Healthcare Provider and Patient Knowledge, Attitudes and Practices (KAP) Regarding Zika Virus

Introduction: Zika virus emergence in the western hemisphere has prompted the critical need for tailored risk counseling. Our team created a KAP survey in order to assess provider and patient awareness of Zika virus symptoms, transmission, treatment, and current and future concerns in order to inform local risk counseling efforts. Methods: The cross-sectional survey was issued in Medical Faculty Associates (MFA) clinics and via online link to healthcare providers and community members. The REDCap Data Collection tool was used to capture responses with subsequent SAS data analysis. Results: A total of 172 responses were collected. Most respondents (97%) were aware of a link between Zika virus and microcephaly. 89% think that a vaccine is important. 52% will restrict travel to Zika endemic regions. 51% will take mosquito protective measures in the US versus 91% in Zika endemic areas. 35% of pregnant women would abstain from sex if their partners traveled to a Zika endemic area whereas 25% would if they themselves were the traveler. 37% plan to delay pregnancy and 58% are concerned about eventually having a child with microcephaly. Of the healthcare providers sampled, about one-fifth could not identify Zika infection symptoms, 16% were unaware of symptom treatment options and 5.4% did not know that Zika virus could be passed transplacentally. 34% believed DEET to be unsafe in pregnancy and 52% were unsure about permethrin safety in pregnancy. Of the 172 survey respondents, most (97%) were aware of a link between Zika virus and microcephaly. 89% think that a vaccine is important. 52% would restrict travel to Zika endemic regions. 51% would practice mosquito safety in the US versus 91% in Zika endemic countries. 35% of pregnant women would abstain from intercourse if their partners traveled to Zika endemic areas whereas 25% would if they themselves were the traveler. 37% plan to delay pregnancy and 58% worry about future children with microcephaly. Of the healthcare providers, 20% could not identify Zika infection symptoms, 16% were unaware of symptom treatment options, 5% were unaware that Zika virus passes transplacentally, and 34% believed DEET to be unsafe in pregnancy. Conclusion: The survey results provide novel insight into the KAP of patients and healthcare providers regarding Zika virus. This data will be used to optimize information distribution to our community, address large knowledge gaps in both patients and providers, and prepare medical providers to offer needed counseling

Evolution of Knowledge, Awareness, and Practices regarding Zika Virus from 2016 to 2017.

Objective. Our team created a knowledge, attitudes, and practice (KAP) survey in order to assess changes over time in healthcare provider and community member awareness of Zika virus symptoms, transmission, treatment, and current and future concerns. Study Design. The cross-sectional survey was issued at an academic medical center in Washington, DC, and via an online link to healthcare providers and community members between June and August 2016. Survey distribution was then repeated the following year, from March to April 2017. Outcomes were compared by survey year and healthcare provider versus community member status using SAS Program Version 9.4. Results. Significant differences in knowledge, attitudes, and practices existed between 2016 and 2017 survey time points. By 2017, more respondents had knowledge of various Zika virus infection characteristics; however healthcare provider knowledge also waned in certain areas. Attitudes towards Zika virus infection displayed an overall decreased concern by 2017. Practice trends by 2017 demonstrated fewer travel restrictions to Zika-endemic areas and increased mosquito protective measures within the US. Conclusions. Our results provide novel insight into the transformation of knowledge, attitudes, and practice of community members and healthcare providers regarding Zika virus since its declaration as a public health emergency of international concern in 2016

Evolution of Knowledge, Awareness, and Practices regarding Zika Virus from 2016 to 2017

Objective. Our team created a knowledge, attitudes, and practice (KAP) survey in order to assess changes over time in healthcare provider and community member awareness of Zika virus symptoms, transmission, treatment, and current and future concerns. Study Design. The cross-sectional survey was issued at an academic medical center in Washington, DC, and via an online link to healthcare providers and community members between June and August 2016. Survey distribution was then repeated the following year, from March to April 2017. Outcomes were compared by survey year and healthcare provider versus community member status using SAS Program Version 9.4. Results. Significant differences in knowledge, attitudes, and practices existed between 2016 and 2017 survey time points. By 2017, more respondents had knowledge of various Zika virus infection characteristics; however healthcare provider knowledge also waned in certain areas. Attitudes towards Zika virus infection displayed an overall decreased concern by 2017. Practice trends by 2017 demonstrated fewer travel restrictions to Zika-endemic areas and increased mosquito protective measures within the US. Conclusions. Our results provide novel insight into the transformation of knowledge, attitudes, and practice of community members and healthcare providers regarding Zika virus since its declaration as a public health emergency of international concern in 2016

Pregnancy Intentionality in Relation to Non-planning Impulsivity.

Introduction: Half of pregnancies in the United States are unintended. We examine a novel risk factor for unintended pregnancies, impulsivity. We hypothesize that women with higher nonplanning impulsivity will be more likely to have an unplanned pregnancy. Methods: The parent study was a prospective cohort study of 125 pregnant women examining the association between impulsivity and weight gain during pregnancy. At an in-person study visit, women completed self-report measures via a secure web form. The 15-item Barratt Impulsiveness Scale (BIS-15) measures impulsivity using subjective statements about the respondent’s behavior with 4 response options: rarely/never, occasionally, often, and almost always/always. Three subscales with 5 questions each measure attention, motor, and nonplanning impulsivity. We categorized women as being less impulsive (subscale score of 5-10) versus more impulsive (11-20). We chose this cutoff as a score of 10 indicates responses of “never/rarely” or “occasionally”, representing lower impulsivity. Pregnancy intention was measured by asking women “When you got pregnant, were you trying to get pregnant?” (yes or no). Results: 34% reported that the current pregnancy was unplanned. 10% of women had high motor impulsivity, 21% high attention impulsivity, and 32% high nonplanning impulsivity. Women who were aged 18-24, obese, less educated, not married, of a lower socioeconomic status, and multigravid were more likely to have higher nonplanning impulsivity. 51% with high nonplanning impulsivity reported unplanned pregnancy compared to 25% (low nonplanning impulsivity). Women with high nonplanning impulsivity had 3.53 times the odds of unplanned pregnancy compared to women with low nonplanning impulsivity (adjusted for other 2 subscales and confounders; 95% CI: 1.23-10.14). Neither motor nor attention impulsivity was associated with pregnancy intention. Conclusions: Women with higher levels of nonplanning impulsivity are at higher risk of having unplanned pregnancies. The 5-item nonplanning subscale of the BIS-15 may help to identify women with high nonplanning impulsivity clinically; women could complete this brief measure prior to office visits, and these scores could direct contraception counseling. Contraception that requires little maintenance and no decision-making at the time of sexual encounters, such as long-acting reversible contraceptives (LARCs), may potentially lower unplanned pregnancy rates among more impulsive women. Further research should focus on creating a framework to identify these women, implementing a screening tool in the clinical setting, and to explore whether increasing LARC use in this population can lower unplanned pregnancy rates