Barriers and enablers to sexual health service use among university students: a qualitative descriptive study using the Theoretical Domains Framework and COM-B model

Applying the COM-B behaviour model to understand factors which impact 15-16 year old students' ability to protect themselves against acquirement of Human Papilloma virus (HPV) in Northern Ireland, UK

High-risk strains of Human Papillomavirus (HPV) can lead to the development of a number of cancers including cervical, vulvar, penile, anal and oropharyngeal. HPV vaccination programmes offer the HPV vaccine to males and females 12-13 years old in schools throughout the UK. However, knowledge of HPV remains low in post-primary schools. The aim of this study is to capture 15-16 year old students' perceptions regarding the current provision of HPV education, and whether providing HPV education to 15-16 year olds could influence their intention to be vaccinated and/or future sexual health decisions related to HPV. Between 5th November 2021 and 6th May 2022, seven focus groups were conducted with 34 students in post-primary schools in Northern Ireland, United Kingdom. The data was analysed using the COM-B behaviour model to explore the perceived facilitators and barriers impacting students' ability to protect themselves from acquirement of HPV. Students perceived their knowledge of HPV to be poor and supported the addition of comprehensive mandatory HPV education at 15-16 years old when many of them were becoming sexually active. They identified barriers including lack of parental education, school ethos and religion and insufficient education regarding their legal rights to self-consent to HPV vaccination. Students felt that removal of these barriers would lead to safer sexual practices, increased awareness of the importance of HPV screening and increased HPV vaccination uptake. The recommendations provided by students need to be supported by the Education Authority in conjunction with the Department of Health in order to be successfully implemented into the post-primary school curriculum.

Problem-solving processes for central venous catheter occlusion within pediatric cancer care: A qualitative study

PURPOSE

Central venous access devices play a crucial role in healthcare settings. However, there is concern regarding the high incidence of blockages occurring before the completion of treatments and existing guidelines for occlusion management are not consistently followed. To explore the decision-making and problem-solving process of occlusion management and identify enablers and barriers to implementing evidence for occlusion management in pediatric cancer care.

METHODS

A qualitative design with individual semi-structured interviews. Participants were selected by purposeful sampling from a tertiary-referral pediatric facility, and semi-structured interviews were conducted.

RESULTS

A total of 13 clinicians and 5 parents were interviewed. The thematic analysis revealed four main decision-making/problem-solving themes: 1) clinical reasoning and judgement for central venous access devices occlusion, 2) capability in central venous access devices occlusion management, 3) colleague collaboration in the escalation process and 4) lack of adequate support to manage the occlusion. This study identified positive and negative influences on the problem-solving process, including clinicians' psychological capabilities, social and physical resources, and beliefs about consequences.

CONCLUSION

This study found that clinicians in pediatric cancer care were able to manage central venous access device occlusions using clinical reasoning and judgment skills, which may conflict with evidence-based practices. The study confirmed the importance of a team approach and prior experience in managing central venous access devices in pediatric oncology settings and identified potential conflicts between clinician decisions based on the patient's current and anticipated conditions and implementation of evidence-based practice. Improving documentation and providing visual aids could benefit clinicians' problem-solving processes.

Personal factors influencing female students' condom use at a higher education institution

BACKGROUND

 South African female students' consistent condom use is low, possibly due to personal factors, such as knowledge about sexual reproductive health, attitudes towards safe sex, risk perceptions and condom use, self-efficacy.

AIM

 This study aimed to investigate the personal factors that influence condom utilisation among female students.

SETTING

 This study was conducted at a higher education institution in the Northern Cape province in South Africa.

METHODS

 A quantitative, descriptive survey design was used. Three hundred and eighty five participants were selected using convenience sampling. The research instrument was a self-administered questionnaire, and the data were analysed using the Statistical Package for the Social Sciences, version 28.

RESULTS

 Almost two-thirds (250, 64.9%) of participants used condoms to prevent pregnancy, sexually transmitted infections (STIs), and human immunodeficiency virus (HIV). Although attitudes towards safe sex were generally positive, low risk perceptions were reported. Consistent use of condoms was found in 32.2% (124) of participants, while 45.3% (174) participants used condoms inconsistently or never. A significant finding was that consistent use increased the likelihood of negotiating for a condom with partners by 9.14 times and confidence in putting one on for a partner by 8.05 times.

CONCLUSION

 The findings depict average levels of the use of condoms among female students. Prevention efforts should concentrate on educating female students to strengthen condom use and self-efficacy.Contribution: This study, supporting existing literature, suggests that preventative efforts should focus on educating young women about condom use, self-efficacy and encouraging STI conversations with sexual partners.

Young Women's Needs Regarding Sexual Preventive Behaviours and Unwanted Pregnancies

Unwanted pregnancies are considered a public health problem that affects women's mental health and quality of life. The aim of this paper was to access university students' understanding and behaviours regarding unwanted pregnancies and identify their needs to prevent them. Qualitative descriptive design was used, and 13 semi-structured interviews were carried out. Women between 18 and 20 years old participated. They discussed a lack of training for themselves, their partners, and their families, their desire to have access to non-in-person health care resources, and their belief that contraception was expensive. Emotional aspects were relevant, affecting the way communication is established with those close to them and with health professionals. Despite the existence of access to sexual health resources, the findings show the existence of needs related to the prevention of unwanted pregnancies. The findings are presented grouping the main identified needs as "related to capability", "related to opportunity", and "related to motivation". Among the aspects to consider when designing interventions to prevent unwanted pregnancies are the feelings shown by these women, the inclusion of couples and family members in educational programs, and access to non-face-to-face health resources and less expensive contraceptive methods. Interventions for social support and understanding of women are necessary both to prevent unwanted pregnancies and to support adolescents with unwanted pregnancies by avoiding criminalization or blame.

Just in case: undergraduate students identifying and mitigating barriers to their sexual and reproductive health needs

BACKGROUND

Many U.S. colleges and universities offer access to a healthcare center that provides sexual and reproductive health (SRH) resources, services, and products. The importance of health centers in college and university settings in reducing sexual health disparities in student populations cannot be stressed enough. This article evaluates a student-led, mutual-aid, grassroots health promotion strategy for students with limited access to healthcare services, supplies, and tools via an anonymous and discrete distribution of SRH resources without charge.

METHODS

In partnership with faculty, undergraduate students worked to address their school's unmet SRH needs by increasing on-campus access to comprehensive, evidence-based, and sex-positive resources. Referred to as Just in Case, this student-led, grassroots health promotion program provided students with supply kits containing contraceptives, sexual health wellness products, basic hygiene supplies, and education materials. Students were surveyed in a pre- (n = 95) post- (n = 73) pilot study to identify contraception acquisition barriers, discern perceptions of on-campus SRH resources, and elucidate trends in this program's use and impact. Chi-square tests of independence were used to compare survey group responses, and association rule mining was employed in tandem to identify SRH items that students requested.

RESULTS

Students identified cost and privacy as significant barriers to acquiring sexual health products on campus. Of the 182 Just in Case supply kits requested by students during the 2022-2023 academic year, condoms were requested most frequently in 75% of fulfilled kits, while emergency contraception and pregnancy tests were asked most often in 61% of kits. 50% of students reported access to contraceptives on campus before this program's implementation, growing to 75% (p < 0.001) 1 year later post-implementation. Similar jumps were observed for reported access to sexual health education (30 to 73%, p < 0.001) and services (36 to 73%, p < 0.001).

CONCLUSION

A student-led SRH supply and resource delivery strategy may immediately reduce SRH inequities and decrease barriers to contraceptive use for students with limited access to on-site SRH product availability.

Health literacy needs and preferences for a technology-based intervention to improve college students' sexual and reproductive health

Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students. Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university. Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis. Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students. Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.

Nurses' perspectives on user-friendly self-sampling interventions for diagnosis of sexually transmitted infections among young women in eThekwini district municipality: a nominal group technique

BACKGROUND

Syndromic management in the main non-laboratory-based management approach for sexually transmitted infections (STI) in most low- and middle-income countries (LMICs) but it has limitations. Self-sampling has been proven as a suitable alternative approach to help improve management STIs by improving access to diagnosis among vulnerable populations. We sought to determine health workers' perspectives on user-friendly self-sampling interventions for STIs among young women in eThekwini District Municipality.

