Longitudinal qualitative exploration of cancer information-seeking experiences across the disease trajectory: the INFO-SEEK protocol

Introduction Α substantial corpus of literature has sought to describe the information-seeking behaviour of patients with cancer. Yet, available evidence comes mainly from cross-sectional studies, which provide ‘snapshots’ of patients’ information needs and information-seeking styles at a single time point. Only a few longitudinal studies currently exist; however, these are quantitative in nature and, despite successfully documenting changes in patients’ information needs throughout the clinical course of cancer, they have failed to provide an evidence-based interpretation of the causes and consequences of change. The goal of this study is threefold: First, we wish to provide a holistic understanding of how cancer information-seeking behaviour may evolve across different stages of the patient journey. Second, we will seek to elucidate the contextual and intervening conditions that may affect possible changes in information seeking. Third, we will attempt to identify what the consequences of these changes are, while heightening their implications for clinical practice and policy. Methods and analysis We will carry out a longitudinal qualitative study, based on face-to-face, in-depth interviews with approximately 25 individuals diagnosed with cancer. Patients will be recruited from 2 oncology hospitals located in Ticino, Switzerland, and will be interviewed at 3 different time points: (1) within 2 weeks after receiving the cancer diagnosis; (2) within 2 weeks after their initial treatment; and (3) 6 months after their initial treatment. All interviews will be recorded and transcribed verbatim. A grounded theory approach will be used for the analysis of the data. Ethics and dissemination The study protocol has been approved by the Ethics Committee of Canton Ticino (CE 2813). Participation in the study will be voluntary, and confidentiality and anonymity ensured. Prior to study participation, patients will be asked to provide signed informed consent. Findings will be disseminated in international peer-reviewed journals and presented in relevant conferences

Justifying age thresholds for mammographic screening: an application of pragma-dialectical argumentation theory

Information campaigns on breast cancer screening in the Netherlands need to convince women above 50 years of age to have biannual mammography, and women below 50 years of age that regular mammograms are not recommended for them. This article reports the results of two experiments in which the construction of the persuasive messages was informed by argumentation-theoretical insights. No differences were found between either statistical and anecdotal evidence or gain- and loss-framing in the attempt to convince women under 50 that they normally do not need regular mammography. A striking contrast emerged, however, between the overwhelming acceptance of breast cancer screening for women above 50 and the relative restraint and reluctance to consent that mammography is usually not recommended for women under 50. The reluctance to accept that regular mammography is not recommended for women under 50 is traced back to ego involvement

"Let Me Tell You Why!”. When Argumentation in Doctor-Patient Interaction Makes a Difference

This paper throws some light on the nature of argumentation, its use and advantages, within the setting of doctor-patient interaction. It claims that argumentation can be used by doctors to offer patients reasons that work as ontological conditions for enhancing the decision making process, as well as to preserve the institutional nature of their relationship with patients. In support of these claims, selected arguments from real-life interactions are presented in the second part of the paper, and analysed by means of a model of argumentation borrowed from classical rhetoric, and refined according to the modern orientation of the pragma-dialectic approac

Beyond the knowledge gap paradigm: the role of psychological empowerment in parents’ vaccination decision

