Factors affecting the decision of nursing students in Taiwan to be vaccinated against hepatitis B infection

Effect of educational intervention based on locus of control structure of attribution theory on self-care behavior of patients with type II diabetes

Background: Different factors, such as personality and psychological characteristics, are effective in the self-care and control of diabetes. This study aimed at determining the effect of educational intervention based on locus of control structure of attribution theory on the self-care behavior of patients with type II diabetes. Methods: This was a quasi-experimental controlled study performed on 180 patients in Babol Diabetes Association. The sampling method was simple random sampling. Data collection tool was form C of standard questionnaire in multidimensional health locus of control (MHLC) and summary of diabetes self-care activities (SDSCA). Based on the results obtained from the initial completion of the questionnaires, educational intervention was designed as three 60-minute educational sessions using short lectures, question and answer, group discussions, and consultation methods, as well as educational materials, such as films, posters, and pamphlets. Intervention was only performed for the test group. The questionnaires were filled out again 2 and 3 months after the intervention. Results: Before the intervention, there was no significant difference in the mean scores of self-care, internal, chance, and external locus of control between the 2 groups. However, 2 to 3 months after the intervention, the mean scores of self-care (p<0.001) and locus of control (p<0.001) increased in the test group. Moreover, the mean score of chance (p<0.001) and external (p<0.001) locus of control decreased significantly. Conclusion: Educational intervention decreases the mean scores of chance and external locus of control and increases the mean score of internal locus of control; as a result, it improves self-care in patients with diabetes.

Nursing Staff Knowledge of the Hepatitis B Virus Including Attitudes and Acceptance of Hepatitis B Vaccination: Development of an Effective Program

Data for this study in a large tertiary referral teaching hospital in Dublin, Ireland were collected by anonymous self administered questionnaires. A total of 137 questionnaires were distributed to nurses working in five wards with a response rate of 88% (120). Objectives included identifying levels of awareness of the infectivity of the hepatitis B virus, ascertaining levels of knowledge of hepatitis B vaccination, and identifying attitudes resulting in acceptance of hepatitis B vaccine. Ninety seven respondents (82%) knew hepatitis B was 100 times more infective than HIV. Ninety eight respondents (83%) had completed a full course of hepatitis B immunizations. Ninety six respondents (93%) reported a hepatitis B antibody level on completion of the immunizations, 13 (14%) knew their actual titer, and 49 of 63 respondents (78%) reported immunity. Factors influencing decisions to accept vaccination included information related to the benefits of the vaccine from an occupational health physician or nurse and the vaccine being provided free of charge. Nurses in this study had an understanding of the hepatitis B infection. The number of nurses choosing to be vaccinated and having an antibody level test performed post-vaccination was high in this group. Most nurses in this study believed they were immune to hepatitis B even though a significant number did not know their hepatitis B antibody level.

Uptake of a new meningitis vaccination programme amongst first-year undergraduate students in the United Kingdom: A cross-sectional study

Background

In 2015 meningococcal group W was declared endemic in the UK, with the meningococcal ACWY vaccination (MenACWY) subsequently introduced amongst adolescents and first-year university students. This study aimed to determine MenACWY uptake amongst students and to evaluate how this was influenced by demographics and via the Health Belief Model (HBM).

Methods

This was a cross-sectional study conducted at a British university amongst first-year undergraduate students aged 18–25 years. Data collection was via an electronic questionnaire encompassing demographics, the HBM and vaccination status. Univariable analysis of the associations between demographics, health beliefs and vaccination was performed, followed by multiple logistic regression.

Results

401 participants were included in analysis. Vaccine uptake was 68.1%. Variables independently associated with vaccination upon multiple regression were age, gap-year, perceived effectiveness of the vaccine and knowledge about risk of meningitis. Compared to 18 year-olds, the odds of vaccination were reduced for 19 year-olds (aOR = 0.087, 95% CI = 0.010–0.729), 20 year-olds (aOR = 0.019, 95% CI = 0.002–0.161) and 21–25 year-olds (aOR = 0.003, 95% CI = <0.001–0.027). In contrast, taking a gap year (aOR = 2.939, 95% CI = 1.329–6.501), higher perceived vaccine effectiveness (aOR = 3.555, 95% CI = 1.787–7.073) and knowledge about meningitis risk (aOR = 2.481, 95% CI = 1.165–5.287) were independently associated with increased uptake.

Conclusions

MenACWY uptake amongst students in this study and in other sources is above the national coverage for all adolescents (35.3%), indicating that this vaccination programme may be increasing health inequalities. Older students are less likely to become vaccinated due to differing vaccination policy in this age-group. In future, strategies that focus on specific student cohorts and that highlight vaccine effectiveness and the risk of meningitis should be considered. National evaluation of this vaccination programme is recommended to clarify its impact on health inequalities.

Factors predicting completion of the human papillomavirus vaccine series

PURPOSE

This study identified factors associated with completion of the three dose quadrivalent human papillomavirus vaccine (HPV4) series by female adolescents.

METHODS

Between February and September 2008, we prospectively surveyed 11- to 26-year-old female members of an integrated managed care organization shortly after their first HPV4 dose to identify factors that predicted series completion. We used regression analyses to assess whether self-reported experiences at the index visit, knowledge/attitudes about HPV and HPV4, and medical record data on adverse events, demographic characteristics, care-utilization frequency, and visit characteristics, were associated with vaccine series completion within one year of the first HPV4 dose.

