How acceptable are innovative health-care technologies? A survey of public beliefs and attitudes in England and Wales

Impact of screening participation on modelled mortality benefits of a multi-cancer early detection test by socioeconomic group in England

BACKGROUND

Cancer burden is higher and cancer screening participation is lower among individuals living in more socioeconomically deprived areas of England, contributing to worse health outcomes and shorter life expectancy. Owing to higher multi-cancer early detection (MCED) test sensitivity for poor-prognosis cancers and greater cancer burden in groups experiencing greater deprivation, MCED screening programmes may have greater relative benefits in these groups. We modelled potential differential benefits of MCED screening between deprivation groups in England at different levels of screening participation.

METHODS

We applied the interception multi-cancer screening model to cancer incidence and survival data made available by the National Cancer Registration and Analysis Service in England to estimate reductions in late-stage diagnoses and cancer mortality from an MCED screening programme by deprivation group across 24 cancer types. We assessed the impact of varying the proportion of people who participated in annual screening in each deprivation group on these estimates.

RESULTS

The modelled benefits of an MCED screening programme were substantial: reductions in late-stage diagnoses were 160 and 274 per 100 000 persons in the least and most deprived groups, respectively. Reductions in cancer mortality were 60 and 99 per 100 000 persons in the least and most deprived groups, respectively. Benefits were greatest in the most deprived group at every participation level and were attenuated with lower screening participation.

CONCLUSIONS

For the greatest possible population benefit and to decrease health inequalities, an MCED implementation strategy should focus on enhancing equitable, informed participation, enabling equal participation across all socioeconomic deprivation groups.

TRIAL REGISTRATION NUMBER

NCT05611632.

Which Framework to Use? A Systematic Review of Ethical Frameworks for the Screening or Evaluation of Health Technology Innovations

Innovations permeate healthcare settings on an ever-increasing scale. Health technology innovations (HTIs) impact our perceptions and experiences of health, care, disease, etc. Because of the fast pace these HTIs are being introduced in different healthcare settings, there is a growing societal consensus that these HTIs need to be governed by ethical reflection. This paper reports a systematic review of argument-based literature which focused on articles reporting on ethical frameworks to screen or evaluate HTIs. To do this a four step methodology was followed: (1) Literature search conducted in five electronic literature databases; (2) Identification of relevant articles; (3) Development of data-extraction tool to analyze the included articles; (4) Analysis, synthesis of data and reporting of results. Fifty-seven articles were included, each reporting on a specific ethical framework. These ethical frameworks existed out of characteristics which were grouped into five common ones: (1) Motivations for development and use of frameworks; (2) Objectives of using frameworks; (3) Specific characteristics of frameworks (background context, scope, and focus); (4) Ethical approaches and concepts used in the frameworks; (5) Methods to use the frameworks. Although this multiplicity of ethical frameworks shows an increasing importance of ethically analyzing HTIs, it remains unclear what the specific role is of these analyses. An ethics of caution, on which ethical frameworks rely, guides HTIs in their design, development, implementation, without questioning their technological paradigm. An ethics of desirability questions this paradigm, without guiding HTIs. In the end, a place needs to be found in-between, to critically assess HTIs.

Understanding opposition to human gene editing A role for pathogen disgust sensitivity?

Recent advances in gene editing technology promise much for medical advances and human well-being. However, in parallel domains, there have been objections to the use of such biotechnologies. Moreover, the psychological factors that govern the willingness to use gene editing technology have been underexplored to date. In this registered report, we sought to test whether pathogen disgust sensitivity is linked with opposition to gene editing. U.K.-based adult participants (N = 347) were recruited to this study. Gene editing attitudes reflected two largely distinct latent factors concerning enhancing human traits and treating medical disorders. In contrast to prediction, pathogen disgust sensitivity was related to greater support for gene editing in both of these domains. This result suggests that gene editing, at least in the current study, is not viewed as pathogenic, or that the perceived benefits of gene editing outweigh any perceived pathogen risk.

Contextualizing geneticization and medical pluralism: How variable institutionalization of traditional, complementary, and alternative medicine (TCAM) conditions effects of genetic beliefs on utilization

As genetic models are increasingly incorporated in medicine, health service users seem to accept these models to varying degrees. To appreciate these differences, this paper examines how health service users' genetic beliefs of health are associated with their use of traditional, complementary, and alternative medicine (TCAM) via responses from 31 countries in the 2011 ISSP survey. It finds an interesting contrast between East Asian countries and other countries in the world. The negative association between genetic beliefs and TCAM use is strong in the latter, whereas it is weak in the former. More intriguingly, the analysis demonstrates significant cross-national differences within East Asian countries. Chinese and Koreans reveal a negative relationship between genetic beliefs and TCAM use, while Japanese show a positive relationship. The paper provides an explanation to these cross-national differences by drawing on comparative studies of medical systems. When TCAM is institutionalized as valid and distinct medical resources, and when TCAM is practically available to everyday use, health service users who subscribe to genetic beliefs are likely to use TCAM as well. These findings contribute to revealing the pragmatic nature of health-seeking action and the institutional context in which geneticization and medical pluralism are conditioned to form.

Acceptance of ambulatory blood pressure monitoring in a semi-rural population in South Africa

BACKGROUND

Ambulatory blood pressure monitoring is a valuable tool that helps in providing an insight into the diagnosis and management of hypertension; however, no evidence exists of its acceptance in the diverse South African population.

AIM

We assessed the acceptance of an ambulatory blood pressure monitor in patients attending public sector primary health care (PHC) clinics.

SETTING

Five PHC clinics in the Makana subdistrict in the Eastern Cape.

