Knowledge and the Prediction of Behavior: The Role of Information Accuracy in the Theory of Planned Behavior

"Cultural and conceptual knowledge": Reformulation and conceptual analysis of a key component of the health literacy model

Extensive evidence of health disparities and systemic racism has prompted scholars to examine constructs that may account for differences in the burden of disease. One such construct is health literacy, which has been posited to have four components: print literacy, oral literacy, numeracy, and cultural and conceptual knowledge. Consistent with historical trends related to culturally based constructs, the latter component has garnered the least attention in the published literature, despite its pervasive influence on health care outcomes. We engage in a reformulation and conceptual analysis of cultural and conceptual knowledge, defined as the filter through which individuals obtain, process, and understand health information and options for diagnosis and treatment. We propose the construct of cultural schema, and operationalize the construct as having cognitive (knowledge, beliefs) and affective (attitudes, emotions) components. As we strive to achieve a more complex understanding of influences on behavioral outcomes, a greater focus on these culturally based factors is essential. In this article, we present a conceptual analysis that seeks to advance the field by: (a) providing distinct definitions for each component that can be applied across fields of study and theoretical frameworks, (b) offering measurement considerations consistent with their conceptualizations, and (c) making recommendations for future theory, research, and practice. We hope that with greater conceptual and measurement clarity of cultural schema, more consistent results will be obtained, constructs and processes that affect health outcomes will be identified, and more personalized intervention will be possible, optimizing the limited resources available for health promotion efforts.

Do boys have the same intentions to get the HPV vaccine as girls? Knowledge, attitudes, and intentions in France

BACKGROUND

The vaccine coverage against human papillomavirus (HPV) vaccination remains low in France. The objective of this study was to study adolescent perceptions by comparing boys and girls, in order to build effective school-based interventions.

METHODS

This paper presents a cross-sectional study in French middle school pupils. They completed online questionnaires on their knowledge and attitudes toward the HPV vaccine, HPV vaccination status, their intention, reasons to vaccinate or not to vaccinate, and psychological antecedents of vaccination. A structural equation modeling (SEM) analysis was used to test the hypothesized model.

RESULTS

The participants are 818 pupils aged from 12 to 16 years (Mage = 13.78). Most pupils were in the pre-contemplative stage (62.7 % of boys and 40.8 % of girls). SEM analysis indicated that the relationship between the level of HPV knowledge, the representations of vaccines in general, and vaccine intention was mediated by attitudes towards the HPV vaccine among both boys and girls.

CONCLUSIONS

These findings reveal a high percentage of boys who do not feel concerned by the HPV vaccine and highlight the need to consider the psychological antecedents of vaccination in general in addition to the specific attitudes to the HPV vaccine.

Should Communication Campaigns Promoting Vaccination Address Misinformation Beliefs? Implications from a Nationally Representative Longitudinal Survey Study among U.S. Adults

Public health communication campaign planners must carefully consider whether misinformation beliefs are important to target and, ideally, correct. Guided by the reasoned action approach, we hypothesized that behavior-specific beliefs regarding COVID-19 vaccination would account for any observed relationship between general coronavirus misinformation beliefs (misinformation beliefs that are not specific to the anticipated consequences of COVID-19 vaccination) and subsequent vaccine uptake. To test our hypothesis, we used panel data from a two-wave nationally representative sample of U.S. adults pre- and post-vaccine availability (T1: July 2020, T2: April/June 2021, analytic sample: n = 665). Contrary to our hypothesis, we find a residual observed relationship between general coronavirus misinformation beliefs and subsequent vaccine uptake (AOR = 0.40, SE = 0.10). Intriguingly, our post-hoc analyses do show that after also adjusting for T2 behavioral beliefs, this association was no longer significant. With this and other justifications, we recommend that messages promoting vaccination prioritize targeting relevant behavioral beliefs.

Advancing assessment of responsive feeding environments and practices in child care

Child care environments offer an ideal setting for feeding interventions. CELEBRATE Feeding is an approach implemented in child care environments in two Maritime Provinces in Canada to support responsive feeding (RF) to foster children's self-efficacy, self-regulation, and healthy relationships with food. This study aimed to describe RF in child care using established and enhanced scoring frameworks. The Environment and Policy Assessment and Observation (EPAO) was modified to reflect RF environments and practices, resulting in our modified EPAO and a CELEBRATE scale. Observations were conducted in 18 child care rooms. Behaviours and environments were scored on both scales, creating 21 RF scores, with a score of '3' indicating the most responsiveness. Descriptive analyses of the scores were conducted. The overall room averages were Mean (M) = 41.00, Standard Deviation (SD) = 7.07 (EPAO), and M = 37.92 SD = 6.50 (CELEBRATE). Most responsive scores among rooms within our EPAO and CELEBRATE scales, respectively, were 'educators not using food to calm or encourage behaviour' (M = 2.94, SD = 0.24; M = 2.98, SD = 0.06) and 'not requiring children to sit at the table until finished' (M = 2.89, SD = 0.47; M = 2.97, SD = 0.12). The least responsive scores within the EPAO were 'educator prompts for children to drink water' (M = 0.78, SD = 0.94) and 'children self-serving' (M = 0.83, SD = 0.38). The least responsive in the CELEBRATE scale were 'enthusiastic role modelling during mealtime' (M = 0.70, SD = 0.68) and 'praise of mealtime behaviour unrelated to food intake' (M = 0.74, SD = 0.55). The CELEBRATE scale captured unique observation information about RF to allow documenting change over time with detailed measurement to inform and support nutrition interventions within child care environments.

Factors associated with dietary behaviour change support in patients: A qualitative study among community nurses

AIM

To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes.

BACKGROUND

Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long-term complications from chronic lifestyle-related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential.

DESIGN

A qualitative descriptive study.

METHODS

Data were collected in the Netherlands in 2018-2019 via semi-structured face-to-face interviews with 18 nurses. Interview guide themes were informed by the COM-B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis.

RESULTS

Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse-patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context.

CONCLUSION

It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet.

IMPACT

The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self-management. Well-fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients.

PATIENT OR PUBLIC CONTRIBUTION

A nurse provided feedback on the interview guide.

Health and safety of health workers in the Suame Municipality of Ghana - Lessons learnt from the COVID-19 outbreak in infection prevention and control for future pandemics

Objectives

Effective adherence to infection prevention and control practices is needed to reduce the rate of healthcare-acquired infections among healthcare workers. Policies to control healthcare-acquired infections among healthcare workers can be designed and implemented using information on adherence to infection prevention and control practices adherence and its determinants. This study, therefore, sought to assess the adherence to infection prevention and control practices among healthcare workers during the 2019 Coronavirus disease pandemic.

Methods

A multicentre cross-sectional study was conducted among 323 randomly selected healthcare workers in four health facilities in the Suame Municipality, Ghana. Data on participants' socio-demographics, knowledge of infection prevention and control practices and adherence to infection prevention and control practices were collected using a pre-tested structured questionnaire. Multivariate logistic regression analysis was used to examine the effect of demographic characteristics and knowledge of infection prevention and control on adherence to infection prevention and control practices among study participants.

Results

Over three-quarters (75.9%) of the study participants had adequate knowledge of infection prevention and control practices with a significant knowledge gap in the colour coding of bin liners for waste segregation (35.6%). The proportion of study participants who reported good adherence to infection prevention and control practices was 86.7%. Healthcare workers who were 33 years and above (Adjusted odds ratio (AOR): 0.27; 95% Confidence interval (CI): 0.08-0.92) and absence of an infection prevention and control committee at the facility AOR: 0.25; 95% CI: 0.08-0.73) had reduced odds of good adherence to infection prevention and control practices. Nursing staff (AOR: 9.49, 95% CI: 2.51-35.87) and having adequate knowledge of infection prevention and control practices (AOR: 2.66; 95% CI: 1.19-5.97) were associated with increased odds of good adherence to infection prevention and control practices.

Conclusion

Adherence to infection prevention and control practices was high among this sample of Ghanaian healthcare workers. Interventions and strategies to improve adherence should include the setting up of infection prevention and control committees, education and strict observance of colour coding of bin liners for waste segregation and intensification of training of healthcare workers in infection prevention and control practices.

