Linking patient-centered communication with cancer information avoidance: The mediating roles of patient trust and literacy

OBJECTIVES

This study, drawing on the pathway mediation model developed by Street and his colleagues (2009) that links communication to health outcomes, explores how patient-centered communication affects cancer information avoidance.

METHODS

Data was gathered through online access panel surveys, utilizing stratified sampling across Germany, Switzerland, the Netherlands, and Austria. The final sample included 4910 non-cancer and 414 cancer patients, all receiving healthcare from clinicians within the past year.

RESULTS

The results demonstrated that patient-centered communication is directly associated with reduced cancer information avoidance, especially among cancer patients. Additionally, this association is indirectly mediated through patient trust and healthcare literacy.

CONCLUSION

The findings provide empirical evidence that reveals the underlying mechanism linking clinician-patient communication to patient health information behavior.

PRACTICE IMPLICATIONS

The potential of clinician-patient communication in addressing health information avoidance is highlighted by these findings. Future interventions in healthcare settings should consider adopting patient-centered communication strategies. Additionally, improving patient trust and literacy levels could be effective in reducing cancer information avoidance.

Medication safety perceptions in China: Media exposure, healthcare experiences, and trusted information sources

OBJECTIVE

Amid ongoing medication safety concerns in China and limited research on public perceptions, this study investigates the correlations between media exposure, healthcare experiences, and individuals' perceptions of medication safety. It also examines individuals' reliance on information sources during safety crises.

METHODS

A multistage stratified random sampling was employed with the gross sample containing 3090 Chinese adults aged 18-60 years. Data were analyzed using multiple linear regression.

RESULTS

Social media exposure was found to negatively correlate with perceptions of current medication safety and its perceived improvement, while exposure to television and print media showed positive correlations. Positive healthcare experiences were associated with improved medication safety perceptions. Among various information sources, healthcare professionals were deemed most trustworthy during medication safety incidents.

CONCLUSIONS

Media exposure and personal healthcare experiences significantly shape individuals' perceptions of medication safety in China, with healthcare professionals playing a crucial role in this context. Practiceimplications: Effective health crisis communication in China needs to be multifaceted, integrating traditional media and social media platforms to disseminate accurate information broadly. Additionally, healthcare professionals should be actively involved in crisis communication. Their role as trusted sources can be leveraged to clarify misconceptions, and reassure the public during medication safety incidents.

Linguistic and (micro)cultural differences in the global debate about re-naming 'schizophrenia': A mixed-methods survey from Switzerland

BACKGROUND AND HYPOTHESIS

This survey explores Swiss mental health professionals', users', and relatives' opinions on re-naming schizophrenia exploiting Switzerland's specific multilingualism to examine possible effects of linguistic and microcultural differences on the issue.

STUDY DESIGN

Opinions on 'schizophrenia' were collected using a self-rated online questionnaire incl. Freetext answers available in the three main Swiss languages, German, French and Italian. It was distributed to the main professional and self-help organizations in Switzerland between June and October 2021.

STUDY RESULTS

Overall, 449 persons completed the questionnaire, 263 in German, 172 in French and 14 in Italian. Of the total sample, 339 identified as mental health professionals, 81 as relatives and 29 as users. Considering the whole sample, almost half favored a name-change with a significant difference between stakeholder- and between language groups. Also, the name 'schizophrenia' was evaluated more critically than the diagnostic concept. Qualitative analysis of freetext answers showed a highly heterogenous argumentation, but no difference between language groups.

CONCLUSIONS

Our results suggest the attitude towards re-naming might itself be subject to (micro)cultural difference, and they highlight the nature of 'schizophrenia' as not only a scientific, but also a linguistic and cultural object. Such local factors ought to be taken into consideration in the global debate.

The Impact of COVID-19 and Exposure to Violent Media Content on Cyber Violence Victimization Among Adolescents in South Korea: National Population-Based Study

BACKGROUND

Because of the COVID-19 pandemic and consequent stay-at-home mandates, adolescents faced isolation and a decline in mental health. With increased online activity during this period, concerns arose regarding exposure to violent media content and cyber victimization among adolescents. Yet, the precise influence of pandemic-related measures on experiences of cyber violence remains unclear. Hence, it is pertinent to investigate whether the pandemic altered the dynamics of cyber violence victimization for individuals.

OBJECTIVE

This study aims to investigate the effects of COVID-19 and exposure to violent media content on cyber violence victimization among adolescents in South Korea.

METHODS

We used national survey data from 2019 (n=4779) and 2020 (n=4958) to investigate the potential impact of COVID-19 on the prevalence of cyber violence among young adolescents. The data encompassed responses from elementary fourth-grade students to senior high school students, probing their exposure to violent media content, average internet use, as well as experiences of victimization and perpetration.

RESULTS

The analysis revealed a noteworthy decline in cyber victimization during 2020 compared with 2019 (B=-0.12, t=-3.45, P<.001). Furthermore, being a perpetrator significantly contributed to cyber victimization (B=0.57, t=48.36, P<.001). Additionally, younger adolescents (β=-.06, t=-6.09, P<.001), those spending more time online (β=.18, t=13.83, P<.001), and those exposed to violent media (β=.14, t=13.89, P<.001) were found to be more susceptible to victimization.

CONCLUSIONS

Despite the widespread belief that cyber violence among adolescents surged during COVID-19 due to increased online activity, the study findings counter this assumption. Surprisingly, COVID-19 did not exacerbate cyber victimization; rather, it decreased it. Given the strong correlation between cyber victimization and offline victimization, our attention should be directed toward implementing real-life interventions aimed at curbing violence originating from in-person violence at school.

Electronic Health Literacy Among Baby Boomers: A Typology

BACKGROUND

Forecasts suggest that older adults will place unprecedented demands on future health care systems. Electronic health (eHealth) resources can potentially mitigate some pressures, but to be effective patients need to be able to use them. The negative relationship between eHealth literacy and age usually results in older adults classified as one homogenous mass, which misses the opportunity to tailor interventions.

OBJECTIVE

This research examines similarities and differences within the baby boom cohort among a sample that uses the internet for health information.

METHODS

We used an electronic survey with random samples of baby boomers (N = 996) from the United States, the United Kingdom, and New Zealand.

KEY RESULTS

Four distinct subgroups, or segments, emerged. While not different from a socioeconomic perspective, these four groups have very different levels of eHealth literacy and corresponding health behaviors. Therefore, we contribute a more complex picture than is usually presented in eHealth studies.

CONCLUSIONS

Resulting insights offer a useful starting point for providers wishing to better tailor health products, services, and communications to this large cohort of future older individuals. [HLRP: Health Literacy Research and Practice. 2024;8(1):e3-e11.].

Unlocking the brain secrets of social media through neuroscience

Neuroscientific buzzwords, such as 'brain hacks', have become commonplace when discussing social media (SM)-platform engineering. Despite societal debates, few studies have used neuroscientific approaches to validate the claims empirically. We call here for a transformative shift engaging scientists and other stakeholders to address this critical knowledge gap.

