The literature demonstrates that working in a crisis line volunteer role,despite being rewarding, poses a risk of adverse effects on health andadditional pressure exists with the COVID-19 pandemic. Despite this, thereis limited research on the experiences of such volunteers.This study aimed to explore the experiences of Samaritans volunteers inIreland during the COVID-19 pandemic, thereby contributing to the overallknowledge of crisis line volunteering, and gaining an understanding of howthis role is impacted by the pandemic.A qualitative approach was taken, and semi-structured interviews wereconducted with volunteers from Samaritans branches in Ireland (n = 13). Datawere then analysed using thematic analysis.Four overarching themes were identified: (1) responding to calls in thecontext of COVID-19, with sub-themes being change in the nature of calls,reliance on existing approach in handling calls and varying emotionalresponses to calls, (2) sense of loss, with sub-themes being loss of olderand vulnerable volunteers, reduced social connectedness and restrictedaspects of the service, (3) positive experiences, with sub-themes beingsupportive culture, new personal skills and perspectives and volunteering asan escape from lockdown and (4) adaptation challenges, with sub-themes beinglogistical changes and concern for sustainability of the service.Findings highlight important insights into the experiences of Samaritansvolunteers in Ireland, revealing that the pandemic brought about challenges,but also gave rise to some positive experiences. Implications of thesefindings are discussed in the context of the existing literature andrecommendations made. Telephone crisis line services provide valuable support which is accessible andfree to people experiencing emotional distress, relieving pressure onstate-provided mental health systems .Such seHowever, mental health work can also have negative effects on the serviceprovider’s own wellbeing . Crisis Implications pertain not only to volunteer health, but also to the quality ofservice provided . Yet, thA prominent crisis line organisation which has influenced the development oftelephone helplines worldwide , the SamWhile these findings provide important insight into the Samaritans volunteerexperience and demonstrate a similar pattern to that of findings on crisis linevolunteering in general, this research is limited by its narrow focus on UKvolunteers only and some are older findings e.g. .Further, additional pressure has since been placed on crisis line volunteers withthe ongoing coronavirus (COVID-19) pandemic, an unprecedented public healthchallenge. Emerging research has raised concerns of effects on population mentalhealth, specifically the development of new mental health issues and anexacerbation of existing ones . In IrelSignificant research has been conducted with healthcare and mental healthprofessionals, exploring the effects of the pandemic on their wellbeing andfinding notably high levels of distress, depression, anxiety and burnout incomparison to the general population’s . Less isA gap exists in the research, with a paucity of studies examining crisis linevolunteers . StudiesA qualitative, exploratory research design using semi-structured interviews wasemployed; the aim was to explore the experiences of the volunteers and, as Established in Ireland in 1961, Samaritans currently has over 2,000 activevolunteers operating 21 branches across the country. Volunteers are selectedthrough application and interview and undergo comprehensive training for therole and supervision from a ‘mentor’ (an experienced volunteer) before takingcalls on their own. On average, volunteers engage in listening duties in thebranch for approximately 3 hours every week and volunteers can also hold otherpositions within the organisation.At the time of interviews, March 2021, Ireland was under strict governmentrestrictions in order to reduce virus transmission see .n = 13). This sample size was deemed appropriate for thisstudy; M = 56.92, SD = 14.38). Of these, 10identified as female and 3 as male. Varying lengths of time volunteering withSamaritans were reported, from less than 3 to over 20 years. Of the 21Samaritans branches in Ireland, volunteers from 10 participated in thisstudy.A total of 13 participants completed interviews for this study respondedto the recruitment advertisement, and a detailed plain language statement andconsent form were sent to these volunteers via email addresses they provided.One female volunteer then declined to take part, citing the interview design ofthe study as the reason. Individual semi-structured interviews with open-endedquestions were conducted with participants via Zoom  in MarchInterviews were transcribed verbatim by the first author. To ensure anonymity,participant names were replaced with pseudonyms and any other identifyinginformation, for example Samaritans branch location, were omitted.Supplemental Material 1 for further details).Reflexive thematic analysis was conducted on the data, in line with An initial hand-coding took place, before the qualitative software package NVivo(release 1.5.1 (940) for Windows, Ethical approval was obtained on 20th January 2021 from the Dublin CityUniversity School of Psychology Ethics Committee.Supplemental Material 2).In line with the standard for enhancing rigour and credibility in qualitativeresearch, the practice of reflexivity was considered . The firFour overarching themes were identified: (1) responding to calls in the context ofCOVID-19, (2) sense of loss, (3) positive experiences and (4) adaptation challenges,with 11 sub-themes; While these main themes are salient and distinct, it is important to note that someof the sub-themes are interwoven, as demonstrated in the final thematic mappresented in The following subsections expand on each theme and include illustrative quotationsfrom participants. Some quotes have been edited to omit unnecessary repetition (e.g.‘it’s-it’s’) or redundant words Each volunteer spoke to some extent about the content of calls: change in thenature of the calls during the pandemic was identified, with COVID-19described as being present, in some form, in almost every conversation:‘COVID-19 (. . .) umbrellas kind of every conversation that we have now. (.. .) it mightn’t be a direct worry with the caller, but it certainly lurksin the background if it’s not in the foreground (John)’. Volunteers alsonoticed an exacerbation in existing issues for callers, attributing this tosafety restrictions and worry. In particular, there was a perception thatcallers’ feelings of loneliness and isolation had increased: As a volunteer, the guidelines are still the same, that we listen towhatever the caller wants to tell us and we will listen and helpthem and encourage them to talk for as long as they want. So that initself hasn’t changed. (Lily)Many participants believed that their approach to engaging with callersremained the same, feeling that initial Samaritans training had preparedthem to support people in distress and that the topic of COVID-19 was seenfundamentally as another distress for the caller: However, some volunteers also felt that the pandemic added a layer ofdifficulty when using pre-pandemic approaches: ‘There’s definitely moreuncertainty so you kinda have to manage-manage that and kind of explore thatwith people, about the future and what they see it being but I wouldn’t saymy approach is overly different’ (Cian).Normally you would say to them, you know, ‘Have you any plans forlater on today, you know, would you go for a walk, you know, youmentioned such a person before, would you meet them for coffee orsomething?’ (. . .) but all those things aren’t there at the moment.(. . .) It’s only made it- you just have to think a bit more.