Patient and Provider Perspectives on How Trust Influences Maternal Vaccine Acceptance Among Pregnant Women in Kenya

Background Pregnant women and newborns are at high risk for infectious diseases. Altered immunity status during pregnancy and challenges fully vaccinating newborns contribute to this medical reality. Maternal immunization is a strategy to protect pregnant women and their newborns. This study aimed to find out how patient-provider relationships affect maternal vaccine uptake, particularly in the context of a lower middle- income country where limited research in this area exists. Methods We conducted semi-structured, in-depth narrative interviews of both providers and pregnant women from four sites in Kenya: Siaya, Nairobi, Mombasa, and Marsabit. Interviews were conducted in either English or one of the local regional languages. Results We found that patient trust in health care providers (HCPs) is integral to vaccine acceptance among pregnant women in Kenya. The HCP-patient relationship is a fiduciary one, whereby the patients’ trusts is primarily rooted in the provider’s social position as a person who is highly educated in matters of health. Furthermore, patient health education and provider attitudes are crucial for reinstating and fostering that trust, especially in cases where trust was impeded by rumors, community myths and misperceptions, and religious and cultural factors. Conclusion Patient trust in providers is a strong facilitator contributing to vaccine acceptance among pregnant women in Kenya. To maintain and increase immunization trust, providers have a critical role in cultivating a positive environment that allows for favorable interactions and patient health education. This includes educating providers on maternal immunizations and enhancing knowledge of effective risk communication tactics in clinical encounters

“‘What on Earth Was I Thinking?’ How Anticipating Plan’s End Places an Intention in Time”

How must you think about time when you form an intention? Obviously, you must think about the time of action. Must you frame the action in any broader prospect or retrospect? In this essay I argue that you must: you thereby commit yourself to a specific prospect of a future retrospect – a retrospect, indeed, on that very prospect. In forming an intention you project a future from which you will not ask regretfully, referring back to your follow-through on that intention, “What on earth was I thinking?” I argue that this broader attitude expresses the self-accountability necessary for practical commitment

Culture and disaster risk management - synthesis of stakeholder attitudes during 3 Stakeholder Assemblies in Romania, Italy and Portugal

This report provides a synthesis of the results of three CARISMAND Stakeholder Assemblies held in A) Bucharest,Romania on April 14-15, 2016; B) Rome,Italy on February 27-28, 2017; and C) Lisbon,Portugal on February 27-28, 2018. These Stakeholder Assemblies, together with six Citizen Summits (see Deliverables D5.3 – D5.9) were part of the CARISMAND cycle of events (see Figure 1 below). This cycle of events was the key concept at the core of the CARISMAND project which aimed to ensure a comprehensive feedback loop betweendisaster practitioners and citizens. It also allowed for the progression of ideas co-created by disaster practitioners and citizens. The locations of the three Stakeholder Assemblies were chosen due to their rather different “backgrounds”. The three countries had been struck at the time of the respective event by different types of disasters. In addition, the three countries have very different “cultures”, or cultural impacts, at a societal level. Romania has a comparatively strong authoritative systems due to its political history; Italy has experienced a strong direct in-flow of migrants in the last years due to its geological location; and Portugal has long been a traditional “melting pot” where, over more than a millennium, people from different cultural backgrounds and ethnic origins (in particular North Africa, South America, and Europe) have lived together. Accordingly, these differences were expected to allow a wide range of practitioners’ attitudes and perceptions related to cultural factors in disaster management to emerge. In order to not only gather a variety of attitudes and perceptions but also promote cross-sectional knowledge transfer, the audience in all three events consisted of a wide range of practitioners who are typically involved in disaster management, e.g., civil protection agencies , the emergency services, paramedics, nurses, environmental protection agencies, the Red Cross, firefighters, the military, and the police. Further, these practitioners were from several regions in the respective country; in Portugal, the Stakeholder Assembly also included practitioners from the island of Madeira. The 40-60 participants per event were recruited via invitations sent to various organisations and institutions that play a role in disaster management, and via direct contacts of local partners in the CARISMAND consortium. Each assembly consisted of a mix of presentations and discussion groups to combine dissemination with information gathering (for detailed schedules see Appendices A1-A3). In an initial general assembly, the event started with presentations of the CARISMAND project and its main goals and concepts. Then, participants were split into small working groups in separate breakout rooms, where they discussed and provided feedback on a specific topic. After each working group session, panel discussions allowed the participants to present the results of their working group to the rest of the audience. After each panel discussion, keynote speakers gave presentations related to the topic that had been discussed during the working groups. This schedule was designed to ensure that participants are provided with detailed information about recent developments in disaster management, but without influencing the attitudes and perceptions expressed in the working groups. In the third Stakeholder Assembly, different sets of recommendations for practitioners (related to the use of cultural factors in disaster management) were presented to the general audience, followed by small discussion group sessions as described above.The project was co-funded by the European Commission within the Horizon2020 Programme (2014–2020).peer-reviewe