METHOD

A cross-sectional study was conducted with 70 hypertensive patients. Eligible patients were between 40 and 75 years old, taking either enalapril and hydrochlorothiazide or enalapril, hydrochlorothiazide and amlodipine. Socio-demographic, clinical and acceptance data were collected. The monitor cuff remained in place for 24 h. Acceptance was assessed after the monitor was removed. An overall acceptance score was generated to classify acceptance as either good or poor.

RESULTS

The mean years of schooling was 5.9 years, with 22 reporting no school attendance. Generally, acceptance was good, with 70% of the population rating the technique as 'acceptable' (acceptance score of > 23/30). Most participants reported minimal discomfort with only 13.3% reporting that it hindered normal daily activities. Night readings interrupted sleep in 43%, with extreme sleep disturbance (≥ 3 awakenings) reported in just over half the patients. Increased years of schooling was the only variable associated with acceptance score (r = -0.243, p = 0.042).

CONCLUSION

Ambulatory blood pressure monitoring was generally well-accepted, with few adverse effects being reported. Use of this technique at PHC facilities could reduce the incidence of misdiagnosis and uncontrolled hypertension.

Attitudes Regarding Enrollment in a Genetic Research Project: An Informed Consent Simulation Study Comparing Views of People With Depression, Diabetes, and Neither Condition

In this study, participants with a self-reported history of depression, diabetes, or no illness underwent a simulated informed consent process for a hypothetical genetic study related to depression or diabetes. Participants completed a survey assessing their perceived understanding of the research process, perceptions of its risks and benefits, their satisfaction with the informed consent process, and their readiness to make a hypothetical enrollment decision. All participants indicated strong readiness to make an enrollment decision regarding the research characterized in the simulation. Participants reported understanding the consent process relatively well and being generally satisfied with it. Greater concerns were expressed regarding psychosocial risks than biological risks for genetic studies on mental disorders. Our study documented positive attitudes toward volunteering for research that involved the collection of genetic data.

Attitudes of Potential Participants Towards Molecular Therapy Trials in Huntington's Disease

BACKGROUND

Advances in molecular therapeutic approaches in the last decade are translating into the design of non-traditional clinical trials. In order to improve their feasibility, it is important to understand the attitudes of potential participants towards these trials, their motivations to get involved and acceptance of risks.

OBJECTIVE

We aimed to better understand the willingness of potential participants to participate in different molecular therapy trials for Huntington's disease (HD) based on their clinical and genetic status, trial design and goals of the treatment.

METHODS

An anonymous survey was distributed through the Huntington's Disease Society of America (HDSA) on-line portal/website. Various hypothetical scenarios were presented followed by a survey consistent of Likert scale responses ascertaining willingness to participate, collecting demographic, clinical and genetic information.

RESULTS

There were a total of 87 responses, including patients diagnosed with HD, pre-manifesting mutation carriers and asymptomatic participants at risk. The majority of participants indicated they were very likely or likely to participate in clinical trials independent of study design or goals of the therapy, with a more favorable view in premanifesting mutation carriers. However, more invasive procedures and trials including placebo were less favorably viewed across all diagnostic groups.

CONCLUSIONS

In summary, most individuals in the HD community would consider participation in novel molecular therapy trials, but study design and goals could impact patient recruitment. This data can be used to inform the recruitment and consent process into clinical trials and to address common concerns by potential participants.

Supporting Adherence to Medicines for Long-Term Conditions

Abstract. Pharmaceutical prescriptions are core to the treatment of most chronic illnesses, yet only half are taken as prescribed. Despite the high costs of nonadherence to individuals and society, effective adherence-promoting interventions are elusive. This is partly due to the sheer complicity of the issue. There are numerous determinants of adherence, both internal to the patient (intrinsic) and external (extrinsic, e.g., environmental or health system-related factors). Also, the relative importance of these determinants varies between individuals and even within the same individual over time and across treatments, presenting a challenge for intervention design. One complication is that interventions can target several levels: (1) patient (e.g., enhancing motivation and/or ability to adhere), (2) patient-provider interactions (e.g., improving communication and the prescribing process), and (3) the healthcare system (e.g., providing the opportunity to access medication through regulatory approval and co-payment schemes). Here, we focus on level 1: the patient. Although environmental factors are important, the effect of an intervention designed to change them will depend on how they impact on the individual. We describe the Perceptions and Practicalities Approach (PAPA), a pragmatic framework positing that adherence/nonadherence is essentially a produce of individual motivation and ability. Adherence interventions, targeted at any level, will therefore be more effective if tailored to address the perceptions and practicalities underpinning individual motivation and ability. We discuss how PAPA can be operationalized, including the application of theoretical models of illness and treatment representation (Necessity-Concerns Framework and Leventhal’s Common-Sense Model) to address salient adherence-related perceptions.

Ethical Concerns About Human Genetic Enhancement in the Malay Science Fiction Novels

Advancements in science and technology have not only brought hope to humankind to produce disease-free offspring, but also offer possibilities to genetically enhance the next generation's traits and capacities. Human genetic enhancement, however, raises complex ethical questions, such as to what extent should it be allowed? It has been a great challenge for humankind to develop robust ethical guidelines for human genetic enhancement that address both public concerns and needs. We believe that research about public concerns is necessary prior to developing such guidelines, yet the issues have not been thoroughly investigated in many countries, including Malaysia. Since the novel often functions as a medium for the public to express their concerns, this paper explores ethical concerns about human genetic enhancement expressed in four Malay science fiction novels namely Klon, Leksikon Ledang, Transgenesis Bisikan Rimba and Transgenik Sifar. Religion has a strong influence on the worldview of the Malays therefore some concerns such as playing God are obviously religious. Association of the negative image of scientists as well as the private research companies with the research on human genetic enhancement reflects the authors' concerns about the main motivations for conducting such research and the extent to which such research will benefit society.

