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Hakim H, Driedger SM, Gagnon D, Chevrier J, Roch G, Dubé E, Witteman HO. Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review. JMIR Serious Games 2024; 12:e47257. [PMID: 38421688 PMCID: PMC10906656 DOI: 10.2196/47257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. OBJECTIVE In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. METHODS We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. RESULTS Of 1402 records, we included 28 (2%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25%) explained the development of the tool, 16 (57%) described evaluation, and 2 (7%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44%) were web-based tools, 8 (32%) mobile (native mobile or mobile-enabled web) apps, and 6 (24%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. CONCLUSIONS Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dominique Gagnon
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Julien Chevrier
- Bibliothèque Louise-Lalonde-Lamarre, Polytechnique Montréal, Montréal, QC, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
| | - Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
- Département d'anthropologie, Université Laval, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Malik AA, Ahmed N, Shafiq M, Elharake JA, James E, Nyhan K, Paintsil E, Melchinger HC, Team YBI, Malik FA, Omer SB. Behavioral interventions for vaccination uptake: A systematic review and meta-analysis. Health Policy 2023; 137:104894. [PMID: 37714082 PMCID: PMC10885629 DOI: 10.1016/j.healthpol.2023.104894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/22/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries. METHODS We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately. FINDINGS Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes. INTERPRETATION Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.
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Affiliation(s)
- Amyn A Malik
- Yale Institute for Global Health, New Haven, CT 06510, USA; Analysis Group, Inc, Boston, MA 02199, USA
| | - Noureen Ahmed
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Mehr Shafiq
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University School of Public Health, New York, NY 10032, USA
| | - Jad A Elharake
- Yale Institute for Global Health, New Haven, CT 06510, USA; UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA; The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Erin James
- Yale Institute for Global Health, New Haven, CT 06510, USA
| | - Kate Nyhan
- Yale University, New Haven, CT 06510, USA
| | - Elliott Paintsil
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University Institute of Human Nutrition, New York, NY 10032, USA
| | | | | | - Fauzia A Malik
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Saad B Omer
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA.
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Bekker HL, Winterbottom AE, Gavaruzzi T, Finderup J, Mooney A. Decision aids to assist patients and professionals in choosing the right treatment for kidney failure. Clin Kidney J 2023; 16:i20-i38. [PMID: 37711634 PMCID: PMC10497379 DOI: 10.1093/ckj/sfad172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 09/16/2023] Open
Abstract
Background Kidney services vary in the way they involve people with kidney failure (PwKF) in treatment decisions as management needs change. We discuss how decision-science applications support proactively PwKF to make informed decisions between treatment options with kidney professionals. Methods A conceptual review of findings about decision making and use of decision aids in kidney services, synthesized with reference to: the Making Informed Decisions-Individually and Together (MIND-IT) multiple stakeholder decision makers framework; and the Medical Research Council-Complex Intervention Development and Evaluation research framework. Results This schema represents the different types of decision aids that support PwKF and professional reasoning as they manage kidney disease individually and together; adjustments at micro, meso and macro levels supports integration in practice. Conclusion Innovating services to meet clinical guidelines on enhancing shared decision making processes means enabling all stakeholders to use decision aids to meet their goals within kidney pathways at individual, service and organizational levels.
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Affiliation(s)
- Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Department of Public Health, Aarhus University, Denmark
- ResCenPI – Research Centre for Patient Involvement, Aarhus University, Aarhus and the Central Denmark Region, Denmark
| | - Anna E Winterbottom
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Renal Unit, St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
| | - Teresa Gavaruzzi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Jeanette Finderup
- ResCenPI – Research Centre for Patient Involvement, Aarhus University, Aarhus and the Central Denmark Region, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrew Mooney
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Renal Unit, St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
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Hilton Z, Hoq M, Danchin M, Kaufman J. Reducing COVID-19 Vaccine Decisional Conflict in Parents of 5-11-Year-Old Children in Australia: A Single Arm Pre-Post Study. Vaccines (Basel) 2023; 11:1296. [PMID: 37631864 PMCID: PMC10458235 DOI: 10.3390/vaccines11081296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/27/2023] Open
Abstract
COVID-19 vaccine uptake among 5-11-year-olds is significantly lower than that of the 12+ age group. Some parents may have decided against vaccinating their children for COVID-19; others may be undecided and may be seeking more information to support their decision. We aimed to assess the effect of a decision support tool on parents' level of decisional conflict, vaccine hesitancy, and intention to vaccinate. We conducted a single-arm, cross-sectional online pre-post intervention survey of parents from Victoria, Australia, who had not yet vaccinated their 5-11-year-old child for COVID-19. We measured change in decisional conflict, intention, and hesitancy towards COVID-19 vaccines for children before and after viewing a decision support tool. We used logistic regression to identify characteristics associated with reduced decisional conflict. Between May and September 2022, 108 parents took part in the study. The tool reduced decision conflict in 25% (27/107) of parents, with reduced decisional conflict more likely among parents initially undecided about vaccinating, compared to parents who did not intend to vaccinate their child (OR, 12.58 95% CI 3.21 to 9.30). For most parents, hesitancy (83%, 90/108) and intention (89%, 96/108) remained the same. The decision support tool was modestly effective at reducing decisional conflict, particularly among undecided parents.
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Affiliation(s)
- Zephaniah Hilton
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Parkville 3052, Australia (M.D.); (J.K.)
| | - Monsurul Hoq
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Parkville 3052, Australia (M.D.); (J.K.)
- The National Child Health Poll, The Royal Children’s Hospital, Parkville 3052, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne 3052, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Parkville 3052, Australia (M.D.); (J.K.)
- Department of General Medicine, The Royal Children’s Hospital, Parkville 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
| | - Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Parkville 3052, Australia (M.D.); (J.K.)
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
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Thorpe A, Delaney RK, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Fagerlin A. Parents' Psychological and Decision-Making Outcomes following Prenatal Diagnosis with Complex Congenital Heart Defect: An Exploratory Study. MDM Policy Pract 2023; 8:23814683231204551. [PMID: 37920604 PMCID: PMC10619352 DOI: 10.1177/23814683231204551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/24/2023] [Indexed: 11/04/2023] Open
Abstract
Background. Parents with a fetus diagnosed with a complex congenital heart defect (CHD) are at high risk of negative psychological outcomes. Purpose. To explore whether parents' psychological and decision-making outcomes differed based on their treatment decision and fetus/neonate survival status. Methods. We prospectively enrolled parents with a fetus diagnosed with a complex, life-threatening CHD from September 2018 to December 2020. We tested whether parents' psychological and decision-making outcomes 3 months posttreatment differed by treatment choice and survival status. Results. Our sample included 23 parents (average Age[years]: 27 ± 4, range = 21-37). Most were women (n = 18), non-Hispanic White (n = 20), and married (n = 21). Most parents chose surgery (n = 16), with 11 children surviving to the time of the survey; remaining parents (n = 7) chose comfort-directed care. Parents who chose comfort-directed care reported higher distress (x ¯ = 1.51, s = 0.75 v. x ¯ = 0.74, s = 0.55; Mdifference = 0.77, 95% confidence interval [CI], 0.05-1.48) and perinatal grief (x ¯ = 91.86, s = 22.96 v. x ¯ = 63.38, s = 20.15; Mdifference = 27.18, 95% CI, 6.20-48.16) than parents who chose surgery, regardless of survival status. Parents who chose comfort-directed care reported higher depression (x ¯ = 1.64, s = 0.95 v. x ¯ = 0.65, s = 0.49; Mdifference = 0.99, 95% CI, 0.10-1.88) than parents whose child survived following surgery. Parents choosing comfort-directed care reported higher regret (x ¯ = 26.43, s = 8.02 v. x ¯ = 5.00, s = 7.07; Mdifference = 21.43, 95% CI, 11.59-31.27) and decisional conflict (x ¯ = 20.98, s = 10.00 v. x ¯ = 3.44, s = 4.74; Mdifference = 17.54, 95% CI; 7.75-27.34) than parents whose child had not survived following surgery. Parents whose child survived following surgery reported lower grief (Mdifference = -19.71; 95% CI, -39.41 to -0.01) than parents whose child had not. Conclusions. The results highlight the potential for interventions and care tailored to parents' treatment decisions and outcomes to support parental coping and well-being. Highlights Question: Do the psychological and decision-making outcomes of parents differ based on their treatment decision and survival outcome following prenatal diagnosis with complex CHD?Findings: In this exploratory study, parents who decided to pursue comfort-directed care after a prenatal diagnosis reported higher levels of psychological distress and grief as well as higher decisional conflict and regret than parents who decided to pursue surgery.Meaning: The findings from this exploratory study highlight potential differences in parents' psychological and decision-making outcomes following a diagnosis of complex CHD for their fetus, which appear to relate to the treatment approach and the treatment outcome and may require tailoring of psychological and decision support.
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Affiliation(s)
- Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Applied Health Research, University College London, London, UK
| | - Rebecca K. Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Nelangi M. Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Division of Pediatric Cardiology at Seattle Children’s Hospital, Seattle, WA, USA
| | - Elissa M. Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mandy L. Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Lisa M. Hansen
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Linda M. Lambert
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation
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Terrell R, Alami A, Krewski D. Interventions for COVID-19 Vaccine Hesitancy: A Systematic Review and Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6082. [PMID: 37372669 PMCID: PMC10298220 DOI: 10.3390/ijerph20126082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Vaccines effectively protect against COVID-19, but vaccine hesitancy and refusal hinder vaccination rates. This systematic review aimed to (1) review and describe current interventions for addressing COVID-19 vaccine hesitancy/refusal and (2) assess whether these interventions are effective for increasing vaccine uptake. The protocol was registered prospectively on PROSPERO and comprehensive search included Medline, Embase, CINAHL, PsycInfo, and Web of Science databases. Only studies that evaluated the effectiveness of non-financial interventions to address COVID-19 vaccine hesitancy were included, while those focusing intentions or financial incentive were excluded. Risk of bias for all included studies was evaluated using Cochrane risk of bias tools. In total, six articles were included in the review (total participants n = 200,720). A narrative synthesis was performed due to the absence of common quantitative metrics. Except for one randomized controlled trial, all studies reported that interventions were effective, increasing COVID-19 vaccination rates. However, non-randomized studies were subject to confounding biases. Evidence on the effectiveness of COVID-19 vaccine hesitancy interventions remains limited and further evidence is needed for the development of clear guidance on effective interventions to increase vaccine uptake.
