Health professional feedback on HPV vaccination roll-out in a developing country Vaccine

Background: Worldwide, Zambia has the highest cervical cancer incidence rates (58.4/100,000 per year) and mortality rates (36.2/100,000 per year). The human papilloma virus (HPV) vaccine is considered a vital preventative measure against cervical cancer, particularly in sub-Saharan countries, such as Zambia. Past research suggests health professionals’ experiences with HPV vaccination rollout can have practical implications for effective delivery. Objective: To explore health professionals’ perspectives on the HPV vaccination programme in Zambia. Methods: Researcher travelled to Zambia and conducted semi-structured interviews with fifteen health professionals working in private, government, and missionary clinics/hospitals. Observation was conducted for triangulation purposes. Thematic analysis was used to analyse the data. Findings: Five main themes emerged; medical misconceptions about the HPV vaccination, particularly with regards to infertility; fear of the unknown, including possible side effects and inadequate empirical research; need for prior desensitisation to resolve cultural barriers prior to vaccination rollout; a rural-urban divide in health awareness, particularly in relation to cancer vaccines; and economic concerns associated with access to the HPV vaccination for most of the Zambian population. Conclusion: Overall, the findings indicate that an essential avenue for facilitating HPV vaccination rollout in Zambia is by implementing a pre-rollout community effort that removes or softens cultural barriers, particularly in rural areas. It is also essential to correct erroneous HPV presumptions health professionals may have around infertility. Affordability remains a seemingly intractable hindrance that hampers HPV vaccination rollout in Zambia

Ethnic inequalities in doctor-patient communication regarding personal care plans: the mediating effects of positive mental wellbeing

Objective: There is limited understanding of ethnic inequalities in doctor-patient communication regarding personal care plans (PCPs). This study investigated the mediating effects of positive mental wellbeing on differences in PCP-related doctor-patient communication amongst South Asian and Caucasian UK residents. Design: Data from 10980 respondents to the 2013 Health Survey for England was analysed using bootstrapping methods. Constructs from the WEMWBS (Warwick and Edinburgh Mental Wellbeing Scale) (Stewart-Brown and Janmohamed 2008) were assessed as mediators of relations between ethnicity and several doctor-patient communication variables, including PCP-related interactions; (a) had a PCP-related discussion about a long-term condition with a doctor/nurse, and (b) had this conversation within the past year, (c) agreed to a PCP with a health professional; and (d) talked to a doctor in the past 2 weeks. Results: Bootstrapped mediation analysis (Hayes 2013) showed that three positive mind-sets mediated associations between ethnicity and doctor-patient contact, including PCP-related communication. Being able to make up one’s mind (ab = -0.05; BCa CI [-0.14, 0.01]) mediated the effect of ethnicity on agreeing to a PCP, while having energy to spare (ab = 0.07; BCa CI [-0.04, 0.12]), and feeling good about oneself (ab = 0.03; BCa CI [0.01, 0.07]), mediated ethnic effects on talking to a doctor during the past fortnight. The mediating effect of reported energy persisted after controlling for medical history, perceived health, and other covariates. Conclusions: Ethnic disparities in doctor-patient interaction, including PCP-related communication, are partly explained by positive mental wellbeing. Gauging positive psychological moods in patients, particularly self-worth, self-perceived vigour and decisiveness, are relevant to addressing ethnic inequalities in doctor-patient communication. As PCPs may have direct implications for patient health it is important for health professionals to address deficits in psychological functioning that may precipitate ethnic inequalities in setting up PCPs

Personal care plans and glycaemic control: the role of body mass index and physical activity

Background: Although BMI (body mass index) and physical activity are implicated in diabetes complications, it is unclear how these factors influence personalised care planning linked to glycaemic control. This study assessed the mediating effects of BMI and physical activity on relations between personalised care plans (PCPs) and glycated haemoglobin (HbA1c) levels, using population-based data. Method: Bootstrapping was used to analyse PCP, HbA1c, BMI, and physical activity data from 3894 respondents to the 2014 Health Survey for England, for whom HbA1c data was available, regardless of diabetes status. This group comprised 1812 (46.5%) males, 17 and 2082 (53.5%) females, aged 16 to 90 (Mean = 51.68 years, SD = 17.25). Results: Patients with a PCP had higher HbA1c levels compared to those without a care plan. BMI influenced this relationship amongst patients aged 40 to 60; those with a PCP and higher HbA1c also tended to have higher BMI values. Physical activity did not affect the relationship between PCPs and glycaemic control. Conclusions: BMI, but not physical activity, partly explained higher HbA1c levels in patients with a PCP. Given recent population-based evidence implicating exercise in diabetes complications, some debate is needed on the role of physical activity in personalised care planning and glycaemic control