Acceptability of microneedle-patch vaccines: A qualitative analysis of the opinions of parents

INTRODUCTION

Vaccines incorporated into microneedle-based patch platforms offer advantages over conventional hypodermic injections. However, the success and clinical utility of these platforms will depend on its acceptance among stakeholders. Minimal focus has been placed on determining parents' acceptability of microneedle-patch vaccines intended for paediatric use. This qualitative study probes the perceived acceptability of microneedle technology for paediatric vaccination in a parent population.

RESEARCH DESIGN AND METHODOLOGY

Focus groups (n=6) were convened through purposive sampling of Cork city primary schools. Discussions were audio-recorded, transcribed verbatim, anonymised, independently verified and analysed by thematic analysis, with constant comparison method applied throughout.

RESULTS

The opinions of 32 parents were included. All participants declared that their children were fully vaccinated. Five core themes were identified and defined as: (i) concern, (ii) suitability for paediatric use, (iii) potential for parental administration, (iv) the role of the healthcare professional and (v) special populations. Drivers for acceptance include; concerns with current vaccines and vaccination programmes; attributes of microneedle-patch (reduced pain, bleeding, fear and increased convenience) and endorsement by a healthcare professional. Barriers to acceptance include; lack of familiarity, concerns regarding feasibility and suitability in paediatrics, allergic potential, inability to confirm delivery and potential reduction in vaccine coverage.

CONCLUSION

This is the first study to explore parental acceptance of microneedle-patch vaccines. Capturing the opinions of parents, the ultimate decision makers in paediatric vaccination, is crucial in the understanding of the eventual uptake of microneedle technology and therefore adds to literature currently available. This study has revealed that even "vaccine-acceptors"; parents who agree with, or do not question vaccination, will question the safety and efficacy of this novel method. Participants in this study remained tentative. However, the study has also revealed that endorsement by healthcare professionals could reduce this tentativeness, thereby identifying the role of healthcare professionals in disseminating information and providing support to parents. An increased awareness of developments in microneedle technology is needed to permit informed decision-making by parents.

Effect of genomics-related literacy on non-communicable diseases

Recent progress in genomic research has raised expectations for the development of personalized preventive medicine, although genomics-related literacy of patients will be essential. Thus, enhancing genomics-related literacy is crucial, particularly for individuals with low genomics-related literacy because they might otherwise miss the opportunity to receive personalized preventive care. This should be especially emphasized when a lack of genomics-related literacy is associated with elevated disease risk, because patients could therefore be deprived of the added benefits of preventive interventions; however, whether such an association exists is unclear. Association between genomics-related literacy, calculated as the genomics literacy score (GLS), and the prevalence of non-communicable diseases was assessed using propensity score matching on 4646 participants (males: 1891; 40.7%). Notably, the low-GLS group (score below median) presented a higher risk of hypertension (relative risk (RR) 1.09, 95% confidence interval (CI) 1.03-1.16) and obesity (RR 1.11, 95% CI 1.01-1.22) than the high-GLS group. Our results suggest that a low level of genomics-related literacy could represent a risk factor for hypertension and obesity. Evaluating genomics-related literacy could be used to identify a more appropriate population for health and educational interventions.

Public opinions about human enhancement can enhance the expert-only debate: A review study

Human enhancement, the non-medical use of biomedical technologies to improve the human body or performance beyond their 'natural' limitations, is a growing trend. At the same time, the use of these technologies has societal consequences. In societal debates about human enhancement, however, it is mainly the voices of experts that are being heard, and little is known about the public's understanding of human enhancement. The views of the public can give valuable insights, and can, in turn, supplement experts' voices in political decision-making as has been argued before for other emerging technologies. This study presents a systematic literature review of current public perceptions and attitudes towards technologies for human enhancement. Results show that the public's view has not been assessed often. Studies originate mainly from western-oriented countries and cover a broad range of enhancement technologies. In the studies, the majority of respondents hold moderate to strong negative attitudes towards enhancement technologies for non-medical applications, although the type of technology influences these opinions. The study provides an overview of what is known about citizens' attitudes towards technologies for human enhancement.

Survey of Attitudes and Ethical Concerns Related to Gene Therapy Among Medical Students and Postgraduates in China

Gene therapy is becoming an important treatment modality for gravely ill patients, and today's medical students and postgraduates are both potential consumers and future providers of gene therapy. Therefore, their attitudes and concerns about gene therapy may directly influence its long-term development and implementation in the clinic. We performed a cross-sectional survey of medical students and postgraduates at West China Medical School of Sichuan University. A custom-designed questionnaire was distributed to 600 students, and 579 were valid (96.98% response). Most respondents (84.46%) indicated little prior knowledge about gene therapy. The proportion of respondents considering gene therapy as acceptable ranged from 63.73% for serious illness to 17.72% for genetic enhancement. Adverse side effects were the most frequent concern among respondents when asked to imagine that they would receive gene therapy to treat a severe brain-related illness. These results suggest that medical students in China consider gene therapy's acceptability to be rather low, and are most concerned about its adverse side effects.

Public attitudes toward genetic risk testing and its role in healthcare

Developments in genomics continue to increase the number of disorders for which genetic testing is available, whether in the primary healthcare system, through direct-to-consumer testing, or as part of expanded newborn screening panels. This paper reviews a robust literature on public attitudes toward genetics and genetic testing. In general, attitudes are positive about genetic research and new genomic technologies, with majorities indicating an interest in genetic testing. However, complex beliefs comprise the public's thinking about genetics. Attitudes are driven by beliefs about the type of genetic research, the personal and clinical utility of tests, and the area of genetics in which testing is applied. Limitations of current research are noted and suggestions made for future research.