Even though the efficacy and safety of immunization have been widely proven (Plotkin, 2014), an increasing number of parents have refused to vaccinate their children against serious infectious diseases in the past twenty years (Dubé, Gagnon, Nickels, Jeram, & Schuster, 2014). A recent shift in the study of vaccination decision- making has seen scholars moving beyond the idea that mere lack of knowledge could explain why parents decide to opt out of the recommended schedule, showing that making a vaccination decision is a complex cognitive and emotional process where several factors play a role. Variables such as risk perception, anticipated regret or prosocial attitude can potentially contribute to choosing or not choosing a given vaccination (Yaqub, Castle-Clarke, Sevdalis, & Chataway, 2014). The aim of this dissertation, which is based on the Health Empowerment Model (Schulz & Nakamoto, 2013), is to explore and assess the role of vaccination knowledge (as a dimension of vaccination literacy) in parental vaccination decision-making, while studying, at the same time, the implications of parents’ psychological empowerment on the decision about immunizing their child, with a special focus on the measles-mumps-rubella (MMR) vaccination. Six unique studies that employed both qualitative (individual interviews and focus groups) and quantitative (content analysis, survey and experiment) methods are presented, which aim to assess the influence of vaccination literacy and psychological empowerment on vaccination-related outcomes such as intention, while providing a valid and reliable measurement tool for the empowerment construct as well as a context-specific conceptualization. A content analysis (Chapter II) focusing on the arguments cited by users posting online about vaccination shows that a distinction can be made between an anti-vaccination group, a general pro- vaccination group (using diverse arguments supporting vaccination) and a safety- focused pro-vaccination group. The anti-vaccination group appears to be more active than the others and to also use multiple sources (mainly its own experience and media). The findings of an interview study (Chapter III) reveal that parents tend to misinterpret current vaccination recommendations and experience negative outcomes of their low self-perceived competence. The study also shows that parents think that their MMR vaccination decision can have an impact on different levels and that they have a preference for shared-decision making in relation to their child’s healthcare provider. A second qualitative study employing focus group interviews (Chapter IV) shows that parents are concerned with their legal responsibility and issues of freedom with regards to the MMR vaccination decision. A key finding is that parents’ relationship with the pediatrician in terms of trust is crucial to their self-perceived competence, suggesting their preference for a model of autonomy that does not exclude a shared decision-making approach with the child’s healthcare provider. Finally, a distinction emerges between information seekers, avoiders, and passive recipients. A scale is developed and its psychometric properties are evaluated (Chapter V) to provide a valid and reliable tool to measure psychological empowerment in the vaccination decision. The final tool captures parents’ perceived influence of one’s personal and family experience regarding vaccination, their desire not to ask other parents about their experience with vaccinations and their lack of interest in the vaccination opinion of other parents. These elements can be seen as context-specific extensions of the empowerment dimension of self-determination. The findings of an experimental study (Chapter VI) demonstrate that providing accurate information on the vaccination through a smartphone app employing gamification can positively and significantly increase parents’ knowledge and empowerment. Furthermore, providing information in a gamified way also led to a higher intention to vaccinate and higher parental confidence in the decision. Finally, a mixed method study to evaluate the experiment described above (Chapter VII), suggests that parents have a preference for information and opinions, compared to solely being empowered and pushed to look for information. The results recommend that empowering efforts be always accompanied by proper and exhaustive information. On the basis of these findings, this dissertation contributes to understanding parents’ empowerment needs in the vaccination decision, providing new insights to current research that seeks to study the vaccination decision as a complex process. The results of the studies can significantly inform ways to improve not only communication between health professionals and parents on the vaccination topic, but also future public health strategies and policies ultimately aimed at increasing vaccination coverage

School-based diabetes interventions and their outcomes: a systematic literature review

Type 1 diabetes is one of the most common chronic childhood diseases, while type 2 diabetes in children is increasing at alarming rates globally. Against this backdrop, the school is a critical environment for children with diabetes. They continue to face barriers to education that may lead to depression, poor academic performance, and poor quality of life. To address these challenges, diabetes interventions have been implemented in school and the goal was to systematically review these interventions and their outcomes between 2000 and 2013. Fifteen studies were included in the narrative synthesis. Education of school personnel was the main focus before 2006. Studies reported gains in knowledge and perceived confidence of school staff. Since 2006, more comprehensive interventions have been developed to promote better care coordination and create a safe school environment. These studies reported improved diabetes management and quality of life of students. Assessment tools varied and study design included randomized controlled trials, quantitative and qualitative methods. Although many of the studies reported a significant difference in the parameters measured, it was not possible to determine optimal ways to improve the health, quality of life and academic performance of children with diabetes, given the disparity in scope, assessment tools and measured outcomes. Experimental designs, longer follow-up studies, larger sample sizes, and a higher number of participating schools are critical issues to consider in future studies. Most of the research was conducted in North America and further research is needed in other parts of the world

Distorted food pyramid in kids programmes: A content analysis of television advertising watched in Switzerland

Background: In the light of increasing childhood obesity, the role of food advertisements relayed on television (TV) is of high interest. There is evidence of food commercials having an impact on children's food preferences, choices, consumption and obesity. We describe the product categories advertised during kids programmes, the type of food promoted and the characteristics of food commercials targeting children. Methods: A content analysis of the commercials aired during the kids programmes of six Swiss, one German and one Italian stations was conducted. The commercials were collected over a 6-month period in 2006. Results: Overall, 1365 h of kids programme were recorded and 11 613 advertisements were found: 3061 commercials (26.4%) for food, 2696 (23.3%) promoting toys, followed by those of media, cleaning products and cosmetics. Regarding the broadcast food advertisements, 55% were for fast food restaurants or candies. Conclusion: The results of the content analysis suggest that food advertising contributes to the obesity problem: every fourth advertisement is for food, half of them for products high in sugar and fat and hardly any for fruit or vegetables. Long-term exposure to this distortion of the pyramid of recommended food should be considered in the discussion of legal restrictions for food advertising targeting childre