Modeling the influence of attitudes, trust, and beliefs on endoscopists' acceptance of artificial intelligence applications in medical practice

Introduction

The potential for deployment of Artificial Intelligence (AI) technologies in various fields of medicine is vast, yet acceptance of AI amongst clinicians has been patchy. This research therefore examines the role of antecedents, namely trust, attitude, and beliefs in driving AI acceptance in clinical practice.

Methods

We utilized online surveys to gather data from clinicians in the field of gastroenterology.

Results

A total of 164 participants responded to the survey. Participants had a mean age of 44.49 (SD = 9.65). Most participants were male (n = 116, 70.30%) and specialized in gastroenterology (n = 153, 92.73%). Based on the results collected, we proposed and tested a model of AI acceptance in medical practice. Our findings showed that while the proposed drivers had a positive impact on AI tools' acceptance, not all effects were direct. Trust and belief were found to fully mediate the effects of attitude on AI acceptance by clinicians.

Discussion

The role of trust and beliefs as primary mediators of the acceptance of AI in medical practice suggest that these should be areas of focus in AI education, engagement and training. This has implications for how AI systems can gain greater clinician acceptance to engender greater trust and adoption amongst public health systems and professional networks which in turn would impact how populations interface with AI. Implications for policy and practice, as well as future research in this nascent field, are discussed.

How Physicians Tackle Internet-Misinformed Patients: Going Beyond Traditional Patient-Centered Communication - A Study Protocol

Background

The proliferation of misleading and irrelevant health information on the Internet has become a significant public concern. Inappropriate use of online materials can cause harm to patients' health and quality of life. While close attention has been paid to health campaigns and education programs that aim to disseminate accurate health knowledge, the role of physicians, who directly communicate with patients in medical encounters and provide personalized information, has been overlooked. Therefore, this study focuses on physicians and their communication strategies with internet-misinformed patients (IMPs).

Objective

This study aims to understand the communicative strategies physicians use to tackle IMPs and explore connections between physicians' communicative strategies and patient-centered communication.

Methods

Approximately 10 to 15 physicians from diverse cultural backgrounds, including Ticino (an Italian-speaking region in Switzerland), Milan and China will be interviewed. Interviews will be conducted in-person or online through video conferencing software programs. Physicians will be asked about their experiences with IMPs, communicative strategies for addressing patients' misconceptions, balancing patient preferences, decision-making obstacles, and envisioning an ideal relationship with them. A thematic analysis will be utilized to analyze data, employing a general inductive approach.

Discussion

The results will provide valuable insights into effective clinical communication strategies that address patients' misuse of internet materials and inform policymakers and healthcare providers about the limitations and applicability of patient-centered communication in the current digital era.

Childhood fever and medical students: A multicentre, educational intervention

AIM

Misconceptions and non-evidence-based practices toward childhood fever are reported worldwide. Medical students might be ideal candidates to introduce long-lasting changes in clinical practice. However, no study has gauged the effectiveness of an educational intervention to improve fever management in this population. We conducted an educational, interventional study on childhood fever among final-year medical students.

METHODS

We conducted a prospective, multicentre interventional study employing a pre/post-test design. Participants from three Italian Universities filled in a questionnaire just before the intervention (T0), immediately after (T1) and 6 months later (T2) in 2022. The intervention was a two-hour lecture focused on the pathophysiology of fever, recommendations for its treatment and risks associated with improper management.

RESULTS

188 final-year medical students (median age of 26 years, 67% females) were enrolled. Relevant improvements in the criterion for treating fever and conceptions about the beneficial effects of fever were observed at T1 and T2. Similar data were found for the reduction of physical methods advice to decrease body temperature and concerns for brain damage from fever.

CONCLUSION

This study shows for the first time that an educational intervention is effective in changing students' conceptions and attitudes toward fever both in the short and medium term.

"What does not kill you… mutates and tries again." A study on personality determinants of post-traumatic growth during the COVID-19 pandemic

Introduction. The COVID-19 pandemic was recognized as a collective trauma and as a major threat to mental health. Recent literature focused on the stress symptomatology or post-traumatic stress disorder associated to the COVID-19 exposure. The concept that people have a natural inclination toward growth, even under stressful and threatening events, gathered less attention. Previous research has analyzed antecedents of post-traumatic growth (PTG) with non-conclusive results. Methods. The present research aimed at including findings on PTG from personality traits, i.e., sense of control and self-mastery, and distal condition of nurturance and support received by others, i.e., cognitive and affective well-being. Analyses were based on 4934 interviews with adults (Mage = 57.81 years, 55.5% women) from the Swiss Household Panel study. Results. Relationships over time emerged between sense of control and self-mastery on PTG and worries, measured after two years, via the mediation of cognitive and affective well-being. Conclusion. Results come from a large study in a design seldom employed in this type of research and can inform both research and interventions.

Vitamin D Supply of Multivitamins Commercialized Online by Amazon in Western and Southern Europe: A Labeling Analysis

Multivitamins are commonly used by the general population, often without medical prescription. The purpose of this report is to inform on the daily vitamin D supply provided by multivitamins containing vitamin D that are commercialized online by Amazon in Western and Southern Europe. We surveyed multivitamins aimed at adults using the following marketplaces: amazon.es®, amazon.de®, amazon.it®, and amazon.fr®. We identified 199 vitamin D3-containing multivitamins sold by Amazon marketplaces: 77 from amazon.es®, 73 from amazon.de®, 33 from amazon.it®, and 16 from amazon.fr®. No multivitamin contained vitamin D2. The daily vitamin D3 supply ranged from 16 to 2000 IU: it was less than 400 IU daily in 108 (54%), 400−800 IU daily in 53 (27%), and more than 800 IU daily in the remaining 38 (19%) products. The vitamin D3 supply of products sold by amazon.it® was on average higher (p < 0.05) than that of products sold by amazon.de®, amazon.fr®, and amazon.es®. In conclusion, the vitamin D supply of multivitamins sold by Amazon may be insufficient, marginally sufficient, or adequate for subjects at high risk of hypovitaminosis D such as subjects 65 years or more of age, pregnant (or lactating) women, or patients on drug treatment or with an underlying disease, where a vitamin D supplementation is advocated.

Perceived COVID-19 susceptibility and preventive behaviors: moderating effects of social support in Italy and South Korea

BACKGROUND

The COVID-19 pandemic hit Italy much harder than South Korea. As a way of explaining the different impact in the two countries, this study examines the moderating role of social support on the relationship between perceived susceptibility and preventive behaviors in the two countries.

METHODS

Surveys were conducted in South Korea (n = 1396) and Italy (n = 487) of participants aged 50 to 89 years.

RESULTS

South Koreans felt higher levels of perceived social support than their Italian counterparts. As would be expected, greater perceived susceptibility was associated with increased preventive behavior. Furthermore, a significant three-way interaction effect was found for perceived susceptibility, social support, and country. For Italians, a person who feels him/herself highly susceptible will increase preventive behaviors, if there is a lot of social support. On the other hand, for South Koreans, those with a low level of susceptibility perform more preventive measures than people with a high level of susceptibility if there is a lot of social support.

