Social Work Research

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COVID-19 Misinformation Prophylaxis: Protocol for a Randomized Trial of a Brief Informational Intervention
(JMIR, 2020-12) Agley, Jon; Xiao, Yunyu; Thompson, Esi; Golzarri-Arroyo, Lilian; School of Social Work
Background: As the COVID-19 pandemic continues to affect life in the United States, the important role of nonpharmaceutical preventive behaviors (such as wearing a face mask) in reducing the risk of infection has become clear. During the pandemic, researchers have observed the rapid proliferation of misinformed or inconsistent narratives about COVID-19. There is growing evidence that such misinformed narratives are associated with various forms of undesirable behavior (eg, burning down cell towers). Furthermore, individuals’ adherence to recommended COVID-19 preventive guidelines has been inconsistent, and such mandates have engendered opposition and controversy. Recent research suggests the possibility that trust in science and scientists may be an important thread to weave throughout these seemingly disparate components of the modern public health landscape. Thus, this paper describes the protocol for a randomized trial of a brief, digital intervention designed to increase trust in science. Objective: The objective of this study is to examine whether exposure to a curated infographic can increase trust in science, reduce the believability of misinformed narratives, and increase the likelihood to engage in preventive behaviors. Methods: This is a randomized, placebo-controlled, superiority trial comprising 2 parallel groups. A sample of 1000 adults aged ≥18 years who are representative of the population of the United States by gender, race and ethnicity, and age will be randomly assigned (via a 1:1 allocation) to an intervention or a placebo-control arm. The intervention will be a digital infographic with content based on principles of trust in science, developed by a health communications expert. The intervention will then be both pretested and pilot-tested to determine its viability. Study outcomes will include trust in science, a COVID-19 narrative belief latent profile membership, and the likelihood to engage in preventive behaviors, which will be controlled by 8 theoretically selected covariates. Results: This study was funded in August 2020, approved by the Indiana University Institutional Review Board on September 15, 2020, and prospectively registered with ClinicalTrials.gov. Conclusions: COVID-19 misinformation prophylaxis is crucial. This proposed experiment investigates the impact of a brief yet actionable intervention that can be easily disseminated to increase individuals’ trust in science, with the intention of affecting misinformation believability and, consequently, preventive behavioral intentions.
Effects of ACT Out! Social Issue Theater on Social-Emotional Competence and Bullying in Youth and Adolescents: Cluster Randomized Controlled Trial
(JMIR Publications, 2021-01-06) Agley, Jon; Jun, Mikyoung; Eldridge, Lori; Agley, Daniel L.; Xiao, Yunyu; Sussman, Steve; Golzarri-Arroyo, Lilian; Dickinson, Stephanie L.; Jayawardene, Wasantha; Gassman, Ruth; School of Social Work
Background: Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective: This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students' receptiveness to the intervention. Methods: This study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. Results: Intervention fidelity was uniformly excellent (>96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants' social-emotional competence. The intervention's impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. Conclusions: This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school.
Factors Associated with Reported Likelihood to Get Vaccinated for COVID-19 in a Nationally Representative US Survey
(Elsevier, 2021-06) Agley, Jon; Xiao, Yunyu; Thompson, Esi E.; Golzarri-Arroyo, Lilian; School of Social Work
Objectives While general principles related to vaccination hesitancy have been well-researched, reports on reluctance to be vaccinated for COVID-19 in the US are somewhat surprising given the disease’s substantive disruption of everyday life. However, the landscape in which people are making COVID-19 vaccination decisions has recently evolved with releases of encouraging vaccine-related data and changes to official messaging about the virus. Therefore, this study sought to identify factors associated with reported likelihood to get vaccinated for COVID-19 among US adults in late January 2021. Study Design We used the Prolific online research panel to survey a nationally representative sample of 1,017 US adults. Methods Respondents were asked about their behavioral intentions toward COVID-19 vaccination, trust in science, perceptions related to COVID-19, and selected sociodemographic factors. We computed associations between those 11 independent variables and likelihood to get vaccinated for COVID-19 using multiple linear regression. Results Around 73.9% of respondents indicated at least some likelihood to get vaccinated for COVID-19. Trust in science and perceived seriousness of COVID-19 were positively associated, and identifying as Black or African American was negatively associated, with intention to get vaccinated. Other factors were moderately, weakly, or not at all associated with intention. Conclusions Building trust in science and truthfully emphasizing the seriousness of catching COVID-19 should be further researched for their potential to support campaigns to encourage COVID-19 vaccination. Data continue to suggest the importance of dialogue with Black communities about COVID-19 vaccination.