METHODS

Healthcare workers providing STI healthcare services in the study location participated in a nominal group technique (NGT) workshop. The NGT workshop was aimed enabling collaboration with key health providers in identifying user-friendly self-sampling interventions for diagnosis of STIs among young women. Data collection was conducted in two phases: phase 1 determined barrier that hinder young women from accessing current STI healthcare services and phase 2 focused on determining the key strategies for self-sampling interventions to diagnose STIs in young women. Thematic analysis and percentage form analysis were used to examine qualitative and quantitative data respectively.

RESULTS

The following barriers were identified: negligence; myths about STIs; fear of judgement; denial; operating hours; lack of knowledge of STI symptoms and safe sex practices; and stigma associated with STIs. The following strategies were suggested: hand out self-sampling kits at popular restaurants; collect self-sampling kits from security guard at primary healthcare clinics (PHCs); receive STI diagnostic results via SMS or email or the clinic for treatment; improve youth friendly services at PHCs; educate the public on proper use of the kits. Education about STIs and handing out self-sampling kits at clinics, universities, schools, pharmacies or via outreach teams were ranked high priority strategies.

CONCLUSIONS

The findings highlight the need to address stigma and fear of judgment and provide comprehensive education to improve healthcare-seeking behaviour in young women. Additionally, the study also indicates that using eHealth solutions could significantly enhance the accessibility and efficiency of STI healthcare services in LMICs.

Development of Interventions to Support Provincial Implementation of the Baby-Friendly Initiative: A Study Protocol

Breastfeeding is internationally recognized as the optimal form of infant nutrition. The Baby-Friendly Initiative (BFI) is an evidence-informed program that leads to improved breastfeeding outcomes. Despite the benefits of breastfeeding, Nova Scotia has one of the lowest breastfeeding rates in Canada. Additionally, only two birthing hospitals in the province have BFI designation. We aim to address this gap using a sequential qualitative descriptive design across three phases. In Phase 1, we will identify barriers and facilitators to BFI implementation through individual, semi-structured interviews with 40 health care professionals and 20 parents. An analysis of relevant policy and practice documents will complement these data. In Phase 2, we will develop implementation interventions aimed at addressing the barriers and facilitators identified in Phase 1. An advisory committee of 10-12 administrative, clinical, and parent partners will review these interventions. In Phase 3, the interventions will be reviewed by a panel of 10 experts in BFI implementation through an online survey. Feedback on the revised implementation interventions will then be sought from 20 health system and parent partners through interviews. This work will use implementation science methods to support integrated and sustained implementation of the BFI across hospital/community and rural/urban settings in Nova Scotia. This study was not registered.

Increasing chronic disease preventive care in community mental health services: clinician-generated strategies

BACKGROUND

People with a mental health condition experience a high prevalence of chronic disease risk behaviours e.g., tobacco smoking and physical inactivity. Recommended 'preventive care' to address these risks is infrequently provided by community mental health services. This study aimed to elucidate, among community mental health managers and clinicians, suggestions for strategies to support provision of preventive care.

METHODS

Three qualitative focus groups (n = 14 clinicians) were undertaken in one regional community mental health service to gather perspectives of barriers to preventive care provision, deductively coded against the domains of the Theoretical Domains Framework (TDF). Drawing on the learnings from the focus groups, individual interviews (n = 15 managers and clinicians) were conducted in two services to identify suggestions for strategies to increase preventive care. Strategies were inductively coded and mapped into TDF domains.

RESULTS

Barriers were identified across a wide range of TDF domains, most notably knowledge and environmental context and resources. Nine strategies were identified across three themes: training, resources and systems changes; mapping to all 14 TDF domains.

CONCLUSION

Future research seeking to increase implementation of preventive care may be guided by these findings. There is need for greater recognition and resourcing of preventive care as a priority and integral component of mental health treatment.

Need for Sexual, Reproductive, and Mental Health Promotion Among Diverse College Students in a COVID-19 Era

In 2020, the COVID-19 pandemic forced unprecedented disruptions in higher education operations. While the adverse mental health effects experienced by college students due to these changes are well documented, less is known about the impact on their sexual and reproductive health (SRH), and the reciprocal relationships between SRH and mental health among adolescents and emerging adults. This position paper reviews existing literature on the effects of the COVID-19 pandemic on SRH, sexual violence, unintended pregnancy, sexually transmitted illness and human immunodeficiency virus rates and highlights issues specific to college-aged males, females, racial/ethnic and sexual minorities, and individuals with disabilities. The need to conceptualize SRH as an integral component of normal development, overall health, and well-being in the context of COVID-19 is discussed. The need to prioritize the design and implementation of developmentally appropriate, evidence-based SRH interventions specifically targeting college students is identified. Furthermore, an intergenerational approach to SRH that includes parents/caregivers and/or college faculty and staff (e.g., coaches, trainers) could facilitate comprehensive SRH prevention programming that enhances sexual violence prevention training programs currently mandated by many colleges. Policies and programs designed to mitigate adverse pandemic-related exacerbations in negative SRH outcomes are urgently needed and should be included in mainstream clinical psychology, not only focused on preventing unwanted outcomes but also in promoting rewarding interpersonal relationships and overall well-being. Recommendations for clinical psychologists and mental health researchers are made.

Primary healthcare provider experience of knowledge brokering interventions for mood management

Background

Knowledge brokering is a knowledge translation strategy used in healthcare settings to facilitate the implementation of evidence into practice. How healthcare providers perceive and respond to various knowledge translation approaches is not well understood. This qualitative study used the Theoretical Domains Framework to examine healthcare providers' experiences with receiving one of two knowledge translation strategies: a remote knowledge broker (rKB); or monthly emails, for encouraging delivery of mood management interventions to patients enrolled in a smoking cessation program.

Methods

Semi-structured interviews were conducted with 21 healthcare providers recruited from primary care teams. We used stratified purposeful sampling to recruit participants who were allocated to receive either the rKB, or a monthly email-based knowledge translation strategy as part of a cluster randomized controlled trial. Interviews were structured around domains of the Theoretical Domains Framework (TDF) to explore determinants influencing practice change. Data were coded into relevant domains.

Results

Both knowledge translation strategies were considered helpful prompts to remind participants to deliver mood interventions to patients presenting depressive symptoms. Neither strategy appeared to have influenced the health care providers on the domains we probed. The domains pertaining to knowledge and professional identity were perceived as facilitators to implementation, while domains related to beliefs about consequences, emotion, and environmental context acted as barriers and/or facilitators to healthcare providers implementing mood management interventions.

Conclusion

Both strategies served as reminders and reinforced providers' knowledge regarding the connection between smoking and depressed mood. The TDF can help researchers better understand the influence of specific knowledge translation strategies on healthcare provider behavior change, as well as potential barriers and facilitators to implementation of evidence-informed interventions. Environmental context should be considered to address challenges and facilitate the movement of knowledge into clinical practice.

"They have their own people": Emotional connections, community belonging, and Chinese gay, bisexual and other men who have sex with men (GBMSM) college students' needs for sexual health support

Gay, bisexual and other men who have sex with men (GBMSM) college students in China have unique sexual health challenges, including a higher risk of HIV infection, stigma and discrimination against LGBTQ (lesbian, gay, bisexual, transgender, and queer) population, and limited access to LGBTQ-affirmative sexual health support. Nonetheless, previous research or policymaking has rarely addressed the students' needs for sexual health support from their perspectives. This study aims to explore GBMSM college students' perceptions and attitudes to current sexual health resources, the challenges they encounter, and their expectations to acquiring LGBTQ-affirmative sexual health information and services. The exploration was carried out through field visits and in-depth interviews with 26 GBMSM college students and eight relevant stakeholders in five cities in China. Qualitative thematic analysis was applied to the interview transcripts and fieldwork memos. Four themes emerged around the preference and needs of GBMSM students in dealing with their sexual health challenges: the association between tackling sexual health challenges and entering LGBTQ communities, the roles of emotional attachment in shaping the preference for HIV-related care and support, the desired modes of acquiring sexual health support, and the current unmet service needs. We discovered that the information-and-care-seeking behaviors of GBMSM college students are highly influenced by and connected to their participation in online and in-person LGBTQ communities. Due to the overall stigmatizing sociocultural environment of LGBTQ in China, GBMSM college students tend to rely on LGBTQ communities, seeking trust and a sense of belongingness for tackling their sexual health challenges. Conventional school-based sexual health educational programs, which often apply top-down, stigma-and-fear-based, and non-LGBTQ-inclusive teaching strategies, rarely help GBMSM college students to solve sexual health problems in real life. GBMSM college students are eager to have LGBTQ-affirmative "health managers" who can understand their emotional experiences and interpersonal contexts and assist them with sexual health issues. However, such support is generally perceived as limited by the students. Our study highlights these unmet needs of the GBMSM students and emphasizes the importance of developing future LGBTQ-affirmative sexual health programs among Chinese GBMSM college students and young GBMSM in general.

