Maltese translation and adaptation of champion's health belief model scale and the revised illness perception questionnaire for breast screening among maltese women

Background and Purpose: Translating, adapting, and piloting Champion's Health Belief Model Scale for Mammography Screening (CHBMS-MS) and Revised Illness Perception Questionnaire (IPQ-R) among Maltese women.  Methods: The Maltese questionnaire (Maltese Breast Screening Questionnaire [MBSQ]) was developed through 9 steps. Bilingual women (n = 15) completed MBSQ at 2 time points.  Results: During forwardbackward translations (Steps 1-4), 4 English controversial terms were raised. Twelve experts agreed on terminologies during adaptation process (Step 5). Following face validity (n = 6; Step 6), 3 items were deleted. Following reconciliation (Step 7) and proofreading (Step 8), MBSQ consisted of 121 items. Pilot testing (Step 9) showed positive correlation (CHBMS-MS = .87, IPQ-R 5 .85; p < .001); high Cronbach's alpha (CHBMS-MS 5 .93, IPQ-R = .92); overall acceptable internal consistency (CHBMS-MS = .69-.83, IPQ-R = .75-.93); and acceptable test-retest reliability correlations: CHBMS-MS (Maltese = .62-.76; English = .61-.84), IPQ-R (Maltese = .63-.82; English = .61-.91; p < .001).  Conclusions: Maltese and English scale items demonstrated high reliability and validity preliminary values

A national cross-sectional study of adherence to timely mammography use in Malta

Background:  Routine mammography improves survival. To achieve health benefits, women must attend breast screening regularly at recommended time intervals. Maltese women are routinely invited to undergo mammography at three-year intervals at an organized breast screening programme (MBSP) or can opt to attend a private clinic. Previous research shows that health beliefs, particularly perceived barriers, were the most significant predictors of uptake to the first MBSP invitation. Whether these beliefs and other factors are predictive of adherence with recommended time intervals for mammography at organized or private screening in Malta is unknown. For the first time, this paper explores the predictors for Maltese women screened within or exceeding the recommended three-year frequency in organized or private screening in Malta.  Methods:  Information was obtained from a cross-sectional survey of 404 women, aged 50 to 60 years at the time of their first MBSP invitation, where women's characteristics, knowledge, health beliefs and illness perceptions were compared. The main variable of interest was women's mammography attendance within a three-year interval (ADHERENT) or exceeding three years (NON-ADHERENT). Data were analysed using descriptive statistics, chi-square test, Mann Whitney test, Independent Samples t-test and Shapiro Wilk test.  Results:  At the time of the survey, 80.2% (n = 324) had been screened within three years (ADHERENT), 5.9% (n = 24) had exceeded the three-year frequency (NON-ADHERENT) while 13.9% (n = 56) never had a mammogram. No significant associations were found between ADHERENT or NON-ADHERENT women in relation to sociodemographic or health status variables (p > 0.05). Knowledge of screening frequency was significantly associated with women's mammography adherence (χ2 = 5.5, p = 0.020). Health beliefs were the strongest significant predictors to describe the variance between ADHERENT and NON-ADHERENT screeners. When Mann Whitney test and Independent Samples t-test were applied on mammography adherence, perceived barriers and cues to action were found to be the most important predictors (p = 0.000, p = 0.039 respectively).  Conclusions:  To increase routine and timely mammography practices, women who are non-adherent to recommended time frequency guidelines should be targeted, together with their health beliefs, predominantly perceived barriers and cues to action

Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional survey

Background  Women’s beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to explore factors associated with BS uptake in Malta and subsequently, to identify the most important predictors to first screening uptake.  Methods  This cross-sectional survey enrolled Maltese women (n=404) ages 50 to 60 at the time of their first screening invitation, invited to the National Breast Screening Programme by stratified random sampling, with no personal history of BC. Participants responded to a 121-item questionnaire by telephone between June–September 2015. Data were analyzed using descriptive statistics, chi-square tests and logistic regression.  Results  There is high awareness of BC signs and symptoms among Maltese women (>80% agreement for 7 out of 8 signs), but wide variation about causation (e.g., germ or virus: 38.6% ‘agree’, 30.7% ‘disagree’). ‘Fear’ was the key reason for non-attendance to first invitation (41%,n=66) and was statistically significant across all subscale items (p<0.05). Most items within HBM constructs (perceived barriers; cues to action; self-efficacy) were significantly associated with first invitation to the National Breast Screening Programme, such as fear of result (χ2=12.0,p=0.017) and life problems were considered greater than getting mammography (χ2=38.8,p=0.000). Items within CSM constructs of Illness Representation (BC causes; cyclical cancer timeline; consequences) were also significantly associated, such as BC was considered to be life-changing (χ2=18.0,p=0.000) with serious financial consequences (χ2=13.3,p=0.004). There were no significant associations for socio-demographic or health status variables with uptake, except for family income (χ2=9.7,p=0.047). Logistic regression analyses showed that HBM constructs, in particular perceived barriers, were the strongest predictors of non-attendance to first invitation throughout the analyses (p<0.05). However, the inclusion of illness representation dimensions improved the model accuracy to predict non-attendance when compared to HBM alone (65% vs 38.8%).  Conclusions  Interventions should be based on theory including HBM and CSM constructs, and should target first BS uptake and specific barriers to reduce disparities and increase BS uptake in Malta

Lifetime utilization of mammography among Maltese women: a cross-sectional survey

Background: The knowledge of Maltese women not attending the Maltese Breast Screening Programme (MBSP) for mammography screening is scarce. Previous research has identified two distinct groups of non-attendees: those who do not attend because a mammogram was taken elsewhere and those who never attended for mammography anywhere. It is however unknown which determinants are predictive of lifetime attendance 'anywhere' and 'real' non-attendance. The present study examines the relationship between ever-using (Lifetime attendees) or never using mammography (Lifetime non-attendees) and psychosocial - as well as sociodemographic factors, with the aim to identify predictors that can inform practice. Methods: Women's characteristics, knowledge, health beliefs and illness perceptions were compared, based on prior data of 404 women, aged 50-60 years at the time of their first MBSP invitation. The main variable of interest described women's attendance to mammography (LIFETIME ATTENDEES) and no mammography (LIFETIME NON-ATTENDEES). Data were analyzed using descriptive statistics, chi-square tests, Mann Whitney test, Independent Samples t-test, Shapiro Wilk test and logistic regression. Results: During their lifetime, 86.1% of Maltese women (n = 348) were attendees, while 13.9% (n = 56) were non-attendees. Non-attendees were more likely to be women with a lower family income (χ2 = 13.1, p = 0.011), widowers (χ2 = 9.0, p = 0.030), non-drivers (χ2 = 7.7, p = 0.006), without a breast condition (χ2 = 14.2, p < 0.001), who had no relatives or close friends with cancer (χ2 = 8.3, p = 0.016), and who were less encouraged by a physician (χ2 = 4.9, p = 0.027), unsure of the screening frequency (χ2 = 28.5, p < 0.001), more anxious (p = 0.040) and fearful (p = 0.039). Perceived benefits, barriers, cues to action, self-efficacy and emotional representations were the most significant variables to describe the differences between lifetime attendees and non-attendees. Perceived barriers and cues to action were the strongest predictors for lifetime non-attendance (p < 0.05 respectively). Conclusions: The health beliefs of women who have never attended for mammography during their lifetime should be targeted, particularly perceived barriers and cues to action. Further research should focus on understanding knowledge gaps, attitudinal barriers and emotional factors among 'real' non-attendees who require a more targeted approach

Prediction of Infectious Disease outbreaks based on limited information

The last two decades have seen several large-scale epidemics of international impact, including human, animal and plant epidemics. Policy makers face health challenges that require epidemic predictions based on limited information. There is therefore a pressing need to construct models that allow us to frame all available information to predict an emerging outbreak and to control it in a timely manner. The aim of this thesis is to develop an early-warning modelling approach that can predict emerging disease outbreaks. Based on Bayesian techniques ideally suited to combine information from different sources into a single modelling and estimation framework, I developed a suite of approaches to epidemiological data that can deal with data from different sources and of varying quality. The SEIR model, particle filter algorithm and a number of influenza-related datasets were utilised to examine various models and methodologies to predict influenza outbreaks. The data included a combination of consultations and diagnosed influenza-like illness (ILI) cases for five influenza seasons. I showed that for the pandemic season, different proxies lead to similar behaviour of the effective reproduction number. For influenza datasets, there exists a strong relationship between consultations and diagnosed datasets, especially when considering time-dependent models. Individual parameters for different influenza seasons provided similar values, thereby offering an opportunity to utilise such information in future outbreaks. Moreover, my findings showed that when the temperature drops below 14°C, this triggers the first substantial rise in the number of ILI cases, highlighting that temperature data is an important signal to trigger the start of the influenza epidemic. Further probing was carried out among Maltese citizens and estimates on the under-reporting rate of the seasonal influenza were established. Based on these findings, a new epidemiological model and framework were developed, providing accurate real-time forecasts with a clear early warning signal to the influenza outbreak. This research utilised a combination of novel data sources to predict influenza outbreaks. Such information is beneficial for health authorities to plan health strategies and control epidemics