InP-quantum dots in Al0.20Ga0.80InP with different barrier configurations

Systematic ensemble photoluminescence studies have been performed on type-I InP-quantum dots in Al0.20Ga0.80InP barriers, emitting at approximately 1.85 eV at 5 K. The influence of different barrier configurations as well as the incorporation of additional tunnel barriers on the optical properties has been investigated. The confinement energy between the dot barrier and the surrounding barrier layers, which is the sum of the band discontinuities for the valence and the conduction bands, was chosen to be approximately 190 meV by using Al0.50Ga0.50InP. In combination with 2 nm thick AlInP tunnel barriers, the internal quantum efficiency of these barrier configurations can be increased by up to a factor of 20 at elevated temperatures with respect to quantum dots without such layers.Comment: physica status solidi (c) (Proceedings of QD 2008

Sequential and direct ionic excitation in the strong-field ionization of 1-butene molecules

We study the Strong-Field Ionization (SFI) of the hydrocarbon 1-butene as a function of wavelength using photoion-photoelectron covariance and coincidence spectroscopy. We observe a striking transition in the fragment-associated photoelectron spectra: from a single Above Threshold Ionization (ATI) progression for photon energies less than the cation D0–D1 gap to two ATI progressions for a photon energy greater than this gap. For the first case, electronically excited cations are created by SFI populating the ground cationic state D0, followed by sequential post-ionization excitation. For the second case, direct sub-cycle SFI to the D1 excited cation state contributes significantly. Our experiments access ionization dynamics in a regime where strong-field and resonance-enhanced processes can interplay

Impact of patients’ judgment skills on asthma self-management: a pilot study

Background. The majority of current health literacy tools assess functional skills including reading, writing, and numeracy. Although these tools have been able to underline the impact of such skills on individuals’ health behaviour, there is a need for comprehensive measures to examine more advanced skills. The individual’s ability to use health-related information considering his/her own health context, and judging positive and negative consequences of their decisions has been conceptualized as judgment skills. The present study used a newly developed judgment skills tool to explore asthma self-management practices. Design and methods. Eighty asthma patients were recruited from medical offices during the year 2013. The questionnaire was self-administered and contained health literacy questions, the judgment skill tool, the Asthma Control Test, and several self-management questions.Results. Sixty-nine percent of participants had adequate health literacy, while 24% and 5% had marginal and inadequate levels, respectively. The high-judgment group referred more to their doctor when experiencing asthma problems t(76)=−2.18, P<0.032; complied more with the use of their control medicine t(77)=−3.24, P<0.002 and went more regularly to the doctor t(78)=−1.80, P<0.038 (one-tailed) than the low-judgment group.Conclusions. The judgment skills tool can help identify asthma patients’ health information use and reveal how this use may affect some self-management practices

Exploring the Measurement Properties of the eHealth Literacy Scale (eHEALS) Among Baby Boomers: A Multinational Test of Measurement Invariance

BACKGROUND: The eHealth Literacy Scale (eHEALS) is one of only a few available measurement scales to assess eHealth literacy. Perhaps due to the relative paucity of such measures and the rising importance of eHealth literacy, the eHEALS is increasingly a choice for inclusion in a range of studies across different groups, cultures, and nations. However, despite its growing popularity, questions have been raised over its theoretical foundations, and the factorial validity and multigroup measurement properties of the scale are yet to be investigated fully. OBJECTIVE: The objective of our study was to examine the factorial validity and measurement invariance of the eHEALS among baby boomers (born between 1946 and 1964) in the United States, United Kingdom, and New Zealand who had used the Internet to search for health information in the last 6 months. METHODS: Online questionnaires collected data from a random sample of baby boomers from the 3 countries of interest. The theoretical underpinning to eHEALS comprises social cognitive theory and self-efficacy theory. Close scrutiny of eHEALS with analysis of these theories suggests a 3-factor structure to be worth investigating, which has never before been explored. Structural equation modeling tested a 3-factor structure based on the theoretical underpinning to eHEALS and investigated multinational measurement invariance of the eHEALS. RESULTS: We collected responses (N=996) to the questionnaires using random samples from the 3 countries. Results suggest that the eHEALS comprises a 3-factor structure with a measurement model that falls within all relevant fit indices (root mean square error of approximation, RMSEA=.041, comparative fit index, CFI=.986). Additionally, the scale demonstrates metric invariance (RMSEA=.040, CFI=.984, ΔCFI=.002) and even scalar invariance (RMSEA=.042, CFI=.978, ΔCFI=.008). CONCLUSIONS: To our knowledge, this is the first study to demonstrate multigroup factorial equivalence of the eHEALS, and did so based on data from 3 diverse nations and random samples drawn from an increasingly important cohort. The results give increased confidence to researchers using the scale in a range of eHealth assessment applications from primary care to health promotions