CONCLUSIONS

This study provides insights into how cognitive factors, such as susceptibility and severity, as well as social and environmental factors can be taken into account, and the public be told the real risk and given behavioral guidelines when a pandemic is approaching. Given the critical role of social support as a coping mechanism in crisis situations, societies should mull over ways to increase emotional and instrumental support.

Perception, knowledge and attitude towards childhood fever: A survey among final-year medical students

AIMS

Undue concerns about the consequences of fever and its inappropriate management have been documented worldwide among physicians. However, no data exist on medical students. We investigated the perception, knowledge and attitude towards childhood fever among final-year medical students.

METHODS

Between June and September 2021, final-year medical students of six Italian universities were invited to complete an online survey on their conceptions and attitude towards pharmacological and non-pharmacological management of childhood fever. History of relevant personal or second-hand experience with childhood fever was also addressed. Both quantitative and qualitative approaches were used.

RESULTS

Of 1095 (69%) final-year medical students, 756 completed the survey. Many students believe that high fever might cause brain damage, would recommend physical methods and alternate two drugs for fever. Most students do not think that fever has mainly beneficial effects. In Northern Italy, students are less likely to believe that fever might lead to brain damage (OR 0.55, 95% CI 0.33-0.94), and in Southern Italy students are more likely to advise physical methods (OR 1.77, 95% CI 1.22-2.57) and less likely to believe that fever has mainly beneficial effects (OR 0.55, 95% CI 0.39-0.77). History of a relevant personal episode of fever during childhood was not associated with these outcomes.

CONCLUSIONS

Misconceptions about fever are common among final-year medical students in Italy. Cultural factors rather than individually learned traits might underlie these beliefs. Medical students are a promising target for educational interventions to improve childhood fever management.

New insights into fever phobia: a pilot qualitative study with caregivers and their healthcare providers

Despite the availability of clinical guidelines on the correct symptomatic management of fever in children, several studies have reported inaccurate knowledge about this symptom and inappropriate management behaviours among caregivers. There is evidence that caregivers' management of fever is largely influenced by unrealistic and unwarranted concerns about the potential harm that elevated body temperature can cause, a phenomenon commonly referred to as fever phobia. Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the influence of the relationship between caregivers and the healthcare team. The aim of this pilot study was to explore and describe fever-related knowledge, experience and behaviour among a sample of caregivers, paediatricians and their medical assistants in the Canton of Ticino, Switzerland. We used a qualitative study design with semi-structured, one-to-one interviews with paediatricians employed in private healthcare facilities, their medical assistants and caregivers with at least one child between the ages of 0 and 3 years. We conducted individual interviews either in person or by phone, according to participants' preferences, between October 2020 and February 2021. We performed an inductive-deductive analysis of the transcripts to identify the most meaningful themes from participants' reports. The analysis of the transcripts yielded three main themes. The first theme refers to participants' awareness of the emotional component in managing the child's fever and the challenges this component presents. The second theme refers to the risk of overtreating when the child's right to be sick is not recognized and respected. The third theme refers to the importance of the relational component, showing how a solid therapeutic alliance with the healthcare team helps caregivers develop self-confidence in managing the child's fever. This study contributes to advance our understanding of fever phobia and to a better conceptualization and operationalization of this phenomenon.

CONCLUSION

Our results point out to the importance of going beyond a knowledge gap paradigm and recognizing both the emotional and the relational component of fever phobia, the former being entrenched in latter, that is, the unique relationship caregivers establish with their child's paediatrician and the medical assistant.

WHAT IS KNOWN

• Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the relational component of this phenomenon.

WHAT IS NEW

• Our results point out to the importance of recognizing the emotional component of fever phobia, beyond its declarative and procedural knowledge dimensions. They also suggest that overtreating is not necessarily and not only the result of a phobia but also of a particular conception of health and the relational component of this phenomenon, which is entrenched in the unique relationship caregivers establish with their child's paediatrician and the medical assistant.

Effects of Perceived School Rule Enforcement on Traditional and Cyber Victimization: A Panel Study among Early Adolescents

Traditional and cyber victimization can be considered similar in several respects, including the long-lasting damage done to the wellbeing of youth. However, it is important to acknowledge that they represent two clearly distinct phenomena and, as such, the impact of school rules on their development might differ. The present longitudinal study applies a multilevel model for a change approach to data resulting from a four-waves survey that followed a random sample of 101 Swiss middle school classes (N = 1500; M_ageT1 = 11.54, SD = 0.40) for a period of two school years. Findings from the analyses-which were conducted controlling for gender and economic status-showed that those students who perceive that school rules are implemented more consistently experience a slightly less steep increase in victimization online. A similar effect for traditional victimization was not found, probably because the observed change in this phenomenon was less. Considering the overall small effects found by this research, further investigation on the relation between school rule enforcement and peer victimization is recommended.

Social capital and health information seeking in China

Background

People’s potentials to seek health information can be affected by their social context, such as their social networks and the resources provided through those social networks. In the past decades, the concept of social capital has been widely used in the health realm to indicate people’s social context. However, not many such studies were conducted in China. Chinese society has its special quality that many Western societies lack: people traditionally render strong value to family relations and rely heavily on strong social ties in their social life. Therefore, the purpose of this study was to examine the association between different types of social capital and health information-seeking behavior (HISB) in the Chinese context. The different types of social capital were primarily bonding and bridging, as well as cognitive and structural ones.

Methods

Our analysis is based on a total of 3090 cases taken from the Health Information National Trends Survey (HINTS) – China, 2017. Dataset was weighted due to the overrepresentation of female respondents and hierarchical multiple regression analyses as well as binary logistic regression tests were operated to examine the associations between people’s social capital and their HISB.

Results

Some aspects of social capital emerged as positive predictors of HISB: information support (standing in for the cognitive component of social capital) promoted health information seeking, organization memberships (standing in for the structural component) encouraged cancer information seeking, and both the use of the internet and of traditional media for gaining health information were positively linked with bridging networks and organization memberships. Bonding networks (structural component) were not correlated with any other of the key variables and emotional support (cognitive social capital) was consistently associated with all health information-seeking indicators negatively.

Conclusions

Social capital demonstrated significant and complex relationships with HISB in China. Structural social capital generally encouraged HISB in China, especially the bridging aspects including bridging networks and organization memberships. On the other hand, emotional support as cognitive social capital damaged people’s initiatives in seeking health-related information.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13895-2.

Parent-child Communication, Social Norms, and the Development of Cyber Aggression in Early Adolescence

To understand the development of cyber aggression during adolescence, it is important to consider the temporal variability of its potential predictors. This study uses a four-wave survey to investigate how changes in peer norms, parental norms, and parental communication are associated with two-year trajectories of online peer aggression. The sample includes 1521 Swiss middle school students (M_age T1 = 11.54, SD = 0.40; 48% female). The results showed that over time a better parental communication quality and anti-aggression norms predicted lower rates and slower development of cyber aggression. Moreover, parental variables emerged as a quite stable deterrent of aggressive conduct. Although entrance into adolescence is characterized by the rise of peer influence, results from this study suggest that parents maintain an important protective role.

