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Kawamura H, Kishimoto K. Identifying factors improving the intention to use antibiotics appropriately in children and adults using protection motivation theory. PEC INNOVATION 2024; 4:100293. [PMID: 38847019 PMCID: PMC11153234 DOI: 10.1016/j.pecinn.2024.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/10/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024]
Abstract
Objective This study aimed to employ hypothetical models based on the protection motivation theory (PMT) to identify factors that improve the intention to use antibiotics appropriately (intention) among individuals who take antibiotics or administer them to their children. Methods Adult Japanese participants, including 600 parents who administer antibiotics to children aged <14 years and 600 adults who take them, completed an online survey. Structural equation modeling (SEM) was conducted on hypothetical models representing intention using 19 questions based on PMT. If the hypothesized model did not fit, SEM was repeated to search for a new model. Results The hypothesized models did not fit. Two factors were extracted from SEM: "understanding the risk of antimicrobial resistance" and "excessive expectation of antibiotics." In adults, SEM revealed that "excessive expectation of antibiotics" (β = -0.50, p < 0.001) negatively influenced intention; in children, "excessive expectation of antibiotics" (β = -0.52, p < 0.001) negatively influenced intention, while "understanding the risk of antimicrobial resistance" (β = 0.22, p < 0.001) positively influenced intention. Conclusion Factors influencing intention varied between adult and pediatric antibiotic use. Innovation Awareness activities for appropriate antibiotic use should be tailored to population characteristics.
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Affiliation(s)
- Hitomi Kawamura
- Division of Social Pharmacy, Department of Healthcare and Regulatory Sciences, Graduate School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
- Department of Pharmacy, Tokyo Rosai Hospital, 4-13-21 Omoriminami, Ota-ku, Tokyo 143-0013, Japan
| | - Keiko Kishimoto
- Division of Social Pharmacy, Department of Healthcare and Regulatory Sciences, Graduate School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
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Yang X, Galárraga O, Cao W, Lin H, Cao F, Chang C. Financial incentive interventions for smoking cessation among Chinese smokers: study protocol for a cluster randomised controlled trial. BMJ Open 2024; 14:e080344. [PMID: 38684254 PMCID: PMC11086505 DOI: 10.1136/bmjopen-2023-080344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION There is an urgent issue to relieve the burdens caused by tobacco use through feasible and effective smoking cessation interventions, particularly in a middle-income country with less accessible smoking cessation services and high demand for quitting smoking. Financial incentives have shown effective in changing health behaviours, thus needing to test its portability to a wider implementation and effectiveness of increasing smoking cessation rates. METHODS AND ANALYSIS This is a three-arm cluster randomised controlled trial. 462 eligible participants will be assigned to 2 financial incentive groups-rewards or deposits, or the control group. All participants including those in the control group will receive text messages to help quitting smoking developed by the US National Cancer Institute over a 3-month intervention period. In addition to text messages, reward group participants will be rewarded with CNY200 and CNY400 (CNY100 approximately US$15) for sustained smoking abstinence at 1 month and 3 months follow-up assessments; participants in the deposit group will accumulate CNY200 and CNY600 in the deposit accounts after verified smoking abstinence at 1 month and 3 months follow-up assessments, and all the deposits will be given at once right after the 3-month follow-up visit. The primary outcome is biochemically verified smoking abstinence rate sustained for 6 months after enrolment. ETHICS AND DISSEMINATION This trial protocol has been approved by the Ethics Committee of Peking University Health Science Centre (date: 23 February 2023; ethical approval number: IRB00001052-22172). Results and findings of this trial will be disseminated in peer-reviewed journals and professional conferences. TRIAL REGISTRATION NUMBER ChiCTR-IOR-2300069631.
