Understanding help-seeking intentions in male military cadets: An application of perceptual mapping

Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study

BACKGROUND

In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold.

OBJECTIVE

The purpose of this observational study was to examine Marines' self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination.

METHODS

As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines' written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good (κ=0.81).

RESULTS

A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45%), low estimates of risk (33/235, 14%), and fear of physical discomfort (29/235, 12%). Resulting interventions directly targeted Marines' self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine).

CONCLUSIONS

Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors.

Help-seeking for Intimate Partner Violence and Abuse: Experiences of Serving and Ex-serving UK Military Personnel

Purpose

Intimate Partner Violence and Abuse (IPVA) is as a major health concern globally. The prevalence of IPVA perpetration and victimisation has been found to be higher in military compared to civilian populations. Of concern, help-seeking for other psychosocial difficulties among military communities has been shown to be both limited and challenging, and military personnel could face additional or amplified barriers to help-seeking for IPVA than their civilian counterparts. This study aimed to use qualitative methods to explore the experiences of, and barriers to, help-seeking for IPVA victimisation and perpetration among UK military personnel.

Methods

Thematic analysis was conducted on 40 one-to-one semi-structured interviews with military personnel (29 male, 11 female).

Results

Four superordinate themes were derived, thematically organised according to different levels of the social ecological model: Military cultural factors; Support service factors; Interpersonal factors; and Individual factors. At a military cultural level, participants described difficulties in help-seeking for IPVA resulting from widespread stigma and hypermasculine attitudes in military communities, minimisation of violence, perceived pressure from chain of command, and fear of consequences of reporting. At a support-service level, participants' negative views or experiences and lack of awareness of services were also significant in deterring help-seeking. At an interpersonal level, participants recounted how relationships with military colleagues, their partner and their family could be both instrumental or a hindrance to help-seeking for IPVA. At an individual level, lack of insight into IPVA and different forms of abuse were suggested through minimisation of violence and described to contribute to delay in help-seeking. Shame, compounded by multi-layered stigma present at each social ecological model level, was a key reason for delaying or avoiding help-seeking.

Conclusions

The findings indicate the added challenges in help-seeking for IPVA experienced by military personnel and highlight a need for a whole systems approach to improve the provision of support for IPVA in the military serving and ex-serving community to instil meaningful change.

Men's help-seeking and engagement with general practice: An integrative review

Aim

To critically synthesize the literature that describes men's help‐seeking and engagement with general practice.

Design

Integrative literature review.

Data sources

CINAHL plus, Medline and APA PsycInfo were searched for papers published between 1999 and March 2021.

Review methods

After screening titles and abstracts, full‐text papers were screened against inclusion / exclusion criteria. All included papers were assessed for methodological quality. Findings were extracted, critically examined and synthesized into themes.

Results

Twenty studies met the inclusion criteria. Thematic analysis revealed four themes related to; (1) structural barriers, (2) internal barriers, (3) men's understanding of the role of general practice, and (4) self‐care and help‐seeking. The findings indicate that men can find general practice unwelcoming and unaccommodating. Men can also experience psychological barriers that impact engagement and help‐seeking. Men predominantly view general practice as a source of acute health care and do not appreciate the role of general practice in preventive health care and advice.

Conclusion

This review has provided insight into the issues around the barriers to health care engagement, men's understanding of the role of general practice and their associated help‐seeking. Seeking to further understand these issues could assist in the development of strategies to promote engagement of men with general practice health care.

Impact

This review highlights research about men's engagement with general practice and the missed opportunities in receiving preventive health care and education.

Enhancing men's engagement with general practice has the potential to reduce the impact of their health on quality of life and improve health outcomes.

