What factors shape doctors’ trustworthiness? Patients’ perspectives in the context of hypertension care in rural Tanzania

Introduction: There is increasing evidence that improving patient trust in doctors can improve patients’ use of healthcare services, compliance and continuing engagement with care –particularly for chronic diseases. Consequently, much of the current literature on trust in therapeutic relationships focuses on factors shaping doctors’ trustworthiness. However, few studies on this issue have been conducted among rural populations in low-income Africa, where health service delivery, cultural norms and patient expectations differ from those in high-income countries. This study examined patients’ perspectives of factors that shape doctors’ trustworthiness in rural Tanzania in the context of hypertension care. Methods: A qualitative inquiry using in-depth interviews was conducted between 2015 and 2016 in two characteristically rural districts of Tanzania. Data were analysed thematically. Results: The accounts of 34 patients from a Western-based care setting were examined. There was broad consensus about factors shaping doctors’ trustworthiness along the care trajectory (before, during and after a therapeutic encounter). Two major themes emerged: doctors’ interpersonal behaviours and doctors’ technical competence. Good interpersonal behaviour and technical skills in healthcare settings were factors that constructed a positive reputation in the community and shaped patients’ initial trust before a physical encounter. Doctors’ interpersonal behaviours that portrayed good customer care, understanding and sympathy shaped trustworthiness during a physical encounter. Finally, doctors’ technical competence shaped trustworthiness during and after an encounter. Participants used these factors to differentiate a trustworthy (‘good’) doctor from an untrustworthy (‘bad’) doctor. Conclusion: Good interpersonal behaviours and good technical skills are important in shaping patients’ judgements of doctors’ trustworthiness in rural Tanzania. The present findings provide useful insights for designing interventions to improve patient trust in doctors to address challenges associated with non-communicable diseases in rural low-income Africa

‘Making it Meaningful’: Co-designing an intervention to improve medication safety for people from culturally and linguistically diverse backgrounds accessing cancer services.

This study reports on the process of using an adapted Experienced-Based Co-Design (EBCD) conducted with culturally and linguistically diverse (CALD) consumers and cancer service staff to co-design the novel ‘Making it Meaningful’(MiM) instrument at a cancer service in Australia. Multi-source experiential and contextual information was gathered in phase 1 of the co-design and this evidence, coupled with knowledge gathered via a feedback event was used to inform three co-design workshops in phase 2. A series of meetings were conducted prior to and in between the workshops. Theory was progressively integrated into the workshop content. Two Mandarin speaking CALD consumers and three cancer service staff participated as co-design members. Workshops were supported by a multilingual fieldworker, co-facilitated by researchers and a consumer co-facilitator, and conducted using a hybrid model (face-to-face or online participation). In the first workshop members democratically selected to focus on a strategy to enable CALD consumers to make non-emergency urgent contact with the cancer service for medication related communication. The second workshop resulted in consensus to develop an accessible instrument that would identify appropriate contacts and information sources for medication management between appointments. In the third workshop, the prototype MiM instrument was developed and refined. The MiM is a novel instrument designed with CALD consumers to enhance their knowledge of medication management and empower them to contact cancer service staff about medication safety concerns. Feasibility testing is the next step with successful implementation requiring senior health leadership support and involvement of co-design members as change agents. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Post-pandemic assessment of public knowledge, behavior, and skill on influenza prevention among the general population of Beijing, China

SummaryBackgroundThe aim of this study was to assess the knowledge, behavioral, and skill responses toward influenza in the general population of Beijing after pandemic influenza A (H1N1) 2009.MethodsA cross-sectional study was conducted in Beijing, China, in January 2011. A survey was conducted in which information was collected using a standardized questionnaire. A comprehensive evaluation index system of health literacy related to influenza was built to evaluate the level of health literacy regarding influenza prevention and control among residents in Beijing.ResultsThirteen thousand and fifty-three valid questionnaires were received. The average score for the sum of knowledge, behavior, and skill was 14.12±3.22, and the mean scores for knowledge, behavior, and skill were 4.65±1.20, 7.25±1.94, and 2.21±1.31, respectively. The qualified proportions of these three sections were 23.7%, 11.9%, and 43.4%, respectively, and the total proportion with a qualified level was 6.7%. There were significant differences in health literacy level related to influenza among the different gender, age, educational level, occupational status, and location groups (p<0.05). There was a significant association between knowledge and behavior (r=0.084, p<0.001), and knowledge and skill (r=0.102, p<0.001).ConclusionsThe health literacy level remains low among the general population in Beijing and the extent of relativities in knowledge, behavior, and skill about influenza was found to be weak. Therefore, improvements are needed in terms of certain aspects, particularly for the elderly and the population of rural districts. Educational level, as a significant factor in reducing the spread of influenza, should be considered seriously when intervention strategies are implemented

Information seeking behaviors of individuals impacted by COVID-19 international travel restrictions: an analysis of two international cross-sectional studies

