SESSION 1, STREAM 1: WORKING WITH COMMUNITIES

Title: Developing a critical approach to public health during the Covid-19 pandemic

Authors: Helen Eborall & Jeni Harden

Background: In the 2020-21 academic year, the context of the Covid-19 pandemic coincided with a newly revised MBChB curriculum at Edinburgh Medical School. As part of the Social & Ethical Aspects of Medicine module, we developed a semester-long unit, ‘Health in Communities,’ through which students learnt about public health, from a critical perspective. In this presentation, we will reflect on the different ways in which the pandemic impacted on the teaching and learning.

Summary of Work: The Health in Communities unit ran for eleven weeks, beginning with a background to public health and health inequalities, covering current public health concerns and key structural factors in the 2020s and taking a critical look at public health action and health promotion interventions at different levels. To bring the material to life, in a five-session community practical, each group of students connected (remotely) with a GP, Community Link Worker and representatives from local third sector organisations. Using a case study vignette of an individual in the GP’s practice locality, with interrelated health and social circumstances, students learnt about how each professional (or organisation) could support the individual, along with learning about the limits to each type of support in countering underlying structural influences.

Discussion and Conclusions: As Kendall et al (2021) have commented, Covid-19 opened up medical students’ sociological imagination. In this new ‘Health in Communities’ unit, Covid-19 impacted on the teaching and learning in each weekly topic, by adding to the course material and providing vivid and timely case studies for applied learning, illustrating how Covid-19 exacerbated many inequalities in health. Furthermore, while the remote delivery of this unit due to the January-March 2021 lockdown presented both challenges to the learning environment, it created opportunities for the practical element of the unit; for example, the inclusion of community professionals for whom logistical barriers would have hindered involvement previously and the chance to hear first-hand how community-based organisations were continuously adapting to Covid-19-related restrictions in order to support those most in need.

In the backdrop of continued uncertainty of the pandemic, as we plan for the 2021-22 year, we will retain the structure, material and modality of this unit and have identified several ways in which to adapt/extend to improve it.

Title: Community Literacy: Learning pandemic preparedness from HIV survivors

Authors: Yudit Namer, Florian Drüke, Oliver Razum

For many communities, the Covid-19 pandemic has been the largest and most intrusive health emergency that they encountered. It was the first time that their social relationships have been subjected to rules and regulations, the distance between each other has been surveilled, and forms of social contact became a threat. For communities whose lives were impacted by the HIV pandemic, however, none of this was new. The HIV pandemic has been with us for 40 years, and an estimated 38 million people live with HIV in the world (UNAIDS, 2020). Despite regional differences, gay men or men with male sexual partners and transgender people are disproportionately at risk (UNAIDS, 2020). On the one hand, this disproportionality signifies stigma, especially for LGBTQI+ communities. On the other hand, it may indicate that these communities have the lived experience of resilience when it comes to survivorship, fighting stigma, dealing with loss, and living with health risks.

 

In the beginning of the Covid-19 pandemic the LGBTQI+ community has shown how vital their knowledge could be, by distributing zines and other guiding materials within a very different atmosphere and with a different tone from those of official institutions. By telling stories of preparedness and familiarity, feelings of anxiety and panic were countered. In Salonee Bhaman’s words: “…because our communities have had to hold each other tightly and provide for contingency in the face of state neglect for a long time… [w]e have insurgent and hard-won knowledge”. The community work then focused on “to share this information, to connect these communities, and think about who falls through first when society cracks under outsize pressure” (Bhaman, 2020). Experiences of survivorship (despite being widely documented) do not translate into research or education on strategies for pandemic preparedness, which becomes a lost opportunity of the larger society to learn. Both medical and Public Health curricula lack pedagogies in history of medicine that incorporate the perspectives of communities with lived experience of survivorship. We identify this as a lack in what we call community literacy on the side of scientific and professional communities. Incorporating community literacy calls for a different way of generating teaching materials. These need to be co-produced with members of the LGBTQI+ community in a highly participatory way centred on testimonies

Title: Improving COVID-19 Vaccine Uptake among Patients with Serious Mental Illness

Authors: Ramya Sriskandarajah (Year 3 Medical Student, Imperial College London), Yu Chiu Chiang (Year 3 Medical Student, Imperial College London), Dr Arti Maini

Background: Patients with severe mental illness (SMI) have a low rate of COVID-19 vaccine uptake. At Imperial College London, all third-year medical students undertake Community Action Projects (CAP) during their primary care placements. They work collaboratively with patients and local communities to identify and help address community health and wellbeing priorities. Additionally, a cohort of third-year medical students undertake training in health coaching skills to support person-centred conversations, shared decision-making and health behaviour change. Here we describe a CAP that draws on health coaching approaches and other behaviour change methods to improve COVID-19 vaccine uptake among patients with SMI.  

 

Summary of Work

2 of the co-authors (both third-year medical students) undertook a CAP during their primary care placement in London from January-March 2021. This involved identifying all patients at their practice with a diagnosed SMI who had not yet had the COVID-19 vaccine.  48 patients were identified and telephoned to explore their vaccine-related concerns. 30 of these patients discussed their reasons for not yet having the vaccine. These included: low confidence in the safety and effectiveness of the vaccine;  belief that the vaccine was not relevant for them; and inconvenience relating to obtaining the vaccine. To address this, the students designed a tailored information leaflet, held conversations with patients drawing on person-centred health coaching skills including motivational interviewing and facilitated vaccine access (available through a home service and vaccine availability at depot injection clinics). Subsequent follow-up discussions with patients drew further on health coaching approaches (including non-judgemental exploration of patient perspectives, solution-oriented questions, goal-setting, positive affirmations and reflective listening).  These conversations facilitated trust, confidence-building and shared decision-making, empowering patients to make a more informed choice.

Discussion: Our project highlights the value of health coaching approaches including motivational interviewing in conversations with patients with SMI, together with provision of tailored information and facilitating vaccine access, supporting them to make more informed decisions regarding the COVID-19 vaccine.

Conclusions: Exploring the perspectives of patients with SMI is crucial to address low uptake of COVID-19 vaccines. Strategies to address patient concerns include tailored information and person-centred health coaching approaches to facilitate shared decision-making. A trusting relationship between patients and healthcare professionals is crucial.

Take-home Message: Behaviour change methods including person-centred health coaching conversations, tailored information and facilitating vaccine access can enable patients with SMI to make more informed decisions about the COVID-19 vaccine, thereby improving vaccine uptake.