Applying the COM-B behaviour model to understand factors which impact school immunisation nurses' attitudes towards designing and delivering a HPV educational intervention in post-primary schools for 15-17 year old students in Northern Ireland, UK

INTRODUCTION

Human Papilloma Virus (HPV) is responsible for the development of cervical, vaginal, vulvar, penile, oropharyngeal and anal cancers. Throughout the UK, Immunisation nurses (IMNs) deliver school-based HPV vaccinations to students 12-13 years old. Providing HPV education to 15-17 year old students may promote decision-making regarding their sexual health and award opportunity for unvaccinated students to self-consent to the vaccination. This study aims to explore the perceptions of IMNs regarding the value of providing HPV education to 15-17 year old students and to explore whether IMNs feel that the design/delivery of this education should form part of their professional role.

METHODS

Six focus groups were conducted online with IMNs from all five Health and Social Care Trusts in Northern Ireland, UK, between January-June 2021. Data were analysed using the COM-B model to identify factors that might influence IMNs' behaviour towards designing/delivering this education for 15-17 year old students.

RESULTS

IMNs were highly motivated to design and deliver this HPV education. Facilitators promoting this behaviour included their specialist training, their previous sexual health teaching experience and their desire to educate young people. Barriers negatively influencing this behaviour included lack of time/resources, parental influences, lack of school support and lack of teaching/presentation skills training.

CONCLUSION

IMNs feel that they are the most appropriate professionals to design/deliver HPV education for 15-17 year old students. National policy change, based on collaboration between the Public Health Agency and Education Authority, is a key factor in facilitating IMNs to implement this school-based HPV education intervention.

Knowledge, attitudes, and practices regarding COVID-19 among university students and employees in Massachusetts, USA: A qualitative study

OBJECTIVE

To explore the knowledge, attitudes, and practices regarding COVID-19 in university affiliates to inform future COVID-19 policies and practices.

PARTICIPANTS

Undergraduate students, graduate students and university employees at a large public university.

METHODS

Semi-structured focus groups and interviews were conducted between December 2020 and January 2021. Data were analyzed via inductive thematic analysis.

RESULTS

Analysis of data from the 36 participants generated five themes: COVID-19 knowledge, stress and coping, trust, decision-making, and institutional feedback. Misunderstanding of COVID-19 preventive behaviors was common, which appeared to compound high levels of stress and presented an educational opportunity. University investment in an asymptomatic testing program was reported to increase perceived safety.

CONCLUSIONS

Participants' experiences with a large university's COVID-19 response suggest a desire for consistent and transparent communication and an opportunity for institutions to examine the effectiveness of their communication strategies, public health protocols, and mechanisms for assessing and mitigating stress.

Successful Integration of HIV PrEP in Primary Care and Women's Health Clinical Practice: A Model for Implementation

Ending the HIV Epidemic is contingent upon the increased utilization of pre-exposure prophylaxis (PrEP). The majority of PrEP in the United States is prescribed in specialty care settings; however, to achieve national implementation goals, it is necessary to expand PrEP services in primary care and women's health clinics. To this end, a prospective cohort study was conducted of health care providers participating in one of three rounds of a virtual program aimed at increasing the number of PrEP prescribers in primary care and women's health clinics within the NYC Health and Hospitals network, the public healthcare system of New York City. Provider prescribing behavior was compared at pre-intervention (August 2018-September 2019) and post-intervention (October 2019-February 2021). Among 104 providers, the number prescribing PrEP increased from 12 (11.5%) to 51 (49%) and the number of individual patients on PrEP increased from 19 to 128. The program utilized clinical integration models centering on existing STI management workflows and was associated with increased numbers of PrEP prescribers and volume of prescriptions in primary care and women's health clinics. The dissemination of similar programs could support national scale-up of PrEP.

Investigating the impact of stigma, accessibility and confidentiality on STI/STD/HIV self-testing among college students in the USA: protocol for a scoping review

INTRODUCTION

In 2019, there were 2.5 million reported cases of chlamydia, gonorrhoea and syphilis. The Centers for Disease Control and Prevention reported in the USA, young people aged 15-24 made up 61% and 42% of chlamydia and gonorrhoea cases, respectively. Moreover, the highest rates of sexually transmitted infections (STIs) were reported among college-aged students. In this paper, we outline our protocol to systematically review the published literature on, the use of STI/HIV self-test kits, increasing STI/HIV testing uptake, and stigma, access and confidentiality issues, among young adult college students in the USA.

METHODS AND ANALYSIS

This scoping review will be conducted and reported according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will search electronic databases, OVID Medline, OVID Embase, Web of Science, Cochrane Library, PubMed and CINAHL, for articles published in English from inception to the present. We will search other alternative sources such as ProQuest, Google Scholar and Google to identify grey literature. A two-step process will be used to identify eligible studies based on the defined inclusion criteria. First, the title and abstract of identified articles will be screened for possible inclusion. Second, full-text articles of relevant studies will be retrieved and screened for inclusion. Both screening steps will be done by two people independently. Finally, data will be extracted by two researchers working independently. Any arising disagreements will be resolved by consensus or by a third author.

ETHICS AND DISSEMINATION

This study is a scoping review of the literature. Therefore, ethics approval is not required. Our plan for the dissemination of findings includes peer-reviewed manuscripts, conferences and webinars.

Improving Adolescent Perceptions of Barriers and Facilitators to Sexual and Reproductive Health Services Through Sexual Health Education

PURPOSE

This study examines whether comprehensive sexual health education that provides information on clinical services can change adolescents' perceptions of barriers, facilitators, and intention to use services and whether changes in perceptions differ by participant characteristics.

METHODS

Adolescent participants in a statewide sexual health education program in California were surveyed at baseline and at exit about their perceptions of barriers, facilitators, and intention to use clinical services. Linked baseline and exit surveys (n = 7,460) assessed change in perceptions after program completion. Logistic regression analyses that accounted for the clustered data structure assessed associations between participant characteristics and improvement in perceptions.

RESULTS

After the program, there were significant reductions in two perceived barriers (worry about cost and judgment by staff), but there were also small but significant increases in perceptions of two barriers (worry about confidentiality of services and test results). There were significant increases in all three perceived facilitators and intention to use sexual and reproductive health services, which rose from 90.6% at baseline to 96.2% at exit. Younger youth were more likely than older youth to show improvement in all perceived facilitators and intentions. Girls and Black youth were more likely than boys and Hispanic youth to show improvement in two facilitators (knowing what to expect and access). No sociodemographic characteristics were consistently associated with reductions in perceived barriers.

DISCUSSION

Comprehensive sexual health education that addresses adolescents' questions and concerns regarding clinical services can help to reduce perceived barriers, increase facilitators, and increase intention to use services if needed.

"It was protected, except, it wasn't [with] a condom": a mixed-methods study of BBVs/STIs protective practices among International University Students in Sydney, Australia

BACKGROUND

A number of previous sex-related studies among international students in Australia and other Western societies may be limited by conflating students from conservative and non-conservative sexual backgrounds. Such conflation leads to situations where nuances and complexities around sex-related experiences are lost or, at most, tangentially investigated. To address this research problem, this study used a mixed-methods design to examine protective practices against blood-borne viruses and sexually transmissible infections (BBVs/STIs) among Sydney-based East Asian and sub-Saharan African international students.