The right pick: Does a self-assessment measurement tool correctly identify health care consumers with inadequate health literacy?

OBJECTIVES

The aim of this study was to investigate whether a self-report measurement instrument (the Brief Health Literacy Screen, BHLS) correctly identifies healthcare consumers with inadequate health literacy. The yardstick for assessing the tool was the Newest Vital Sign (NVS).

METHODS

The study used baseline data from the Västerbotten Intervention Programme - VIsualiZation of Asymptomatic Atherosclerotic disease for Optimum Cardiovascular Prevention (VIPVIZA), a randomized controlled trial that is nested within the Västerbotten Intervention Program (VIP) in Sweden. Our analyses were computed on a subsample of 460 persons who underwent the measure of both health literacy scales. ROC analysis was used for the crucial computations.

RESULTS

The potential of the BHLS to identify healthcare consumers with inadequate health literacy remained unsatisfying for the complete sample, but reached an acceptable level for women and persons with only basic education.

CONCLUSIONS

The relationship is somewhat weaker than in comparable research in various other European countries. The differences might partly have been caused by the use of self-perception questions. Self-delusions, invariably a part of self-perception, may have affected the respective measure.

PRACTICE IMPLICATIONS

Caution is advised when patients' health literacy is assessed by only a few questions for self-report.

Dynamics of adolescents' smartphone use and well-being are positive but ephemeral

Well-being and smartphone use are thought to influence each other. However, previous studies mainly focused on one direction (looking at the effects of smartphone use on well-being) and considered between-person effects, with self-reported measures of smartphone use. By using 2548 assessments of well-being and trace data of smartphone use collected for 45 consecutive days in 82 adolescent participants (Mage = 13.47, SDage = 1.62, 54% females), the present study disentangled the reciprocal and individual dynamics of well-being and smartphone use. Hierarchical Bayesian Continuous Time Dynamic Models were used to estimate how a change in frequency and duration of smartphone use predicted a later change in well-being, and vice versa. Results revealed that (i) when participants used the smartphone frequently and for a longer period, they also reported higher levels of well-being; (ii) well-being positively predicted subsequent duration of smartphone use; (iii) usage patterns and system dynamics showed heterogeneity, with many subjects showing reciprocal effects close to zero; finally, (iv) changes in well-being tend to persist longer than changes in the frequency and duration of smartphone use.

Unfolding Media Source Characteristics Regarding Food Fraud Misinformation: A Comparative Study of the Health Information National Trends Survey (HINTS) in China

BACKGROUND

The ongoing rumors and fake news regarding food fraud, adulteration, and contamination are highly visible. Health risk information circulating through media and interpersonal communication channels has made health crisis an important research agenda.

OBJECTIVE

This study explores the issue of food fraud and the effect of rumors, incidents, and misinformation. Further, it studies whether and how these issues have provided evidence-based interventions for food handlers and regulators to mitigate food fraud misinformation.

METHODS

The Health Information National Trends Survey (HINTS) was adopted for collaborative study in China, after which a cross-sectional survey with door-to-door interviews was performed. Participants from Beijing and Hefei were selected using multistage sampling of adults during May, 2017. Based on four government surveillance reports on food rumors and safety incidents, a descriptive, correlation, and multivariate variance analysis was applied to the data.

RESULTS

A total of 3,090 results were gathered and analyzed. An average of 83.6% (n = 2,584) respondents heard at least one food rumor. Learning about food fraud is correlated with interpersonal connections (e.g., doctors or health specialists) for accessing food health information. Overall, Chinese citizens with a higher level of interpersonal connection were more likely to be concerned about food incidents with the statistical difference (P< .001). The Interpersonal connection was the highest frequency of communication sources (n = 698, 55.7%), followed by traditional media (n = 325, 25.9%) and Internet portal (n = 144, 11.5%). There was a significant relationship between media use and media category in Beijing (P<.001) and in Hefei (P<.001). Overall, Beijing's responses to the food fraud and incidents risks were lower than in Hefei (P < .01). The respondents in Beijing were confronted more frequently by food rumors (range 346-1253) than those in Hefei (range 155-946). The urban dwellers in Beijing and their rural counterparts in Hefei also differ in terms of perceiving different levels of food risk from different media sources. The food rumor narratives examined the conspiracy belie finds that social media play a more important role in influencing attitude against misinformation for users in Hefei, rather than in Beijing.

CONCLUSIONS

A media complementarity and food fraud information acquisition examined food fraud rumors and incidents with intent to harm, mainly done for economic gain. The HINTS China reports that around 73.6% out of 2,584 Chinese respondents prefer to go to their physicians for quarrying food health information first; however, when asked where they actually went and got access to food rumors, up to 36.6% of out of 1,462 Beijing respondents and 55.6% out of 1,122 Hefei respondents reported going online first. This study extends beyond local food products to foreign countries that import conspiracy beliefs with fake food. Nonetheless, consumers have to be on guard not just against fake food, but also spreading fake information and rumors about food. The aim of this study is to focus on characterizing media sources, types of food fraud misinformation, and risk perception of food safety, which mixes urgency and suspicions, and to provide evidence-based interventions for risk management guidance, with the hypotheses of the significant correlations between media types and sources and consumers' exposing and perceiving levels of food rumors and risks.

CLINICALTRIAL

Unsusceptible to Social Communication? The Fixture of the Factors Predicting Decisions on Different Vaccinations

Protection Motivation Theory (PMT) holds that individuals under threat base their protection decisions on threat and coping appraisals. In the case of preventable communicable diseases, the theory holds that motivation for vaccination will be higher the more alarming a person's threat appraisals and the more promising her coping appraisals are. This study aims at describing how the influence model of PMT accommodates different changes and conditions: the addition of new factors such as knowledge, health literacy, and attitudes, and the inclusion of several highly similar threats in the form of different communicable diseases. The question raised is: Do people, when making vaccination decisions, think of vaccination as a unified entity or as separate units? In the first case, they would show similar factors across different vaccinations, probably thinking of the common biomedical functioning of vaccination. In the latter case, the predictors would change from vaccination to vaccination, and people might have different treatments of the subject in public communication on their minds. Data came from a representative survey among adult Swiss residents. Among the results are the following: PMT is affirmed; people show a unified way of determining their motivation to vaccinate; knowledge contributes strongly to protection motivation; and neither public discussion of threats nor experiences among acquaintances shows much of an impact.

A longitudinal application of the Actor Partner Interdependence Model extended Mediations to the health effects of dyadic support

Supportive communicative experiences within close relationships, such as dyadic support, have a protective effect on individuals’ health and emotional well-being. However, little is known about how partners interact in determining their own and others’ health or the mechanisms through which dyadic support influences physical health. We addressed those gaps by studying 1088 romantic couples from three consecutive years (T1, T2, T3; Swiss Household Panel). The study applied a data analysis strategy called Actor Partner Interdependence Model extended Mediation, which allows for mediation processes while considering the interdependence, or non-independence, of data coming from partners. Results showed that dyadic support was positively associated with perceived health over two years through the mediation of optimistic attitudes and depressive mood, both for person and partner effects. The present study demonstrates the interplay between the dyadic process and personality dispositions in maintaining good health.