Education, incentive, and engineering-based interventions to promote the use of seat belts

BACKGROUND

Over 1.3 million people die each year as a result of traffic collisions and hundreds of thousands of others are permanently and seriously injured. Most of these deaths occur in low- and middle-income countries, where mortality rates can be up to 10 times higher than those of some high-income countries. Seat belts are designed to accomplish two key functions - to prevent the occupant from being ejected from the vehicle by the force of impact, and to extend the time that the decelerating force is applied to a person. Seat belts also spread the area of impact both to larger and less vulnerable parts of the body. Since the 1950s, seat belts have been factory-fitted to most vehicles, and today around 90% of high-income countries have adopted seat belt legislation that makes it mandatory for some, if not all, vehicle occupants to wear seat belts. However, the simple passing of laws is not sufficient to ensure seat belt use, and, while the enforcement of seat belt laws does increase seat belt use, other interventions have been developed to encourage voluntary - and hence sustainable - behaviour change.

OBJECTIVES

To evaluate the benefits of behavioural-change interventions (educational-based, incentive-based, engineering-based, or a combination, but not enforcement-based) that promote the use of seat belts, and to determine which types of interventions are most effective.

SEARCH METHODS

On 9 August 2022, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), OvidSP Embase, OvidSP MEDLINE, 14 other databases, and clinical trials registers. We also screened reference lists and conference proceedings, searched websites of relevant organisations, and contacted road safety experts. The search was performed with no restrictions in terms of language and date of publication.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), both individually randomised and cluster-randomised, that evaluated education, engineering, incentive-based interventions (or combinations) that promoted seat belt use.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of RCTs, evaluated the risk of bias, and extracted data. We performed a narrative synthesis based on effect direction due to the heterogeneity observed between RCTs and reported the synthesis in accordance with reporting guidelines for systematic reviews without meta-analysis, as appropriate. We assessed the certainty of the evidence using the GRADE approach. We analysed data on the primary outcome, frequency of wearing a seat belt. None of the included RCTs reported the other primary outcome, crash-related injury rate or the secondary outcome, crash-related mortality rates of interest in this review.

MAIN RESULTS

We included 15 completed RCTs (12 individual, parallel-group, and three cluster) that enroled 12,081 participants, published between 1990 and 2022. Four trials were published between 2019 and 2022, and the remaining trials were published 10 or more years ago. We also identified four ongoing RCTs. Thirteen RCTs were conducted in the USA. Trials recruited participants from various sites (worksites, schools, emergency departments, a residential retirement community, and primary care settings) and different age groups (adults, late adolescents, early adolescents, and dyads). Thirteen trials investigated educational interventions, one of which used education in addition to incentives (one of the intervention arms) measured through participant self-reports (12) and observation (one), and two trials investigated engineering-based interventions measured through in-vehicle data monitor systems at various follow-up periods (six weeks to 36 months). We grouped RCTs according to types of education-based interventions: behavioural education-based, health risk appraisal (HRA), and other education-based interventions. The evidence suggests that behavioural education-based (four trials) interventions may promote seat belt use and HRA interventions (one trial) likely promote seat belt use in the short term (six weeks to nine months). Four of the six trials that investigated behavioural education-based interventions found that the intervention compared to no or another intervention may promote seat belt use. These effects were measured through participant self-report and at various time points (six-week to 12-month follow-up) (low-certainty evidence). One of the three trials investigating HRA only or with additional intervention versus no or another intervention showed observed effects likely to promote seat belt use (moderate-certainty evidence). The evidence suggests that engineering-based interventions using vehicle monitoring systems (with in-vehicle alerts and with or without notifications/feedback) may promote the use of seat belts. One trial showed that engineering interventions (in-vehicle alerts and feedback) may promote seat belt use while the other showed unclear effects in two of the three intervention groups (low-certainty evidence). Both trials had small sample sizes and high baseline seat belt use.

AUTHORS' CONCLUSIONS

The evidence suggests that behavioural education-based interventions may promote seat belt use and HRA (including incentives) with or without additional interventions likely promote seat belt use. Likewise, for engineering-based interventions using in-vehicle data monitor systems with in-vehicle alerts, with or without notifications/feedback the evidence suggests the interventions may promote the use of seat belts. Well-designed RCTs are needed to further investigate the effectiveness of education and engineering-based interventions. High-quality trials that examine the potential benefits of incentives to promote seat belt use, either alone or in combination with other interventions, as well as trials to investigate other types of interventions (such as technology, media/publicity, enforcement, insurance schemes, employer programmes, etc.) to promote the use of seat belts, are needed. Evidence from low- and middle-income economies is required to improve the generalisability of the data. In addition, research focused on determining which interventions or types of interventions are most effective in different population groups is needed.

Fruit and Vegetable Consumption during the COVID-19 Lockdown in Serbia: An Online Survey

The global impact of the COVID-19 pandemic has significantly influenced individuals' dietary choices and food-buying behavior. Present research specifically delves into the alterations in fruit and vegetable (F&V) consumption among consumers in Serbia during the pandemic. The study employs an extended model of the theory of planned behavior (TPB), incorporating the construct of consumers' knowledge to comprehensively explore behavioral changes. Conducted in the first half of 2020, the study engaged 479 participants from Serbia, using an online questionnaire for data collection. Structural equation modelling was employed for a thorough analysis of the gathered responses. The main outcome revealed a noteworthy connection between consumers' knowledge and their attitudes, subjective norms, and intentions regarding F&V consumption. Subjective norms significantly influenced consumers' desire to increase F&V intake during and after the outbreak. These intentions aligned with actual behavior changes, indicating a shift toward higher F&V consumption. Consumer knowledge also notably shaped attitudes and behaviors regarding F&V intake. Notably, the TPB proved valuable in predicting and understanding these dietary shifts during global crises like the pandemic. These insights not only bolster healthier eating habits but also have broader implications for public health. Understanding consumer behavior dynamics during crises like COVID-19 is crucial for crafting effective strategies to promote overall human health and well-being.

Knowledge and attitudes of German and Swiss community pharmacists towards biologicals and biosimilars - a prospective survey before and after the COVID-19 pandemic

BACKGROUND

Knowledge, attitudes and substitution laws of biosimilars are not consistent across countries. Biosimilar acceptance among patients and healthcare professionals may be suffering from gaps in knowledge and understanding about biosimilars and their regulatory approval process. Pharmacists' roles and responsibilities changed considerably during the COVID-19 pandemic. Thus, they might have gained new skills and self-confidence in counseling and substitution of biosimilars.

AIMS

To examine and compare the knowledge, perceptions and information needs of German and Swiss pharmacists regarding original biologicals and biosimilars in 2020 and 2022.

METHODS

We conducted an online survey among Swiss and German community pharmacies in February 2020 (before) and August 2022 (after the COVID-19 pandemic). Descriptive statistics were calculated and the Chi-Square test was used for comparisons among categorical variables.

RESULTS

A total of 764 pharmacists took part in the survey (390 in 2020 and 374 in 2022) with comparable demographics. The frequency of dispensing biologicals remained similar between German and Swiss pharmacists in 2020 and 2022, but the Swiss dispensation of biosimilars increased significantly in 2022 compared to 2020. Concerning the understanding of the term biosimilars, knowledge remained moderate in both countries in both years. Participants were equally familiar with the term and most felt sufficiently informed. In both countries, substitution with a biosimilar showed the least confidence of all attitudes. A third of the participants indicated correct substitution rules in their country. In both years, around 85% of the participants were highly interested in additional training on this topic.

DISCUSSION/CONCLUSION

The results indicate that similarities and differences between Germany and Switzerland regarding knowledge and attitudes towards biologicals and biosimilars remained unchanged before and after the COVID-19 pandemic. An influence of the pandemic is unlikely. There is still a clear lack of knowledge among community pharmacists on biosimilars, especially regarding the substitution rules. Due to a rising market with many benefits but also big challenges to overcome, the topic of biosimilars should receive more attention in the future. This requires additional training for pharmacists.

Effects of virtual interventions based on the theory of planned behavior to improve obesity-preventive lifestyle among girls, during COVID-19 pandemic

BACKGROUND

Adolescence is a critical period for the spread of obesity and overweight. This research was conducted with the aim of determining the effect of an educational intervention based on the theory of planned behavior on promoting obesity-related behaviors in overweight female students in Gachsaran.

METHODS

this quasi-experimental study was conducted on 90 female students of the first secondary school in the form of two intervention and control groups. Information related to nutritional status and the structures of the theory of planned behavior were collected using a researcher-made questionnaire whose validity and reliability have been confirmed. The educational intervention was carried out during five virtual training sessions. The data obtained three months after the intervention were analyzed using SPSS statistical software, version 20, using independent t-tests, paired t-tests, and equivalent non-parametric tests.

