Trust in Doctors, Positive Attitudes, and Vaccination Behavior: The Role of Doctor-Patient Communication in H1N1 Vaccination

Effects of Message Framing and Narrative Format on Promoting Persuasive Conversations with Others About the Flu Vaccine

This study examines the effects of message framing (loss vs. gain) and format (narrative vs. expository) on intentions to discuss flu vaccination with a close social referent. We test the effects of video messages using a two-wave web-based randomized experiment among adults in Israel (baseline: N = 429, one-month follow-up: N = 241). Exposure to narrative messages was positively associated with intentions to discuss flu vaccination. Exposure to loss-framed messages was positively associated with increased likelihood of discussing vaccination with the referent at follow-up. Effects of message framing and format were moderated by concern for the referent's health. Findings support the use of persuasive messages to motivate interpersonal conversation to promote vaccination. Results contribute to theory on risk-framing by showing that audiences may evaluate loss-framed messages according to their risk perceptions, when greater concern for health risks motivate action, not only for one's own health but for another person's health.

Validation of the Bangla version of the Communication Skills Attitude Scale with the medical students of Bangladesh

Background

Effective communication skill of physicians is an important component of high-quality healthcare delivery and safe patient care. Communication is embedded in the social and cultural contexts where it takes place. An understanding of medical students' attitudes and learning communication skills would help to design and deliver culturally appropriate medical education. The Communication Skills Attitude Scale (CSAS) is a widely used and validated tool to measure the attitude of medical students toward learning communication skills in different populations, settings, and countries. However, there is no culturally adapted and validated scale in Bangla in the Bangladesh context. This study aims to culturally adapt the CSAS into Bangla, and validate it in a cohort of medical students in Bangladesh.

Methods

This study used a cross-sectional survey design to collect data from purposively selected 566 undergraduate medical students from the Rajshahi division. The survey was conducted from January to December 2023. Descriptive statistics like frequency distribution and measures of central tendency were used to measure perception regarding communication skills. The sample adequacy was measured through the Kaiser-Meyer-Olkin test. The internal consistency of the items was identified using Cronbach's alpha (α) coefficients.

Result

The results of the study show that the Bangla version of the scale is feasible, valid, and internally consistent in the context of a developing country, Bangladesh. The overall internal consistency of the Bangla version is good since the value of Cronbach's alpha (α) is 0.882. For PAS, the internal consistency is 0.933. While, for NAS, the value is 0.719. The item-wise average scores in the PAS indicate that female medical students are more willing to learn communication skills compared with male students (α = 0.933). While, the scores in the NAS indicate that the male students tend to have more negative attitude toward learning communication skills compared with female students (α = 0.719).

Conclusion

The CSAS-Bangla is a valid and reliable tool for assessing communication skill attitudes among Bangla speaking medical students. This scale can be used in future studies to measure the attitude of students, designing and evaluating communication skills training programs in medical colleges.

Do COVID-19 Vaccination Policies Backfire? The Effects of Mandates, Vaccination Passports, and Financial Incentives on COVID-19 Vaccination

Faced with the challenges of motivating people to vaccinate, many countries have introduced policy-level interventions to encourage vaccination against COVID-19. For example, mandates were widely imposed requiring individuals to vaccinate to work and attend school, and vaccination passports required individuals to show proof of vaccination to travel and access public spaces and events. Furthermore, some countries also began offering financial incentives for getting vaccinated. One major criticism of these policies was the possibility that they would produce reactance and thus undermine voluntary vaccination. This article therefore reviews relevant empirical evidence to examine whether this is indeed the case. Specifically, we devote separate sections to reviewing and discussing the impacts of three major policies that were implemented during the COVID-19 pandemic: vaccination mandates, vaccination passports, and the provision of financial incentives. A careful analysis of the evidence provides little support that these policies backfire but instead can effectively promote vaccination at the population level. The policies are not without limitations, however, such as their inability to mobilize those that are strongly hesitant to vaccines. Finally, we discuss how policy-level interventions should be designed and implemented to address future epidemics and pandemics.