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Affiliation(s)
- Rowan Terrell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1S 5B6, Canada
| | - Abdallah Alami
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1S 5B6, Canada
| | - Daniel Krewski
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1S 5B6, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
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Gendler Y. Development and Appraisal of a Web-Based Decision Aid for HPV Vaccination for Young Adults and Parents of Children in Israel-A Quasi-Experimental Study. Vaccines (Basel) 2023; 11:1038. [PMID: 37376426 DOI: 10.3390/vaccines11061038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND This study aimed to develop and evaluate the effectiveness of two web-based decision aids designed to help parents of children aged 10-17 years and young adults aged 18-26 years make informed decisions about the HPV vaccine. METHODS The decision aids were developed according to the International Patient Decision Aid Standards (IPDAS) criteria and included information about the vaccine, probabilities of benefits and side effects, personal narratives, and values clarification. The study utilized a quasi-experimental design and included 120 Hebrew-speaking parents and 160 young adults. Participants completed baseline surveys and, two weeks after using the decision aid, completed a follow-up survey. RESULTS Both parents and young adults experienced a reduction in decisional conflict, an increase in self-efficacy, and greater confidence in the safety and effectiveness of the vaccine. The proportion of participating parents deciding to vaccinate their children against HPV increased from 46% to 75%, and the proportion of participating young adults leaning towards receiving the HPV vaccine increased from 64% to 92%. CONCLUSIONS The study highlights the importance of using decision aids to support informed decision making about vaccination and suggests that web-based decision aids may be a useful tool for supporting Israeli parents and young adults to make HPV vaccination decisions.
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Affiliation(s)
- Yulia Gendler
- The Department of Nursing, School of Health Sciences, Ariel University, Ariel 40700, Israel
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Wang Y, Fekadu G, You JHS. Cost-Effectiveness Analyses of Digital Health Technology for Improving the Uptake of Vaccination Programs: Systematic Review. J Med Internet Res 2023; 25:e45493. [PMID: 37184916 DOI: 10.2196/45493] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Vaccination is the most effective strategy to prevent infectious diseases, yet vaccination coverage has not reached the target level. To promote vaccination uptake, digital health interventions (DHIs) have been used in various vaccination programs. OBJECTIVE This study aimed to perform a systematic review of the cost-effectiveness analyses of DHIs for the improvement of the uptake of vaccination programs. METHODS A literature review was conducted in MEDLINE (Ovid), Embase (Ovid), APA PsycINFO (Ovid), Web of Science, Scopus, CINAHL Ultimate (EBSCOhost), Center for Review and Dissemination, and Institute for IEEE Xplore up to October 2022. Health economic evaluations that met the following inclusion criteria were included: (1) adult or pediatric vaccination programs; (2) interventions delivered through digital technology; (3) full-scale health economic analyses including cost-effectiveness, cost-utility, cost-benefit, or cost-consequence analyses; and (4) evaluations conducted by model-based or trial-based analyses. The quality of each included study was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). RESULTS The systematic review included 7 studies. Four of the cost-effectiveness studies were conducted by model-based analyses, and 3 were trial-based analyses. One study reported the additional cost per quality-adjusted life years (QALYs) gained, whereas 6 studies reported the additional cost per individual vaccinated (or return case). The vaccines targeted the human papillomavirus (HPV) vaccine, influenza vaccination, measles-mumps-rubella (MMR) vaccine, and children immunization at different ages. The DHIs were delivered by television campaign, web-based decision aid, SMS text message, telephone, and computer-generated recall letters. The studies were classified as very good (n=5) and good (n=2) qualities. One study concluded that the DHI was cost-saving, and 6 studies concluded that the DHI was cost-effective. CONCLUSIONS This study is the first systematic review on cost-effectiveness analyses of DHIs to improve vaccination uptake. All included studies have good to very good quality on study assessment and reported the DHIs to be cost-saving or cost-effective in the improvement of vaccination uptake.
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Affiliation(s)
- Yingcheng Wang
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, China (Hong Kong)
| | - Ginenus Fekadu
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, China (Hong Kong)
| | - Joyce Hoi-Sze You
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, China (Hong Kong)
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Allen JD, Matsunaga M, Lim E, Zimet GD, Nguyen KH, Fontenot HB. Parental Decision Making Regarding COVID-19 Vaccines for Children under Age 5: Does Decision Self-Efficacy Play a Role? Vaccines (Basel) 2023; 11:478. [PMID: 36851355 PMCID: PMC9959902 DOI: 10.3390/vaccines11020478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND COVID-19 vaccines are now available under Emergency Use Authorization for children ages 6 months to 5 years. We examined parents' intentions to vaccinate their children under the age of 5 years and assessed whether their confidence in making an informed decision about vaccination (decision self-efficacy) was associated with these intentions. METHOD We conducted a cross-sectional online survey of U.S. parents between 23 March and 5 April 2022. We examined associations between parental intention to vaccinate their young children ( RESULTS Of the 591 parents in this sample, 49% indicated that they intended to vaccinate their child(ren), 29% reported that they would not, and 21% were undecided. In bivariate analyses, race/ethnicity, health insurance, flu vaccination in the past 12 months, and parental COVID-19 vaccination status were significantly related to parental intention to vaccinate their child(ren). In the multivariable analyses, which controlled for these factors, parents who intended to vaccinate their child(ren) had greater confidence in their ability to make informed decisions about COVID-19 vaccinations compared to those who were unsure about vaccination. Each one standard deviation in the Decision Self-Efficacy score was associated with a 39% increase in intention to vaccinate one's child versus being unsure about vaccination (AOR 1.39, 95% CI 1.09, 1.77). CONCLUSIONS Parents who are unsure about vaccinating their children against COVID-19 may benefit from interventions designed to increase their ability to obtain, understand, and utilize information to make informed decisions.
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Affiliation(s)
- Jennifer D. Allen
- Department of Community Health, Tufts University School of Arts and Sciences, 574 Boston Ave, Medford, MA 02155, USA
| | - Masako Matsunaga
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
| | - Eunjung Lim
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Suite 1001, Indianapolis, IN 46202, USA
| | - Kimberly H. Nguyen
- Department of Public Health and Community Medicine, Tufts University Medical School, 136 Harrison Ave, Boston, MA 02111, USA
| | - Holly B. Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster Hall, Honolulu, HI 96822, USA
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11
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Düzgün MV, İşler Dalgıç A. The Effect of Interventions on the Prevention of Parental Vaccine Refusal and Hesitancy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. GÜNCEL PEDIATRI 2022. [DOI: 10.4274/jcp.2022.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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McCulloh RJ, Darden PM, Snowden J, Ounpraseuth S, Lee J, Clarke M, Newcomer SR, Fu L, Hubberd D, Baldner J, Garza M, Kerns E. Improving pediatric COVID-19 vaccine uptake using an mHealth tool (MoVeUp): study protocol for a randomized, controlled trial. Trials 2022; 23:911. [PMID: 36307830 PMCID: PMC9616622 DOI: 10.1186/s13063-022-06819-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) vaccines demonstrate excellent effectiveness against infection, severe disease, and death. However, pediatric COVID-19 vaccination rates lag among individuals from rural and other medically underserved communities. The research objective of the current protocol is to determine the effectiveness of a vaccine communication mobile health (mHealth) application (app) on parental decisions to vaccinate their children against COVID-19. METHODS Custodial parents/caregivers with ≥ 1 child eligible for COVID-19 vaccination who have not yet received the vaccine will be randomized to download one of two mHealth apps. The intervention app will address logistical and motivational barriers to pediatric COVID-19 vaccination. Participants will receive eight weekly push notifications followed by two monthly push notifications (cues to action) regarding vaccinating their child. Through branching logic, users will access customized content based on their locality, degree of rurality-urbanicity, primary language (English/Spanish), race/ethnicity, and child's age to address COVID-19 vaccine knowledge and confidence gaps. The control app will provide push notifications and information on general pediatric health and infection prevention and mitigation strategies based on recommendations from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). The primary outcome is the proportion of children who complete COVID-19 vaccination series. Secondary outcomes include the proportion of children who receive ≥ 1 dose of COVID-19 vaccine and changes in parent/caregiver scores from baseline to immediately post-intervention on the modified WHO SAGE Vaccine Hesitancy Scale adapted for the COVID-19 vaccine. DISCUSSION The COVID-19 pandemic inflicts disproportionate harm on individuals from underserved communities, including those in rural settings. Maximizing vaccine uptake in these communities will decrease infection rates, severe illness, and death. Given that most US families from these communities use smart phones, mHealth interventions hold the promise of broad uptake. Bundling multiple mHealth vaccine uptake interventions into a single app may maximize the impact of deploying such a tool to increase COVID-19 vaccination. The new knowledge to be gained from this study will directly inform future efforts to increase COVID-19 vaccination rates across diverse settings and provide an evidentiary base for app-based vaccine communication tools that can be adapted to future vaccine-deployment efforts. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov NCT05386355 . Registered on May 23, 2022.
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Affiliation(s)
- Russell J McCulloh
- Children's Hospital & Medical Center, 8200 Dodge St., Omaha, NE, 68114, USA.
| | - Paul M Darden
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Jessica Snowden
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Songthip Ounpraseuth
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Jeannette Lee
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Martina Clarke
- College of Information Science & Technology, University of Nebraska Omaha, 172 Peter Kiewit Institute, 1110 South 67th Street, Omaha, NE, 68182, USA
| | - Sophia R Newcomer
- School of Public Health and Community Health Sciences, University of Montana, Skaggs Building Room 177, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Linda Fu
- Office of the Director, National Institutes of Health, 11601 Landsdown Sreet, Rockville, MD, 20852, USA
| | - DeAnn Hubberd
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Jaime Baldner
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Maryam Garza
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Ellen Kerns
- University of Nebraska Medical Center, 42nd and Emile St., Omaha, NE, 68131, USA
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13
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McCulloh RJ, Darden P, Snowden J, Ounpraseuth S, Lee J, Clarke M, Newcomer SR, Fu L, Hubberd D, Baldner J, Garza M, Kerns E. Improving pediatric COVID-19 vaccine uptake using an mHealth tool (MoVeUP): a randomized, controlled trial. RESEARCH SQUARE 2022:rs.3.rs-2070396. [PMID: 36238712 PMCID: PMC9558439 DOI: 10.21203/rs.3.rs-2070396/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Coronavirus disease 2019 (COVID-19) vaccines demonstrate excellent effectiveness against infection, severe disease, and death. However, pediatric COVID-19 vaccination rates lag among individuals from rural and other medically underserved communities. The research objective of the current protocol is to determine the effectiveness of a vaccine communication mobile health (mHealth) application (app) on parental decisions to vaccinate their children against COVID-19. Methods: Custodial parents/caregivers with ≥1 child eligible for COVID-19 vaccination who have not yet received the vaccine will be randomized to download one of two mHealth apps. The intervention app will address logistical and motivational barriers to pediatric COVID-19 vaccination. Participants will receive eight weekly push notifications followed by two monthly push notifications (cues to action) regarding vaccinating their child. Through branching logic, users will access customized content based on their locality, degree of rurality-urbanicity, primary language (English/Spanish), race/ethnicity, and child's age to address COVID-19 vaccine knowledge and confidence gaps. The control app will provide push notifications and information on general pediatric health and infection prevention and mitigation strategies based on recommendations from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). The primary outcome is the proportion of children who complete COVID-19 vaccination series. Secondary outcomes include the proportion of children who receive ≥1 dose of COVID-19 vaccine and changes in parent/caregiver scores from baseline to immediately post-intervention on the modified WHO SAGE Vaccine Hesitancy Scale adapted for the COVID-19 vaccine. Discussion: The COVID-19 pandemic inflicts disproportionate harm on individuals from underserved communities, including those in rural settings. Maximizing vaccine uptake in these communities will decrease infection rates, severe illness, and death. Given that most US families from these communities use smart phones, mHealth interventions hold the promise of broad uptake. Bundling multiple mHealth vaccine-uptake interventions into a single app may maximize the impact of deploying such a tool to increase COVID-19 vaccination. The new knowledge to be gained from this study will directly inform future efforts to increase COVID-19 vaccination rates across diverse settings and provide an evidentiary base for app-based vaccine communication tools that can be adapted to future vaccine-deployment efforts. Clinical Trials Registration: Name of the registry: clinicaltrials.gov Trial registration number: NCT05386355 Date of registration: May 23, 2022 URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT05386355.
