Bats and belief: A sequential qualitative study in Thailand

Bats are wildlife and distribute globally. In Thailand, there are hundreds of bat species in different locations within four regions. However, few motivations and influences for having contact with bats have been documented. This sequential qualitative study was conducted in ten provinces representing the four regions of Thailand from September 2016 to June 2017. The study was designed to obtain information on villagers' attitudes, perceptions, beliefs and cultural contexts in relation to bats. Focus group discussions (FGDs) were conducted with 305 respondents. Of these respondents, 142 (46.6%) reported coming into contact with bats through various activities, such as hunting, eating, cooking, collecting bat guano, cleaning bat feces, and finding carcasses in houses and communities. Villagers called bats by different names in different regions. They reported having been in contact with bats in different ways based on occupations, bat species, bat habitats, attitudes, perceptions, beliefs toward bats, and cultural contexts. Villagers in the northern and northeastern regions reported having regularly eaten bats. In contrast, the respondents in the central region did not eat bats due to local norms, religious beliefs, and regulations. By ethnicity, the Blu and Thai Dum groups reported coming into contact with and eating bats more often than the Thais. Our results provide evidence-based information on the human-bat interface in different regions in Thailand. The results of this qualitative study could be useful for strategic planning of proper education and interventions for bat conservation, bat contact behavior, and risk of bat-borne diseases among villagers in the future.

[Coronavirus: Predictive brain and terror management]

Emerging infectious diseases like Covid-19 cause a major threat to global health. When confronted with new pathogens, individuals generate several beliefs about the epidemic phenomenon. Many studies have shown that individual protective behaviors largely depend on these beliefs. Due to the absence of treatment and vaccine against these emerging pathogens, the relation between these beliefs and these behaviors represents a crucial issue for public health policies. In the premises of the Covid-19 pandemic, several preliminary studies have highlighted a delay in the perception of risk by individuals, which potentially holds back the implementing of the necessary precautionary measures: people underestimated the risks associated with the virus, and therefore also the importance of complying with sanitary guidelines. During the peak of the pandemic, the salience of the threat and of the risk of mortality could then have transformed the way people generate their beliefs. This potentially leads to upheavals in the way they understand the world. Here, we propose to explore the evolution of beliefs and behaviors during the Covid-19 crisis, using the theory of predictive coding and the theory of terror management, two influential frameworks in cognitive science and in social psychology.

Belief in and use of traditional Chinese medicine in Shanghai older adults: a cross-sectional study

Background

Traditional medicine is broadly used across Asian societies for various medical conditions and health concerns. However, there remains a wide disparity between users and non-use, which makes it imperative to understand the factors affecting the lay perception and utilization of traditional medicine. This study systematically examined the demographic, medical, and socioeconomic factors affecting belief in and use of traditional medicine among older adults of Shanghai, China.

Methods

We used the data from Survey of Life and Opinion on Shanghai Older Adults in 2013 with a sample of 3418 older adults aged 50 years or older. The multilevel logistic models were applied to examine the associations between faith and utilization of traditional medicine and a set of factors of the respondents, including demographics (gender, age, rural/urban residence), socioeconomic status (educational attainment, income, primary occupation), social support (marital status, social network), and disease/conditions. The associations between individual use of traditional medicine and the profile of socioeconomic development and the medical services conditions of local communities were also modelled.

Results

We found that cardiovascular diseases, lung diseases, cancer, prostatitis, arthritis, and nervous system diseases were positive correlates for using traditional medicine. Older adults who had a cancer, a prostatitis, or a fracture had more faith in traditional treatment. Rural living, higher educational attainment, and white-collar occupation promoted the use of traditional medicine. A higher number of strong social ties and a tie connected with medical staff were positive factors of use as well.

Conclusion

The belief in and use of traditional medicine were prevalent among older adults in Shanghai, China. Though not conclusive, our study suggested that traditional medicine in China appears to serve two distinct functions, namely complementary medicine for those socioeconomically advantaged whereas alternative medicine for those socioeconomically disadvantaged.

The effects of education in psychiatry on attitudes towards antidepressants in nursing students: A cross-sectional study

BACKGROUND

Stigma associated with depression and antidepressants is strong among the general population but also among patients and health professionals.

OBJECTIVES

This cross-sectional study is aimed at: 1) evaluating the knowledge and attitude towards antidepressant by nursing student; 2) exploring the association between instruction in psychiatry and representation of depression and antidepressants.

PARTICIPANTS

2037 undergraduate students from 10 French nursing schools were invited to participate in 2017, 1475 (73%) completed the questionnaire.

