Improving e-therapy for mood disorders among lesbians and gay men

Introduction This toolkit provides the first comprehensive set of guidelines for tailoring mood-disorder e-therapies to the needs of same-sex attracted people. It gives developers of e-therapies a set of practical recommendations for adjusting e-therapies to more effectively accommodate lesbians and gay men. These recommendations are supported by in-depth research that was designed specifically to inform this toolkit. Summaries of this research are provided in the toolkit and detailed findings are available in published research articles. This toolkit also provides information on the mental health-related challenges that are often faced by same-sex attracted people and links readers to key resources and organisations for further information. Checklists and other tools are included as aids for developers to assess the inclusiveness and relevance of e-therapies to lesbians and gay men. In short, this toolkit contains an extensive set of tools and explains why and how they could be implemented

Understanding how the Australian vaccine‐refusal movement perceives itself

Public health responses to the vaccine-refusal (VR) movement are hindered by inadequate research about the movement's aims, identity and perceived value for its members. This study examined how members of the VR movement in Australia described the movement and what being part of it meant to them. Descriptions of the VR movement by 696 members from across Australia were collected between January and May in 2017 via an online survey. The data were analysed using thematic discourse analysis. Members' understandings of the movement and the beliefs underpinning these understandings were examined. Vaccine refusal was underpinned by distinct epistemic beliefs. Participants believed that mainstream vaccine promotion relies on dishonest communication of compromised research. They saw the VR movement as a science-based movement, researching both 'mainstream' and 'hidden' knowledge, promoting scientific values and advocating for better vaccine studies. Participants believed responsible parenting requires personally researching healthcare choices. Participants constructed the movement's identity in relation to common criticisms of vaccine refusal. These were discredited and repurposed to portray the movement as being brave and righteous. Participants believed people in the movement are astute, informed, responsible and courageous. They believed many members were impacted by vaccine-related harms, from which the movement now saves others. They saw themselves as fighting for an inconvenient truth that the mainstream ignores. Vaccine promotion needs to address the epistemic beliefs associated with vaccine refusal, yet these have been inadequately understood. Our findings contribute to understanding these beliefs. Furthermore, our findings suggest what messages targeting vaccine-refusing people should focus on. This may include acknowledging the significant effort that vaccine-refusing people invest in trying to protect their children, catering to vaccine-refusing people's high engagement and desire for detailed information, and avoiding stigmatising or confrontational vaccine-promotion strategies

Psychosocial and demographic characteristics relating to vaccine attitudes in Australia

Objective: Distrust in vaccination is a public health concern. In responding to vaccination distrust, the psychosocial context it occurs in needs to be accounted for. But this psychosocial context is insufficiently understood. We examined how Australians’ attitudes to childhood vaccination relate to broader psychosocial characteristics pertaining to two key areas: health and government. Design: 4370 Australians were surveyed and divided into five vaccine attitude groups. Logistic univariable and multivariable regression analyses were used to compare differences in psychosocial characteristics between these groups. Results: Multivariate analysis showed that, compared to groups with positive vaccine attitudes, groups with negative attitudes were more informed, engaged and independent health consumers, with greater adherence to complementary medicine, but lower belief in holistic health. They had higher distrust in the mainstream healthcare system, higher conspiracist ideation, and were more likely to vote for minor political parties. They were more likely to be male, religious, have children, and self-report better health. Conclusions: This research revealed HOW profiles of psychosocial characteristics differed between each of the five attitudes to childhood vaccines. Practice implications: These findings are useful for tailoring communications about vaccination-related concerns. They also show that more granular classification and measurement of vaccine attitudes may be useful

How do patients and the public understand overtesting and overdiagnosis? A protocol for a thematic meta-synthesis of qualitative research

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. INTRODUCTION: Examining patient and public understanding of overtesting and overdiagnosis (OverTD) is vital for reducing the burden of OverTD. Studies from disparate contexts, disciplines and focusing on disparate healthcare issues have examined patient and public understanding of OverTD. A synthesis is needed to bring this literature together, examine common themes, strengthen conclusions and identify gaps. This will help steer further research, policy and practice to improve patient and public understanding of OverTD. The objective of this study is to synthesise qualitative research data about patient and public understanding of OverTD. METHODS AND ANALYSIS: A thematic meta-synthesis will be used to synthesise primary qualitative research and qualitative components of primary mixed-methods research about patient and public understanding of OverTD. Studies published in English will be included. These will be identified using systematic searches from inception to March 2020 in the Scopus, CINAHL, PsycINFO and MEDLINE databases. Studies that satisfy eligibility criteria will be assessed for methodological quality using the Critical Appraisal Skills Programme (CASP) checklist. Thematic meta-synthesis will comprise three stages: (1) line-by-line coding; (2) generation of descriptive themes and (3) generation of analytic themes. Confidence in the synthesis findings will be assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence (GRADE CERQual) approach. A summary of GRADE CERQual results will be presented alongside the key themes. Study eligibility screening, data extraction, analysis and the CASP and GRADE CERQual assessments will be undertaken independently by two review authors. ETHICS AND DISSEMINATION: Ethics approval is not required for this secondary analysis of published data. The results will be disseminated in peer-reviewed journals and may be presented in conference papers and elsewhere. PROSPERO REGISTRATION NUMBER: CRD42020156838

How do people understand overtesting and overdiagnosis? Systematic review and meta-synthesis of qualitative research

Rationale: The public should be informed about overtesting and overdiagnosis. Diverse qualitative studies have examined public understandings of this information. A synthesis was needed to systematise the body of evidence and yield new, generalisable insights. Aim: Synthesise data from qualitative studies exploring patient and public understanding of overtesting and overdiagnosis. Methods: We searched Scopus, CINAHL, Ovid MEDLINE and PsycINFO databases from inception to March 18, 2020. We included published English-language primary studies exploring the perspectives of patients/the public about overtesting/overdiagnosis from any setting, year and relating to any condition. Only qualitative parts of mixed-methods studies were synthesised. We excluded studies that only examined overtreatment or sampled people with specialised medical knowledge. Two authors independently selected studies, extracted data, assessed the methodological quality of included studies using the CASP tool, and assessed confidence in the synthesis findings using the GRADE-CERQual approach. Data was analysed using thematic meta-synthesis, utilising descriptive and interpretive methods. Results: We synthesised data from 21 studies, comprising 1638 participants, from 2754 unique records identified. We identified six descriptive themes, all graded as moderate confidence (indicating they are likely to reasonably represent the available evidence): i) high confidence in screening and testing; ii) difficulty in understanding overuse; iii) acceptance that overuse can be harmful; iv) rejection or problematisation of overuse; v) limited impacts of overuse information on intended test and screening uptake; vi) desire for information and shared decision-making regarding overuse. The descriptive themes were underpinned by two analytic themes: i) perceived intrinsic value of information and information gathering, and; ii) differences in comprehension and acceptance of overuse concepts. Conclusions: This study identified novel and important insights about how lay people interpret overuse concepts. It will guide the development of more effective public messages about overuse, highlighting the importance of interpretative frameworks in these communications