Culture and disaster risk management - stakeholder attitudes during Stakeholder Assembly in Lisbon, Portugal

This report provides a summary of the topics discussed and the results of the third CARISMAND Stakeholder Assembly conducted in Lisbon, Portugal on 27-28 February 2018. In order to promote cross-sectional knowledge transfer and gather a variety of attitudes and perceptions, as in the first and second CARISMAND Stakeholder Assemblies held in Romania and Italy in the previous years, the audience consisted of a wide range of practitioners who are typically involved in disaster management, e.g., civil protection, the emergency services, paramedics, nurses, environmental protection, Red Cross, firefighters, military, and the police. Further, these practitioners were from several regions in Portugal, including the island of Madeira. The 40 participants were recruited via invitations sent to various Portuguese organisations and institutions, and via direct contacts of the Civil Protection Department in Lisbon which is one of the partners in the CARISMAND consortium. The event consisted of a mix of presentations and discussion groups to combine dissemination with information gathering (for the detailed schedule/programme see Appendix 1). Furthermore, this third Stakeholder Assembly was organised and specifically designed to discuss and collect feedback on a comprehensive set of recommendations for disaster practitioners, which will form one of the core elements of the CARISMAND Work Package 9 ‘Toolkit’. These recommendations, which have all been formulated on the basis of Work Packages 2-10 results, were structured in four, main “sets”: 1. Approaches to ethnicity in disaster management; 2. Culturally aware disaster-related training activities; 3. Cultural factors in disaster communication, with the sub-sets: a. Cultural values and emotions; (cross-)cultural symbols; “physical” aides and methods; b. Involvement of cultural leaders; involvement of specific groups; usage of social media and mobile phone apps; and 4. Improving trust, improving disaster management. In an initial general assembly, the event started with presentations of the CARISMAND project and its main goals and concepts, including the concept of culture adopted by CARISMAND, and the planned CARISMAND Toolkit architecture and functionalities. These were followed by a detailed presentation of the first of the above mentioned sets of recommendations for practitioners. Then, participants of the Stakeholder Assembly were split into small groups in separate breakout rooms, where they discussed and provided feedback to the presented recommendations. Over the course of the 2-day event, this procedure was followed for all four sets of recommendations. To follow the cyclical design of CARISMAND events, and wherever meaningful and possible, the respective Toolkit recommendations for practitioners provided also the basis for a respective “shadow” recommendation for citizens which will be discussed accordingly in the last round of CARISMAND Citizen Summits (Citizen Summit 5 in Lisbon, and Citizen Summit 6 in Utrecht) in 2018. The location of the Third Stakeholder Assembly was selected to make use of the extensive local professional network of the Civil Protection Department in Lisbon, but also due to Portugal being a traditional “melting pot” where, over more than a millennium, people from different cultural backgrounds and local/ethnical origins (in particular Africa, South America, and Europe) have lived both alongside and together. All documents related to the Working Groups, i.e. discussion guidelines and consent forms, were translated into Portuguese. Accordingly, all presentations, as well as the group discussions were held in Portuguese, aiming to avoid any language/education-related access restrictions, and allowing participating practitioners to respond intuitively and discuss freely in their native language. For this purpose, simultaneous interpreters and professional local moderators were contracted via a local market research agency (EquaçãoLógica), which also provided the basic data analysis of all Working Group discussions and an independent qualitative evaluation of all recommendations presented in the event. The results of this analysis and evaluation will demonstrate that most recommendations were seen by the participating practitioners to be relevant and useful. In particular, those recommendations related to the use of cultural symbols and the potential of mobile phone apps and/or social media were perceived as stimulating and thought-provoking. Some recommendations were felt to be less relevant in the specific Portuguese context, but accepted as useful in other locations; a very small number was perceived to be better addressed to policy makers rather than practitioners. These and all other suggestions for improvement of the presented CARISMAND Toolkit recommendations for practitioners have been taken up and will be outlined in the final chapter of this report.The project was co-funded by the European Commission within the Horizon2020 Programme (2014-2020).peer-reviewe