Patient concerns and physician strategies for addressing COVID-19 vaccine hesitancy

OBJECTIVE

COVID-19 vaccination is critical for reducing serious illness and hospitalizations, yet many remain hesitant. We conducted a survey of frontline physicians to identify patient concerns and physician strategies to address COVID-19 vaccine-hesitancy.

METHODS

A national random sample of physicians in frontline specialties selected from a comprehensive list of practicing physicians in the U.S. were emailed a survey in August 2021. Multiple choice and open-ended questions inquired about patient concerns related to the COVID-19 vaccines and strategies used by physicians to counter vaccine misinformation and encourage vaccine-hesitant patients. Weighting was applied to achieve representativeness and reduce non-response bias. Network analysis examined co-occurring patient concerns. Open-ended responses on communication strategies were coded via thematic analysis. Multi-variable logistic regression examined associations between physician and pandemic characteristics with patient concerns and use of communication strategies.

RESULTS

531 physicians responded: primary care (241); emergency medicine (142); critical care (84); hospitalists (34); and infectious disease (30). Weighted response balance statistics showed excellent balance between respondents and nonrespondents. On average, physicians reported four patient vaccine concerns. Safety, side effects, vaccine misinformation, and mistrust in government were most common, and often co-occurring. 297 physicians described communication strategies: 180 (61 %) provided vaccine education and 94 (32 %) created a safe space for vaccine discussion. Narrative responses from physicians provided compelling examples of both successes and communication challenges arising from misinformation. Compared with emergency medicine, critical care (OR 2.45, 95 % CI 1.14, 5.24), infectious disease (OR 2.45, 95 % CI 1.00, 6.02), and primary care physicians (OR 1.66, 95 % CI 1.02, 2.70) were more likely to provide communication strategies.

CONCLUSIONS

Many physicians engage with vaccine hesitant patients using a variety of strategies. Dissemination of effective system and physician-level communication interventions could enhance physician success.

COVID-19 Vaccine Boundary Work: The Case of Facebook Comments in Southeast Georgia

Although much research has considered the worldview of the vaccine hesitant, little attention has been given to the cultural conflict over what it means to be a person who takes vaccines. Through a qualitative content analysis of comments made on the Facebook pages of media outlets serving southeast Georgia, this analysis identifies both motives for rejecting the vaccine and outlines the symbolic boundaries that the vaccine hesitant have erected to distinguish themselves from vaccine advocates. The motives include perfunctory rejections, claims that the vaccine is ineffective, illegitimate, injurious in the short and long term, poisonous, infectious, particularly dangerous for children, and a component of conspiracy theories. These symbolic boundaries include distinguishing vaccine advocates from the vaccine hesitant by personal characteristics such as irrationality and authoritarianism. There are also social boundaries rooted in social locations - namely conservatives vs. liberals and non-elites vs. elites. This study also demonstrates how vaccine proponents engage with these symbolic boundaries. Vaccine proponents both contest and accept these boundaries. Likewise, pro-vaccine comments vary in terms of whether they stigmatize the boundary between vaccine user and non-user. This study adds to the literature on health communication and vaccines by confirming previous reports of the reasons for not taking the COVID-19 vaccine, indicating that public communication on vaccines is not regionally specific, and demonstrating the role that ostensible vaccine advocates might play in contributing to vaccine hesitancy.

Determinants of COVID-19 vaccination intention in Central and Eastern Europe: A cross-sectional study in Poland, Romania, and Slovenia

BACKGROUND

Identifying predictors of vaccination intention is critical to developing appropriate programs and campaigns targeting groups reluctant to be vaccinated. This study aimed to identify the determinants of vaccination intention at the beginning of the COVID-19 pandemic in three Central and Eastern European (CEE) countries: Poland, Romania, and Slovenia.

