Nonstructural barriers to adult vaccination

Adult vaccination coverage remains low, despite vaccine recommendations, improved access, and reimbursement. Low vaccination coverage and an aging population at higher risk from vaccine-preventable diseases lead to preventable disability and deaths, straining healthcare systems. An Advisory Board meeting was, therefore, held to identify non-structural barriers to adult vaccination and discuss potential solutions to increase uptake. Many non-structural factors can influence vaccine uptake, such as heterogeneity in the population, (fear of) vaccine shortages, incentives, or mandates for vaccination, understanding of disease burden and personal risks, time and opportunity for healthcare providers (HCPs) to discuss and deliver vaccines during general practice or hospital visits, trust in the health system, and education. To address these barriers, push-pull mechanisms are required: to pull patients in for vaccination and to push HCP performance on vaccination delivery. For patients, the focus should be on lifelong prevention and quality of life benefits: personal conversations are needed to increase confidence and knowledge about vaccination, and credible communication is required to build trust in health services and normalize vaccination. For providers, quality measurements are required to prioritize vaccination and ensure opportunities to check vaccination status, discuss and deliver vaccines are not missed. Financial and quality-based incentives may help increase uptake.

The association of caregiver attitudes, information sources, and trust with HPV vaccine initiation among adolescents

This study described caregiver attitudes and the information sources they access about HPV vaccination for adolescents and determined their influence on human papillomavirus (HPV) vaccination initiation. An online survey was administered to 1,016 adults in July 2021. Participants were eligible if they were the caregiver of a child aged 9-17 residing in Mississippi, Arkansas, Tennessee, Missouri, and select counties in Southern Illinois. Multivariate logistic regression was used to estimate the association of caregiver attitudes and information sources with HPV vaccination. Information from doctors or healthcare providers (87.4%) and internet sources other than social media (31.0%) were the most used sources for HPV vaccine information. The highest proportion of caregivers trusted their doctor or healthcare providers (92.4%) and family or friends (68.5%) as sources of information. The HPV vaccine series was more likely to be initiated in children whose caregivers agreed that the vaccine is beneficial (AOR = 4.39, 95% CI = 2.05, 9.39), but less likely with caregivers who were concerned about side effects (AOR = 0.61, 95% CI = 0.42, 0.88) and who received HPV vaccination information from family or friends (AOR = 0.57, 95% CI = 0.35, 0.93). This study found that caregivers' attitudes, information sources, and trust in those sources were associated with their adolescent's HPV vaccination status. These findings highlight the need to address attitudes and information sources and suggest that tailored interventions considering these factors could increase HPV vaccination rates.

Communicating uncertainties regarding COVID-19 vaccination: Moderating roles of trust in science, government, and society

This study examined how uncertainty affects information seeking and avoidance behaviors via information insufficiency in the COVID-19 vaccination context. It also investigated how trust in science, government, and society moderate the effects of information insufficiency. An online experiment with 131 Korean adults showed that uncertainty indirectly affects information seeking intentions via information insufficiency, which is moderated by science trust and governmental trust. It also showed that uncertainty indirectly affects information avoidance intentions via information insufficiency, which is moderated by social trust.

Racial and Ethnic Differences in Openness to Communication From Local Faith-Based Congregations During Public Health Emergencies

OBJECTIVES

During public health emergencies, people at risk of exposure or illness will likely be presented with extensive information about an unfamiliar topic and be asked to make decisions quickly. In difficult situations, people often turn to trusted leaders, including from their local faith-based congregation (FBC). We examined how people receive, interpret, and respond to health communication information from clergy and lay leaders from their local FBC during public health emergencies.

METHODS

We analyzed responses to 10 questions from a 2021 nationally representative US survey. Porter Novelli designed the survey and administered it to 4510 US adults aged ≥18 years, of whom 3553 people completed the survey. We examined sociodemographic characteristics, trust of health information from clergy and lay leaders, and willingness to engage in health behaviors recommended by their FBC and receive health services through their local FBC. All estimates were weighted. We conducted bivariate analysis with contrast t tests for proportions at α = .05.

RESULTS

More than half of adults (55.4%), including 65.8% of non-Hispanic Black and 58.8% of Hispanic or Latino adults, were members of an FBC. Among FBC members, a higher percentage of Hispanic or Latino (29.1%) and non-Hispanic Black (36.3%) adults than non-Hispanic White adults (20.4%) reported trust in their FBC for health information (P < .05). This trust translated into greater intent to engage in health behaviors promoted by the local FBC among non-Hispanic Black respondents (31.4%) compared with non-Hispanic White respondents (22.5%) (P < .05).

CONCLUSIONS

Public health officials can consider ways to better understand how the cultures and practices of populations being served influence people's health perceptions and behaviors. Collaboration between federal, state, and local public health officials and FBCs can promote health equity during public health emergencies.

Comparing Subjective Similarity of Automated Driving Styles to Objective Distance-Based Similarity

OBJECTIVE

This study explores subjective and objective driving style similarity to identify how similarity can be used to develop driver-compatible vehicle automation.

BACKGROUND

Similarity in the ways that interaction partners perform tasks can be measured subjectively, through questionnaires, or objectively by characterizing each agent's actions. Although subjective measures have advantages in prediction, objective measures are more useful when operationalizing interventions based on these measures. Showing how objective and subjective similarity are related is therefore prudent for aligning future machine performance with human preferences.

METHODS

A driving simulator study was conducted with stop-and-go scenarios. Participants experienced conservative, moderate, and aggressive automated driving styles and rated the similarity between their own driving style and that of the automation. Objective similarity between the manual and automated driving speed profiles was calculated using three distance measures: dynamic time warping, Euclidean distance, and time alignment measure. Linear mixed effects models were used to examine how different components of the stopping profile and the three objective similarity measures predicted subjective similarity.

RESULTS

Objective similarity using Euclidean distance best predicted subjective similarity. However, this was only observed for participants' approach to the intersection and not their departure.

CONCLUSION

Developing driving styles that drivers perceive to be similar to their own is an important step toward driver-compatible automation. In determining what constitutes similarity, it is important to (a) use measures that reflect the driver's perception of similarity, and (b) understand what elements of the driving style govern subjective similarity.

Young adults' expectations for healthcare following institutional betrayal

Healthcare-related institutional betrayal has been used to examine how patients' previous negative healthcare experiences influence their current provider-level trust and future interactions with the healthcare system. However, healthcare-related institutional betrayal has rarely been considered among emerging independent users of the healthcare system: college students. Moreover, it is unknown whether healthcare-related institutional betrayal is associated with future healthcare expectations among this population. Using a trauma-informed framework, this study examined the relations among self-reported experiences of healthcare-related institutional betrayal, trust in healthcare providers, and subsequent expectations for healthcare among college students (n = 967). Analyses considered whether greater past healthcare-related institutional betrayal during one's worst healthcare experience predicts i) lower current trust in healthcare providers and ii) greater negative expectations for future healthcare above and beyond trauma symptoms and the perceived severity of participants' worst healthcare experiences. Sixty-nine percent of participants endorsed having experienced at least one act of institutional betrayal, the most common being the institution not taking proactive steps to prevent unpleasant healthcare experiences (28.5%). As predicted theoretically, greater experiences of institutional betrayal accounted for 16% of the variance in current trust in healthcare providers, even after accounting for trauma symptoms and the severity of the worst healthcare experience. Greater endorsement of institutional betrayal experiences were also significantly associated with negative expectations for future healthcare. Given the youthfulness of the sample, it is noteworthy that 41.4% of participants endorsed at least one negative expectation for future healthcare. Future research should examine how negative expectations are related to healthcare avoidance behaviors.