Examining the ethical and social issues of health technology design through the public appraisal of prospective scenarios: a study protocol describing a multimedia-based deliberative method

Background

The design of health technologies relies on assumptions that affect how they will be implemented, such as intended use, complexity, impact on user autonomy, and appropriateness. Those who design and implement technologies make several ethical and social assumptions on behalf of users and society more broadly, but there are very few tools to examine prospectively whether such assumptions are warranted and how the public define and appraise the desirability of health innovations. This study protocol describes a three-year study that relies on a multimedia-based prospective method to support public deliberations that will enable a critical examination of the social and ethical issues of health technology design.

Methods

The first two steps of our mixed-method study were completed: relying on a literature review and the support of our multidisciplinary expert committee, we developed scenarios depicting social and technical changes that could unfold in three thematic areas within a 25-year timeframe; and for each thematic area, we created video clips to illustrate prospective technologies and short stories to describe their associated dilemmas. Using this multimedia material, we will: conduct four face-to-face deliberative workshops with members of the public (n = 40) who will later join additional participants (n = 25) through an asynchronous online forum; and analyze and integrate three data sources: observation, group deliberations, and a self-administered participant survey.

Discussion

This study protocol will be of interest to those who design and assess public involvement initiatives and to those who examine the implementation of health innovations. Our premise is that using user-friendly tools in a deliberative context that foster participants’ creativity and reflexivity in pondering potential technoscientific futures will enable our team to analyze a range of normative claims, including some that may prove problematic and others that may shed light over potentially more valuable design options. This research will help fill an important knowledge gap; intervening earlier in technological development could help reduce undesirable effects and inform the design and implementation of more appropriate innovations.

Prevailing public perceptions of the ethics of gene therapy

Gene therapy research is advancing rapidly, and hopes of treating a large number of brain disorders exist alongside ethical concerns. Most surveys of public attitudes toward these ethical issues are already dated and the content of these surveys has been researcher-driven. To examine current public perceptions, we developed an online instrument that is responsive and relevant to the latest research about ethics, gene therapy, and the brain. The 16-question survey was launched with the platform Amazon Mechanical Turk and was made available to residents of Canada and the United States. The survey was divided into six themes: (1) demographic information, (2) general opinions about gene therapy, (3) medical applications of gene therapy, (4) identity and moral/belief systems, (5) enhancement, and (6) risks. We received and analyzed responses from a total of 467 participants. Our results show that a majority of respondents (>90%) accept gene therapy as a treatment for severe illnesses such as Alzheimer disease, but this receptivity decreases for conditions perceived as less severe such as attention deficit hyperactivity disorder (79%), and for nontherapeutic applications (47%). The greatest area of concern for the application of gene therapy to brain conditions is the fear of not receiving sufficient information before undergoing the treatment. The main ethical concerns with enhancement were the potential for disparities in resource allocation, access to the procedure, and discrimination. When comparing these data with those from the 1990s, our findings suggest that the acceptability of gene therapy is increasing and that this trend is occurring despite lingering concerns over ethical issues. Providing the public and patients with up-to-date information and opportunities to engage in the discourse about areas of research in gene therapy is a priority.

Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework

BACKGROUND

Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it.

OBJECTIVE

To assess the utility of the NCF in explaining nonadherence to prescribed medicines.

DATA SOURCES

We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles.

STUDY ELIGIBILITY CRITERIA

Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication.

PARTICIPANTS

Patients with long-term conditions.

STUDY APPRAISAL AND SYNTHESIS METHODS

Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models.

RESULTS

We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used.

LIMITATIONS

Few prospective longitudinal studies using objective adherence measures were identified.

CONCLUSIONS

The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and support optimal adherence to appropriate prescriptions.

Utilizing social media to study information-seeking and ethical issues in gene therapy

Background

The field of gene therapy is rapidly evolving, and while hopes of treating disorders of the central nervous system and ethical concerns have been articulated within the academic community, little is known about views and opinions of different stakeholder groups.

Objective

To address this gap, we utilized social media to investigate the kind of information public users are seeking about gene therapy and the hopes, concerns, and attitudes they express.

Methods

We conducted a content analysis of questions containing the keywords “gene therapy” from the Q&A site “Yahoo! Answers” for the 5-year period between 2006 and 2010. From the pool of questions retrieved (N=903), we identified those containing at least one theme related to ethics, environment, economics, law, or society (n=173) and then characterized the content of relevant answers (n=399) through emergent coding.

Results

The results show that users seek a wide range of information regarding gene therapy, with requests for scientific information and ethical issues at the forefront of enquiry. The question sample reveals high expectations for gene therapy that range from cures for genetic and nongenetic diseases to pre- and postnatal enhancement of physiological attributes. Ethics questions are commonly expressed as fears about the impact of gene therapy on self and society. The answer sample echoes these concerns but further suggests that the acceptability of gene therapy varies depending on the specific application.

Conclusions

Overall, the findings highlight the powerful role of social media as a rich resource for research into attitudes toward biomedicine and as a platform for knowledge exchange and public engagement for topics relating to health and disease.

Public attitudes towards genetic testing revisited: comparing opinions between 2002 and 2010

Ten years after the Human Genome Project, medicine is still waiting for many of the promised benefits, and experts have tempered their high expectations. Public opinion on genetic testing has generally been favourable but is this still the case? The aim of this study is to compare public experiences, beliefs and expectations concerning genetic testing over the years (2002 vs 2010). A cross-sectional questionnaire survey was conducted using the Dutch Health Care Consumer Panel in 2002 and 2010. Responses to questions in identical wording were compared. In 2002 and 2010, 817 (63%) and 978 (70%) members responded, respectively. Awareness and reported use of genetic tests remained stable over time. In 2010, more respondents expected genetic testing to become more widely applied, believed that knowledge about the genetic background of disease helps people live longer, and that testing should be promoted more intensively. In 2010, they were also more interested in their own genetic make-up. On the one hand, the concern that a dichotomy would emerge between people with 'good genes' and 'bad genes' was higher. On the other hand, respondents thought that insurance companies would be less likely to demand a genetic test in order to calculate health insurance premiums. In conclusion, the results suggest that in 8 years, expectations of benefits and potential use of genetic testing have been raised among the public, resulting in more positive opinions. Worries on inequity remain, although worries about premium differentiation by insurance companies have decreased.