RESULTS

The present study showed that the scores of the constructs of awareness, perceived behavior control, subjective norms, intention, and nutritional behaviors were significantly improved after the intervention (p < 0.001). The results of the Mann-Whitney test showed that the two intervention and control groups did not have a significant difference in terms of the average overall physical activity score after the intervention (p = 0.078).

CONCLUSION

The results of the present study showed that training based on the theory of planned behavior in the conditions of COVID-19 disease and in a virtual form had an effect on nutritional behavior but could not increase physical activity behavior in adolescents with weight loss.

An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER)

BACKGROUND

Clinicians often report that their own anxiety and low self-efficacy inhibit their use of evidence-based suicide prevention practices, including gold-standard screening and brief interventions. Exposure therapy to reduce clinician maladaptive anxiety and bolster self-efficacy use is a compelling but untested approach to improving the implementation of suicide prevention evidence-based practices (EBPs). This project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot test an exposure-based implementation strategy (EBIS) to target clinician anxiety to improve suicide prevention EBP implementation.

METHODS

We will develop, iteratively refine, and pilot test an EBIS paired with implementation as usual (IAU; didactic training and consultation) in preparation for a larger study of the effect of this strategy on reducing clinician anxiety, improving self-efficacy, and increasing use of the Columbia Suicide Severity Rating Scale and the Safety Planning Intervention in outpatient mental health settings. Aim 1 of this study is to use participatory design methods to develop and refine the EBIS in collaboration with a stakeholder advisory board. Aim 2 is to iteratively refine the EBIS with up to 15 clinicians in a pilot field test using rapid cycle prototyping. Aim 3 is to test the refined EBIS in a pilot implementation trial. Forty community mental health clinicians will be randomized 1:1 to receive either IAU or IAU + EBIS for 12 weeks. Our primary outcomes are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics. Secondary outcomes are the engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to implementation) and preliminary effectiveness of EBIS on implementation outcomes (adoption and fidelity) assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews).

DISCUSSION

Outcomes from this study will yield insight into the feasibility and utility of directly targeting clinician anxiety and self-efficacy as mechanistic processes informing the implementation of suicide prevention EBPs. Results will inform a fully powered hybrid effectiveness-implementation trial to test EBIS' effect on implementation and patient outcomes.

TRIAL REGISTRATION

Clinical Trials Registration Number: NCT05172609 . Registered on 12/29/2021.

Intention to Donate Kidney and Associated Factors Among Students in Bahir Dar University: Application of Theory of Planned Behavior

Background

Kidney donation is the donation of a kidney from a living or dead person to another living person who requires transplantation. The scarcity of kidneys is a great public health concern worldwide, owing to an increase in end-stage renal failure. There is no sufficient evidence regarding the intention to donate kidneys in Ethiopia.

Objective

To assess the intention to donate kidneys and its associated factors among Bahir Dar University students in Ethiopia in 2023 by the application of theory of planned behavior.

Method and Materials

This institution-based cross-sectional study was conducted from March 7 to April 5, 2023. A multistage sampling technique was used to select 630 participants. Self-administered structured questionnaires were used to collect data. Data were entered into Epi-data version 4.6, and exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Bivariate and multivariate linear regression analyses were performed. Findings with a p-value <0.05 at the 95% confidence interval were considered statistically significant and interpreted by the unstandardized beta (ß) coefficient.

Results

The mean score of intention to donate the kidney was 12.9 ± 4.1 standard deviation. Direct attitude (B = 0.341, 95% CI = 0.265, 0.416), direct subjective norm (B = 0.088, 95% CI = 0.010, 0.167), direct perceived behavioral control (B = 0.353, 95% CI 0.251, 0.455), knowledge (B = 0.417, 95% CI 0.251, 0.583), and previous experience of blood donation (B = 0.915, 95% CI 0.321, 1.510) were factors associated with intention to kidney donation.

Conclusion

The mean score of intention to donate kidneys was 12.9 ± 4.1 SD. Direct attitude, direct subjective norm, direct perceived behavioral control, experience with blood donation, and knowledge of participants were significant factors for the intention to donate kidneys. Therefore, social and behavioral change communication strategies should address these factors in order to increase kidney donation.

Let's talk about PFAS: Inconsistent public awareness about PFAS and its sources in the United States

The presence of per- and polyfluoroalkyl substances (PFAS) in U.S. drinking water has recently garnered significant attention from the media, federal government, and public health professionals. While concerns for PFAS exposure continue to mount, the general public's awareness and knowledge of the contaminant has remained unknown. This exploratory study sought to fill this data gap by administering a nationwide survey in which the awareness of PFAS and community contamination, awareness of PFAS containing products and intentions to change product use, and awareness and concern about PFAS in drinking water were assessed. The results indicated that almost half the respondents had never heard of PFAS and do not know what it is (45.1%). Additionally, 31.6% responded that they had heard of PFAS but do not know what it is. A large portion of respondents (97.4%) also responded that they did not believe their drinking water had been impacted by PFAS. Demographic association did not influence knowledge of PFAS or levels of concern with PFAS in drinking water. The strongest predictor of PFAS awareness was awareness due to known community exposure. The respondents aware of community exposure were more likely to have knowledge of PFAS sources, change their use of items with potential PFAS contamination, and answer that their drinking water sources were also contaminated with PFAS. Based on the received responses, PFAS information and health risks need to be better communicated to the public to help increase awareness. These efforts should also be coordinated between government agencies, utilities, the research community, and other responsible entities to bolster their effectiveness.

Climate change beliefs and their correlates in Latin America

The ability of climate skeptics to block climate action depends on prevailing beliefs among the public. Research in advanced democracies has shown skepticism about the existence, the causes, and the consequences of climate change to be associated with socio-demographic features and political ideology. Yet, little is known about climate-related beliefs elsewhere. We address this gap by mapping beliefs in climate change and their correlates in Latin America. We show skepticism over the existence and anthropogenic origins of climate change to be limited, but identify a high number of skeptics around the severity of its consequences. Furthermore, we show skepticism to be correlated with psychological rather than socio-political factors: individualistic worldviews in particular drive disbelief in the severe consequences of climate change, a worrying finding in contexts where social trust is low. These findings offer a starting point for better addressing the constraining effects of climate skepticism in the Global South.

Sleep, Activity, and Nutrition Among an Army Sample: Strengths, Deficits, and Demographic Differences

Sleep, activity, and nutrition (SAN) are key components in overall health, and an individual's knowledge about and self-confidence to engage in healthy SAN behaviors can have an impact on their actions. This evaluation examined SAN knowledge, self-confidence, and behaviors among U.S. Army Soldiers prior to participating in a health promotion program. Baseline surveys from participating Soldiers provide evidence in this evaluation. U.S. Army Soldiers (N = 11,485) participating in a health promotion program completed surveys. Participants completed an online survey assessing SAN knowledge, self-confidence, and behaviors (among other constructs). We examined the common patterns of SAN behaviors, the associations between them, and the differences based on gender and rank. Knowledge, self-confidence, and behaviors were correlated within each of the three SAN domains. Men reported more aerobic exercise (d = .48) and more resistance training (d = .34) per week than women. Officers reported greater self-confidence in their ability to consume a post-exercise snack (i.e., refuel; d = .38), greater refueling behaviors (d = .43), greater activity knowledge (d = .33), and greater self-confidence in their ability to achieve activity goals (d ranging from .33 to .39), compared to enlisted Soldiers. Finally, greater confidence in one's ability to achieve healthy sleep correlated with getting more sleep, both during workweek (r = .56, p < .001) and weekend (r = .25, p < .001). These baseline data support the need for health promotion of SAN behaviors among these Soldiers.

Assessment of factors influencing physicians' intention to prescribe transfusion using the theory of planned behavior

BACKGROUND

Blood shortage is a persistent problem affecting Taiwan's health-care system. The theory of planned behavior (TPB) has been commonly used in studies of health advocacy. The purpose of this study was to develop a questionnaire measuring clinicians' intention to prescribe transfusion based on the TPB.

METHOD

A questionnaire comprising 15 items for assessing clinicians' intention to prescribe blood transfusion was developed, and it collected demographic characteristics, tested patient blood management (PBM) and perceived knowledge of PBM. Furthermore, the questionnaire contained four subscales related to the TPB. A total of 129 clinicians participated in this pilot study between July and December2020. Item analysis and exploratory factor analysis were conducted to examine the validity and reliability of this measurement instrument.