Gender-responsive language in the National Policy Guidelines for Immunization in Kenya and changes in prevalence of tetanus vaccination among women, 2008–09 to 2014: A mixed methods study
(Elsevier, 2021) Dutta, Tapati; Agley, Jon; Lin, Hsien-Chang; Xiao, Yunyu; School of Social Work
Global evidence suggests that maternal vaccination rates are partly related to intersectional gender-related disparities. Kenya recently eliminated maternal and neonatal tetanus, but previously had low rates of tetanus vaccination in many districts. Examining both national data and gender-responsive language in policies can potentially illuminate this progress. This study used mixed-methods approach: content analysis to identify gender-responsive language in Kenya's National Policy Guidelines for Immunization 2013, and logistic regression to analyze data from the Kenya Demographic and Health Surveys: 2008–09 (pre-policy) and 2014 (post-policy) to determine whether vaccination utilization significantly changed pre- and post-policy. Kenya's vaccine Guidelines highlighted a comprehensive life-cycle approach with several mentions of targeted immunization sensitization interventions for diverse sub-populations of women and gatekeepers. Logistic regression suggested an association between year of survey administration and prevalence of tetanus vaccination, with greater adjusted odds post policy implementation (e.g., 2014). Further in-depth research, like elite interviews, might prove valuable.
HIV/AIDS and Substance Use Prevention for African American Young Adults: Field Evaluation of “Color it Real”
(Sage, 2021) Agley, Jon; Xiao, Yunyu; Jayawardene, Wasantha; Gay, Albert; King, Rosemary; Horne, Kelly; Walker, Roland; School of Social Work
In the United States, African Americans continue to bear a disproportionate amount of risk from HIV and illicit drug use, highlighting the importance of culturally responsive prevention programming. Manualized HIV and substance use prevention curricula that are conceptually African centered are few, and evaluative data of such programs are sparse. This research brief aims to describe a field evaluation of the “Color it Real” (CIR) program, a 6-session, 12-hr HIV and substance use prevention curriculum for African American males and females aged 18 to 24 years. Participants (n = 225) were recruited using convenience sampling from two cities within a high-risk county in Indiana. Attitudes, knowledge, and confidence related to HIV and substance use were assessed before and after the intervention. Wilcoxon and McNemar tests were used to compare pretest and posttest scores, and binary logistic regression models were used to examine sociodemographic associations with outcomes. Among the analytic sample (n = 195), the CIR program was associated with several improved attitudes and increased knowledge related to HIV and substance use, but not with increased confidence in sexual negotiation skills. These findings represent the first published data from CIR since the developers’ original study, and support continued use of the curriculum by our program. Given the positive findings (i.e., attitudes and knowledge) and community receptiveness to CIR, we believe that a randomized, controlled trial of the intervention that includes longitudinal behavioral measurement would be a meaningful addition to prevention research.
Misinformation about COVID-19: evidence for differential latent profiles and a strong association with trust in science
(Springer Nature, 2021-01-07) Agley, Jon; Xiao, Yunyu; School of Social Work
Background: The global spread of coronavirus disease 2019 (COVID-19) has been mirrored by diffusion of misinformation and conspiracy theories about its origins (such as 5G cellular networks) and the motivations of preventive measures like vaccination, social distancing, and face masks (for example, as a political ploy). These beliefs have resulted in substantive, negative real-world outcomes but remain largely unstudied. Methods: This was a cross-sectional, online survey (n=660). Participants were asked about the believability of five selected COVID-19 narratives, their political orientation, their religious commitment, and their trust in science (a 21-item scale), along with sociodemographic items. Data were assessed descriptively, then latent profile analysis was used to identify subgroups with similar believability profiles. Bivariate (ANOVA) analyses were run, then multivariable, multivariate logistic regression was used to identify factors associated with membership in specific COVID-19 narrative believability profiles. Results: For the full sample, believability of the narratives varied, from a low of 1.94 (SD=1.72) for the 5G narrative to a high of 5.56 (SD=1.64) for the zoonotic (scientific consensus) narrative. Four distinct belief profiles emerged, with the preponderance (70%) of the sample falling into Profile 1, which believed the scientifically accepted narrative (zoonotic origin) but not the misinformed or conspiratorial narratives. Other profiles did not disbelieve the zoonotic explanation, but rather believed additional misinformation to varying degrees. Controlling for sociodemographics, political orientation and religious commitment were marginally, and typically non-significantly, associated with COVID-19 belief profile membership. However, trust in science was a strong, significant predictor of profile membership, with lower trust being substantively associated with belonging to Profiles 2 through 4. Conclusions: Belief in misinformation or conspiratorial narratives may not be mutually exclusive from belief in the narrative reflecting scientific consensus; that is, profiles were distinguished not by belief in the zoonotic narrative, but rather by concomitant belief or disbelief in additional narratives. Additional, renewed dissemination of scientifically accepted narratives may not attenuate belief in misinformation. However, prophylaxis of COVID-19 misinformation might be achieved by taking concrete steps to improve trust in science and scientists, such as building understanding of the scientific process and supporting open science initiatives.