Bodies of knowledge: Nature, holism and women’s plural health practices

The proliferation of complementary and alternative medicine (CAM), and women’s high level of engagement with these practices, has presented sociology with a range of questions regarding gender, embodiment and identity work in the context of contemporary medical pluralism. The current study, drawing on 60 qualitative interviews with women from the Australian Longitudinal Study on Women’s Health (ALSWH), examines how a group of Australian women negotiate CAM and biomedicine in a range of health and illness contexts. Selected from the mid-aged cohort of this national study, here we explore their accounts of engagement with CAM and biomedicine, unpacking their logics underpinning, and rhetorical practices surrounding, their therapeutic engagement. The results provide significant insight into: the importance of ideas about nature, holism and strengthening; perceptions of the harshness and softness of medicines for women’s bodies; and, the relative importance of scientific proof vis-a-vis individual subjectivities. Ultimately, their accounts illustrate gendered and embodied strategies of strategic integration, and importantly, border crossing. We conclude that while women’s engagement with CAM and biomedicine may be indeed be gendered in character, we suggest a rethinking of gender-based resistance (to biomedicine) or gender-alignment (to CAM) arguments; the notion of women as designers would more adequately capture the landscapes of contemporary medical pluralism.

Public attitudes to the promotion of genomic crop studies in Japan: correlations between genomic literacy, trust, and favourable attitude

This study aimed to assess public attitudes in Japan to the promotion of genomic selection in crop studies and to examine associated factors. We analysed data from a nationwide opinion survey. A total of 4,000 people were selected from the Japanese general population by a stratified two-phase sampling method, and 2,171 people participated by post; this survey asked about the pros and cons of crop-related genomic studies promotion, examined people's scientific literacy in genomics, and investigated factors thought to be related to genomic literacy and attitude. The relationships were examined using logistic regression models stratified by gender. Survey results showed that 50.0% of respondents approved of the promotion of crop-related genomic studies, while 6.7% disapproved. No correlation was found between literacy and attitude towards promotion. Trust in experts, belief in science, an interest in genomic studies and willingness to purchase new products correlated with a positive attitude towards crop-related genomic studies.

e-Health Technologies in Home Care Nursing

The innovative impact of advancing e-Health technologies is more frequently being discussed in nursing science. Nurses play an important role in collecting data and giving support to other users, especially in home care. Since issues of acceptance play a major role, the following article, which presents findings based on a focus group consisting of the elderly, caretaking relatives and professional nurses, is discussed from an ethical point of view in the context of international debate. It is interesting to note, that to some extent there is substantial ambivalence in the willingness to integrate such technologies into daily care. A need for technical assistance is clearly recognizable, however, limits as well. The authors’ findings indicate that a fundamental discussion on the relevance of e-Health methods in professional nursing needs to be held. It should address the ethical questions of often conflicting interests and rights (protection of identity, privacy and safety) in situations of high vulnerability.

Validation of a trust in medical technology instrument

A patient's trusting attitude towards technology used in their medical care may be a predictor of acceptance or rejection of the technology and, by extension, the physician. The aim of this study was to rigorously determine the validity of an instrument for measuring patients' trust in medical technology. Instrument validity was established based on a framework, which included test and data evidence for validity assessment. The framework for validity assessment evaluates the instrument on content, substantive, structural, generalizability, external and consequential aspects of validity. The results of the current study show that the instrument is reliable and valid for assessing a patient's trust in obstetric medical technology.

Public attitudes and beliefs about genetics

The existing research base on public attitudes about genetics shows that people's attitudes vary according to the specific technologies and purposes to which genetic knowledge is applied. Genetic testing is viewed highly favorably, genetically modified food is viewed with ambivalence, and cloning is viewed negatively. Attitudes are favorable for uses that maintain a perceived natural order and unfavorable for uses that are perceived to change it. Public concerns about control of genetic information and eugenics are evident, but their strength and relevance to policy preference are unclear. The pattern of attitudes can be explained by theories of attitude formation, and the existing base of information can be deepened and given more explanatory and predictive power by integrating future research into the various traditions that theorize attitude formation.

Attitudes of social science students in Israel and Austria towards the belated twins scenario--an exploratory study

This article discusses results of a questionnaire survey of 156 university students in Israel and Austria examining reactions towards the Belated Twins scenario, which entails the artificial twinning of embryos of which one is immediately carried to term while the other one is born later. The scenario resembles a case of human reproductive cloning in terms of result (the creation of genetically identical individuals in a time-delayed manner) but it involves gamete fusion like "natural" reproduction. By means of qualitative text analysis we discuss the core themes mobilized both in support and opposition to the scenario. While Israeli and Austrian respondents held similar general attitudes (about half were in favour of legalizing Belated Twins, while about a third opposed it), they drew partly on different arguments to arrive at their conclusions. In both groups, uncertainty stemming from "novel" elements in the scenario was regularly interpreted as negatively exacerbating existing issues.

Validation of the group-based medical mistrust scale among urban black men

BACKGROUND

Socioculturally relevant measures of medical mistrust are needed to better address health disparities, especially among Black men, a group with lower life expectancy and higher death rates compared to other race/gender groups.

OBJECTIVES

The study aim was to investigate the psychometric properties of the Group-Based Medical Mistrust Scale (GBMMS) in a Black male sample.

DESIGN

Data were collected as part of a randomized controlled trial testing educational strategies to support Black men's decisions about prostate cancer screening.