METHODS

This mixed-methods study generated quantitative data using anonymous online survey (n = 149), and qualitative data through in-depth interviews (n = 20). The main recruitment strategy involved advertising the study through paper and electronic flyers. Quantitative data were analysed using logistic regression, while interviews data were analysed using reflexive thematic analysis.

RESULTS

Self-reported BBVs/STIs protective practices in the last 12 months include abstinence (28.7%), consistent condom use (19.9%), occasional condom use (18.7%), single partner fidelity (25.1%), other strategies (1.8%), and nothing (5.8%). Further, findings from the bivariate analysis showed higher BBVs/STIs prevention knowledge, lower acculturation into Australian sexual culture, greater access to sexual health information, less conservative sexual norms, greater emotional social support and older age were significantly associated with increased protective practices. Variables significant at bivariate level were entered into a logistic regression. The model was statistically significant, (X²(6) = 31.33, p < 0.01) and explained 33.1% of the variance in BBVs/STIs protective practices. However, only acculturation to sexual norms in Australia (OR = 0.883, 95% CI = 0.820-0.952) was found to be independent predictor of BBVs/STIs protective practices. The results of the study based on the quantitative data, indicated condom use (consistent and occasional) was the most reported BBVs/STIs protective behaviour among sexually active participants. Therefore, interviews data was used to explore condom-use motives and practices. The interviews results showed participants primary concern as regards condom use was around pregnancy and not BBVs/STIs. Thus, some participants described safe sex largely as contraception, with BBVs/STIs constituting a secondary concern or no concern at all.

CONCLUSIONS

Based on the results of this study, tailored sexual health interventions for international students; which incorporate strategies for modifying perceived sexual norms in Australia, are advocated. In addition, this study recommends sexual health interventions that promote dual protection of condoms for both contraception and BBVs/STIs.

A qualitative study of barriers and facilitators to the implementation of a pilot school-based, toothbrushing programme

Background

While supervised toothbrushing programmes have been established in many countries of the world, little is known about different perspectives on their implementation. The aim of the study was to explore stakeholders' barriers and facilitators to implementation of a school-based toothbrushing programme in Taiwan.

Methods

Focus groups and interviews were used to explore the views of elementary school students, teachers, staff, and nurses in a piloted school-based toothbrushing programme. The topic guides were developed according to the Theoretical Domains Framework (TDF) to cover the behavioural factors systematically and comprehensively. Data were analysed with content analysis.

Results

Overall, 36 students, 29 teachers/staff, and five school nurses (N = 65) were included. The overarching theme was the importance of habit formation for both staff and children to ensure that toothbrushing as part of the programme was embedded into the school schedule and routine. While children did not necessarily appear to retain the dental knowledge which was taught in the programme, the provision of fluoride toothpaste and toothbrush for their use in schools allowing teachers and staff to choose the timing of the brushing and engaging classmates to supervise each other were found to be key factors.

Conclusions

Implementing a school-based toothbrushing programme with the support of staff and active engagement of children can help children to develop a toothbrushing habit. Classmate-supervised toothbrushing may reduce the burden on teachers and staff to implement the programme.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02494-7.

College Student Experiences Regarding the Impact of the COVID-19 Pandemic on Their Sexual Lives

The COVID 19 pandemic has impacted sexual health in a variety of ways. The purpose of this research was to examine the ways in which college students (attending a university providing primarily online curriculum during fall 2020 and spring 2021 semesters) perceive the pandemic influencing their sexual health and lives. Participants were undergraduate students (N = 66) at a mid-sized Western university recruited during the beginning of the spring 2021 semester. Participants completed an anonymous online survey. A Thematic Analysis of responses to two open-ended questions asking about the impact of the COVID-19 pandemic on their sexual health and lives was conducted. Several important themes were identified during this analysis: (1) Sexual activity and quality, (2) Relationship dynamics, (3) Self-focus, (4) New partners, (5) Sexual healthcare, (6) No change. Findings have implications for promoting sexual health for students during times when the majority of instruction is conducted online.

Examining Theoretical Factors That Influence Teachers' Intentions to Implement Inclusive Physical Education

Purpose: The purpose of the current study was to apply the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation, and Behavior model (COM-B) to examine theoretical predictors of teachers' intentions to implement inclusive physical education. Methods: Ontario primary and secondary teachers (n = 383) completed an online questionnaire which assessed potential factors associated with intentions toward implementation of inclusive physical education. Results: The final statistical model explained 72% of variance in intentions to implement inclusive physical education with the following theoretical domains identified as significant (p<.05) predictors: knowledge (β .09), professional role and identity (β .22), memory, attention, and decision making (β .14), social influence (β .37), and emotion (β -.20). Regarding the COM-B, the component Motivation explained the greatest amount of variance in intentions to implement inclusive physical education. Conclusions: The application of the TDF and COM-B model in this study work to extend current literature through advancing understanding regarding cognitive, affective, and social factors related to teachers' intentions to implement inclusive physical education. Teacher training strategies should take into consideration multidimensional approaches to support teachers' motivations to implement inclusive physical education. Future research and intervention should seek to target and foster factors such as social influences, social/professional role and identity, and knowledge. These factors, in turn, may improve teachers' intentions to implement inclusive physical education.

HIV knowledge, sexual practices, condom use and its associated factors among international students in one province of China: a cross-sectional study

OBJECTIVE

China has seen an increasing number of international students in recent years, mostly from Africa and Asia. However, little is known about these students' HIV knowledge, sexual practices and potential HIV risk. This study aimed to describe HIV-related risk among international students.

DESIGN

An online cross-sectional survey.

SETTING

10 universities situated in one province of China.

PARTICIPANTS

617 international students filled out the questionnaire and 607 international students were included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Socio-demographic and programme-related characteristics, HIV-related knowledge, sexual practices and other HIV/sexually transmitted infection-related variables. Logistic regression analyses were performed to examine factors associated with inconsistent condom use among international students.

RESULT

The results showed that in total, only 51.6% (313/607) of international students had adequate HIV-related knowledge, and 64.9% (394/607) reported not receiving any HIV related education or training while studying in China. Moreover, 32.3% (196/607) reported having penetrative sex including oral, vaginal and anal sex during the period in which they studied in China and among them. The proportions of inconsistent condom use in vaginal and oral intercourse while studying in China were 52.6% (50/95) and 79.5% (35/44), respectively, with casual partners, and 60% (80/129) and 91.2% (52/57) with regular partners, respectively. Female gender, being married and having multiple sexual partners were associated with inconsistent condom use.

CONCLUSION

The present study indicated that international students in one province of China have suboptimal HIV-related knowledge, significant unprotected sex, less HIV testing and less safe sex education, which highlights an urgent need to provide HIV education and related health services to international students in China.

A Qualitative Study Evaluating the Factors Affecting Families' Adherence to the First COVID-19 Lockdown in England Using the COM-B Model and TDF

The ability of families to adhere to public health guidance is critical to controlling a pandemic. We conducted qualitative interviews with 30 parents of children aged 18 and under, between 16 and 21 April 2020 when schools in England were closed due to the COVID-19 pandemic. Using the Theoretical Domains Framework, we classified the factors that influenced adherence to seven non-pharmaceutical interventions. We found 40 factors that influenced a family’s ability to adhere. Parents generally indicated they could adhere and reported how their family had changed their behaviour to comply with the guidance. Parents primarily reported they were motivated to adhere out of concern for the health consequences of COVID-19, and because the guidance was delivered by the government. However, we found that reduced access to resources (e.g., technology, transport, and outside space) and social influences that encouraged non-adherent behaviour, decreased adherence. Furthermore, we suggest that families with low psychological and physical ability may face additional challenges to adherence and need to be supported. During future school closures, public health agencies should account for these factors when developing guidance.