(Niamh)We get challenging kinds of calls, our female volunteers get a lot ofsex calls (. . .) people are coming in to do something and they’regetting abused, effectively. (. . .) at times you might come in andhave a duty or two and it’s really, really, you know, crap, that thecalls are not of any quality.Relating to their own response to calls, volunteers remarked on the differentemotions which arose and the variance in these. It was clear that providingsupport for the callers brought about a positive emotional reaction in thevolunteer when they felt that they had ‘been there’ for that caller:‘Regardless of what type of call you get, because you’re at the other end ofthe phone, it’s very rewarding, full stop, regardless of the type ofqualities. That you can be there for somebody’ (Chloe). However, certaincalls were pinpointed as a challenge - namely distressing calls and abusivecalls. Listening to others in distress can unsettle volunteers, with Alicestating ‘The calls you take and the things that you hear, they can be quiteupsetting at times’. Seán expressed how disheartening it can be forvolunteers to deal with people misusing the service with abusive calls: There’s a lot of things we haven’t gone through in life and we don’thave that understanding and we try to get that from the person we’retalking to, to get a better understanding of how they’re feelingabout something like that and how it has impacted on their lives,but having gone through the thing of COVID and seeing the isolationand loneliness, yeah without a doubt, it gives you a betterunderstanding of what’s happening. (Megan)Hazel further outlined how such callers can be ‘very aggressive, veryunpleasant, manipulative in a different way who appear to be trying tocompletely undermine your self esteem’, exemplifying the extent of thisissue. Additionally, many volunteers described a change in how callsaffected them emotionally during the pandemic. John noted ‘you are on alevel playing field with callers when it comes to COVID-19’. This aspectserved as both a positive and negative for volunteers. Experiencing thepandemic themselves enabled volunteers to better empathise with the callers: COVID-19 is affecting everybody. Of course, it is, in-in big andsmall ways. And, you know, it does make it that little extra toughto be really positive and rock solid going into a duty. (. . .) if acaller wants to give out yards about COVID-19 and how this and thatand their lives are now gone. You know, you can’t join them in that.Although you-you might want to (laughs) (John)However, it was clear that COVID-19-related calls resonated with volunteersand brought about difficult emotions, with conversations hitting closer tohome for some: When it’s very close to home, especially during COVID, an awful lotof the older people ringing that are isolated, you know, they’re notobviously seeing anyone, haven’t seen family for, you know, for ayear or so now. Ahmm, and then it’s sort of, you know, that’s mysituation (. . .) that’s the challenge of it, it sort of makes you-,you know, things that are going on in your life as well. (Jodie)One participant described how listening to older callers ring in withisolation or loneliness worries made them think of their own situation: The majority of volunteers spoke about the sense of loss felt in their roleduring the pandemic. Three sub-themes represent this finding: loss ofvolunteers, reduced social connectedness and restricted aspects of theservice.Because of the over-seventies cocooning it’s harder to fill theslots. So I ended up working at more than one shift a week for a lotof weeks. That can be tiring and draining (. . .) and there’s nomagic wand, the centre still has to be filled. So a lot of peoplewould end up doing extra shifts and that can be tiring. (Chloe)The decline in volunteer numbers due to restrictions, resulting in gaps inshifts, was perceived to have a major impact on all volunteers. Often extrashifts were taken to ensure calls were answered and there were mixedexperiences regarding this, with some finding it challenging: On the other hand, many saw it as their duty to step up and take on extrashifts to ensure that the service was maintained, with Julia stating: ‘Thoseof us who are able to do duty feel that’s a privilege, you know, it- we cando it, so we do it’. Cian felt that the pandemic ‘pushed (them) a little bitmore to my duties’. Indeed Jodie had been on a break from volunteering, butwas motivated to return to the role: ‘When people had to cocoon at thebeginning of COVID, I stepped up back then (. . .) during COVID it’sdefinitely put things in perspective and there is a real need for doing, youknow, what we do’. The loss of volunteers was also a significant challengefor those in director roles: ‘In my role as (. . .) director, it’s beenhugely challenging because we lost nearly fifty percent of our volunteers inthe first part of COVID, mainly because we have quite an older population’(Seán).We are a little fractured at the moment, as a community, becausethere’s-there are only ever two people allowed in the building atonce. And the way it’s time slotted, volunteers have to leave andfifteen minutes later, another two volunteers will commence, so wenever cross paths (John)If you know your fellow volunteer has a difficult call or, say if Ihad a difficult call. Usually when they- when the other person wouldbe finished the call they’d leave the phone off so that they’d bethere to give you support immediately, or sometimes you may needthem to listen in to the call, ehm, because of the content. And, sothat is one impact, really, you know, although the support is there,it’s not- it’s not physically beside you, the way it normally wouldbe. (Jacqueline)It was evident that restrictions had given rise to a loss of socialinteraction amongst the volunteers. The Samaritans community was describedas important, with a sense of camaraderie: ‘You’re part of a team, so I getsomething out of it too like I- you know, you meet people, (. . .) I kind ofenjoy that part’, (Alice). However effects of restrictions on connectingwith fellow volunteers was heavily emphasised by all, with a sense ofseparation and distance prevalent which affected both the social aspect ofthe role and the support between volunteers: We as a team have never met face to face (. . .) So you lose- there’sa lot lost in that sense. So yeah, that’s what we’ve lost, big timeyou know and it’s- yes, we’re very supportive of one another, butyou’ve lost that initial contact of, ahm, of being there for oneanother. (Megan)This loss was also present in the running of the branches, with thosevolunteers holding director and deputy director positions mentioning theimpact felt with respect to working with others: If anything (laughs) there’s less pressure (. . .) and less emailsand there’s less things, because there’s not as much happening. But(. . .) there’s lots of things we can’t do, which we would havenormally done because our fundraising would have been publicity atthe same time, so, d’ya know, but we can’t do anything like that butin-in the same time we’re not worried about getting permits to dothe fundraising. So, you know, kind of a two-edged sword. (Lily)This sub-theme captures the losses felt as a result of restrictions onservice provision. The loss of fundraising was a cause for concern fordirectors, who translated it into a loss of income: ‘That obviously is anissue and for some branches that would be far more serious than for others,just depending on how they fund themselves’ (Julia). However, one branchdirector described this loss as both a positive and negative experience: Despite the prevailing sense of change and loss, it was evident that volunteersalso found positive experiences through their role during the pandemic, asexemplified by the three sub-themes of a supportive culture, new skills andperspectives and volunteering as an escape from lockdown.You’d argue it’s a family anyway, but I mean you-you know thatthey’re there supporting you and you know they have your back(. . .)if you go into anything, highs, lows, or anything they will be thereto cheer you on. (Lily)All of the volunteers related how supportive and positive the Samaritansorganisation is, from both an organisational perspective and aninterpersonal volunteer perspective. As noted, the connections betweenvolunteers is a salient part of the role and this contributed to the senseof support, both as a Samaritan and as an individual outside of the role,with the Samaritans community referred to as ‘a little family’ (Rebecca): I would deal with them within-within the system, I talk about themwith my- whoever was on duty with me, or the leader. Ahm, yeah- no,no the whole idea is to kind of be supported within Samaritans,because everybody understands what the calls are like, that’s-that’sthe way the structure works and I think it works very well.(Julia)With respect to the organisational culture, volunteers felt looked after,with the Samaritans support system identified by most as their main way ofcoping with distressing calls: The support that I feel going into the place and how safe I feel and,eh, how considered I feel as well. You know, it was very clearlydrilled into us that if we ever did feel uncomfortable going intothe branch or anything like that, for whatever reason, you know,it’d be completely understood. (John)This sense of a supportive organisational culture continued with the pandemicand in spite of the challenges faced, volunteers described feeling supportedin the branches. This was in relation to physical safety, with Jacquelinenoting ‘All the safety measures are in place, it’s probably one of the mostsanitised buildings I’d say in (. . .) at the moment, really (laughs)’, aswell as emotional support: It just changes you intrinsically, it just changes how you look atthings, it changes how you think, it makes you aware of howdifferent things could be, how easy things can change for you inyour life (. . .) personally it changed how I see things.Positive experiences were reported in relation to personal growth through thevolunteer role. The skills learned through the Samaritans training and theexperience with callers were considered by many to be transferable andadvantageous in their own lives: ‘My listening skills improved a thousandpercent, um, I find that I use the Samaritans training in everyday