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Aguolu OG, Malik AA, Ahmed N, Omer SB. Overcoming Vaccine Hesitancy for Future COVID-19 and HIV Vaccines: Lessons from Measles and HPV Vaccines. Curr HIV/AIDS Rep 2022; 19:328-343. [PMID: 36114951 PMCID: PMC9483354 DOI: 10.1007/s11904-022-00622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The discovery of vaccines significantly reduced morbidity and mortality of infectious diseases and led to the elimination and eradication of some. Development of safe and effective vaccines is a critical step to the control of infectious diseases; however, there is the need to address vaccine hesitancy because of its potential impact on vaccine uptake. METHODS We conducted a narrative review of studies on interventions to address measles and human papillomavirus vaccine hesitancy. We discussed how lessons learned from these studies could be applied towards COVID-19 and future human immunodeficiency virus vaccines. RESULTS We found that there are several successful approaches to improving vaccine acceptance. Interventions should be context specific and build on the challenges highlighted in various settings. CONCLUSION Strategies could be used alone or in combination with others. The most successful interventions directly targeted the population for vaccination. Use of financial incentives could be a potential tool to improve vaccine uptake.
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Affiliation(s)
- Obianuju G. Aguolu
- Yale Institute for Global Health, Yale University, New Haven, CT USA
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT USA
| | - Amyn A. Malik
- Yale Institute for Global Health, Yale University, New Haven, CT USA
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT USA
| | - Noureen Ahmed
- Yale Institute for Global Health, Yale University, New Haven, CT USA
- Yale School of Public Health, Yale University, New Haven, CT USA
| | - Saad B. Omer
- Yale Institute for Global Health, Yale University, New Haven, CT USA
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT USA
- Yale School of Public Health, Yale University, New Haven, CT USA
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15
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Scalia P, Durand MA, Elwyn G. Shared decision-making interventions: An overview and a meta-analysis of their impact on vaccine uptake. J Intern Med 2022; 291:408-425. [PMID: 34700363 DOI: 10.1111/joim.13405] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The interest in shared decision making (SDM) and the use of patient decision aids have increased significantly. Research indicates that this approach has benefits, and yet, implementation remains a challenge. To illustrate this development, we focus on vaccine hesitancy which has become a serious public health challenge during the COVID-19 pandemic. Various strategies have been used in healthcare, with limited success, to help patients overcome vaccine hesitancy. It is unclear whether SDM interventions can increase vaccination rates. AIMS Our aim was two-fold: to provide an overview of SDM and the use of patient decision aids and to determine the effect of SDM interventions on vaccine uptake. METHODS To provide an overview, we drew on our knowledge of the field and summarized the most recent systematic reviews. We examined the impact on vaccine hesitancy by searching for randomized controlled trials (RCTs) of SDM interventions, conducted a meta-analysis and calculated a pooled odds ratio. Additional outcomes were reported in a narrative synthesis. RESULTS SDM is viewed as the pinnacle of patient-centred care, supported by an ethical imperative and by empirical evidence of benefits. We found 10 RCTs that met our inclusion criteria. SDM interventions significantly increased vaccine uptake compared to control groups (odds ratio = 1.45; 95% confidence interval [1.17-1.80]; p < 0.01). Some RCTs also reported significantly decreased decisional conflict and increased decision confidence. CONCLUSION Future healthcare delivery systems will need to consider how to support the implementation of SDM. Interventions designed to facilitate this approach can represent a helpful, ethically defensible, strategy to increase vaccination rates.
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Affiliation(s)
- P Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - M-A Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.,Unité mixte de recherché, Centre d'Épidémiologie et de Recherche en santé des Populations, Université de Toulouse, Toulouse, France.,Institut national de la santé et de la recherche médicale, Université Paul Sabatier Toulouse III, Toulouse, France.,Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland
| | - G Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
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16
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Vanderpool RC, Gaysynsky A, Chou WYS, Tonorezos ES. Using Behavioral Science to Address COVID-19 Vaccine Hesitancy Among Cancer Survivors: Communication Strategies and Research Opportunities. J Behav Med 2022; 46:366-376. [PMID: 35305205 PMCID: PMC8933612 DOI: 10.1007/s10865-022-00304-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
Due to cancer survivors’ increased vulnerability to complications from COVID-19, addressing vaccine hesitancy and improving vaccine uptake among this population is a public health priority. However, several factors may complicate efforts to increase vaccine confidence in this population, including the underrepresentation of cancer patients in COVID-19 vaccine trials and distinct recommendations for vaccine administration and timing for certain subgroups of survivors. Evidence suggests vaccine communication efforts targeting survivors could benefit from strategies that consider factors such as social norms, risk perceptions, and trust. However, additional behavioral research is needed to help the clinical and public health community better understand, and more effectively respond to, drivers of vaccine hesitancy among survivors and ensure optimal protection against COVID-19 for this at-risk population. Knowledge generated by this research could also have an impact beyond the current COVID-19 pandemic by informing future vaccination efforts and communication with cancer survivors more broadly.
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Affiliation(s)
- Robin C Vanderpool
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 20850, Rockville, MD, USA.
| | - Anna Gaysynsky
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 20850, Rockville, MD, USA.,ICF Next, Rockville, MD, USA
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 20850, Rockville, MD, USA
| | - Emily S Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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17
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Vujovich-Dunn C, Kaufman J, King C, Skinner SR, Wand H, Guy R, Leask J. A systematic review and meta-analysis of effectiveness of decision aids for vaccination decision-making. Vaccine 2021; 39:3655-3665. [PMID: 34052064 DOI: 10.1016/j.vaccine.2021.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to assess the effectiveness of vaccination decision aids compared with usual care on vaccine uptake, vaccine attitudes, decisional conflict, intent to vaccinate and timeliness. METHODS Searches were conducted in OVID Medline, OVID Embase, CINAHL, PsycINFO, the Cochrane Library and SCOPUS. Randomised controlled trials were included if they evaluated the impact of decision aids as defined by the International Patient Decision Aids Standards Collaboration. Where possible, meta-analysis was undertaken. Where meta-analysis was not possible, we conducted a narrative synthesis. Risk of bias in included trials was assessed using the Cochrane Collaboration's risk of bias tool. Data were analysed using STATA. RESULTS Five RCTs were identified that evaluated the effectiveness of decision aids in the context of vaccination decision making. Meta-analysis of four studies showed that decision aids may have slightly increased vaccination uptake, but this was reduced to no effect once studies with higher risk of bias were excluded. Meta-analysis of three studies showed that decision aids moderately increased intention to vaccinate. Narrative synthesis of two studies suggested that decision aids reduced decisional conflict. One study reported that decision aids decreased perceived risk of vaccination. Content, format and delivery method of the decision aids varied across the studies. It was not clear from the information reported whether these variations affected the effectiveness of the decision aids. CONCLUSION Decision aids can assist in vaccine decision making. Future studies of decision aids could provide greater detail of the decision aids themselves, which would enable comparison of the effectiveness of different elements and formats. Standardising decision aids would also allow for easier comparison between decision aids.
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Affiliation(s)
- Cassandra Vujovich-Dunn
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, NSW 2052, Australia.
| | - Jessica Kaufman
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia; Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Victoria 3086 Australia.
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Locked Bag 4001, 2145 Westmead, NSW, Australia; The Children's Hospital at Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Locked Bag 4001, 2145 Westmead, NSW, Australia.
| | - S Rachel Skinner
- The Children's Hospital at Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Locked Bag 4001, 2145 Westmead, NSW, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, NSW 2006, Australia.
| | - Handan Wand
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, NSW 2052, Australia.
| | - Rebecca Guy
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, NSW 2052, Australia.
| | - Julie Leask
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Locked Bag 4001, 2145 Westmead, NSW, Australia; University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown, NSW 2006, Australia.
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Torracinta L, Tanner R, Vanderslott S. MMR Vaccine Attitude and Uptake Research in the United Kingdom: A Critical Review. Vaccines (Basel) 2021; 9:402. [PMID: 33921593 PMCID: PMC8073967 DOI: 10.3390/vaccines9040402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
This review critically assesses the body of research about Measles-Mumps-and-Rubella (MMR) vaccine attitudes and uptake in the United Kingdom (UK) over the past 10 years. We searched PubMed and Scopus, with terms aimed at capturing relevant literature on attitudes about, and uptake of, the MMR vaccine. Two researchers screened for abstract eligibility and after de-duplication 934 studies were selected. After screening, 40 references were included for full-text review and thematic synthesis by three researchers. We were interested in the methodologies employed and grouped findings by whether studies concerned: (1) Uptake and Demographics; (2) Beliefs and Attitudes; (3) Healthcare Worker Focus; (4) Experimental and Psychometric Intervention; and (5) Mixed Methods. We identified group and individual level determinants for attitudes, operating directly and indirectly, which influence vaccine uptake. We found that access issues, often ignored within the public "anti-vax" debate, remain highly pertinent. Finally, a consistent theme was the effect of misinformation or lack of knowledge and trust in healthcare, often stemming from the Wakefield controversy. Future immunisation campaigns for children, including for COVID-19, should consider both access and attitudinal aspects of vaccination, and incorporate a range of methodologies to assess progress, taking into account socio-economic variables and the needs of disadvantaged groups.
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Affiliation(s)
- Louis Torracinta
- Institute of Human Sciences, University of Oxford, Oxford OX2 6QS, UK; (L.T.); (R.T.)
| | - Rachel Tanner
- Institute of Human Sciences, University of Oxford, Oxford OX2 6QS, UK; (L.T.); (R.T.)
- The Jenner Institute, University of Oxford, Oxford OX3 7DQ, UK
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Naveed Z, Saeed A, Kakar A, Khalid F, Alnaji N, Kumar G. Understanding the accountability issues of the immunization workforce for the Expanded Program on Immunization (EPI) in Balochistan: An exploratory study. J Glob Health 2021; 11:06001. [PMID: 33692897 PMCID: PMC7916446 DOI: 10.7189/jogh.11.06001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Among all provinces of Pakistan, immunization coverage is poorest in Balochistan. There is no provincial immunization policy for Balochistan including a lack of human resource management policy. Maladministration and lack of accountability leading to health workforce demotivation and poor performance can be a crucial reason behind an inefficient and ineffective immunization program in Balochistan. The objective of this study was to better understand the accountability issues of EPI workforce at provincial and district level leading to poor program performance and to identify governance strategies for management of inefficiency, demotivation and absenteeism. Methods An exploratory qualitative study was carried out to explore issues related to human resource (HR) accountability within immunization program of Balochistan for developing strategies to improve performance of the program. Five districts were selected using purposive sampling based on the comparative poor and good routine immunization coverages and Human Development Index (HDI). Interviews were conducted with EPI Staff and District Health Officers (DHOs) in each district including provincial EPI Staff. A semi-structured and open-ended questionnaire was used. Thematic analysis was used to analyze the qualitative data. Results Major barriers to HR accountability included lack of a written HR policy, proper service structure including promotions and benefits and understanding of accurate job description coupled with inadequate HR development budget and activities. Most important demotivating factors were inadequate number of vaccinators, deficient budget with delayed wage and salary disbursements resulting in poor immunization coverage and a lack of appreciation/feedback from senior management for the frontline workers. Key challenge for vaccinators was poor community orientation and mobilization. Although, the participants proposed some solutions based on their perspective, none were elaborate or precise. Conclusions Adaptation of National Immunization Policy tailored to the provincial context and proper implementation is much needed. Review of current allocations of vaccinators and need based relocation along with recruitment of new vaccinators with clear job description and terms of reference is desirable. Review of current incentive structure is required. Finally, trust building between community and the vaccination program and social mobilization about the benefits of vaccinations through community influential is vital.
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Affiliation(s)
- Zaeema Naveed
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Abid Saeed
- Provincial Disease Surveillance & Rapid Response Unit (PDSRU), Provincial Directorate of Health, Quetta, Balochistan, Pakistan
| | - Aftab Kakar
- N-STOP (FELTP), Provincial Directorate of Health Quetta, Balochistan, Pakistan
| | | | - Nada Alnaji
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gaurav Kumar
- Department of Health Promotion and Disease Prevention, University of Nebraska Medical Center, Omaha, Nebraska, USA
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20
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Frawley JE, McKenzie K, Forssman BL, Sullivan E, Wiley K. Exploring complementary medicine practitioners' attitudes towards the use of an immunization decision aid, and its potential acceptability for use with clients to reduce vaccine related decisional conflict. Hum Vaccin Immunother 2021; 17:588-591. [PMID: 32966138 PMCID: PMC7899682 DOI: 10.1080/21645515.2020.1787069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
While Australia boasts a high immunization rate, geographical pockets of low uptake still challenge herd immunity on a community level. For some parents, concerns about immunization lead to distrust of conventional sources of vaccine information and complementary medicine (CM) practitioners may be more readily trusted as a source of information about vaccines. Decision aids are common educational resources that are developed to support informed decision making. We interviewed CM practitioners to explore their attitudes to immunization decision aids in general and the acceptability of recommending this resource to parents with concerns or questions about immunization. While some practitioners felt that it might be biased towards immunizations, all said that they would recommend the resource to parents. CM practitioners are a trusted source of information, including immunization advice for some parents. CM practitioners were generally supportive of decision aids as a tool they could use in their practice to help parents with immunization questions, where a premium is often placed on patient choice.
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Affiliation(s)
- Jane E Frawley
- Australian Centre for Public and Population Health Research, University of Technology Sydney , Sydney, Australia
| | - Kirsty McKenzie
- Australian Centre for Public and Population Health Research, University of Technology Sydney , Sydney, Australia
| | - Bradley L Forssman
- Public Health Unit, Nepean Blue Mountains Local Health District , Sydney, Australia
| | - Elizabeth Sullivan
- Australian Centre for Public and Population Health Research, University of Technology Sydney , Sydney, Australia.,School of Medicine and Public Health, University of Newcastle , Newcastle, Australia
| | - Kerrie Wiley
- School of Public Health, University of Sydney , Sydney, Australia
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21
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Robertson EG, Cohen J, Signorelli C, Grant DM, Fardell JE, Wakefield CE. What instruments should we use to assess paediatric decision-making interventions? A narrative review. J Child Health Care 2020; 24:458-472. [PMID: 31450963 DOI: 10.1177/1367493519869717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is an increasing number of shared decision-making (SDM) interventions in paediatrics. However, there is little consensus as to the best instruments to assess the feasibility and impact of these interventions. This narrative review aims to answer: (1) what feasibility, knowledge and decision-making instruments have been used to assess paediatric SDM interventions and (2) what are the psychometric properties of used decision-making instruments, guided by the 'consensus-based standards for the selection of health measurement instrument' criteria. We conducted a review of the peer-reviewed literature. We identified 23 studies that evaluated a paediatric intervention to facilitate SDM for a specific health decision. Eighteen studies assessed intervention feasibility, with a wide variability in assessment between studies. Twelve studies assessed objective knowledge, and four studies assessed subjective knowledge with all but one study aggregating correct responses. We identified nine decision-making instruments that had been assessed psychometrically, although few had been thoroughly evaluated. The Decisional Conflict Scale was the most commonly-used instrument and the only instrument evaluated in paediatrics. Our study revealed a lack of consistency in the instruments used to evaluate decision-making interventions in paediatrics, making it difficult to compare interventions. We provide several recommendations for researchers to improve the assessment of SDM interventions in paediatrics.
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Affiliation(s)
- Eden G Robertson
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Jennifer Cohen
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Christina Signorelli
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - David M Grant
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
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22
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Saunier F, Berthelot P, Mottet-Auselo B, Pelissier C, Fontana L, Botelho-Nevers E, Gagneux-Brunon A. Impact of a decision-aid tool on influenza vaccine coverage among HCW in two French hospitals: A cluster-randomized trial. Vaccine 2020; 38:5759-5763. [PMID: 32684500 DOI: 10.1016/j.vaccine.2020.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Nosocomial outbreaks of seasonal influenza are frequent, and vaccination is largely recommended for healthcare workers (HCWs). Vaccine coverage in French HCWs does not exceed 20%. Decision-aids (DA) are potential useful interventions to increase vaccine coverage (VC). Our aim was to evaluate the impact of a DA on HCWs influenza vaccine coverage. MATERIAL AND METHODS Prospective cluster-randomized trial conducted in 83 departments in two public hospitals (a teaching and a non-teaching hospital) during the 2018-2019 flu season. Distribution of the DA and of questionnaire about decisional conflict and knowledge in the departments randomized in the intervention group. RESULTS A total number of 3 547 HCWs were concerned by the study (1 953 in the intervention group, 1 594 in the control group). Global VC was 35.6% during the 2018-2019 season, instead of 23.6% in the 2017-2018 season (p < 0.005). During the 2018-2019 season, VC was 31% (95% CI 28.7-33.3) in the control group and 38.7% (95% CI 36.5-40.9) in the intervention group (p < 0.005). Among the 158 HCWs exposed to the DA who answered the survey, 51.3% had no decisional conflict. HCWs without decisional conflict were more prone to get vaccinated before flu season. CONCLUSION The use of the DA was associated with a 25% relative increase in VC among HCWs against seasonal influenza. This modest increase remained far from the WHO 75% target, but may have reduced the number of nosocomial. Multi-component interventions are needed to increase VC in HCWs.
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Affiliation(s)
- Florian Saunier
- Department of Infectious Diseases, and Infection Control Unit, University Hospital of Saint-Etienne, France
| | - Philippe Berthelot
- Department of Infectious Diseases, and Infection Control Unit, University Hospital of Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, Centre International de Recherche en Infectiologie, Université Jean Monnet, Université de Lyon, Saint-Etienne, France; Institut de Recherche PRESAGE, Chaire vaccination, Prévention et Contrôle de l'Infection, Université de Lyon Saint-Etienne, France
| | | | - Carole Pelissier
- Department of occupational medicine, University Hospital of Saint-Etienne, France
| | - Luc Fontana
- Department of occupational medicine, University Hospital of Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious Diseases, and Infection Control Unit, University Hospital of Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, Centre International de Recherche en Infectiologie, Université Jean Monnet, Université de Lyon, Saint-Etienne, France; Institut de Recherche PRESAGE, Chaire vaccination, Prévention et Contrôle de l'Infection, Université de Lyon Saint-Etienne, France
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, and Infection Control Unit, University Hospital of Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, Centre International de Recherche en Infectiologie, Université Jean Monnet, Université de Lyon, Saint-Etienne, France; Institut de Recherche PRESAGE, Chaire vaccination, Prévention et Contrôle de l'Infection, Université de Lyon Saint-Etienne, France.
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23
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Hoefel L, Lewis KB, O’Connor A, Stacey D. 20th Anniversary Update of the Ottawa Decision Support Framework: Part 2 Subanalysis of a Systematic Review of Patient Decision Aids. Med Decis Making 2020; 40:522-539. [DOI: 10.1177/0272989x20924645] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. The Ottawa Decision Support Framework (ODSF) has guided the development of patient decision aids (PtDAs) for 20 years and needs updating across a range of decisions and hypothesized outcomes. Purpose. To determine the effectiveness of ODSF-developed PtDAs on hypothesized outcomes and to recommend framework changes. Data Source. A subanalysis of randomized controlled trials included in the 2017 Cochrane review of PtDAs comparing PtDAs to usual care in adults considering health treatment or screening decisions (searched to 2015). Study Selection. Trials in the original review that evaluated ODSF-developed PtDAs. Data Synthesis. Meta-analyses of ODSF outcomes with similar measurements and descriptions of other reported outcomes. Results. Of 105 trials, 24 evaluated ODSF-developed PtDAs. Compared with usual care, ODSF PtDAs improved knowledge (mean difference [MD] 13.85; 95% confidence interval [CI] 10.32−17.37; 14 trials), increased accurate risk perceptions (risk ratio [RR] 2.41; 95% CI 1.66−3.48; 7 trials), and increased congruence between informed values and chosen options (RR 1.32; 95% CI 1.09−1.59; 4 trials). They reduced perceived decisional needs as measured using the Decisional Conflict Scale (MD −5.92; 95% CI −8.58 to −3.26; 15 trials) and the proportion of undecided patients (RR 0.65; 95% CI 0.50−0.83; 13 trials). Non-ODSF PtDAs, designed with or without a specific framework, also outperformed usual care. Few ODSF trials measured secondary outcomes. Limitations. The included trials had heterogeneity. Conclusion. ODSF PtDAs address decisional needs and improve decision quality; the best indicator of addressing perceived uncertainty is “proportion undecided.” Secondary ODSF outcomes should be reduced to adherence to one’s chosen option and use/costs of health services, which warrant further research.
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Affiliation(s)
- Lauren Hoefel
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Canada
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24
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Bruel S, Leclercq T, Ginzarly M, Botelho-Nevers E, Frappé P, Gagneux-Brunon A. Patient decision aid in vaccination: a systematic review of the literature. Expert Rev Vaccines 2020; 19:305-311. [DOI: 10.1080/14760584.2020.1742111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- S. Bruel
- Department of General Practice, Jean Monnet University, Saint Etienne, France
- HESPER EA, University of Lyon, Claude Bernard Lyon 1 University, Saint-Etienne University, France
| | - T. Leclercq
- Department of General Practice, Jean Monnet University, Saint Etienne, France
| | - M. Ginzarly
- The Clinic, Dubai International Financial Center, United Arab Emirates
| | - E. Botelho-Nevers
- CIC-INSERM 1408, CHU de Saint-Etienne, France
- Groupe Immunité des Muqueuses et Agents Pathogènes EA 3064, Jean Monnet University, University of Lyon, France
| | - P. Frappé
- Department of General Practice, Jean Monnet University, Saint Etienne, France
| | - A. Gagneux-Brunon
- CIC-INSERM 1408, CHU de Saint-Etienne, France
- Groupe Immunité des Muqueuses et Agents Pathogènes EA 3064, Jean Monnet University, University of Lyon, France
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25
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Van Velthoven MH, Milne-Ives M, de Cock C, Mooney M, Meinert E. Use of Apps to Promote Childhood Vaccination: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e16929. [PMID: 32022694 PMCID: PMC7055758 DOI: 10.2196/16929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/28/2019] [Indexed: 12/02/2022] Open
Abstract
Background The decline in the uptake of routine childhood vaccinations has resulted in outbreaks of vaccine-preventable diseases. Vaccination apps can be used as a tool to promote immunization through the provision of reminders, dissemination of information, peer support, and feedback. Objective The aim of this review is to systematically review the evidence on the use of apps to support childhood vaccination uptake, information storage, and record sharing. Methods We will identify relevant papers by searching the following electronic databases: PubMed, Embase by Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Education Resources Information Center (ERIC). We will review the reference lists of those studies that we include to identify relevant additional papers not initially identified using our search strategy. In addition to the use of electronic databases, we will search for grey literature on the topic. The search strategy will include only terms relating to or describing the intervention, which is app use. As almost all titles and abstracts are in English, 100% of these will be reviewed, but retrieval will be confined to papers written in the English language. We will record the search outcome on a specifically designed record sheet. Two reviewers will select observational and intervention studies, appraise the quality of the studies, and extract the relevant data. All studies will involve the use of apps relating to child vaccinations. The primary outcome is the uptake of vaccinations. Secondary outcomes are as follows: (1) use of app for sharing of information and providing vaccination reminders and (2) use of app for storage of vaccination information; knowledge and decision making by parents regarding vaccination (ie, risks and benefits of vaccination); costs and cost-effectiveness of vaccination apps; use of the app and measures of usability (eg, usefulness, acceptability, and experiences of different users: parents and health care professionals); use of technical standards for development of the app; and adverse events (eg, data leaks and misinformation). We will exclude studies that do not study an app. We anticipate a limited scope for meta-analysis and will provide a narrative overview of findings and tabular summaries of extracted data. Results This project was funded by the Sir David Cooksey Fellowship in Healthcare Translation at the University of Oxford, Oxford, United Kingdom. We will submit the full systematic review for publication in the Journal of Medical Internet Research. Conclusions This review will follow, where possible, the Cochrane Collaboration and the Centre for Review and Dissemination methodologies for conducting systematic reviews. We will report our findings based on guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review results will be used to inform the development of a vaccination app. International Registered Report Identifier (IRRID) PRR1-10.2196/16929
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Affiliation(s)
| | - Madison Milne-Ives
- Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Oxford, United Kingdom
| | - Caroline de Cock
- Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Oxford, United Kingdom
| | - Mary Mooney
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Edward Meinert
- Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Oxford, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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26
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Clarke RM, Sirota M, Paterson P. Do previously held vaccine attitudes dictate the extent and influence of vaccine information-seeking behavior during pregnancy? Hum Vaccin Immunother 2019; 15:2081-2089. [PMID: 31291160 PMCID: PMC6773393 DOI: 10.1080/21645515.2019.1638203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/07/2019] [Accepted: 06/20/2019] [Indexed: 11/28/2022] Open
Abstract
Pregnancy represents a high information need state, where uncertainty around medical intervention is common. As such, the pertussis vaccination given during pregnancy presents a unique opportunity to study the interaction between vaccine attitudes and vaccine information-seeking behavior. We surveyed a sample of pregnant women (N = 182) during early pregnancy and again during late pregnancy. The variables of vaccine confidence and risk perception of vaccination during pregnancy were measured across two questionnaires. Additional variables of decision conflict and intention to vaccinate were recorded during early pregnancy, while vaccine information-seeking behavior and vaccine uptake were recorded during late pregnancy. 88.8% of participants reported seeking additional information about the pertussis vaccine during pregnancy. Women that had a lower confidence in vaccination (p = .004) and those that saw the risk of pertussis disease as high compared to the risk of side effects from the pertussis vaccination during pregnancy (p = .004) spent significantly more time seeking information about the pertussis vaccination. Women's perception of risk related to vaccination during pregnancy significantly changed throughout the pregnancy (t(182) = 4.685 p< .001), with women perceiving the risk of pertussis disease higher as compared to the risk of side effects from the vaccine as the pregnancy progresses. The strength and influence of information found through seeking was predicted by intention to vaccinate (p = .011). As such, we suggest that intention to vaccinate during early pregnancy plays a role in whether the information found through seeking influences women towards or away from vaccination.
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Affiliation(s)
- Richard M. Clarke
- Department of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Miroslav Sirota
- Department of Psychology, University of Essex, Colchester, UK
| | - Pauline Paterson
- Department of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, London, UK
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27
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Wang LDL, Lam WWT, Fielding R. Development and pre/post testing of a decision aid supporting Chinese parental and young women's HPV vaccination decision-making. Women Health 2019; 60:330-340. [PMID: 31195899 DOI: 10.1080/03630242.2019.1626791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We developed and tested the acceptability and utility of a novel HPV vaccination decision aid (DA) among Chinese young women aged 18-26 years and parents of adolescent girls aged 9-17 years. From March to May 2016, a total of 101 parents plus 109 young women completed baseline surveys assessing their HPV vaccination knowledge, decision self-efficacy, decision conflict, and HPV vaccination intention. Two weeks after receiving the DA, 84 (83.2%) parents and 92 (84.4%) young women completed re-assessments. Chi-square tests or t-tests were performed to compare the before-and-after differences. Cohen's d was calculated to indicate the effect size. After reading the DA, both participating young women's and parents' knowledge of HPV vaccination (Cohen's d = 0.62 among young women and d = 0.59 among parents) and decision self-efficacy (d = 0.38 among young women and d = 0.59 among parents) significantly increased. Both young women's and parents' decision conflict (d = -0 · 98 and -1.06) significantly decreased. The proportion of young women intending to receive HPV vaccination and parents deciding to vaccinate daughters against HPV significantly increased (p < 0 · 0001). The DA showed good acceptability and utility facilitating HPV vaccination decision-making for most Chinese young women and parents of adolescent girls. Further randomized controlled trials of this tool are essential.
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Affiliation(s)
- Linda Dong-Ling Wang
- School of Medicine, Yangzhou University, Yangzhou, China.,Centre for Psycho-Oncology Research and Training, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - Wendy Wing Tak Lam
- Centre for Psycho-Oncology Research and Training, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - Richard Fielding
- Centre for Psycho-Oncology Research and Training, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
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28
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Leinweber KA, Columbo JA, Kang R, Trooboff SW, Goodney PP. A Review of Decision Aids for Patients Considering More Than One Type of Invasive Treatment. J Surg Res 2019; 235:350-366. [PMID: 30691817 PMCID: PMC10647019 DOI: 10.1016/j.jss.2018.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/29/2018] [Accepted: 09/07/2018] [Indexed: 10/27/2022]
Abstract
With continuous advances in medicine, patients are faced with several medical or surgical treatment options for their health conditions. Decision aids may be useful in helping patients navigate these options and choose based on their goals and values. We reviewed the literature to identify decision aids and better understand the effect on patient decision-making. We identified 107 decision aids designed to help patients make decisions between medical treatment or screening options; 39 decision aids were used to help patients choose between a medical and surgical treatment, and five were identified that aided patients in deciding between a major open surgical procedure and a less invasive option. Many of the decision aids were used to help patients decide between prostate, colorectal, and breast cancer screening or treatment options. Although most decision aids were not associated with a significant effect on the actual decision made, they were largely associated with increased patient knowledge, decreased decisional conflict, more accurate perception of risks, increased satisfaction with their decision, and no increase in anxiety surrounding their decision. These data identify a gap in use of decision aids in surgical decision-making and highlight the potential to help surgical patients make value-based, knowledgeable decisions regarding their treatment.
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Affiliation(s)
| | - Jesse A Columbo
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Ravinder Kang
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Spencer W Trooboff
- VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Philip P Goodney
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
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29
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Crocker-Buque T, Mounier-Jack S. Vaccination in England: a review of why business as usual is not enough to maintain coverage. BMC Public Health 2018; 18:1351. [PMID: 30522459 PMCID: PMC6282278 DOI: 10.1186/s12889-018-6228-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The vaccine system in England underwent radical changes in 2013 following the implementation of the Health and Social Care Act. There have since been multi-year decreases in coverage of many vaccines. Healthcare professionals have reported finding the new system fragmented and challenging. This study aims to produce a logic model of the new system and evaluate the available evidence for interventions to improve coverage. METHODS We undertook qualitative document analysis to develop the logic model using process evaluation methods. We performed a systematic review by searching 12 databases with a broad search strategy to identify interventions studied in England conducted between 2006 and 2016 and evaluated their effectiveness. We then compared the evidence base to the logic model. RESULTS We analysed 83 documents and developed a logic model describing the core inputs, processes, activities, outputs, outcomes and impacts of the new vaccination system alongside the programmatic assumptions for each stage. Of 9,615 unique articles, we screened 624 abstracts, 45 full-text articles, and included 16 studies: 8 randomised controlled trials and 8 quasi-experimental studies. Four studies suggest that modifications to the contracting and incentive systems can increase coverage, but changes to other programme inputs (e.g. human or capital resources) were not evaluated. Four multi-component intervention studies modified activities and outputs from within a GP practice to increase coverage, but were part of campaigns or projects. Thus, many potentially modifiable factors relating to routine programme implementation remain unexplored. Reminder/recall systems are under-studied in England; incentive payments to adolescents may be effective; and only two studies evaluated carer information. CONCLUSIONS The evidence base for interventions to increase immunisation coverage in the new system in England are limited by a small number of studies and by significant risk of bias. Several areas important to primary care remain unexplored as targets for interventions, especially modification to organisational management.
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Affiliation(s)
- Tim Crocker-Buque
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H9SH, UK.
| | - Sandra Mounier-Jack
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H9SH, UK
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30
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Williamson L, Glaab H. Addressing vaccine hesitancy requires an ethically consistent health strategy. BMC Med Ethics 2018; 19:84. [PMID: 30355355 PMCID: PMC6201581 DOI: 10.1186/s12910-018-0322-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/04/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory and presumptive vaccination. MAIN TEXT It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner. CONCLUSION Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics.
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Affiliation(s)
- Laura Williamson
- Biobehavioral Health Department, Pennsylvania State University, University Park, USA.
| | - Hannah Glaab
- Biobehavioral Health Department, Pennsylvania State University, University Park, USA
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31
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Vaccine hesitancy, refusal and access barriers: The need for clarity in terminology. Vaccine 2018; 36:6556-6558. [DOI: 10.1016/j.vaccine.2017.08.004] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/02/2017] [Accepted: 08/02/2017] [Indexed: 11/17/2022]
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32
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Daley MF, Narwaney KJ, Shoup JA, Wagner NM, Glanz JM. Addressing Parents' Vaccine Concerns: A Randomized Trial of a Social Media Intervention. Am J Prev Med 2018; 55:44-54. [PMID: 29773490 PMCID: PMC8606186 DOI: 10.1016/j.amepre.2018.04.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/01/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Successful strategies are needed to address parental vaccine hesitancy, a significant public health issue. The study objective was to assess whether an Internet-based platform with vaccine information and interactive social media components improved parents' vaccine-related attitudes. STUDY DESIGN A three-arm RCT. SETTING/PARTICIPANTS The study was conducted in a large Colorado integrated healthcare organization. Parents were enrolled during September 2013 through October 2015 and followed through November 2016; data were analyzed in 2017. Parents, recruited during pregnancy, were given a survey about vaccine-related attitudes at enrollment (i.e., baseline) and when their child was aged 3-5 months and 12-15 months (Timepoints 1 and 2, respectively). Parental vaccine hesitancy was assessed at baseline. INTERVENTION Study participants were randomized to the following: a study website with vaccine information and social media components (VSM arm); a website with vaccine information only (VI); or usual care. MAIN OUTCOME MEASURES Change in parental vaccine attitudes over time by baseline degree of vaccine hesitancy. RESULTS Among 1,093 study participants, 945 (86.5%) completed all three surveys. Comparing baseline with Timepoint 1 among vaccine-hesitant parents, the VSM and VI arms were associated with significant improvements in attitudes regarding vaccination benefits compared to usual care (VSM mean change 0.23 on a 5-point scale, 95% CI=0.05, 0.40, VI mean change 0.22, 95% CI=0.04, 0.40). Comparing baseline with Timepoint 2 among hesitant parents, the VSM and VI arms were also associated with significant reductions in parental concerns about vaccination risks compared to usual care (VSM mean change -0.37, 95% CI= -0.60, -0.14, VI mean change -0.31, 95% CI= -0.55, -0.07). Self-efficacy around vaccine decision making also improved among vaccine-hesitant parents. No intervention effect was observed among parents not vaccine-hesitant at baseline. CONCLUSIONS Among vaccine-hesitant parents, an Internet-based intervention improved parents' attitudes about vaccines. TRIAL REGISTRATION This study was registered at www.clinicaltrials.gov NCT01873040.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Nicole M Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
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Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest 2018; 18:149-207. [DOI: 10.1177/1529100618760521] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
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Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
| | | | | | - Julie Leask
- Faculty of Nursing and Midwifery, University of Sydney
- Faculty of Medicine, University of Sydney
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
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Sharing knowledge about immunisation (SKAI): An exploration of parents' communication needs to inform development of a clinical communication support intervention. Vaccine 2018; 36:6480-6490. [PMID: 29395532 DOI: 10.1016/j.vaccine.2017.10.077] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 08/11/2017] [Accepted: 10/24/2017] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The SKAI (Sharing Knowledge About Immunisation) project aims to develop effective communication tools to support primary health care providers' consultations with parents who may be hesitant about vaccinating their children. AIM This study explored parents' communication needs using a qualitative design. METHODS Parents of at least one child less than five years old were recruited from two major cities and a regional town known for high prevalence of vaccine objection. Focus groups of parents who held similar vaccination attitudes and intentions were convened to discuss experiences of vaccination consultations and explore their communication needs, including preferences. Draft written communication support tools were used to stimulate discussion and gauge acceptability of the tools. RESULTS Important differences in communication needs between group types emerged. The least hesitant parent groups reported feeling reassured upon reading resources designed to address commonly observed concerns about vaccination. As hesitancy of the group members increased, so did their accounts of the volume and detail of information they required. Trust appeared to be related to apparent or perceived transparency. More hesitant groups displayed increased sensitivity and resistance to persuasive language forms.
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“It just forces hardship”: impacts of government financial penalties on non-vaccinating parents. J Public Health Policy 2018; 39:156-169. [DOI: 10.1057/s41271-017-0116-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Carolan K, Verran J, Crossley M, Redfern J, Whitton N, Amos M. Impact of educational interventions on adolescent attitudes and knowledge regarding vaccination: A pilot study. PLoS One 2018; 13:e0190984. [PMID: 29351325 PMCID: PMC5774691 DOI: 10.1371/journal.pone.0190984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/22/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Current immunisation levels in England currently fall slightly below the threshold recommended by the World Health Organization, and the three-year trend for vaccination uptake is downwards. Attitudes towards vaccination can affect future decisions on whether or not to vaccinate, and this can have significant public health implications. Interventions can impact future vaccination decisions, and these interventions can take several forms. Relatively little work has been reported on the use of vaccination interventions in young people, who form the next generation of individuals likely to make vaccination decisions. METHOD We investigated the impact of two different types of educational intervention on attitudes towards vaccination in young people in England. A cohort of young people (n = 63) was recruited via a local school. This group was divided into three sub-groups; one (n = 21) received a presentation-based intervention, one (n = 26) received an interactive simulation-based intervention, and the third (n = 16) received no intervention. Participants supplied information on (1) their attitudes towards vaccination, and (2) their information needs and views on personal choice concerning vaccination, at three time points: immediately before and after the intervention, and after six months. RESULTS Neither intervention had a significant effect on participants' attitudes towards vaccination. However, the group receiving the presentation-based intervention saw a sustained uplift in confidence about information needs, which was not observed in the simulation-based intervention group. DISCUSSION Our findings with young people are consistent with previous work on vaccination interventions aimed at adults, which have shown limited effectiveness, and which can actually reduce intention to vaccinate. Our findings on the most effective mode of delivery for the intervention should inform future discussion in the growing "games for health" domain, which proposes the use of interactive digital resources in healthcare education.
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Affiliation(s)
- Kate Carolan
- School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Joanna Verran
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Matthew Crossley
- School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
| | - James Redfern
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Nicola Whitton
- Faculty of Education, Manchester Metropolitan University, Manchester, United Kingdom
| | - Martyn Amos
- School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
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Visser O, Hulscher ME, Antonise-Kamp L, Akkermans R, van der Velden K, Ruiter RA, Hautvast JL. Assessing determinants of the intention to accept a pertussis cocooning vaccination: A survey among healthcare workers in maternity and paediatric care. Vaccine 2018; 36:736-743. [DOI: 10.1016/j.vaccine.2017.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/08/2017] [Accepted: 12/10/2017] [Indexed: 10/18/2022]
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Fadda M, Galimberti E, Fiordelli M, Romanò L, Zanetti A, Schulz PJ. Effectiveness of a smartphone app to increase parents' knowledge and empowerment in the MMR vaccination decision: A randomized controlled trial. Hum Vaccin Immunother 2017; 13:2512-2521. [PMID: 29125783 DOI: 10.1080/21645515.2017.1360456] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Researchers are trying to build evidence for mhealth effectiveness in various fields. However, no evidence yet is showing the effectiveness of mhealth on parents' attitudes and behavior with regard to recommended vaccination of their children. The aim of this study was to look into the effects of 2 smartphone-based interventions targeting MMR vaccination knowledge and psychological empowerment respectively. The interventions used gamification features and videos in combination with text messages. We conducted a 2x2 between-subject factorial randomized controlled trial (absence/presence of knowledge intervention X absence/presence of empowerment intervention) with parents of young children in Italy. We randomly allocated 201 eligible participants to one of the 4 conditions. Data were collected by questionnaires at baseline and posttest. Primary outcomes were MMR vaccination knowledge, psychological empowerment, risk perception, and preferred decisional role; secondary outcomes included MMR vaccination intention, attitude, confidence, and recommendation intention. A significant gain in vaccination knowledge was reported by all experimental groups compared with the control (F(3,179) = 48.58, p < .000), while only those receiving both interventions reported a significant increase in their psychological empowerment (t(179) = -2.79, p = .006). Participants receiving the intervention targeting knowledge reported significantly higher intention to vaccinate (t(179) = 2.111; p = .03) and higher confidence in the decision (t(179) = 2.76; p = .006) compared with the control group. Parent-centered, gamified mobile interventions aimed at providing parents with vaccination-related information can be used to increase their knowledge, their intention to vaccinate as well as their confidence in the vaccination decision.
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Affiliation(s)
- Marta Fadda
- a Institute of Communication and Health, Faculty of Communication Science , University of Lugano , Lugano , Switzerland
| | - Elisa Galimberti
- a Institute of Communication and Health, Faculty of Communication Science , University of Lugano , Lugano , Switzerland
| | - Maddalena Fiordelli
- a Institute of Communication and Health, Faculty of Communication Science , University of Lugano , Lugano , Switzerland
| | - Luisa Romanò
- b Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
| | - Alessandro Zanetti
- b Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
| | - Peter J Schulz
- a Institute of Communication and Health, Faculty of Communication Science , University of Lugano , Lugano , Switzerland
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Abstract
BACKGROUND Decision aids (DAs) have been shown to increase decision quality in randomized controlled trials. This study compared the effectiveness of two different decision aids with different modes of delivery. PARTICIPANTS AND METHODS Patients with angiogram-proven coronary artery disease (CAD) were eligible to participate and randomly assigned to either a booklet/DVD DA or an online DA. Participants completed a survey after viewing the material that assessed patients' knowledge, treatment preferences, use of and satisfaction with the tool, and open-ended reflections on the treatment decision-making process. RESULTS Of the 62 patients screened, 34 agreed to participate and were randomly assigned to a group. Of those, 28 (15/17 booklet/DVD and 13/17 online) participants completed the survey. Patients were more likely to report reviewing all of the booklet/DVD DA compared with the online DA (60 vs. 31%, P=0.15). Knowledge scores were significantly higher in the booklet/DVD DA group than the online DA group (67 vs. 47%, P=0.018). Participants in both arms felt it was very or extremely important that doctors give patients materials like these before a catheterization (93% for booklet/DVD DA and 85% for online, P=0.54). Patients' qualitative feedback highlighted significant gaps in knowledge about treatment options, as well as a strong desire to have educational materials in advance of diagnostic catheterizations. CONCLUSION The pilot study suggests that both decision aids are highly valued by patients with CAD. The booklet/DVD DA was associated with higher rates of complete review and improved knowledge about the management of stable coronary disease.
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Lewis KB, Wood B, Sepucha KR, Thomson RG, Stacey D. Quality of reporting of patient decision aids in recent randomized controlled trials: A descriptive synthesis and comparative analysis. PATIENT EDUCATION AND COUNSELING 2017; 100:1387-1393. [PMID: 28256281 DOI: 10.1016/j.pec.2017.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/18/2017] [Accepted: 02/22/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Variable reporting of patient decision aids (PDAs) in published articles raises uncertainty about whether the intervention meets the definition of a PDA. We appraised the quality of reporting of PDA characteristics in randomized controlled trials (RCTs). METHODS RCTs eligible for the Cochrane review of PDAs and published June 2012 to April 2015 were included. Quality of PDA reporting was appraised using the International Patient Decision Aid Standards Instrument (v4.0). We descriptively synthesized and comparatively analysed qualifying and certification criteria reported in each publication against their presence in actual PDAs. RESULTS Seventeen RCTs evaluating sixteen PDAs were included. Ten PDAs (58.8%) were reported using all qualifying criteria. Two (11.8%) were reported using all certification criteria. The median score for reporting qualifying criteria was 6 of 6 (range 4-6). The median score for reporting certification criteria was 2 of 10 (range 2-3) for screening and 1 of 6 (range 0-6) for treatment decisions. CONCLUSION Reporting of PDAs in RCTs is suboptimal. Incomplete reporting poses challenges for clinicians and researchers needing to identify PDA content for clinical practice and/or future research. PRACTICE IMPLICATIONS Authors should report IPDASi (v4.0) criteria in published articles. Reporting guidelines for PDA evaluation studies are in development to improve reporting within the scientific literature.
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Affiliation(s)
| | - Brianne Wood
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Richard G Thomson
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada.
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Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes‐Rovner M, Llewellyn‐Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4:CD001431. [PMID: 28402085 PMCID: PMC6478132 DOI: 10.1002/14651858.cd001431.pub5] [Citation(s) in RCA: 1228] [Impact Index Per Article: 175.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. OBJECTIVES To assess the effects of decision aids in people facing treatment or screening decisions. SEARCH METHODS Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. SELECTION CRITERIA We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. DATA COLLECTION AND ANALYSIS Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. MAIN RESULTS We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. AUTHORS' CONCLUSIONS Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.
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Affiliation(s)
- Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
- Ottawa Hospital Research InstituteCentre for Practice Changing Research501 Smyth RdOttawaONCanadaK1H 8L6
| | - France Légaré
- CHU de Québec Research Center, Université LavalPopulation Health and Optimal Health Practices Research Axis10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Krystina Lewis
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | | | - Carol L Bennett
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramAdministrative Services Building, Room 2‐0131053 Carling AvenueOttawaONCanadaK1Y 4E9
| | - Karen B Eden
- Oregon Health Sciences UniversityDepartment of Medical Informatics and Clinical EpidemiologyBICC 5353181 S.W. Sam Jackson Park RoadPortlandOregonUSA97239‐3098
| | - Margaret Holmes‐Rovner
- Michigan State University College of Human MedicineCenter for Ethics and Humanities in the Life SciencesEast Fee Road956 Fee Road Rm C203East LansingMichiganUSA48824‐1316
| | - Hilary Llewellyn‐Thomas
- Dartmouth CollegeThe Dartmouth Center for Health Policy & Clinical Practice, The Geisel School of Medicine at DartmouthHanoverNew HampshireUSA03755
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Lyndal Trevena
- The University of SydneyRoom 322Edward Ford Building (A27)SydneyNSWAustralia2006
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Witteman HO, Presseau J, Nicholas Angl E, Jokhio I, Schwalm JD, Grimshaw JM, Bosiak B, Natarajan MK, Ivers NM. Negotiating Tensions Between Theory and Design in the Development of Mailings for People Recovering From Acute Coronary Syndrome. JMIR Hum Factors 2017; 4:e6. [PMID: 28249831 PMCID: PMC5352859 DOI: 10.2196/humanfactors.6502] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/13/2022] Open
Abstract
Background Taking all recommended secondary prevention cardiac medications and fully participating in a formal cardiac rehabilitation program significantly reduces mortality and morbidity in the year following a heart attack. However, many people who have had a heart attack stop taking some or all of their recommended medications prematurely and many do not complete a formal cardiac rehabilitation program. Objective The objective of our study was to develop a user-centered, theory-based, scalable intervention of printed educational materials to encourage and support people who have had a heart attack to use recommended secondary prevention cardiac treatments. Methods Prior to the design process, we conducted theory-based interviews and surveys with patients who had had a heart attack to identify key determinants of secondary prevention behaviors. Our interdisciplinary research team then partnered with a patient advisor and design firm to undertake an iterative, theory-informed, user-centered design process to operationalize techniques to address these determinants. User-centered design requires considering users’ needs, goals, strengths, limitations, context, and intuitive processes; designing prototypes adapted to users accordingly; observing how potential users respond to the prototype; and using those data to refine the design. To accomplish these tasks, we conducted user research to develop personas (archetypes of potential users), developed a preliminary prototype using behavior change theory to map behavior change techniques to identified determinants of medication adherence, and conducted 2 design cycles, testing materials via think-aloud and semistructured interviews with a total of 11 users (10 patients who had experienced a heart attack and 1 caregiver). We recruited participants at a single cardiac clinic using purposive sampling informed by our personas. We recorded sessions with users and extracted key themes from transcripts. We held interdisciplinary team discussions to interpret findings in the context of relevant theory-based evidence and iteratively adapted the intervention accordingly. Results Through our iterative development and testing, we identified 3 key tensions: (1) evidence from theory-based studies versus users’ feelings, (2) informative versus persuasive communication, and (3) logistical constraints for the intervention versus users’ desires or preferences. We addressed these by (1) identifying root causes for users’ feelings and addressing those to better incorporate theory- and evidence-based features, (2) accepting that our intervention was ethically justified in being persuasive, and (3) making changes to the intervention where possible, such as attempting to match imagery in the materials to patients’ self-images. Conclusions Theory-informed interventions must be operationalized in ways that fit with user needs. Tensions between users’ desires or preferences and health care system goals and constraints must be identified and addressed to the greatest extent possible. A cluster randomized controlled trial of the final intervention is currently underway.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Pavillon Ferdinand-Vandry 2881, Quebec City, QC, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Emily Nicholas Angl
- Patients Canada, Toronto, ON, Canada.,Pivot Design Group Inc, Toronto, ON, Canada
| | | | - J D Schwalm
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada.,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Beth Bosiak
- Women's College Research Institute, Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Madhu K Natarajan
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada.,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Noah M Ivers
- Women's College Research Institute, Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Butler AM, Weller B, Titus C. Relationships of Shared Decision Making with Parental Perceptions of Child Mental Health Functioning and Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:767-74. [PMID: 25577238 DOI: 10.1007/s10488-014-0612-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Experts encourage parents and practitioners to engage in shared decision making (SDM) to provide high quality child mental health care. However, little is known regarding SDM among families of children with common mental health conditions. The objectives of this study were to examine associations between parental report of SDM and parental perceptions of (a) receiving child mental health care and (b) child mental health functioning. We analyzed cross-sectional data on children with a common mental health condition (attention-deficit hyperactivity disorder, oppositional-defiant or conduct disorder, anxiety, or depression) from the 2009/2010 National Survey of Children with Special Healthcare Needs (N = 9,434). The primary independent variable was parent-reported SDM, and the dependent variables were parental perception of (a) their child receiving all needed mental health care (b) their children's impairment in school attendance and extracurricular activity participation, and (c) severity of their children's mental health condition. Multivariate logistic and multinomial regression analyses were conducted. Greater parent-reported SDM was associated with parental perceptions of receiving all needed child mental health care and children not having school or extracurricular impairment. Greater SDM was also associated with perceptions of children having a mild mental health condition compared to children having a moderate or severe condition. Findings provide a basis for future longitudinal and intervention studies to examine the benefit of SDM for improving parental perceptions of the quality of child mental health care and mental health functioning among children with common mental health conditions.
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Affiliation(s)
- Ashley M Butler
- Department of Pediatrics, Baylor College of Medicine, 1102 Bates St., Suite 940, Houston, TX, 77030, USA.
| | - Bridget Weller
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Courtney Titus
- Department of Pediatrics, Baylor College of Medicine, 1102 Bates St., Suite 940, Houston, TX, 77030, USA
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Corben P, Leask J. To close the childhood immunization gap, we need a richer understanding of parents' decision-making. Hum Vaccin Immunother 2016; 12:3168-3176. [PMID: 27564975 PMCID: PMC5215493 DOI: 10.1080/21645515.2016.1221553] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/22/2016] [Accepted: 08/03/2016] [Indexed: 12/22/2022] Open
Abstract
Vaccination is widely acknowledged as one of the most successful public health interventions globally and in most high-income countries childhood vaccination coverage rates are moderately high. Yet in many instances, immunisation rates remain below aspirational targets and have shown only modest progress toward those targets in recent years, despite concerted efforts to improve uptake. In part, coverage rates reflect individual parents' vaccination attitudes and decisions and, because vaccination decision-making is complex and context-specific, it remains challenging at individual and community levels to assist parents to make positive decisions. Consequently, in the search for opportunities to improve immunisation coverage, there has been a renewed research focus on parents' decision-making. This review provides an overview of the literature surrounding parents' vaccination decision-making, offering suggestions for where efforts to increase vaccination coverage should be targeted and identifying areas for further research.
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Affiliation(s)
- Paul Corben
- North Coast Public Health, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Julie Leask
- School of Public Health, University of Sydney, University of Sydney, NSW, Australia
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Sobo EJ. What is herd immunity, and how does it relate to pediatric vaccination uptake? US parent perspectives. Soc Sci Med 2016; 165:187-195. [PMID: 27497915 DOI: 10.1016/j.socscimed.2016.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 11/17/2022]
Abstract
In light of current concern over pediatric immunization rates, 53 US parents with at least one child kindergarten age or younger were surveyed and interviewed regarding vaccine decision making. Data were collected in 2014 in San Diego, California. Herd immunity was not a salient issue: only six (11.3%) referenced the term or concept spontaneously; others had to be prompted. Parents familiar with herd immunity (70%) variously saw it as not just unnecessary but unproven, illogical, unrealistic, and unreliable. For instance, parents questioned its attainability because many adults do not immunize themselves. Some understood the concept negatively, as an instance of "herd mentality." Further, having knowledge of herd immunity that public health experts would deem 'correct' did not lead to full vaccination. Implications of findings for understanding how the public makes use of scientific information, the potential role of public health messaging regarding altruism and 'free-riding,' and assumptions that vaccine-cautious parents would willfully take advantage of herd immunity are explored in relation to parent role expectations and American individualism.
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Affiliation(s)
- Elisa J Sobo
- Department of Anthropology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-6040, USA.
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46
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Dubé E, Gagnon D, Ouakki M, Bettinger JA, Guay M, Halperin S, Wilson K, Graham J, Witteman HO, MacDonald S, Fisher W, Monnais L, Tran D, Gagneur A, Guichon J, Saini V, Heffernan JM, Meyer S, Driedger SM, Greenberg J, MacDougall H. Understanding Vaccine Hesitancy in Canada: Results of a Consultation Study by the Canadian Immunization Research Network. PLoS One 2016; 11:e0156118. [PMID: 27257809 PMCID: PMC4892544 DOI: 10.1371/journal.pone.0156118] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/08/2016] [Indexed: 11/18/2022] Open
Abstract
"Vaccine hesitancy" is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess the opinions of experts and health professionals concerning the definition, scope, and causes of vaccine hesitancy in Canada. We sent online surveys to two panels (1- vaccination experts and 2- front-line vaccine providers). Two questionnaires were completed by each panel, with data from the first questionnaire informing the development of questions for the second. Our participants defined vaccine hesitancy as an attitude (doubts, concerns) as well as a behaviour (refusing some / many vaccines, delaying vaccination). Our findings also indicate that both vaccine experts and front-line vaccine providers have the perception that vaccine rates have been declining and consider vaccine hesitancy an important issue to address in Canada. Diffusion of negative information online and lack of knowledge about vaccines were identified as the key causes of vaccine hesitancy by the participants. A common understanding of vaccine hesitancy among researchers, public health experts, policymakers and health care providers will better guide interventions that can more effectively address vaccine hesitancy within Canada.
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Affiliation(s)
- Eve Dubé
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
- Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
| | - Dominique Gagnon
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Manale Ouakki
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryse Guay
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Scott Halperin
- Department of Microbiology & Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly O. Witteman
- Département de médecine familiale et de médecine d’urgence, Université Laval, Québec, Québec, Canada
- Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
| | - Shannon MacDonald
- Nursing Faculty, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - William Fisher
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - Laurence Monnais
- Département d'Histoire, Université de Montréal, Montréal, Québec, Canada
| | - Dat Tran
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arnaud Gagneur
- Département de pédiatrie, Service de néonatologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Juliet Guichon
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Vineet Saini
- Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Jane M. Heffernan
- Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joshua Greenberg
- School of Journalism and Communication, Carleton University, Ottawa, Ontario, Canada
| | - Heather MacDougall
- Department of History, University of Waterloo, Waterloo, Ontario, Canada
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Can the vaccine adverse event reporting system be used to increase vaccine acceptance and trust? Vaccine 2016; 34:2424-2429. [PMID: 27049120 DOI: 10.1016/j.vaccine.2016.03.087] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
Vaccine refusal has an impact on public health, and the human pappillomavirus (HPV) vaccine is particularly underutilized. Research suggests that it may be difficult to change vaccine-related attitudes, and there is currently no good evidence to recommend any particular intervention strategy. One reason for vaccine hesitancy is lack of trust that vaccine harms are adequately documented and reported, yet few communication strategies have explicitly attempted to improve this trust. This study tested the possibility that data from the vaccine adverse event reporting system (VAERS) can be used to increase trust that vaccine harms are adequately researched and that potential harms are disclosed to the public, and thereby improve perceptions of vaccines. In the study, participants were randomly assigned to one of three communication interventions. All participants read the Centers for Disease Control (CDC) vaccine information statement (VIS) for the HPV vaccine. Two other groups were exposed to additional information about VAERS, either summary data or full detailed reports of serious adverse events from 2013. Results showed that the CDC's VIS alone significantly increased perceptions of vaccine benefits and decreased perceived risks. Participants who were also educated about VAERS and given summary data about the serious adverse events displayed more trust in the CDC and greater HPV vaccine acceptance relative to the VIS alone. However, exposure to the detailed VAERS reports significantly reduced trust in the CDC and vaccine acceptance. Hence, general information about the VAERS data slightly increased trust in the CDC and improved vaccine acceptance, but the specific VAERS reports negatively influenced both trust and acceptance. Implications for communicating about vaccines are discussed.
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Seale H, Kaur R, Lajoie K, Dixon J, Gallard J. Examining the role of a decision aid in reducing decisional conflict amongst hospital healthcare workers towards receiving the influenza vaccine. BMC Health Serv Res 2016; 16:84. [PMID: 26961353 PMCID: PMC4785629 DOI: 10.1186/s12913-016-1339-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 03/07/2016] [Indexed: 11/14/2022] Open
Abstract
Background Currently the uptake of the influenza vaccine amongst Australian hospital staff remains low. While some staff members choose not to receive the vaccine, others may feel decisional conflict around whether to receive the vaccine or not. Having access to information that is personalized to the staff members’ concerns may alleviate this conflict. Our study aimed to explore the attitudes of hospital staff towards an online decision aid (DA), which focuses on influenza and the vaccine. We were also interested to examine whether they accepted the new tool and whether they had any suggestions for improvements. Methods Forty-one semi-structured interviews were undertaken with a range of hospital staff from two major public hospitals in Sydney and Melbourne, Australia in 2013. Emails and posters were used to inform staff members about the study. Thematic analysis was performed to explore the attitudes of hospital staff towards the DA. Results Our participants were well aware of the time/location of the staff vaccination clinics, however very few reported attending or receiving any educational material about the disease or the vaccine. Amongst those who did receive material, they felt that the messages were “dumbed down”. There was a mostly positive response to the DA from participants, however they felt that unless it was included as part of mandatory training or orientation, it would be difficult to get staff to use the tool. Conclusions Previous studies have established that education is an important component of an influenza vaccination program. We believe that the decision aid offers an alternative approach to delivering balanced information to staff members, which may reduce workload burdens on administrators and drive up rates.
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Affiliation(s)
- Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia.
| | - Rajneesh Kaur
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Kerryn Lajoie
- Immunisation Services, Melbourne, Victoria, Australia
| | - Julie Dixon
- Planning and Population Health, South Eastern Sydney Local Health District, Sydney, Australia
| | - Julie Gallard
- Centre for Hospital Epidemiology and Staff Services, Prince of Wales Hospital, Sydney, Australia
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49
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Grant CC, Chen MH, Bandara DK, Marks EJ, Gilchrist CA, Lewycka S, Carr PEA, Robinson EM, Pryor JE, Camargo CA, Morton SMB. Antenatal immunisation intentions of expectant parents: Relationship to immunisation timeliness during infancy. Vaccine 2016; 34:1379-88. [PMID: 26850758 DOI: 10.1016/j.vaccine.2016.01.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Most women decide about infant immunisation during pregnancy. However, we have limited knowledge of the immunisation intentions of their partners. We aimed to describe what pregnant women and their partners intended for their future child's immunisations, and to identify associations between parental intentions and the subsequent timeliness of infant immunisation. METHODS We recruited a cohort of pregnant New Zealand (NZ) women expecting to deliver between April 2009 and March 2010. The cohort included 11% of births in NZ during the recruitment period and was generalisable to the national birth cohort. We completed antenatal interviews independently with mothers and partners. We determined immunisation receipt from the National Immunisation Register and defined timely immunisation as receiving all vaccines (scheduled at 6-weeks, 3- and 5-months) within 30 days of their due date. We described independent associations of immunisation intentions with timeliness using adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS Of 6172 women, 5014 (81%) intended full immunisation, 245 (4%) partial immunisation, 140 (2%) no immunisation and 773 (13%) were undecided. Of 4152 partners, 2942 (71%) intended full immunisation, 208 (5%) partial immunisation, 83 (2%) no immunisation and 921 (22%) were undecided. Agreement between mothers and partners was moderate (Kappa=0.42). Timely immunisation occurred in 70% of infants. Independent of their partner's intentions, infants of pregnant women who decided upon full immunisation were more likely to be immunised on time (OR=7.65, 95% CI: 4.87-12.18). Independent of the future mother's intentions, infants of partners who had decided upon full immunisations were more likely to be immunised on time (OR=3.33, 95% CI: 2.29-4.84). CONCLUSIONS During pregnancy, most future parents intend to fully immunise their child; however, more partners than mothers remain undecided about immunisation. Both future mothers' and future fathers' intentions are independently associated with the timeliness of their infant's immunisations.
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Affiliation(s)
- Cameron C Grant
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
| | - Mei-Hua Chen
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
| | - Dinusha K Bandara
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
| | - Emma J Marks
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand; Bioinformatics Institute, The University of Auckland, Auckland, New Zealand
| | - Catherine A Gilchrist
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Sonia Lewycka
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Polly E Atatoa Carr
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand; Waikato Clinical School, The University of Auckland, Hamilton, New Zealand
| | - Elizabeth M Robinson
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand; Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Jan E Pryor
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand; Roy McKenzie Centre for the Study of Families, Victoria University, New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
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50
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Witteman HO, Scherer LD, Gavaruzzi T, Pieterse AH, Fuhrel-Forbis A, Chipenda Dansokho S, Exe N, Kahn VC, Feldman-Stewart D, Col NF, Turgeon AF, Fagerlin A. Design Features of Explicit Values Clarification Methods. Med Decis Making 2016; 36:453-71. [DOI: 10.1177/0272989x15626397] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 12/04/2015] [Indexed: 12/31/2022]
Abstract
Background. Values clarification is a recommended element of patient decision aids. Many different values clarification methods exist, but there is little evidence synthesis available to guide design decisions. Purpose. To describe practices in the field of explicit values clarification methods according to a taxonomy of design features. Data Sources. MEDLINE, all EBM Reviews, CINAHL, EMBASE, Google Scholar, manual search of reference lists, and expert contacts. Study Selection. Articles were included if they described 1 or more explicit values clarification methods. Data Extraction. We extracted data about decisions addressed; use of theories, frameworks, and guidelines; and 12 design features. Data Synthesis. We identified 110 articles describing 98 explicit values clarification methods. Most of these addressed decisions in cancer or reproductive health, and half addressed a decision between just 2 options. Most used neither theory nor guidelines to structure their design. “Pros and cons” was the most common type of values clarification method. Most methods did not allow users to add their own concerns. Few methods explicitly presented tradeoffs inherent in the decision, supported an iterative process of values exploration, or showed how different options aligned with users’ values. Limitations. Study selection criteria and choice of elements for the taxonomy may have excluded values clarification methods or design features. Conclusions. Explicit values clarification methods have diverse designs but can be systematically cataloged within the structure of a taxonomy. Developers of values clarification methods should carefully consider each of the design features in this taxonomy and publish adequate descriptions of their designs. More research is needed to study the effects of different design features.
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Affiliation(s)
- Holly O. Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Laura D. Scherer
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Teresa Gavaruzzi
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Arwen H. Pieterse
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Andrea Fuhrel-Forbis
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Nicole Exe
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Valerie C. Kahn
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Deb Feldman-Stewart
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Nananda F. Col
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Alexis F. Turgeon
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Angela Fagerlin
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
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