Increasing Condom Use and STI Testing: Creating a Behaviourally Informed Sexual Healthcare Campaign Using the COM-B Model of Behaviour Change

Sexually transmitted infections (STIs) are a major public health challenge. Although theoretically informed public health campaigns are more effective for changing behaviour, there is little evidence of their use when campaigns are commissioned to the commercial sector. This study describes the implementation of the COM-B model to a sexual health campaign that brought together expertise from academics, sexual healthcare, and marketing and creative professionals. Insights were gathered following a review of the relevant academic literature. Barriers and facilitators to condom use and STI testing were explored with the use of the COM-B model and the Behaviour Change Wheel in a workshop attended by academics, behavioural scientists, healthcare experts and creative designers. Feedback on the creative execution of the campaign was obtained from healthcare experts and via surveys. Barriers to psychological capability, automatic and reflective motivation, and social opportunity were identified as targets for the campaign, and creative solutions to these barriers were collaboratively devised. The final sexual health campaign was rated positively in its ability to change attitudes and intentions regarding the use of condoms and STI testing. This study describes the implementation of the COM-B model of behaviour change to a public sexual health campaign that brought together academics, public and commercial sector expertise. The barriers and facilitators identified in this collaborative process represent potential targets for future public health communication campaigns.

"We want to live a little longer and our family want[s] us around": A summative content analysis of adherence to COVID-19-related guidelines using the Theoretical Domains Framework

Objective

Public adherence to COVID‐19‐related government guidance varied during the initial lockdown in the UK, but the determinants of public adherence to such guidance are unclear. We capture spontaneous reflections on adherence to UK government guidance from a representative UK sample, and use the TDF to identify key determinants of COVID‐related behaviours.

Design

The design was cross‐sectional.

Methods

Qualitative data were collected from a large sample of UK adults (N = 2,252) via an online questionnaire as part of a wider survey about the UK public’s responses to the government’s COVID‐19‐related guidance. Summative content analysis was used to identify key guideline terms in the data, followed by latent analysis to interpret the underlying meanings behind the terms using the TDF as an analytical framework.

Results

Six TDF domains were identified in the data: Environmental Context and Resources; Beliefs about Consequences; Social Influences; Memory, Attention and Decision Processes; Emotion; and Knowledge. Although the samples were motivated and capable of adhering, limitations in their environments, resources, and social support mechanisms restricted behaviour. Self‐reported adherence was sensitive to positive and negative beliefs about the effectiveness of the measures, in addition to interpretations of the terms ‘essential’ and ‘necessary’ in the guidance.

Conclusions

Despite extensive structural obstacles to adherence, the majority of the British public were able to follow government COVID‐19‐related instructions, provided they had sufficient resources, social support, and positive perceptions about the effectiveness of the measures. Ambiguities surrounding key terminology in the guidance left room for interpretation, which may have contributed to non‐adherence.

The Effects of Sociocultural Transitioning on Accessibility to Healthcare: The Case of Haredi Jews Who Leave Their Communities

Minority groups and immigrants encounter complex issues when attempting to access healthcare. This study examines factors affecting access to healthcare by a group of individuals in Israel who decided to leave their Haredi Jewish communities. We conducted 23 semi-structured interviews with individuals disaffiliating from Haredi communities in Israel in order to identify hurdles encountered during the process of seeking healthcare. We focused on specific steps in this process, including recognizing the need for help, deciding to actually turn to the health system, interaction with the system, and behavior after referring to the health system. We identified approximately 20 factors which can be either barriers or catalysts affecting healthcare access at the various stages. These were then traced to religious upbringing, hurdles of sociocultural transition, and unique characteristics of individuals reshaping their lives. The findings can be instrumental in designing culturally adapted health programs for individuals leaving the Haredi community. Moreover, the methodology that we are proposing can serve other investigations studying access to healthcare among various groups undergoing sociocultural transitions.

Taking Action in Student Harassment Situations: Application of the Behaviour Change Wheel to Bystander Intervention

This study applied the Behaviour Change Wheel (BCW) to understand barriers and facilitators to bystander behaviors in UK students. The BCW includes detailed examination of the capabilities, opportunities, and motivations involved in behaviors. Two surveys (n = 515; n = 201) and a focus group study (n = 12) were undertaken. Capability to intervene may be influenced by confidence and beliefs about physical ability and safety. Students appeared to have the physical opportunity to intervene, but social opportunity might be influenced by cultural norms. Motivations might be influenced by beliefs as well as inherent stereotypes about perpetrators and victims. Behavior change techniques (BCTs) such as instruction on how to perform the behavior, reattribution and creating a valued self-identity should be applied to overcome these barriers. A logic model to theorize the change processes underlying bystander behaviors in this population offers a new perspective on what needs to be addressed in interventions.

Embarrassment, Shame, and Reassurance: Emotion and Young People's Access to Online Sexual Health Information

INTRODUCTION

Research suggests that embarrassment and shame are significant barriers to young people's access to sexual health information. In this article, we analyse the relationship between emotion and young people's engagement with online sexual health information.

METHODS

Drawing on the work of Ahmed on the performativity of emotion and Probyn's theorisation of shame, we analyse interviews conducted in 2020 with 37 young people in Australia on sources of sexual health information.

RESULTS

Based on themes emerging from the data, our analysis considers the role of embarrassment and shame in shaping young people's access to sexual health information, the sources they seek, and the forms of information provision they prefer. Overall, we find that shame, embarrassment, and judgement shape our participants' access to sexual health information in four key ways: (1) by enacting suitable sources of information; (2) by propelling curiosity in different directions; (3) by constituting 'normal' bodies, sexuality, and sexual health; and (4) by constituting desired forms of communication.

CONCLUSIONS

As part of these dynamics, our participants use a range of strategies to avoid potential embarrassment or judgement when seeking sexual health information. The article concludes by exploring the implications of these practices and dynamics.

POLICY IMPLICATIONS

Our analysis suggests the need for research, policy, and public health initiatives that are open to the multiple effects of emotion, including those traditionally thought of as negative, and their role in materialising encounters with sexual health information.

Community pharmacists' views on providing a reproductive health service to women receiving opioid substitution treatment: A qualitative study using the TDF and COM-B

Background

The absence of menstruation is common in women who use drugs. This can give a belief that conception is unlikely. When stabilised on Opioid Substitution Treatment (OST), fertility often returns, initially without realisation as ovulation precedes menstruation. This leaves women vulnerable to unplanned pregnancies. Community pharmacists (CPs) are frequently in contact with this patient group through the Supervised Consumption of OST service. This provides a timely opportunity to provide reproductive health (RH) advice. The aim of this study was to investigate pharmacists' views on providing a RH service to women receiving OST.

Methods

Twenty semi-structured interviews based on the Capability-Opportunity-Motivation to Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) were conducted between 2016 and 2017. Data analysis involved deductive coding using the TDF domains. The TDF domains were mapped onto the elements of the COM-B and used in the second step to create the framework and chart the data. The third step involved re-reading and clustering the codes, and inductive themes were generated to explain the data in depth.

Results

Nine of the 14 TDF domains, mapped into five elements of the COM-B, were identified. Five inductive themes were generated: 1) The pharmacists' experience and knowledge of reproductive health (RH) needs of women receiving OST, 2) The pharmacists' approach to providing advice, 3) The pharmacists' perception of the relationship with women receiving OST, 4) Social influences, and 5) Environmental factors. Community pharmacists feared causing offense to women receiving OST and described requiring cues as to when the service was needed. Pharmacists' highlighted a power imbalance in the relationship with women receiving OST. This could influence how receptive this patient group would be to pharmacy RH interventions.

Conclusions

CPs' concerns of providing RH service could hinder a proactive service provision. Supporting good rapport and providing a structured consultation would increase the accessibility of such a service.

•

Reproductive health advice is triggered by social or physical cues from women.

•

Provision of this advice is subject to the reflective thinking of the provider.

•

A power imbalance characterizes supervised opioid substitution treatment.

•

Good rapport and a structured consultation were seen to increase the accessibility.

Distance as explanatory factor for sexual health centre utilization: an urban population-based study in the Netherlands

Background

The central sexual health centre (SHC) in the greater Rotterdam area in the Netherlands helps finding people unaware of their STI/HIV status. We aimed to determine a possible association between SHC utilization and travel distance in this urban and infrastructure-rich area. Insight in area-specific utilization helps adjust outreach policies to enhance STI testing.