events,to be non judgemental, it really helps me in my personal capacity’ (Chloe).Additionally, volunteers noticed how their role facilitated a change intheir perspective, led them to be ‘more aware’, ‘more open-minded’ and have‘a broader outlook on life’. Alice outlines the substance of thisexperience: Particularly through lockdown I found myself that one of the massiveadvantages is kind of recentering your focus, when you think you’vehad a pretty poor day and life is kind of bringing you down a bit,you go and do a duty, you hear some of the stuff that people aregoing through and some of the difficulties that people have and itreally makes you appreciate what you have. (Cian)Volunteers also reflected on the benefit to their perspective during thepandemic: Especially during COVID, from a selfish point of view, it’s beengreat because (. . .) I can go and do my duty and so I’m sort ofgetting out and I’m seeing people. (Jodie)Despite the aforementioned reduced social interaction, the opportunity toengage with others, albeit in a limited capacity, was recognised asimportant: It’s this isolation and loneliness. But from the point of view ofeven going in to see it and be there, it actually took that awayfrom you, because you were actually doing something, the isolationand loneliness. So whereas you’d have possibly been impacted by it,it actually took it away, because you were actually going in thereand being there. (Megan)Indeed, providing the support to those callers feeling affected by thepandemic, often with respect to loneliness and isolation as mentioned, alsoprovided the volunteers themselves with a means of preventing potentiallysimilar effects: I think it’s done a lot for my mental health, it’s kept it, very muchkept it- particularly during COVID, if I wasn’t doing this, I woulddefinitely- I mean I do have some other interests as well, but itwas such a good structure, it gives- and communicating with otherpeople and feeling like doing something useful. (Hazel)Hazel described their experience ‘cocooning’ where they haven’t been able tocarry out their duties, or indeed be otherwise out and about. Theiradditional roles as a duty leader and in caller care, which could be carriedout remotely from home, provided an opportunity for connectedness andengagement: The final theme encapsulates the challenges faced by volunteers in the adaptationof the organisation and elaborates on their experiences of practical andlogistical adjustments in branches, as well as their perspectives on the futureimpacts of the ongoing pandemic.That was actually quite difficult, that was maybe a challenge, eh,that I could say as well, was interviewing over the phone becauseusually face-to-face, it’s much easier interview to gauge people,you feel more comfortable as well, it’s quite hard over the phone.(Cian)I noticed in my role of volunteer care that people often got stressedabout the fact of having to do online training rather than face toface training. It didn’t bother me at all, but I know some people,it did. (Chloe)Many volunteers mentioned the adjustments with restrictions in place,primarily the move from direct personal contact to online. This affectedaspects such as recruitment interviews and training and was highlighted as achallenge, in particular by participants who hold recruitment and directorroles: I think they’re not always taking sufficient account of thedemographics of the-of the volunteers they have. People over- peoplewho haven’t grown up with, um, IT, or haven’t used it in theirworking lives (. . .) not everybody in Samaritans is as keen on oras comfortable with the language and IT as they’d like to think.(Hazel)One participant expressed concern for the older demographic of volunteers andthe challenge the increased use of technology poses to them: The fact that, you know, mental health has been pressurised by what’sgoing on is going to have an impact we’re not even aware of and Ithink our service, we’re-we’re needed, whether we have the capacityto manage that. (Cian)More volunteers, a lot more are needed. And it’s to retainvolunteers, retention. It’s-there’s no magic wand, because,especially nowadays with movement of people, you know, people movefor different jobs or their lives change, especially now with thepandemic, so that’s a problem, too, for retention. (Chloe)The final sub-theme outlines how, based on their experiences, volunteers areworried about the future. Many expressed their fear of the ‘fallout’ of thepandemic with respect to mental health and the subsequent impact that wouldhave on the Samaritans. Additionally, volunteers expressed a worry as towhether the organisation would be able to maintain the service, with anexpected increase in demand meaning a need for more volunteers: This study aimed to gain an understanding of Samaritans volunteers’ experiences inIreland during the COVID-19 pandemic, using a qualitative approach. Key findingssuggest that the pandemic has had a notable impact on the volunteer experience in anumber of ways, from both a negative and positive perspective. Four overarchingthemes were identified from thematic analysis: (1) responding to calls in thecontext of COVID-19, (2) sense of loss, (3) positive experiences and (4) adaptationchallenges. The following section will discuss these themes, which often intertwine,in the context of the literature.In keeping with prior research, calls were observed to have the potential toelicit a positive or negative emotional response in volunteers, highlighting thespectrum of emotions associated with the role .The volThis theme also highlights the duality of an increased sense of empathy in crisisline work, arising from first-hand experience .While vThe themes and sub-themes identified are often interwoven and, when takentogether, create an overall understanding of the volunteer experience.Discussing the themes ‘sense of loss’ and ‘positive experiences’ togetherreflects the sense of the pandemic being a double-edged sword for volunteers.With the loss of volunteer numbers came a prevalent sense of duty among theother volunteers to work extra shifts. Interestingly, this finding contrasts toprevious assertions of feelings of obligation and stress in taking on moreresponsibility within the Samaritans .This diIn line with previous findings, volunteers outlined aspects of the rolebeneficial to their wellbeing, with respect to personal development and socialconnectedness . Indeed,The fourth theme, adaptation challenges, underlines the difficulties faced in theadaptation of the organisation to operate during the pandemic. Primarily notedwas the transition from face-to-face to online contact, particularly for thosein additional roles and older volunteers. Research highlights similartransitional challenges during the pandemic in Irish mental healthcare services. MoreoveTo our knowledge, this is the first qualitative study focusing on the experiencesof Samaritans volunteers in Ireland. As such, this research provides an insightinto volunteers in an Irish context which is comparable to the existingknowledge of UK Samaritans volunteers. Additionally, this study builds upon therecommendations of previous work  in thatRegarding limitations, female volunteers outnumbered male volunteers in thisstudy (10:3). While, in general, more females volunteer than males in Ireland, SamaritFindings have a number of useful implications, both theoretically, with respectto understanding crisis line volunteering during the COVID-19 pandemic andpractically, in terms of the Samaritans organisation in Ireland. A notablefinding is the uncertainty experienced by volunteers when answeringCOVID-19-related calls. While volunteers fell back on their training and theusual guidelines, challenges arose in two aspects: doubt in exploring with acaller and distress where calls resonated with the volunteer’s experience. TheSamaritans organisation should therefore be mindful of this and would perhapsbenefit from providing supplementary training to counteract these challenges.Relatedly, such training could also be an opportunity for additional socialinteraction among volunteers (in keeping with guidelines). Taken together, thesemay help support a positive and healthy volunteer experience. An emphasis mayalso be necessary on training for older Samaritan volunteers who do not feelcomfortable with technology use. The experience of these volunteers can beimproved with continued support to reduce the apprehension of unfamiliartechnology, as outlined by Nonetheless, the Samaritans organisational structure appeared to serve as abuffer for the volunteers throughout the pandemic in terms of coping and supportand this finding has implications for other crisis line organisations, who canperhaps be guided by the Samaritans’ model. Turning to long-term implications,it is important from the perspective of both the volunteers and the callers thatthe Samaritans organisation is as prepared as possible to meet the anticipateddemand. Future research may wish to further explore how crisis lineorganisations can effectively adapt to this novel context.The COVID-19 pandemic presented as a double-edged sword for Samaritans volunteers inIreland, with positive and negative aspects. Findings add to the limited knowledgeof the wellbeing of crisis line volunteers and provide insight into how thispopulation has been affected by the pandemic. Given the unpredictable nature of theongoing public health crisis and the considerable effects it has on populationmental health and, subsequently, crisis line organisations, it is imperative thatvolunteers are sufficiently supported in meeting the anticipated increased demand.Future research should therefore aim to build upon these exploratory findings toexpand the knowledge base and support the volunteers.Click here for additional data file.Supplemental material, sj-docx-1-isp-10.1177_00207640221089538 for Experiencesand wellbeing of Samaritans crisis line volunteers in Ireland during theCOVID-19 pandemic: A qualitative study by Aoife Cooney and Darragh McCashin inInternational Journal of Social Psychiatry