Generation Gaps in Digital Health Literacy and Their Impact on Health Information Seeking Behavior and Health Empowerment in Hungary

Background: Today the internet is a major source of health information, and younger generations have more confidence in their digital information seeking skills and awareness of online resources than older generations. Older generations, however, are more in demand of health services. The aim of our study was to explore these generational differences as related to self-perceived eHealth literacy and health care system utilization.

Methods: A cross-sectional survey study with 522 subjects was done in Hungary. Every subject belonged to one of four generations (Baby boomers, X, Y, and Z). The Web-based survey was designed and tested in English-speaking countries and translated into Hungarian for the present study. Variables include Internet health information seeking, eHealth literacy (measured by eHeals score), the self-perceived gain in empowerment by that information, and the number of health care appointments. One-way ANOVA was used for comparing the scores of the generations, and correlational and linear regression analysis was employed within the generations for further data analysis.

Results: We found significant differences among the generations in eHealth literacy as well as in the self-perceived gain in empowerment: while Boomers were the generation with the lowest eHeals scores, they showed the highest empowerment. Internet health information seeking behavior showed no differences. While subjects who use the Internet more frequently to search for health information have worse self-rated health status, the ones with higher eHeals scores report better subjective health status. We also identified the associations of the above variables within the older generations (Boomers and X) with the frequency of using health-care services: within the generation of Boomers the number of health care appointments was only associated with Internet health information seeking, while in Generation X with eHeals.

Conclusions: Baby boomers seek Internet health information as often as the younger generations, which provides a solid motivation for developing their eHealth literacy skills. We find it crucial to plan the Hungarian health promotion programmes utilizing this high frequency of Internet health information seeking, since the eHealth literacy skills of older generations have an effect on their subjective health status, and they are the most capable of applying information in making decisions.

Effects of Self-Mastery on Adolescent and Parental Mental Health through the Mediation of Coping Ability Applying Dyadic Analysis

Evidence demonstrated that self-mastery and coping ability predict mental health in adults and children. However, there is a lack of research analyzing the relationships between those constructs in parents and children. Self-report data from 89 dyads (adolescents’ mean of age = 14.47, SD = 0.50; parents’ mean of age = 47.24, SD = 4.54) who participated in waves 17, 18, and 19 (following T1, T2, and T3) of a nineteen-wave longitudinal study were analyzed using the Actor-Partner Interdependence Model’s extended Mediation. Results showed significant actor effects of parents’ and adolescents’ self-mastery (T1) on mental health (T3) and the mediator effect of their coping abilities in managing stress (T2). Both a higher parental education level and being a mother positively influenced adolescents’ coping ability. The mutually beneficial relationships between parents’ and adolescents’ self-mastery, coping ability, and mental health were not demonstrated. Self-mastery is a significant predictor of adolescents’ and parents’ mental health, and coping ability serves as a good mediator between them. Qualitative research may clarify reasons why partner effects in the model were found to be non-significant. Further research should re-test this model with a larger sample size during childhood, when parents provide significant behavioral models for their children—as well as in adolescence, considering the peer group—to develop guidelines for behavioral interventions.

Differentiating objective and subjective dimensions of social isolation and apprasing their relations with physical and mental health in italian older adults

Background

International research shows that social isolation is harmful for health, especially for the elderly. Its objective and subjective dimensions are important to distinguish as each stands in a different relation with health. The first aim of the present study is the validation of three scales measuring objective and subjective isolation in an Italian elderly population. The second aim is to analyze subjective and objective social isolation and to appraise their association with health among seniors.

Methods

This cross-sectional survey collected data from 306 over 65 s participants. Questionnaires were administered face-to-face by one author and encompassed: social disconnectedness scale; perceived isolation scale; abbreviated Lubben Social Network Scale; measures of general and mental health, and depression.

Results

The three scales measuring social isolation demonstrated acceptable psychometric properties and validity. Objective and subjective social isolation were not directly associated with physical health, whereas subjective isolation is strongly linked to worse mental health and depression. Higher level of subjective isolation was associated with lower level of physical health through the mediation of mental health. Subjective isolation served as a mediator in the relation between objective isolation and health. Moderation analysis demonstrated that low values of objective isolation predicted high values of mental health but only when subjective isolation was low. None of these relations were moderated by socio-demographic variables.

Conclusion

Subjective and objective isolation are clearly two separate dimensions and the scales validated in this paper showed to be potentially culturally invariant. Researchers should work to find instruments able to depict the complexity of the construct of social isolation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01864-6.

School policies and smoking intention in a Swiss sample of adolescents

The majority of today's adult smokers took up the habit during adolescence. The school community and the rules it imposes are important factors that can influence adolescents' smoking intention and behaviour. Research on the effect of school tobacco policies on adolescents' smoking concludes with mixed results. Our study aims to look at the influence of these policies on the intention to smoke and to know if this relation is mediated by individual and environmental factors. The study includes information on social norms, attitude towards smoking and smoking intention from 4515 students of 32 Ticino middle schools and on the tobacco policy implemented in this school. Linear regression indicates a marginal impact of school policy on intention to smoke. Schools that strongly enforce tobacco policy obtain an increase in their students' intention to smoke, while schools that implement assistance programmes to overcome tobacco use decrease intention to smoke. Mediation models show that the influence of some of tobacco policy dimensions on the intention to smoke is mediated by personal attitudes towards smoking, beliefs about health consequences of smoking and perceived peers smoking. Increasing visibility of tobacco policies and having tobacco prevention programmes have stronger positive effects on smoking intention than other policy dimensions, but only through the mediation of individual and environmental factors.

A reasoned action approach to understand vaccination intention among healthcare professions students

Background

Understanding the predictors of vaccination intention among healthcare workers, including students in healthcare professions (SHPs), is crucial for policy making and for the development of evidence-driven training programs. The reasoned action approach (RAA) model includes three components to predict intention: attitude (experiential/instrumental), perceived norm (injunctive/descriptive), and perceived behavioral control (capacity/autonomy). We aimed to investigate the predictors of seasonal Flu vaccination intention among SHPs of the University of Milan.

Methods

We spread an e-survey to all medical residents and first- and last-year SHPs (medicine, nursery, midwifery, healthcare assistance and prevention techniques). The strength of association between measures of RAA components (as well as sociodemographic data, past vaccination behavior, vaccination knowledge, and perceived vaccination facilitation strategies), and vaccination intention was estimated using uni- and multivariate logistic regression models.

Results

Among 5743 invited SHPs, 884 participated in the survey and were included in the descriptive analyses (52,3% medical residents, 19,9% medicine, 21,1% nursing, 3,6% healthcare assistance, 2,7% prevention techniques and 0,5% midwifery students). Twenty-nine psycho-attitudinal items with an overall Cronbach alpha &gt;0.7 were included in the analyses. The regression analyses were performed on 751 subjects who filled in completely the survey. Past vaccination behavior, vaccination knowledge, experiential attitudes, and perceived vaccination facilitation strategies were positive predictors of Flu vaccination intention (OR 8.16, 2.42, 1.96 and 1.15 respectively, p &lt; 0.05).