Access to accurate information during a crisis is essential. However, while the amount of information circulating during the COVID-19 pandemic has increased exponentially, finding trustworthy resources has been difficult for many, including those affected by international travel restrictions. In this study, we examined the information-seeking behaviors of individuals seeking to travel internationally during the COVID-19 pandemic. We also explored perceptions regarding the value of resources in supporting understanding of COVID-19 travel restriction-related information. Two online cross-sectional surveys targeting four groups were conducted. The groups targeted were: (1) citizens and permanent residents stranded abroad; (2) individuals separated from their partners; (3) individuals separated from immediate families; and (4) temporary visa holders unable to migrate or cross international borders. In total, we analyzed 2,417 completed responses, and a further 296 responses where at least 75% of questions were completed. Findings suggest that social media groups (78.4%, 1,924/2,453), specifically Facebook (86.6%, 2,115/2,422) were the most useful or most used information resource for these groups. Some significant information seeking behavior differences across age and gender were also found. Our study highlights the diversity in information needs of people impacted by COVID-19 travel restrictions and the range of preferred channels through which information is sought. Further, it highlights which challenges hold legitimacy in their target audiences' eyes and which do not. Policymakers may use these results to help formulate more nuanced, consumer-tailored—and hence likely more acceptable, trusted, and impactful—communication strategies as part of future public health emergencies

Estimates of the True Number of Cases of Pandemic (H1N1) 2009, Beijing, China

During 2009, a total of 10,844 laboratory-confirmed cases of pandemic (H1N1) 2009 were reported in Beijing, People’s Republic of China. However, because most cases were not confirmed through laboratory testing, the true number is unknown. Using a multiplier model, we estimated that ≈1.46–2.30 million pandemic (H1N1) 2009 infections occurred

Perceptions of COVID-19 Vaccines: Lessons from Selected Populations Who Experience Discrimination in the Australian Healthcare System

COVID-19 vaccination is particularly challenging among populations who have experienced discrimination in healthcare settings. This paper presents qualitative findings from in-depth interviews about COVID-19 vaccination conducted in Australia between October 2020 and November 2021. Data from four different studies are presented; each population has unique experiences of discrimination within the healthcare system: Aboriginal people; people who inject drugs (PWID); people living with HIV (PLHIV); and gay and bisexual men (GBM). Analyses were guided by the behavioural and social determinants model that forms the basis of the World Health Organization’s “data for action: achieving high uptake of COVID-19 vaccines” interim guidance. All populations viewed vaccination as necessary for community protection, although narratives of community care were most common among Aboriginal people. Concerns about vaccine safety were expressed by all participant groups, although participants living with HIV and GBM were more trusting of vaccines possibly because of their ongoing and usually positive past experiences with biomedical technologies for HIV management and sexual health. Aboriginal participants reported distrust of mainstream government and participants who inject drugs expressed a more generalised suspicion about COVID-19 and its origins. Practical problems related to transport, booking appointments for vaccination and so forth, were more common among participants living with HIV and GBM, possibly because these specific interviews were conducted throughout 2021 when vaccines were more available, whereas data for the other populations were collected before the vaccine rollout. Findings show that vaccine willingness is shaped by past experiences of discrimination in healthcare setting, but different histories of discrimination can differently impact vaccine willingness. Promotional messaging and delivery must take account of these important differences so to not treat these populations homogenously

University life and pandemic influenza: Attitudes and intended behaviour of staff and students towards pandemic (H1N1) 2009

<p>Abstract</p> <p>Background</p> <p>In a pandemic young adults are more likely to be infected, increasing the potential for Universities to be explosive disease outbreak centres. Outbreak management is essential to reduce the impact in both the institution and the surrounding community. Through the use of an online survey, we aimed to measure the perceptions and responses of staff and students towards pandemic (H1N1) 2009 at a major university in Sydney, Australia.</p> <p>Methods</p> <p>The survey was available online from 29 June to 30 September 2009. The sample included academic staff, general staff and students of the University.</p> <p>Results</p> <p>A total of 2882 surveys were completed. Nearly all respondents (99.6%, 2870/2882) were aware of the Australian pandemic situation and 64.2% (1851/2882) reported either "no anxiety" or "disinterest." Asian-born respondents were significantly (p < 0.001) more likely to believe that the pandemic was serious compared to respondents from other regions. 75.9% (2188/2882) of respondents had not made any lifestyle changes as a result of the pandemic. Most respondents had not adopted any specific behaviour change, and only 20.8% (600/2882) had adopted the simplest health behaviour, i.e. hand hygiene. Adoption of a specific behaviour change was linked to anxiety and Asian origin. Students were more likely to attend the university if unwell compared with staff members. Positive responses from students strongly indicate the potential for expanding online teaching and learning resources for continuing education in disaster settings. Willingness to receive the pandemic vaccine was associated with seasonal influenza vaccination uptake over the previous 3 years.</p> <p>Conclusions</p> <p>Responses to a pandemic are subject to change in its pre-, early and mid-outbreak stages. Lessons for these institutions in preparation for a second wave and future disease outbreaks include the need to promote positive public health behaviours amongst young people and students.</p