PARTICIPANTS

Participants included 201 Black men ages 40-75 years recruited in New York City during 2006-2007.

MAIN MEASURES

The primary measures included: race-based medical mistrust, health care participation, avoidance of health care, perceived access to health care, health care satisfaction, racial identity, residential racial segregation, attitudes towards prostate cancer screening, and past prostate cancer screening behavior.

KEY RESULTS

An exploratory factor analysis suggested a three-factor structure. Confirmatory factor analysis supported the three-factor model. Internal consistency was high for the total GBMMS and the three sub-scales: Suspicion, Discrimination, and Lack of Support. Construct validity was supported by: significant positive correlations between GBMMS and avoidance of health care and racial identity as well as significant negative correlations with health care access, health care satisfaction, and attitudes about prostate cancer screening. ANOVA showed that the GBMMS was associated with greater residential racial segregation. Higher total GBMMS scores were associated with not visiting a physician in the last year and not having a regular physician.

CONCLUSIONS

The present findings provide strong additional evidence that the GBMMS is a valid and reliable measure that may be used among urban Black men.

Microneedles in clinical practice--an exploratory study into the opinions of healthcare professionals and the public

PURPOSE

Microneedles are being developed to administer vaccines and therapeutics to and through skin. To date there has been no qualitative or quantitative research into public and health professionals' views on this new delivery technique.

METHODS

Focus groups (n=7) comprising public and healthcare professionals were convened to capture the perceived advantages for, and concerns with, microneedles. Discussions were audio-recorded and transcribed. Transcript analysis identified themes that were explored using a questionnaire identifying consensus or otherwise.

RESULTS

Participants identified many potential benefits of the microneedle delivery system, including reduced pain, tissue damage and risk of transmitting infections compared with conventional injections, as well as potential for self-administration (subject to safeguards such as an indicator to confirm dose delivery). Delayed onset, cost, accurate and reliable dosing and the potential for misuse were raised as concerns. A range of potential clinical applications was suggested. The public (100%) and professional (74%) participants were positive overall about microneedle technology.

CONCLUSIONS

This exploratory research study captured the views of the eventual end-users of microneedle technology. Microneedle researchers should now reflect on their research and development activities in the context of stakeholder engagement in order to facilitate the transfer of this new technology 'from bench to bedside.'

Predictors of parental interest in continuous glucose monitoring for children with type 1 diabetes

BACKGROUND

Optimal control of type 1 diabetes (T1D) in children minimizes long-term complications, but increases hypoglycemic events. A continuous glucose monitor (CGM) can provide real-time information about glucose levels and trends. Little has been published on the characteristics of patients most willing to use CGM.

METHODS

Online survey software was utilized to administer a 50-item questionnaire to parents of children with T1D. The primary outcome was whether the parent expressed a high level of interest in CGM. The proportion of parents who expressed a high level of interest was compared across demographic and clinical variables via chi(2) tests (alpha = 0.05).

RESULTS

Analysis was performed on 457 surveys. The mean +/- SD age of the children was 10 +/- 4.1 years. Mean reported hemoglobin A1c (HbA1c) was 7.8 +/- 1.3%. Of the respondents, 70% used continuous subcutaneous insulin infusion (CSII). Parents reported an average of eight blood glucose (BG) checks daily. Over 90% of the parents indicated a high level of interest in having their child use a CGM. Primary variables related to interest in a CGM were use of CSII (P = 0.002), checking BG more than six times daily (P = 0.005), and parental worry about high or low BG (P = 0.0012 and P = 0.02, respectively). Age of the child and HbA1c were not related to parental interest in a CGM.

CONCLUSIONS

Overall parental interest in CGM was high. Use of CSII, frequent BG checks, and parental worry, but not age of the child or diabetes control, were associated with parental interest in using a CGM.

Fostering deliberations about health innovation: what do we want to know from publics?

As more complex and uncertain forms of health innovation keep emerging, scholars are increasingly voicing arguments in favour of public involvement in health innovation policy. The current conceptualization of this involvement is, however, somewhat problematic as it tends to assume that scientific facts form a "hard," indisputable core around which "soft," relative values can be attached. This paper, by giving precedence to epistemological issues, explores what there is to know from public involvement. We argue that knowledge and normative assumptions are co-constitutive of each other and pivotal to the ways in which both experts and non-experts reason about health innovations. Because knowledge and normative assumptions are different but interrelated ways of reasoning, public involvement initiatives need to emphasise deliberative processes that maximise mutual learning within and across various groups of both experts and non-experts (who, we argue, all belong to the "publics"). Hence, we believe that what researchers might wish to know from publics is how their reasoning is anchored in normative assumptions (what makes a given innovation desirable?) and in knowledge about the plausibility of their effects (are they likely to be realised?). Accordingly, one sensible goal of greater public involvement in health innovation policy would be to refine normative assumptions and make their articulation with scientific observations explicit and openly contestable. The paper concludes that we must differentiate between normative assumptions and knowledge, rather than set up a dichotomy between them or confound them.

Trust relations in a changing health service

Objective:

Trust in health care is an important policy area although research has tended to focus on interpersonal trust between patient and practitioner and has neglected trust relations at the organizational and institutional levels. Each of these levels of trust may have been influenced by recent policy and organizational changes in the NHS as well as wider cultural changes. Our aim was to explore the relationship between patients, practitioners and managers to identify if there was any evidence of changes in trust relations.

Method:

A comparative case study design in two different clinical and organizational settings.

