How effective are digital interventions in increasing flu vaccination amongst pregnant women? A systematic review protocol

Pregnant women and their unborn babies are at increased risk of complications as a result of flu, yet uptake of the flu vaccination in the UK remains low. Digital interventions have proven effectiveness in changing health behaviour, but their effectiveness in increasing flu vaccination amongst pregnant women has not been examined. This protocol details the design and methodology of a systematic review and meta-analysis, examining the effectiveness of digital interventions in increasing flu vaccination amongst pregnant women. Methods: Bibliographic databases will be searched using appropriate search terms related to vaccination, pregnancy and flu. Randomised, non-randomised, quasi randomised controlled trials and other quantitative study designs will be eligible for inclusion, and studies will present the rate of flu vaccination amongst pregnant women of digital interventions compared to non-digital interventions, or usual care. No date or study country restrictions will be put on included studies, but studies will be published in English. Discussion: This is the first known systematic review to examine the effectiveness of digital interventions in increasing the rate of flu vaccination amongst pregnant women. This review has the potential to inform whether digital interventions are an appropriate and successful method of increasing flu vaccination amongst pregnant women, and to determine which mode of digital intervention is most effective. Trial registration: This systematic review is registered on the international prospective register of systematic reviews (PROSPERO). Registration number pending

Effectiveness of a Digital Intervention in Increasing Flu Vaccination Related Risk Appraisal, Intention to Vaccinate and Vaccination Behaviour Amongst Pregnant Women

© The Author(s) 2022. This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by-nc/4.0/Background Pregnant women are at increased risk of complications from flu, but uptake of flu vaccination is below national targets of 75%. Evidence suggests that changing illness risk appraisals may be an effective strategy for increasing vaccination behaviour. In 2018-19, a team of researchers, public health specialists, and pregnant women co-designed a short, animated video targeting (unhelpful) beliefs underlying pregnant women’s risk appraisals of flu with the aim of promoting vaccination uptake. Aims This study aimed to examine the effectiveness of a digital intervention (a short animation) in increasing flu vaccination uptake amongst pregnant women through changing illness risk appraisals. Method A prospective study design was used. Participants were a convenience sample of unvaccinated pregnant women recruited via a Qualtrics Online Panel. Participants received a small payment via the panel company for survey completion. Risk appraisals and intention to vaccinate were measured at baseline and immediately after presentation of the intervention (follow-up one). Approximately six months later, a further survey (follow-up two) was administered to measure vaccination behaviour. Results The baseline and the first follow-up survey were completed by 411 participants. The second follow-up survey was completed by 67 participants. Watching the animation led to an increase in women’s appraisals of the likelihood of getting flu whist pregnant and of the severity of flu during pregnancy, and also increased intentions to have the flu vaccination during pregnancy. Of the 67 respondents who completed the follow-up survey, 38 reported having the vaccination whilst pregnant. Conclusions This study provides evidence that supports the promise of the intervention. An RCT is however required to produce definitive evidence of efficacy. Should such a study prove the intervention to be effective, it could be readily embedded within existing social media campaigns delivered at national and local levels by public health organisations in the UK.Peer reviewe

Effectiveness of a digital intervention in increasing flu vaccination–related risk appraisal, intention to vaccinate and vaccination behaviour among pregnant women

Background Pregnant women are at increased risk of complications from flu, but uptake of flu vaccination is below 75% targets. Evidence suggests that changing illness risk appraisals may increase vaccination behaviour. In 2018–2019, researchers, public health specialists, and pregnant women co-designed a short animation targeting (unhelpful) beliefs underlying pregnant women’s flu risk appraisals aiming t0 promote vaccination uptake. Aims This study aimed to examine effectiveness of a digital intervention (animation) in increasing flu vaccination among pregnant women through changing illness risk appraisals. Method A prospective study design was used, involving convenience sampling of unvaccinated pregnant women recruited via a Qualtrics Online Panel. Participants received small payments via the panel for survey completion. Risk appraisals and intention to vaccinate were measured at baseline and immediately after intervention presentation (follow-up one). Six months later, a further survey (follow-up two) was administered measuring vaccination behaviour. Results Baseline and first follow-up surveys were completed by 411 participants. Watching the animation led to increased appraisals of likelihood of getting flu while pregnant and severity of flu during pregnancy, and increased intentions to accept flu vaccination during pregnancy. Of the 67 respondents who completed follow-up survey two, 38 reported having the vaccination while pregnant. Conclusions This study provides evidence supporting the promise of the intervention. Randomized controlled trials are required to produce definitive efficacy evidence. Should such a study prove intervention effectiveness, it could be readily embedded within existing campaigns at national and local levels by public health organizations

Which patients miss appointments with general practice and why? A systematic review