METHODS

In this cross-sectional study, a sample of unvaccinated 1723 Poles, Romanians, and Slovenians completed an online survey (April 2021). Questions included measures of vaccination intention, attitudes towards vaccines, conspiracy mindset, preference for a type of vaccine, and trust in information sources.

RESULTS

The results showed that mistrust of vaccine benefits and concerns about commercial profiteering negatively predicted vaccination intention. Conversely, trust in information from medical professionals and scientists, official sources, and traditional media was positively related to vaccination intention, while trust in digital media was negatively related to vaccination intention. In addition, preference for mRNA vaccine type was a positive significant predictor of vaccination intention. The differences between countries are discussed.

CONCLUSIONS

The study results deliver suggestions for developing appropriate vaccine uptake programs and campaigns that should consider presenting the positive outcomes of vaccines via official sources and traditional media based on scientific evidence and medical professionals' knowledge.

The Vaccine Training Barometer: Assessing healthcare providers' confidence to answer vaccine-related questions and their training needs

Healthcare providers (HCP) are seen by the public as the most trustworthy source of information about vaccination. While HCPs could be a valuable partner to increase vaccine confidence in general, it is not clear whether they feel confident themselves to address questions concerning vaccination. In the context of the EU Joint Action on Vaccination (EU-JAV), the Vaccine Training Barometer, an online survey tool, was developed to assess how frequently HCPs receive questions about vaccination, how confident they feel to answer these questions, and to what extent they are willing to follow extra training. After a pilot test in Flanders, Belgium, the Barometer was launched and completed by 833 HCPs in Flanders and 291 HCPs in the Spanish regions of Catalonia, Navarre and Valencian Community from November 2020 until January 2021, during the COVID-19 pandemic, just before and during the start of the first COVID-19 vaccination campaigns. In both countries, HCPs frequently received questions about vaccination (mostly on a daily or weekly basis), and about two thirds of them indicated that the frequency of questions had increased during the three months prior to completing the survey. Most questions were about the side effects and safety of vaccines. In both countries, a considerable proportion of HCPs did not feel confident to answer vaccine-related questions (31.5% felt confident in Flanders, 21.6% in Spain). A large proportion of HCPs received questions in the last three months before the survey that they could not answer (52.4% of respondents in Flemish sample, 41.5% in Spanish sample). Only 11.4% (Flanders) and 11.3% (Spain) of the respondents felt they gained sufficient knowledge through their standard education to be able to answer questions about vaccination. Almost all respondents were willing to follow extra training on vaccination (Flanders: 95.4%, Spain: 96.6%). The Vaccine Training Barometer is thus a useful tool to monitor HCPs' confidence to answer questions about vaccination and to capture their training needs.

Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study

BACKGROUND

Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention.

OBJECTIVE

This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians.

METHODS

We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter.

RESULTS

In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively.

CONCLUSIONS

Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially "filling the vacuum" and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects.

Assessing Physician Confidence in Counseling Patients on COVID-19 Disease and Vaccination: A Survey of Physicians' Perspectives in the Kingdom of Saudi Arabia

BACKGROUND

The COVID-19 vaccine has been available and well acceptable among the Saudi population since its introduction in 2020; however, concerns still remain regarding the confidence of doctors in giving such vaccines.

RESEARCH QUESTION

How confident are physicians in the Kingdom of Saudi Arabia about giving counseling and advice for patients regarding COVID-19 disease and COVID-19 vaccines?

OBJECTIVE

 To determine how confident Saudi Arabian doctors are in their ability to advise patients on the COVID-19 illness and COVID-19 vaccines.

AIM

To assist the health authorities in the Kingdom of Saudi Arabia in developing and implementing programs to improve doctors' skills and knowledge in giving advice to patients about the COVID-19 vaccine.