Conclusions

Our results indicated knowledge, experiential attitudes and facilitation strategies as modifiable predictors of vaccination intention among SHPs. Targeted and lasting interventions are needed in order to pursue a change in the strongest predictor, past vaccination behavior.

Key messages

Past vaccination is the strongest predictor of vaccination intention among students in healthcare professions. Knowledge, attitudes and perceived facilitators predict vaccine propensity among students in healthcare professions.

Online Newspaper Framing of Non-Communicable Diseases: Comparison of Mainland China, Taiwan, Hong Kong and Macao

As non-communicable diseases (NCDs) are now well recognized as the leading cause of mortality among adult populations worldwide, they are also increasingly the focus of media coverage. As such, the objective of this study is to describe the framing of NCDs in the coverage of newspapers, with the understanding that it says something about the society producing it. Automatic content analysis was employed to examine disease topics, risks, and cost consequences, thus providing lay people with a chance of learning the etiology of NCDs and information available for fighting diseases. The result of the computational method identified a total of 152,810 news articles with one of the seven supra-categories of NCDs. The category of metabolic diseases was covered most frequently in the past ten years. Three health risks received ample attention in all 11 newspapers: stress burden, tobacco use, and genetic predispositions. The results evidenced how media framed risk information of illnesses would distort the way in which diseases were selected, interpreted, and the outcome communicated. Future research building on our findings can further examine whether news framing affects the way the readers perceive and prevent NCDs.

Tackling the outcome bias related to the effectiveness of antibiotics against the common cold: results of a randomized controlled trial applying the Solomon four-group design

In recent years, antimicrobial resistance (AMR) has become an international public health priority. In the area of human medicine, the mis- and overuse of antibiotics is an important contributor to the development of AMR. Such a non-prudent use of antibiotics is especially prevalent in the treatment of viral infections such as the common cold. The present study aims to address the misconception, also known as outcome bias, that antibiotics may be an effective treatment against the common cold by providing a "debiasing" risk communication intervention. It aims at conveying the non-existence of a cause-effect relationship between antibiotics and the reduction of cold-related symptoms through a visual aid and simple explanatory text. A Solomon four-group design was employed to test for within- and between-subjects effects of the intervention as well as potential sensitization effects of the repeated measurement. A total of 311 participants residing in Germany were randomly assigned to receiving (1) a pretest, the debiasing intervention and post-test (2), a pretest, a control stimulus and post-test (3), the debiasing intervention and post-test, or (4) the post-test only. Outcome measures included knowledge about the effectiveness of antibiotics, the attitude toward using it as treatment against the common cold and the evaluation of a scenario describing an irresponsible use of antibiotics. Within-subjects comparisons found that participants receiving the pre- and post-test and intervention showed improved knowledge (t(77) = -2.53, p = .014), attitude (t(77) = -2.09, p = .040), and evaluation measures (t(77) = -2.23, p = .028). The pretest might, however, have caused a sensitization of participants for knowledge-related questions (t(77) = 2.207, p = .029). Between-subjects comparisons found differences in knowledge levels between the post-test only group and both groups receiving the intervention (F(3, 307) = 5.63, p = .001, η2p = .05]. There were no differences between the intervention and control groups with regard to attitude and evaluation of the scenario. While the risk communication intervention led to an increase in knowledge, the outcomes related to attitude and evaluation of a scenario were only affected positively in one group. Therefore, it seems that communication interventions based on visual aids are a simple method to promote the understanding of the true relationship between antibiotic treatment and the decrease of cold-related symptoms. Variables such as attitude and evaluation of a scenario presenting the irresponsible use of antibiotics require, however, additional interventions facilitating a translation of accurate understanding into respective attitudes and judgments.

Mammography perceptions and practices among women aged 30-49: The role of screening programme availability and cultural affiliation

OBJECTIVE

To explore the role of systematic screening programme availability and cultural affiliation as drivers of mammography perceptions/practices among women aged 30-49, who are not eligible for screening.

METHODS

Cross-sectional survey about mammography perceptions/practices among N = 918 Swiss women (30-49), across three cultural-linguistic regions (Swiss-German, Swiss-French, Swiss-Italian) and 26 cantons.

RESULTS

In cantons offering systematic screening programmes, women appeared more likely to ask for a mammogram, felt more susceptible to breast cancer, and perceived more benefits to screening. Swiss-German women engaged less in screening and felt less susceptible to breast cancer than women in other cultural-linguistic regions. Within the Swiss-German region, women living in cantons with programmes were more likely to ask for a mammogram than in cantons without.

CONCLUSIONS

Programme availability and cultural affiliation both appear related to young women's screening perceptions/practices. While the interaction between these factors should be further explored, this study provides some preliminary evidence that cultural affiliation is the more important driver.

PRACTICE IMPLICATIONS

Health communication efforts should consider the impact of these drivers on women's intentions to have a mammogram, prior to the recommended age. Tailored communication - public and interpersonal - should be directed towards facilitating informed decision-making and avoidance of mammography overuse.

Measuring functional health literacy in Hungary: Validation of S-TOFHLA and Chew screening questions

OBJECTIVES

The first efforts to measure health literacy have recently started in Hungary, thus there remains a need for tools that can be effectively used in the clinical setting. The goal of the present study was two-fold: to validate tools for measuring functional health literacy in Hungary using the Short Test of Functional Health Literacy (S-TOFHLA) and the Chew screening measure, and to provide an overview of the health literacy level of the Hungarian population.

METHODS

The original English versions of both instruments were translated following the principles of cultural adaptation and standardized translation methods. The measures were administered to a random sample (N = 302) that was close to representative of the Hungarian population regarding age, gender and educational background. The Newest Vital Sign functional health literacy test and numerous socio-demographic variables (such as age, gender, education and income) were also administered to test convergent validity.

RESULTS

The Hungarian version of the S-TOFHLA and the Chew questions showed adequate internal consistency. Lower functional health literacy scores showed the expected association with known predictors of health literacy: higher age, male gender and lower education. Especially people above 65 years of age and individuals with a low level of educational attainment or being chronically ill are vulnerable to have marginal health literacy.

CONCLUSION

The Hungarian version of the S-TOFHLA is a valid and reliable measure of health literacy. Moreover, the Hungarian version of the Chew screening questions provides a valid self-reported assessment, which is particularly useful to rapidly detect patients with inadequate health literacy in hospitals. It is expected that these health literacy measurements will be used for not only scientific purposes, but also serve as tools for developing public health policy, especially health education and campaigns reducing potential health disparities in Hungary.

Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk

Aims

Health literacy, the degree to which individuals understand and act upon health information, may have a pivotal role in the prevention of cardiovascular disease (CVD), with low health literacy potentially explaining poorer adherence to prevention guidelines. We investigated the associations between health literacy, ultrasound-detected carotid atherosclerosis and cardiovascular risk factors.

