An instrument to measure psychosocial determinants of health care professionals’ vaccination behavior:Validation of the Pro-VC-Be questionnaire

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Measuring psychosocial determinants of vaccination behavior in healthcare professionals: validation of the Pro-VC-Be short-form questionnaire

BACKGROUND: Vaccine confidence among health care professionals (HCPs) is a key determinant of vaccination behaviors. We validate a short-form version of the 31-item Pro-VC-Be (Health Professionals Vaccine Confidence and Behaviors) questionnaire that measures HCPs’ confidence in and commitment to vaccination.RESEARCH DESIGN AND METHODS: A cross-sectional survey among 2,696 HCPs established a long-form tool to measure 10 dimensions of psychosocial determinants of vaccination behaviors. Confirmatory factor analysis (CFA) models tested the construct validity of 69,984 combinations of items in a 10-item short form tool. The criterion validity of this tool was tested with four behavioral and attitudinal outcomes using weighted modified Poisson regressions. An immunization resource score was constructed from summing the responses of the dimensions that can influence HCPs’ pro-vaccination behaviors: vaccine confidence, proactive efficacy, and trust in authorities.RESULTS: The short-form tool showed good construct validity in CFA analyses (RMSEA = 0.035 [0.024; 0.045]; CFI = 0.956; TLI = 0.918; SRMR 0.027) and comparable criterion validity to the long-form tool. The immunization resource score showed excellent criterion validity.CONCLUSIONS: The Pro-VC-Be short-form showed good construct validity and criterion validity similar to the long-form and can therefore be used to measure determinants of vaccination behaviors among HCPs.</div

Study protocol for a pragmatic cluster randomized controlled trial to improve dietary diversity and physical fitness among older people who live at home (the “ALAPAGE study”)

Background : Diet and physical activity are key components of healthy aging. Current interventions that promote healthy eating and physical activity among the elderly have limitations and evidence of French interventions’ effectiveness is lacking. We aim to assess (i) the effectiveness of a combined diet/physical activity intervention (the “ALAPAGE” program) on older peoples’ eating behaviors, physical activity and fitness levels, quality of life, and feelings of loneliness; (ii) the intervention’s process and (iii) its cost effectiveness. Methods : We performed a pragmatic cluster randomized controlled trial with two parallel arms (2:1 ratio) among people ≥60 years old who live at home in southeastern France. A cluster consists of 10 people participating in a “workshop” (i.e., a collective intervention conducted at a local organization). We aim to include 45 workshops randomized into two groups: the intervention group (including 30 workshops) in the ALAPAGE program; and the waiting-list control group (including 15 workshops). Participants (expected total sample size: 450) will be recruited through both local organizations’ usual practices and an innovative active recruitment strategy that targets hard-to-reach people. We developed the ALAPAGE program based on existing workshops, combining a participatory and a theory-based approach. It includes a 7-week period with weekly collective sessions supported by a dietician and/or an adapted physical activity professional, followed by a 12-week period of post-session activities without professional supervision. Primary outcomes are dietary diversity (calculated using two 24-hour diet recalls and one Food Frequency Questionnaire) and lower-limb muscle strength (assessed by the 30-second chair stand test from the Senior Fitness Test battery). Secondary outcomes include consumption frequencies of main food groups and water/hot drinks, other physical fitness measures, overall level of physical activity, quality of life, and feelings of loneliness. Outcomes are assessed before the intervention, at 6 weeks and 3 months later. The process evaluation assesses the fidelity, dose, and reach of the intervention as its causal mechanisms (quantitative and qualitative data). Discussion : This study aims to improve healthy aging while limiting social inequalities. We developed and evaluated the ALAPAGE program in partnership with major healthy aging organizations, providing a unique opportunity to expand its reach

Trajectories of seasonal influenza vaccination uptake in French people with diabetes from 2006 to 2015