RESULTS

The results indicated no statistically significant correlations between the demographic characteristics and PBM test scores. Regarding perceived knowledge, the results of a one-way analysis of variance revealed that the effect of age, hierarchy of doctors, and education level were significant. In terms of subjective norms, a significant effect on education level was noted [t (129) = 2.28, p < 0.05], with graduate school graduates receiving higher scores than college graduates. An analysis of variance demonstrated the effects of hierarchy, education level, and medical specialty on perceived behavioral control. The results of the regression analyses revealed that perceived knowledge (β = 0.32, p < 0.01) and subjective norms (β = 0.22, p < 0.05) were significantly related to clinicians' behavioral intentions.

CONCLUSIONS

This study revealed that factors affecting clinicians' blood transfusion management can be explained using the TPB-based questionnaire. This study demonstrated that physicians' perceptions of whether most people approve of PBM and their self-assessment of their PBM knowledge affect their intentions to proceed with PBM. According to this finding, a support system among physicians must be established and maintained to increase physicians' confidence in promoting PBM.

LGBTQ + cultural competency training for health professionals: a systematic review

BACKGROUND

Health disparities experienced by LGBTQ + individuals have been partially attributed to health professionals' lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes.

METHODS

Included studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting.

RESULTS

75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial (n = 1), quasi-experimental pretest-posttest without control (n = 39), posttest only with control (n = 1) and posttest only without control (n = 3). Training modalities were multiple modalities with (n = 9) and without simulation (n = 25); single modality with simulation (n = 1); and with didactic lectures (n = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health (n = 28, effect size range = 0.28 - 1.49), (2) skills to work with LGBTQ + clients (n = 8, effect size range = 0.12 - 1.12), (3) attitudes toward LGBTQ + individuals (n = 14, effect size range = 0.19 - 1.03), and (4) behaviors toward LGBTQ + affirming practices (n = 7, effect size range = 0.51 - 1.11).

CONCLUSIONS

The findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals' cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.

Conceptual Foundations of Sustainability

Threats to the health of our environment are numerous. Much research in science and engineering is devoted to documenting, understanding, and attempting to mitigate the harm itself. The root challenge for sustainability, however, is human behavior. As such, changes to human behaviors and the internal processes that drive them are also essential. Critical to understanding sustainability-related behaviors is the individual's conceptualization of the natural world and its components and processes. The papers in this topiCS issue address these conceptualizations by drawing from anthropological, linguistic, educational, philosophical, and social cognitive perspectives as well as traditional psychological approaches to the study of concepts and their development in children. They engage with many domains bearing on environmental sustainability including climate change, biodiversity, land and water conservation, resource use, and design of the built environment. They coalesce around four broad themes: (a) What people know (or believe) about nature broadly and about specific aspects of nature, and how they acquire and use this knowledge; (b) how knowledge is expressed and shared via language; (c) how knowledge and beliefs interact with affective, social, and motivational influences to yield attitudes and behaviors; and (d) how members of different cultures and speakers of different languages differ in these ways. The papers also point to lessons for advancing sustainability via public policy and public messaging, education, conservation and nature management, and design of the built environment.

Climate change knowledge influences attitude to mitigation via efficacy beliefs

Theories proposing climate change apathy is explained by inadequate knowledge do not account for why many informed and concerned Americans fail to act. While correlations between knowledge, efficacy for climate change, and attitude to mitigation have been observed, few studies have examined efficacy for climate change as a mediator. This study aimed to investigate the influence of specific climate change knowledge on attitude to mitigation via efficacy beliefs. A cross-sectional survey of 205 US adults recruited from Amazon's Mechanical Turk assessed participants' climate change knowledge, efficacy for climate change, and attitude to mitigation. Indirect effects of self-efficacy for climate change were observed in three mediation models, suggesting efficacy for climate change explains some of the relationship between specific climate change knowledge and attitude to mitigation. The findings suggest risk communication can motivate pro-environmental attitudes with interventions that deliver information about climate change and develop efficacy for mitigation behavior.

Development and Evaluation of the Teacher Reporting Questionnaire for South African Foundation Phase Educators (TRQ-SA) in Measuring Teachers' Intentions to Report Child Sexual Abuse Suspicions

Globally teachers are mandated by law to report suspected child sexual abuse (CSA). The Teachers' Reporting Questionnaire (TRQ) was constructed to assess teachers' intentions to report CSA suspicions in Australia. The current research examines the development of the Teacher Reporting Questionnaire for South African foundation phase educators (TRQ-SA) and provides an evaluation of the TRQ-SA as a survey instrument for utilization in other studies. The TRQ-SA is a self-administered survey instrument used in a cross-sectional quantitative study that investigated teacher reporting intentions using the theory of planned behavior (TPB). A stratified random sample of 399 teachers from the eight school districts in the Western Cape province of South Africa was achieved. Before the TRQ-SA was developed, a qualitative elicitation study was conducted. Once developed, the questionnaire was pre-tested before the quantitative central study survey was administered. Cronbach's alpha was used to indicate reliability of scales, where a minimum α coefficient of .7 is considered acceptable. In the quantitative survey, the TRQ-SA had the following results: α = .74 was achieved for the attitude towards reporting scale, α = .78 for the subjective norm scale, α = .74 for the perceived behavioral control scale and α = .79 for the intention to report scale. The TRQ-SA achieved good internal consistency for all its TPB scales. The TRQ-SA is a valid and reliable survey instrument which could be used "as is" or amended in similar settings and countries testing the TPB in their own contexts.

A Behavior Analytic Interpretation of Concussion Reporting in Athletes: How the Field of Behavior Analysis Can Help Make Athletes Safer

Concussion resulting from athletic activities is a frequent occurrence in youth, collegiate, and professional sports. The first step in concussion treatment is usually the self-reporting of concussion symptoms by athletes. Unfortunately, over the past decade, concussion nondisclosure has remained a prominent concern in concussion identification. This review begins with a summary of the prominent theories being used to explain the deficit in concussion reporting (ie, lack of concussion knowledge, negative attitudes toward reporting, and socioecological models). Unfortunately, current literature indicates that these theories may not often lead to effective treatments for reporting behavior. We then present an alternative model of concussion reporting, one based on the theories of behavior analysis. The deficit in concussion reporting by athletes may be explained in a comprehensive yet parsimonious way through the behavior analytic principles of differential reinforcement and punishment. We also discuss directions for potential intervention strategies based on behavioral theory.

A longitudinal assessment of variability in COVID-19 vaccine hesitancy and psychosocial correlates in a national United States sample

Recent evidence suggests that COVID-19 vaccine hesitancy is not static. In order to develop effective vaccine uptake interventions, we need to understand the extent to which vaccine hesitancy fluctuates and identify factors associated with both between- and within-person differences in vaccine hesitancy. The goals of the current study were to assess the extent to which COVID-19 vaccine hesitancy varied at an individual level across time and to determine whether disgust sensitivity and germ aversion were associated with between- and within-person differences in COVID-19 vaccine hesitancy. A national sample of U.S. adults (N = 1025; 516 woman; M_age = 46.34 years, SD_age = 16.56, range: 18 to 85 years; 72.6 % White) completed six weekly online surveys (March 20 - May 3, 2020). Between-person mean COVID-19 vaccine hesitancy rates were relatively stable across the six-week period (range: 38-42 %). However, there was considerable within-person variability in COVID-19 vaccine hesitancy. Approximately, 40 % of the sample changed their vaccine hesitancy at least once during the six weeks. There was a significant between-person effect for disgust sensitivity, such that greater disgust sensitivity was associated with a lower likelihood of COVID-19 vaccine hesitance. There was also a significant within-person effect for germ aversion. Participants who experienced greater germ aversion for a given week relative to their own six week average were less likely to be COVID-19 vaccine hesitant that week relative to their own six-week average. This study provides important information on rapidly changing individual variability in COVID-19 vaccine hesitancy on a weekly basis, which should be taken into consideration with any efforts to decrease vaccine hesitancy and increase vaccine uptake. Further, these findings identify-two psychological factors (disgust sensitivity and germ aversion) with malleable components that could be leveraged in developing vaccine uptake interventions.