METHODS

The self-report questionnaire included the Drug Attitude Inventory (DAI) and questions about representation on depression and antidepressant. Four groups of students were built: 1) pre-teaching group (PT) as a reference group, 2) clinical training in psychiatry (CT), 3) receiving mental health theoretical education (TE), 4) receiving both (CT + TE).

RESULTS

The mean (standard deviation) DAI score was negative: -1.9 (±4.4) with only 40% of the nursing students conveying a positive attitude towards antidepressant. A combination of CT and TE was associated with a more positive attitude towards antidepressant in comparison with the PT condition. The CT + TE group was more prone to view antidepressants as effective and safe.

CONCLUSION

There is strong stigma against depression/antidepressants among nursing student. Education combined with clinical experiences in psychiatry improved these representations.

Psychometric evaluation of the illness perception questionnaire for schizophrenia in a Chinese population

BACKGROUND

Illness perceptions have been associated with patients' reactions to health threats and further health outcomes. The Illness Perception Questionnaire for Schizophrenia (IPQS)¹ has been applied in different contexts. However, the validity and reliability of IPQS remain unknown in mainland China.

AIMS AND OBJECTIVES

To test the psychometric properties of the Chinese version of IPQS in mainland China.

DESIGN

A cross-sectional survey.

METHODS

A total of 200 community-dwelling patients with schizophrenia were surveyed in Beijing, China. The validity and reliability of the instrument were tested. As well as demographic data, the IPQS and the Knowledge About Schizophrenia Test (KAST)² were also administered.

RESULTS

Factor analysis was utilised to refine the factor structure of the IPQS. The difference between IPQS and KAST denoted the discriminant validity. The subscale scores among patients of different illness duration, educational attainment, and medication adherence in the past two years were significantly different (P＜0.05), indicating the known-group validity of the IPQS. Except for 'personal control' and 'burdensome effect', other subscales were internally consistent. Most of the subscales proved stable over a four-week period.

CONCLUSION

The Chinese version of IPQS can be used, with some refinements, to assess illness perceptions about schizophrenia for patients in future studies. This will provide empirical evidence for its generalizability and clinical utility and provide deeper insight into Chinese patients' illness perceptions about schizophrenia.

Conjuring cognition: a review of educational magic-based interventions

For hundreds of years, magic tricks have been employed within a variety of pedagogic contexts, including promoting science and mathematics, delivering educational messaging, enhancing scepticism about the paranormal, and boosting creative thinking for product design. This review examines this diverse body of work, focusing on studies that have assessed the impact of such interventions. Although the studies tended to yield positive outcomes, much of the work suffered from methodological shortcomings, including measuring the impact of interventions over a relatively short period of time, focusing on self-report measures and failing to employ control groups. The paper makes several recommendations for future study in the area, including assessing the longer-term impact of magic-based interventions, comparing these interventions to other types of pedagogic techniques, focussing on knowledge retention and behavioural outcomes, and collaborating with magicians to develop more impactful interventions.

Herbal medicine from the perspective of type II diabetic patients and physicians: what is the relationship?

Background

Diabetes mellitus (DM) is a major public health problem and one of the most challenging diseases worldwide. According to the World Health Organization (WHO), the Kingdom of Saudi Arabia (KSA) has the second highest rate of diabetes in the Middle East and seventh highest globally. Some diabetic patients may prefer to use alternative approaches such as herbal remedies to control their blood glucose level and this study aims to assess the prevalence of herbal usage and to evaluate users’ and doctors’ knowledge, attitudes and beliefs about herbal medicine as well as the patient/doctor relationship in this regard.

Method

A cross-sectional survey was conducted in several hospitals and medical centres in Makkah, KSA, between January and March 2019. Around 289 type II diabetic patients and 105 doctors were interviewed.

Results

We found that 68% of the participants were frequent consumers of herbal remedies, especially cinnamon, ginger and fenugreek. Patients’ knowledge of herbal usage was mainly gleaned from family and friends as well as social media, and we found that many (71.4%) did not bother to consult or inform their doctors about their choice to self-medicate with herbs. Patients had no concerns regarding the efficacy and safety of herbal usage use in diabetes, as around half of the participants believe that herbal medicine is effective (54%) and safe (46%) for treating symptoms of diabetes. Two-thirds of the doctors (66%) routinely ask patients whether they use herbs for their condition. Although 25% of the doctors took a positive view of herbal medicine in relation to diabetes, others expressed concerns with the rise in herb use and want to see more attention paid to safety aspects.