METHOD

The research employed an online cross-sectional study methodology to gather insights from doctors employed at hospitals, healthcare centers, and clinics across the Kingdom of Saudi Arabia. The inclusion criteria encompassed doctors actively engaged in healthcare settings, while the exclusion criteria were applied to those who had never encountered COVID-19 patients and those who declined participation in the study.

RESULTS

It was found that doctors were confident that there's a potential for adverse effects that are not yet seen in vaccine trials. Further results showed that primary health care doctors are more confident about the common side effects associated with the approved vaccines.

CONCLUSION

Most doctors were confident about the vaccine, yet they also know that there are some hidden side effects that are not yet discovered. Since patients trusted doctors as the main source of information about the vaccine, the study provided evidence to emphasize the rule of doctors as a reliable source of information.

Role of Trust, Risk Perception, and Perceived Benefit in COVID-19 Vaccination Intention of the Public

COVID-19 vaccination is an effective method for dealing with the COVID-19 pandemic. This study proposed and validated a theoretical intention model for explaining the COVID-19 vaccination intention (CVI) of the public. The theoretical intention model incorporated trust in vaccines, two types of risk perception (risk perception of COVID-19 and risk perception of COVID-19 vaccination), and perceived benefit into a theory of planned behavior (TPB). Structural equation modeling was utilized to test the theoretical intention model with data collected from 816 Chinese adults in China. The results confirmed the crucial role of trust in vaccines, risk perception, and perceived benefit in shaping the CVI of the public. In addition, TPB was found to be applicable in a research context. The theoretical intention model accounted for 78.8% of the variance in CVI. Based on the findings, several practical recommendations for improving COVID-19 vaccination rates were discussed.

Measuring Trust in Primary Care

Policy Points Trust in primary care clinicians is essential for effective patient care and is associated with better health outcomes, but it is rarely assessed, and existing measures have not been thoroughly evaluated. This scoping review reveals that research assessing patients' trust in primary care clinicians largely stopped more than a decade ago but offers candidate measures for future testing, implementation, and policy applications.

CONTEXT

Trust is a fundamental aspect of any human relationship, and medical care is no exception. An ongoing, trusting relationship between clinicians and patients has shown demonstrable value to primary care. However, there is currently no measure of trust in general use, and none endorsed for use by most value-based payment programs. This review searched the literature for any existing measures of patient trust in primary care clinicians and assessed their potential to be implemented as a patient-reported outcome measure.

METHODS

A keyword search on PubMed along with scanning references was conducted to find any trust measures in health care. Measures that did not address primary care clinicians were eliminated and the remaining measures were then assessed for their utility to primary care.

RESULTS

This purposeful, scoping review found four tested measures for assessing patients' trust in primary care clinicians that are candidates for general use. Of these four, the revised Trust in Physicians Scale and Wake Forest Physician Trust Scale are the most tested and viable options.

CONCLUSION

Renewed national interest in trust in health care should focus on the capacity to measure it. This review informs the effort to test trust measures for use in research, practice improvement, and value-based payment. Measuring trust, how it relates to outcomes, and learning how it is produced or lost are key to assisting practices and health systems toward earning it.

Trust Associated with South Korean Sojourners' Chinese COVID-19 Vaccination Intent and Concerns: A Qualitative Study

People's willingness to get vaccinated determines whether the campaigns against the COVID-19 pandemic can be successful in part. Considering the fact that both foreigners and its nationals are exposed to the risk of infection in China, the Chinese government has taken measures favorable to foreigners in terms of the vaccination, yet South Korean sojourners were reluctant to get China-developed COVID-19 vaccines. This study employed the trust in institutions and trust in media as a theoretical framework and seeks to analyze how these two affect South Korean sojourners' intention to get Chinese COVID-19 vaccines. 25 South Korean sojourners living in Beijing participated in semi-structured interviews. The results showed that the mistrust South Korean sojourners have in China's institutions and media, both traditional and social media, led to their reluctance to get Chinese COVID-19 vaccines. In addition, South Korean sojourners' higher interpersonal trust in their peers also influenced their willingness to get vaccines. This study further interpreted such results from the perspective of cultural traits and national properties.