An Investigation of Healthcare Professionals’ Perspectives on the Tasks of Mental Health Counselors in Hospital Settings

With the global mental health implications reported by the spread of COVID 19 (Javed et al., 2020) and the amplified mental health illnesses reported by the State of Mental Health in America (Reinert et al., 2021), there is an increased need to address psychological and emotional health along with physical health. Mental Health Counselors (MHCs) can be the next professional body to support the multidisciplinary teams within hospital settings to complement holistic care focusing on physical and emotional well-being. Researchers have demonstrated addressing the psychological needs of patients from their first admissions to the hospital has significant positive implications on their recovery outcomes as well as psychological, social, and relational well-being post-discharge (Zhang et al., 2016; Ng et al., 2007; Schoultz et al., 2015; McCombie et al., 2016; Hatch et al., 2011). Research on the effects of therapeutic intervention has effectively prevented PTSD in the general population when provided in the first month after trauma exposure (Bryant et al., 2008). Therefore, early therapeutic interventions in hospital settings to identify emotional and psychological reactions (Weinert & Meller, 2007) before discharging patients can significantly impact patients’ post-discharge mental health. However, since counseling is a new profession entering the medical field, role confusion within multidisciplinary teams appears to impact counselors’ effective integration into healthcare as they provide counseling services to hospitalized patients. Therefore, in this study, I address the gap in the literature by exploring the perspectives and expectations of healthcare professionals on what MHCs do in hospital settings. This study was guided by a social constructivist paradigm utilizing an exploratory sequential mixed-methods design, concept mapping (Kane & Trochim, 2007). Healthcare professionals conceptualized MHCs’ tasks in hospital settings to facilitate medical and mental health services and enhance patients’ well-being in 104 statements grouped in 11 clusters forming three central regions. The three main regions include: “Overarching Roles and Responsibilities of MHCs in the Hospital Setting” (Region I) contained two clusters (i.e., ‘Fundamental Roles and Responsibilities in the Hospital Setting,’ & ‘Specific Roles and Responsibilities in Different Hospital Units’) of MHCs’ tasks, while “MHCs’ Specific Roles in the Hospital Setting” (Region II) entailed four clusters (i.e., ‘Building Relationship with Patients,’ ‘Assessing/Evaluating Patients’ Mental Health Status,’ ‘Assisting and Supporting patients with Physical, Psychological, and Social Challenges in Relations to their Medical Condition’ & ‘Educating Patients’) and “MHC’s Roles and Responsibilities as a Multidisciplinary Team Member” (Region III) hosted five clusters(i.e., ‘Advocating for Patients in the Multidisciplinary Team,’ ‘Mediating Communication Between Healthcare Professionals, Patients, and Families,’ ‘Collaborating with Other Multidisciplinary Team Members on Patients’ Care,’ ‘Training Other Multidisciplinary Members on General Wellness and Mental Health’ & ‘Offering Trainings and Emotional Support to Other Multidisciplinary Team Members’). The top three higher-rated clusters as being most important for participants were cluster 7 ‘advocating for patients in the multidisciplinary team,’ cluster 5 ‘assisting and supporting patients with physical, psychological, and social challenges in relation to their medical condition,’ and cluster 11 ‘offering training and emotional support to other multidisciplinary team members.