Referring to the mainstream studies based on the personalization’s hypothesis, which positively evaluates signals of dominance shown by leaders, the analysis of Obama’s rhetoric stays a relevant exception. His risky recall, during his political talks, of his social difficulties as a child of a mixed couple was in fact one of the more surprising aspects of his success. Nevertheless, reactions to his autobiographical sharing were scarcely explored. Based on the idea that these self-disclosures signal his responsivity toward the audience of low social condition and can, therefore, be defined as a sign of humility, this research aims to test if coherence between Obama’s words and his facial expressions of contempt, due to the seriousness of social injustices endured in his childhood, may influence the receivers’ perception of such unexpected communication. Before reading a brief autobiographical sharing taken from a “Back-to-school” speech, a highly ritualized monolog the US President addresses each year to students, 175 Italian participants were presented with a photo of Obama displaying either an expression of contempt (taken from the video of the speech) or a neutral expression. Comparisons between self-assessments of perceptions and reactions of participants assigned to the two experimental conditions show that a facial expression of contempt, coherent with words describing his school difficulties, has been crucial for perceiving this humble political discourse as authentic and not as a simple socially desirable posturing. More studies seem to be needed, however, to understand how humble speech could enhance the positive face of leaders or backfire against them. This article is based on the idea that expressions of humility can positively contribute to politicians’ facework, meant to show a positive face to their audience , but onlHumility can be defined as a multimodal public stance interactively performed through verbal and non-verbal signals, whereby the person places themselves in a horizontal relationship to the interlocutor . TherefoInterestingly, a recent content analysis of common sense on humility  highlighBased on such an appreciative definition of humility, recent studies explored the important role of emotional expressiveness in the perception of the politician’s authenticity.On the one hand, overt expression of emotions, such as when showing anger or sadness, helps politicians to emphasize the importance of the topic at hand . HoweverBased on this line of thought, it is interesting to observe that one main rhetorical strategy used consistently by Barack Obama, both when speaking as an incumbent and when playing the official role of US President, was to overtly refer to him being the son of a mixed married couple, i.e., a social origin illegal in some North American states at the time of his birth. We speculated , 2018b tWithin this theoretical framework, the case study selected refers to a “Back-to-school” speech, delivered by the former US President Barack Obama on 8 September 2009, in front of students of low socioeconomic status at the Wakefield High School of Arlington, Virginia. The “Back-to-school” Presidential address is a highly ritualized monolog, where each American leader in charge is expected to encourage students, at the beginning of every year’s lessons, to make their best to become competent citizens, aware that the future of their community depends on them. In a previous study , we analTo answer this research question, we randomly assigned participants either to a condition in which the expression of contempt taken from the Back-to-school speech preceded the reading of the transcript of a part of Obama’s speech  or to a control condition in which participants observed a neutral expression of Obama’s face before reading the same transcript.To build up the stimulus for the control condition, we first selected, from the same video, a still image of Obama’s face showing, according to FACS analysis , no emotFinally, to avoid the social desirability effects, participants were asked to describe their reactions to Obama’s speech following semi-projective instructions of putting themselves in the shoes firstly of a low-status student and then of a high-status student listening to this presidential address.(Hypothesis 1). In addition, we expect a difference in the reactions of participants, depending on identification suggested in semi-projective instructions. Specifically, we expect that identifying with a low-status student will provoke more positive reactions (Hypothesis 2), while identification with a student who does not experience socioeconomic difficulties will cause more negative reactions (Hypothesis 3). In this first explorative study, only aimed at observing effects on receivers of the facial expressions of the speaker, participants’ endorsement of gender stereotypes, although taken into consideration of introducing the issue of humble political speech, was neither measured nor controlled.Based on the already discussed literature, we expect that participants reading President Obama’s self-disclosure of his own school difficulties, after viewing the image showing Obama’s contempt, i.e., a facial expression consistent with his words, will perceive his humble speech in more positive terms, evaluating it as more sincere. Instead, we expect that the inconsistency between the verbal content and the neutral face shown in the control condition will provoke an evaluation of falsehood and hypocrisy, leading to a negative perception of the speaker a priori power analysis of the required sample  or to the experimental condition (N = 80). The study was conducted during COVID-19 restrictions due to online participation. Despite its limitations, we judged the benefit of this first collection of explorative data worthwhile.By means of G*power , an a prd sample  for ANCO“I get it. I know what that’s like.”As briefly discussed above, the coherence vs. incoherence between facial expression and words was induced using two images of Obama. In the lack of coherence condition (control condition), a well-known photo of Obama’s face showing no emotional expression was presented . In the 1 being this excerpt running from 9.12 to 9.48 min):As already discussed, the excerpt chosen as an instance of Obama’s humble stance refers to his autobiographical social sharing and runs as follows  to 3 (a lot). The adjectives included in the list were either positive  or negative . Adjectives were randomly presented to avoid the order effect.After reading the text, participants were asked the question: welcomed,” “involved,” “impressed,” “encouraged,” “proud,” “reassured,” “surprised,” “inspired,” “moved,” “empowered,” “stimulated,” “valued,” “understood,” and “excited”) or negative  and were randomly presented.Participants were then asked to put themselves in the shoes of a student in a condition of socioeconomic difficulty listening to Barack Obama’s speech and to indicate their reactions to it. Immediately, the same question was proposed, asking participants to identify with a student in medium-high socioeconomic condition. To answer both questions, a list of 32 reactions was presented, asking participants to assess their degree of agreement for each item from 0  to 3 (a lot). The reactions were either positive  to 5 (“sympathy”) by answering the question “What do you feel when thinking of Obama?” Finally, we asked for some personal information, including their political orientation to which participants could respond by positioning themselves in one of the prearranged answers: Left, Center-left, Center, Center-right, Right, or something else.To check familiarity, we asked participants to answer on a scale from 0  to 3 (very) to the question “The experimental procedure was carried out through an online questionnaire, created with Google Forms. It allowed us to divide the questionnaire into several pages, so that the participants could see only one page at a time and cannot go back to previously filled-in pages. Before accessing the