Methods

Baseline data (cross-sectional analysis) from a randomized controlled trial, integrated within the Västerbotten Intervention Program, Northern Sweden, was used. We included 3459 individuals, aged 40 or 50 years with ≥1 conventional risk factor or aged 60 years old. The participants underwent clinical examination, blood sampling, carotid ultrasound assessment of intima-media wall thickness (CIMT) and plaque formation, and answered a questionnaire on health literacy – the Brief Health Literacy Screen. The European Systematic Coronary Risk Evaluation and Framingham Risk Score were calculated.

Results

About 20% of the participants had low health literacy. Low health literacy was independently associated with the presence of ultrasound-detected carotid artery plaques after adjustment for age and education, odds ratio (95% confidence interval) 1.54 (1.28–1.85), demonstrating a similar level of risk as for smoking. Health literacy was associated with CIMT in men. Low health literacy was associated with higher CVD risk scores. Sensitivity analyses with low health literacy set to 9% or 30% of the study sample, respectively, yielded essentially the same results.

Conclusions

Low health literacy was independently associated with carotid artery plaques and a high level of CVD risk scores. Presenting health information in a fashion that is understood by all patients may improve preventive efforts.

Meningococcal disease in Italy: public concern, media coverage and policy change

Background

Between 2015 and 2017 six deaths due to meningitis in the Lombardy Region, Northern Italy, caught the attention of media and increased concern among the population, with a consequent increase in demand for vaccination. Considering the evidence about the impact of media coverage of health issues on public behaviour, this paper investigates the trend of media coverage and internet searches regarding meningitis in the Lombardy Region.

Methods

Content analysis of online articles published from January 2015 to May 2017 and analysis of Google Trends were carried out. A codebook was created in order to assess the content of each article analysed, based on six areas: article characteristics, information about meningococcal disease and vaccination, Local Health Authority activities, accuracy of information and tone of the message.

Results

Both public interest and media attention peaked in December 2016 and January 2017, when the Lombardy Regional Authority changed its policy by offering co-payment to adults with a saving of 50%. The frequency of meningitis coverage decreased after the announcement of policy change. For example, articles containing new information on meningitis or meningococcal vaccine (76 to 48%, p = 0.01) and preventive recommendations (31% down to 10%, p = 0.006) decreased significantly. An alarmist tone appeared in 21% of pre-policy articles that decreased to 5% post-policy (p = 0.03).

Conclusions

The findings suggest a role for the media in fostering public pressure towards health services and policy-makers. A collaboration between Public Health institutions and the media would be beneficial in order to improve communication with the public.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7426-5) contains supplementary material, which is available to authorized users.

Interpersonal trust in doctor-patient relation: Evidence from dyadic analysis and association with quality of dyadic communication

RATIONALE

Although they form a dyadic relationship, doctor's and patient's levels of trust in the other have usually been investigated separately. As members of dyadic relationships, they influence each other's behaviors and are interdependent because they share a past history and eventually a common future.

OBJECTIVES

The aim of this paper was to examine the composition of trust in doctor-patients relationship and estimate its association with quality of doctor's communication. One-With-Many analyses (OWM) were used to examine the composition of trust variance into "doctor and patient effects", "relationship effects", and "reciprocity effects," taking into account the interdependence of the data.

METHOD

Twelve General Practitioners (GPs; Mage = 54.16, SD = 12.28, 8 men) and 189 of their patients (Mage = 47.48, SD = 9.88, 62% women) took part in the study. GPs and their patients completed postconsultation questionnaires on trust and quality of communication.

RESULTS

The findings revealed that "doctor" and "patient" effects were significant. However, the most important part of the variance was attributable to the relationship and reciprocity effects, meaning that if a doctor reported high trust in a particular patient, then the patient reported a similarly high level of trust. Higher quality of communication was positively associated to those relationship effects of trust.

CONCLUSIONS

Our study stresses the importance to investigate trust in doctor-patients relationship as a dyadic and interdependent phenomenon applying appropriate methodological design and analysis. Convergence between doctor's and patients' perceptions of their relationship may enhance trust more than conventional intervention and may ultimately contribute to better health outcomes.

The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis

BACKGROUND

Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment.

DATA SOURCES

Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018.

METHODS

Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included.

RESULTS

The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment.

DISCUSSION

Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.

The doctor-patient relationship and patient resilience in chronic pain: A qualitative approach to patients' perspectives

OBJECTIVES

To study patients' perspectives about the role of the doctor-patient relationship in promoting the resilience process.

METHODS

We conducted in-depth interviews with 20 chronic pain patients. Using open-ended questions, the interviews explored aspects of the doctor-patient relationship that impacted the patients' perceptions of their resilience. Thematic analysis built on an inductive, adaptive approach to data coding was employed to organize a representation of key factors affecting resilience.

RESULTS

The themes emerging from the interviews inform us about how the different aspects of the doctor-patient relationship can promote patient resilience in chronic pain. Three main themes emerged: the doctor providing psychological support, promoting patients' health literacy related to chronic pain and its treatment, and empowering the patients to cooperate in finding the right treatment. This fosters patients' direct outcomes (feeling validated, health literate, and empowered), which, in turn, lead to adaptive coping responses and day-to-day disease management. These direct outcomes are crucial for patients to maintain socially and personally meaningful activities and their functional (physical) capacity.

DISCUSSION

A doctor-patient relationship following the precepts of the patient-centered care is a significant resource that can lead to increased patient resilience. Thus, future interventions promoting patient resilience might consider addressing the doctor-patient relationship.

Using protection motivation theory to predict intention to adhere to official MMR vaccination recommendations in Switzerland

Switzerland has not yet reached the measles vaccination coverage of 95 percent that is recommended by the World Health Organization to achieve herd immunity. Within the overall objective of informing effective ways to promote the combined Measles, Mumps, Rubella (MMR) vaccination in Switzerland, the aim of this study was to identify predictors of parents’ intention to adhere to official MMR vaccination recommendations. Between October 2012 and January 2013, we surveyed 554 parents of middle school students aged 13 to 15 in Ticino, Switzerland. Guided by Protection Motivation Theory (PMT), the survey covered predictors related to threat and coping appraisal with regards to measles and the MMR vaccine, MMR-related social attitudes and social norms, past experience with the disease and the vaccine, and information sources in the MMR vaccine context. Data were analyzed using Structural Equation Modelling. Among central PMT concepts describing people’s threat and coping appraisal, only response (vaccination) efficacy showed to be directly related to parents’ intention to adhere to MMR vaccination recommendations (B = .39, p < .001). In addition, social attitudes (B = .38, p < .001) were a direct predictor. Furthermore, social attitudes, social norms, knowing somebody who experienced MMR vaccination side effects, and having sought MMR information from public health institutions, all indirectly predicted parents’ intention to adhere to MMR recommendations by activating different threat and coping appraisal mechanisms. To conclude, future communication measures from public health institutions should highlight the altruistic aspect (herd immunity) of the immunization practice as well as present evidence on the high effectiveness of the vaccination in reducing the risk at both the individual and collective levels of getting infected with measles.