Methods

The study population consists of all residents aged 15–45 years in the greater Rotterdam area (2015–17). We linked SHC consultation data from STI tested heterosexual clients to the population registry. The association between SHC utilization and distance was investigated by multilevel modelling, adjusting for sociodemographic and area-specific determinants. The data were also stratified by age (aged < 25 years) and migratory background (non-Western), since SHC triage may affect their utilization. We used straight-line distance between postal code area centroid and SHC address as a proxy for travel distance.

Results

We found large area variation in SHC utilization (range: 1.13–48.76 per 1000 residents). Both individual- and area-level determinants determine utilization. Travel distance explained most area variation and was inversely associated with SHC utilization when adjusted for other sociodemographic and area-specific determinants [odds ratio (OR) per kilometre: 0.95; 95% confidence interval (CI): 0.93–0.96]. Similar results were obtained for residents <25 years (OR: 0.95; 95% CI: 0.94–0.96), but not for non-Western residents (OR: 0.99; 95% CI: 0.99–1.00).

Conclusions

Living further away from a central SHC shows a distance decline effect in utilization. We recommend to enhance STI testing by offering STI testing services closer to the population.

CO-DEVELOPMENT OF IMPLEMENTATION INTERVENTIONS TO SUPPORT PARENT-LED INFANT PAIN CARE: A QUALITATIVE DESCRIPTIVE STUDY PROTOCOL (Preprint)

Background

Untreated pain in infants is associated with adverse health outcomes. Despite strong evidence for accessible, effective, and low-cost parent-led pain-relieving interventions such as breastfeeding or chestfeeding and skin-to-skin contact, these interventions are not routinely used.

Objective

The objective of this study is to support the implementation of parent-led pain interventions by identifying barriers to and facilitators of parent-led, evidence-informed pain care in infants during acute procedures. In addition, this study aims to develop theory-informed, contextually relevant implementation interventions for supporting the use of parent-led pain care for infants in hospital and community contexts.

Methods

This study will consist of 2 phases that follow a systematic, theoretically informed approach guided by the Theoretical Domains Framework and Behavior Change Wheel. In phase 1, we will use a qualitative descriptive design to explore barriers and facilitators to using parent-led pain care in infants from the perspectives of hospital and community-based clinicians, clinical leaders, and families. In phase 2, we will use the Behavior Change Wheel to design tailored implementation interventions that have evidence for effectively addressing identified barriers in collaboration with an advisory committee of administrative, clinical, and family leaders.

Results

Ethics approval for this study was obtained in December 2020. As of May 2022, a total of 15 participants have been enrolled in phase 1. The results from all phases will be reported in 2023.

Conclusions

Following the completion of this study, we will have co-designed theoretically informed implementation interventions that can be pilot-tested and experimentally applied. The findings will be used to implement parent-led interventions that improve patient safety and health outcomes for diverse families.

International Registered Report Identifier (IRRID)

DERR1-10.2196/33770

Cohort profile: The UK COVID-19 Public Experiences (COPE) prospective longitudinal mixed-methods study of health and well-being during the SARSCoV2 coronavirus pandemic

Public perceptions of pandemic viral threats and government policies can influence adherence to containment, delay, and mitigation policies such as physical distancing, hygienic practices, use of physical barriers, uptake of testing, contact tracing, and vaccination programs. The UK COVID-19 Public Experiences (COPE) study aims to identify determinants of health behaviour using the Capability, Opportunity, Motivation (COM-B) model using a longitudinal mixed-methods approach. Here, we provide a detailed description of the demographic and self-reported health characteristics of the COPE cohort at baseline assessment, an overview of data collected, and plans for follow-up of the cohort. The COPE baseline survey was completed by 11,113 UK adult residents (18+ years of age). Baseline data collection started on the 13th of March 2020 (10-days before the introduction of the first national COVID-19 lockdown in the UK) and finished on the 13th of April 2020. Participants were recruited via the HealthWise Wales (HWW) research registry and through social media snowballing and advertising (Facebook®, Twitter®, Instagram®). Participants were predominantly female (69%), over 50 years of age (68%), identified as white (98%), and were living with their partner (68%). A large proportion (67%) had a college/university level education, and half reported a pre-existing health condition (50%). Initial follow-up plans for the cohort included in-depth surveys at 3-months and 12-months after the first UK national lockdown to assess short and medium-term effects of the pandemic on health behaviour and subjective health and well-being. Additional consent will be sought from participants at follow-up for data linkage and surveys at 18 and 24-months after the initial UK national lockdown. A large non-random sample was recruited to the COPE cohort during the early stages of the COVID-19 pandemic, which will enable longitudinal analysis of the determinants of health behaviour and changes in subjective health and well-being over the course of the pandemic.

Perceived barriers and facilitators to accessing and utilising sexual and reproductive healthcare for people who experience homelessness: a systematic review

INTRODUCTION

People who experience homelessness face disproportionately poor reproductive health and adverse pregnancy outcomes, including but not limited to unintended pregnancy, abortion, low birth weight and preterm birth, as well as a higher risk of sexually transmitted infections (STIs). Precarious living conditions are known to contribute to poor uptake and engagement with sexual and reproductive healthcare (SRH) for this population.

AIM

To identify and understand the perceived barriers and facilitators for accessing and utilising SRH for people who experience homelessness from their perspective, and the perspective of support staff/volunteers and healthcare professionals.

METHODS

Electronic databases and online sources were searched. Two reviewers independently carried out the screening, data extraction, critical appraisal, data synthesis and thematic analysis of findings.

RESULTS

Following deduplication and screening, 23 papers/reports were considered eligible for the review. Barriers for people experiencing homelessness to accessing and utilising SRH were identified within the themes of complexity, feelings and knowledge (ie, individual-level factors), as well as patient/provider interaction and healthcare system (ie, organisational factors). Facilitators were identified within all of the above themes except for complexity.

CONCLUSIONS

Both population characteristics and attributes of the healthcare system influence access and utilisation of SRH by people experiencing homelessness. Given the complexity of living conditions associated with homelessness, greater efforts to improve access should be placed on healthcare systems and aspects of care delivery. This systematic review highlights current gaps in the literature and provides recommendations for enhancing future research and practice to meet the needs of this vulnerable group more effectively.

Barriers and facilitators to implementing evidence based bleeding management in Australian Cardiac Surgery Units: a qualitative interview study analysed with the theoretical domains framework and COM-B model

Background

Bleeding during cardiac surgery is a common complication that often requires the transfusion of blood products. The combination of bleeding and blood product transfusion incrementally increases adverse outcomes including infection and mortality. Following bleeding management guideline recommendations could assist with minimising risk but adherence is not high, and the cause for lack of adherence is not well understood. This study aimed to identify barriers and facilitators to practicing and implementing evidenced-based intra-operative, bleeding management in Australian cardiac surgery units.

Methods

We used a qualitative descriptive design to conduct semi-structured interviews with Australian cardiac surgeons, anaesthetists and perfusionists. The Theoretical Domains Framework (TDF) was utilised to guide interviews and thematically analyse the data. Categorised data were then linked with the three key domains of the COM-B model (capability, opportunity, motivation - behaviour) to explore and understand behaviour.

Results

Seventeen interviews were completed. Nine of the 14 TDF domains emerged as significant. Analysis revealed key themes to improving capability included, standardisation, monitoring, auditing and feedback of data and cross discipline training. Opportunity for change was improved with interpersonal and interdepartmental collaboration through shared goals, and more efficient and supportive processes allowing clinicians to navigate unfamiliar business and financial models of health care. Results suggest as individuals, clinicians had the motivation to make change and healthcare organisations have an obligation and a responsibility to partner with clinicians to support change and improve goal directed best practice.

Conclusion

Using a theory-based approach it was possible to identify factors which may be positively or negatively influence clinicians ability to implement best practice bleeding management in Australian cardiac surgical units.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06269-8.

Narratives of young black men on barriers to health care and poor health care seeking behaviours at a university setting: a qualitative study

BACKGROUND

Institutions of higher learning provide education, training, independence and life-long skills for young people. However, for students to achieve their optimal growth and intellectual development they need to be healthy psychologically, mentally and physically. This can be achieved through the development of effective health programs for all university students. This qualitative study was designed to explore Black male students' perspectives and experiences regarding the utilization of on-campus health services at the University of KwaZulu-Natal.

