidentiality. There is a need to employ inclusive targeted non-conventional care interventions whilst dealing with complex problems as occur in rural and remote coastal regions.