Variety Is the Spice of Life: Diverse Social Networks Are Associated With Social Cohesion and Well-Being

Both homophily and heterophily are observed in humans. Homophily reinforces homogeneous social networks, and heterophily creates new experiences and collaborations. However, at the extremes, high levels of homophily can cultivate prejudice toward out-groups, whereas high levels of heterophily can weaken in-group support. Using data from 24,726 adults (M = 46 years; selected from 10,398 English neighborhoods) and the composition of their social networks based on age, ethnicity, income, and education, we tested the hypothesis that a middle ground between homophily and heterophily could be the most beneficial for individuals. We found that network homophily, mediated by perceived social cohesion, is associated with higher levels of subjective well-being but that there are diminishing returns, because at a certain point increasing network homophily is associated with lower social cohesion and, in turn, lower subjective well-being. Our results suggest that building diverse social networks provides benefits that cannot be attained by homogeneous networks.

Large Language Models and User Trust: Consequence of Self-Referential Learning Loop and the Deskilling of Health Care Professionals

As the health care industry increasingly embraces large language models (LLMs), understanding the consequence of this integration becomes crucial for maximizing benefits while mitigating potential pitfalls. This paper explores the evolving relationship among clinician trust in LLMs, the transition of data sources from predominantly human-generated to artificial intelligence (AI)-generated content, and the subsequent impact on the performance of LLMs and clinician competence. One of the primary concerns identified in this paper is the LLMs' self-referential learning loops, where AI-generated content feeds into the learning algorithms, threatening the diversity of the data pool, potentially entrenching biases, and reducing the efficacy of LLMs. While theoretical at this stage, this feedback loop poses a significant challenge as the integration of LLMs in health care deepens, emphasizing the need for proactive dialogue and strategic measures to ensure the safe and effective use of LLM technology. Another key takeaway from our investigation is the role of user expertise and the necessity for a discerning approach to trusting and validating LLM outputs. The paper highlights how expert users, particularly clinicians, can leverage LLMs to enhance productivity by off-loading routine tasks while maintaining a critical oversight to identify and correct potential inaccuracies in AI-generated content. This balance of trust and skepticism is vital for ensuring that LLMs augment rather than undermine the quality of patient care. We also discuss the risks associated with the deskilling of health care professionals. Frequent reliance on LLMs for critical tasks could result in a decline in health care providers' diagnostic and thinking skills, particularly affecting the training and development of future professionals. The legal and ethical considerations surrounding the deployment of LLMs in health care are also examined. We discuss the medicolegal challenges, including liability in cases of erroneous diagnoses or treatment advice generated by LLMs. The paper references recent legislative efforts, such as The Algorithmic Accountability Act of 2023, as crucial steps toward establishing a framework for the ethical and responsible use of AI-based technologies in health care. In conclusion, this paper advocates for a strategic approach to integrating LLMs into health care. By emphasizing the importance of maintaining clinician expertise, fostering critical engagement with LLM outputs, and navigating the legal and ethical landscape, we can ensure that LLMs serve as valuable tools in enhancing patient care and supporting health care professionals. This approach addresses the immediate challenges posed by integrating LLMs and sets a foundation for their maintainable and responsible use in the future.

The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria

BACKGROUND

Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the "software" of surveillance.

OBJECTIVE

We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received.

METHODS

A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior.

RESULTS

Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed "always" notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications.

CONCLUSIONS

Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the "software" of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance.

Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients

BACKGROUND

Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided.

OBJECTIVE

This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology.

METHODS

This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors.

RESULTS

We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use).

CONCLUSIONS

Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.

Subjective Rationalities of Nonadherence to Treatment and Vaccination in Healthcare Decision-Making

Objective

In this short report contributing to the literature on treatment and vaccination adherence, nonadherence was examined from the perspective of decision-making (DM) practice in healthcare. The objective of this study was to survey the rationalities given for treatment nonadherence and their association with DM practice.

Methods

The Ottawa decision Support Framework was used as a theoretical background for the study. Multiple choice and open-text responses indicating nonadherence were drawn from vignette survey data. The results have been analyzed and reported as descriptive statistics and findings of data-driven content analysis. The number of observatory units was 1032 in the within-subject study design.

Results

DM practice was predominantly associated with nonadherence to vaccination, whereas nonadherence to treatment was consistently associated with attitudinal reasons independent of DM practice. Nonadherence to vaccination was most often rationalized by prior negative experiences in simple DM scenarios. After other DM practices, nonadherence was rationalized by uncertainty and criticism about the benefits of the recommended vaccine. Mistrust toward healthcare providers stood out, first in treatment nonadherence generally and, second, in vaccination nonadherence after simple DM where the final decision was left to the patient.

Conclusion

In medical DM, adherence to treatment and vaccination may be achieved through a recognition of patients' previous healthcare encounters and potential trust-related concerns, which could pose a risk for nonadherence. To be able to observe these risks, patient engagement and mutual trust should be priorities in decision support in healthcare.

Introducing dynamic consent for improved trust and privacy in research involving human biological material and associated data in South Africa

Biomedical research using human biological material and data is essential for improving human health, but it requires the active participation of many human volunteers in addition to the distribution of data. As a result, it has raised numerous vexing questions related to trust, privacy and consent. Trust is essential in biomedical research as it relates directly to the willingness of participants to continue participating in research. Privacy and the protection of personal information also influence trust. Informed consent has proven to be insufficient as it cannot overcome the informational deficit between primary and unknown future uses of material and data and is therefore not fully informed and invalid. Broad consent is also problematic as it takes full control of samples and data flow from the research participant and inherently requires that a participant must trust that the researcher will use their material or data in a manner that they would find acceptable. This paper attempts to offer some insight into how these related issues can be overcome. It introduces dynamic consent as a consent model in research involving human biological material and its associated data. Dynamic consent is explained, as well as its claims of superiority in instances where future research is possible. It is also shown how dynamic consent contributes to better control of the samples and data by the research participant, and how trust may be improved by using this consent model. Dynamic consent's co-existence with and support of the South African Protection of Personal Information Act of 2013 is also assessed. The limitations of dynamic consent are also discussed.

Public perspectives on the use of different data types for prediction in healthcare

OBJECTIVE

Understand public comfort with the use of different data types for predictive models.

MATERIALS AND METHODS

We analyzed data from a national survey of US adults (n = 1436) fielded from November to December 2021. For three categories of data (identified using factor analysis), we use descriptive statistics to capture comfort level.