•

Switzerland has not yet reached the 95% MMR vaccination coverage goal set by the WHO.

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PMT allows to study parents’ intentions to follow MMR vaccination recommendations.

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Perceived efficacy of the MMR vaccine is the strongest direct predictor of intentions.

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Pro-social attitudes in favor of herd immunity also directly and indirectly predict intentions.

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Doctors and public health institutions should highlight these aspects.

The Measurements and an Elaborated Understanding of Chinese eHealth Literacy (C-eHEALS) in Chronic Patients in China

The rapid rise of Internet-based technologies to disseminate health information and services has been shown to enhance online health information acquisition. A Chinese version of the electronic health literacy scale (C-eHEALS) was developed to measure patients’ combined knowledge and perceived skills at finding and applying electronic health information to health problems. A valid sample of 352 interviewees responded to the online questionnaire, and their responses were analyzed. The C-eHEALS, by showing high internal consistency and predictive validity, is an effective screening tool for detecting levels of health literacy in clinical settings. Individuals’ sociodemographic status, perceived health status, and level of health literacy were identified for describing technology users’ characteristics. A strong association between eHealth literacy level, media information use, and computer literacy was found. The emphasis of face-to-face inquiry for obtaining health information was important in the low eHealth literacy group while Internet-based technologies crucially affected decision-making skills in the high eHealth literacy group. This information is timely because it implies that health care providers can use the C-eHEALS to screen eHealth literacy skills and empower patients with chronic diseases with online resources.

Content, Quality, and Assessment Tools of Physician-Rating Websites in 12 Countries: Quantitative Analysis

BACKGROUND

Websites on which users can rate their physician are becoming increasingly popular, but little is known about the website quality, the information content, and the tools they offer users to assess physicians. This study assesses these aspects on physician-rating websites in German- and English-speaking countries.

OBJECTIVE

The objective of this study was to collect information on websites with a physician rating or review tool in 12 countries in terms of metadata, website quality (transparency, privacy and freedom of speech of physicians and patients, check mechanisms for appropriateness and accuracy of reviews, and ease of page navigation), professional information about the physician, rating scales and tools, as well as traffic rank.

METHODS

A systematic Web search based on a set of predefined keywords was conducted on Google, Bing, and Yahoo in August 2016. A final sample of 143 physician-rating websites was analyzed and coded for metadata, quality, information content, and the physician-rating tools.

RESULTS

The majority of websites were registered in the United States (40/143) or Germany (25/143). The vast majority were commercially owned (120/143, 83.9%), and 69.9% (100/143) displayed some form of physician advertisement. Overall, information content (mean 9.95/25) as well as quality were low (mean 18.67/47). Websites registered in the United Kingdom obtained the highest quality scores (mean 26.50/47), followed by Australian websites (mean 21.50/47). In terms of rating tools, physician-rating websites were most frequently asking users to score overall performance, punctuality, or wait time in practice.

CONCLUSIONS

This study evidences that websites that provide physician rating should improve and communicate their quality standards, especially in terms of physician and user protection, as well as transparency. In addition, given that quality standards on physician-rating websites are low overall, the development of transparent guidelines is required. Furthermore, attention should be paid to the financial goals that the majority of physician-rating websites, especially the ones that are commercially owned, pursue.

Micro-cultural customization of organ donation propagation messages

OBJECTIVE

Organ transplantation is plagued by limited availability of organs. This study investigated the effect of messages promoting organ donation which were customized according to the language-defined micro-cultures in Switzerland.

METHODS

Community-, informative-, and emotional-oriented messages were carried by conventional flyers. A 3 × 3 between-subjects experiment was conducted with short- and long-term willingness to donate, long-term signing of organ donation card and long-term interpersonal communication on organ donation as outcome variables.

RESULTS

The culturally customized interventions appeared to have no immediate effect and consequently no differential effect on willingness to donate organs and on signing a donor card. Among the Swiss Germans, of the three messages, the community-oriented one instigated less interpersonal communication.

CONCLUSION

Findings are consistent with a mechanism in which the message does not have an immediate effect on willingness to donate organs but motivates further thought and related behaviors that lead to higher commitment and later increased willingness to donate.

PRACTICE IMPLICATIONS

Targeting not only the message but also the objective that drives the messages must be considered. Campaigns should include elements that build on the unfolding commitment process to promote the follow-up actions that lead to greater willingness.

An empirical test of the Health Empowerment Model: Does patient empowerment moderate the effect of health literacy on health status?

OBJECTIVE

The Health Empowerment Model (Schulz & Nakamoto, 2013) advocates that the effects of health literacy and empowerment are intertwined on health outcomes. This study aims to test this assumption in the context of health status as a patient outcome.

METHODS

A cross-sectional study was conducted with a sample of 302 participants between June and December 2015. The participants' health literacy (using the NVS and S-TOFHLA tests), empowerment and self-reported health status were assessed.

RESULTS

The participants having a high level of patient empowerment and concurrent adequate health literacy (the so-called 'effective self-managers') reported better health status compared to patients who had either lower health literacy and/or lower empowerment scores (P<0.05). Moreover, the meaningfulness (b=0.053, t(297)=2.29, P=0.02) and competence (b=0.07, t(297)=2.47, P=0.01) sub-dimensions of patient empowerment moderated the effect of the NVS on current health status.

CONCLUSION

The study provides evidence for the independence of health literacy and empowerment and partial evidence for their interaction predicting health status.

PRACTICE IMPLICATIONS

Our findings highlight that health literacy and patient empowerment (in particular its competence and meaningfulness sub-facets) are crucial patient-related variables, to be taken into consideration simultaneously, during screening and health promotion campaigns fostering health status in the general population.

The Mediated Amplification of a Crisis: Communicating the A/H1N1 Pandemic in Press Releases and Press Coverage in Europe

In the aftermath of the A/H1N1 pandemic, health authorities were criticized for failures in crisis communication efforts, and the media were accused of amplifying the pandemic. Considering these criticisms, A/H1N1 provides a suitable case for examining risk amplification processes that may occur in the transfer of information from press releases to print news media during a health crisis. We integrated the social amplification of risk framework with theories of news decisions (news values, framing) in an attempt to contribute to existing research both theoretically and empirically. We conducted a quantitative content analysis of press releases disseminated by health and governmental authorities, as well as the quality and tabloid press in 10 European countries between March 2009 and March 2011. Altogether 243 press releases, 1,243 quality press articles, and 834 tabloid press articles were coded. Consistent with research on news values and framing the results suggest that quality and tabloid papers alike amplified A/H1N1 risks by emphasizing conflict and damage, presenting information in a more dramatized way, and using risk-amplifying frames to a greater extent and risk-attenuating frames to a lesser extent than press releases. To some extent, the quality and tabloid press differed in how risk information was presented. While tabloid press articles seemed to follow the leading quality press with regards to content and framing of health crisis coverage, they exhibited a stronger emphasis on drama and emotion in the way they presented information.