Mapping Perceptual Differences to Understand COVID-19 Beliefs in Those with Vaccine Hesitancy

Thirty percent of US adults are COVID-19 vaccine hesitant, but little is known about them beyond demographics. We used segmentation and perceptual mapping techniques to assess perceptual differences in unvaccinated, vaccine hesitant adults in Philadelphia, PA (n = 110) who answered a cross-sectional survey in-person or online. The sample was 54% ethnic minority, 65% female, 55% earned less than $25,000 with a mean age of 44. K-means cluster analysis identified three audience segments based on reported trust of healthcare providers and personal COVID-19 impact (High Trust/Low impact [n = 34], Moderate Trust/High impact [n = 39], Low Trust/Low impact [n = 23]). Multidimensional scaling analysis created three-dimensional perceptual maps to understand differences in COVID-19 and vaccine perceptions. The Low Trust/Low Impact group showed higher agreement with items related to COVID-19 being a hoax (p = .034) and that minorities should be suspicious of government information (p = .009). Maps indicate vaccine messaging for all groups would need to acknowledge these items, but added messaging about trust of pharmaceutical companies, belief that COVID messages keep changing or that vaccines are not safe would also need to be addressed to reach different segments. This may be more effective than current messaging that highlights personal responsibility or protection of others.

Prospective assessment of contralateral prophylactic mastectomy decision-making in women with average risk: an application of perceptual mapping

Women with early-stage unilateral breast cancer and no familial or genetic risk factors are increasingly electing contralateral prophylactic mastectomy (CPM), despite the lack of evidence demonstrating improved outcomes. To better understand and extend the literature focused on treatment decision-making, a survey was conducted among women with early-stage breast cancer and no associated risk factors, who were in the process of making a surgical decision. This prospective study sought to expand our understanding of the factors that influence patients' decision to have CPM, with the goal of providing healthcare providers with useful guidance in supporting breast cancer patients who are making treatment decisions. Data were collected for this prospective study through an internet survey. Results were analyzed using perceptual mapping, a technique that provides visual insight into the importance of specific variables to groups of women making different surgical decisions, not available through conventional analyses. Results suggest that women more likely to elect CPM demonstrate greater worry about breast cancer through experiences with others and feel the need to take control of their health through selection of the most aggressive treatment option. The information obtained offers guidance for the development of targeted intervention and counsel that will support patients' ability to make high quality, informed decisions.

Anterior Knee Pain Risk Differs Between Sex and Occupation in Military Tactical Athletes

CONTEXT

Anterior knee pain (AKP) is ubiquitous in early-career military members and exacerbated during functional tasks required during military duties. Therefore, it is important to understand risk of this condition in male and female tactical athletes in diverse military occupations.

OBJECTIVE

To assess sex and occupation on AKP risk in military members.

DESIGN

Descriptive Epidemiology Study.

SETTING

United States Armed Forces. Patients All military members diagnosed with anterior or retro-patellar pain, patellar instability, knee tendinopathy on their initial encounter from 2006 to 2015.

OUTCOME MEASURES

The Defense Medical Epidemiology Database was queried for the number of individuals with AKP. Relative risk (RR) and chi-square statistics were calculated in the assessment of sex and occupational category. Regressions were calculated to determine association between service branch, sex, and AKP across time.

RESULTS

From 2006-2015, a total of 151,263 enlisted and 14,335 officer services members were diagnosed with AKP. Enlisted females had an incidence rate of 16.7 per 1000 person-years compared to the enlisted male service members with an incidence rate of 12.7 per 1000 person-years (RR: 1.32, 95%CI: 1.30-1.34, p<0.001) across all AKP diagnoses. Female officers had an incidence rate of 10.7 per 1,000 person-years compared to male officers at an incidence rate of 5.3 per 1000 person-years (RR: 2.01, 95%CI: 1.94-2.09). Differences in risk were also noted across military occupation for both enlisted and officer service members (p<.05).

CONCLUSION

Sex and military occupation were salient factors for AKP risk. Evaluation of training requirements and developing interventions programs across military occupation could serve as a focus for future research aiming to mitigate associated risk factors of AKP.

Improving Communication Messages by Using Perceptual Mapping: Family Planning Survey in East Java and West Nusa Tenggara, Indonesia

Objectives:

Contraceptive methods vary in effectiveness, actions required of users, and side effects. This article aims to analyze the perceptions about contraceptive methods among family planning clients of the East Java and West Nusa Tenggara (NTB) provinces in Indonesia.