questionnaire, participants read the informed consent form and were asked to consent to the processing of data. Subsequently, participants were presented with a first text explaining that every year the President of the United States addresses students with a “Back-to-School” speech and that they will read an excerpt from one of these speeches, delivered by the US President Barack Obama. On the next page, participants were randomly assigned either to the group presented with Obama’s photo showing a neutral expression or to the group presented with Obama’s image showing an expression of contempt and were free to decide when moving to the next page, where they were presented with the excerpt of Obama’s speech. After taking their time for reading the excerpt, participants answered the questions investigating the dependent and control variables. Finally, they gave some information about themselves to better describe the sample.To examine potential differences between experimental and control conditions  concerning the dependent variables, we run a MANCOVA analysis for each adjective describing both Obama’s perception and participants’ emotional reactions. To reduce the type I error, we decided to set the significance level at p ≤ 0.025.Sincere , Spontaneous , Touching , Artifact , Exaggerated , False , Cunning , Hypocrite , Rhetoric , Strategic , and Weak . Hence, as shown in The analysis of variance for the adjectives describing the speaker showed the following level of significance, also by taking into account the Obama’s familiarity as a covariate: Participants were asked to self-assess their reactions to Obama’s autobiographical recall trying to identify themselves firstly with a student in a difficult socioeconomic condition and then with a student in a medium-high economic condition.Interested , Outraged , Perplexed , and Offended . More precisely, participants in the experimental condition declared to be more interested in reading Obama’s autobiographical self-disclosure than participants presented with an image showing a neutral expression. Contrariwise, participants declared to be more outraged, more perplexed, and more offended when reading Obama’s words after seeing the photo showing a neutral expression , depending on their experimental conditions, participants differently self-assessed themselves in reference to the adjectives pression .Interestingly, participants identifying themselves with a student in a medium-high economic condition, when compared between the experimental and the control condition, did not show any significant difference.Taken all together, the results seem to confirm our first hypothesis. The perception of the same autobiographical social sharing, in fact, deeply varied according to the information conveyed by Obama’s facial expression, shown before the reading. We could articulate that coherence between words and facial emotional expression may account for the humble utterance to be sincere, significantly reducing the social distance between this prominent political leader and his audience. On the contrary, the incoherence between his touching words and his neutral face shown before reading could lead perceivers to consider the humble attitude of Obama only as a socially desirable, if not hypocritical, posture. An interesting facet of this data refers to the adjective “weak.” Data suggest that a humble speaker appears weak to his audience not when expressing a controversial reaction, such as contempt, but only when his face is not leaking the same indignant attitude conveyed by his words. This could help to better understand why, in previous studies on humble leaders, we found that they were negatively perceived when discussing moral topics .Regarding the second hypothesis, only some of our theoretical expectations were proved true. When participants put themselves in the shoes of students of low social condition, they were interested in this unusual communicative move, only when Obama’s facial expression was coherent with his words. However, if such passionate and unusual words were associated with a neutral expression, then they backfired, provoking negative reactions instead of social closeness. Interestingly, the falling short of expectancies related to reactions of participants identifying with high-status students suggests that the humble self-exposure of Obama was only fine-tuned for students of low social status: precisely the kind of audience he was addressing during his “Back-to-school” speech. To summarize, the importance of this interconnection between bodily communicative signals, relational humble stance, and potential features of the audience (low or high socioeconomic condition) shed the first light on the complexities of the persuasiveness of the humble political speech. Future studies should better consider other participants’ characteristics, such as political engagement and attitude, or individual differences in the social dominance’s orientation.Based on the idea that a humble stance during political speeches may either enhance the positive face of political leaders or backfire against them, this study aimed to explore the consequences of Obama’s humble sharing of his school difficulties with students of low social condition, listening to a “Back-to-school” discourse he delivered when he was the US President. In the framework of a multimodal analysis of communication, the Independent Variable manipulated was the coherence vs. the lack of coherence between two facial expressions of Obama , shown before presenting participants with an excerpt of the talk conveying a brief autobiographical sharing of his school difficulties. Results highlight how much participants’ reactions changed, only because of seeing Obama’s facial expression of contempt. It could be argued that for receivers, the leaking of a powerful speaker’s emotions during an official talk can act as an indirect yet powerful signal of authenticity, especially when an unexpected self-exposure puts a powerful politician to the same level of his audience. However, this is only a first explorative study, presenting some important limitations, and many questions remain unsolved.per se, by importing procedures developed for this field of study . Finally, the effects of humble communication in political speeches different from “monologs”  must be The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Ethical Committee of the University of Bari. All the procedures followed the Helsinki ethical principles and ethical codes of AIP . Informed consent was obtained for all participants. The patients/participants provided their written informed consent to participate in this study.AM and GL designed the study. IS and SM realized the procedure and collected the data. All authors analyzed the results and co-wrote the article.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


People’s ability to critically assess cancer-related information is essential from a preventional and therapeutic, as well as a general democratic perspective. Such cancer literacy is not just about acquiring factual knowledge. It also involves the ability to analyze how the information is contextualized—how cancer is framed. Previous research concerning the framing of cancer in public discourse is voluminous and penetrating but also fragmented and inaccessible to non-experts. In this study, we have developed an integrated and applicable tool for analyzing cancer discourse by systematically classifying distinctive ways of framing of the concept of cancer. Building on previous research and an inductive framing analysis of a broad range of public cancer discourse, systematically selected from British and Norwegian newspapers, we have characterized nine cancer frames: the biomedical, the environmental, the epidemiological, the personal, the sociopolitical, the economic, the antagonistic, the alternative, and the symbolic frame. This framing scheme may be applied to analyze cancer-related discourse across a plurality of themes and contexts. We also show how different frames combine to produce more complex messages, thereby revealing underlying patterns, strategies, and conflicts in cancer communication. In conclusion, this analytical tool enables critical reading of cancer-related information and may be especially useful in educational initiatives to advance health communication and public understanding of cancer. Cancer literacy, meaning people’s ability to critically assess cancer-related information, is increasingly important. Overall cancer incidence and prevalence are rising, primarily because of an aging population . The worAt the individual level, the word cancer is laden with fear and stigma . Cancer Overall, there is a strong need for tools and methods that facilitate the development of cancer literacy. People should be able to critically assess cancer-related information from difference sources, especially the wide range of content provided by the mass media. Besides formal education, the media represent the public’s primary source of information regarding health and