METHODS

The study population was selected using purposive sampling. Data were collected using four focus group discussions (FGDs) with 36 participants and three key informant interviews. Thematic analysis was conducted to identify the key patterns and themes that emerged from the data.

RESULTS

Emerging themes included poor knowledge and awareness, negative perceptions and attitudes, fear and lack of privacy, and negative experiences leading to poor access and utilization of campus health services. The findings suggested a need for more advocacy and awareness campaigns especially among first year students, campaigns for normalization of sexual health, addressing HIV stigma and discrimination, providing youth friendly services to improve students' use of sexual health services, and ultimately, their overall health and well-being.

CONCLUSIONS

The findings give valuable insights from male students on the barriers and potential solutions to campus health services and highlight where improvements can be directed to increase access and use of health services by the study population.

The Sexual Risk Behaviors Scale (SRBS): Development & Validation in a University Student Sample in the UK

University students are at risk of poor sexual health outcomes. The aim of this study was to develop and test the psychometric properties of the Sexual Risk Behaviors Scale (SRBS), a novel short tool for measuring engagement in sexual risk behaviors in university students. We developed a pool of six items based on a review of recent literature and tested its properties in 547 undergraduate students in the United Kingdom. We used Exploratory Factor Analysis and Confirmatory Factor Analysis to explore and determine the factor structure and dimensionality of the SRBS. We used Item Response Theory and specifically the Graded Response Model to investigate items’ discrimination, information, and differential functioning, respectively, and logistic regression to test whether higher SRBS scores predicted a diagnosis of any sexually transmitted infections in the past 12 months. Results showed that a unidimensional, five-item model fitted the data well, showing satisfactory fit indices and reliability, with all items providing adequate discrimination and information, and no differential item functioning by gender nor by sexual orientation. SRBS total scores significantly predicted the odds of being diagnosed with sexually transmitted infections in the past 12 months. Implications for public health prevention and intervention are discussed.

Making epistemic citizens: Young people and the search for reliable and credible sexual health information

The 21st century has seen the proliferation of technologies and sources of information on issues of all kinds, including sexuality. Amid debates about the role of social media and the internet in mediating sexuality, questions about credible, reliable and objective sources of information have also arisen, particularly in relation to young people's knowledge-seeking. Drawing on theorisations of sexual citizenship, Foucault's notion of the 'episteme', and the work of science and technology studies scholar John Law, this article examines a 'collateral reality' produced by contemporary demands on young people to source, assess and act on sexual health information. Using interviews with 37 young people living in Australia, the analysis identifies a range of approaches to sexual health-seeking practices, key dynamics in the construction of reliability and fact, and the extent and nature of the accommodations young people report making to navigate incomplete and unreliable information. With the contemporary self increasingly framed through the ability to discern truth from falsehood, reality from fake news, these demands and choices have significant implications for qualification as the proper modern citizen. Accommodating information weaknesses and gaps in sexual health information, we argue, produces what we call contemporary 'epistemic citizens'; young people explicitly aware of the limits of official knowledges about sex and sexualities, and of the expectation that individual citizens must either content themselves with officially constituted sexual selves or else seek and enact marginal or unofficial alternatives using sources generally denigrated as unreliable. As we will conclude, current forms of sexual health information and related calls for youth literacy operate as a mechanism for generating a specific modern form of epistemic citizenship. Future sexuality education might consider ways to support even more literate, sophisticated epistemic citizens relieved of the responsibility to piece the truth together on their own, and who in turn feel more included.

Comparison of barriers and facilitators of MIND diet uptake among adults from Northern Ireland and Italy

Background

The aim of the study was to identify and compare components of the COM-B (capability, opportunity, motivation and behaviour) model, that influences behaviour to modify dietary patterns in 40–55-year olds living in Northern Ireland (NI) and Italy, in order to reduce the risk of cognitive decline in later life.

Methods

This was a qualitative study examining factors influencing Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet behaviour. This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework to further understand behaviour. Twenty-five Northern Irish and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40 and 55 years.

Results

Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) reported as a facilitator to the Italian sample only.

Conclusions

Cross-cultural differences in relation to psychosocial barriers and facilitators were found in both samples. More barriers than facilitators towards uptake of the MIND diet were found. There is a need for interventions that increase capability, opportunity, and motivation to aid behaviour change. The findings from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

Improving case detection of tuberculosis in hospitalised Kenyan children-employing the behaviour change wheel to aid intervention design and implementation

BACKGROUND

The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. Guidelines for tuberculosis clinical decision-making are in place in Kenya, and the National Tuberculosis programme conducts several trainings on them yearly. By 2018, there were 183 GeneXpert® machines in Kenyan public hospitals. Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. We describe the process of designing a contextually appropriate, theory-informed intervention to improve case detection of TB in children and implementation guided by the Behaviour Change Wheel.

METHODS

We used an iterative process, going back and forth from quantitative and qualitative empiric data to reviewing literature, and applying the Behaviour Change Wheel guide. The key questions reflected on included (i) what is the problem we are trying to solve; (ii) what behaviours are we trying to change and in what way; (iii) what will it take to bring about desired change; (iv) what types of interventions are likely to bring about desired change; (v) what should be the specific intervention content and how should this be implemented?

RESULTS

The following behaviour change intervention functions were identified as follows: (i) training: imparting practical skills; (ii) modelling: providing an example for people to aspire/imitate; (iii) persuasion: using communication to induce positive or negative feelings or stimulate action; (iv) environmental restructuring: changing the physical or social context; and (v) education: increasing knowledge or understanding. The process resulted in a multi-faceted intervention package composed of redesigning of child tuberculosis training; careful selection of champions; use of audit and feedback linked to group problem solving; and workflow restructuring with role specification.

CONCLUSION

The intervention components were selected for their effectiveness (from literature), affordability, acceptability, and practicability and designed so that TB programme officers and hospital managers can be supported to implement them with relative ease, alongside their daily duties. This work contributes to the field of implementation science by utilising clear definitions and descriptions of underlying mechanisms of interventions that will guide others to do likewise in their settings for similar problems.

Test@Work Texts: Mobile Phone Messaging to Increase Awareness of HIV and HIV Testing in UK Construction Employees during the COVID-19 Pandemic

Background: HIV poses a threat to global health. With effective treatment options available, education and testing strategies are essential in preventing transmission. Text messaging is an effective tool for health promotion and can be used to target higher risk populations. This study reports on the design, delivery and testing of a mobile text messaging SMS intervention for HIV prevention and awareness, aimed at adults in the construction industry and delivered during the COVID-19 pandemic. Method: Participants were recruited at Test@Work workplace health promotion events (21 sites, n = 464 employees), including health checks with HIV testing. Message development was based on a participatory design and included a focus group (n = 9) and message fidelity testing (n = 291) with assessment of intervention uptake, reach, acceptability, and engagement. Barriers to HIV testing were identified and mapped to the COM-B behavioural model. 23 one-way push SMS messages (19 included short web links) were generated and fidelity tested, then sent via automated SMS to two employee cohorts over a 10-week period during the COVID-19 pandemic. Engagement metrics measured were: opt-outs, SMS delivered/read, number of clicks per web link, four two-way pull messages exploring repeat HIV testing, learning new information, perceived usefulness and behaviour change. Results: 291 people participated (68.3% of eligible attendees). A total of 7726 messages were sent between March and June 2020, with 91.6% successfully delivered (100% read). 12.4% of participants opted out over 10 weeks. Of delivered messages, links were clicked an average of 14.4% times, max 24.1% for HIV related links. The number of clicks on web links declined over time (r = -6.24, p = 0.01). Response rate for two-way pull messages was 13.7% of participants. Since the workplace HIV test offer at recruitment, 21.6% reported having taken a further HIV test. Qualitative replies indicated behavioural influence of messaging on exercise, lifestyle behaviours and intention to HIV test. Conclusions: SMS messaging for HIV prevention and awareness is acceptable to adults in the construction industry, has high uptake, low attrition and good engagement with message content, when delivered during a global pandemic. Data collection methods may need refinement for audience, and effect of COVID-19 on results is yet to be understood.