Exploring attitudes of healthcare professionals towards those with fibromyalgia: A Q-methodological approach

Fibromyalgia remains a difficult condition to diagnose and treat. Research suggests that this leads to frustrating experiences for service users and healthcare professionals. This has led to negative healthcare professional attitudes towards working with those with fibromyalgia. The research to date reports negative attitudes and predominantly investigates attitudes of primary care physicians. This study explores the attitudes of a range of healthcare professionals towards those diagnosed with fibromyalgia. Using Q-methodology, 27 healthcare professionals completed a sorting task and questionnaire to prioritise statements relating to a range of different attitudes towards service users. All participants significantly loaded onto three factors that explained a total of 64% of the data variance. Factor 1 reflected the attitude 'Service users with fibromyalgia are no different to other service users and I enjoy working with them'. Factor 2 reflected the attitude 'Service users with fibromyalgia are inaccurate informants of their own condition due to lack of understanding of their condition and are not likely to engage in treatments'. Factor 3 reflected the attitude 'Service users with fibromyalgia are trustworthy with a lot of clinical problems [but I lack confidence in specialist skills to support them]'. Contrary to the current literature, there appears to be supportive attitudes from healthcare professionals towards service users diagnosed with fibromyalgia. Increased specialised training, clinical exposure to working with fibromyalgia and reflective practice spaces were identified as elements that could improve healthcare professional attitudes.

Health Communication Research Informs Inflammatory Bowel Disease Practice and Research: A Narrative Review

Background

In the absence of targeted empirical evidence on effective clinical communication in inflammatory bowel disease (IBD), a broad overview of existing evidence on effective communication in healthcare and available recommendations for communication in telehealth is provided and mapped onto IBD research and practice.

Methods

A narrative literature review was conducted using Pubmed and Scopus databases and snowballing literature search.

Results

Evidence-based relationship building strategies include communicating emotions, acknowledging and addressing patients' hesitancy, and ensuring continued support. A particular recommendation regarding telehealth interaction is to avoid long stretches of talk. Effective informational strategies include facilitating and supporting information exchange and considering patients' preferences in decision-making. In teleconsultations, clinicians should ask direct questions about patients' emotional state, clarify their understanding of patients' concerns and check patients' understanding, address at least one patient-reported outcome when discussing the recommended treatment, and shorten the consultation where possible. Strategies for maximizing effective clinical communication in the spoken communicative mode include using infographics and simple language, and assessing adherence at the beginning of the consultation. For teleconsultations, clinicians are advised to allow patients to explain the reason for their call at the beginning of the teleconsultation, probe additional concerns early and before ending the teleconsultation, and be mindful of technical issues such as voice delays.

Conclusions

Use of question prompt lists, decision aids, micro-lessons, and communication training interventions for clinicians could be beneficial in IBD care. Further research into the implementation of such interventions as well as clinical communication concerns specific to IBD is warranted.

A Game-Theory-Based Approach to Promoting Health Policy among Minorities

The importance of designing policy measures that government and other public bodies apply to different populations has been escalating in recent decades. This study seeks the best way to induce conservative minority groups to cooperate with healthcare policy. The case study focuses on the Bedouin population of Israel and its willingness to accept COVID-19 vaccination. The study is based on vaccination data from the Israel Ministry of Health for the country's entire Bedouin population, twenty-four semi-structured in-depth interviews with relevant key stakeholders, and the use of game-theory tools to profile the players, the utility functions, and various equilibrium combinations. By comparing the groups and integrating game-theory tools into the process, we reveal variables that may affect healthcare processes among conservative minority communities. Finally, cross-tabulating the results with the interview findings strengthens the insights and allows a culturally adjusted policy to be adopted. The different starting points of different minority populations have implications for the design of requisite policies in both the short and the long terms. The analysis of the game allowed us to indicate the strategy that policymakers should adopt in consideration of variables that should be taken into account in order to improve cooperation and the ability to apply policy. To increase vaccination rates among conservative minority communities in general and the Bedouin population in particular, trust in the government must be increased in the long term. In the short term, trust in the medical profession must be increased, and also health literacy.

