Uncertain news: Trust and preventive practices in respiratory infectious diseases

Trust influences a range of human behaviors including health decision making. Over the past 60 years a significant industry has sprung up to influence public opinion and mobilize grassroots challenges against evidence-based threats to vested interests. Simultaneously, media reports of scientific fraud, misrepresentation, constantly changing “evidence” for health, and “hyped” predictions of disasters that were ultimately less significant amplify doubts about the reliability of scientific evidence and technology when hazards arise. This has contributed to the appearance of decay of trust in the veracity of scientific claims. Population responses during communicable disease epidemics illustrate these interacting processes that simultaneously create uncertainty and significant discomfort within communities. Research on the relative influences of formal versus informal information sources in driving protective behavior during recent influenza epidemics shows how both the uptake of everyday preventive practices such as hand hygiene, and specific health interventions, such as vaccination are affected by these processes. We review recent work on influenza-related personal preventive practices, with a particular focus on the shifting roles and utility of formal and informal sources in decision making among the public, and consider the implications within the context of prevailing levels of trust, uncertainty, and doubt surrounding health care recommendations.postprin

Medication decision-making for patients with renal insufficiency in inpatient and outpatient care at a US Veterans Affairs Medical Centre: a qualitative, cognitive task analysis.

BackgroundMany studies identify factors that contribute to renal prescribing errors, but few examine how healthcare professionals (HCPs) detect and recover from an error or potential patient safety concern. Knowledge of this information could inform advanced error detection systems and decision support tools that help prevent prescribing errors.ObjectiveTo examine the cognitive strategies that HCPs used to recognise and manage medication-related problems for patients with renal insufficiency.DesignHCPs submitted documentation about medication-related incidents. We then conducted cognitive task analysis interviews. Qualitative data were analysed inductively.SettingInpatient and outpatient facilities at a major US Veterans Affairs Medical Centre.ParticipantsPhysicians, nurses and pharmacists who took action to prevent or resolve a renal-drug problem in patients with renal insufficiency.OutcomesEmergent themes from interviews, as related to recognition of renal-drug problems and decision-making processes.ResultsWe interviewed 20 HCPs. Results yielded a descriptive model of the decision-making process, comprised of three main stages: detect, gather information and act. These stages often followed a cyclical path due largely to the gradual decline of patients' renal function. Most HCPs relied on being vigilant to detect patients' renal-drug problems rather than relying on systems to detect unanticipated cues. At each stage, HCPs relied on different cognitive cues depending on medication type: for renally eliminated medications, HCPs focused on gathering renal dosing guidelines, while for nephrotoxic medications, HCPs investigated the need for particular medication therapy, and if warranted, safer alternatives.ConclusionsOur model is useful for trainees so they can gain familiarity with managing renal-drug problems. Based on findings, improvements are warranted for three aspects of healthcare systems: (1) supporting the cyclical nature of renal-drug problem management via longitudinal tracking mechanisms, (2) providing tools to alleviate HCPs' heavy reliance on vigilance and (3) supporting HCPs' different decision-making needs for renally eliminated versus nephrotoxic medications

The Influence of Social-Cognitive Factors on Personal Hygiene Practices to Protect Against Influenzas: Using Modelling to Compare Avian A/H5N1 and 2009 Pandemic A/H1N1 Influenzas in Hong Kong

# The Author(s) 2010. This article is published with open access at Springerlink.com Background Understanding population responses to influenza helps optimize public health interventions. Relevant theoretical frameworks remain nascent. Purpose To model associations between trust in information, perceived hygiene effectiveness, knowledge about the causes of influenza, perceived susceptibility and worry, and personal hygiene practices (PHPs) associated with influenza. Methods Cross-sectional household telephone surveys on avian influenza A/H5N1 (2006) and pandemic influenza A/ H1N1 (2009) gathered comparable data on trust in formal and informal sources of influenza information, influenzarelated knowledge, perceived hygiene effectiveness, worry, perceived susceptibility, and PHPs. Exploratory factor analysis confirmed domain content while confirmatory factor analysis was used to evaluate the extracted factors. The hypothesized model, compiled from different theoretical frameworks, was optimized with structural equation modelling using the A/H5N1 data. The optimized model was then tested against the A/H1N1 dataset. Results The model was robust across datasets though corresponding path weights differed. Trust in formal information was positively associated with perceived hygien