RESULTS

Public comfort with data use for prediction is low. For 13 of 15 data types, most respondents were uncomfortable with that data being used for prediction. In factor analysis, 15 types of data grouped into three categories based on public comfort: (1) personal characteristic data, (2) health-related data, and (3) sensitive data. Mean comfort was highest for health-related data (2.45, SD 0.84, range 1-4), followed by personal characteristic data (2.36, SD 0.94), and sensitive data (1.88, SD 0.77). Across these categories, we observe a statistically significant positive relationship between trust in health systems' use of patient information and comfort with data use for prediction.

DISCUSSION

Although public trust is recognized as important for the sustainable expansion of predictive tools, current policy does not reflect public concerns. Low comfort with data use for prediction should be addressed in order to prevent potential negative impacts on trust in healthcare.

CONCLUSION

Our results provide empirical evidence on public perspectives, which are important for shaping the use of predictive models. Findings demonstrate a need for realignment of policy around the sensitivity of non-clinical data categories.

Work and the public understanding of science

This study examines whether engaging in science work and work that is substantively complex (e.g. requiring independent thought and judgment) is related to interest in science, science knowledge, and confidence in the scientific community in the United States. It also examines whether the conditions of work mediate the relationship between education and these science-related outcomes. Occupation-level data from O*NET are merged with survey data from the General Social Survey. Results indicate that science work is related to interest in science and science knowledge and that work complexity is related to confidence in the scientific community. Results offer only limited evidence of mediation-science work mediates the relationship between educational attainment and science knowledge but not the relationships involving interest or confidence. In sum, results indicate that the conditions of work are associated with science attitudes, and that researchers should examine these connections in future research.

Vaccinating without complete willingness against COVID-19: Personal and social aspects of Israeli nursing students and faculty members

Soon after the coronavirus disease 2019 (COVID-19) pandemic outbreak, it became clear that vaccination will be the most useful tool to combat the disease. Despite the apparent safety and efficacy of the developed anti-COVID-19 vaccines, relatively high percentages of the population worldwide refused to get vaccinated, including many health workers and health students. The present cross-sectional study examined the motives, attitudes, and personal characteristics of those who did not get vaccinated against COVID-19 or vaccinated without complete willingness among nursing students and nursing faculty members in Israel (n = 472). Results show that the vast majority of the study participants (97%) received at least one dose of the anti-COVID-19 vaccine. Nearly 37% of the participants indicated that they received the vaccine without complete willingness. As compared to faculty members, nursing students reported lower trust in the efficacy of the vaccine, perceived the COVID-19 pandemic as a health threat to a lesser extent, exhibited lower institutional and personal trust, and had higher levels of posttraumatic stress disorder symptoms. Non-Jewish participants were at risk of vaccinating without complete willingness. These findings underscore the need for developing evidence-based strategies to promote the safety and efficacy of the anti-COVID-19 vaccines in nursing schools.

Trust in numbers: Serious numbers and speculative fictions in rare earth elements exploration

In the early 2010s, a spectacular fall in prices for a class of mineral commodities called the rare earth elements (REEs) and the collapse of hundreds of new exploration companies made clear the fragility of the high-risk markets around these companies and the strategies of legitimation that supported them. New regulatory processes built around technical disclosures generated vast stores of geotechnical data. Rather than generating trust among market actors, however, these processes dramatically altered the temporalities of global extraction and energized unruly narrative spaces. In their efforts to keep mineral claims active and companies afloat, REE-focused exploration experts have struggled to navigate different arenas of discussion while holding their respective logics in tension. Drawing on ethnographic fieldwork with exploration geologists and promoters, this article examines how experts federate flows of 'serious' and 'speculative' information in both carefully regulated reports and rumor-filled online forums. Such spaces are organized by aesthetic conventions and social criteria for establishing persuasiveness-forms that STS scholars have long analyzed as literary technologies. Rather than helping to secure experts' authority, however, I argue that the diverse literary technologies that now dominate exploration promotion and finance work have radically redistributed interpretive roles. In their struggles to mediate senses of 'crisis' endemic within venture markets, exploration experts must enact the ideals undergirding new regulatory requirements even as they learn to defer to the speculative musings of others.

Compliance with COVID-19 preventative health measures in the United Kingdom: a latent profile analysis

Governments have adopted unprecedented measures to assist in slowing the spread of the COVID-19 pandemic, but compliance varies among individuals. This UK study uses latent profile analysis to identify four classes of individuals on factors believed to influence compliance. Those who sought health information from authoritative sources and actively sought information from multiple sources were most compliant. Profile differences in compliance and vaccination status were also primarily driven by trust in healthcare institutions over trust in government. These findings contribute to understanding compliance profiles and emphasise the importance of authoritative information and trust in healthcare systems.

How people decide who is correct when groups of scientists disagree

Uncertainty that arises from disputes among scientists seems to foster public skepticism or noncompliance. Communication of potential cues to the relative performance of contending scientists might affect judgments of which position is likely more valid. We used actual scientific disputes-the nature of dark matter, sea level rise under climate change, and benefits and risks of marijuana-to assess Americans' responses (n = 3150). Seven cues-replication, information quality, the majority position, degree source, experience, reference group support, and employer-were presented three cues at a time in a planned-missingness design. The most influential cues were majority vote, replication, information quality, and experience. Several potential moderators-topical engagement, prior attitudes, knowledge of science, and attitudes toward science-lacked even small effects on choice, but cues had the strongest effects for dark matter and weakest effects for marijuana, and general mistrust of scientists moderately attenuated top cues' effects. Risk communicators can take these influential cues into account in understanding how laypeople respond to scientific disputes, and improving communication about such disputes.

COVID-19 vaccine acceptance among college students in South Carolina: do information sources and trust in information matter?

BACKGROUND

For college students who are exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play a role in shaping the vaccine acceptance spectrum (refusal, hesitancy, and acceptance).

METHODS

Based on an online survey among 1,062 college students in South Carolina, we investigated vaccine information sources among college students and examined how COVID-19 vaccine acceptance was associated with information source and trust level in each source.

RESULTS

The top three sources of COVID-19 vaccine information were health agencies, mass media, and personal social networks. Trust in mass media, health agencies, scientists, and pharmaceutical companies was negatively associated with vaccine refusal. Trust in government and scientists was negatively associated with vaccine hesitancy.

DISCUSSION

Our findings highlight the importance of restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era.

Advance Care Planning: A Story of Trust Within the Family

As the family usually plays a central role at the end of life, the quality of family relationships may influence how individuals approach advance care planning (ACP). Our study investigates the associations of trust in relatives with regard to end-of-life (EOL) issues-used as a proxy measure of family relationship quality-with individuals' engagement in EOL discussions, advance directive (AD) awareness, approval and completion, and designation of a healthcare proxy. Using nationally representative data of adults aged 55 years and over from wave 6 (2015) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) in Switzerland (n = 1911), we show that complete trust in relatives is related to higher engagement in ACP. Subject to patient consent, the family should, therefore, be included in the ACP process, as such practice could enhance patient-centered EOL care and quality of life at the end of life.