Methods:

The data were obtained from the operational research of the Improving Contraceptive Method Mix Project in Indonesia, conducted in 2015–2016 in six districts in East Java and West Nusa Tenggara. The total sample size was 12,190 women aged 15–49 years. The perceptual mapping method uses cross-sectional surveys that require the respondent to rate the level to which they associate specific elements with each other, based on similarities and differences of perceived association. The correlation matrices for six contraceptive methods and five attributes were subjected to a multidimensional scaling analysis.

Results:

The results showed injectable to be the most preferred method, which was positioned closest to the attributes ‘easy to use’ and ‘easy to get’, followed by pills. Implants ranked higher than other long-acting and permanent method.

Conclusion:

Injectables and pills were the most preferred because people believe that they were ‘easy to use’ and ‘easy to get’. The least preferred methods were tubectomy and vasectomy because the respondents thought those were not close to any attributes at all. To increase the demand for the long-acting and permanent method choice in the provinces of East Java and West Nusa Tenggara, the attributes ‘easy to use’ and ‘easy to get’ should be emphasized in the long-acting and permanent method Information Education and Communication messages.

Evaluating Suicide Risk Using the Reasons for Dying-Reasons for Living (RFD-RFL) Index in a Military Psychiatric Inpatient Setting

The present study aimed to explore reasons for dying (RFD) and reasons for living (RFL) among suicidal inpatients, conceptualize the RFD-RFL index, and examine whether suicide risk indicators were associated with the RFD-RFL index scores. Participants were military personnel (N = 167) psychiatrically hospitalized following a suicide-related crisis who provided baseline data as part of a randomized controlled trial. Family was the most commonly reported RFL (39.7%) and was the top ranked RFL for 65.9% of participants. The most frequently endorsed RFD categories included general descriptors of self (26.9%), general statements about escape (19.7%), and others/relationships (19.1%). Greater RFD-RFL index scores were associated with a greater wish to die relative to wish to live, greater hopelessness, and with a history of lifetime multiple suicide attempts. Endorsing more RFD relative to RFL may indicate heightened suicide risk. Results of this study identify the characteristics of RFD and RFL among a high-risk, military sample, and provide preliminary support for the clinical utility of evaluating the quantities of RFD and RFL. Clinicians are encouraged to explore RFD and RFL when working with suicidal patients. Future research may explore military-specific RFD and evaluate the validity of the proposed RFD-RFL index.

A Hypothesis of Gender Differences in Self-Reporting Symptom of Depression: Implications to Solve Under-Diagnosis and Under-Treatment of Depression in Males

The phenomenon of female preponderance in depression has been well-reported, which has been challenged by higher rates of suicide and addictive behaviors in males, and a longer life-span in females. We thus propose an alternative hypothesis "Gender differences in self-reporting symptom of depression," suggesting mild-moderate depression tends to be reported more often by females, and severe depression and suicide tend to be reported more often by males. Potential mechanisms that account for this difference may include three aspects: covariation between estrogen levels and the incidence peak of female depression, gender differences in coping style (e.g., comparative emotional inexpressiveness and non-help-seeking in males), and gender differences in symptom phenotypes (e.g., atypical symptoms in male depression). Our newly presented hypothesis implied the overlooked under-diagnosis and under-treatment of depression in males. For effective diagnoses and timely treatment of male depression, it is critical to incorporate symptoms of depression in males into the relevant diagnostic criteria, encourage males to express negative emotions, and increase awareness of suicidal behavior in males.