Culture and disaster risk management - citizens’ reactions and opinions during Citizen Summit in Frankfurt, Germany

The analyses and results in this document are based on the data collected during the fourth Citizen Summit held in Frankfurt/Germany on June 14th 2017. As the previous three Citizen Summits held in Romania, Malta and Italy, this Citizen Summit was designed as a one-day event combining public information with feedback gathering through different methods of data collection. In the morning session, 42 questions with pre-defined answer options were posed to the audience and collected via an audience response system. In the afternoon session, small moderated group discussions of approximately 1.5 hours duration were held, which followed a detailed set of questions and discussion guidelines, including a short association exercise. All questions and discussions aimed to explore cultural factors in citizens’ attitudes, feelings, and perceptions towards disaster risks, as well as their identification in relation to disaster preparation, response and recovery. In coordination with the Work Package 11 briefs, the definition and design of the questions was based on: 1) Results from Citizen Summits 1 and 2, complementing in particular the data related to risk perception with the aim to build up a comprehensive base for cultural comparison across all six summits; 2) Results from Stakeholder Assemblies 1 and 2, in particular regarding the identification of non-professional (“cultural”) leaders in disaster situations, motivators for improving disaster preparedness, and the role of trust/distrust; 3) Results from Work Package 3, aiming to complement and increase knowledge about citizens’ uptake of mobile phone apps and interest in usage of different features, also in contrast to social media use; 4) Results from Work Package 4, in particular regarding recent research findings in the relationships between perceived disaster preparedness and actual disaster preparedness, and in the ambivalent relationships between trust in authorities and citizens’ personal preparedness; 5) Results from Work Package 7, aiming to complement the research regarding citizen empowerment by exploring trust as a bi-directional relationship between citizens and disaster managers; and 6) Results from Work Package 8, taking into account the role of media in all phases of disaster management. For a detailed overview of all questions asked and topics discussed please see Appendix A. Overall, 105 citizens participated in this Germany event. The total sample shows a relatively even gender and age distribution, which is unsurprising given the target quotas that were requested from the recruiting local market research agency. The comparatively low number of senior citizens aged 65 and above was expected and reflects mobility issues. Participants were asked about three key aspects of experience of disasters and disaster risk perception that could potentially have an impact on how other questions were answered. Two out of three respondents indicated that they themselves, or a close friend or family member, have experienced a disaster, more than half (54%) felt that they were living in an area that is specifically prone to disasters, and 62% answered that they know other people in the area where they live who they think are particularly vulnerable or exposed to disasters. Slight gender differences (as well as age-related differences) were found to be not statistically significant (p>=.05). This report is structured in five main sections: After this introduction, the second section will provide an overview of the different methods applied. The third section, based on the quantitative data collected via the audience response system, presents the results from questions on general disaster risk perceptions, disaster preparedness, behaviours in disaster situations with a particular focus on the use of mobile phone apps and social media, and trust between citizens and different authorities including trust in different social media sources. In the fourth section, based on the qualitative data collected in the ten discussion groups, the analyses will take up the topics introduced in the previous section, focusing first on the role of citizens’ trust in different entities, in particular towards different authorities, “non-professional” leaders, and the media. Furthermore, this section will report on the participating citizens’ attitudes towards improving their disaster preparedness through different measures. In all topics, the analyses seek to identify different cultural aspects which may play a role in an improved disaster preparedness and response. The final section compares and contrasts the results from Sections 3 and 4, draws some tentative conclusions, and identifies topics and issues that should feed into the last round of events in 2018, i.e. the 3rd Stakeholder Assembly, as well as the 5th and 6th Citizen Summits.The project was co-funded by the European Commission within the Horizon2020 Programme (2014-2020).peer-reviewe

Look Who's Talking Now: Implications of AV's Explanations on Driver's Trust, AV Preference, Anxiety and Mental Workload

Explanations given by automation are often used to promote automation adoption. However, it remains unclear whether explanations promote acceptance of automated vehicles (AVs). In this study, we conducted a within-subject experiment in a driving simulator with 32 participants, using four different conditions. The four conditions included: (1) no explanation, (2) explanation given before or (3) after the AV acted and (4) the option for the driver to approve or disapprove the AV's action after hearing the explanation. We examined four AV outcomes: trust, preference for AV, anxiety and mental workload. Results suggest that explanations provided before an AV acted were associated with higher trust in and preference for the AV, but there was no difference in anxiety and workload. These results have important implications for the adoption of AVs.Comment: 42 pages, 5 figures, 3 Table