Social and Demographic Influences of Trust in Cancer Information Among Brooklyn, New York Residents

Little is known regarding the patterns of trust sources for cancer information among diverse populations in the US, which is particularly poignant during the current era of misinformation. Our objective to assess trust from different sources among a sample of Brooklyn, New York residents. Using data from the NCI funded Brooklyn Cancer Health Impact Program, we examined HINTS validated questions examining trust in cancer information across 9 sources. Logistic regression models were used to examine associations with cancer information trust sources. For trust in government health agencies, participants who had less than a college degree were almost 30% less likely to report high levels of trust (aOR: 0.71; 95% CI: 0.52-0.98), participants who reported a household income under $50,000 were 35% less likely report high levels of trust (aOR: 0.65; 95% CI: 0.47-0.89). Participants whose primary language was Spanish were significantly less likely to trust government (aOR: 0.45; 95% CI: 0.29-0.70), newspapers and magazines (aOR: 0.54; 95% CI, 0.34-0.84), and charitable organizations (aOR: 0.48; 95% CI, 0.31-0.75) compared to participants whose primary was English. New York is the most populous city in the US, a city of immigrants, and it is important for healthcare and public health professionals to explore how they can utilize media to provide accurate scientific evidence to combat cancer misinformation.

Patient competence in chronic illness: A concept derivation

AIMS AND OBJECTIVES

This paper aims to inform nursing and other healthcare disciplines by clearly defining patient competence and the skills required to improve self-care behaviours.

BACKGROUND

Competence has been defined in education and leadership. However, competence in persons with chronic disease has not been expanded upon since one publication in 1983. Patient competence needs to be developed and defined so that healthcare disciplines can understand the attributes necessary for a patient to be deemed competent to promote self-care behaviours.

DESIGN

A concept derivation.

METHODS

Walker and Avant's approach to concept derivation was used to identify a base concept (competence) that is well-defined in another field, define the concepts associated with the parent field, and transpose that definition to a new field to formulate a redefined concept. PsycINFO, Scopus, Web of Science and Medline were searched, and 21 articles were included.

RESULTS

Patient competence is defined as the ability of a person with a chronic illness to reach skill mastery, achieve knowledge, maintain a positive attitude and develop trust in themselves and in healthcare providers that will facilitate active engagement to improve self-care behaviours.

CONCLUSIONS

Defining patient competence is important in assisting nurses and other healthcare providers in understanding the attributes needed to deem a patient competent, especially those living with chronic illnesses requiring lifelong self-care behaviours. More research is needed to aid in the designing of a precise instrument for measuring this phenomenon.

RELEVANCE TO CLINICAL PRACTICE

Concept derivation of patient competence provides a framework for nurses and other members of the healthcare profession to understand the attributes needed to determine patient competence.

Psychometric evaluation of the Trust in Science and Scientists Scale

Reliable and valid measurement of trust in science and scientists is important. Assessing levels of such trust is important in determining attitudes and predicting behaviours in response to medical and scientific interventions targeted at managing public crises. However, trust is a complex phenomenon that has to be understood in relation to both distrust and mistrust. The Trust in Science and Scientists Scale has been adopted with increasing frequency in large-scale public health research. Detailed psychometric evaluation of the scale is overdue and makes meaningful comparisons between studies that use the scale difficult. Here, we examine the scale's dimensionality across five separate samples. We find that two factors emerge that are divided by their item polarity. Implications for scale use and trust in science measurement are discussed.

Examining the relationship between metacognitive trust in thinking styles and supernatural beliefs

Conflicting findings have emerged from research on the relationship between thinking styles and supernatural beliefs. In two studies, we examined this relationship through meta-cognitive trust and developed a new: (1) experimental manipulation, a short scientific article describing the benefits of thinking styles: (2) trust in thinking styles measure, the Ambiguous Decisions task; and (3) supernatural belief measure, the Belief in Psychic Ability scale. In Study 1 (N = 415) we found differences in metacognitive trust in thinking styles between the analytical and intuitive condition, and overall greater trust in analytical thinking. We also found stronger correlations between thinking style measures (in particular intuitive thinking) and psychic ability and paranormal beliefs than with religious beliefs, but a mixed-effect linear regression showed little to no variation in how measures of thinking style related to types of supernatural beliefs. In Study 2, we replicated Study 1 with participants from the United States, Canada, and Brazil (N = 802), and found similar results, with the Brazilian participants showing a reduced emphasis on analytical thinking. We conclude that our new design, task, and scale may be particularly useful for dual-processing research on supernatural belief.

Psychotherapeutic approaches: hopefully, globally effective

Many patients have lasting disorders due, for example, to excessive and chronic childhood stress. For these patients, certain psychotherapeutic approaches may be maximally effective, and this may be universally the case. This piece is intended to give providers optimal tools for reaching and helping these patients who, otherwise, may remain among those worst off. These interventions should enhance patients' trust, the quintessential precondition for enabling these patients to change. Specific interventions discussed include anticipating ambiguity and clarifying this before ambiguity occurs, therapists indicating that they will support patients' and families' wants over their own views, feeling and disclosing their emotions, validating patients' anger, laughing, going beyond usual limits, explaining why, asking before doing, discussing religion and ethics, and informing whenever this could be beneficial.

From plaster casts to picket lines: Public support for industrial action in the National Health Service in England

This paper explores public sentiment towards strike action among healthcare workers, as a result of their perceived inadequate pay. By analysing survey data collected in England between 2022 and 2023, the study focuses on NHS nurses and junior doctors, due to their critical role in delivering essential public services. Results indicate higher public support for strikes by nurses and junior doctors compared to other professions such as postal workers, teachers, rail workers, airport workers, civil servants and university lecturers. However, variation in support for strikes by healthcare workers is observed across societal segments. Significant disparities in support are linked to individual political affiliations, left-right ideological positions and trust in the NHS. In short, nonconservative voters, individuals leaning towards left-wing politics and those with greater trust in the NHS demonstrate higher likelihoods of supporting strikes by health workers. These findings carry implications for future strike decisions and highlight specific target groups for enhanced communication efforts to garner increased public support.

A paradigm shift?-On the ethics of medical large language models

After a wave of breakthroughs in image-based medical diagnostics and risk prediction models, machine learning (ML) has turned into a normal science. However, prominent researchers are claiming that another paradigm shift in medical ML is imminent-due to most recent staggering successes of large language models-from single-purpose applications toward generalist models, driven by natural language. This article investigates the implications of this paradigm shift for the ethical debate. Focusing on issues like trust, transparency, threats of patient autonomy, responsibility issues in the collaboration of clinicians and ML models, fairness, and privacy, it will be argued that the main problems will be continuous with the current debate. However, due to functioning of large language models, the complexity of all these problems increases. In addition, the article discusses some profound challenges for the clinical evaluation of large language models and threats to the reproducibility and replicability of studies about large language models in medicine due to corporate interests.