Background: Missed GP appointments have considerable time and cost implications for healthcare services. Aim: This systematic review aims to explore the rate of missed primary care appointments, what the reported reasons are for appointments being missed, and which patients are more likely to miss appointments. Design: This study reports the findings of a systematic review. Setting: Included studies report the rate or reasons of missed appointments in a primary care setting. Method: Databases were searched using a pre-defined search strategy. Eligible studies were selected for inclusion based on detailed inclusion criteria through title, abstract and full text screening. Quality was assessed on all included studies, and findings were synthesised to answer the research questions. Results: A total of 26 studies met the inclusion criteria for inclusion in the review. Of these, 19 reported a rate of missed appointments, with a mean rate of 15.2% and a median of 12.9% appointments being missed. Twelve studies reported a reason appointments were missed, with work or family commitments, forgetting the appointment and transportation difficulties were most commonly reported. 20 studies reported characteristics of people likely to miss appointments. Patients who were likely to miss appointments were those from minority ethnicity, low socio-demographic status and younger patients. Conclusions: Findings from this review have potential implications for targeted interventions to address missed appointments in primary care. This is the first step for clinicians being able to target interventions to reduce the rate of missed appointments

Do automated digital health behaviour change interventions have a positive effect on self-efficacy? A systematic review and meta-analysis

© 2019 Taylor & Francis. This is an Accepted Manuscript of an article published by Taylor & Francis in Health Psychology Review on 20/01/2020, available online: https://doi.org/10.1080/17437199.2019.1705873.Self-efficacy is an important determinant of health behaviour. Digital interventions are a potentially acceptable and cost-effective way of delivering programmes of health behaviour change at scale. Whether behaviour change interventions work to increase self-efficacy in this context is unknown. This systematic review and meta-analysis sought to identify whether automated digital interventions are associated with positive changes in self-efficacy amongst non-clinical populations for five major health behaviours, and which BCTs are associated with that change. A systematic literature search identified 20 studies (n=5624) that assessed changes in self-efficacy and were included in a random effects meta-analysis. Interventions targeted: healthy eating (k=4), physical activity (k=9), sexual behaviour (k=3), and smoking (k=4). No interventions targeting alcohol use were identified. Overall, interventions had a small, positive effect on self-efficacy (푔 = 0.190, CI [0.078; 0.303]). The effect of interventions on self-efficacy did not differ as a function of health behaviour type (Qbetween = 7.3704 p = 0.061, df = 3). Inclusion of the BCT ‘information about social and environmental consequences’ had a small, negative effect on self-efficacy (Δ푔= - 0.297, Q=7.072, p=0.008). Whilst this review indicates that digital interventions can be used to change self-efficacy, which techniques work best in this context is not clear.Peer reviewedFinal Accepted Versio

Use of a pharmacy-based GP video consultation service : a mixed methods study

Background Little is known about private general practice appointment services offered via video. This study aimed to explore which patients are using a video pharmacy-based general practitioner (GP) appointment service, including patterns of use, reasons for using the service, and satisfaction with the service. Methods Descriptive statistics and parametric and nonparametric tests were used to conduct a retrospective cross-sectional analysis of routinely collected data on consultations, and postconsultation questionnaires. Interviews were conducted with patients and GPs. Results A total of 7,928 consultations were included in the analysis. More than half of appointments were booked for the same day, with lunchtime appointments being popular. The most common health condition was respiratory conditions, and 9% of consultations were used by patients using the service more than once. At least one prescription was issued in over half of all consultations. Overall, satisfactions of consultations were high. Conclusions The characteristics of those patients using the video consultation service match data on who uses online services in general practice. This study shows that some patients are willing to pay to use this private service because they feel it is more convenient, NHS services do not have capacity to see them at the time they need, or they do not have access to regular GP services

Anterior cruciate ligament injury: Towards a gendered environmental approach

Background: The anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3-6 times more likely to experience injury compared with boys/men. To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes. However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are 'entangled' and influence each other. Objective: This paper discusses the curious absence of gender as an influencer in the dialogue surrounding ACL injuries. We propose adding gender as a pervasive developmental environment as a new theoretical overlay to an established injury model to illustrate how gender can operate as an extrinsic determinant from the presport, training and competition environments through to ACL injury and the treatment environment. Approach: We draw on social epidemiological theories of the embodiment of gender and health to provide plausible examples of how gender may influence ACL injury, and demonstrate the opportunity for new, interdisciplinary research in the field. Conclusion: Over 20 years of research has failed to decrease the ACL injury rate disparity between girls/women and boys/men. Embedding gender in the study of ACL injury will heighten awareness of possible influences outside the traditional biological elements, challenge us to think about the inextricable 'entanglement' of sex and gender, and inform more effective approaches to ACL injury prevention and treatment