Doctor of Philosophy

dissertationUsing eye-tracking technology to capture the visual scanpaths of a sample of laypersons (N = 92), the current study employed a 2 (training condition: ABCDE vs. Ugly Duckling Sign) Ã- 2 (visual condition: photorealistic images vs. illustrations) factorial design to assess whether SSE training succeeds or fails in facilitating increases in sensitivity and specificity. Self-efficacy and perceived importance were tested as moderators, and eye-tracking fixation metrics as mediators, within the framework of Visual Skill Acquisition Theory (VSAT). For sensitivity, results indicated a significant main effect for visual condition, F(1,88) = 7.102, p = .009, wherein illustrations (M = .524, SD = .197) resulted in greater sensitivity than photos (M = .425, SD = .159, d = .55). For specificity, the main effect for training was not significant, F(1,88) = 2.120, p = .149; however, results indicated a significant main effect for visual condition, F(1,88) = 4.079, p = .046, wherein photos (M = .821, SD = .108) resulted in greater specificity than illustrations (M = .770, SD = .137, d = .41). The interaction for training Ã- visual condition, F(1,88) = 3.554, p = .063, was significant within a 90% confidence interval, such that those within the UDS Photo condition displayed greater specificity than all other combinations of training and visual condition. No significant moderated mediation manifested for sensitivity, but for specificity, the model was significant, r = .59, R2 = .34, F(9,82) = 4.7783, p =.001, with Percent of Time in Lookzone serving as a significant mediator, and both self-efficacy and visual condition significantly moderating the mediation. For those in the photo condition with very high self-efficacy, UDS increased specificity directly. For those in the photo condition with self-efficacy levels at the mean or lower, there was a conditional indirect effect through Percent of Time in Lookzoneâ€"which is to say that these individuals spent a larger amount of their viewing time on target (observing the atypical nevi)â€"and time on target is positively related to specificity. Findings suggest that existing SSE training techniques may be enhanced by maximizing visual processing efficiency

Cervical cancer prevention practices through screening and vaccination: A cross-sectional study among Hong Kong Chinese women

postprin

Chinese immigrant parents' vaccination decision making for children: A qualitative analysis

Background: While immunization coverage rates for childhood routine vaccines in Hong Kong are almost 100%, the uptake rates of optional vaccines remain suboptimal. Understanding parental decision-making for children's vaccination is important, particularly among minority groups who are most vulnerable and underserved. This study explored how a subsample of new immigrant mothers from mainland China, a rapidly-growing subpopulation in Hong Kong, made decisions on various childhood and adolescent vaccines for their offspring, and identified key influences affecting their decision making. Methods. Semi-structured in-depth interviews were conducted with 23 Chinese new immigrant mothers recruited by purposive sampling. All interviews were audio-taped, transcribed and analyzed using a Grounded Theory approach. Results: Participants' conversation revealed five underlying themes which influenced parents' vaccination decision-making: (1) Institutional factors, (2) Insufficient vaccination knowledge and advice, (3) Affective impacts on motivation, (4) Vaccination barriers, and (5) Social influences. The role of social norms appeared overwhelmingly salient influencing parents' vaccination decision making. Institutional factors shaped parent's perceptions of vaccination necessity. Fear of vaccine-targeted diseases was a key motivating factor for parents adopting vaccination. Insufficient knowledge about vaccines and targeted diseases, lack of advice from health professionals and, if provided, suspicions regarding the motivations for such advice were common issues. Vaccination cost was a major barrier for many new immigrant parents. Conclusions: Social norms play a key role influencing parental vaccination decision-making. Insight gained from this study will help inform healthcare providers in vaccination communication and policymakers in future vaccination programme. © 2014 Wang et al.; licensee BioMed Central Ltd.Link_to_subscribed_fulltex

Digital behavioral technology, vulnerability and justice:towards an integrated approach

The paper introduces the notion of 'digital behavioral technologies' and discusses them from the perspectives of vulnerability and justice, thereby integrating perspectives from bioethics or public health ethics and political philosophy. Digital behavioral technologies have seen a massive uptake in recent years, but the market for them is hardly regulated. We argue that understanding the impact of digital behavioral technologies requires understanding individuals not as abstract, atomized agents, but rather to take their embeddedness into social structures into account. This also allows extending the focus to groups, relationships and whole societies, which are often structurally unjust. This perspective provides a corrective to an overly individualistic consideration of digital behavioral technologies, which may suggest itself because of their focus on individual bodies. We point out some implications of this integrated approach with regard to the regulation of digital behavioral technologies. We conclude by describing some implications both for those who work on digital behavioral technologies and for those who work on questions of vulnerability and justice

Risk Communication for the Future

The conventional approach to risk communication, based on a centralized and controlled model, has led to blatant failures in the management of recent safety related events. In parallel, several cases have proved that actors not thought of as risk governance or safety management contributors may play a positive role regarding safety. Building on these two observations and bridging the gap between risk communication and safety practices leads to a new, more societal perspective on risk communication, that allows for smart risk governance and safety management. This book is Open Access under a CC-BY licence