Results:

Trust is still important for effective therapeutic and working relationships but the nature of that trust and how it is lost and won appears to be affected by the organizational context in which health services are delivered. The increasing partnership between patients and clinicians in managing health problems and the greater interdependence of clinicians and managers in providing multidisciplinary shared care have changed how patients, clinicians and managers trust each other. For many informants trust can no longer be assumed, it is conditional and has to be earned. However, the sources of trust are the quality of the patient- clinician interaction, the competence and empathy that is displayed rather than informed trust based on abstract disembodied data. Likewise in inter-practitioner relationships and clinician-manager relations trust no longer appears to be primarily based on professional status and seniority, instead it appears to be conditional and may be earned through a variety of strategies that demonstrate honesty, reliability, competence, accessibility and an indication that colleagues share similar values and have a common agenda.

Conclusion:

Trust is still important for effective therapeutic and working relationships.

Relationship between public attitudes toward genomic studies related to medicine and their level of genomic literacy in Japan

The aim of this study was to assess public attitudes toward the promotion of genomic studies related to medicine and to examine the relationship between public attitudes and the level of genomic literacy by analyzing data from a nationwide opinion survey. The participants comprised 4,000 people (age, 20-69) selected from the Japanese general population by using the two-step stratified random sampling method. They were queried on the following topics in a mail survey: (1) pros and cons of the promotion of genomic studies related to medicine, (2) level of scientific literacy in genomics, (3) demographic and socioeconomic background, and (4) knowledge and attitudes toward science in general and genetic testing in particular. We examined the relationship between the approval of promotion and literacy level, using logistic regression models stratified by gender. Our results showed the response rate was 54.3% (2,171/4,000), and 69.4% participants favored the promotion of genomic studies related to medicine. Only 1.3% participants expressed a negative attitude. Multivariate analysis revealed that approval of promotion was related to a high literacy score. This relationship was stronger in males than in females (the highest quartile of score vs. the lowest: adjusted odds ratio, 3.36 for males and 1.86 for females; 95% confidence interval, 1.88-5.98 for males and 1.17-2.95 for females). We determined that a majority of the Japanese participants currently approved of the promotion of genomic studies related to medicine and that people with a high level of genomic literacy tended to approve the promotion.

Ciência, tecnologia e inovação em saúde e desenvolvimento social e qualidade de vida: teses para debate

Este texto apresenta algumas teses importantes para o desenvolvimento da ciência e tecnologia em saúde, a serem discutidas na 13ª Conferência Nacional de Saúde. Nele foram analisados, com base na literatura, os fatores e processos que determinaram os padrões atuais de produção, incorporação e avaliação de tecnologias nos sistemas de serviços de saúde, que se inserem no contexto de medicalização das sociedades contemporâneas. Foram analisadas também as políticas públicas científicas e tecnológicas e de saúde propostas nos anos 90 nos países desenvolvidos e em desenvolvimento para aumentar o impacto do desenvolvimento científico e tecnológico sobre a saúde das populações. Foram identificadas as dificuldades que essas políticas enfrentam para alcançar o impacto desejado, e os desafios a serem superados no século XXI.

Attitudes towards human reproductive cloning, assisted reproduction and gene selection: a survey of 4600 British twins

BACKGROUND

Surveys have shown opposition to human reproductive cloning (HRC) in many countries. Views of identical (monozygotic, MZ) twins are of particular interest, as they naturally share 100% of their genes. We investigated attitudes of British twins towards HRC in the context of assisted reproduction technologies (ART) and gene selection.

METHODS

About 4651 identical and non-identical (dizygotic, DZ) twins expressed their degree of agreement or disagreement to nine statements relating to ART, gene selection and HRC in a self-completion questionnaire.

RESULTS

Most subjects (70% and 78% respectively) did not regard the use of medical technologies to treat infertility as interfering with either nature or God's will, despite believing that infertility is not a disease (54%). Attitudes to gene selection and HRC were context dependent, with more favourable views towards preventing serious diseases than towards enhancing traits. About 44% supported a permanent ban of HRC. MZ twins were significantly more likely to agree that HRC should be allowed for medical purposes, such as saving a sibling's life, than were DZ twins. Increasing religiosity generally correlated with more negative attitudes.

CONCLUSIONS

Many attitudes are context dependent. More positive views of MZ twins towards HRC could be linked to their experience with being genetically identical.

Towards an understanding of British public attitudes concerning human cloning

The ability of scientists to apply cloning technology to humans has provoked public discussion and media coverage. The present paper reports on a series of studies examining public attitudes to human cloning in the UK, bringing together a range of quantitative and qualitative methods to address this question. These included a nationally representative survey, an experimental vignette study, focus groups and analyses of media coverage. Overall the research presents a complex picture of attitude to and constructions of human cloning. In all of the analyses, therapeutic cloning was viewed more favourably than reproductive cloning. However, while participants in the focus groups were generally negative about both forms of cloning, and this was also reflected in the media analyses, quantitative results showed more positive responses. In the quantitative research, therapeutic cloning was generally accepted when the benefits of such procedures were clear, and although reproductive cloning was less accepted there was still substantial support. Participants in the focus groups only differentiated between therapeutic and reproductive cloning after the issue of therapeutic cloning was explicitly raised; initially they saw cloning as being reproductive cloning and saw no real benefits. Attitudes were shown to be associated with underlying values associated with scientific progress rather than with age, gender or education, and although there were a few differences in the quantitative data based on religious affiliation, these tended to be small effects. Likewise in the focus groups there was little direct appeal to religion, but the main themes were 'interfering with nature' and the 'status of the embryo', with the latter being used more effectively to try to close down further discussion. In general there was a close correspondence between the media analysis and focus group responses, possibly demonstrating the importance of media as a resource, or that the media reflect public discourse accurately. However, focus group responses did not simply reflect media coverage.