Cyberbullying, Mental Health, and Violence in Adolescents and Associations With Sex and Race: Data From the 2015 Youth Risk Behavior Survey

Background. Cyberbullying is a serious issue among adolescents, but little is known about how demographics are associated with mental health conditions and violent behaviors. The present study examined the association of cyberbullying victimization with mental health conditions and violent behaviors among adolescents, specifically examining potential differences by sex and race. Methods. National data obtained from a representative sample of 9th to 12th grade students (N = 15 465) in the United States were examined using bivariate and logistic regression analysis. Results. More than 15% of students reported cyberbullying victimization. Females were twice as likely to report victimization than males, and non-white students were 50% less likely to report cyberbullying victimization. Cyberbullying victimization was significantly more likely in students who reported depressive symptoms, suicidal ideation, suicide planning, carrying a weapon, and engaging in a physical fight. These associations were more pronounced in males. Conclusions. Our findings show that female and white adolescents are at increased risk of being cyberbullied. However, negative mental health outcomes and violent behaviors are more pronounced in males, indicating potential negative effects of being a cyberbullying victim based on sex. We envisage the best way to combat cyberbullying is to develop programs that are sensitive to potential demographic differences to empower students based on individual risks.

Take Charge, Get Cured: The development and user testing of a culturally targeted mHealth decision tool on HCV treatment initiation for methadone patients

OBJECTIVE

This paper describes the development of a mobile health tool to facilitate Hepatitis C (HCV) treatment decision making in methadone patients.

METHODS

Using an iterative, formative evaluation framework, we used commercial marketing techniques to create 3D maps of survey data to develop culturally relevant messaging that was concept tested. The resulting tool was then user tested and results were used to modify the tool.

RESULTS

The "Take Charge, Get Cured" tool was developed with surveys (n = 100), perceptual mapping analysis, concept testing (n = 5), and user testing (n = 10). "Think aloud" sessions were audio recorded and surveys given. Patients thought the goal of the tool was to encourage treatment and it was aimed to the needs of methadone patients. Means of 6.7-7 (on a 7 point scale) were observed for survey items related to ease of use, content, and satisfaction.

CONCLUSION

The iterative development was essential to ensuring a culturally targeted tool, specific to the needs of HCV + methadone patients. There was a high level of acceptance for the tool.

PRACTICE IMPLICATIONS

Our study indicates that using a formative evaluation strategy is essential for development of highly targeted patient communication, especially in hard-to-reach populations.

Understanding Parents' Perceptions of School-Based BMI Screening and BMI Report Cards Using Perceptual Mapping: Implications for School Nurses

Half of U.S. states measure students' body mass index (BMI), with many communicating that information to parents through a "BMI report card" or notification letter. School nurses are usually responsible for implementing these programs and communicating results to parents. The purpose of this study was to understand parents' perceptions of BMI screening programs to help inform school nurses about messages that are most helpful to use in report cards to motivate parents to follow-up with a health-care provider or to make behavioral changes for their child. Using a cluster analysis and perceptual mapping methods, a commercial marketing technique that creates three-dimensional graphic maps, we identified four unique clusters of parents based on their core attitudes and beliefs related to BMI screenings and report cards. Based on vector modeling techniques, key message strategies were developed that can be used by school nurses to enhance parent response to a BMI report card.

Mapping the Barriers and Facilitators of HCV Treatment Initiation in Methadone Maintenance Therapy Patients: Implications for Intervention Development

An estimated 70-90% of current methadone users have Hepatitis C (HCV). Current treatments have few side effects and can cure infection in 8-12 weeks, but less than 10% of methadone patients initiate treatment. Engaging this group in treatment is an important strategy to lower both morbidity and mortality from liver disease and eliminate a significant reservoir of HCV in communities. To understand how to address this treatment gap we used commercial marketing techniques called perceptual mapping and vector message modeling to analyze survey data from 100 HCV+ methadone patients from four centers in Philadelphia. Results were used to understand barriers and facilitators to treatment initiation and to devise targeted message strategies to adapt to a mobile health communication intervention. Results indicate that focusing on how treatment can make one feel "in charge", positive interactions with healthcare providers, the positive attributes of the new vs. old HCV treatments, and providing strategies to address tangible barriers to getting treatment, would be important to address in a communication intervention. These marketing methods allow for focusing on specific variables to "move" the group toward a treatment decision, making them an innovative technique to use in developing highly targeted health communication messages.