Conclusion

The study concludes that herbal remedies are commonly used by diabetic patients and that a gap exists in the relationship between patients and doctors concerning the disclosure of herbal remedy use and views on its safety.

Attitudes and beliefs regarding food in a multi-ethnic Asian population and their association with socio-demographic variables and healthy eating intentions

BACKGROUND

Attitudes and beliefs regarding food are known to influence dietary behaviours and may reflect cultural traditions. Therefore, understanding the food culture in the population is important to inform culturally relevant and acceptable public health interventions.

OBJECTIVE

(1) To evaluate attitudes towards pleasure and health with regard to eating and its association with healthy eating intentions. (2) To assess traditional beliefs about 'hot-cold balance' and its influence on food choice.

METHODS

We conducted a cross-sectional study using an online research panel comprising of 787 male and female adults of Chinese, Malay and Indian ethnicity recruited from population-based cohorts and public housing estates in Singapore. A self-administered questionnaire was used to assess beliefs and attitudes towards food. To evaluate the association of beliefs and attitudes with socio-demographic determinants and potential consequences for healthy eating intentions, multivariable logistic regression was used with adjustment for age, gender and ethnicity.

RESULTS

Beliefs about the importance of considering hot-cold balance for food choice were common among all three Asian ethnic groups and most prominent among the Chinese ethnic group (56.3% Malay, 64.5% Indian and 72.4% Chinese). The majority of participants (73.8%) often consider the effects of diet on health, but also value eating pleasure greatly (84.9%). Older age was associated with a shift in attitudes from valuing eating pleasure towards health. Valuing the importance of food for health was associated with a wide range of healthy eating intentions, whereas highly valuing eating pleasure was associated with a lower intention to reduce salt intake.

CONCLUSION

In a cosmopolitan Asian population, both eating for health and eating for pleasure were valued highly and traditional beliefs regarding the hot-cold balance were held by the majority.

Stigmatizing Beliefs About Depression in Diverse Ethnic Groups of Asian Americans

Focusing on diverse ethnic groups of Asian Americans, the present study examined the prevalence, ethnic variations, and predictors of stigmatizing beliefs about depression (beliefs that associate depression with a sign of weakness, shame to the whole family, and family disappointment, and beliefs that antidepressant medicines are addictive). Data were drawn from 2609 participants (age range 18-98) in the 2015 Asian American Quality of Life survey that includes Chinese, Asian Indian, Korean, Vietnamese, Filipinos, and other Asians. Results of a series of logistic models indicated that age, gender, ethnicity, length of stay in the U.S., English proficiency, and acculturation were significantly associated with stigmatizing beliefs about depression. Ethnic variations in beliefs were also observed. Implications for research and practice are discussed.

Cardiac patients' beliefs about their illness and treatment: A sequential exploratory mixed methods design

Background: Cardiac patients’ beliefs about illness and treatment can disturb their treatment process, treatment regimen adherence, and daily activities. Exploring these beliefs by the use of appropriate, valid, and accurate scales can be helpful in false beliefs reforming by nurses and finally, result in life quality promotion. Therefore, this study is conducted to design and psychometry a questionnaire probing about cardiac patients’ beliefs about illness and treatment.

Methods: The sequential combination exploratory mixed methods design was used to develop the questionnaire format, which involved two sections: the quantitative and qualitative step. The qualitative step included probing the role of cultural beliefs about illness and treatment in two steps, including the literature and related tools review and fieldwork (semi-structured interviews with cardiac patients). Seventeen studies were checked in the literature review. Twenty-two cardiac patients were selected and interviewed by purposive sampling. The interviews continued up to the data saturation. The data analysis was conducted in both steps using conventional content analysis and textual content analysis. The quantitative step was a methodology study accomplished in two parts. The questionnaire items were formed using the data and items pool in the first part while the psychometric properties of the questionnaire were checked using face, content and construct validity and the reliability was probed using internal consistency and stability in the second part. The data were transferred into SPSS software program, version 18.0 for Windows (α<0.05).

Results: 319 codes were extracted from the analyzing phase which formed 6 categories including prognosis, prevention, contexts, treatment efficiency, mentality and lifestyle as well as 9 sub-categories including understanding the danger, attitude toward disease, attitude toward treatment, society’s culture, feeling hopeless, treatment regimen ignorance, self-curing, trying to survive and physical outcomes. The items pool was formed using literature reviews and interviews. A 30-itemed questionnaire was formed after the psychometric process. The Kaiser-Meyer-Olkin (KMO) index and the Bartlett’s test of sphericity showed good results. Six components from the exploratory content analysis including prognosis, prevention, contexts, treatment efficiency, mentality, and lifestyle gained 51.7% variance totally. The interclass correlation coefficient was 0.83 in responding to the items for two times.