science , 11. TV framed he spice [turmeric] may play a significant role in preventing or treating lung disease, brain disease and a variety of cancers – including multiple myeloma, colon cancer and pancreatic cancer” (DM038). There were also allusions to skepticism towards the mainstream medical and pharmaceutical industries: “I have news that Big Pharma doesn’t particularly want to hear. The ingredients for that pill are probably already right there on your kitchen shelves” (DM038).alternative frame stands in contrast to the scientifically based discourse of the biomedical, epidemiological, and environmental frame. It has a strong position in public discourse and poses a challenge to efforts to promote evidence-based understanding of cancer  works by ‘switching on’ the body’s immune system to fight cancer cells” (DM005). Finally, there were articles that depicted cancer as a fight at the societal and political level: “It is up to us in the community to act […] Ignoring cancer won’t beat it” (GU023).antagonistic frame is a powerful tool for rallying support and sympathy, at the individual as well as the political level, and there are valid arguments for framing cancer as an enemy, also from a biological perspective. This frame has a prominent position in public cancer discourse, and its conflicting function calls for special attention.Overall, we found that cancer was framed as an adversary in several different contexts, often in combination with other frames (elaborated below). This kind of framing has been criticized for promoting unrealistic expectations, disempowering patients, and undermining preventative behaviors . ConcurrSome articles used the concept of cancer as a symbol to describe something else. Typically, they applied cancer in metaphors or similes to describe other entities or phenomena as evil, invasive, or spreading: “Corruption can no longer be described as a cancer on the system: it is the system” (DM034); “this new censorship is spreading like a cancer across British universities” (DM045).symbolic frame uses the concept of cancer to describe something else and is thus different from discourse that uses metaphors to describe cancer mmunotherapy […] works by ‘switching on’ the body’s immune system to fight cancer cells” (DM005). In other cases, the antagonistic frame combined with the sociopolitical and economic frame to present cancer as a public enemy. This combination typically reflected the war on cancer mentality, often aiming for a cure and often appearing in articles calling on people to promote research funding and donate to cancer charities: “[W]ith YOUR help, you could help us smash our £1million target […] helping scientists make positive steps towards a cure” (SU028). Similarly, the antagonistic frame combined with the personal frame to present the psychological hardship of cancer: “[H]e had ‘fought the constant recurrences of his cancer with dogged courage’” (GU095).Some frames combined to evoke a new composite meaning. For instance, the alternative frame with the personal frame typically presented cancer as a spiritual and metaphysical phenomenon: “[H]e’d ask a child if their cancer was caused by negative energy” (DM032). Conversely, the alternative frame combined with the biomedical and environmental frame to compose a pseudoscientific message: “Ounce for ounce, herbs and spices have more antioxidants than any other food group. This means they can help prevent the initial triggering of mutations in your DNA that could lead to cancer or other diseases” (DM046). These combined messages have varying degrees of scientific validity. They may be difficult to recognize and assess, without expert knowledge, and deciphering and countering such pseudoscientific discourses represent a key challenge in cancer communication.Another combinatory modification was seen for the alternative frame. Combining the epidemiological, sociopolitical, and economic frames all presented the issue of cancer at the level of population and society, and their permutations tended to converge to a public health perspective. In one article, for example, the epidemiological frame was used to demonstrate the quantitative scope of cancer, and the economic frame related those numbers to financial implications, while the sociopolitical frame used the unfavorable scenario as grounds to campaign for improvements of care . Conversely, elements of the biomedical frame added authority and factual substance to personal stories about cancer: “If I’d hoped my cancer was early stage and non-invasive, my follow-up appointment that Friday revealed a different story […] It was likely to be grade two or three, depending on whether he discovered a spread to my lymph nodes during my mastectomy” (DM056).Other frames were inherently distinct but complemented one another to produce synergic effects. For example, predominantly biomedically framed articles sometimes included elements of the In this study, we have developed an applicable tool for analyzing cancer communication. Specifically, we have identified and categorized nine different cancer frames, which may be recognized in cancer discourse across different themes and context. This unified framing scheme may be used in education and further research to facilitate cancer literacy.The analyzed material of newspaper articles was limited to the recent 5-year period and a Western European context, and there may be historical or cultural aspects to cancer that are missing. Moreover, this qualitative, largely inductive study aimed to identify and characterize a set of frames based on obtaining consensus between the coders and does not include an assessment of inter-coder reliability. A deductive analysis, for example, to explore differences between countries or media sources, will require a quantitative design and is deferred to future studies.We also acknowledge that our framing scheme is merely one of several possible ways to classify public cancer discourse and that different framing schemes address different problems of communication. Yet, for the purpose of developing a simple framework that may be used for educational purposes, to analyze cancer discourse across themes and topics, we believe that this framing scheme represents a sensible balance between simplicity and discriminatory power.antagonistic frame is clearly related to the vast literature  as a malicious foe.Whereas the nine frames are related to previously described frames, there are also important differences. The ented by , 22) whienvironmental frame, clearly defined by how it attributes cancer to exposure and lifestyle-related factors, and an epidemiological frame, which specifically concerns the statistical and population-based aspects of the disease. These frames are further defined by their distinction from the biomedical frame, which concerns the biological, diagnostic, and therapeutic aspects of cancer.We also identified an Another novel feature of the presented framing scheme is the ability to identify and explore a variety of frame combinations. The use of one frame may be modified, reinforced, or complemented by other frames, and an article may represent different permutations of the nine frames. The framing scheme may thus be used to dissect composite framing effects in more complex messages. Such analysis may reveal the underlying strategies or conflicts in cancer communication, which may be difficult to identify without a comprehensive framing scheme.Combined, the nine cancer frames may be used as a tool for cancer education. The concept of framing, and how it affects communication, is quite easy to understand and may be applied to different levels of education, from secondary school to PhD courses. As demonstrated by Carver et al. , a set oGroups of students may be presented with the framing scheme and asked to identify which frames are used in different media articles . Each frMoreover, the framing scheme may be used by professionals, including journalist, researchers, and healthcare providers to analyze their own as well as others’ cancer-related communication. This ability to critically assess cancer discourse is of special relevance to healthcare professionals, who communicate about cancer on a regular basis. How they frame the concept of cancer may have profound implications, not only for the patient’s understanding of disease, but may also influence their preventive behavior and therapeutic compliance . More atWith regard to further research, a unified framing scheme may be applied in quantitative analyses to reveal underlying patterns in communication . The canIn conclusion, we have developed a practical tool for contextual analysis of cancer-related information. The nine cancer frames are based on a synthesis of previous research as well as an independent analysis of a large, international material of newspaper articles. This framing scheme may be applied in further research and educational initiatives to promote cancer literacy and a better understanding of cancer as a multi-dimensional problem in science and society.