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Affiliation(s)
- Xiaochen Yang
- Peking University Department of Social Medicine and Health Education, Beijing, Beijing, China
| | - Omar Galárraga
- Brown University School of Public Health, Providence, UK
| | - Wangnan Cao
- Department of Social Medicine and Health Education, Peking University, Beijing, China
| | - Haoxiang Lin
- Peking University Institute for Global Health and Development, Beijing, China
| | - Fei Cao
- Department of Marketing, Tianjin University of Finance and Economics, Tianjin, China
| | - Chun Chang
- Peking University Department of Social Medicine and Health Education, Beijing, Beijing, China
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Lim KH, Cheong YL, Lim HL, Cheong KC, Hashim MHM, Marine AA, Cheah YK, Lim JH, Mohd Ghazali S. Validity and reliability of the Malay language Perception Towards Smoking Questionnaire (BM-PTSQ) among secondary school adolescents: Further validation using Confirmatory Factor Analysis. Tob Induc Dis 2024; 22:TID-22-25. [PMID: 38268983 PMCID: PMC10807019 DOI: 10.18332/tid/176164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Perception is an essential factor influencing smoking among adolescents. Thus, a valid tool for measuring perception is a requisite in smoking studies. This study further establishes the validity and reliability of a Malay language version of the Perception Towards Smoking Questionnaire (BM-PTSQ) for assessing the perception of smoking among secondary school-going adolescents in Malaysia. METHODS We administered the BM-PTSQ to 669 secondary school students selected through multistage sampling; 60% of respondents were male (n=398), and 69.9% (n=463) were from rural areas. Respondents were aged 13-16 years, 36.4% (n=241) were 13 years, 40.0% (n=265) were 14 years, and 23.6% (n=156) were 16 years old. We used parallel and exploratory factor analysis (EFA) to determine the domains of the questionnaire. In addition, we also employed EFA, confirmatory factor analyses (CFA), and Cronbach's alpha to evaluate the construct validity and reliability of the BM-PTSQ. RESULTS EFA and parallel analysis identified two domains in the BM-PTSQ that accounted for 62.9% of the observed variance, and CFA confirmed the two-domain structure. The two domains' internal consistency scores ranged from 0.702 to 0.80, which suggested adequate reliability. CONCLUSIONS The BM-PTSQ has acceptable psychometric validity and is appropriate for assessing smoking perception and intention among Malaysian secondary school-aged youth. Researchers should further evaluate this tool's applicability in a more sociodemographically diverse population.
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Affiliation(s)
- Kuang Hock Lim
- Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Yoon Ling Cheong
- Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Hui Li Lim
- Clinical Research Centre, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Kee Chee Cheong
- Department of Biostatistics, and Data Repository, National Institutes of Health, Shah Alam, Malaysia
| | - Mohd Hazilas Mat Hashim
- Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Ali Aman Marine
- Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Yong Kang Cheah
- School of Economics, Finance and Banking, College of Business, Universiti Utara Malaysia, Sintok, Malaysia
| | - Jia Hui Lim
- Pharmacy Department, Putrajaya Hospital, Putrajaya, Malaysia
| | - Sumarni Mohd Ghazali
- Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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An S, Sun S. Serial multiple mediation of perceived professional healthcare support and social structural factors in the relationship between care-seeking behavior and perinatal mental health in Chinese mothers. BMC Public Health 2023; 23:2386. [PMID: 38041013 PMCID: PMC10691162 DOI: 10.1186/s12889-023-17310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND In previous studies, it has been observed that mother's perinatal mental health (PMH) problems can be improved by engaging in appropriate health care-seeking behaviors. However, the exact mechanism that influences the relationship between these two factors is still not fully understood. This cross-sectional study aims to examine the serial multiple mediating effects of perceived professional healthcare support (PPHS) and social structural factors on the association between care-seeking behavior and PMH. METHODS The cross-sectional study evaluated 1705 Chinese mothers (pregnancy 12 to 41 weeks) through questionnaires from October 2021 to November 2022. These mothers were selected from three hospitals in Wuxi, with an annual delivery volume of at least 5000. We conducted a structural equation model (SEM) analysis to examine the multiple mediating effect of PPHS and social structural factors (social stigma or social trust) between care-seeking behavior and PMH. After analyzing the results of the SEM, we used bootstrapping to further test the mediating effect. RESULTS Among the 1705 Chinese mothers surveyed, 636 (37.3%) sought help from professionals. It was observed that more women tended to seek professional help during the early stages of pregnancy (12 to 28 weeks) compared to the later stages (28 to 41 weeks) (t = 1.47, p < 0.05). The results of the SEM analysis indicated that the mother's care-seeking behavior did not have a significant direct effect on PMH. However, it was identified as a crucial distal variable, with its significant effect being fully mediated by PPHS and social structural factors. The mediation effect of PPHS and social stigma on the pathway from care-seeking behavior to PMH was found to be 92.9% (direct effect = 0.002; indirect effect = 0.026). Additionally, the mediating effect of stigma contributed to 21.9% of the association between care-seeking behavior and PPHS (direct effect = 0.405; indirect effect = 0.114). Similarly, the mediation effect of PPHS and social trust on the pathway from care-seeking behavior to PMH was 73.3% (direct effect = 0.008; indirect effect = 0.022). Moreover, the mediating effect of social trust contributed to 22.0% of the association between care-seeking behavior and PPHS (direct effect = 0.407; indirect effect = 0.115). The proposed model showed a good fit with the collected data. CONCLUSION This study examines the serial multiple mediation effect, in which PPHS and social structural factors mediate the relationship between PMH and professional care-seeking behavior. We suggest three levels of intervention: implementing mental health in all policies, providing training for healthcare providers, and establishing healthcare channels with easily accessible information.