Free Kick: FIFA’s Unintended Role in Illuminating Jurisdictional Gaps of International Criminal Courts

In the wake of the FIFA corruption scandal of 2015, certain realities have come to light. FIFA’s corruption knows no bounds, but fans of the sport will watch nonetheless. What is less apparent is that the two most prominent international criminal courts—the International Court of Justice (ICJ) and the International Criminal Court (ICC) fail to have jurisdiction over the FIFA organization or its officials when they engage in white-collar crimes that sanction human rights abuses abroad. This Note examines how FIFA officials’ acceptance of Qatari bribes to host the 2022 World Cup exposed alarming jurisdictional inadequacies of the ICJ and ICC. The deficiencies of these global courts provide the potential for future organizations and their officials to exploit jurisdictional nuance in order to avoid being prosecuted for international crimes. This Note begins by discussing the origins of the two courts and the circumstances that led to their creation, while pointing out the basis of jurisdiction in each court. The Note will then describe the kafala system that governs Qatar’s migrant worker population and FIFA’s involvement in human rights abuses in Qatar that were committed through the kafala system. This Note will then assess how the jurisdictional limitations of both the ICJ and the ICC prevent these global criminal courts from having jurisdiction over organizations like FIFA or its officials, and will conclude by advocating for amending the Rome Charter, which established the ICC, to include nonnatural organizations like FIFA within the jurisdiction of the court and bolstering the accomplice liability section of the statute to ensnare individuals who cause human rights abuses indirectly through white collar crimes

Improving Participation in Breast Screening Programmes: A mixed methods study to increase breast screening uptake in Malta

Background: Breast cancer is the most common cancer among Maltese women. No studies have explored factors related to mammography underutilisation in Malta. This thesis aimed to explore barriers and facilitators to mammography screening among Maltese women to inform future screening interventions. Methods: Seven studies were conducted through mixed methods research. First, a survey instrument to assess associations between health beliefs, illness perceptions and mammography was piloted-tested among Maltese women (Study 1). Four quantitative studies explored associations and predictors to mammography use: study 2 investigated factors associated with a first screening invitation; study 3 investigated reattendance; studies 4 and 5 examined lifetime mammography practices and timely adherence respectively. A systematic review of interventions, which employed the Health Belief Model and/or Common-Sense Model to improve mammography uptake, was conducted (Study 6). Experts helped to construct a logic model of the problem and change objectives, while members of the public interpreted the quantitative findings through the World Café method. Study 7 consisted of face-to-face interviews with non-attendees. Intervention Mapping was used to synthesise the findings and propose recommendations to increase uptake. Findings: The survey instrument was valid and reliable for use with Maltese women (Study 1). Health beliefs were strong predictors of mammography underutilisation and illness perceptions improved non-attendance predictions (Studies 2-5). First attendance is associated with reattendance (Study 3). Illness perceptions however are rarely included in mammography interventions (Study 6). Experts supported multiple interventions, including physician recommendations, education and counselling, while members of the public identified the involvement of partners and daughters in health decision-making. Qualitative findings found that health-related knowledge was low, and that socio-cultural factors impeded attendance, particularly support networks, household dynamics, traumatic histories and mental health approaches (Study 7). Conclusion: Multiple, theoretical strategies are considered more effective. Interventions, implemented within the community setting, should target women’s barriers, particularly fear, when first invited. Family members and practitioners can help to address screening barriers

Preparing Counselors in Training to Work within Interdisciplinary Settings: What Are Supervisee’s Needs from Supervision

Counselors are increasingly required to work in diverse and multicultural settings and within interprofessional and multi-professional teams (Schmit et al., 2018). For counselors to work effectively with professionals from other disciplines, they need training in collaborative competencies that include knowledge of each professions’ roles, responsibilities, and expertise (Arthur & Russell-Mayhew, 2010). Arthur and Russell-Mayhew identified supervision as possible leverage to support counselors in acquiring competencies to learn with and from other disciplines. However, there is limited research on how supervision supports health professionals, particularly counselors, in an interdisciplinary team (Owens et al., 1999). Therefore, the purpose of this study is to explore the perceived supervision needs of counselors in training (CITs) working in interprofessional settings to contribute to the gap in the literature.https://digitalcommons.odu.edu/gradposters2021_education/1000/thumbnail.jp

An Investigation of Healthcare Professionals\u27 Perspectives on the Tasks of Mental Health Counselors in Hospital Settings

In this study, we attempted to understand what other healthcare professionals considered mental health counselors’ (MHCs) tasks in their hospital setting to facilitate medical and mental health services and enhance patients’ well-being. Using an exploratory sequential mixed-methods design (concept mapping), we obtained 3 regions of MHCs’ tasks (i.e., Overarching Roles and Responsibilities of MHCs in the Hospital Setting, MHCs’ Specific Roles in the Hospital Setting, and MHCs’ Roles and Responsibilities as a Multidisciplinary Team Member) represented in 11 clusters. We discussed the results with implications for MHCs, healthcare professionals, counselor educators, and researchers, along with the current study\u27s limitations