Conclusion: This study developed a questionnaire about cardiac patients’ beliefs regarding their illness and treatment. It can be used for the educational, research, and treatment purposes as a questionnaire with short, easy, and grammatically simple items that have appropriate validity and reliability. Using this scale can be helpful in evaluating clients’ beliefs and recognize their educational needs.

Iranian midwives' attitudes and beliefs toward physiological childbirth: a cross-sectional study

BACKGROUND

The significant role of midwives in providing labor and delivery care underscores the necessity of the identification of attitudes and beliefs of these groups of maternity care providers toward physiological childbirth. The purpose of the current study was to describe midwives' attitudes and beliefs toward physiological childbirth and identify its related factors.

METHODS

This cross-sectional study was carried out on 200 midwives working in the labor and delivery wards of selected hospitals in an urban area of Tehran, Iran, through the continuous sampling method from May to July 2018. The data were collected using a two-part demographic characteristic form and Midwives' Attitudes and Beliefs Questionnaire-Revised toward physiological childbirth. Data analysis was performed in SPSS software (version 25). The significance level was set at P < 0.05.

RESULTS

The mean score of midwives' attitudes and beliefs toward physiological childbirth were 119.90 with a standard deviation of 9.30. Moreover, of the different domains of Midwives' Attitudes and Beliefs Questionnaire-Revised, the women's experience of birth (78.53) and the medical model conflict (51.05) obtained the highest and lowest scores, respectively. According to the multiple linear regression model analysis, the total mean score of midwives' attitudes and beliefs toward physiological childbirth was significantly correlated with the level of education and interest in the profession (P < 0.05). Midwives with a master degree obtained higher scores (4.32) in terms of attitudes and beliefs toward physiologic childbirth, compared to those with an associate or bachelor degree. Also, there were 0.09 increases in the attitude and belief score of midwives per one score increase in their interest in the profession. It can be concluded that these two variables explained 16% of the variation in the scores of midwives' attitudes and beliefs to physiological childbirth.

CONCLUSION

The results of this study showed that midwives with higher levels of education and more interest in their profession had more positive attitudes and beliefs toward physiological childbirth. Therefore, it is necessary to motivate midwives to obtain higher levels of education and increase their interest in the profession to promote physiological childbirth.

Assessment of the belief and attitudes of Iranian healthcare personnel's toward the influenza infection and influenza vaccination

Introduction

Influenza is one of the main public health problems and health care personnels (HCPs) are one of the at-risk groups for this infection. The goal of the current study was to identify the beliefs and attitudes of the Iranian HCPs about influenza and the influenza vaccine.

Methods

This cross-sectional study was performed in a general hospital in Tehran, Iran from January to June 2016. A total of 418 questionnaires were distributed among the HCPs. The Chi² test, linear regression and one-way ANOVA were used for data analysis, α: 0.05 was considered as a statistically significant level. All analyses were performed using the SPSS19 software.

Results

The influenza vaccination coverage was 57.7%; the highest vaccine rate belongs to the allied health professionals (68.2%). Two main causes for avoiding the influenza vaccination were; the “fear of vaccine adverse effects” and the “uncertainty about the vaccine effectiveness”. The linear regression analysis identified that the physicians had the highest belief score, followed by the nurses and the allied health professionals (p < 0.001).

Conclusions

Educational planning on influenza and influenza vaccination is necessary to improve the vaccination coverage and to reduce the influenza mortality and morbidity in susceptible patients.

Effects of an empowerment program for survivors of sexual violence on attitudes and beliefs: evidence from the Democratic Republic of Congo

BACKGROUND

Women's empowerment may require women to change their beliefs and views about their rights and capabilities. Empowerment programs often target women who have survived sexual and gender-based violence (SGBV), with the justification that these women may develop disempowered beliefs as a coping mechanism, or face greater barriers to, or derive greater benefits from, the adoption of empowered beliefs and preferences. We investigated an intensive, six-month residential empowerment program ("City of Joy") for SGBV survivors in eastern Democratic Republic of the Congo (DRC), where more than one in five women have experienced SGBV.