Motivating Individuals to Take Responsible Ocean Action: The Mediatory Effects of Attitude toward the Ocean

When considering how to improve public literacy and behavior related to specific themes, top priority is usually given to strategies that enhance relevant knowledge. Fostering attitude comes later. Understanding the mechanisms of behavior may help us develop better policy and educational strategies. However, how knowledge and attitude impact behavior is still under investigation. The aim of this study is to explore the relationships among ocean knowledge, attitude toward the ocean, and the intention to behave responsibly in the marine setting. Specifically, we investigated a potential mediation mechanism by recruiting a total of 266 participants, whose ocean knowledge, attitudes toward the ocean, and intention to behave responsibly were evaluated using questionnaires. The results indicate that a person's attitude toward the ocean may indeed be a mediating factor between ocean knowledge and their intention to show positive marine behavior. In order to engage people in responsible ocean behavior, other forms of assistance from marine policy and education are recommended. Additionally, it would be of interest for future studies to investigate the effects of attitude and attitude-related knowledge in the development of ocean actions.

LGBTQ+ health education interventions for nursing students: A systematic review

OBJECTIVES

Nurses are the largest segment of the American healthcare workforce, yet little is known about how American nursing students are educated about lesbian, gay, bisexual, transgender, queer, and other individuals' (LGBTQ+) health and the efficacy of these trainings. This systematic review assessed articles in English that quantitatively evaluated the effects of curricula and training for nursing students regarding LGBTQ+ health and examined their effects on students' outcomes.

DESIGN

Systematic review.

DATA SOURCES

Six electronic databases (PubMed, CINAHL, British Nursing Index, Embase, Scopus and PsycINFO).

REVIEW METHODS

Controlled vocabulary and/or keywords were used for each database. Of the initial 1766 citations, 26 articles met inclusion criteria. Data extracted included study design, sample characteristic/size, training topic, modality, duration, trainer, measurement tool, training target, effect size, and key finding.

RESULTS

Nearly 80 % of the reviewed studies were published between 2018 and 2021. All studies included were quasi-experimental: pretest-posttest with control (n = 3), without control (n = 20), and posttest only without control (n = 3). Training modalities were categorized into four groups: multimodal pedagogy with (n = 7) and without simulation (n = 6), single modality with simulation (n = 6) and with didactic lectures (n = 7). Eight studies employed LGBTQ+ people as trainers. Eight studies included interprofessional students; 18 studies engaged only nursing students. Interventions improved students' knowledge about LGBTQ+ health (n = 8), attitudes toward LGBTQ+ communities (n = 8), comfort level regarding interacting with LGBTQ+ individuals (n = 7), confidence in providing LGBTQ+ inclusive care in practice (n = 13) and LGBTQ+ cultural competence in nursing care (n = 2).

CONCLUSIONS

Educating and qualifying nursing students about LGBTQ+ health may improve their knowledge, attitudes, and skills when interacting with LGBTQ+ patients and may reduce health disparities for LGBTQ+ clients. Broad integration of content and competencies in LGBTQ+ health and well-being in nursing curricula should be prioritized. Future research should include rigorous, longitudinally designed evaluation of training curricula focusing on students' actual behavior changes. Evaluation should include comparison groups and validated measurement instruments about LGBTQ+ health education constructs specifically for nursing students.

Public's awareness of biobanks and willingness to participate in biobanking: the moderating role of social value orientation

Although the awareness of biobanks is considered to be a key factor in the willingness to participate in biobanking, the empirical evidence on their relationship is inconsistent. The present study investigated social value orientation as an explanatory factor in this relationship. A representative sample of 600 Slovaks completed Slider Measure to assess their social value orientation. Thereafter, they reported their level of awareness of biobanks and their willingness to provide biospecimens and personal information to biobanks. The results showed a positive relationship between awareness and willingness. Although social value orientation was not the moderator, we found that this relationship was significant only in the groups of altruists and individualists. The results remained robust after taking sociodemographic and institutional trust factors into account. Our findings imply that biobank awareness programmes should highlight both prosocial and proself motives to attract people with various social value orientations to participate in biobanking.

The use of theory of planned behavior to systemically study the integrative-qualitative intentional behavior in Romanian preschool education with network analysis

Predicting preschool teachers' intention to adopt qualitative and inclusive early childhood intentional behaviors represents an important research field. The objective of this research is first to develop and validate a scale to assess the integrative-qualitative intentional behavior (IQIB-ECEC) of preschool teachers in order to achieve SDG4.2's objective of ensuring that all children have access to high-quality pre-primary education and then to systemically analyze the relationship between variables with Network Analysis. The theory of planned behavior (TPB) describes key individual beliefs (attitudes, subjective norms, and perceived behavior control) that affect people's intentions to engage in a certain conduct and has previously been used with success in evaluating people's intentions to adopt a certain behavior. This research represents one of the first Romanian attempts to use the theory of planned behavior to study the Integrative-Qualitative Intentional Behavior in Romanian Preschool Education and systemically analyze results with Network Analysis approach. This study used a randomized 300 Romanian preschool teachers enrolled in a National Training Program entitled Qualitative and Inclusive Early Childhood Education managed by the Romanian Educational Ministry. Data were collected via an online questionnaire. The scale validation followed a confirmatory factor analysis (CFA). The fitting of the IQIB-ECEC 19-item scale showed that all coefficients CFI (0.942), TLI (0.920), SRMR (0.0452), and RMSEA (0.0451) bring strong evidence in the favor of the statistical validity of the scale. The final IQIB-ECEC 19 items and 8 factors scale obtained a Cronbach's alpha of 0.77. The systemic Network Analysis approach was used in interpreting data. The centrality of the network model was further investigated and the clustering coefficients index were calculated. According to the results, perceived power/control beliefs and behavioral intention were detected as the most important dimensions, whereas behavioral beliefs were less important. These findings were discussed in terms of their theoretical and practical significance.

Concussion knowledge, attitudes, and norms: How do they relate?

BACKGROUND

Relationships between the constructs of concussion-related knowledge, attitudes, and norms and their influence on observed care-seeking behaviors have previously been examined. Current models posit that these constructs serve as potential mediators of care-seeking behaviors; however, the dynamics between them have yet to be reconciled.

METHODS

A cross-sectional, online survey explored relationships among the latent constructs of concussion-related knowledge, attitudes, and norms in parents of middle school children who participate in sports in multiple settings. A just-identified and two overidentified path models were explored and compared in an effort to understand such relationships.

RESULTS

A total of 426 parents of United States middle school students were surveyed and included in analyses (mean age = 38.7±9.9 years; 55.6% female; 51.4% white/non-Hispanic; 56.1% with at least a bachelor's degree). All parents had middle school aged children who participated in sport in both the club and school settings. The best fitting model was a just-identified model with concussion-related norms influencing concussion-related knowledge and attitudes, and concussion-related knowledge influencing attitudes. This model accounted for 14% of the variance in attitude and 12% of the variance in knowledge.

CONCLUSIONS

Study findings suggest that the constructs of concussion-related knowledge, attitudes and norms are directly related to one another, yet the dynamics of such relationships may be complex. As such, a parsimonious interpretation of these constructs may not be appropriate. Future research should work to further reconcile the dynamics between these constructs, and the impact these dynamics may have in influencing care-seeking behaviors beyond serving as mediators.

Large and small financial incentives may motivate COVID-19 vaccination: A randomized, controlled survey experiment

INTRODUCTION

Experts continue to debate how to increase COVID-19 vaccination rates. Some experts advocate for financial incentives. Others argue that financial incentives, especially large ones, will have counterproductive psychological effects, reducing the percent of people who want to vaccinate. Among a racially and ethnically diverse U.S. sample of lower income adults, for whom vaccine uptake has lagged compared with higher income adults, we empirically examine such claims about relatively large and small guaranteed cash payments.

METHODS

In 2021, we conducted a randomized, controlled experiment among U.S. residents with incomes below $80,000 who reported being unvaccinated against COVID-19. Study participants were randomized to one of four study arms. In two arms, respondents first learned about a policy proposal to pay $1,000 or $200 to those who received COVID-19 vaccination and were then asked if, given that policy, they would want to vaccinate. In the two other arms, respondents received either an educational message about this vaccine or received no vaccine information and were then asked if they wanted to vaccinate for COVID-19. The primary analyses estimated and compared the overall percentage in each study arm that reported wanting to vaccinate for COVID-19. In other analyses, we estimated and compared these percentages for subgroups of interest, including gender, race/ethnicity, and education.

MAIN RESULTS

Among 2,290 unvaccinated adults, 79.7% (95%CI, 76.4-83.0%) of those who learned about the proposed $1,000 payment wanted to get vaccinated, compared with 58.9% (95%CI, 54.8-63.0%) in the control condition without vaccine information, a difference of 20 percentage points. Among those who learned of the proposed $200 payment, 74.8% (95% CI, 71.3-78.4%) wanted to vaccinate. Among those who learned only about the safety and efficacy of COVID-19 vaccines, 68.9% (95% CI, 65.1-72.7%) wanted to vaccinate. Findings were consistent across various subgroups.