Addressing COVID-19 Vaccine Hesitancy: The Role of Medical Students

We conducted a survey study at the Icahn School of Medicine at Mount Sinai to assess COVID-19 vaccine attitudes and behaviors among medical students. Almost all respondents (96.5%, n = 222) believed vaccines were effective and reported being asked about the COVID-19 vaccine by family members (79.0%, n = 180). However, when asked how they respond when someone shares misinformation, 89.0% (n = 202) responded they agree to avoid conflict, 44.9% (n = 102) listened empathically, and 9.3% (n = 21) corrected the misinformation. Medical school education can address this disconnect, using standardized patients and role-playing to give students the tools to address vaccine hesitancy within their communities.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01670-2.

Could Belief in Fake News Predict Vaccination Behavior in the Elderly?

Willingness to get a vaccine was important during the COVID-19 pandemic. Previous studies suggest that vaccine hesitation during the pandemic could have been related to truth discernment, belief in information, exposure to misinformation, attitudes to vaccines, and conspiracy beliefs. Previous studies were mostly with younger adults, and studies with older adults are lacking. This study aimed to analyze the relationship between the trust or belief in fake online news (print news was not included), truth discernment, attitudes, and willingness to be vaccinated during the COVID-19 pandemic while controlling for some significant factors/variables that could affect vaccination in a sample of older adults. There were 504 pre-retirees and retirees participating in this study. Participants from Lithuania age ranged from 50 to 90 years old (M = 64.37, SD = 9.10), 58.3 percent were females. Results from several path models predicting the participants willingness to get a vaccine suggested that stronger conspiracy beliefs and skeptical attitudes toward vaccination would be related to lower willingness to get vaccinated. Participants who disbelieved in the headlines were already vaccinated. Therefore, it seems that discernment (the ability to distinguish which information is true and which is not) is not related to the willingness to vaccinate.

Trust in physicians and trust in government predict COVID-19 vaccine uptake

OBJECTIVE

We consider how trust in government, trust in physicians, and interpersonal trust affect the likelihood of COVID-19 vaccine uptake.

METHODS

A survey of 3057 registered South Dakota voters was fielded in April 2021 that measured COVID-19 vaccine uptake, three aspects of trust, and several other factors related to vaccine hesitancy. Logistic regression was utilized to analyze the responses.

RESULTS

We found positive, statistically significant, and substantively impactful effects for trust in government and trust in physicians on the likelihood of COVID-19 vaccine uptake, and null results for interpersonal trust.

CONCLUSIONS

Our findings provide a more nuanced understanding of the relationship between trust and COVID-19 vaccine uptake, and suggest that public health official as well as physicians should strive to increase the public's trust in the medical community.

To Be (Vaccinated) or Not to Be: The Effect of Media Exposure, Institutional Trust, and Incentives on Attitudes toward COVID-19 Vaccination

The COVID-19 vaccine has become a strategic vehicle for reducing the spread of the pandemic. However, the uptake of the vaccine by the public is more complicated than simply making it available. Based on social learning theory, this study examines the role of communication sources and institutional trust as barriers and incentives as motivators of people's attitudes toward vaccination and actual vaccination. Data were collected via an online panel survey among Israelis aged 18-55 and then analyzed using structural equation modeling (SEM). Findings show that social media trust negatively mediates the effect of exposure to information on the vaccine on attitudes toward vaccination. However, mass media trust and institutional trust positively mediate this relationship. Incentives were effective motivators for forming positive attitudes and moderating the effect of institutional trust on attitude toward vaccination. This study facilitates a deeper understanding of health communication theory in pandemics and makes important recommendations for practitioners and policy makers.