METHODS

We asked 175 participants about their beliefs and preferences pertaining to political, financial, and domestic empowerment. Interviews took place immediately before and after participation in the program, and we tested for differences in views of empowerment between entry and exit using paired t-tests and McNemar's test. We also conducted 50 semi-structured interviews about empowerment with an additional 30 women who had completed the program up to 5 years earlier and then returned to their home community.

RESULTS

Prior to enrolling in the program, participants had fairly empowered views regarding politics, less empowered views regarding finances, and still less empowered views regarding the domestic sphere. After completing the program, participants had significantly more empowered views in all three domains, particularly regarding domestic violence, how families should treat men and women, and women's economic rights. Participants in their home communities reported taking a more active role in community affairs and speaking out against the mistreatment of women.

CONCLUSION

This study adds to the evidence that women's empowerment programs can change participants' beliefs and thus increase the confidence with which they participate in their communities and support one another.

"It all needs to be a full jigsaw, not just bits": exploration of healthcare professionals' beliefs towards supported self-management for long-term conditions

BACKGROUND

Long-Term Conditions are physical health issues which profoundly impact physical and psychological outcomes and have reached epidemic worldwide levels. An increasing evidence-base has developed for utilizing Supported Self-Management to ensure Health, Social Care & Voluntary staff are knowledgeable, skilled, and experienced to enable patients to have the confidence and capability to self-manage their conditions. However, despite Health Psychology theories underpinning chronic care models demonstrating beliefs are crucially associated with intention and behaviour, staff beliefs towards Supported Self-Management have received little attention. Therefore, the study aimed to explore healthcare professionals' beliefs towards Supported Self-Management for Long-Term Conditions using the Theory of Planned Behaviour.

METHODS

A mixed-methods approach was conducted within a single UK local government authority region in 2 phases: (1) Qualitative focus group of existing Supported Self-Management project staff (N = 6); (2) Quantitative online questionnaire of general Long-Term Conditions staff (N = 58).

RESULTS

(1) Eighty two utterances over 20 theme sub-codes demonstrated beliefs that Supported Self-Management improves healthcare outcomes, but requires enhancements to patient and senior stakeholder buy-in, healthcare culture-specific tailoring, and organizational policy and resources; (2) Mean scores indicated moderate-strength beliefs that Supported Self-Management achieves positive healthcare outcomes, but weak-strength intentions to implement Supported Self-Management and beliefs it is socially normative and perceived control over implementing it. Crucially, regression analyses demonstrated intentions to implement Supported Self-Management were only associated with beliefs that important others supported it and perceived control over, or by whether it was socially encouraged.

CONCLUSIONS

Healthcare professionals demonstrated positive attitudes towards Supported Self-Management improving healthcare outcomes. However, intentions towards implementing this approach were low with staff only slightly believing important others (including patients and clinicians) supported it and that they had control over using it. Future Supported Self-Management projects should seek to enhance intention (and consequently behaviour) through targeting beliefs that important others do indeed actually support this approach and that staff have control over implementing it, as well as enhancing social encouragement.

A patient caregiver survey in Indonesia: Knowledge and perception of antibiotic use and microbial resistance

BACKGROUND

A successful antibiotic stewardship program depends not only the knowledge and perceptions of healthcare providers but also patients and caregivers. Accordingly, the caregiver will decide to give the medication for their children. This survey was conducted to observe the caregivers' knowledge and perceptions of antibiotic use and antibiotic resistance; and their relationship.

METHODS

We developed 14 item questions in a knowledge questionnaire and 30 item questions in a perception questionnaire. The knowledge questionnaire was measured by a Guttman scale, with 'Yes' or 'No' answers, while the perception questionnaire used a five-point Likert scale.

RESULTS

The knowledge about antibiotic resistance is low, while the knowledge about antibiotic administration was the highest score. Caregivers' perceptions and beliefs about antibiotic use and antibiotic resistance were mostly in the neutral category. The association between knowledge and perceptions about antibiotic use and antibiotic resistance in this study was weak.

CONCLUSIONS

The caregivers' knowledge about antibiotic use was identified to be sufficient, particularly, the antibiotic definition (highest score). The caregivers' belief about antibiotic use and microbial resistance was neutral (3.5-3.7).