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting - modern diagnostics meet age-old challenges

BACKGROUND

Detection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has the potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making the machines widely available in Kenya, but use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings.

METHODS

This was an exploratory qualitative study with an embedded case study approach. Data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; desk review of guidelines, job aides and policy documents. The Capability, Opportunity and Motivation (COM-B) framework was used to interpret emerging themes.

RESULTS

At individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes, patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological), motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices and beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological), motivation (reflective & automatic) and opportunity (physical).

CONCLUSION

We used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries and can be feasibly implemented by the National TB programme.

Exploring factors constraining utilization of contraceptive services among adolescents in Southeast Nigeria: an application of the socio-ecological model

Background

High rate of teenage pregnancy in Nigeria is potentially an indication of poor access to and utilization of contraceptives among this age group. This paper presents findings from in-depth exploration of perceived barriers to utilization of contraceptive services by adolescents.

Methods

A qualitative study was conducted in six communities in Ebonyi state, southeast Nigeria. Eighty-one in-depth interviews and six focus group discussions were conducted. Respondents comprised policy makers, community leaders, health service providers and parents of adolescents. Pre-tested interview guides were used to collect information on perceived barriers to utilization of contraceptive services by adolescents. All interviews were audio recorded and transcribed in English. Data was analysed using thematic framework approach, and the socio-ecological model was adapted for data synthesis.

Results

Individual level factors that limit access to contraceptives for adolescents include lack of awareness and poor knowledge, fear of side effects, low self-esteem, and inability to afford cost of services. Interpersonal (family-related) barriers to access include poor parent-child communication of sexual and reproductive health matters and negative attitude of parents towards to sexuality education for adolescents. Health systems barriers to accessing contraceptives for adolescents include lack of privacy and confidentiality, stock-out of contraceptive commodities, judgmental attitude of health workers, insufficient staff that are skilled in adolescent sexual and reproductive health. Gendered cultural norms, societal shaming and religious intolerance also preclude adolescents from accessing and using contraceptive services. Wider societal factors such as negative peer and media influence, absence of sexuality education in schools, lack of social networks in communities; and macro level factors such as poor economic conditions were also perceived to limit access to contraceptives for adolescents.

Conclusion

Utilization of contraception is constrained by an interplay of factors acting at various levels. Addressing these barriers could contribute to improved access to contraceptive services for adolescents, as well as reduction in unwanted teenage pregnancy.

Linkage of voluntary medical male circumcision clients to adolescent sexual and reproductive health (ASRH) services through Smart-LyncAges project in Zimbabwe: a cohort study

OBJECTIVES

WHO recommended strengthening the linkages between various HIV prevention programmes and adolescent sexual reproductive health (ASRH) services. The Smart-LyncAges project piloted in Bulawayo city and Mt Darwin district of Zimbabwe established a referral system to link the voluntary medical male circumcision (VMMC) clients to ASRH services provided at youth centres. Since its inception in 2016, there has been no assessment of the performance of the referral system. Thus, we aimed to assess the proportion of young (10-24 years) VMMC clients getting 'successfully linked' to ASRH services and factors associated with 'not being linked'.

DESIGN

This was a cohort study using routinely collected secondary data.

SETTING

All three VMMC clinics of Mt Darwin district and Bulawayo province.

PRIMARY OUTCOME MEASURES

The proportion of 'successfully linked' was summarised as the percentage with a 95% CI. Adjusted relative risks (aRR) using a generalised linear model was calculated as a measure of association between client characteristics and 'not being linked'.

RESULTS

Of 1773 young people registered for VMMC services, 1478 (83%) were referred for ASRH services as they had not registered for ASRH previously. Of those referred for ASRH services, the mean (SD) age of study participants was 13.7 (4.3) years and 427 (28.9%) were out of school. Of the referred, 463 (31.3%, 95% CI: 30.0 to 33.8) were 'successfully linked' to ASRH services and the median (IQR) duration for linkage was 6 (0-56) days. On adjusted analysis, receiving referral from Bulawayo circumcision clinic (aRR: 1.5 (95% CI: 1.3 to 1.7)) and undergoing circumcision at outreach sites (aRR: 1.2 (95% CI: 1.1 to 1.3)) were associated with 'not being linked' to ASRH services.

CONCLUSION

Linkage to ASRH services from VMMC is feasible as one-third VMMC clients were successfully linked. However, there is need to explore reasons for not accessing ASRH services and take corrective actions to improve the linkages.

Bleeding Management Practices of Australian Cardiac Surgeons, Anesthesiologists and Perfusionists: A Cross-Sectional National Survey Incorporating the Theoretical Domains Framework (TDF) and COM-B Model

Purpose

Excessive bleeding is an acknowledged consequence of cardiac surgery, occurring in up to 10% of adult patients. This clinically important complication leads to poorer patient outcomes. Clinical practice guidelines are available to support best practice however variability in bleeding management practice and related adverse outcomes still exist. This study had two objectives: 1) to gain insight into current bleeding management practice for adult cardiac surgery in Australia and how that compared to guidelines and literature; and 2) to understand perceived difficulties clinicians face implementing improvements in bleeding management.

Methods

A national cross-sectional questionnaire survey was utilized. Perspectives were sought from cardiac surgeons, cardiac anesthesiologists and perfusionists. Thirty-nine closed-ended questions focused on routine bleeding management practices to address pre and intra-operative care. One open-ended question was asked; “What would assist you to improve bleeding management with cardiac surgery patients?” Quantitative data were analysed with SPSS. Qualitative data were categorized into the domains of the Theoretical Domains Framework; the domains were then mapped to the COM-B model.

Results

Survey responses from 159 Anesthesiologists, 39 cardiac surgeons and 86 perfusionists were included (response rate 37%). Four of the recommendations queried in this survey were reported as routinely adhered to < 50% of the time, 9 queried recommendations were adhered to 51–75% of the time and 4 recommendations were routinely followed >76% of the time.

Conclusion

There is a wide variation in peri-operative bleeding management practice among cardiac anaesthesiologists, surgeons and perfusionists in Australian cardiac surgery units. Conceptualizing factors believed necessary to improve practice with the TDF and COM-B model found that bleeding management could be improved with a standardized approach including; point of care diagnostic assays, a bleeding management algorithm, access to concentrated coagulation factors, cardiac surgery specific bleeding management education, multidisciplinary team agreement and support, and an overarching national approach.

Designing an intervention to improve sexual health service use among university undergraduate students: a mixed methods study guided by the behaviour change wheel

Introduction

University undergraduate students are within the population at highest risk for acquiring sexually transmitted infections, unplanned pregnancy, and other negative health outcomes. Despite the availability of sexual health services at university health centres, many students delay or avoid seeking care. In this study, we describe how the Behaviour Change Wheel was used as a systematic approach to design an intervention to improve sexual health service use among university undergraduate students.

Methods

This paper describes the intervention development phase of a three-phased, sequential explanatory mixed methods study. Phases one and two included a quantitative and qualitative study that aimed to better understand students’ use of sexual health services. In phase three, we followed the Behaviour Change Wheel to integrate the quantitative and qualitative findings and conduct stakeholder consultation meetings to select intervention strategies, including intervention functions and behaviour change techniques.

Results

Key linkages between opportunity and motivation were found to influence students’ access of sexual health services. Stakeholders identified six intervention functions (education, environmental restructuring, enablement, modelling, persuasion, and incentivization) and 15 behaviour change techniques (information about health consequences, information about social and environmental consequences, feedback on behaviour, feedback on outcomes of behaviour, prompts/cues, self-monitoring of behaviour, adding objects to the environment, goal setting, problem solving, action planning, restructuring the social environment, restructuring the physical environment, demonstration of the behaviour, social support, credible source) as relevant to include in a toolbox of intervention strategies to improve sexual health service use.

Conclusions

This study details the use of the Behaviour Change Wheel to develop an intervention aimed at improving university students’ use of sexual health services. The Behaviour Change Wheel provided a comprehensive framework for integrating multiple sources of data to inform the selection of intervention strategies. Stakeholders can use these strategies to design and implement sexual health service interventions that are feasible within the context of their health centre. Future research is needed to test the effectiveness of the strategies at changing university students’ sexual health behaviour.