The effects of live streamer's expertise and entertainment on the viewers' purchase and follow intentions

This study explores the impact of two characteristics of streamers-expertise and entertainment-on viewers' purchase intention and follow intention in live-streaming e-commerce, with a specific focus on viewers' trust and flow experience as two mediators and viewers' optimal stimulation level as a moderator. We implemented a methodological approach where participants were randomly directed to enter a live broadcast room and watch a 10-min live session before engaging in a structured questionnaire. 399 valid questionnaires were collected from the participants. These 399 valid questionnaires were subsequently utilized to validate the research model using structural equation modeling (SEM). The results suggest that streamer expertise and entertainment enhance viewers' trust and flow experience, which then leads to an increase in their intention to make a purchase and continue following the streamer. Furthermore, the viewers' optimal stimulation level acts as a moderator in the connections between streamer characteristics and viewers' trust and flow experience, suggesting that individual differences among consumers affect how they respond to streamer characteristics. From the dual perspectives of the streamer and the viewer, this study provides a more comprehensive theoretical perspective on customer behavior in live streaming commerce by not only focusing on consumers' short-term, transactional behavior inclinations but also long-term, relational behavior intentions.

Parents' User Experience Accessing and Using a Web-Based Map of COVID-19 Recommendations for Health Decision-Making: Qualitative Descriptive Study

BACKGROUND

The eCOVID19 Recommendations Map & Gateway to Contextualization (RecMap) website was developed to identify all COVID-19 guidelines, assess the credibility and trustworthiness of the guidelines, and make recommendations understandable to various stakeholder groups. To date, little has been done to understand and explore parents' experiences when accessing and using the RecMap website for COVID-19 health decision-making.

OBJECTIVE

To explore (1) where parents look for COVID-19 health information and why, (2) parents' user experience when accessing and using the RecMap website to make health decisions, and (3) what knowledge mobilization activities are needed to increase parents' awareness, use, and engagement with the RecMap website.

METHODS

We conducted a qualitative descriptive study using semistructured interviews and a think-aloud activity with parents of children aged 18 years or younger living in Canada. Participants were asked to provide feedback on the RecMap website and to "think aloud" as they navigated the website to find relevant COVID-19 health recommendations. Demographic information was collected using a web-based questionnaire. A hybrid deductive and inductive thematic approach guided analysis and data synthesis.

RESULTS

A total of 21 participants (13/21, 62% mothers) were interviewed and participated in a think-aloud activity. The data were categorized into four sections, representative of key elements that deductively and inductively emerged from the data: (1) parent information seeking behaviors and preferences for COVID-19, (2) RecMap website usability, (3) perceived usefulness of the RecMap website, and (4) knowledge mobilization strategies to increase awareness, use, and engagement of the RecMap website. Parents primarily used the internet to find COVID-19 information and focused on sources that they determined to be credible, trustworthy, simple, and engaging. As the pandemic evolved, participants' information-seeking behaviors changed, specifically their topics of interest and search frequency. Most parents were not aware of the RecMap website before this study but found satisfaction with its concept and layout and expressed intentions to use and share it with others. Parents experienced some barriers to using the RecMap website and suggested key areas for improvement to facilitate its usability and perceived usefulness. Recommendations included a more user-friendly home page for lay audiences (separate public-facing user interface), improving the search and filter options, quicker navigation, clearer titles, more family-friendly graphics, and improving mobile-friendly access. Several strategies to disseminate the RecMap website were also expressed, including a mix of traditional and nontraditional methods (handouts and social media) in credible and high-traffic locations that parents frequent often.

CONCLUSIONS

Overall, parents liked the concept of the RecMap website but had some suggestions to improve its usability (language, navigation, and website interface). These findings can be used to improve the RecMap website for parents and offer insight for the development and dissemination of effective web-based health information tools and resources for the general public.

A cross-sectional study on exploring the antecedents of patient's revisit intention: Mediating role of trust in the hospital among patients in India

BACKGROUND

In the healthcare domain, patients' trust in the hospital plays an instrumental role in determining the behavioral intention of the patient. This article attempts to investigate the impact of service quality perception on behavioral intention with the mediating effect of trust in the hospital and patient satisfaction.

METHODS

This research was carried out in multispecialty hospitals located in Bangalore Urban and Mysore districts of Karnataka during August 2021. This was a questionnaire-based study and the sample size was 242. Statistical Package for the Social Science (SPSS) 27.0 and SmartPLS 3.0 software was used to analyze the data.

RESULTS

The findings revealed that perceived service quality significantly influences trust through patient satisfaction (observed partial mediation) and patient satisfaction significantly impacts behavioral intention through trust (observed partial mediation).

CONCLUSION

This study empowers hospital managers to understand the factors influencing behavioral intention. Healthcare professionals must ensure that good quality service is delivered to enhance patient satisfaction and trust in adverse services, which influence behavioral intention among the patients.

Communicating diagnostic uncertainty reduces expectations of receiving antibiotics: Two online experiments with hypothetical patients

The overprescription of antibiotics due to diagnostic uncertainty and inappropriate patient expectations influence antimicrobial resistance. This research assesses (i) whether communicating diagnostic uncertainty reduces expectations of receiving antibiotics and (ii) which communication strategies minimise unintended consequences of such communication. In two experimental online studies conducted in January and April 2023, participants read a vignette describing a doctor consultation for an ear infection and expressed their expectations of receiving antibiotics, trust in their doctor, rated the doctor's reputation and provided their intention to get a second doctor's opinion. Study 1 (N = 2213) investigated whether communicating diagnostic uncertainty and social externalities of antibiotic use (the negative social impacts of developing antibiotic resistance) decreases expectations for antibiotics and explores potential unintended consequences on the doctor-patient relationship. In Study 2 (N = 527), we aimed to replicate and extend the findings by adding specific treatment recommendations. Disclosing diagnostic uncertainty (vs. certainty) and communicating (vs. not communicating) the social externalities of antibiotic overuse reduced patients' expectations of receiving antibiotics. Yet, communicating uncertainty impaired trust in the doctor and the doctor's reputation. Combining the communication of uncertainty with specific treatment recommendations-particularly delayed antibiotic prescriptions-showed important to prevent these unintended consequences.

The impact of health beliefs and trust in health information sources on SARS-CoV-2 vaccine uptake

Background

Health beliefs may mediate the relationship between trust and vaccination decisions, as confidence in online health information has expanded quickly. However, little is known about how health attitudes and trust in health information affect COVID-19 vaccine intention. This study aimed to assess the effect of health beliefs and trust in information sources on the willingness to receive a COVID-19 vaccine among the general public in Saudi Arabia.

Methods

This study was designed and carried out at the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Selected items were extracted from the Saudi Residents' Intention to Get Vaccinated Against COVID-19 (SRIGVAC) survey. They were categorized and validated into constructs of a health belief model (the perceived threat of COVID-19, vaccine-related benefits, barriers, and safety concerns) and trust in health information (from online platforms and health authorities/providers). Regression analysis and parallel mediation were used to assess the predictors of vaccination intentions.