Beliefs are multidimensional and vary in stability over time - psychometric properties of the Beliefs and Values Inventory (BVI)

The cognitive processes underlying belief are still obscure. Understanding these processes may lead to more targeted treatment to better address functional impairment, such as occurs with delusions. One way in which this might be accomplished is to understand healthy, everyday beliefs, and how these may relate to characteristics observed in delusions. As yet, no such measure exists to accurately measure belief across a range of themes and dimensions. This paper outlines two studies documenting the creation and psychometric properties of a novel measure assessing three different dimensions of belief across themes of politics, science, the paranormal, religion, and morality in UK samples (n = 1, 673 total). Reliability estimates suggested good to excellent consistency (alpha > 0.8 per theme) with moderate to excellent reliability at 48 h (ICC = 0.61 –0.96) and 3.5 months (ICC = 0.61 –0.89). Factor analyses suggested good support for our five chosen themes of belief, suggesting they are distinct topic areas. Correlations across theme and dimension suggested dissociable characteristics within themes. These results have implications for 1. understanding the stability and relationship between themes of belief in a population and, 2. exploring how beliefs may change over time or as a result of an intervention. Full analysis code and data are available from the Open Science Framework (https://osf.io/hzvwr/).

"It depends how one understands it:" a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia

Background

The Zambian Ministry of Health implemented a reactive one-dose Oral Cholera Vaccine (OCV) campaign in April 2016 in three Lusaka compounds, followed by a pre-emptive second-round in December. Understanding uptake of this first-ever two-dose OCV campaign is critical to design effective OCV campaigns and for delivery of oral vaccines in the country and the region.

Methods

We conducted 12 Focus Group Discussions (FGDs) with men and women who self-reported taking no OCV doses and six with those self-reporting taking both doses. Simple descriptive analysis was conducted on socio-demographic and cholera-related data collected using a short questionnaire. We analyzed transcribed FGDs using the framework of dose, gender and geographic location.

Results

No differences were found by gender and location. All participants thought cholera to be severe and the reactive OCV campaign as relevant if efficacious. Most reported not receiving information on OCV side-effects and duration of protection. Those who took both doses listed more risk factors (including ‘wind’) and felt personally susceptible to cholera and protected by OCV. Some described OCV side-effects, mostly diarrhoea, vomiting and dizziness, as the expulsion of causative agents. Those who did not take OCV felt protected by their good personal hygiene practices or, thought of themselves and OCV as powerless against the multiple causes of cholera including poor living conditions, water, wind, and curse. Most of those who did not take OCV feared side-effects reported by others. Some interpreted side-effects as ‘western’ malevolence. Though > 80% discussants reported not knowing duration of protection, some who did not vaccinate, suggested that rather than rely on OCV which could lose potency, collective action should be taken to change the physical and economic environment to prevent cholera.

Conclusions

Due to incomplete information, individual decision-making was complex, rooted in theories of disease causation, perceived susceptibility, circulating narratives, colonial past, and observable outcomes of vaccination. To increase coverage, future OCV campaigns may benefit from better communication on eligibility and susceptibility, expected side effects, mechanism of action, and duration of protection. Governmental improvements in the physical and economic environment may increase confidence in OCV and other public health interventions among residents in Lusaka compounds.

Acupuncture during pregnancy and the perinatal period: Women's attitudes, beliefs and practices

BACKGROUND

Acupuncture during pregnancy and the perinatal period aims to increase normal birth and enhance a woman's birth experience by decreasing intervention and adverse birth outcomes. Acupuncture in Australian maternity services has not been well accepted, and there is limited research evidence as to whether women are supportive of acupuncture treatment.

OBJECTIVE

The aims of this study were to understand childbearing aged women's attitudes, beliefs and practices to using acupuncture during pregnancy and the perinatal period, and possible acceptance of a midwife providing acupuncture treatments.

DESIGN

A descriptive/explorative quantitative methodology was used to gather data from childbearing aged women using an online survey. Statistical analysis was used for quantitative data and content analysis for the free-text responses. Recruitment of respondents took place in 2017 via Facebook birth and parenting groups and pages.

FINDINGS

Of 304 respondents, 68% (n = 206) had used acupuncture, and of these, 68% (n = 140) used acupuncture for concerns during pregnancy and the perinatal period. The majority of respondents indicated they would consider acupuncture during pregnancy and the perinatal period (89%) and 62% indicated they would have a midwife provide a treatment. The free-text responses provided mostly positive comments on the outcomes and satisfaction of acupuncture treatments (84% n = 199).

CONCLUSION

The majority of respondents would consider acupuncture during pregnancy and the perinatal period, were positive to trying acupuncture for various concerns, and were positive towards a midwife providing treatments. These findings raise awareness of women's desire for the choice of an acupuncture treatment during pregnancy and the perinatal period.