DISCUSSION

Despite several study limitations, the results do not support concerns that the financial incentive policies aimed to increase COVID-19 vaccination would have counterproductive effects. Instead, those who learned about a policy with a large or small financial incentive were more likely than those in the control condition to report that they would want to vaccinate. The positive effects extended to subgroups that have been less likely to vaccinate, including younger adults, those with less education, and racial and ethnic minorities. Financial incentives of $1,000 performed similarly to those offering only $200.

Suicide knowledge and intention to intervene: college students

Objective: The revised Willingness to Intervene against Suicide questionnaire and the Expanded Revised Facts on Suicide Quiz were employed to examine the relationship between college students' knowledge about suicide and intention to intervene. Participants: College students (n = 515) participated, a majority being women and Caucasian. Methods: Participants completed an online survey. Data were analyzed in SPSS. Results: College students have poor knowledge of suicide facts; however, this low level of accurate knowledge was not associated with intention to intervene with a suicidal person. Attitudes, subjective norms, perceived behavioral control, sex, and no previous suicide attempt were all significant predictors of intention to intervene. Conclusions: These results challenge the notion that one must be well-informed in order to intend to take action.

A Vision for University Biology Education for Non-science Majors

As college science educators, we must prepare all future college graduates to be engaged, science-literate citizens. Yet data suggest that most college biology classes as currently taught do little to make science truly useful for students' lives and provide few opportunities for students to practice skills needed to be key decision makers in their communities. This is especially important for our non-science majors, as they represent the vast majority (82%) of college students. In this essay, we identify three critical aspects of useful college science education to prepare science literate non-science majors: prioritize local socioscientific issues; highlight communal opportunities in science that impact students' communities; and provide students with opportunities to practice skills necessary to engage with science beyond the classroom.

Factors associated with human tolerance of snakes in the southeastern United States

Conservation of snakes is influenced by humans’ beliefs, attitudes, and behaviors toward these often-maligned animals. We investigated public attitudes toward snakes through an online survey of undergraduate students (n = 743) at a large public university in a southeastern U.S. state. We used behavioral intent (i.e., how a person would react if they encountered a snake) to assess tolerance of different snake species. We also examined various predictors of tolerance including demographic attributes and a variety of cognitive (e.g., knowledge, value orientations) and affective (e.g., emotions) social-psychological variables. Tolerance of snakes varied based on whether the snake was venomous or non-venomous: about 36% of students said they were likely to kill venomous snakes they encountered, compared with 9% who said they would kill non-venomous snakes and 21% of students who said they would kill snakes whose identity was uncertain. However, most students (54%) could not distinguish between venomous and non-venomous species. Value orientations and emotions were strong predictors of tolerance for snakes, suggesting snake outreach and management strategies should account for both cognitive and affective antecedents of behavior.

A Systematic Review of the Education and Awareness Interventions to Prevent Online Child Sexual Abuse

Online child sexual abuse is highly prevalent in current society, in part, due to how technologically advanced children and adults have become. While much of the focus has been on perpetrator intervention, it is prudent to consider responses safeguarding children from potential perpetrators. Therefore, this review aimed to identify all the available empirical research on the prevention methods linked to education and awareness to determine the approaches' effectiveness, successes, and failures to aid future interventions. Databases were systematically searched for studies published between 2000 to 2020. Nine studies providing different prevention methods for online child sexual abuse were selected. A total sample of n = 672 and a descriptive approach was used for this study. While the interventions seemed to improve knowledge retainment of online safety, there was no significant change for risky online behavior. These findings provide specific suggestions for future interventions, particularly those focusing on risky online behaviors.

Change of air quality knowledge, perceptions, attitudes, and practices during and post-wildfires in the United States

Amid worsening climate change, the recurrent wildfires have substantially worsened air quality in the Western United States (U.S.). Understanding the knowledge, attitudes, perception, and practices (KAPP) over time in response to natural disasters such as wildfires is crucial for public health interventions and disaster preparedness. This is the first study to investigate the change in air quality KAPP over time in response to natural disasters. Previous studies have only assessed KAPP at a fixed time point. Using a two-wave panel survey (during and post-wildfires), we assessed the association between KAPP and respiratory health indicators as well as the changes over time in 212 participants in the U.S. Between the two waves, we found a significant 8% increase in knowledge, which was mainly driven by participants in areas unaffected by the wildfires. In addition, we found differential associations between KAPP and respiratory health indicators between areas affected and unaffected by the wildfires. These findings suggest that experiencing wildfires may affect KAPP and more longitudinal studies are warranted, particularly during periodic air quality crises.

Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study

Background

Patients who deteriorate in hospital wards without appropriate recognition and/or response are at risk of increased morbidity and mortality. Track-and-trigger tools have been implemented internationally prompting healthcare practitioners (typically nursing staff) to recognise physiological changes (e.g. changes in blood pressure, heart rate) consistent with patient deterioration, and then to contact a practitioner with expertise in management of acute/critical illness. Despite some evidence these tools improve patient outcomes, their translation into clinical practice is inconsistent internationally. To drive greater guideline adherence in the use of the National Early Warning Score tool (a track-and-trigger tool used widely in the United Kingdom and parts of Europe), a theoretically informed implementation intervention was developed (targeting nursing staff) using the Theoretical Domains Framework (TDF) version 2 and a taxonomy of Behaviour Change Techniques (BCTs).

Methods

A three-stage process was followed: 1. TDF domains representing important barriers and enablers to target behaviours derived from earlier published empirical work were mapped to appropriate BCTs; 2. BCTs were shortlisted using consensus approaches within the research team; 3. shortlisted BCTs were presented to relevant stakeholders in two online group discussions where nominal group techniques were applied. Nominal group participants were healthcare leaders, senior clinicians, and ward-based nursing staff. Stakeholders individually generated concrete strategies for operationalising shortlisted BCTs (‘applications’) and privately ranked them according to acceptability and feasibility. Ranking data were used to drive decision-making about intervention content.

Results

Fifty BCTs (mapped in stage 1) were shortlisted to 14 (stage 2) and presented to stakeholders in nominal groups (stage 3) alongside example applications. Informed by ranking data from nominal groups, the intervention was populated with 12 BCTs that will be delivered face-to-face, to individuals and groups of nursing staff, through 18 applications.

Conclusions

A description of a theory-based behaviour change intervention is reported, populated with BCTs and applications generated and/or prioritised by stakeholders using replicable consensus methods. The feasibility of the proposed intervention should be tested in a clinical setting and the content of the intervention elaborated further to permit replication and evaluation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08128-6.

Study on Influencing Factors of Micro and Small Enterprises' Work Safety Behavior in Chinese High-Risk Industries

Due to the limited work safety resources and the poor awareness of work safety from business owners with absolute decision-making power, safety accidents frequently occur in Chinese micro and small enterprises (MSEs) in high-risk industries. This study identifies the influencing factors of work safety behavior from MSEs, government safety supervision departments, and work safety service agencies. Based on the theory of planned behavior (TPB), the mechanism model of work safety behavior is built from the aspects of behavior attitude, subjective norms, behavior control cognition, past behaviors, and risk awareness of the enterprise. Based on the interview with nearly 600 MSEs in the east of China over 6 months, the results show that the work safety awareness of the business owner determines the work safety lever of the enterprise, and the work safety behavior of MSEs is a passive restraint behavior. Our findings provide a new perspective on the formation of MSEs’ work safety behavior in high-risk industries.

A systematic review of the evidence on the effect of parental communication about health and health behaviours on children's health and wellbeing

Parents report feeling unsure how best to talk with their children about sensitive health topics and may avoid such conversations; yet if children have questions or concerns about their health, talking to a parent could enhance their health and wellbeing. We investigated the effects of parental communications about health and health behaviours on children's health and wellbeing, and explored what strategies can encourage parents to communicate about health. We conducted a systematic review and narrative synthesis of research published between January 2008 and April 2020 from five databases. Of 14,007 articles identified, 16 met inclusion criteria focusing on five topics: diet and weight (n = 5), body image (n = 2), sexual health (n = 7), physical activity (n = 1) and bullying (n = 1). Positive child outcomes were associated with positive general parent-child communication characterised by warmth, openness and allowing children choice. Conversely, hostility, negative and inconsistent messaging were associated with poorer outcomes. Interventions to increase parent-child communication could be classified as providing single directive messages, media campaigns or intensive support. Single messages increased communication frequency; media campaigns and intensive interventions showed mixed outcomes. No differences in outcomes were found according to child's gender or socio-economic status. Generally, parents were less confident in initiating, rather than continuing, conversations and were more likely to initiate conversations when they felt they had good topic knowledge. While the relatively small, diverse sample limits the strength of these findings, this review provides provisional support for approaches to promote positive parent-child communication about health that are associated with better child health and wellbeing.