The novel coronavirus of 2019 (COVID-19) has been and continues to be a rapidly developing public health crisis, that has also disrupted routine and maintenance health care for people living with chronic conditions. Some of these chronic conditions also put individuals at increased risk of COVID-19 complications, particularly if the condition is not under control. For these reasons, the exploratory study reported here examined the needs and preparedness of patients at a community health organization that specifically provides hepatitis B virus (HBV) care for high-risk groups that had previously tested positive for HBV.Current study utilized exploratory analysis of qualitative COVID-19-related statements collected during calls to a total of 44 patients reached during April and May, 2020 in the Washington D.C. area. Researchers worked with a community based non-profit organization to reach current HBV + and HCV + patients to provide retention in care and assess patient needs in maintaining management of their condition adapted to include offering medication refills, telehealth, and other resources. We gathered emergent themes, using socio-ecological framework, regarding capacity and needs for managing their chronic condition in a vulnerable population during the initial, most interrupted, time period of a global public health crisis.From the notes of the calls, five thematic categories emerged: COVID-19 prevention awareness, assistance program access, medical resource access, access to knowledge and awareness about assistance programs, and needs and barriers. From these five themes, providers can develop strategies to better prepare their patients and provide care to patients with chronic conditions during major disruptions.Future recommendations include increasing hepatitis and COVID-19 vaccine efforts, collaborating with community partners, and screening and understanding social determinants of health that affect racial and ethnic minorities. The novel coronavirus of 2019 (COVID-19) has been and continues to be a rapidly developing global public health crisis. What initially presented as primarily a respiratory virus with a high mortality rate, has more recently come to be understood to be a systemic disease that causes inflammation and cellular death in many parts of the body, leading in some cases to long-term impact and suffering . SeveralMany of these underlying conditions are disproportionately distributed among marginalized and minority communities, putting already economically vulnerable populations at greater risk , 8. GlobIn the case of HBV as an underlying condition, we also see disparities. Globally, particularly in low- and middle-income countries, where we see significantly higher burden of disease in parts of Africa and Asia, COVID-19 has caused disruptions to already vulnerable efforts to detect, prevent, and treat HBV . DomestiTo compound this increased urgency in need, when COVID-19 first overtook the U.S. in March 2020, most non-urgent medical care (as well as other activities) were temporarily suspended , 17. As This study is an exploratory analysis of qualitative COVID-19-related statements collected during calls to hepatitis B patients. Researchers worked with Hepatitis B Initiative of Washington DC (HBI-DC), a community based non-profit organization that “works to prevent liver cancer caused by hepatitis B and C among people of Asian, Pacific Islander, and African descent, and other high-risk groups” . During Patients were asked the following questions related to COVID-19:Are you at risk for COVID-19? Yes/No◦ If Yes: Have you recently travelled to an area with a known local spread of COVID-19?◦ If Yes: Have you come into close contact (within 6 feet) of someone who has a laboratory confirmed COVID-19 diagnosis in the past 14 days?◦ If Yes: Do you have fever (greater than 100.4F or 38.0C) OR symptoms of lower respiratory illness, such as coughing, shortness of breath, difficulty breathing, or sore throat?▪ If Yes: What was the result?◦ If Yes: Have you been able to get tested? Yes/NoDo you have any symptoms? Yes/No◦ If Yes: What kind?Do you need any support or resources? Yes/NoFinancial Hardship & Social determinants of Health:Are you or family member  experiencing a financial hardship  due to the COVID-19? Yes/NoAre you able to pay your mortgage or rent or utilities? Yes/NoDo you have enough food? Yes/NoCOVID-19 Risks and Prevention:The Socio-Ecological Model illustrates how an individual’s health choices are influenced by layers of factors at intrapersonal, interpersonal, social network, institutional, and community levels . In partrd through May 30th, 2020, by HBI-DC staff.HBI-DC called patients who had tested positive for hepatitis B or hepatitis C at their screening events. This DC-based non-profit organization works with individuals of Asian, Pacific Islander, and African ancestry and other high-risk groups to provide hepatitis B and hepatitis C education, screening, vaccination, and linkage to care. Patients were reached by phone between March 23Participants were current patients at HBI-DC, that had a current hepatitis B or C positive test result, and that had provided a phone number. All patients were adults and of Asian, Pacific Island, or African descent. Forty-four patients were reached during those two months, which is comparable to the outreach efforts from previous years. Of those reached, 27 were male 61.4%), and the average age was 51.3 years old (range 31–74 years old). Of those reached, 31 (70.5%) reported not having insurance, and 35 (79.5%) reported not having a primary care provider (PCP)  and this information was shared with patients as well, “…sent him the information through Aunt Bertha for food stamps.”For medical assistance, medication was being mailed to the patients wherever they were to ensure continuity in medication uptake, “Called her to inquire about meds and she said they have the meds mailed to patients. I called patient back and gave her number to patient to call her right away.” This service was being made available even to patients who have moved regardless of their new location, “…patient went to Mongolia, taking meds, medications are finishing. Called Doctor for meds, doctor said NIH  pharmacy can ship to Mongolia.” There was also the provision of telehealth services for patients in need of doctor’s appointment that could be accessed by phone, “Offered that TeleHealth is an option to have a video call with her doctor…” Information was also given to patients to help them update insurance coverage, “Doctor suggested reapplying due to COVID and he might qualify; resource was sent to patient.”The patients were also offered free transportation services for medical purposes for those patients who had no means of transportation to get medical attention, “Can offer resource on free bus tokens or she can apply for Medicaid and medical transportation is free.”There were various medical resources that were availed to the patients. Access to these resources varied from patient to patient. There were those who were able to access health screening services such as colonoscopy, ultrasound, endoscopy and blood tests, “He had a PCP. He just got an Ultrasound test from his family doctor on 5/15/20 because of the pain in the stomach.” Unfortunately, there were those who were not able to access these services due to the restricted movement during the pandemic, “Patient was scheduled for a liver biopsy on 3/18, cancelled due to COVID-19 situation…” There were patients who also needed access to free medical care, “She also needs a free clinic to go to for Hepatitis…” and they were advised on how to go about it.Access to the health facility was not a challenge for some of the patients, while others were not able to access the health facility. One of the reasons mentioned for lack of access was the long distance between the patient and the health facility, “Patient says Baltimore is too far.” For some, the facility wasn’t open for appointments, “I assisted him with tips as he has pre-diabetes and he is waiting to get to his Doctor as it is closed due to COVID.”Patients were able to see their doctors, and their appointments were scheduled at different times throughout the year. There were patients with appointments every three or six months and others who had appointments scheduled as frequent as weekly. However, for most of the regular check-ups, appointments were cancelled due to the COVID-19 pandemic, “Patient went to NIH every week for testing to get ready for treatment to start as soon as approved, since January. April 10 appointment was cancelled due to COVID situation…” There were patients who had been appointed different doctors from their regular ones, which was a barrier for some, “…contacted patient coordinator and got Dr's e-mail address. Hasn't sent e-mail, a little hesitant, because used to have a different doctor…”.When it comes to medication uptake, most of the patients were reported to be adhering to the prescriptions given to them by their doctors, “Spoke with patient and he was put on medication from December 2019 and has finished his prescription.” Few were reported to not adhering to the prescriptions and not taking medication at all, “Not taking medications.” Another statement made about this was, “Patient says she is still taking meds…”.Information about the available resources and programs in place to assist patients in various ways was known to some and unknown to others. Information for local support services for food assistance, financial assistance, etc., was provided to those patients that did not already have the information. One of the statements made about food assistance was, “Patient started receiving food stamps. Searched for free school lunch in her area, advised to go on Monday to elementary school for free lunch for her child….”The patients were also given information concerning where they will be able to get help with paying utility bills for those not able to, “He says he needs assistance with paying his electric bill, so I will find him a resource to help him. Referred him to Friends for Neighborhood Progress Inc to get assistance with electric bill.”