Patients beliefs on intravenous and subcutaneous routes of administration of biologics for severe asthma treatment: A cross-sectional observational survey study

Background

Understanding how patients generate preferences for administration route alternatives may improve health-care delivery and clinical outcomes. Recently, novel biological therapies with subcutaneous (SC) and intravenous (IV) administration routes have been approved for severe uncontrolled asthma. The aim of our study was to assess the preferred route of biologic therapy administration and related beliefs among patients with severe uncontrolled asthma.

Methods

We conducted a cross-sectional observational survey study. Patients answered an anonymous, self-administered questionnaire after an outpatient visit in pulmonary disease clinics located throughout Italy. Socio-demographic and clinical information together with the 12-Item Short Form Survey (SF-12), Work Productivity Impairment Scale and the medical resources utilization module of the Health & Work Survey were collected. Patients beliefs and preference towards SC and IV administration were investigated by means of an ad hoc 13 item questionnaire.

Results: the main findings

150 patients fulfilled the inclusion criteria and completed the questionnaire (47.3% males). Preference for IV and SC administration was 18.7% and 81.3%, respectively. Compared with patients preferring SC formulation, patients that favored IV were older (p ​= ​0.04), less likely to escalate corticosteroid dose (p ​= ​0.03) and had emergency room (ER) access (p ​= ​0.009) during asthma exacerbations. Patients felt that SC was more convenient than IV, but this belief was not associated with higher likelihood of preferring SC administration. IV formulations were more likely associated with quicker and more effective drug action (p ​= ​0.0001), procedural safety and medical oversight (p ​= ​0.0002) and social support (p ​= ​0.007). Predictors of IV preference were represented by the association of worse asthma control and increased use of ER services, and by beliefs toward formulation effectiveness/efficiency in reducing symptoms (p ​= ​0.04 and p ​< ​0.0001, respectively). The model achieved excellent discrimination of administration route preference (area under the curve ​= ​0.87).

Conclusions

Preference is guided by partially misleading beliefs, which may generate wrong expectations that in turn can affect treatment satisfaction and adherence. Convenience and efficacy beliefs for drugs with different routes of administration always should be discussed with patients to achieve informed shared-decision making.

Trial registration

Not applicable.

Prediction and perception: Insights for (and from) tinnitus

More than 150 years have passed since Helmholtz first described perception as a process of unconscious inference about the causes of sensations. His ideas have since inspired a wealth of literature investigating the mechanisms underlying these inferences. In recent years, much of this work has converged on the notion that the brain is a hierarchical generative model of its environment that predicts sensations and updates itself based on prediction errors. Here, we build a case for modeling tinnitus from this perspective, i.e. predictive coding. We emphasize two key claims: (1) acute tinnitus reflects an increase in sensory precision in related frequency channels and (2) chronic tinnitus reflects a change in the brain's default prediction. We further discuss specific neural biomarkers that would constitute evidence for or against these claims. Finally, we explore the implications of our model for clinical intervention strategies. We conclude that predictive coding offers the basis for a unifying theory of cognitive neuroscience, which we demonstrate with several examples linking tinnitus to other lines of brain research.

Association between illness representation and psychological distress in stroke patients: A systematic review and meta-analysis

AIMS

This paper aims to systematically review the illness perceptions of stroke patients and to examine the association between illness representation and psychological distress in empirical research studies.

BACKGROUND

Patients' perceptions of health threats determine their coping behavior. Several recent studies have focused on illness belief and distress in stroke patients. This information is suitable for a meta-analysis to further understand stroke patients' illness perceptions.

DESIGN

Systematic review and meta-analysis.

METHOD

An electronic literature search was conducted using the CINAHL, MEDLINE, PubMed, Cochrane library, and Google Scholar databases. Search strategies were title (stroke or cerebrovascular accident or CVA or cerebral vascular event or transient ischemic attack or TIA) and keyword (disease or illness) and keyword (perceptions or attitudes or opinion or experience or view or reflection or beliefs). The literature search covers the period of January 1990 to October 2018. Seven articles were included in the meta-analysis and Fisher's z was calculated with correlation coefficient or regression coefficient values for eight illness representation dimensions and psychological distress. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 3.0 software.