Results

Based on the responses of 3,091 participants, vaccine-related barriers and safety concerns negatively influenced vaccination intention, whereas vaccine benefits and the perceived threat of COVID-19 were positively correlated with vaccination intention. Trust in online health information had a direct relationship with intentions (β = 0.09, p < 0.0001) as well as indirect relationships through the perceived benefits (β = 0.095), the perceived barriers (β = -0.029), and the perceived safety concerns toward the vaccine (β = -0.010). The relationship between the willingness to vaccinate and trust in authentic information was fully mediated by all domains of health beliefs, with indirect coefficients of 0.004, 0.310, -0.134, and -0.031 for the perceived threat, vaccine benefits, barriers, and safety concerns, respectively.

Conclusion

The relationship between the willingness to vaccinate and trust in authentic information was fully mediated by all domains of health beliefs. Vaccine coverage in Saudi Arabia can be optimized by targeting the health beliefs of the general public.

"There was No Opportunity to Express Good or Bad": Perspectives From Patient Focus Groups on Patient Experience in Clinical Trials

To understand how patients perceive their experiences leading up to, during, and after a clinical trial, and the relationship these experiences had with future willingness to participate, we conducted 3 focus groups with patients who had prior clinical trial involvement (n  =  25). Discussion topics included clinical trial discovery, enrollment, communication, trust, patient-centricity, and future enrollment. Patient focus groups revealed a variety of motivations for enrolling in clinical trials (eg, altruism, efficacious treatment, curiosity, desperation, etc.). Patients learned about clinical trials through trusted sources (eg, primary care physicians, patient advocacy groups) and social media. Access and uncertainty about clinical trials were barriers to enrollment. Patient-centric communication and attention given to disease states and symptom severity were valued and made patients feel genuinely cared about. Post-trial follow up and being informed of trial results were inconsistently reported by patients. Critically, patients described frustration with an overall lack of patient experience measurement. Patients identified a need to measure experiences before, during, and after clinical trials and emphasized that doing so would facilitate patient trust and overall experience.

Signals of belonging: emergence of signalling norms as facilitators of trust and parochial cooperation

Mechanisms of social control reinforce norms that appear harmful or wasteful, such as mutilation practises or extensive body tattoos. We suggest such norms arise to serve as signals that distinguish between ingroup 'friends' and outgroup 'foes', facilitating parochial cooperation. Combining insights from research on signalling and parochial cooperation, we incorporate a trust game with signalling in an agent-based model to study the dynamics of signalling norm emergence in groups with conflicting interests. Our results show that costly signalling norms emerge from random acts of signalling in minority groups that benefit most from parochial cooperation. Majority groups are less likely to develop costly signalling norms. Yet, norms that prescribe sending costless group identity signals can easily emerge in groups of all sizes-albeit, at times, at the expense of minority group members. Further, the dynamics of signalling norm emergence differ across signal costs, relative group sizes, and levels of ingroup assortment. Our findings provide theoretical insights into norm evolution in contexts where groups develop identity markers in response to environmental challenges that put their interests at odds with the interests of other groups. Such contexts arise in zones of ethnic conflict or during contestations of existing power relations. This article is part of the theme issue 'Social norm change: drivers and consequences'.

Trust in the Transplant Team Associated With the Level of Chronic Illness Management-A Secondary Data Analysis of the International BRIGHT Study

A trustful relationship between transplant patients and their transplant team (interpersonal trust) is essential in order to achieve positive health outcomes and behaviors. We aimed to 1) explore variability of trust in transplant teams; 2) explore the association between the level of chronic illness management and trust; 3) investigate the relationship of trust on behavioral outcomes. A secondary data analysis of the BRIGHT study (ID: NCT01608477; https://clinicaltrials.gov/ct2/show/NCT01608477?id=NCT01608477&rank=1) was conducted, including multicenter data from 36 heart transplant centers from 11 countries across four different continents. A total of 1,397 heart transplant recipients and 100 clinicians were enrolled. Trust significantly varied among the transplant centers. Higher levels of chronic illness management were significantly associated with greater trust in the transplant team (patients: AOR= 1.85, 95% CI = 1.47-2.33, p < 0.001; clinicians: AOR = 1.35, 95% CI = 1.07-1.71, p = 0.012). Consultation time significantly moderated the relationship between chronic illness management levels and trust only when clinicians spent ≥30 min with patients. Trust was significantly associated with better diet adherence (OR = 1.34, 95%CI = 1.01-1.77, p = 0.040). Findings indicate the relevance of trust and chronic illness management in the transplant ecosystem to achieve improved transplant outcomes. Thus, further investment in re-engineering of transplant follow-up toward chronic illness management, and sufficient time for consultations is required.

More Is Not Always Better: Impacts of AI-Generated Confidence and Explanations in Human-Automation Interaction

OBJECTIVE

The study aimed to enhance transparency in autonomous systems by automatically generating and visualizing confidence and explanations and assessing their impacts on performance, trust, preference, and eye-tracking behaviors in human-automation interaction.

BACKGROUND

System transparency is vital to maintaining appropriate levels of trust and mission success. Previous studies presented mixed results regarding the impact of displaying likelihood information and explanations, and often relied on hand-created information, limiting scalability and failing to address real-world dynamics.

METHOD

We conducted a dual-task experiment involving 42 university students who operated a simulated surveillance testbed with assistance from intelligent detectors. The study used a 2 (confidence visualization: yes vs. no) × 3 (visual explanations: none, bounding boxes, bounding boxes and keypoints) mixed design. Task performance, human trust, preference for intelligent detectors, and eye-tracking behaviors were evaluated.

RESULTS

Visual explanations using bounding boxes and keypoints improved detection task performance when confidence was not displayed. Meanwhile, visual explanations enhanced trust and preference for the intelligent detector, regardless of the explanation type. Confidence visualization did not influence human trust in and preference for the intelligent detector. Moreover, both visual information slowed saccade velocities.

CONCLUSION

The study demonstrated that visual explanations could improve performance, trust, and preference in human-automation interaction without confidence visualization partially by changing the search strategies. However, excessive information might cause adverse effects.

APPLICATION

These findings provide guidance for the design of transparent automation, emphasizing the importance of context-appropriate and user-centered explanations to foster effective human-machine collaboration.

Psychoanalytic Contributions to Psychodynamic Psychiatry and Psychotherapy: Erik Erikson's Psychosocial Developmental Theory

Erik Erikson gives us a comprehensive psychosocial schema encompassing the life cycle from birth to death. In elucidating key issues at each life stage-the epigenetic crises-he defines important parameters of development that distinguish between the normative and the pathologic. Individuals at any developmental stage can be evaluated with respect to these fundamental milestones.

Parents' Trust in COVID-19 Messengers and Implications for Vaccination

PURPOSE

To characterize factors associated with parents' trust in messengers of COVID-19 guidance and determine whether trust in their doctors is associated with COVID-19 vaccination.

DESIGN

Web-based and mailed survey (January-June 2022).

SETTING

Maryland, USA.

SUBJECTS

567 parents/caregivers of public elementary and middle school students.

MEASURES

Parents rated trust in 9 messengers on a 4-point scale ["not at all" (0) to "a great deal" (3)], dichotomized into low (0-1) vs high (2-3). They reported on health insurance, income, race, ethnicity, education, sex, urbanicity, political affiliation, and COVID-19 vaccination.