Culture and disaster risk management - synthesis of citizens’ reactions and opinions during 6 Citizen Summits : Romania, Malta, Italy, Germany, Portugal and the Netherlands

The analyses and results in this document are based on the data collected during six Citizen Summits held in A) Romania (Bucharest) on July 9th, 2016 B) Malta on July 16th, 2016 C) Italy (Rome) on June 17th, 2017 D) Germany (Frankfurt) on June 24th, 2017 E) Portugal (Lisbon) April 14th, 2018 F) The Netherlands (Utrecht)on May 12th, 2018. All Citizen Summits were designed as one-day events combining public information with feedback gathering through different methods of data collection, as laid out in Deliverable D5.1 (Structural design & methodology for Citizen Summits). A total of 619 citizens participated in the six events. In the morning session, the Citizen Summits started with a presentation of the CARISMAND project and its main goals and concepts. Then, several sets of questions with pre-defined answer options were posed to the audience and responses collected via an audience response system. All questions in this part of the event aimed to explore citizens’ attitudes, perceptions, and intended behaviours related to disasters and disaster risks. Between these sets of questions, additional presentations were held that informed the audience about state-of-the-art disaster preparedness and response topics (e.g., large-scale disaster scenario exercises, use of social media and mobile phone apps), as well as CARISMAND research findings. Furthermore, the last round of Citizen Summits (CS5 in Lisbon and CS6 in Utrecht) were organised and designed to additionally discuss and collect feedback on recommendations for citizens, which have all been formulated on the basis of Work Packages 2-10 results and in coordination with the Work Package 11 brief. These Toolkit recommendations will form one of the core elements of the Work Package 9 CARISMAND Toolkit. In the afternoon session of each event, small moderated group discussions (with 8-12 participants each) of approximately 2 hours’ duration were held, which aimed to gather citizens’ direct feedback on the topics presented in the morning sessions, following a detailed discussion guideline. For a detailed overview of all questions asked and topics discussed, please see Appendices A-1 to A-3. The rest of this report is structured in six main sections: After the executive summary and this introduction, the third section will present an overview of the different methods applied. The fourth section will provide a synthesis of quantitative and qualitative data collected during all Citizen Summits. The fifth section will present the evaluation of CARISMAND Toolkit recommendations for citizens, followed by a final concluding chapter.The project was co-funded by the European Commission within the Horizon2020 Programme (2014-2020).peer-reviewe

Citizens of Character - The Values and Character Dispositions of 14-16 Year Olds in the Hodge Hill Constituency

Citizens of Character explores the attitudes, dispositions, and values of 14-16 year old students in a particular urban environment - the six schools of the Hodge Hill constituency in Birmingham - and the extent to which the education system and the local environment advance or inhibit their sense of self, their values and their character development. These students constituted a heterogeneous group of religious and non-religious individuals. This project goes beyond the normal exploration and measurement of strengths of character in individuals and looks at the factors that build character in families and schools. This research has wider implications for the relationship between character and aspirations, social change, school cultures, citizenship, identity and religion. The study discusses what students understand by character. It set out to ascertain the moral values held by a group of students living in an inner-city area. The study sought to question who or what has influenced their moral values and examined which individuals, institutions and situations might have hindered or promoted their development. Some of the issues and concerns which arose - for example, relations with neighbours, the matter of local and national pride and questions of trust - may seem not to impinge upon character education as such but are relevant in a wider context

Promissory Estoppel and the Protection of Interpersonal Trust

This paper examines the role of trust in promissory estoppel and the extent to which the law should protect trust when a promise is made. Part II of this Article summarizes some of the scholarship discussing the nature and role of trust. In particular, it discusses the role of trust in a market economy, and the related role of trust in Contracts law. Part III examines whether there is a difference between trust and reliance, and whether it matters. Part III further asserts that a separate discussion of trust is beneficial because it has the potential to guide and inform internal decision-making in a way that is not possible by simply focusing on outward reliance. Part IV of this Article discusses the role of trust in the doctrine of promissory estoppel. Part V sets forth why the law should promote an optimal level of trust, as opposed to a maximum protection of trust no matter what. It discusses the need for promisees to exercise self-reliance and self-protection in order to avoid overreliance. Part VI identifies the types of cases where trust should be protected. Such cases include ones where the promisee is engaged in a transaction that she cannot avoid, where she has no control over the structure of the transaction, and where she has no choice but to trust the promisor (or more accurately, trust the legal system to enforce the promise). Part VII presents the polar end of the spectrum where trust should not be protected. Part VIII concludes the Article