RESULTS

A total of 49 studies were reviewed, and seven studies with a total of 507 participants were eligible for the meta-analysis. For patients' perceived anxiety and depression, six of seven studies, with 285 to 461 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that stroke patients' perception of a strong illness identity, timeline-acute/chronic, timeline-cyclical, consequences, and emotional responses were significantly and positively related to anxiety and depression. The pooled z-value ranged from 0.189 to 0.460. Conversely, for protective-related factors, such as stroke patients' perceived personal control, treatment control, and illness coherence, only perceived illness coherence was significantly negatively associated with depression (z-value, -0.122; 95% CI: -0.241, -0.002). For patients' perceived overall distress, three of seven studies with 173 participants showed that there were significant and positive associations between identity, consequence, emotions, and distress (z-value ranges = 0.493-0.711) as well as a significant and negative association between illness coherence and overall distress (z-value, -0.226; 95% CI: -0.379, -0.073).

CONCLUSION

An association between illness representation and distress exists in stroke patients. Risk factors are the most significant in terms of this relationship, and protective factors do not have a protective health impact. Protection factors need to be promoted to reduce patient distress.

Due deference to denialism: explaining ordinary people's rejection of established scientific findings

There is a robust scientific consensus concerning climate change and evolution. But many people reject these expert views, in favour of beliefs that are strongly at variance with the evidence. It is tempting to try to explain these beliefs by reference to ignorance or irrationality, but those who reject the expert view seem often to be no worse informed or any less rational than the majority of those who accept it. It is also tempting to try to explain these beliefs by reference to epistemic overconfidence. However, this kind of overconfidence is apparently ubiquitous, so by itself it cannot explain the difference between those who accept and those who reject expert views. Instead, I will suggest that the difference is in important part explained by differential patterns of epistemic deference, and these patterns, in turn, are explained by the cues that we use to filter testimony. We rely on cues of benevolence and competence to distinguish reliable from unreliable testifiers, but when debates become deeply politicized, asserting a claim may itself constitute signalling lack of reliability.

Beliefs About the End of AIDS, Concerns About PrEP Functionality, and Perceptions of HIV Risk as Drivers of PrEP Use in Urban Sexual Minority Men: The P18 Cohort Study

Using cross-sectional data from an ongoing cohort study of young gay, bisexual, and other men who have sex with men (N = 492), we examined the extent to which cognitive factors such as beliefs about the end of AIDS, concerns about the manner in which PrEP works, and perceptions about risk of contracting HIV, are related to PrEP uptake and use. While almost all participants indicted awareness of PrEP, a mere 14% had ever used PrEP. Those with lower concerns about the side effects of PrEP and greater belief that treatment and PrEP would eliminate AIDS were also more likely to have ever used PrEP. Our findings support the ongoing challenges of PrEP uptake as means of curtailing HIV in young sexual minority men, and suggest that beyond the structural factors, consideration must be given to further educating the population as a means of adjusting potentially faulty beliefs, concerns, and perceptions which may influence PrEP utilization.

Primary care patient beliefs and help-seeking preferences regarding depression in China

Patient beliefs about depression and its treatment in primary care clinics in China influence the delivery of care. Our objective was to investigate primary care patients' beliefs about depression and its treatment as well as help-seeking preferences regarding depression in China to aid in the development and promotion of interventions that are acceptable to patients with depression. 100 primary care nurses used the Public Knowledge and Beliefs Survey Package (PKBSP) to assess patients in the primary care clinic waiting rooms. Of the 2639 patients, 15.5% were depressed. Patients with higher education level were less likely to be depressed. Differences in beliefs were significantly associated with age, education level and depression status, but no significant differences were found on gender. Help-seeking preferences were also significantly associated with age, education level and depression status. Patients screened with PHQ-9 positive depression were less willing to endorse "take antidepressants" and "consult a non-medical practitioner" than non-depressed patients. However, they were more willing to endorse "consult a psychotherapist". Patient beliefs about depression and its treatment highlight a need for modification of current paradigms, practices, and approaches to improve the acceptability of depression care provision. Efforts to increase collaboration between primary care physicians and mental health professionals are needed.

Believing does not equal remembering: The effects of social feedback and objective false evidence on belief in occurrence, belief in accuracy, and recollection

We examined the impact of social feedback and objective false evidence on belief in occurrence, belief in accuracy, and recollection of an autobiographical experience. Participants viewed six virtual scenes (e.g., park) and were tested on their belief/recollection. After 1-week, participants were randomly assigned to four groups. One group received social feedback that one scene was not experienced. A second group received objective false evidence that one of the scenes was not shown. A third group received both social feedback and objective false evidence and the control group did not receive any manipulation. Belief in occurrence dropped considerably in the social feedback group and in the combined group. Also, nonbelieved memories were most likely to occur in participants receiving both social feedback and objective false evidence. We show that social feedback and objective false evidence undermine belief in occurrence, but that they leave belief in accuracy and recollection unaffected.