ANALYSIS

ANOVA and t-tests were computed to compare overall trust by parent characteristics. Multivariable logistic regression was run to evaluate factors associated with high trust for each messenger. Multivariable logistic regression was used to evaluate the relationship between trust in doctors and odds of COVID-19 vaccination.

RESULTS

Most trusted messengers were doctors (M = 2.65), family members (M = 1.87), and schools (M = 1.81). Parents' trust varied by racial identity, sex, urbanicity, health insurance, and political affiliation. Greater trust in their or their child's doctor was associated with greater odds of child (aOR: 2.97; 95% CI: 1.10, 7.98) and parent (aOR: 3.30; 95% CI: 1.23, 1.47) vaccination.

CONCLUSION

Parent characteristics were associated with trust, and trust was linked to vaccination. Public health professionals should anticipate variability in trusted messengers to optimize uptake of public health guidance.

How to communicate with children, according to Health Play Specialists in the United Kingdom: A qualitative study

Child-focused anthropologists have described how sick-children utilise 'Play' and 'imagination' as a tool to cope and make-meaning of their illness-experiences. Health Play Specialists (HPS) are professional healthcare-workers who advocate for children and use 'playful' methods to improve communication with, and the lived-experience of, children in hospital. The research aim of this study was to identify strategies and methods employed by HPS to effectively communicate with children. The research methodology comprises interviews conducted with HPS and utilises a qualitative data-analysis model. The main findings include: the importance of 'Play' for chronically ill children; how HPS utilise material-resources to explain illnesses and procedures to children; structural challenges HPS face as a profession; and applicable advice for paediatric-healthcare-workers. This research highlights the importance of introducing a 'pro-play' mindset to healthcare-workers, in order to facilitate children's basic human-rights in hospital. It seeks to advocate for the potential of 'Play' and the value of HPS within paediatric-healthcare-settings, as well as the need for further recognition and multidisciplinary research in this area.

I think, therefore I act, Revisited: Building a stronger foundation for risk analysis

Actively open-minded thinking (AOT) is a thinking style in which people engaged in judgment and decision-making actively seek out and then evaluate information in a manner that is intentionally disconnected from their prior beliefs and motivations and in line with self-perceptions of autonomy. Actively open-minded thinkers have been observed to make both more accurate judgments about the magnitude of risks and more evidence-based decisions under uncertainty in a wide range of situations such as climate change and politics. In addition, actively open-minded thinkers functioning in domains where they lack a desired level of knowledge are open to "outsourcing" the job of critical reasoning thinking to credible experts; in other words, they are better able to gauge who is trustworthy and then rely on the insights of these trustworthy others to help them reach a conclusion. We report results from a follow-up to research previously published in Risk Analysis that confirms these tenets in the context of COVID-19. We then extend these results to offer a series of recommendations for strengthening the process and outcomes of risk analysis: leveraging the latent norm of autonomy and personal agency that underpins AOT, activating or engaging with approaches to reasoning-such as decision structuring-that are in line with AOT, and working upstream and downstream of risk analysis to establish AOT as a norm of its own.

[Tuning in addictology, the story of a shared musical experience]

Music can be used as a therapeutic tool with people suffering from complex addictions and traumas. By playing together, the patient and care team create a transitional space conducive to emotional attunement and trust. This shared experience facilitates connection and engagement in the therapeutic relationship, which conveys a sense of security. Music is a powerful tool in the treatment of addiction and trauma. It helps to repair damaged bonds and develop empathy, cooperation and creativity within the care team.

The experience of entering residential aged care: The views of residents, family members and staff-an Appreciative Inquiry

OBJECTIVES

To understand resident, family and staff perspectives of older people's transition to residential aged care and initiatives that support this transition.

METHODS

A qualitative Appreciative Inquiry was undertaken with residents, family members and staff in residential aged care. It included semistructured interviews (n = 40), three focus groups (n = 17) and an organisational summit (n = 72). Each stage sought to build on the previous one, deepening understanding of the issues experienced and identifying positive strategies for change. Data were analysed thematically using framework analysis.

RESULTS

The transition experience was characterised by grief and guilt felt by family members and the challenges they faced in participating in a decision to admit a relative to residential aged care. Residents found the transition challenging but stressed the need to adjust to the situation. Family members struggled with trusting others to provide appropriate care and both residents and relatives reported challenges in communicating with staff. Initiatives were recommended by the organisational summit to assist in the transition to residential aged care. These included developing a service navigator role, co-designing new systems and resources with residents and relatives, and ensuring more consistent staffing.

CONCLUSIONS

Improved communication strategies and resources are needed to support the resident's identity, build trust in the organisation and support transition to residential aged care. Staff should continue to value the contribution family members play in the life of the resident and the culture of the aged care community.

The moderating role of trust in pandemic-relevant institutions on the relation between pandemic fatigue and vaccination intentions

This research helps to clarify the relation between pandemic fatigue (PF) and vaccination intentions (VI). Theoretically, two patterns seem plausible. First, as with any other health protective measure, PF might reduce the motivation to get vaccinated. Second, PF might increase the motivation to get vaccinated because vaccination reduces the number of (other) health protective measure needed. We tested these two opposing predictions and further explored the moderating role of trust in pandemic-relevant institutions on the link between PF and VI in two large-scale survey studies from Denmark and Germany (collected between 2020 and 2021; total N > 22,000). Data was analyzed using multiple regression models. Analyses reveal a negative link between PF and VI that is less pronounced for people high in trust. Results remain stable when accounting for covariates and quadratic trends. Thus, trust might buffer the negative relation between PF and VI.

A meta-analysis of technology acceptance in healthcare from the consumer's perspective

Consumer-oriented health care technologies are increasingly available and transforming global health delivery systems. However, there is a paucity of research that systematically investigates health care technology acceptance from the consumer's perspective. This study conducts a literature review and meta-analysis to examine consumers' adoption intentions toward health care technologies. The findings suggest that technology acceptance models are transferable to health care technology with modifications, and factors such as perceived risks, technology performance expectancy, consumer trust, and habit significantly correlate with consumers' adoption intentions. This study provides valuable insights into health care technology management and practical implications for health care service designers, providers, and regulatory authorities.

When evidence changes: Communicating uncertainty protects against a loss of trust

Scientific findings can be overturned when new evidence arises. This study examines how communicating and explaining uncertainty around scientific findings affect trust in the communicator when findings change. In an online experiment (N = 800, convenience sample), participants read a fictitious statement from a public health authority announcing that there was no link between a new COVID-19 vaccine and heart muscle inflammation. The authority communicated (1) no uncertainty, (2) uncertainty without giving a reason, (3) uncertainty due to imprecision, or (4) uncertainty due to incomplete accounting of patients. Participants were then informed that the authority's statement was no longer correct as new data showed a link between the vaccine and heart muscle inflammation. Participants rated the authority's trustworthiness before and after the evidence update. Our findings indicate that communicating uncertainty buffers against a loss of trust when evidence changes. Moreover, explaining uncertainty does not appear to harm trust.