Information and Communication Technology, Well-being, and Ethnicity

The relationship between use of information and communication technologies (ICTs) and well-being is an increasingly debated public health issue. Currently, there is limited understanding of how the ethnic digital divide influences this association. Thus, this study assessed how ethnicity has historically moderated relations between ICT (mobile phone, computer, TV) uptake, and several well-being indicators; (a) long-term health (chronic illness), (b) cigarette smoking, and (c) self-perceptions of personal health. Archived data from a UK Office for National Statistics household survey 2007-2011 (97,697 participant records) was analysed, controlling for multiple socio-demographic confounders. Mobile phone dependence was associated with poorer health perceptions in Caucasian women, but more favourable appraisals in ethnic minority females (OR = 0.51). Furthermore, mobile phone uptake was more strongly related to increased behavioural risk (cigarette smoking) in Caucasian men compared with ethnic minority males (OR = 1.68). Ethnicity did not influence relations between ICT uptake and long-term health. Overall, ethnicity was implicated in relations between mobile phone use and well-being indicators: unfavourable associations occurred primarily in Caucasians

Mobile Technology Usage Mediates Gender Differences in Physical Activity

Gender differences in how technology is used to facilitate physical activity engagement was examined. 578 adults completed a survey assessing gender, mobile device usage, stages of change in physical activity based on the transtheoretical model of behaviour change (TTM) and relevant covariates. Data analysis revealed that both cumulative device types and cumulative reasons for using devices mediated gender differences in stage membership for physical activity. Females used fewer devices and reported fewer reasons for using such devices than male participants. These dispositions predicted a reduced probability of achieving action/maintenance stages for physical activity. Females used fewer mobile devices and perceived fewer incentives for using such devices. As a result they are less likely to enter the action/maintenance stages of physical activity. Interventions to promote female participation in physical activity need to recognise gender differences in the use of mobile technology

Efficacy of the Best Possible Self protocol in diabetes self-management: A mixed-methods approach.

Recent research has demonstrated that positive affect may facilitate illness self-management. This study used a sequential exploratory mixed-methods typology to assess whether a brief writing task designed to boost positive affect (the Best Possible Self protocol) could improve aspects of diabetes self-management, specifically. A qualitative investigation explored people with diabetes' ( n = 20) views regarding Best Possible Self feasibility and acceptability, while a subsequent quantitative investigation assigned people with diabetes ( n = 50) to a Best Possible Self or non-Best Possible Self condition and assessed affect and self-management behaviours over a 4-week period. Findings indicated that individuals were receptive to the Best Possible Self and that it provided benefits for diabetes self-management

Positive Affect as a Buffer Against Psychopathology in Diabetes Patients: A Randomised Controlled Trial

The aim of this study was to assess a brief ‘positive’ psychological intervention’s effectiveness in facilitating positive affect amongst people with diabetes

The best possible self‐intervention as a viable public health tool for the prevention of type 2 diabetes: A reflexive thematic analysis of public experience and engagement

Background: Public health initiatives seek to modify lifestyle behaviours associated with risk (e.g., diet, exercise, and smoking), but underpinning psychological and affective processes must also be considered to maximize success. Objective: This study aimed to qualitatively assess how participants engaged with and utilized the best possible self (BPS)-intervention specifically as a type 2 diabetes (T2D) prevention tool. Design and Methods: Fourteen participants engaged with a tailored BPS intervention. Reflexive thematic analysis analysed accounts of participant's experiences and feasibility of use. Results: All participants submitted evidence of engagement with the intervention. The analysis considered two main themes: Holistic Health and Control. The analysis highlighted several nuanced ways in which individuals conceptualized their health, set goals, and received affective benefits, offering insights into how people personalized a simple intervention to meet their health needs. Conclusions: To our knowledge, this is the first study to tailor the BPS intervention as a public health application for the prevention of T2D. The intervention enabled users to identify their best possible selves in a way that encouraged T2D preventive behaviours. We propose that our tailored BPS intervention could be a flexible and brief tool to assist public health efforts in encouraging change to aid T2D prevention. Public Contribution: The format, language and application of the BPS intervention were adapted in response to a public consultation group that developed a version specifically for application in this study

Cultural Identity Conflict Informs Engagement with Self-Management Behaviours for South Asian Patients Living with Type-2 Diabetes: A Critical Interpretative Synthesis of Qualitative Research Studies

The prevalence of type-2 diabetes (T2D) is increasing, particularly among South Asian (SA) communities. Previous research has highlighted the heterogeneous nature of SA ethnicity and the need to consider culture in SA patients’ self-management of T2D. We conducted a critical interpretative synthesis (CIS) which aimed to a) develop a new and comprehensive insight into the psychology which underpins SA patients’ T2D self-management behaviours and b) present a conceptual model to inform future T2D interventions. A systematic search of the literature retrieved 19 articles, including 536 participants. These were reviewed using established CIS procedures. Analysis identified seven constructs, from which an overarching synthesizing argument ‘Cultural Conflict’ was derived. Our findings suggest that patients reconstruct knowledge to manage their psychological, behavioural, and cultural conflicts, impacting decisional conflicts associated with T2D self-management and health professional advice (un)consciously. Those unable to resolve this conflict were more likely to default towards cultural identity, continue to align with cultural preferences rather than health professional guidance, and reduce engagement with self-management. Our synthesis and supporting model promote novel ideas for self-management of T2D care for SA patients. Specifically, health professionals should be trained and supported to explore and mitigate negative health beliefs to enable patients to manage social-cultural influences that impact their self-management behaviours. Keywords: type 2 diabetes; South Asian; culture; conflict; healthcare; qualitative; evidence synthesi