“He explained that he did not know where to go for help. I researched both small business and unemployment benefits. I called the small business administration and they told me they are only issuing loans. I felt unemployment benefits was best for him as he did not want a loan.”Some patients also requested information about how to file for unemployment in order to get financial assistance, “He also stated that he would like for me to send him information for unemployment assistance in Prince William County and SNAP …” The most convenient support information was shared with the patients after thorough consideration and research:When it came to healthcare information, some of the patients were given information on how they could get follow-up appointments because they were not aware of how to do that and asked for assistance, “He would like to get some information about doctor follow up and medication treatment…”.Information was also given to the patients about how they could manage their existing health conditions because they were not able to access a doctor due to COVID-19, “I assisted him with tips as he has prediabetes and he is waiting to get to his doctor as it is closed due to COVID.” Importance of taking medication and going for regular medical check-ups were also emphasized with the patients.There were various challenges and barriers that the patients were facing which were identified during the follow-up calls. Unemployment was one major impact of COVID-19 which affected patients leading to financial barriers. Some were not able to pay for their utility bills or even buy food for their families, “…needs assistance with rent (connected) because working reduced hours, 4–5 h/day.” There were requests for information concerning food assistance from the patients, “Needs help with food assistance…”.“I asked her if she has enough medications and she says she will need a refill soon in the next two weeks, since she goes to Kaiser, I advised her to call soon to ask for a refill because they might have procedures for pick up due to the Coronavirus.”There were also challenges with medication access. There were patients who had no money to purchase medication, “…needs medication but too expensive, advised her to call doctor and ask for generic that insurance will cover because she said it's $1,000 a month.” For some, their medication was running out and needed a refill but there were a few challenges regarding picking up the medication:Some of the patients also mentioned not having received information about their illnesses, “…spoke with the patient and he states that he never heard anything about Hep B from the clinic only Hep C…” and arrangements were made to assist them. Transportation also came up as a need mentioned by one of the patients, “…patient needs help with transportation…”. They were assisted with information regarding this, too.In addition, there were patients who did not have any challenges or barriers stopping them from accessing the services and products they required for healthy living, which was noted in quite a number of the statement reports, “Patient seems to be doing good and has no need for assistance…” Figs.  and 3.FiThe study reported here explored the needs of patients affected with Hepatitis B virus during the early months of the COVID-19 pandemic. The following five themes emerged from exploratory analysis of the qualitative interviews from 44 participants: 1) awareness of COVID-19 protective measures, 2) access to assistance programs offered, 3) access to medical resources, 4) access to knowledge and information about assistance programs, and 5) needs and barriers.Participants were aware and reminded of precautions to stay safe from COVID-19 due to their increased risk for complications with positive Hepatitis B virus infection status. During routine outreach from HBI-DC staff, participants were informed of assistance programs, such as school food programs; medical support including ensuring continuation of medication as prescribed and providing guidance for telehealth with a provider as needed; and transportation services for medical care. In terms of medical resources available for participants, while some were able to receive screenings and blood tests as necessary, some procedures were cancelled due to prioritization of care for patients directly affected by COVID-19. Similarly, participants described varied access to healthcare facility and appointments that were reassigned to a different provider or cancelled due to COVID-19. Information about assistance programs for food, utilities, unemployment, financial support, and transportation were provided to participants who were not aware of the resources available for them. Assistance with medical follow-up appointments and emphasis on adherence to prescribed medication regimen was provided for those having a hard time getting access to care due to COVID-19. Some participants described barriers to medication access due to financial hardship and not receiving necessary information or medical advice about their hepatitis diagnosis due to COVID-19.Most participants expressed a strong need for assistance, and challenging barriers to accessing care and basic necessities , as well as insufficient knowledge about medical and assistance programs. It is important to highlight that all 44 participants were of Asian, Pacific Island, or African descent. Kardashian, et al., (2021) emphasize social determinants of health and heightened liver disease disparities during COVID-19 . Racial Increasing COVID-19 vaccine efforts especially for racial and ethnic minorities to decrease the disparities of impact from the disease.Collaborating with community partners to address needs of vulnerable populations affected by hepatitis infection, including providing information about how to use telemedicine, and assistance programs for medication, transportation, food, etc.Screening for, understanding, and addressing social determinants of health that affect racial and ethnic minorities.Based on the needs highlighted from our study, as well as the literature, future recommendations include:The strengths of the study reported here are that we were able to collect qualitative exploratory data from 44 individuals affected by hepatitis infection via a community partner outreach communication channel during the early part of 2020, when the COVID-19 began to emerge in the U.S. This allowed us to get an understanding of how COVID-19 was impacting the participants and their basic care needs during the that stage of the pandemic.Some of the limitations of the study are that it is a relatively small study, consisting of 44 participants utilizing a single community health organization in the Washington D.C. area. There were only participants of Asian, Pacific Island, or African descent, excluding Hispanics who are also largely affected by liver diseases . Future This current exploratory qualitative study examined the needs and preparedness of patients at a community health organization that specifically provides HBV care for high-risk groups that had previously tested positive for HBV. From the notes of the calls, health care providers can develop strategies to better prepare their patients and provide care to their patients during major disruptions. Needs-related themes that emerged in this study indicate potential solutions see Fig. . For exaViral Hepatitis National Strategic Plan’s recommendations in light of COVID-19, to address the added barriers to care that are faced by communities that shoulder a disproportionate share of the disease burden by addressing informational and resource access deficiencies [Due to the novelty of the COVID-19 global pandemic, in early 2020, health care providers found themselves needing to pivot their care delivery models and priorities without precedence and limited guidance. At the time of publication two years later, there is still very limited published guidance on how best to provide support for patients with chronic conditions during a public health crisis. In looking at the impact of COVID-19 on diabetes patients, another chronic condition associated with increased risks and similar maintenance needs, suggested recommendations are similar to the ones found in this study. These include clear guidance communication, continuity of care, and access to services and resources . Our recciencies .