Abstract dans revueInternational audienceIntroductionSeasonal influenza vaccine (SIV) is recommended in France for people aged 65 years or older and those with clinical risk factors, including diabetes. The French National Health Insurance Fund (NHIF) can identity these individuals and send them a voucher so they can obtain the vaccine free of charge. Despite this, SIV coverage remains below the target of 75% and has progressively decreased since the 2009 pandemic. We aimed to identify temporal trajectories (T) over a 10-year period of SIV uptake (SIVU) among patients with diabetes and to describe their correlates.MethodsWe identified patients with diabetes in 2006 (n = 17,259) among a representative sample of French NHIF beneficiaries. We followed them from 2006 through 2015, using SIV reimbursement claims and group-based trajectory modeling to identify SIVU-T and drug reimbursement claims to assess diabetes severity and comorbidity status. A multinomial logistic regression allowed us to study characteristics associated with the SIVU-T.ResultsWe found 6 SIVU-T: (1) “never” T (prevalence: 32%): people with quasi null SIVU probabilities (≤ 5%); (2) “late increasing” T (4%): SIVU probability varying from ≤ 10% before 2011/12 to 85% in 2015/16; (3) “early increasing” T (8%): probability varying from ≤ 10% in 2006/07 to ≥ 80% starting in 2009/10; (4) “regular” T (33%): probability always ≥ 95%; (5) “progressively non-vaccinated” T (14%): probability decreasing from 90% in 2006/07 to 20% in 2015/16; (6) “post-pandemic decreasing” T (9%): probability decreasing right after the 2009/10 season.Overall, compared to the “never” T group, people in all other trajectories had poorer health at inclusion and/or over the study period (severe diabetes, high comorbidity score), people in the “late increasing” T group were more likely to have received newly free vaccination vouchers and/or changed general practitioners (GPs) during follow-up, and those in the “early increasing” T more likely to have received newly free vaccination vouchers and to have been hospitalized for an influenza-like illness during the follow-up. Those with “regular” T were slightly older than those with “never” T and less likely to have been hospitalized due to diabetes; those with a “progressively non-vaccinated” T were oldest (mean age at inclusion = 80 ± 7 years versus 65 ± 14 in the study population). Finally, people with a “post-pandemic decreasing” T were more frequently women, more likely to have been hospitalized due to an influenza-like illness, and to have changed GPs during the follow-up.ConclusionsSIVU behavior was stable in most people with diabetes over the study period: one third were vaccinated regularly and another third never. The latter were globally healthier than the other groups and may feel less vulnerable to it, despite their clinical risk. About 25% became less inclined toward vaccination in one of two different patterns: the “progressively non-vaccinated” T may reflect the patient and/or healthcare professional's doubts about the benefits of SIV after a certain age (in part due to immunoscenescence); those in the “post-pandemic decreasing” T may have lost confidence in SIV after controversies in France during the 2009 mass vaccination campaign against the pandemic. About 10% became more likely to be vaccinated during the study period; our results suggest that receiving free vouchers for the first time might have triggered or fostered this behavioral change. Changing GPs and hospitalization for an influenza-like illness were associated with both increasing and decreasing trajectories. These events may represent key opportunities to foster or prevent behavioral changes toward SIV. Further research is needed to better understand the chronology of these events and potential causal pathways. These results should help stakeholders to adapt public health interventions to specific subgroups

Seasonal influenza vaccine uptake among people with disabilities: A nationwide population study of disparities by type of disability and socioeconomic status in France

International audiencePeople with disabilities use various preventive health services less frequently than others, notably because of a lower socioeconomic status (SES). We examined variations of seasonal influenza vaccine uptake according to type/severity of disability and SES. We analyzed (in 2016) data from the 2008 French national cross-sectional survey on health and disability (n=12,396 adults living in the community and belonging to target groups for seasonal influenza vaccination). We defined seasonal influenza vaccine uptake during the 2007–2008 season by the self-reporting of a flu shot between September 2007 and March 2008. We built scores of mobility, cognitive, and sensory limitations, and an SES score based on education, occupation, and income. We performed bivariate analyses and then multiple log-binomial regressions. The prevalence of vaccine uptake was 23% in the 18–64 group and 63% in the ≥65 group. In bivariate analyses, it was higher among people in both age groups who had mobility and/or cognitive limitations and in the ≥65 group among those with sensory limitations. In the multiple regression analyses, only the presence of major mobility limitations in the18–64 group remained significant. The probability of vaccine uptake was higher in the highest SES category than in the lowest. Among at-risk groups, people with disabilities were more frequently vaccinated than others, mainly because of their higher levels of morbidity and healthcare use. Socioeconomic inequalities in access to vaccination persist in France. Future research is needed to monitor the trend in vaccine uptake in institutions

Alcohol and cancer: risk perception and risk denial beliefs among the French general population