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Affiliation(s)
- Shanshan An
- Department of Social Medicine, Jiangnan University, Wuxi, 214122, China
| | - Sheng Sun
- Department of Social Medicine, Jiangnan University, Wuxi, 214122, China.
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Zhang D, Liu R, Li X, Yuan Y, Zhou G. How do self-exempt beliefs affect intentions to quit smoking? An exploration of the mediating role of threat appraisal and coping appraisal. Front Psychol 2023; 14:1260561. [PMID: 38098517 PMCID: PMC10720447 DOI: 10.3389/fpsyg.2023.1260561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Numerous smokers are cognizant of the detrimental effects associated with this habit yet exhibit a persistent reluctance to cease their tobacco consumption. Self-exempt beliefs serve as an obstacle to the cessation of this addictive behavior. This research explored the impact of self-exempt beliefs on the readiness to quit smoking based on the Protection Motivation Theory (PMT) model and the mediating roles of threat appraisal and coping appraisal. Methods Self-exempt beliefs, PMT constructs, and the intention to quit smoking constituted the theoretical model. The questionnaires were collected from 488 Chinese adult male smokers based on snowball sampling. Exploratory Factor Analysis (EFA) was used to examine the underlying factor structure of the pre-designed self-exempt beliefs scale. The reliability, validity, path coefficients, and explanatory power of the model were calculated using Partial Least Squares Structural Equation Modeling (PLS-SEM). Results and discussion The results showed that : (1) three common factors (skeptic beliefs, bulletproof beliefs, and "worth it" beliefs) with a total of 11 items were retained after EFA; (2) skeptic beliefs and "worth it" beliefs had a significantly negative effect on both threat appraisal and coping appraisal, while bulletproof beliefs did not; (3) bulletproof beliefs had a significantly positive direct impact on intention to quit, "worth it" beliefs had a significantly negative direct impact on intention, while skeptic beliefs had no significantly direct impact on intention; (4) threat appraisal and coping appraisal positively and significantly predicted cessation intention; and (5) threat appraisal and coping appraisal, as two main cognitive processes, acted as full mediations between skeptic beliefs and the intention to quit, as complementary partial mediations between "worth it" beliefs and the intention, and as non-mediation between bulletproof beliefs and the intention. Our findings suggest that efforts to undermine or "prevent" these self-exempt beliefs, particularly "worth it" and skeptic beliefs, may be an effective tactic for health communication interventions for quitting smoking.
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Affiliation(s)
- Dan Zhang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Institute of Health Development, Guizhou Medical University, Guiyang, China
| | - Runhua Liu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Institute of Health Development, Guizhou Medical University, Guiyang, China
| | - Xinchen Li
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Yuanyuan Yuan
- Department of Management Engineering, Guizhou Traffic Technician and Transportation College, Guiyang, China
| | - Geyao Zhou
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Institute of Health Development, Guizhou Medical University, Guiyang, China
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Lin H, Li M, Xiao L, Chang C, Liu GG. Efficacy of personalised text message intervention in reducing smoking frequency and amount for non-abstinent smokers: A double-blind, randomised controlled trial. J Glob Health 2023; 13:04133. [PMID: 37883205 PMCID: PMC10602206 DOI: 10.7189/jogh.13.04133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Background Emerging evidence supports the efficacy of mobile phone interventions for smoking cessation. However, behaviour changes of smokers who fail to reach abstinence and the related psychological mechanism are still understudied. We aimed to evaluate the efficacy of a behaviour change theory-based smoking cessation intervention delivered through personalised text messages from the perspective of smokers who fail to reach abstinence. Methods We conducted a two-arm, double-blind, randomised controlled trial, with the intervention group receiving personalised text messages developed specifically for this study, and the control group receiving non-personalised ones related to smoking cessation. These messages were sent over a period of three months. We looked at three outcomes: changes in smoking frequency, in smoking amount, and in protection motivation theory (PMT) construct scores. Results We obtained smoking cessation results for 722 participants who went through the randomisation process (intervention: 360, control: 362; block randomisation design). Overall, 32.3% of baseline daily smokers in the intervention group and 20.0% in the control group changed to weekly smokers during the follow-up period (P < 0.001), while 43.4% of consistent daily smokers in the intervention group and 32.8% in the control group continuously reduced their smoking amount (P < 0.001). We observed associations between the intrinsic rewards of smoking and changes from daily to weekly smoking, the perceived severity of smoking and reductions in smoking amount, as well as the self-efficacy of quitting and changes from daily to weekly smoking/reductions in smoking amount. Conclusions We found that a personalised text message-based intervention was more likely to decrease the frequency and amount of smoking in smokers who failed to reach abstinence compared to a non-personalised one. We also explored the possible psychological mechanism of such positive effects. Here we provide evidence for countries to consider the promotion of smoking cessations using behaviour theory-driven personalised text messages, which may be more cost-effective than traditional approaches. Registration Peking University: ChiCTR2100041942.