RESULTS

Of 899 survey respondents (27% of 3347 survey recipients), 786 (87%) maintained continuous enrollment in the health plan in the year following the first HPV4 dose. Fifty percent (n = 393) completed the vaccine series within that year. In multivariate analyses of survey respondents, only respondents' ability to correctly identify the number of shots required for series completion was significantly associated with series completion. Reported bruising was associated with decreased likelihood of completion, and the clinician stating that future shots were required was associated with increased likelihood, but both were of borderline significance. Females ages 16-20 had the lowest series completion.

CONCLUSIONS

Improving HPV4 completion will require targeted efforts. Our results suggest that providers may help by stressing the need for additional doses of vaccine, and confirming that patients understand this information. Special attention should be given to females ages 16-20. Future randomized trials should assess the effect on vaccine completion of these simple, low-cost interventions.

Nursing students' immunisation status and knowledge about viral hepatitis in Turkey: a multi-centre cross-sectional study

BACKGROUND

The aims of this multi-centre cross-sectional survey were to detect Turkish nursing students' level of knowledge on viral hepatitis, to evaluate their rates of exposure to blood and to find out their hepatitis A (HAV), hepatitis B (HBV) vaccination status.

METHODS

This multi-centre cross-sectional study was conducted in 14 nursing schools located in the seven geographical regions of Turkey. A questionnaire composed of 47 questions on socio-demographic factors, level of knowledge on HAV, HBV, hepatitis C (HCV) immunisation status, exposure history and attitudes was applied to the study group.

RESULTS

A total of 1491 third- and fourth-year nursing students participated with an 89% response rate. The mean age of the participating students was 21.4 ± 1.3. Their mean knowledge score was 23.7 ± 4.6 (71/100) and was significantly higher in fourth-year students than third-year students. There were significant differences in mean scores among nursing schools. Among the participants, 85.3% had received HBV vaccine and 9.1% had received HAV vaccine. The percentage of students who signify themselves at increased risk of acquiring viral hepatitis was 97.3%. Of the students, 28.1% had sustained a needle-stick injury and 5.4% had experienced conjunctival exposure to blood.

CONCLUSIONS

Curriculum differences among nursing schools have a significant effect on nursing students' level of knowledge. For this reason, nursing schools should organize HBV immunisation programmes for their students to increase vaccination coverage.

How to define and measure concordance between patients' preferences and medical treatments: A systematic review of approaches and recommendations for standardization

OBJECTIVE

The purpose is to systematically review the methods used to calculate the association between patients' preferences and treatment choices and to present a set of recommendations for definition and measurement of this concept.

METHODS

A systematic review of the literature from 1967 to 2007 identified articles that reported a relationship between patients' preferences and their treatment choices. Potential citations were identified from electronic databases, the Cochrane Collaborative review, and identified experts. Relevant articles were abstracted by two reviewers independently using standard forms.

RESULTS

The search identified 3114 unique citations, the full text of 180 articles was examined, and 49 articles were included. These 49 studies used a variety of definitions of preferences and choices, and calculated concordance in different ways. Half of the studies tied their method to a theoretical framework. There were problems with many of the studies that limit the ability to generalize or make comparisons across studies.

CONCLUSION

There is no consistent method for defining or calculating the match between patients' preferences and treatment choices. There is a need for more clarity in the definition and reporting of this type of concordance in measures of decision quality.

PRACTICE IMPLICATIONS

The match between an informed patient's preferences and treatment choices is a key component of patient-centered care. Valid and reliable measures of the level of concordance are needed.

Actions and Beliefs Related to Hepatitis B and Influenza Immunization Among Registered Nurses in Texas

Studies indicate that roughly half of health care workers are not immunized against hepatitis B and influenza. Findings from a survey of 1,000 registered nurses (RNs) conducted to analyze their beliefs and actions related to immunization recommendations are reported. Only 8% of the responding RNs chose not to receive vaccination against hepatitis B. The primary reasons that nurses declined hepatitis B vaccination were because they were not working in nursing or did not believe they were at risk of exposure. Similarly, 86% of the RNs reported they had ever received a flu shot, and 69% reported of being immunized during 2 of the previous 4 years. Rationale for receiving immunization included belief in its effectiveness, belief that they were at risk of exposure, and that it was provided free of charge. Reasons for declining included concerns about side effects, lack of concern about getting the illness, and doubts about effectiveness. The nurses who responded to the survey appear to value immunizations and generally adhere to immunization recommendations. Further study needs to be conducted on related issues, including follow-up for assessment of long-term protection of hepatitis B immunization and adherence to guidelines for postexposure prophylaxis. Ongoing monitoring and further study of serious complications of hepatitis B immunizations are also needed.

The need for evolution in healthcare decision modeling

STATEMENT OF PROBLEM

Many healthcare decisions are difficult because they are complex and have important consequences such as the impact on survival or quality-of-life of individuals and on allocation of limited resources. The present state-of-the-art in healthcare decision modeling is often inadequate to properly assess these decisions.

METHODS

Based on a literature search and the experience of the authors, typical methodologies used in healthcare decision analysis modeling are explored and compared with methods used in other practices. An example of hormonal therapy decisions is used.

RESULTS

Useful methods that have been developed in other fields are presented. These include methods targeted toward appropriate assessment and representation of the complexity of decisions, assessment of uncertainty, use of nonexpected value decision analysis, and use of multi-attribute decision criteria.

CONCLUSION

The state-of-the-art in healthcare decision modeling can be improved through learning from other practices.