Determinants of the decision to build up excessive food stocks in the COVID-19 crisis

In 2020, the first COVID-19 lockdowns resulted in food panic buying and excessive food stockpiling across many countries around the world. Many governments recommend keeping emergency food stocks for three to ten days for times of potential shortages in food supply. Based on data from an online survey conducted among Swiss inhabitants, we investigated the effect of knowledge level and stockpiling behaviour according to governmental stockpiling recommendations in normal times on the decision to build up more food stocks than usual during the first lockdown in 2020. For this purpose, we applied a combination of latent class analysis and logistic regression. Latent classes were constructed based on knowledge level and stockpiling behaviour according to governmental stockpiling recommendations in normal times. Subsequently, the information on class membership was used as predictor of the decision to excessively stockpile food during the first lockdown. The variable “class membership” revealed that respondents with a low knowledge level and food stocks below governmental recommendations in normal times had a 7.6 percentage points lower probability of excessively stockpiling food during the first lockdown than respondents with a high knowledge level and recommended food stocks in normal times. Excessive stockpiling was additionally driven by the worry that certain food products would disappear from the supermarket shelves entirely or would be in short supply. Moreover, regression results revealed that respondents who reduced their shopping frequency during the first lockdown in 2020 showed a higher probability of building up more food stocks than usual. Our findings are crucial for food suppliers and policymakers to understand the drivers of panic buying and to prevent this phenomenon in future crises.

Consumers’ Intention to Adopt m-payment/m-banking: The Role of Their Financial Skills and Digital Literacy

The adoption of mobile payment (m-payment) and mobile banking (m-banking) is low in several countries, despite its associated benefits. The present study examines the impact of Pakistani consumers’ financial skills and digital literacy on their intention to adopt m-payment/m-banking using the Technology Acceptance Model (TAM). The data were collected from 454 individual smartphone users residing in Punjab province via an online and offline questionnaire survey. Structural equation modeling was used to analyze the consumers’ data. The results endorse that (1) their financial skills have no association with intention to adopt but through perceived usefulness; (2) their digital literacy bridges a strong association with intention and through perceived ease of use. Furthermore, this study discusses the theoretical and practical implications of the findings, as well as limitations and future directions.

The Act of Prevention: Knowledge, Attitudes, and Perception Among Caretakers of Kidney Disease Patients in Rural Wardha District of Central India

Background

There is a continual rise in the prevalence of non-cancerous conditions such as chronic kidney disease (CKD) owing to an enormous load of diabetes, hypertension, and vascular diseases. A positive attitude and healthy lifestyle for CKD prevention can only be followed when the masses are well aware and educated about the disease. This study aimed to compare, correlate, and evaluate the distribution of knowledge, attitudes, and perceptions among relatives or caretakers of patients with kidney disease or at risk of the disease.

Methodology

This cross-sectional study aimed at obtaining data on the knowledge, attitudes, and perceptions using the Chronic Kidney Diseases Screening Index questionnaire from the relatives of CKD patients. All data were computed and analyzed using SPSS version 28.0 (IBM Corp., Armonk, NY, USA).

Results

The majority of the relatives of CKD patients had poor knowledge (63.6%) and poor attitude (51.6%) levels. On the contrary, most respondents had good practices (52.8%) level toward the risk for CKD. A significant correlation was noted between education and knowledge (p < 0.050). A significant association was also observed between education and occupation with attitude (p < 0.001 and p < 0.050, respectively). Additionally, a significant association was noted between age and perception (p < 0.001).

Conclusions

Informed and well-educated populations are less prone to acquire or progress to CKD. From this study, we can understand the need for improvement in public knowledge, which has the potential to help in saving the lives of many patients progressing toward end-stage renal diseases.

Determinants of Ruminant Farmers' Use of Sustainable Production Practices for Climate Change Adaptation and Mitigation in Enugu State, Nigeria

A sustainable ruminant production system ensures economically viable livestock systems that meet the current and future demands of animal products as well as the environmental safety of current and future generations. The study analyzed the determinants of ruminant farmers' use of sustainable production practices for climate change adaptation and mitigation in Enugu State, Nigeria. Multistage sampling procedure was used to select ninety six (96) ruminant farmers that constituted the sample for the study. Semi-structured interview schedule with open ended questions was used in data collection. Data were analyzed using multiple regression and Pearson Moment Correlation statistics. Access to veterinary services (t = 2.056, p = 0.044), monthly household income (t = 3.582, p = 0.001) and annual income from ruminant production (t = −2.635, p = 0.011) were socio-economic factors that significantly influenced use of sustainable practices. The adjusted R- square implies that the three factors were able to explain 24% of variance in use of sustainable practices. There is a significant positive correlation (r = 0.426, p = 0.000) between knowledge level of farmers and their use of sustainable production practices. Schemes for financial inclusion such as payment for ecosystem services can spur farmers to adopt mitigation strategies. Improved climate change knowledge can enhance ruminant farmer's resilience to the increasing impacts of climate change.

Muslims and Mental Health Services: A Concept Map and a Theoretical Framework

Muslim populations in Western countries are growing, and they face biopsychosocial, spiritual, and economic challenges. Although Islam gives utmost attention to mental health stability, Muslims tend to underutilize mental health services. Mental health professionals, whether they be researchers, practitioners, or trainers working in schools, colleges/universities, mental health agencies, and research institutions, are well positioned to serve Muslims. Mental health professionals can address Muslims' biopsychosocial and spiritual issues and enhance their quality of life. In the current study, as the authors, we (a) reviewed 300 peer-reviewed manuscripts on Muslim mental health to understand how researchers have used concept maps or theoretical frameworks to design their empirical research, (b) prepared a comprehensive concept map based on the literature review to determine the central concepts affecting Muslims' approach to the use of mental health services, and (c) proposed a contextual theoretical (conceptual) framework. We titled the framework as Muslims' approach to use of mental health services based on the Theory of Planned Behavior and the Theory of Reasoned Action (TPB/TRA) in the context of a Social Ecological Model (SEM). We drew the framework based on TPB/TRA, SEM, and the review of Muslim mental health literature (the concept map). The concept map and the framework provide the most important constructs about challenges Muslim's face when attempting to utilize mental health services. Future researchers can use the concept map and the framework to conduct theoretically and evidence-based grounded empirical research. We provided implications for researchers, practitioners, educators, and social advocates wishing to contribute to service provision to this population.

Modeling fruit and vegetable consumption in Serbia

Although regular intake of fruits and vegetables has an essential role in a healthy diet and well-being, a majority of consumers in Serbia have a suboptimal intake of these groceries. To understand the main determinants of this unsatisfactory situation, the study tested an extended model of the theory of planned behavior intending to suggest necessary steps for improving fruits and vegetables daily intake. This theory, extended for the role of knowledge, was tested using structural equation modeling. Fit indices confirmed the utility of this extended model of the theory of planned behavior in explaining consumers' behavior as well as the mediating role of behavioral intentions. Serbia, as one of the central developing countries in the Balkans, was chosen to test the model with the possibility of applying it to other developing countries facing malnutrition. Data were collected in North Serbia, through an online survey (n=688). Despite consumers' high awareness of fruits and vegetables' beneficial health effects, the influence of consumers' knowledge only is not sufficient to trigger behavioral changes. Consumers' intentions and behavior should be influenced indirectly, by changing their attitudes and subjective norms. All custom-made activities promoting a higher fruit and vegetable intake should consider the present findings to achieve a bigger effect on behavioral changes among consumers.