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Affiliation(s)
- Haoxiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Min Li
- DeZhou Center for Disease Control and Prevention, Beijing, China
| | - Li Xiao
- China Center for Health Education, Beijing, China
| | - Chun Chang
- School of Public Health, Peking University, Beijing, China
| | - Gordon G Liu
- Institute for Global Health and Development, Peking University, Beijing, China
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Lin H, Liu Y, Zhang H, Zhu Z, Zhang X, Chang C. Assessment of a Text Message-Based Smoking Cessation Intervention for Adult Smokers in China: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e230301. [PMID: 36857056 PMCID: PMC9978944 DOI: 10.1001/jamanetworkopen.2023.0301] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
IMPORTANCE Successful smoking cessation strategies are an important part of reducing tobacco use. However, providing universal smoking cessation support can be a challenge for most countries because it requires sufficient resources. One way to expand access is to use mobile technologies to provide cessation support. OBJECTIVE To assess the efficacy of a behavior change theory-based smoking cessation intervention using personalized text messages. DESIGN, SETTING, AND PARTICIPANTS This study was a 2-arm double-blind randomized clinical trial conducted in 5 cities in China. Daily or weekly smokers 18 years or older were eligible for inclusion if they owned a mobile phone and used the WeChat social media app. A total of 722 participants were randomized to the intervention or control group between April 1 and July 27, 2021. INTERVENTIONS Intervention group participants received a personalized text message-based smoking cessation intervention that was based on the transtheoretical model and protection motivation theory and developed by this study's investigators. Control group participants received a nonpersonalized text message-based smoking cessation intervention developed by the US National Cancer Institute. Both groups received 1 to 2 text messages per day for 3 months through the app. MAIN OUTCOMES AND MEASURES The primary outcome was the biochemically verified 6-month sustained abstinence rate, defined as the self-report of no smoking of any cigarettes after the designated quit date, which was validated biochemically by an expired air carbon monoxide level of less than 6 ppm at each follow-up point. RESULTS A total of 722 participants (mean [SD] age, 41.5 [12.7] years; 716 men [99.2%]; all of Chinese ethnicity) were randomly assigned to the intervention group (360 participants) or the control group (362 participants). Biochemically verified continuous abstinence at 6 months was 6.9% in the intervention group and 3.0% in the control group (odds ratio [OR], 2.66; 95% CI, 1.21-5.83). Among smokers with low nicotine dependence, the intervention group had significantly better abstinence rates for most of the indicators after adjusting for covariates (eg, biochemically verified 24-hour point prevalence of abstinence at 1 month: adjusted OR, 2.15; 95% CI, 1.05-4.38). Among smokers with moderate and high nicotine dependence, only the biochemically verified 24-hour point prevalence of abstinence at 6 months was statistically significant (adjusted OR, 4.17; 95% CI, 1.34-3.00). The pattern was similar for quitting intention, and the personalized text message-based intervention was more effective for smokers who had strong quitting intention than for those who had weak quitting intention. CONCLUSIONS AND RELEVANCE In this study, the behavior change theory-based smoking cessation intervention using personalized text messages was more effective than an intervention using nonpersonalized text messages. The intervention was most effective among smokers with low nicotine dependence and strong quitting intention. This study's findings also provide further evidence regarding the potential benefits of mobile health interventions for other behaviors. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR2100041942.
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Affiliation(s)
- Haoxiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yihua Liu
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hao Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengjie Zhu
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xiaoyue Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
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