JMIR Publications

ABSTRACT

Background:

Health systems restricted inpatient visitation due to COVID-19. There is no existing evidence of how they communicated these policies to the public nor their communication choices' impact on public perception.

Objective:

To describe patterns of restrictive visitation policies, the manner in which health systems communicated them to the general public, and identify communication strategies that maximize public perception despite visitation restrictions.

Methods:

We conducted a sequential exploratory mixed-methods study of COVID-era visitation policies published on facility websites in Pennsylvania captured between April 30 and May 20, 2020 and a factorial experiment to test how key elements of hospitals’ visitation policy communication are associated with individuals’ willingness to seek care, conducted in October 2020. For analysis of policies, we included all inpatient health care facilities in Pennsylvania. For the factorial experiment, U.S. adults were drawn from an online research panel. In the factorial experiment, we varied the justification for restricted visitation, the degree to which the health system expressed ownership of the policy, and the inclusion of family-centered care support plans. Our primary outcome was willingness to recommend the hypothetical hospital using a 5-point Likert scale.

Results:

We identified 104 unique policies on inpatient visitation from 363 facilities’ websites. The policies’ mean Flesch-Kincaid Grade Level was 14.2. Most policies prohibited family presence (99, 95.2%). Health systems justified the restricted visitation on the basis of community protection (59, 56.7%), authorities’ guidance or regulations (34, 32.7%), or scientific rationale (23, 22.1%). A minority (38, 36.5%) addressed how restrictive visitation may impair family-centered care. Most used passive voice to communicate restrictions. Of the 1321 participants who completed the online survey, 53.7% were women, 73.2% were White, and 18.8% were Black. Visitation policy elements significantly associated with willingness to recommend the hospital included justifications promoting community protection (OR 1.44, 95% CI 1.24-1.68) or based on scientific rationale (OR 1.30, 95% CI 1.12-1.51), rather than based on governing authority; the hospital expressing a high degree of ownership over the decision (OR 1.16, 95% CI 1.04-1.29); and inclusion of family-centered care support plans (OR 2.80, 95% CI 2.51-3.12).

Conclusions:

Health systems can immediately improve public receptiveness of restrictive visitation policies by modifying their public communication of these policies. Clinical Trial: N/A