Modeling fruit and vegetable consumption in Serbia

Although regular intake of fruits and vegetables has an essential role in a healthy diet and well-being, a majority of consumers in Serbia have a suboptimal intake of these groceries. To understand the main determinants of this unsatisfactory situation, the study tested an extended model of the theory of planned behavior intending to suggest necessary steps for improving fruits and vegetables daily intake. This theory, extended for the role of knowledge, was tested using structural equation modeling. Fit indices confirmed the utility of this extended model of the theory of planned behavior in explaining consumers' behavior as well as the mediating role of behavioral intentions. Serbia, as one of the central developing countries in the Balkans, was chosen to test the model with the possibility of applying it to other developing countries facing malnutrition. Data were collected in North Serbia, through an online survey (n=688). Despite consumers' high awareness of fruits and vegetables' beneficial health effects, the influence of consumers' knowledge only is not sufficient to trigger behavioral changes. Consumers' intentions and behavior should be influenced indirectly, by changing their attitudes and subjective norms. All custom-made activities promoting a higher fruit and vegetable intake should consider the present findings to achieve a bigger effect on behavioral changes among consumers.

Assessing Causal Pathways and Targets of Implementation Variability for EBP use (Project ACTIVE): a study protocol

Background

Advancing causal implementation theory is critical for designing tailored implementation strategies that target specific mechanisms associated with evidence-based practice (EBP) use. This study will test the generalizability of a conceptual model that integrates organizational constructs and behavioral theory to predict clinician use of cognitive-behavioral therapy (CBT) techniques in community mental health centers. CBT is a leading psychosocial EBP for psychiatric disorders that remains underused despite substantial efforts to increase its implementation.

Methods

We will leverage ongoing CBT implementation efforts in two large public health systems (Philadelphia and Texas) to recruit 300 mental health clinicians and 600 of their clients across 40 organizations. Our primary implementation outcomes of interest are clinician intentions to use CBT and direct observation of clinician use of CBT. As CBT comprises discrete components that vary in complexity and acceptability, we will measure clinician use of six discrete components of CBT. After finishing their CBT training, participating clinicians will complete measures of organizational and behavior change constructs delineated in the model. Clinicians also will be observed twice via audio recording delivering CBT with a client. Within 48 h of each observation, theorized moderators of the intention-behavior gap will be collected via survey. A subset of clinicians who report high intentions to use CBT but demonstrate low use will be purposively recruited to complete semi-structured interviews assessing reasons for the intention-behavior gap. Multilevel path analysis will test the extent to which intentions and determinants of intention predict the use of each discrete CBT component. We also will test the extent to which theorized determinants of intention that include psychological, organizational, and contextual factors explain variation in intention and moderate the association between intentions and CBT use.

Discussion

Project ACTIVE will advance implementation theory, currently in its infancy, by testing the generalizability of a promising causal model of implementation. These results will inform the development of implementation strategies targeting modifiable factors that explain substantial variance in intention and implementation that can be applied broadly across EBPs.

Determinants of restaurant consumers' intention to practice COVID-19 preventive behavior: an application of the theory of planned behavior

BACKGROUND/OBJECTIVES

The purpose of this study was to examine the effects of knowledge about coronavirus disease 2019 (COVID-19), attitude, subjective norm, and perceived behavioral control on behavioral intentions to practice COVID-19 preventive behaviors using the theory of planned behavior (TPB).

SUBJECTS/METHODS

A total of 519 restaurant customers' responses was collected in this study through an online self-administered questionnaire. Descriptive statistical analysis was performed on socio-demographic factors. One-way analysis of variance and t-test were conducted to determine differences in the constructs from the TPB according to age and sex. The hypotheses were tested using structural equation modeling (SEM).

RESULTS

SEM revealed the positive effect of knowledge about COVID-19 on attitude, subjective norm, and perceived behavioral control to prevent the spread of COVID-19 in restaurants. Attitude, subjective norm, behavior intention, and knowledge positively affected COVID-19 preventive behavior intentions in restaurants.

CONCLUSIONS

The results of this study confirmed that the TPB is helpful in elucidating the determinants of consumers' intention to practice COVID-19 preventive behavior in restaurants. These findings can help policy makers and professionals provide material for further public health interventions and inform them about awareness-raising, guidelines, and health education programs.

The impact of patient education on knowledge, attitudes, and cardiac rehabilitation attendance among patients with coronary artery disease

OBJECTIVE

Patient education (PE) delivered during exercise-based cardiac rehabilitation (CR) aims to promote health behaviour change, including attendance at CR exercise sessions, by imparting knowledge about coronary artery disease (CAD) and improving CR-related attitudes. This study evaluated the impact of PE on aspects of patient motivation (i.e., CAD-related knowledge, attitudes towards CR) and exercise session attendance.

METHODS

Adults with CAD referred to a 12-week CR program were recruited. CAD knowledge, perceived necessity/suitability of CR, exercise concerns, and barriers to CR were assessed pre/post-PE, and at 12-week follow-up. CR exercise attendance was obtained by chart review.

RESULTS

Among 90 patients (60 ± 10 years; 88% men), CAD knowledge and perceived necessity of CR improved pre- to post-PE; gains persisted at 12-weeks. Stronger pre-CR intentions to attend exercise sessions predicted greater attendance. Greater knowledge gains did not predict improvements in CR attitudes or exercise attendance.

CONCLUSION

Whereas PE may be useful for improving knowledge and attitudes regarding CAD self-management, more formative research is needed to determine whether PE can promote CR attendance.

PRACTICE IMPLICATIONS

Cardiac PE programs may be more successful in promoting exercise attendance if they target patients' behavioural intentions to attend and attitudes toward CR, rather than focussing exclusively on imparting knowledge.

Knowledge and Information Exposure About Family Planning Among Women of Reproductive Age in Informal Settlements of Kira Municipality, Wakiso District, Uganda

Introduction: A high unmet need for family planning (FP) prevails in sub-Saharan Africa. Knowledge, awareness creation, and ensuring accessibility are frequently used to increase FP uptake. However, evidence on knowledge or information dissemination about FP among marginalized populations in urban settings in Africa is limited. This study explored the knowledge of FP methods, media exposure, and contact with FP providers among women from an informal settlement in Uganda.

Methods: Using a cross-sectional study design, we interviewed 626 women aged 15–49 years living in informal settlements of Kira municipality, selected through multistage sampling. Using a standard questionnaire, data was collected on socioeconomic characteristics, knowledge of FP methods, and access to media FP messages among others. Binomial log-linear regression was used to assess disparities in exposure to media FP messages or provider information. Data were analyzed using STATA version 14, at a 5% level of statistical significance.

Results: Nearly all women in the survey were aware of FP methods (99.7%). On average, each woman was aware of 10 FP methods. The most commonly known methods were male condoms (98.2%), injectables (97.4%), and the oral contraceptive pill (95.2%). Use of any contraceptive was found among 42.7% of respondents. Exposure to media was found in 70.6% of the respondents, mostly through television (58.5%) and radio (58.3%). Discussing FP with a provider was significantly associated with media exposure (aPR 1.4, 95% CI: 1.24–1.56). Less than 50% of women who were not using FP had contact with an FP provider. Women in union (aPR 1.6, 95% CI: 1.01–2.68) and those with access to media messages (aPR 2.5, 95% CI: 1.37–4.54) were more likely to have contact with a provider to discuss FP.

Conclusion: There is high general awareness about FP methods and media exposure, but method use was low. Further exploration of women's understanding of FP methods and the fit between existing education programs and FP knowledge needs in this urban setting should be conducted. The potential for mobile health solutions in this urban population should be explored. Future studies should focus on the knowledge and understanding of FP among unmarried and nulliparous women and those with no access to media information.

Reporting Sexual Assault: Can Knowledge of How to Protect Forensic Evidence Influence Intentions to Report?

Responding to the high prevalence, low reporting, and poor conviction rates of adult sexual assault, Australian criminal jurisdictions have introduced protocols that allowed collection of medical forensic evidence from victims without police notification, since 1999. To assess the influence of reforms on potential victim behavior, this study measured lay knowledge of measures to protect forensic evidence of sexual assault, and predictors of intention to report adult sexual assault through the lens of the theory of planned behavior (TPB). An online survey was conducted with a sample of University of Canberra students and community members (N = 204). Results indicated moderate lay knowledge of how to protect evidence of sexual assault; however, only 46.1% of the sample were aware that evidence could be collected without police notification. The TPB successfully explained 55.6% of variance in intention to report future sexual assault. Participants who had experienced previous adult sexual assault victimization were significantly less likely to intend to report future sexual assault than those who had not. Knowledge of forensic evidence of sexual assault was not related to intention to report by self-efficacy as predicted; instead, it was mediated via subjective norms. Results indicated the potential value education to improve lay awareness of how to protect and report medical forensic evidence and to foster social norms that value reporting, particularly among school and university students.