Predictors of Pregnancy Disclosure in DIII Collegiate Athletes

CONTEXT

Pregnant athletes cannot receive proper care if they choose to conceal their pregnancy. Unfortunately, there are many factors that may lead an athlete to conceal. Whereas the extant qualitative literature suggests scholarship and sponsorship are prominent factors in the decision to disclose, this research is limited to elite athletes.

OBJECTIVE

The purpose of the current study was to quantitatively examine predictors of pregnancy disclosure beyond scholarship and sponsorship in DIII college athletes.

DESIGN

Cross-sectional study.

SETTING

Midwestern United States.

PARTICIPANTS

Athletes on DIII women's sports teams (N = 127).

MEASURES

Confidence in the AT, perceived training and performance changes, athletic identity, and athletic identity during pregnancy. Two separate multiple regression analyses were conducted with the four predictors and two outcomes: likelihood to disclose and time to disclosure.

RESULTS

Confidence in the AT and athletic identity during pregnancy were significant predictors in both models, whereas the variable of perceived training and performance changes was only significant in the likelihood to disclose model. Athletic identity was not a significant predictor in either model. Results suggest DII athletes believe they would be more likely to disclose their pregnancy and may disclose sooner if they feel that their AT can properly manage their physical, emotional, and social wellness during. Additionally, disclosure is promoted if they believe they will still be viewed as an athlete by themselves and the people around them.

CONCLUSIONS

These findings emphasize the importance of the role of the AT, with implications that formal education of ATs should include the holistic support of the pregnant athlete.

A systematic literature review of the 'commercialisation effect' on public attitudes towards biobank and genomic data repositories

Initiatives that collect and share genomic data to advance health research are widespread and accelerating. Commercial interests in these efforts, while vital, may erode public trust and willingness to provide personal genomic data, upon which these initiatives depend. Understanding public attitudes towards providing genomic data for health research in the context of commercial involvement is critical. A PRISMA-guided search of six online academic databases identified 113 quantitative and qualitative studies using primary data pertaining to public attitudes towards commercial actors in the management, collection, access, and use of biobank and genomic data. The presence of commercial interests yields interrelated public concerns around consent, privacy and data security, trust in science and scientists, benefit sharing, and the ownership and control of health data. Carefully considered regulatory and data governance and access policies are therefore required to maintain public trust and support for genomic health initiatives.

Access to technology, internet usage, and online health information-seeking behaviors in a racially diverse, lower-income population

Background

This study examined access to technology, internet usage, and online health information-seeking behaviors, in a racially diverse, lower-income population.

Methods

Data were obtained via a cross-sectional survey of low-income communities in Houston, Los Angeles, and New York between April and August 2023. Binary responses to the following online health information-seeking behaviors, internet and technology access, were examined: using the internet to (i) understand a medical diagnosis, (ii) fill a prescription, (iii) schedule a healthcare appointment, (iv) email communication with a healthcare provider, and (v) access electronic health records and medical notes.

Results

41% of survey respondents identified as non-Hispanic Black individuals, 33% as non-Hispanic White individuals, and 22% as Hispanic individuals. 69% reported a pre-tax annual household income of less than $35,000. 97% reported ownership/access to a smart device; 97% reported access to reliable internet. In the past year, only 59% reported using the internet to better understand their medical diagnosis, 36% reported filling a prescription online, 47% scheduled a medical appointment online, 47% viewed electronic health records online, and 56% emailed healthcare providers. Female sex, higher incomes, and having at least a bachelor's degree were significantly associated with all five online health information-seeking attributes.

Conclusion

Despite high technology adoption rates, we observed suboptimal online health information-seeking behaviors. This underutilization has potential adverse implications for healthcare access and use given the documented advantage of HIT. Efforts to increase health information-seeking behaviors should explore the identification of HIT barriers, and patient education to increase familiarity and usage in this population.

Communicating trust and trustworthiness through scientists' biographies: Benevolence beliefs

A goal of many science communicators is to foster trust in scientists and their work. This study investigates if existing textual resources that scientists create in the course of their regular activities can be improved to enhance perceptions of scientists as trustworthy. Building on Mayer et al.'s integrative model of organizational trust, we examine how communicating benevolence through short biographies can affect trustworthiness perceptions using a 3 (degree of benevolence information: high, unspecified, low) × 3 (research area: crop genetics, corn and soy genetics, biotechnology use) survey design. We find that the degree of benevolence information significantly influences perceptions of benevolence and integrity, as well as willingness to trust, with these effects being consistent across different research areas. However, the degree of benevolence communicated had no significant effect on the perceived competence of the scientists. These findings underscore the importance of highlighting benevolence in communication to positively influence trustworthiness perceptions, thus offering insights for science communication practices.

Ethnic Disparities in COVID-19 Vaccine Mistrust and Receipt in British Columbia, Canada: Population Survey

BACKGROUND

Racialized populations in the United States, Canada, and the United Kingdom have been disproportionately affected by COVID-19. Higher vaccine hesitancy has been reported among racial and ethnic minorities in some of these countries. In the United Kingdom, for example, higher vaccine hesitancy has been observed among the South Asian population and Black compared with the White population, and this has been attributed to lack of trust in government due to historical and ongoing racism and discrimination.

OBJECTIVE

This study aimed to assess vaccine receipt by ethnicity and its relationship with mistrust among ethnic groups in British Columbia (BC), Canada.

METHODS

We included adults ≥18 years of age who participated in the BC COVID-19 Population Mixing Patterns Survey (BC-Mix) from March 8, 2021, to August 8, 2022. The survey included questions about vaccine receipt and beliefs based on a behavioral framework. Multivariable logistic regression was used to assess the association between mistrust in vaccines and vaccine receipt among ethnic groups.

RESULTS

The analysis included 25,640 adults. Overall, 76.7% (22,010/28,696) of respondents reported having received at least 1 dose of COVID-19 vaccines (Chinese=86.1%, South Asian=79.6%, White=75.5%, and other ethnicity=73.2%). Overall, 13.7% (3513/25,640) of respondents reported mistrust of COVID-19 vaccines (Chinese=7.1%, South Asian=8.2%, White=15.4%, and other ethnicity=15.2%). In the multivariable model (adjusting for age, sex, ethnicity, educational attainment, and household size), mistrust was associated with a 93% reduced odds of vaccine receipt (adjusted odds ratio 0.07, 95% CI 0.06-0.08). In the models stratified by ethnicity, mistrust was associated with 81%, 92%, 94%, and 95% reduced odds of vaccine receipt among South Asian, Chinese, White, and other ethnicities, respectively. Indecision, whether to trust the vaccine or not, was significantly associated with a 70% and 78% reduced odds of vaccine receipt among those who identified as White and of other ethnic groups, respectively.

CONCLUSIONS

Vaccine receipt among those who identified as South Asian and Chinese in BC was higher than that among the White population. Vaccine mistrust was associated with a lower odds of vaccine receipt in all ethnicities, but it had a lower effect on vaccine receipt among the South Asian and Chinese populations. Future research needs to focus on sources of mistrust to better understand its potential influence on vaccine receipt among visible minorities in Canada.