Quality control questions on Amazon's Mechanical Turk (MTurk): A randomized trial of impact on the USAUDIT, PHQ-9, and GAD-7
(Springer, 2021-08-06) Agley, Jon; Xiao, Yunyu; Nolan, Rachael; Golzarri-Arroyo, Lilian; School of Social Work
Crowdsourced psychological and other biobehavioral research using platforms like Amazon's Mechanical Turk (MTurk) is increasingly common - but has proliferated more rapidly than studies to establish data quality best practices. Thus, this study investigated whether outcome scores for three common screening tools would be significantly different among MTurk workers who were subject to different sets of quality control checks. We conducted a single-stage, randomized controlled trial with equal allocation to each of four study arms: Arm 1 (Control Arm), Arm 2 (Bot/VPN Check), Arm 3 (Truthfulness/Attention Check), and Arm 4 (Stringent Arm - All Checks). Data collection was completed in Qualtrics, to which participants were referred from MTurk. Subjects (n = 1100) were recruited on November 20-21, 2020. Eligible workers were required to claim U.S. residency, have a successful task completion rate > 95%, have completed a minimum of 100 tasks, and have completed a maximum of 10,000 tasks. Participants completed the US-Alcohol Use Disorders Identification Test (USAUDIT), the Patient Health Questionnaire (PHQ-9), and a screener for Generalized Anxiety Disorder (GAD-7). We found that differing quality control approaches significantly, meaningfully, and directionally affected outcome scores on each of the screening tools. Most notably, workers in Arm 1 (Control) reported higher scores than those in Arms 3 and 4 for all tools, and a higher score than workers in Arm 2 for the PHQ-9. These data suggest that the use, or lack thereof, of quality control questions in crowdsourced research may substantively affect findings, as might the types of quality control items.
Suicide Prevention Among College Students Before and During the COVID-19 Pandemic: Protocol for a Systematic Review and Meta-analysis
(JMIR Research Protocols, 2021-05-17) Xiao, Yunyu; Hinrichs, Rachel; Johnson, Nina; McKinley, Amanda; Carlson, Joan; Agley, Jon; Yip, Paul Siu Fai; School of Social Work
Background: Suicide is the second leading cause of death for college-aged individuals worldwide and in the United States. Recent studies have identified preliminary evidence of widening disparities in suicidal behaviors across sex, sexual orientation, race/ethnicity, age, and socioeconomic status among college students. Few systematic reviews and meta-analyses offer a comprehensive understanding of on-campus and off-campus suicide interventions, nor is collated information available for different types of screening, assessment, treatment, and postvention plans. Further challenges have been identified since the COVID-19 pandemic, calling for cost-effective and innovative interventions to address increased rates of suicidal behaviors among college students facing unprecedented stressors. Objective: This research protocol describes the first systematic review and meta-analysis to identify the most effective and cost-effective intervention components for universal and targeted (indicated and selected) suicide prevention among college students in a global context. Special attention will be placed on disparities in suicide prevention across sociodemographic subgroups, inclusive interventions beyond campus, global context, and intervention responses to the COVID-19 pandemic. Methods: A sensitive search strategy will be executed across MEDLINE (Ovid), EMBASE, PsycINFO (EBSCO), ERIC (EBSCO), Cochrane Library, Dissertations and Theses Global (ProQuest), Scopus, Global Index Medicus, SciELO, African Journals Online, Global Health (CABI), and Google Scholar. Data extraction and evaluation will be conducted by three independent researchers. Risk of bias will be assessed. A multilevel meta-regression model and subgroup analysis will be used to analyze the data and estimate effect sizes. Results: The initial search was completed in December 2020 and updated with additional other-language studies in March 2020. We expect the results to be submitted for publication in mid-2021. Conclusions: Despite increasing rates of suicidal behaviors among college students, few preventative efforts have targeted this population, and fewer focus on factors that might place specific demographic groups at heightened risk. The impact of COVID-19 on suicidal behaviors among college students highlights and exacerbates the urgent need for rapid and effective interventions that might differ from traditional approaches. This equity-focused study will address these gaps and provide a valuable analysis of the effectiveness of suicide prevention programs and interventions. Findings will inform clinicians, researchers, policy makers, families, and organizations about evidence-based interventions for reducing the gaps in the suicide crisis among college students from different sociodemographic groups. Trial Registration: PROSPERO CRD42020225429; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225429
Using infographics to improve trust in science: a randomized pilot test
(BMC, 2021-05-29) Agley, Jon; Xiao, Yunyu; Thompson, Esi E.; Golzarri-Arroyo, Lilian; School of Social Work
This study describes the iterative process of selecting an infographic for use in a large, randomized trial related to trust in science, COVID-19 misinformation, and behavioral intentions for non-pharmaceutical prevenive behaviors. Five separate concepts were developed based on underlying subcomponents of ‘trust in science and scientists’ and were turned into infographics by media experts and digital artists. Study participants (n = 100) were recruited from Amazon’s Mechanical Turk and randomized to five different arms. Each arm viewed a different infographic and provided both quantitative (narrative believability scale and trust in science and scientists inventory) and qualitative data to assist the research team in identifying the infographic most likely to be successful in a larger study.

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