Illness action rediscovered: a case study of upper limb pain

Theoretical frameworks provide generalised accounts of illness action although empirical studies of the process are still in short supply. This study of upper limb pain provided a case study of illness action; as it is a common condition, there is uncertainty about its treatment and management, orthodox and non-orthodox care are seen as legitimate sources of help and it is linked with a range of causes. Face-to-face informal interviews were carried out with 47 informants with upper limb pain and their practitioners (n= 19). The data were analysed in two different ways. The general stages of the illness action process were identified through a descriptive analysis of the upper limb pain sufferers' accounts and the policies and practices reported by their practitioners. Then, case studies were constructed to depict individual pathways through healthcare and consequences for sufferers. The illness action process was characterised by the normalisation and accommodation of pain informed by a discourse that predominantly invoked ageing and the wear and tear of the body. Practitioners also preferred to adopt a biomechanical approach and were reluctant to attribute psychosocial labels. The case studies illustrated the divergent, negotiated and opportunistic nature of the process and showed that the use of both orthodox and non-orthodox care formed only part of strategies used to manage upper limb pain. Sufferers evaluated the care they received in terms of pain alleviation, and were resigned to searching for the best way of living with their pain.

[From production to evaluation of health systems technologies: challenges for the 21st century]

The study analyzes factors and processes identified in the literature that determine the patterns of production, use and assessment of the health care technologies, which are part of the "medicalization" of contemporary societies. We also evaluate the scientific and technological public and health care policies proposed during the 1990s in developed and developing countries to enhance the impact of scientific and technological development on population health. Problems facing these policies were identified, as were the challenges to be overcome in the twenty-first century.

What choices should we be able to make about designer babies? A Citizens' Jury of young people in South Wales

BACKGROUND

Young people will increasingly have the option of using new technologies for reproductive decision making but their voices are rarely heard in debates about acceptable public policy in this area. Capturing the views of young people about potentially esoteric topics, such as genetics, is difficult and methodologically challenging.

DESIGN

A Citizens' Jury is a deliberative process that presents a question to a group of ordinary people, allows them to examine evidence given by expert witnesses and personal testimonies and arrive at a verdict. This Citizens' Jury explored designer babies in relation to inherited conditions, saviour siblings and sex selection with young people.

PARTICIPANTS

Fourteen young people aged 16-19 in Wales.

RESULTS

Acceptance of designer baby technology was purpose-specific; it was perceived by participants to be acceptable for preventing inherited conditions and to create a child to save a sibling, but was not recommended for sex selection. Jurors stated that permission should not depend on parents' age, although some measure of suitability should be assessed. Preventing potential parents from going abroad was considered impractical. These young people felt the Human Fertilisation and Embryology Authority should have members under 20 and that the term 'designer baby' was not useful.

CONCLUSIONS

Perspectives on the acceptability of this technology were nuanced, and based on implicit value judgements about the extent of individual benefit derived. Young people have valuable and interesting contributions to make to the debate about genetics and reproductive decision making and a variety of innovative methods must be used to secure their involvement in decision-making processes.

Researching trust relations in health care: conceptual and methodological challenges--introduction

PURPOSE

The aim of this paper is to provide a rationale for examining trust in health care.

DESIGN/METHODOLOGY/APPROACH

Conducts a review of the literature of trust relations in health care that highlighted that most empirical research has addressed threats to patient-provider relationships and trust in health care systems from the patient's perspective, but studies in the organisational literature suggests that trust relations in the workforce, between providers and between providers and managers, may also influence patient-provider relationships and levels of trust.

FINDINGS

Suggests that trust is not primarily dispositional or an individual attribute or psychological state, but is constructed from a set of inter-personal behaviors or from a shared identity. These behaviors are underpinned by sets of institutional rules, laws and customs.

RESEARCH LIMITATIONS/IMPLICATIONS

This introductory paper has presented some evidence from an international, comparative study but there is the need for further, more detailed investigation into why trust relations may vary in different health care systems.

ORIGINALITY/VALUE

This introductory paper provides a rationale for examining trust in health care and a context for the different elements of trust.

Twins: A cloning experience

Drawing upon qualitative interviews with monozygotic (identical) twins sharing 100% of their genes, and with dizygotic (fraternal) twins and singletons as control groups, this paper explores what it means to be genetically identical. (The twins interviewed were from the TwinsUK register in London.) In the context of the ongoing debate on human reproductive cloning, it examines questions such as: To what extent do identical twins perceive their emotional and physical bond to be a result of their genetic makeup? What would they think if they had been deliberately created genetically identical? How would they feel about being genetically identical to a person who was born a few years earlier or later? First, our respondents ascribed no great significance to the role of genes in their understanding of what it means to be identical twins. Second, the opinion that human reproductive cloning would "interfere with nature", or "contradict God's will", was expressed by our respondents exclusively on the abstract level. The more our respondents were able to relate a particular invented cloning scenario to their own life-worlds, the lower the prevalence of the argument. Third, for all three groups of respondents, the scenario of having been born in one of the other groups was perceived as strange. Fourth, the aspect that our respondents disliked about cloning scenarios was the potential motives of the cloners. Without equating monozygotic twins directly with "clones", these results from "naturally" genetically identical individuals add a new dimension to what a future cloning situation could entail: The cloned person might possibly (a) perceive a close physical and emotional connection to the progenitor as a blessing; (b) suffer from preconceptions of people who regard physical likeness as a sign of incomplete individuality; and (c) perceive the idea of not having been born a clone of a particular person as unpleasant.

'Medicine's next goldmine?' The implications of new genetic health technologies for the health service

There is considerable uncertainty about the implications of the new genetics for health services. These are the enthusiasts who argue that molecular genetics will transform health care and others argue that the scope for genetic interventions is limited. The aim of this paper is to examine some of the questions, tensions and difficulties which face health care providers particularly in developed countries as they try to come to terms with the dilemmas raised by new genetic health care technologies (NGHTs). It identifies questions for research which may help the development of robust and flexible strategies for implementation.