International audienceBackground: Worldwide, millions of deaths each year are attributed to alcohol. We sought to examine French people’s beliefs about the risks of alcohol, their correlates, and their associations with alcohol use. Methods: Data came from the 2010 Barome` tre Cancer survey, a random cross-sectional telephone survey of the French general population (n = 3359 individuals aged 15–75 years). Using principal component analysis of seven beliefs about alcohol risks, we built two scores (one assessing risk denial based on self-confidence and the other risk relativization). Two multiple linear regressions explored these scores’ socio-demographic and perceived information level correlates. Multiple logistic regressions tested the associations of these scores with daily drinking and with heavy episodic drinking (HED). Results: About 60% of the respondents acknowledged that alcohol increases the risk of cancer, and 89% felt well-informed about the risks of alcohol. Beliefs that may promote risk denial were frequent(e.g. 72% agreed that soda and hamburgers are as bad as alcohol for your health). Both risk denial and risk relativization scores were higher among men, older respondents and those of low socioeconomic status. The probability of daily drinking increased with the risk relativization score and that of HED with both scores. Conclusions: Beliefs that can help people to deny the cancer risks due to alcohol use are common in France and may exist in many other countries where alcoholic beverages have been an integral part of the culture. These results can be used to redesign public information campaigns about the risks of alcohol

Social Differentiation of Sun-Protection Behaviors The Mediating Role of Cognitive Factors

International audienceINTRODUCTION: Adherence to sun-protection guidelines in developed countries is low, especially among people of low SES. Mechanisms underlying this social differentiation are poorly understood. This study aimed to examine the social differentiation of sun-protection behaviors and of two cognitive factors (knowledge about both sun health and behavioral risk factors for cancer) and to determine if these cognitive factors mediate the association between SES and sun-protection behaviors.METHODS: Data came from the 2010 Baromètre Cancer survey (analyzed in 2014), a random cross-sectional telephone survey conducted among the French general population (n=3,359 individuals aged 15-75 years). First, bivariate associations between a composite individual SES indicator (based on education level, occupation, and income) and both sun-protection behaviors and cognitive factors were tested with chi-square tests and ANOVA. Then, confirmatory factor analysis and structural equation modeling were used to test the mediating role of cognitive factors with a multiple mediation model including four latent variables.RESULTS: In bivariate analyses, the individual SES indicator was positively associated with sun-protection behaviors and both cognitive factors. Multiple mediation analyses showed that both cognitive factors partially mediated the effect of individual SES on sun-protection behaviors. The overall proportion of mediated effects was 48%. The direct effect of SES remained significant.CONCLUSIONS: These results suggest that interventions aimed at modifying the knowledge and perceptions of people of low SES might help to reduce social differentiation of sun-protection behaviors. Further qualitative research is needed to better understand these cognitive factors and develop suitable prevention messages

Vaccine hesitancy about the HPV vaccine among French young women and their parents: a telephone survey

International audienceBackground The human papillomavirus (HPV) vaccine reduces the burden of cervical and other cancers. In numerous countries, a slow uptakeof this vaccine persists, calling for a better understanding of the structural factors leading to vaccine acceptation. We aimed to assess the attitudes toward HPV vaccination among its intended public to explore its specific characteristics. Methods A random cross-sectional telephone survey of the French general population provided data from a sample of 2426 respondents of the target public: the parents of young women and the young women aged 15-25 themselves. We applied cluster analysis to identify contrasting attitudinal profiles, and logistic regressions with a model averaging method to investigate and rank the factors associated with these profiles. Results A third of the respondents had never heard of HPV. However, most of the respondents who had heard of it agreed that it is a severe (93.8%) and frequent (65.1%) infection. Overall, 72.3% of them considered the HPV vaccine to be effective, but 54% had concerns about its side effects. We identified four contrasting profiles based on their perceptions of this vaccine: informed supporters, objectors, uninformed supporters, and those who were uncertain. In multivariate analysis, these attitudinal clusters were the strongest predictors of HPV vaccine uptake, followed by attitudes toward vaccination in general. Conclusions Tailored information campaigns and programs should address the specific and contrasted concerns about HPV vaccination of both young women and of their parents

General practitioners’ attitudes and behaviors toward HPV vaccination: A French national survey

International audienceOBJECTIVE:General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs' perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations.METHODS:Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs' HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general.RESULTS:Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR=0.13; 95%CI=0.09-0.21; partial R(2)=0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR=0.13; 95%CI=0.07-0.24; partial R(2)=0.05), and doubts about vaccine utility in general (OR=0.78; 95%CI=0.71-0.86; partial R(2)=0.03).CONCLUSION:Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine