Understanding and promoting AIDS-preventive behavior: insights from the theory of reasoned action

Social and structural factors associated with interest in HIV preexposure prophylaxis among Black women in the United States

In a nationwide sample of cisgender Black women in the US, we assessed the associations between social and structural factors and interest in using HIV preexposure prophylaxis (PrEP). Among 315 respondents, 62.2% were interested in PrEP if it were provided for free. Positive social norms surrounding PrEP, including injunctive norms (perceived social acceptability of PrEP use) and descriptive norms (perceived commonality of PrEP use), were positively associated with interest in using PrEP. Concerns about HIV infection, recently visiting a health care provider, and comfort discussing PrEP with a provider were also positively associated with interest in using PrEP. Anticipating PrEP disapproval from others was negatively associated with interest in PrEP. Although PrEP can promote autonomy and personal discretion, Black women's PrEP-related decisions occur in a complex social environment. Black women may benefit from interventions to promote positive norms and attitudes surrounding PrEP at the community level and empower them in discussions with their providers about PrEP.

Evaluation of community knowledge and attitude toward COVID-19: the case of Hawassa city, Sidama, Ethiopia

Background

Scientific information on the knowledge and attitude of the community toward the COVID-19 pandemic is a vital step for effective control measures. This study aimed to investigate the level of knowledge and attitude of Hawassa city residents toward COVID-19 and the interaction among knowledge and attitude toward COVID-19.

Methods

A community-based cross-sectional study with stratified random sampling was used from June 2020 to August 2020. Five hundred and eighty-seven residents were selected for the study, which aimed to evaluate their knowledge and attitude toward COVID-19 using a standardized structured questionnaire. Data were collected using face-to-face interviews that strictly follow the WHO and the Ministry of Health Ethiopia guidelines for COVID-19 prevention. Attitude and knowledge were categorized based on the mean score value. Descriptive statistics and two independent multiple logistic regressions were applied to identify the possible determinants of knowledge and attitude using SPSS version 20 set at 95% CIs with a value of p of <0.05 considered statistically significant.

Results

In total, 61.7% of the participants were knowledgeable about the virus and 65.9% had a positive attitude toward COVID-19. Educational level with the categories of second degree and above (AOR = 29.709, 95% CI = 1.239-712.55), first degree (AOR = 3.476, 95% CI = 3.278-22.02), certificate/diploma (AOR = 1.062-18.24, 95% CI = 1.062-18.24), and grade 12 completed (AOR = 1.903, 95% CI = 2.12-6.809); employment status of respondents who were self-employed (AOR = 9.545, 95% CI = 1.165-78.173) and employed respondents (AOR = 10.053, 95% CI = 1.783-56.673); reading interest with categories always (AOR = 34.45, 95% CI = 26.608-4462.226) and sometimes (AOR = 17.24, 95% CI = 17.213-1661.966); and habit of using social media with categories always (AOR = 38.708, 95% CI = 5.086-294.610) and sometimes (AOR = 3.432, 95% CI = 3.504-23.378) were the significant explanatory variables that were correlated with knowledge of the respondents.

Conclusion

Although the knowledge and attitude of respondents toward COVID-19 were positive, there is a need to use more effective strategies to improve their knowledge and attitude toward COVID-19, and increasing knowledge on preventive behaviors among the community was mandatory to attain better results. The educational level, use of social media, and reading habits of the respondents appear to play significant roles in determining their level of knowledge and attitude toward COVID-19.

The Impact of Providers as Health Discussants on Black Women's Interest in PrEP for HIV Prevention

This study sought to examine the role of providers as health discussants (HD) on interest in preexposure prophylaxis for HIV prevention in a national sample of adult Black cisgender women (N = 315). Health discussant networks, a type of social network, may be influential in HIV prevention efforts. These networks, often composed of individuals' families, have improved health utilization outcomes in other disciplines. However, health discussants in HIV prevention are understudied, especially when considering providers as network members. We conducted a cross-sectional online survey and collected socio-demographic information, sexual history, HIV concerns, PrEP attitudes, healthcare utilization, mistrust, social support, and HD information. We used descriptive statistics and logistic regression to analyze data. Associations between PrEP interest and variables were examined. We found that older, partnered, who had recent healthcare visits or health insurance were more likely to involve healthcare providers as discussants. Anticipated PrEP stigma decreased provider involvement. Among participants listing providers as discussants, there was a greater likelihood of interest in using PrEP. Our findings indicate that healthcare provider support and social factors are crucial in promoting PrEP engagement among Black women. Integrating social dynamics and positive provider-patient interactions is essential for successful PrEP implementation.

The Efficacy of Virtual-based Nutritional Interventions on Knowledge, Attitude, and Practices of Individuals with Hypertension: A Comparative Study Analysis

Introduction

Hypertension (HTN) is multifactorial, complex disorder predictable to affect all genders and foremost preventable risk factor for blood pressure and cardiovascular diseases.

Objectives

The present study was assessing the knowledge, attitude, and practices (KAPs) regarding HTN and creating the awareness of its better management among the hypertensive population through nutrition education intervention.

Methodology

A total of 82 participants were selected and questionnaire was used to elicit sociodemographic profile and KAP regarding HTN and its management. Nutrition education intervention was carried out through the online mode.

Results and Discussion

Results observed in preintervention between knowledge with attitude in experimental group and control group (r =+0.273 and r =+0.271), practice (r =+0.275 and r =+0.263), and attitude with practice (r =+0.521 and r =+0.186) were positive correlation similarly postintervention of both group obtained significant positive correlation. The statistical analysis of various sociodemographic factors of pre and postintervention in the experimental group and control group revealed a significant improvement in the mean posttest scores of KAP. Meanwhile, various sociodemographic factors obtained had nonsignificant (P > 0.005) in experimental group; a control group of pretest and posttest reported significant differences (P < 0.05). The posttest total mean score on nutritional knowledge and practice in the experimental group also showed a large significant (P < 0.05) increase when compared to the pretest mean score. There was no significant improvement in the total mean scores in any dimensions of the control group.

Conclusion

The study therefore helped the experimental group subjects in improving their overall knowledge about the importance of nutrition in HTN and also instilled positive attitude and practices toward the management of HTN through lifestyle modifications.

The Attitudes and Practices Regarding COVID-19 among General Practitioners from Croatia and Bosnia and Herzegovina: A Cross-Sectional Study

Attitudes toward COVID-19 (coronavirus disease 2019) prevention and control may have influenced general practitioners' (GPs') work during the COVID-19 pandemic. The present study aimed to investigate the attitudes and practices of GPs from Croatia and Bosna and Herzegovina regarding COVID-19 prevention and control as well as the factors which may have influenced them. A cross-sectional study using a self-administered, anonymous questionnaire was conducted between February and May of 2022 on 200 Croatian and Bosnian GPs. The study revealed that the attitudes and practices of the surveyed GPs regarding COVID-19 prevention and control were satisfactory. The Croatian GPs reported a larger number of positive attitudes toward COVID-19 prevention and control (p = 0.014), while no significant differences in practices were established. Among the Croatian GPs, more positive attitudes toward COVID-19 prevention and control were reported by participants who had finished a formal education on the prevention of infectious diseases and occupational safety (p = 0.018), while among the Bosnian GPs, more positive attitudes were reported by older GPs (p = 0.007), males (p = 0.026), GPs with a longer length of service (p = 0.005), GPs who had finished a formal education on the prevention of infectious diseases and occupational safety (p < 0.001), GPs who had finished a formal education on adequate hand hygiene (p < 0.001), and GPs who had finished a formal education on COVID-19 prevention for GPs (p = 0.001). Considering GPs' practices regarding COVID-19 prevention and control, among the Croatian GPs, more positive practices were reported by older GPs (p = 0.008), females (p = 0.002), GPs who had a partner (p = 0.021), GPs who were specialists in family medicine (p = 0.014), GPs with a longer length of service (p = 0.007), and GPs who had finished a formal education on the prevention of infectious diseases and occupational safety (p = 0.046), while among the Bosnian GPs, no significant correlations were determined. The general practitioners' sociodemographic and employment characteristics strongly influenced their attitudes and practices regarding the prevention and control of COVID-19. The cultural differences between Croatia and Bosnia and Herzegovina, as well as the organizational specificities of their healthcare systems, probably modified the observed differences in the individual patterns of associations between the outcome and explanatory variables in the surveyed neighboring countries.

HiSTEP: A Single-Arm Pilot Study of a Technology-Assisted HIV Self-testing Intervention in Kampala, Uganda

We developed and pilot tested a 3-month HIV self-testing intervention called HiSTEP ("HIV Self-testing Engagement Project") among 95 adult (18+ years) at-risk (condomless sex < 3 months) adults in Kampala, Uganda. HiSTEP leverages theoretically-grounded (in the Information-Motivation-Behavioral Skills model) text messages, a telehealth centre with live support, and "last-mile" HIV self-testing kit delivery to a location chosen by the participant. Nearly 94% of participants were retained at month 3. HIV self-testing was highly acceptable across age and gender groups (94% very satisfied), although older women had slightly lower acceptability ratings (92% very satisfied). Only 13% of participants used HIV self-testing prior to enrollment. Over the 3-month study period, 86% of participants ordered a total of 169 HIV self-testing kits (69% for participant use; 31% for use by others). Findings show that the intervention approach taken in HiSTEP may be particularly valuable for engaging at-risk Ugandan adults in HIV self-testing using a novel technology-assisted promotion and delivery method.

Response to a sexual risk reduction intervention provided in combination with hepatitis C treatment by HIV/HCV co-infected men who have sex with men: a reflexive thematic analysis

BACKGROUND

Hepatitis C virus reinfections in HIV-positive men-who-have-sex-with-men (MSM) challenge the effectiveness of antiviral treatment. To fight this problem, an adapted sexual risk reduction intervention was implemented within a hepatitis C treatment trial. Following this, the current study had two aims and describes 1) how the program was received by participants; and 2) their responses to the program regarding sexual risk taking. Based on the participants' input, we hoped to judge the intervention's potential for scale-up.

METHODS

Seventeen participants who received the sexual risk reduction intervention in addition to hepatitis C treatment were recruited for semi-structured interviews six to 12 months post-intervention. We evaluated the responses via reflexive thematic analysis and applied the concept of sense-making.

RESULTS

Giving hepatitis C a place and living without it again illustrates how participants received the program and how their experiences were altered by the impact of sense-making. Based on their responses, we allocated participants to three groups: 1. Avoid risks: get rid of hepatitis C for life. For these men, hepatitis C remained a life-threatening disease: they actively modified their risk behavior and felt supported by the intervention in maintaining their behavioral changes. 2. Minimize risks: live as long as possible without hepatitis C. In contrast to group 1, these men saw hepatitis C as a manageable disease. The intervention facilitated reflection on risks and how to develop behavioral changes that suited them individually. 3. Accept risks; live with the risk of hepatitis C. These men perceived behavioral changes as much more difficult than "easy" medical treatment. They expected to either undergo repeated rounds of treatment or stay HCV re-infected.

CONCLUSION

These results illustrate the diversity of men's responses and their decisions regarding sexual risk behavior after participating in a combination of antiviral treatment and a sexual risk reduction intervention. Two major aspects were identified: 1) Teachable moments, particularly at the time of diagnosis/treatment, could offer an opportunity to develop openness for behavioral change; 2) adapting sexual risk reduction interventions to sense-making patterns could help to improve its effectiveness. Support for reducing infection risk and raising awareness of preventative measures are additional benefits.

TRIAL REGISTRATION

Clinical Trial Number: NCT02785666 , 30.05.2016.

Assessing Knowledge, Attitudes and Practices Towards COVID-19 Public Health Preventive Measures Among Patients at Mulago National Referral Hospital

Background

COVID-19 has become a major global health challenge, with Uganda reporting over 20,000 cases. There is, however, a scarcity of data on the perception of patients in Uganda towards the highly infectious disease. We aimed to assess the awareness, knowledge, attitudes, and practices towards COVID-19 preventive measures among patients at Mulago National Referral Hospital (MNRH), Uganda.

Methods

A cross-sectional quantitative survey was conducted in August, 2020, among patients in surgical and medical wards at MNRH. An interviewer-administered, pre-validated questionnaire was used to collect data that was entered into Google Forms and analyzed using Microsoft Excel and STATA 16. Descriptive statistics was used to present data from univariate analysis. Patients whose knowledge and practice scores were greater or equal to the average score were regarded to have good knowledge and practices respectively. Chi-square, Fisher’s Exact tests and binary logistic regression were used to assess factors associated with COVID-19 knowledge and practices. A P<0.05 was statistically significant.

Results

Overall, 114 patients were approached and 102 consented to participate. Most were females (53.8%), aged above 45 years (31.4%) with 40.2% reporting primary level as the highest level of education. About 55.9% (n=57) had adequate knowledge for COVID-19 and its related practices, and 52% (n=53) had good COVID-19 related practices. Knowledge significantly differed by marital status at bivariate analysis (P=0.020), however this lost significance at logistic regression. Female patients were thrice more likely to have good COVID-19 prevention practices compared to males (COR: 2.59, 95% CI: 1.2 to 5.8, P=0.020). Some 47 (46.1%) participants perceived that COVID-19 preventive measures were not difficult at all to observe.

Conclusion

About half of the patients at Mulago National Referral Hospital lack adequate knowledge and practice on COVID-19 prevention. Continued patient education is required to increase knowledge which will in turn improve adherence to COVID-19 preventive practices.

Beliefs on COVID-19 Among Electronic Cigarette Users: Behavioral Responses and Implications for COVID Prevention and E-Cigarette Interventions

E-cigarette users’ beliefs about COVID-19 may shape their responses to the pandemic and their e-cigarette consumption. A U.S. national cross-sectional survey of 562 e-cigarette users was conducted in April 2020. Participants self-reported nicotine consumption, COVID-19 beliefs, beliefs about e-cigarettes, social distancing, COVID-19 disruptions, cessation considerations, and individual characteristics. Ordinary least squares (OLS) regression provided unstandardized, and standardized coefficients. Frequency of e-cigarette use is inversely associated with beliefs COVID-19 is relevant (β = −0.215). Beliefs e-cigarettes are addictive, harmful, or pose a risk to future health were positively associated with beliefs COVID-19 is relevant (β = 0.171; β = 0.164; β = 0.203), beliefs the media are truthful on COVID-19 (β = 0.133; β = 0.136; β = 0.137), and beliefs e-cigarette users are at greater risk (β = 0.279; β = 0.411; β = 0.447). All three COVID-19 beliefs (COVID relevant; media truthful; and greater risk) were positively associated with social distancing (β = 0.307; β = 0.259; β = 0.115), work disruptions (β = 0.134; β = 0.135; β = 0.130), family disruptions (β = 0.232; β = 0.131; β = 0.164), friendship disruptions (β = 0.214; β = 0.139; β = 0.133), and considerations of quitting (β = 0.250; β = 0.222; β = 0.620). Strong associations between e-cigarette beliefs and COVID-19 beliefs exist. COVID-19 beliefs are associated with behavioral responses, such as social distancing and considerations of e-cigarette cessation. Interventions may be able to leverage COVID-19 beliefs to reduce e-cigarette consumption or promote cessation during the pandemic.

Effectiveness of a Peer-Led Web-Based Intervention to Improve General Self-Efficacy in Using Dating Apps Among Young Adults: Randomized Clustered Trial

BACKGROUND

Online dating apps are popular platforms for seeking romance and sexual relationships among young adults. As mobile apps can easily gain access to a pool of strangers ("new friends") at any time and place, it leads to heightened sexual health risks and privacy concerns.

OBJECTIVE

This study aimed to evaluate the effectiveness of a peer-led web-based intervention for online dating apps to prepare Chinese college students so that they have better self-efficacy when using dating apps.

METHODS

An open clustered randomized controlled trial was conducted among students from three colleges (The University of Hong Kong, Hang Seng University of Hong Kong, and Yijin Programme of Vocational Training College) in Hong Kong. Students aged 17 to 27 years who attended common core curriculum or general education were randomized into intervention and control groups. The intervention material, developed with high peer engagement, included four short videos, an interactive scenario game, and a risk assessment tool. An existing website promoting physical activities and healthy living was used as a control. Using the information, motivation, and behavioral skills (IMB) approach to design the evaluation, questionnaires covering participants' sociodemographics and dating app characteristics, as well as the general self-efficacy scale (GSE) as the primary outcome and the risk propensity scale (RPS) as the secondary outcome were administered before, immediately after, and at 1 month after the intervention. Intention-to-treat analysis was adopted, and between-group differences were assessed using the Mann-Whitney U test. A post-hoc multiple linear regression model was used to examine the correlates of the GSE and RPS.

RESULTS

A total of 578 eligible participants (290 in the intervention group and 288 in the control group) participated in the study with 36 lost to follow-up. There were more female participants (318/542, 58.7%) than male participants in the sample, reflecting the distribution of college students. Over half of the participants (286/542, 52.8%) reported the following reasons for using dating apps: being curious (170/498, 34.1%), trying to make new friends (158/498, 31.7%), and finding friends with similar interests (121/498, 24.3%). Overall, the participants in the intervention group reported favorable experiences when compared with the finding in the control group. There was significant improvement in the GSE score and reduction in the RPS score (P<.001) in the intervention group. University of Hong Kong students were more susceptible to risk reduction after the intervention when compared with students from the other two institutions.

CONCLUSIONS

The online intervention was effective in improving general self-efficacy and reducing risk tendency among young students. Future work is needed to determine if this approach is cost-effective and such behavioral change is sustainable.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03685643; https://clinicaltrials.gov/ct2/show/NCT03685643.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-018-3167-5.

Knowledge, Attitudes and Practices Toward Prevention and Early Detection of COVID-19 and Associated Factors Among Religious Clerics and Traditional Healers in Gondar Town, Northwest Ethiopia: A Community-Based Study

BACKGROUND

COVID-19 control measures efforts are affected by the knowledge, attitudes, and practices of the public, particularly religious clerics and traditional healers, who have close contact and are widely accepted by a significant number of community members.

METHODS

A community-based cross-sectional study was conducted to determine knowledge, attitudes and practices towards COVID-19 and its associated factors among religious clerics and traditional healers in Gondar town. Study participants who met our inclusion criteria were selected using a simple random sampling technique. Data were collected by trained data collectors through face-to-face interviews. The reliability of the questionnaire was assessed using Cronbach's alpha. Knowledge, attitudes and practices scores were calculated to give the overall knowledge, attitude and practice score. Binary logistic regression was fitted to identify associated factors and odds ratio was used to measure the strength of the association.

RESULTS

A total of 410 religious clerics and traditional healers were included in the study with a response rate of 97.1%. Of the total participants, 60.7% (95%: CI (56-65%)) had good knowledge, 34.1% (95%: CI (30-39%)) had a positive attitude and 15.6% (95%: CI (12-19%)) had good practices towards prevention and early detection of COVID-19. Less than one third of the participants practiced physical distancing (28%) and facemask use (17.8%). In multivariate logistic regression, age, educational status and marital status were significantly associated with knowledge score. Likewise, age and marital status were significantly associated with the positive attitude score. In addition, age, educational status, and the presence of underlying disease were significantly associated with the good practice score.

CONCLUSION

Majority of the participants had poor practice and negative attitudes. Therefore, there should be a sensitization program to fill the gap in the knowledge, attitudes and practice measures of COVID-19 especially for elderly and illiterates.

Knowledge, attitudes, anxiety, and preventive behaviours towards COVID-19 among health care providers in Yemen: an online cross-sectional survey

BACKGROUND

The growing incidence of coronavirus (COVID-19) continues to cause fear, anxiety, and panic amongst the community, especially for healthcare providers (HCPs), as the most vulnerable group at risk of contracting this new SARS-CoV-2 infection. To protect and enhance the ability of HCPs to perform their role in responding to COVID-19, healthcare authorities must help to alleviate the level of stress and anxiety amongst HCPs and the community. This will improve the knowledge, attitude and practice towards COVID-19, especially for HCPs. In addition, authorities need to comply in treating this virus by implementing control measures and other precautions. This study explores the knowledge, attitude, anxiety, and preventive behaviours among Yemeni HCPs towards COVID-19.

METHODS

A descriptive, web-based-cross-sectional study was conducted among 1231 Yemeni HCPs. The COVID-19 related questionnaire was designed using Google forms where the responses were coded and analysed using the Statistical Package for the Social Sciences software package (IBM SPSS), version 22.0. Descriptive statistics and Pearson's correlation coefficient test were also employed in this study. A p-value of < 0.05 with a 95% confidence interval was considered as statistically significant. The data collection phase commenced on 22nd April 2020, at 6 pm and finished on 26th April 2020 at 11 am.

RESULTS

The results indicated that from the 1231 HCPs participating in this study, 61.6% were male, and 67% were aged between 20 and 30 years with a mean age of 29.29 ± 6.75. Most (86%) held a bachelor's degree or above having at least 10 years of work experience or less (88.1%). However, while 57.1% of the respondents obtained their information via social networks and news media, a further 60.0% had never attended lectures/discussions about COVID-19. The results further revealed that the majority of respondents had adequate knowledge, optimistic attitude, moderate level of anxiety, and high-performance in preventive behaviours, 69.8, 85.10%, 51.0 and 87.70%, respectively, towards COVID-19.

CONCLUSION

Although the Yemeni HCPs exhibited an adequate level of knowledge, optimistic attitude, moderate level of anxiety, and high-performance in preventive behaviours toward COVID-19, the results highlighted gaps, particularly in their knowledge and attitude towards COVID-19.

Perception and attitude of healthcare workers in Saudi Arabia with regard to Covid-19 pandemic and potential associated predictors

BACKGROUND

Healthcare workers (HCWs) face considerable mental and physical stress caring for patients with Covid-19. They are at higher risk of acquiring and transmitting this virus. This study aims to assess perception and attitude of HCWs in Saudi Arabia with regard to Covid-19, and to identify potential associated predictors.

METHODS

In a cross-sectional study, HCWs at three tertiary hospitals in Saudi Arabia were surveyed via email with an anonymous link, by a concern scale about Covid-19 pandemic during 15-30 April, 2020. Concerns of disease severity, governmental efforts to contain it and disease outcomes were assessed using 32 concern statements in five distinct domains. Multiple regression analysis was used to identify predictors of high concern scores.

RESULTS

A total of 844 HCW responded to the survey. Their average age was 40.4 ± 9.5 years, 40.3% were nurses, 58.2% had direct patient contact, and 77.3% were living with others. The majority of participants (72.1%) had overall concern scores of 55 or less out of a maximum score of 96 points, with an overall mean score of 48.5 ± 12.8 reflecting moderate level of concern. Three-fourth of respondents felt at risk of contracting Covid-19 infection at work, 69.1% felt threatened if a colleague contracted Covid-19, 69.9% felt obliged to care for patients infected with Covid-19 while 27.7% did not feel safe at work using the standard precautions available. Nearly all HCWs believed that the government should isolate patients with Covid-19 in specialized hospitals (92.9%), agreed with travel restriction to and/or from areas affected by Covid-19 (94.7%) and felt safe the government implemented curfew and movement restriction periods (93.6%). Predictors of high concern scores were; HCWs of Saudi nationality (p < 0.001), younger age (p = 0.003), undergraduate education (p = 0.044), living with others (p = 0.003) working in the western region (p = 0.003) and direct contact with patients (p = 0.018).

CONCLUSIONS

This study highlights the high concern among HCWs about Covid-19 and identifies the predictors of those with highest concern levels. To minimize the potential negative impact of those concerns on the performance of HCWs during pandemics, measures are necessary to enhance their protection and to minimize the psychological effect of the perceived risk of infection.

Knowledge, attitude, practice and perceived barriers among healthcare workers regarding COVID-19: a cross-sectional survey from Pakistan

A self-administered validated (Cronbach's alpha=0.077) questionnaire was used to assess knowledge, attitude and practice among healthcare workers (HCWs) in Pakistan regarding coronavirus disease 2019 (COVID-19). Findings showed that HCWs have good knowledge (93.2%, N=386), a positive attitude [mean 8.43 (standard deviation 1.78)] and good practice (88.7%, N=367) regarding COVID-19. HCWs perceived that limited infection control material (50.7%, N=210) and poor knowledge regarding transmission (40.6%, N=168) were the major barriers to infection control. Regression analysis indicated that pharmacists were more likely to demonstrate good practice than other HCWs (odds ratio 2.247, 95% confidence interval 1.11-4.55, P=0.025). This study found that HCWs in Pakistan have good knowledge, but there are gaps in specific aspects of knowledge and practice that warrant attention.

Knowledge, attitude, practice and perceived barriers among healthcare workers regarding COVID-19: a cross-sectional survey from Pakistan

A self-administered validated (Cronbach's alpha=0.077) questionnaire was used to assess knowledge, attitude and practice among healthcare workers (HCWs) in Pakistan regarding coronavirus disease 2019 (COVID-19). Findings showed that HCWs have good knowledge (93.2%, N=386), a positive attitude [mean 8.43 (standard deviation 1.78)] and good practice (88.7%, N=367) regarding COVID-19. HCWs perceived that limited infection control material (50.7%, N=210) and poor knowledge regarding transmission (40.6%, N=168) were the major barriers to infection control. Regression analysis indicated that pharmacists were more likely to demonstrate good practice than other HCWs (odds ratio 2.247, 95% confidence interval 1.11-4.55, P=0.025). This study found that HCWs in Pakistan have good knowledge, but there are gaps in specific aspects of knowledge and practice that warrant attention.

A dyadic approach to understanding safer sex behavior in intimate heterosexual relationships

This study applied a dyadic approach to condom-use research. Partners from 124 heterosexual couples independently completed a questionnaire assessing condom-related attitudes, subjective norms, perceived behavioral control, and intentions to use condoms. Results demonstrate the superiority of a dyadic approach to understanding couples’ condom-use intentions and behavior over traditional, individual-level approaches. The addition of partner effects to the model, via the actor–partner interdependence model, resulted in an increase in the variance accounted for in condom-use intentions and this dyadic model showed better fit compared to the individual-level model. The results suggest that consideration of relationship partners plays an important role in the prediction of safer sex intentions.

Suubi4Her: a study protocol to examine the impact and cost associated with a combination intervention to prevent HIV risk behavior and improve mental health functioning among adolescent girls in Uganda

BACKGROUND

Asset-based economic empowerment interventions, which take an integrated approach to building human, social, and economic capital, have shown promise in their ability to reduce HIV risk for young people, including adolescent girls, in sub-Saharan Africa. Similarly, community and family strengthening interventions have proven beneficial in addressing mental health and behavioral challenges of adolescents transitioning to adulthood. Yet, few programs aimed at addressing sexual risk have applied combination interventions to address economic stability and mental health within the traditional framework of health education and HIV counseling/testing. This paper describes a study protocol for a 5-year, NIMH-funded, cluster randomized-controlled trial to evaluate a combination intervention aimed at reducing HIV risk among adolescent girls in Uganda. The intervention, titled Suubi4Her, combines savings-led economic empowerment through youth development accounts (YDA) with an innovative family strengthening component delivered via Multiple Family Groups (MFG).

METHODS

Suubi4Her will be evaluated via a three-arm cluster randomized-controlled trial design (YDA only, YDA + MFG, Usual Care) in 42 secondary schools in the Central region of Uganda, targeting a total of 1260 girls (ages 15-17 at enrollment). Assessments will occur at baseline, 12, 24, and 36 months. This study addresses two primary outcomes: 1) change in HIV risk behavior and 2) change in mental health functioning. Secondary exploratory outcomes include HIV and STI incidence, pregnancy, educational attainment, financial savings behavior, gender attitudes, and self-esteem. For potential scale-up, cost effectiveness analysis will be employed to compare the relative costs and outcomes associated with each study arm.

CONCLUSIONS

Suubi4Her will be one of the first prospective studies to examine the impact and cost of a combination intervention integrating economic and social components to reduce known HIV risk factors and improve mental health functioning among adolescent girls, while concurrently exploring mental health as a mediator in HIV risk reduction. The findings will illuminate the pathways that connect economic needs, mental health, family support, and HIV risk. If successful, the results will promote holistic HIV prevention strategies to reduce risk among adolescent girls in Uganda and potentially the broader sub-Saharan Africa region.

TRIAL REGISTRATION

Clinical Trials NCT03307226 (Registered: 10/11/17).

Knowledge, attitudes and practices of hypertensive patients towards prevention and early detection of chronic kidney disease: a cross sectional study from Palestine

BACKGROUND

Hypertension is the second most common cause of chronic kidney disease (CKD). Therefore, the aims of the study were to assess the knowledge, attitudes and practices (KAP) of hypertensive patients towards prevention and early detection of CKD, and to determine the clinical and socio-demographic factors, which affect the KAP regarding prevention of CKD.

METHODS

A cross-sectional study was held using the CKD screening Index to assess the KAP of 374 hypertensive patients who were selected from multiple primary healthcare centers in Nablus, Palestine. The CKD Screening Index is formed of three scales. First, the knowledge scale was a dichotomous scale of 30 items, while the attitude scale used 5-point Likert-type scale for 18 items and finally the practice scale was measured using 4-point Likert-type scale for 12 items. Multiple linear regression analysis was used to determine the association between clinical and socio-demographic factors and practices.

RESULTS

In total, 374 hypertensive patients participated in the study. The mean age of participants was 59.14 ± 10.4 years, (range 26-85). The median (interquartile range) of the knowledge, attitude, and practice scores of hypertensive patients towards prevention and early detection of CKD were 20 (16-23), 69 (65-72), and 39 (36-42), respectively. In multiple linear regression analysis, patients age < 65 years (p < 0.001) and patients with high education level (p = 0.009) were the only factors significantly associated with higher knowledge scores. Additionally, patients age < 65 years (p = 0.007), patients with high income (p = 0.005), and patients with high knowledge score (p < 0.001) were the only factors significantly associated with higher attitude scores. Furthermore, regression analysis showed that patients with higher total knowledge (p = 0.001) as well as higher total attitudes scores towards CKD prevention (p < 0.001), male gender (p = 0.048), and patients with normal body mass index (BMI) (p = 0.026) were statistically significantly associated with higher practice score towards CKD prevention.

CONCLUSIONS

Among hypertensive patients, higher scores for total knowledge and attitudes toward prevention, male sex, and normal BMI were associated with modestly higher scores for prevention practices. Finally the findings may encourage healthcare workers to give better counseling to improve knowledge.

Psychological distress, health protection, and sexual practices among young men who have sex with men: Using social action theory to guide HIV prevention efforts

The present study addresses gaps in the literature related to theory development for young men who have sex with men (YMSM) sexual practices through the application and modification of Social Action Theory. Data come from the Healthy Young Men study (N = 526), which longitudinally tracked a diverse cohort of YMSM ages 18–24 to characterize risk and protective factors associated with drug use and sexual practices. Structural equation modeling examined the applicability of, and any necessary modifications to a YMSM-focused version of Social Action Theory. The final model displayed excellent fit (CFI = 0.955, TLI = 0.947, RMSEA = 0.037) and suggested concordance between social support and personal capacity for sexual health promotion. For YMSM, practicing health promotion and avoiding practices that may put them at risk for HIV was associated with both social isolation and psychological distress (β = -0.372, t = -4.601, p<0.001); psychological distress is an internalized response to environmental and cognitive factors and sexual practices are an externalized response. Results point to the utility of Social Action Theory as a useful model for understanding sexual practices among YMSM, the application of which shows health protective sexual practices are a function of sociocognitive factors that are influenced by environmental contexts. Social Action Theory can help prevention scientists better address the needs of this vulnerable population.

Racial differences in willingness to participate in HIV prevention clinical trials among university students in KwaZulu-Natal, South Africa

Students, especially women, are in the highest HIV incidence group in Sub-Saharan Africa. Willingness to participate is a crucial element in recruitment of participants for clinical trials, including HIV prevention trials. There is increasing incidence of HIV among university students, highlighting the importance of evaluating their willingness to participate in prevention trials. Assessment of willingness to participate assists in determining community preparedness for trials. This cross-sectional study aimed to evaluate willingness to participate and explore racial differences and factors associated with willingness to participate in HIV prevention research. The Clinical Research Involvement Scale and demographic questionnaire were administered online to university students aged 18–45 years at the University of KwaZulu-Natal in South Africa. The instruments evaluated associations between willingness to participate and age, gender, relationship status, parity, religion, education, student and employment status, and access to private health care. This study enrolled 636 participants, of which 509 records were analysable. Most students were willing to participate in HIV prevention research irrespective of race. However, Black students expressed greater intention to participate compared to White and Indian students. Racial differences in factors that affect intentions to participate were differences in risk perception and seeking access to better quality health care. The Clinical Research Involvement Scale is a reliable instrument in this population. Validity improved with removal of factors, motivation to comply, and outcome evaluations. These findings may not be generalizable to other student populations in Southern Africa.

Correlates of Young Men's Intention to Discuss Birth Control with Female Partners

CONTEXT

Heterosexually active men who wish to prevent conception, but are not willing to use condoms consistently, need to discuss birth control with female partners. Improving the understanding of correlates of men's intention to have such discussions is one step toward supporting this health-facilitating behavior.

METHODS

A sample of 372 heterosexually active men aged 18-25 were recruited and surveyed online between December 2010 and June 2011. Men answered questions on attitudes toward, norms regarding and self-efficacy about discussing birth control, and about endorsement of two sexual scripts. Multiple regression analyses tested these measures' associations with intention to discuss birth control, controlling for age and relationship status.

RESULTS

Attitudes, norms and self-efficacy were each positively associated with men's intention to discuss birth control, accounting for 34% of variance. The more strongly men endorsed a traditional masculinity sexual script, the less likely they were to intend to discuss birth control (coefficient, -0.2). Endorsement of an alternative, gender-equitable "sex-positive woman" script, which emphasizes sexual pleasure and emotional connection as goals for both partners, had no association with intention.

CONCLUSION

Strategies that merit further exploration as potential supports for men's intention to discuss birth control include improving men's self-efficacy and positive attitudes and norms pertaining to such discussions, and reducing belief in traditionally masculine sexual scripts or transforming them to include discussing birth control. Future research should work both experimentally and longitudinally to document each element of the process that ends with men's full participation in effective contraceptive use.

An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia

Background

Middle East Respiratory Syndrome (MERS) is caused by MERS coronavirus (MERS-CoV). More than 80% of reported cases have occurred in Saudi Arabia, with a mortality exceeding 50%. Health-care workers (HCWs) are at risk of acquiring and transmitting this virus, so the concerns of HCWs in Saudi Arabia regarding MERS were evaluated.

Methods

An anonymous, self-administered, previously validated questionnaire was given to 1031 HCWs at three tertiary hospitals in Saudi Arabia from October to December, 2014. Concerns regarding the disease, its severity and governmental efforts to contain it, as well as disease outcomes were assessed using 31 concern statements in five distinct domains. A total concern score was calculated for each HCW. Multiple regression analyses were used to identify predictors of high concern scores.

Results

The average age of participants was 37.1 ± 9.0 years, 65.8% were married and 59.1% were nurses. The majority of respondents (70.4%) felt at risk of contracting a MERS-CoV infection at work, 69.1% felt threatened if a colleague contracted MERS-CoV, 60.9% felt obliged to care for patients infected with MERS-CoV and 87.8% did not feel safe at work using standard precautions. In addition, 87.7% believed that the government should isolate patients with MERS in specialized hospitals, 73.7% agreed with travel restriction to and from areas affected by MERS and 65.3% agreed with avoiding inviting expatriates from such areas. After adjustment for covariates, high concern scores were significantly associated with being a Saudi national (p < 0.001), a non-physician (p < 0.001) and working in the central region (p < 0.001).

Conclusions

The majority of respondents reported concern regarding MERS-CoV infection from exposure at work. The overall level of concern may be influenced by previous experience of MERS outbreaks and related cultural issues. The concerns of HCWs may affect their overall effectiveness in an outbreak and should be addressed by incorporating management strategies in outbreak planning.

HIV Testing Behavior and Social Network Characteristics and Functions Among Young Men Who have Sex with Men (YMSM) in Metropolitan Detroit

HIV testing promotion is a critical HIV prevention strategy, especially among at-risk groups such as young men who have sex with men (YMSM). Based on a web survey of 194 YMSM (18-24), we examine the association of social network characteristics and functions, and of individual-level characteristics, with three HIV testing behaviors (ever, repeat, and recent testing). Network homophily was associated with recent testing in multivariable models. The network function of information acquisition was associated with ever testing and repeat testing. Perceived stigma regarding HIV-related help-seeking was negatively related to recent testing. Individual characteristics were associated with testing outcomes in all models; age, perceived behavioral control, and positive attitudes had the greatest influence. Individual characteristics had a stronger association with ever testing and repeat testing than network characteristics and functions; however, this relationship was reversed for recent testing. Findings support the value of multi-level and network-focused interventions for promoting HIV testing among YMSM.

Awareness of droplet and airborne isolation precautions among dental health professionals during the outbreak of corona virus infection in Riyadh city, Saudi Arabia

Background

This study aimed to determine knowledge, attitude and practice of airborne and droplet isolation precautions among Dental Health Professionals (DHPs) (dental students, interns, practitioners and auxiliaries) during the outbreak of MERS (Middle East Respiratory Syndrome), corona virus infection in Riyadh city, Saudi Arabia.

Material and Methods

A cross-sectional survey was conducted among 406 dental health professionals (DHPs) working in selected dental facilities in Riyadh city, Saudi Arabia during the outbreak of MERS (April-June 2013). A structured, close-ended, self-administered questionnaire explored the knowledge, attitude, and practice towards droplet and isolation precautions. Collected data was subjected to descriptive statistics to express demographic information, mean knowledge score, mean attitude score and practice score of DHPs. Inferential statistics (Mann-Whitney U test and Kruskal Wallis tests, p < 0.05) were used to examine differences between study variables. Spearman’s rho correlation was used to identify the association between the knowledge-attitude, knowledge-practice, and attitude-practice.

Results

A response rate of rate of 90.22% (406 out of 452) was obtained. The mean scores of knowledge, attitude and practice were 10.61 ± 1.19, 50.54 ± 7.53 and 8.50 ± 2.14 respectively. Spearman’s correlation test revealed a significant linear positive correlation between knowledge and attitude (r-0.501, P- 0.01), knowledge and practice (r-0.185, P-0.01) and attitude and practice (r-0.351, P- 0.01) of DHPs about airborne isolation precautions.

Conclusions

Dental health professionals considered in the present study showed good knowledge, positive attitude and good practice towards droplet and airborne isolation precautions during outbreak of MERS.

Key words:Knowledge, attitude, practice, droplet, airborne, precaution, dental professionals.

Tu Amigo Pepe: Evaluation of a Multi-media Marketing Campaign that Targets Young Latino Immigrant MSM with HIV Testing Messages

Latino immigrant men who have sex with men (MSM) are at risk for HIV and delayed diagnosis in the United States. This paper describes the evaluation of a pilot of the Tu Amigo Pepe, a multimedia HIV testing campaign aimed at Latino MSM in Seattle, WA particularly targeting immigrants who may not identify as gay, ages 18-30 years old. The 16-week campaign included Spanish-language radio public service announcements (PSAs), a Web site, social media outreach, a reminder system using mobile technology, print materials and a toll-free hotline. In developing the PSAs, the Integrated Behavioral Model was used as a framework to reframe negative attitudes, beliefs and norms towards HIV testing with positive ones as well as to promote self-efficacy towards HIV testing. The campaign had a significant and immediate impact on attitudes, beliefs, norms and self-efficacy towards HIV testing as well as on actual behavior, with HIV testing rates increasing over time.

An Agentic Psychology Model Based on the Paradigmatic Repositioning of the Theory of Planned Behaviour

Despite the existence of strong empirical support for the theories of reasoned action and planned behaviour (TRAJTPB), an analysis of the concept of intention and its operational definition indicates the need for a paradigmatic adjustment. An Agentic Psychology Model (APM) has been developed which incorporates the essence of the TRA equation whilst reconstruing it as a rule governing the intelligibility of clusters of accounts or statements that might be made about a particular intention or action. Aternative methods based on account cluster test-frames and semantic mapping techniques are presented, together with results from previous research, to indicate how the APM might be deployed in empirical investigations operating at the interstices of the positivist and critical paradigms in social psychology.

HIV/AIDS in Asian and Pacific Islander Communities in the United States: A Follow-up Review and Analysis with Recommendations for Researchers and Practitioners

A steady increase in the spread of HIV in Asian and Pacific Islander (API) communities in the United States has been reported in the new millennium. This article provides an update on Yep's earlier synthesis of research on HIV/AIDS in API communities in the United States [1], and offers recommendations for further theoretical work and community interventions. First, the AIDS Risk Reduction Model (ARRM) is introduced and described. Second, using ARRM as an organizing framework, behavioral research on API HIV/AIDS published since 1992–93 is reviewed and synthesized. Third, the ARRM is examined for its appropriateness for API communities. Finally, recommendations are offered for researchers and practitioners doing HIV education and prevention work in U.S. API communities in the coming decade.

AIDS in any community of color involves a thorough discourse on AIDSphobia, racism, homophobia, sex(uality), sexism, classism, and other social diseases that compose the total realities of the pandemic…. The AIDS crisis in Asian America is riddled with complexities [2, pp. 201–202].

The development of Asian American responses to the HIV/AIDS epidemic has been a struggle for visibility and particularity within an epidemic in which Asians and Pacific Islanders were first invisible and then seen as monocultural by dominant institutions [3, p. 63].

Drug Attitudes, Racial Identity, and Alcohol Use among African American Adolescents

This research examined relationships among four variables, including (a) participation in a culturally based prevention program, (b) changes in drug attitudes, (c) changes in racial identity, and (d) changes in alcohol use. The sample included 311 African American sixth graders (56% male) enrolled in a national study of high-risk youth. Participants completed the Children’s Racial Identity Scale, the Africentric Values Scale for Children, the Tentative Drug Use Scale, the Children’s Social Desirability Scale, and an index of alcohol use. The results indicated that youth who became more tolerant (lenient) in their drug attitudes between sixth and seventh grades were more likely to increase their alcohol use. In addition, two alternative models were tested to examine the dynamics of how changing racial identity and drug attitudes operate in a culturally based intervention to reduce the likelihood of future drug use. Support was found for both models with no convincing evidence showing that one was better than the other.

The Attainment of Important Health Goals Throughout Adulthood: An Integration of the Theory of Planned Behavior and Aspects of Social Support

This research integrates the Theory of Planned Behavior (TPB) with aspects of social support and explores the utility of variables within each model in predicting the attainment of important health goals. Incorporating an idiographic methodology, 290 respondents ranging in age from 27 to 87 years were administered a postal survey and completed a brief follow-up telephone survey months later. The postal survey included measures of respondent's most important health goals, attitudes, motivation to comply with subjective norms, control beliefs, behavioral intention, and plan-of-action for attaining the health goal, as well as aspects of social support. The follow-up telephone survey inquired into respondents' successful goal attainment and health. Results indicate association, between TPB components and aspects of social support. Further, the emotional and instrumental support provided by a family member or friend and size of social support network were found to be unique predictors of health goal attainment after controlling for TPB components. The importance of personalized goals and social support in designing health interventions for older adults is discussed.

Risk and Rationality in Adolescent Decision Making

Crime, smoking, drug use, alcoholism, reckless driving, and many other unhealthy patterns of behavior that play out over a lifetime often debut during adolescence. Avoiding risks or buying time can set a different lifetime pattern. Changing unhealthy behaviors in adolescence would have a broad impact on society, reducing the burdens of disease, injury, human suffering, and associated economic costs. Any program designed to prevent or change such risky behaviors should be founded on a clear idea of what is normative (what behaviors, ideally, should the program foster?), descriptive (how are adolescents making decisions in the absence of the program?), and prescriptive (which practices can realistically move adolescent decisions closer to the normative ideal?). Normatively, decision processes should be evaluated for coherence (is the thinking process nonsensical, illogical, or self-contradictory?) and correspondence (are the outcomes of the decisions positive?). Behaviors that promote positive physical and mental health outcomes in modern society can be at odds with those selected for by evolution (e.g., early procreation). Healthy behaviors may also conflict with a decision maker's goals. Adolescents' goals are more likely to maximize immediate pleasure, and strict decision analysis implies that many kinds of unhealthy behavior, such as drinking and drug use, could be deemed rational. However, based on data showing developmental changes in goals, it is important for policy to promote positive long-term outcomes rather than adolescents' short-term goals. Developmental data also suggest that greater risk aversion is generally adaptive, and that decision processes that support this aversion are more advanced than those that support risk taking.

A key question is whether adolescents are developmentally competent to make decisions about risks. In principle, barring temptations with high rewards and individual differences that reduce self-control (i.e., under ideal conditions), adolescents are capable of rational decision making to achieve their goals. In practice, much depends on the particular situation in which a decision is made. In the heat of passion, in the presence of peers, on the spur of the moment, in unfamiliar situations, when trading off risks and benefits favors bad long-term outcomes, and when behavioral inhibition is required for good outcomes, adolescents are likely to reason more poorly than adults do. Brain maturation in adolescence is incomplete. Impulsivity, sensation seeking, thrill seeking, depression, and other individual differences also contribute to risk taking that resists standard risk-reduction interventions, although some conditions such as depression can be effectively treated with other approaches.

Major explanatory models of risky decision making can be roughly divided into (a) those, including health-belief models and the theory of planned behavior, that adhere to a “rational” behavioral decision-making framework that stresses deliberate, quantitative trading off of risks and benefits; and (b) those that emphasize nondeliberative reaction to the perceived gists or prototypes in the immediate decision environment. (A gist is a fuzzy mental representation of the general meaning of information or experience; a prototype is a mental representation of a standard or typical example of a category.) Although perceived risks and especially benefits predict behavioral intentions and risk-taking behavior, behavioral willingness is an even better predictor of susceptibility to risk taking—and has unique explanatory power—because adolescents are willing to do riskier things than they either intend or expect to do. Dual-process models, such as the prototype/willingness model and fuzzy-trace theory, identify two divergent paths to risk taking: a reasoned and a reactive route. Such models explain apparent contradictions in the literature, including different causes of risk taking for different individuals. Interventions to reduce risk taking must take into account the different causes of such behavior if they are to be effective. Longitudinal and experimental research are needed to disentangle opposing causal processes—particularly, those that produce positive versus negative relations between risk perceptions and behaviors.

Counterintuitive findings that must be accommodated by any adequate theory of risk taking include the following: (a) Despite conventional wisdom, adolescents do not perceive themselves to be invulnerable, and perceived vulnerability declines with increasing age; (b) although the object of many interventions is to enhance the accuracy of risk perceptions, adolescents typically overestimate important risks, such as HIV and lung cancer; (c) despite increasing competence in reasoning, some biases in judgment and decision making grow with age, producing more “irrational” violations of coherence among adults than among adolescents and younger children. The latter occurs because of a known developmental increase in gist processing with age. One implication of these findings is that traditional interventions stressing accurate risk perceptions are apt to be ineffective or backfire because young people already feel vulnerable and overestimate their risk. In addition, research shows that experience is not a good teacher for children and younger adolescents, because they tend to learn little from negative outcomes (favoring the use of effective deterrents, such as monitoring and supervision), although learning from experience improves considerably with age. Experience in the absence of negative consequences may increase feelings of invulnerability and thus explain the decrease in risk perceptions from early to late adolescence, as exploration increases. Finally, novel interventions that discourage deliberate weighing of risks and benefits by adolescents may ultimately prove more effective and enduring. Mature adults apparently resist taking risks not out of any conscious deliberation or choice, but because they intuitively grasp the gists of risky situations, retrieve appropriate risk-avoidant values, and never proceed down the slippery slope of actually contemplating tradeoffs between risks and benefits.

Age differences in the understanding of wealth and power: the mediating role of future time perspective

Individuals' understanding of wealth and power largely determines their use of resources. Moreover, the age range of wealth and power holders is increasing in modern societies. Thus, the current study examines how people of different ages understand wealth and power. As varying future time perspective is related to changes in prioritised life goals, it was tested as a potential mediator of the age differences. A total of 133 participants aged 18-78 years were asked 8 open-ended questions regarding their understanding of the possible use and desired use of wealth and power, after which they reported their future time perspective. Compared with possible use, the participants mentioned relatively more prosocial elements when they talked about their desired use of the resources, especially power. The older adults expressed more prosocial understanding in regard to the desired use of wealth and the possible use of power compared to their younger counterparts. The age differences were fully mediated by future time perspective. The results suggest that age is a critical factor that influences individuals' conceptualisation of wealth and power. Life-span developmental stage and future time perspective are important factors to consider for explaining individual differences in the exercise of wealth and power and for promoting their prosocial usage.

Do behavioral scientists really understand HIV-related sexual risk behavior? A systematic review of longitudinal and experimental studies predicting sexual behavior

Behavioral interventions to reduce sexual risk behavior depend on strong health behavior theory. By identifying the psychosocial variables that lead causally to sexual risk, theories provide interventionists with a guide for how to change behavior. However, empirical research is critical to determining whether a particular theory adequately explains sexual risk behavior. A large body of cross-sectional evidence, which has been reviewed elsewhere, supports the notion that certain theory-based constructs (e.g., self-efficacy) are correlates of sexual behavior. However, given the limitations of inferring causality from correlational research, it is essential that we review the evidence from more methodologically rigorous studies (i.e., longitudinal and experimental designs). This systematic review identified 44 longitudinal studies in which investigators attempted to predict sexual risk from psychosocial variables over time. We also found 134 experimental studies (i.e., randomized controlled trials of HIV interventions), but of these only 9 (6.7 %) report the results of mediation analyses that might provide evidence for the validity of health behavior theories in predicting sexual behavior. Results show little convergent support across both types of studies for most traditional, theoretical predictors of sexual behavior. This suggests that the field must expand the body of empirical work that utilizes the most rigorous study designs to test our theoretical assumptions. The inconsistent results of existing research would indicate that current theoretical models of sexual risk behavior are inadequate, and may require expansion or adaptation.

Japanese Encephalitis in Assam, India: Need to Increase Healthcare Workers' Understanding to Improve Health Care

INTRODUCTION

Japanese encephalitis (JE) is a major cause of high morbidity and mortality in several states across India. However, in 2014, a sharp rise was observed in the number of cases of JE in north-eastern Assam state, and 51% of the total cases of JE in India were reported from the Assam in the same year. In this regard, a study was conducted to evaluate the knowledge and attitudes of healthcare workers in Darrang, a district of Assam highly affected by JE.

METHODS

A cross sectional study was conducted for 2 months among HCWs in the major district hospital of Darrang, Assam. A pre-tested, self-administered questionnaire was used to collect data from the participants. Convenience sampling approach was used to collect data from different departments of the hospitals. Descriptive and logistic regression analyses were used to express the results.

RESULTS

The knowledge of HCWs regarding JE was poor with a mean knowledge score of 11.02±2.39 (out of 17), while their attitudes were positive with a mean attitudes score of 43.16± 2.47 (ranging from 13 to 52). Overall, 40.4% and 74.3% of participants demonstrated good knowledge and positive attitudes respectively. Cut-off score for good knowledge and positive attitudes toward JE was set as ≥12 and >40 respectively. Older participants (40-49 years) and experienced workers (>10 years) were significantly associated with good knowledge as compared to their referent group (p<0.05), while knowledge of nurses and other orderlies were significantly lower than physicians (p<0.01). Similar factors were associated with the positive attitudes of the participants with the exception of experience. Television was the major source of information regarding JE reported by HCWs (79%).

CONCLUSION

Although the knowledge was not optimized, HCWs exhibited positive attitudes towards JE. Future research is required to design, implement and evaluate interventions to improve the knowledge of JE among HCWs.

Knowledge and attitude of healthcare workers about Middle East Respiratory Syndrome in multispecialty hospitals of Qassim, Saudi Arabia

BACKGROUND

With the increase in prevalence of Middle East Respiratory Syndrome (MERS), healthcare workers (HCWs) are at risk of acquiring and subsequently transmitting this lethal virus. In view of this, HCWs were evaluated for their knowledge of and attitude towards MERS in Saudi Arabia.

METHODS

A cross sectional study was performed in two hospitals of Qassim region in Saudi Arabia. A total of 280 healthcare workers were selected to participate in this study. Knowledge and attitude were assessed by using self-administered and pretested questionnaire. Descriptive statistics were carried out to express participants' demographic information, mean knowledge score and mean attitude score of HCWs. Inferential statistics (Mann-Whitney U test and Kruskal Wallis tests, p < 0.05) were used to examine differences between study variables. Chi squares tests were used to assess the association between study variables and attitude questions. Spearman's rho correlation was used to identify the association between the knowledge, attitude scores.

RESULT

Participants demonstrated good knowledge and positive attitude towards MERS. The mean scores of knowledge and attitude were 9.45 ± 1.69 (based on 13 knowledge questions) and 1.82 ± 0.72 (based on 7 attitude questions). The correlation between knowledge and attitude was significant (correlation coefficient: 0.12; P <0.001). HCWs were less educated about the management (42.4%), source (66%) and consequences of MERS (67.3%), while a majority of them were well aware of the hallmark symptoms (96%), precautionary measures (96%) and hygiene issues (94%). Although the majority of respondents showed positive attitude towards the use of protective measures (1.52 ± 0.84), their attitude was negative towards their active participation in infection control program (2.03 ± 0.97). Gender and experience were significantly associated with knowledge and attitude (P < 0.05).

CONCLUSIONS

The findings of this study showed that healthcare workers in Qassim region of Saudi Arabia have good knowledge and positive attitude towards MERS. Yet there are areas where low knowledge and negative attitude of HCWs was observed. However, studies are required to assess the knowledge and attitude of HCWs at national level so that effective interventions could be designed as surveillance and infection control measures are critical to global public health.

Application of the Information-Motivation and Behavioral Skills (IMB) model in risky sexual behaviors amongst male students

As AIDS is not merely a hygienic problem but a disease that creates a great deal of economic, cultural, and social problems, it is necessary for most of the state and nongovernmental organizations and individuals to participate in both controlling AIDS and preventing it. As no effective vaccine or therapy for this disease exists currently, the only method for avoiding being afflicted by this disease is prevention. The present study aims to examine the Information-Motivation and Behavioral Skills (IMB) model in risky sexual behaviors. For this purpose, a group of 151 male students was sampled using a multistage random sampling method to complete the quality of HIV information questionnaire, national AIDS questionnaire, international AIDS questionnaire and global positive attitude to AIDS questionnaire. The results show that there is a significant relationship between the perception of HIV infection risk and sexual behavior. Thus, the perception of risk is considered the first step toward modifying sexual behaviors from risk-taking behaviors to safer behaviors.

Condom use: The discrepancy between practice and behavioral expectations

Aim: The overall aim of this paper is to examine sexually active young people’s behavioral expectations of condom use. Methods: We collected data at nine youth clinics and one sexually transmitted infections (STI) clinic in Sweden. We included participants whom had been sexually active during the past 12 months: A total of 1022 participants between the ages of 15 and 31 were included. We analyzed the data separately, for different types of sexual practices and types of sexual partners. Multinomial logistic regression was used to analyze age and gender differences for discrepancies. Results: The behavioral expectation of condom use differed, depending on the type of sexual practice and the type of partner. For all types of sex, the overall pattern showed that the participants were most likely to use a condom with a casual unknown partner, followed by a casual known partner, regular partner and lastly, a main partner. Our results also demonstrated that there is a discrepancy between the behavioral expectation of condom use and the self-reported condom use. The lowest discrepancy was for oral sex, especially with a main partner, and the largest discrepancy was for anal sex and vaginal sex with a casual partner. Conclusions: Our results imply that the participants had a greater expectation of condom use than actually occurs, especially for casual unknown partners. There is a lack of knowledge about the risks associated with oral sex, which is evident in the results of the participants’ behavioral expectations of condom use under those conditions.

Willingness to use HIV pre-exposure prophylaxis among opiate users

Few studies of pre-exposure prophylaxis (PrEP) to prevent HIV infection have focused on drug users. Between February to September 2013, we asked 351 opiate injectors entering detoxification treatment about HIV risk, knowledge about PrEP, and willingness to use a once daily PrEP pill under one of two randomly assigned effectiveness scenarios-40 % (low) or 90 % (high) effective in reducing HIV risk. Participants were 70 % male and 87 % non-Hispanic White. Only 7 % had heard of a drug to reduce HIV risk, yet once informed, 47 % would be willing to take such a pill [35 % of those in the low effectiveness scenario and 58 % in the high group (p < 0.001)]. Higher perceived HIV risk was associated with greater willingness to take medication. Increasing knowledge of PrEP and the rate of HIV reduction-effectiveness promised will influence its use among targeted high-risk drug users.

Information Behavior and HIV Testing Intentions Among Young Men at Risk for HIV/AIDS

Health research shows that knowing about health risks may not translate into behavior change. However, such research typically operationalizes health information acquisition with knowledge tests. Information scientists who investigate socially embedded information behaviors could help improve understanding of potential associations between information behavior-as opposed to knowledge-and health behavior formation, thus providing new opportunities to investigate the effects of health information. We examine the associations between information behavior and HIV testing intentions among young men who have sex with men (YMSM), a group with high rates of unrecognized HIV infection. We used the theory of planned behavior (TPB) to predict intentions to seek HIV testing in an online sample of 163 YMSM. Multiple regression and recursive path analysis were used to test two models: (a) the basic TPB model and (b) an adapted model that added the direct effects of three information behaviors (information exposure, use of information to make HIV-testing decisions, prior experience obtaining an HIV test) plus self-rated HIV knowledge. As hypothesized, our adapted model improved predictions, explaining more than twice as much variance as the original TPB model. The results suggest that information behaviors may be more important predictors of health behavior intentions than previously acknowledged.

Psychosocial correlates of the motivation to abstain from sexual intercourse among Indonesian adolescents

OBJECTIVES

Adolescents in Indonesia have limited access to sexuality education, resulting in increased risk of sexually transmitted infections and unplanned pregnancies. This study aimed to understand psychosocial correlates of sexual abstinence intentions to inform future sexuality education.

METHODS

Data were collected in 79 secondary schools among 2315 students, aged 14-20 years, in Jambi, Lampung, Jakarta and Bali. A self-completed questionnaire measured attitudes, risk perception, subjective norms, perceived behavioural control and intentions towards sexual abstinence.

RESULTS

Significant associations with intention to abstain from sexual intercourse were found for experience with sexual intercourse, perceived behavioural control, attitude and subjective norms of peers and parents, explaining 31% of the variance in abstinence intention.

CONCLUSIONS

To promote adolescents' informed sexual decision-making, sexuality education programmes in Indonesia may benefit from addressing past sexual behaviour and perceived behavioural control, subjective norms of peers and attitudes.

A cross-sectional assessment of knowledge, attitude and practice among Hepatitis-B patients in Quetta, Pakistan

Background

Hepatitis-B is a life threatening infection resulting in 0.6 million deaths annually. The prevalence of Hepatitis-B is rising in Pakistan and furthermore, there is paucity of information about Knowledge, Attitude and Practice among Hepatitis-B patients. Better disease related knowledge is important to have positive attitude and that will bring the good practices which will prevent the further spread of infection. This study aimed to evaluate knowledge, attitude and practice of Hepatitis-B Patients in Quetta city, Pakistan.

Methods

A cross-sectional, descriptive study was undertaken with 390 Hepatitis-B patients attending two public hospitals in Quetta city, Pakistan. Knowledge, attitude and practice regarding Hepatitis-B were assessed using a pre-validated questionnaire containing 20, 7 and 8 questions for knowledge, attitude and practice, respectively. Descriptive statistics were used for elaborating patients’ demographic characteristics and mean scores for knowledge, attitude and practice of Hepatitis-B patients. Inferential statistics (Mann–Whitney U test and Kruskal Wallis tests, p < 0.05) were used to establish association between study variables. Spearman’s rho correlation was used to identify the association between the knowledge, attitude and practice scores.

Results

Out of 390 patients, 223 (57.2%) were males, with the majority (136, 34.9%) in the age group of 38–47 years. Mean age of the study cohort was 32.6 ± 9.5 years. One hundred and four (26.7%) had primary level education, with 110 (28.2%) working in the private sector. The mean scores for knowledge, attitude and practice were 8.48 ± 2.7, 3.87 ± 1.2 and 2.37 ± 1.0, respectively. Education, locality and occupation were significantly associated with knowledge, attitude and practice scores. Significant positive linear correlations between knowledge-attitude (r = 0.466, p < 0.01) knowledge-practice (r = 0.221, p < 0.01) and attitude-practice (r = 0.224, p < 0.01) were also observed from the study results.

Conclusion

The findings of this study indicate that Hepatitis-B patients lack a basic understanding of infection control and management. This can result in the further spread of Hepatitis-B infection. Extensive health education campaigns should be provided to the patients in the hospital as well as in community settings for rational control and management of the disease.

Predicting Intended Condom Use among Tanzanian Students using the Theory of Planned Behaviour

This study examined whether perceived behavioural control predicted the intention to use condoms at next sexual intercourse above the components of the theory of reasoned action, as well as the sufficiency of the theory of planned behaviour (TPB) as a theory of intention among Tanzanian adolescents. Five hundred and twenty-eight students who were sexually active, from seven secondary schools in Arusha, Northern Tanzania, completed a questionnaire designed to measure the components of the TPB. Behavioural intentions were significantly predictable from attitudes (.11), subjective norms (.22) and perceived behavioural control (.48). The inclusion of past behaviour into the regression equation increased R(2) only marginally (2 percent) but significantly, suggesting that the TPB provides a fairly accurate explanation of intention to use condoms among Tanzanian adolescents. The implications of this finding in relation to theoretical and practical issues are discussed.

Correlates of condom use among chinese college students in hunan province

A cross-sectional survey was conducted to test an integrated model of condom use with a sample of 490 sexually active Chinese college students. A number of variables in the integrated model were predictors of condom use, explaining 33.4% of the variance in use. Partner communication was the strongest predictors (β = .317, SE = .038, p < .001). Self-efficacy (β = .252, SE = .076, p < .001), positive attitudes (β = .150, SE = .060, p < .001), and social norms (β = .207, SE = .080, p < .001) were also significant predictors of condom use. Additionally, peer communication marginally significantly predicted condom use (β = .089, SE = .039, p = .055). This study provides evidence of the utility of the theories of reasoned action and planned behavior as an effective underlying theoretical framework for HIV prevention and safe sex intervention programs in a non-Western culture. The study also provides evidence that communication with sexual partners about condom use should be one of the most important factors to be considered in the development of HIV prevention and safer sex education programs for Chinese youth.

Clinician attitudes, social norms and intentions to use a computer-assisted intervention

The National Drug Abuse Treatment Clinical Trials Network (CTN) works to bridge the gap between research and practice and tested a Web-delivered psychosocial intervention (the Therapeutic Education System, TES) in 10 community treatment centers. Computer-assisted therapies, such as Web-delivered interventions, may improve the consistency and efficiency of treatment for alcohol and drug use disorders. Prior to the start of the study, we surveyed counselors (N=96) in participating treatment centers and assessed counselor attitudes, perceived social norms and intentions to use a Web-delivered intervention. Analysis of the intention to adopt a Web-delivered intervention assessed the influence of attitudes and perceived social norms. Perceived social norms were a significant contributor to clinician intention to adopt Web-based interventions while attitude was not. To promote successful implementation, it may be helpful to create social norms supportive of computer-assisted therapies.

Understanding behavioral intent to participate in shared decision-making in medically uncertain situations

OBJECTIVE

This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent based on the Theory of Reasoned Action (TRA) and applied to men between the ages of 45 and 70 in the context of their participation in shared decision-making (SDM) in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information that may facilitate greater understanding, efficiency and effectiveness of clinician-patient consultations.

MATERIALS AND METHODS

Twenty-five male subjects from the Philadelphia community participated in this study. Individual semi-structure patient interviews were conducted until data saturation was reached. Based on their review of the patient interview transcripts, researchers conducted a qualitative content analysis to identify prevalent themes and, subsequently, create a category framework. Qualitative indicators were used to evaluate respondents' experiences, beliefs, and behavioral intent relative to participation in shared decision-making during medical uncertainty.

RESULTS

Based on the themes uncovered through the content analysis, a category framework was developed to facilitate understanding and increase the accuracy of predictions related to an individual's behavioral intent to participate in shared decision-making in medical uncertainty. The emerged themes included past experience with medical uncertainty, individual personality, and the relationship between the patient and his physician. The resulting three main framework categories include 1) an individual's Foundation for the concept of medical uncertainty, 2) how the individual Copes with medical uncertainty, and 3) the individual's Behavioral Intent to seek information and participate in shared decision-making during times of medically uncertain situations.

DISCUSSION

The theme of Coping (with uncertainty) emerged as a particularly critical behavior/characteristic amongst the subjects. By understanding a subject's disposition with regard to coping, researchers were better able to make connections between a subject's prior experiences, their knowledge seeking activities, and their intent to participate in SDM. Despite having information and social support, the subjects still had to cope with the idea of uncertainty before determining how to proceed with regard to shared decision-making. In addition, the coping category reinforced the importance of information seeking behaviors and preferences for shared decision-making.

CONCLUSIONS

This study applies and extends the field of behavioral and health informatics to assist medical practice and decision-making in situations of medical uncertainty. More specifically, this study led to the development of a category framework that facilitates the identification of an individual's needs and motivational factors with regard to their intent to participate in shared decision-making in situations of medical uncertainty.

Midlife women online: evaluation of an internet-based program to prevent unintended pregnancy & STIs

BACKGROUND

Midlife women are an underserved population in the areas of unintended pregnancy and STI prevention yet remain at risk for both health conditions.

METHODS

A randomized controlled trial of an Internet-based multimedia program to reduce risk of unintended pregnancy and STIs among midlife women was conducted with 164 women ages 40-55 years of age.

RESULTS

Women in the treatment condition compared to the control condition reported significant gains in attitudes, self-efficacy, and behavioral intentions at posttest.

CONCLUSION

Interventions specifically targeted to midlife women can impact constructs known to reduce risk. Implications for future research and intervention development are presented.

Theory development for HIV behavioral health: empirical validation of behavior health models specific to HIV risk

In the presence of numerous health behavior theories, it is difficult to determine which of the many theories is most precise in explaining health-related behavior. New models continue to be introduced to the field, despite already existing disparity, overlap, and lack of unification among health promotion theories. This paper will provide an overview of current arguments and frameworks for testing and developing a comprehensive set of health behavior theories. In addition, the authors make a unique contribution to the HIV health behavior theory literature by moving beyond current health behavior theory critiques to argue that one of the field's preexisting, but less popular theories, Social Action Theory (SAT), offers a pragmatic and broad framework to address many of the accuracy issues within HIV health behavior theory. The authors conclude this article by offering a comprehensive plan for validating model accuracy, variable influence, and behavioral applicability of SAT.

The validity of reporting willingness to use a supervised injecting facility on subsequent program use among people who use injection drugs

BACKGROUND

Innovative health programs for injection drug users (IDUs), such as supervised injecting facilities (SIFs), are often preceded by evaluations of IDUs' willingness to use the service. The validity of these surveys has not been fully evaluated. We sought to determine whether measures of willingness collected prior to the opening of a Canadian SIF accurately predicted subsequent use of the program.

METHODS

Data were derived from a prospective cohort of IDUs. The sample size for this study was 640 IDUs. Using multivariate logistic regression, it was assessed if a history of reporting willingness to use the program, were it available, was associated with subsequent use. In sub-analysis restricted to individuals who had a history of reported willingness, we used multivariate longitudinal analysis to identify factors associated with not attending the SIF.

RESULTS

Among 442 IDUs, 72% of those who reported initial willingness to use a SIF later attended the program, and a prior willingness to use a SIF significantly predicted later attendance (adjusted odds ratio = 1.67). In sub-analyses restricted to those who had a history of reporting willingness to use the SIF, not using the program was predicted by not frequenting the neighborhood where the SIF was located.

CONCLUSION

Our findings indicate that reported willingness measures collected from IDUs regarding potential SIF program participation prior to its opening independently predicted later attendance even when variables that were likely determinants of willingness were adjusted for. These data suggest that willingness measures are reasonably valid tools for planning the delivery of health services among IDU populations.