Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach.

BACKGROUND: People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries. OBJECTIVE: This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera. METHODS: We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers. RESULTS: The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities. CONCLUSIONS: This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers' role.

External validation of triage tools for adults with suspected COVID-19 in a middle-income setting: an observational cohort study.

BACKGROUND: Tools proposed to triage ED acuity in suspected COVID-19 were derived and validated in higher income settings during early waves of the pandemic. We estimated the accuracy of seven risk-stratification tools recommended to predict severe illness in the Western Cape, South Africa. METHODS: An observational cohort study using routinely collected data from EDs across the Western Cape, from 27 August 2020 to 11 March 2022, was conducted to assess the performance of the PRIEST (Pandemic Respiratory Infection Emergency System Triage) tool, NEWS2 (National Early Warning Score, version 2), TEWS (Triage Early Warning Score), the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS (Pandemic Medical Early Warning Score) in suspected COVID-19. The primary outcome was intubation or non-invasive ventilation, death or intensive care unit admission at 30 days. RESULTS: Of the 446 084 patients, 15 397 (3.45%, 95% CI 34% to 35.1%) experienced the primary outcome. Clinical decision-making for inpatient admission achieved a sensitivity of 0.77 (95% CI 0.76 to 0.78), specificity of 0.88 (95% CI 0.87 to 0.88) and the negative predictive value (NPV) of 0.99 (95% CI 0.99 to 0.99). NEWS2, PMEWS and PRIEST scores achieved good estimated discrimination (C-statistic 0.79 to 0.82) and identified patients at risk of adverse outcomes at recommended cut-offs with moderate sensitivity (>0.8) and specificity ranging from 0.41 to 0.64. Use of the tools at recommended thresholds would have more than doubled admissions, with only a 0.01% reduction in false negative triage. CONCLUSION: No risk score outperformed existing clinical decision-making in determining the need for inpatient admission based on prediction of the primary outcome in this setting. Use of the PRIEST score at a threshold of one point higher than the previously recommended best approximated existing clinical accuracy.

Information Overload in Emergency Medicine Physicians: A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts.

BACKGROUND: Information overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession. OBJECTIVE: This study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom. METHODS: This study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed t tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics. RESULTS: The vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment. CONCLUSIONS: There is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care.

Peer-led information literacy training: a qualitative study of students' experiences of the NICE Evidence search Student Champion Scheme.

BACKGROUND: The National Institute for Health and Care Excellence (NICE) Evidence search Student Champion Scheme aims to enable undergraduate health and social care students to teach their peers skills for information literacy (IL), thereby encouraging future evidence-based practice. OBJECTIVES: To analyse the Student Champions' teaching methods; discover what effects the Scheme had on their IL; and uncover any differences between disciplines. METHODS: Fifty-one reflective reports, written by Student Champions and submitted to NICE, were thematically analysed using a non-linear six-stage model. Four health disciplines from academic year 2017/2018 were featured. RESULTS: (a) Students preferred active teaching methods; (b) reported benefits of participation included gaining/developing new skills and increased confidence; (c) students believed that participating improved their skills for IL; (d) multiple recommendations for improving the Scheme were given; and (e) students wanted the Scheme to be offered earlier in their degrees. DISCUSSION: Champions from all disciplines positively benefit from participating in the Scheme. However, they also have concerns which are not well-documented in the literature. CONCLUSION: Student Champions have overall positive experiences. There is demonstrated improvement in their IL, and they become familiar with a useful evidence-based practice resource. They also offer recommendations for future improvements to the Scheme.

Information Literacy in Food and Activity Tracking Among Parkrunners, People With Type 2 Diabetes, and People With Irritable Bowel Syndrome: Exploratory Study.

BACKGROUND: The tracking, or logging, of food intake and physical activity is increasing among people, and as a result there is increasing evidence of a link to improvement in health and well-being. Crucial to the effective and safe use of logging is a user's information literacy. OBJECTIVE: The aim of this study was to analyze food and activity tracking from an information literacy perspective. METHODS: An online survey was distributed to three communities via parkrun, diabetes.co.uk and the Irritable Bowel Syndrome Network. RESULTS: The data showed that there were clear differences in the logging practices of the members of the three different communities, as well as differences in motivations for tracking and the extent of sharing of said tracked data. Respondents showed a good understanding of the importance of information accuracy and were confident in their ability to understand tracked data, however, there were differences in the extent to which food and activity data were shared and also a lack of understanding of the potential reuse and sharing of data by third parties. CONCLUSIONS: Information literacy in this context involves developing awareness of the issues of accurate information recording, and how tracked information can be applied to support specific health goals. Developing awareness of how and when to share data, as well as of data ownership and privacy, are also important aspects of information literacy.

Novel insights into views towards H1N1 during the 2009 Pandemic: a thematic analysis of Twitter data.

BACKGROUND: Infectious disease outbreaks have the potential to cause a high number of fatalities and are a very serious public health risk. OBJECTIVES: Our aim was to utilise an indepth method to study a period of time where the H1N1 Pandemic of 2009 was at its peak. METHODS: A data set of n = 214 784 tweets was retrieved and filtered, and the method of thematic analysis was used to analyse the data. RESULTS: Eight key themes emerged from the analysis of data: emotion and feeling, health related information, general commentary and resources, media and health organisations, politics, country of origin, food, and humour and/or sarcasm. DISCUSSION: A major novel finding was that due to the name 'swine flu', Twitter users had the belief that pigs and pork could host and/or transmit the virus. Our paper also considered the methodological implications for the wider field of library and information science as well as specific implications for health information and library workers. CONCLUSIONS: Novel insights were derived on how users communicate about disease outbreaks on social media platforms. Our study also provides an innovative methodological contribution because it was found that by utilising an indepth method it was possible to extract greater insight into user communication.

Peer teaching and information retrieval: the role of the NICE Evidence search student champion scheme in enhancing students' confidence.

BACKGROUND: This research reports on the NICE Evidence search (ES) student champion scheme (SCS) first five years of activity (2011-2016) in terms of its impact on health care undergraduate students' information search skills and search confidence. OBJECTIVES: A review of students' evaluation of the scheme was carried out to chart the changes in attitude towards NICE Evidence search as an online health care information source and to monitor students' approach to information seeking. METHODS: This study is based on the results of questionnaires distributed to students before and after attending a training session on NICE Evidence search delivered by their own peers. The exercise was implemented in health related universities in England over a period of five consecutive academic years. RESULTS: (i) Students' search confidence improved considerably after the training; (ii) ES was perceived as being an increasingly useful resource of evidence based information for their studies; (iii) the training helped students develop discerning search skills and use evidence based information sources more consistently and critically. CONCLUSIONS: The NICE SCS improves confidence in approaching information tasks amongst health care undergraduate students. Future developments could involve offering the training at the onset of a course of study and adopting online delivery formats to expand its geographical reach.

Trust and Credibility in Web-Based Health Information: A Review and Agenda for Future Research.

BACKGROUND: Internet sources are becoming increasingly important in seeking health information, such that they may have a significant effect on health care decisions and outcomes. Hence, given the wide range of different sources of Web-based health information (WHI) from different organizations and individuals, it is important to understand how information seekers evaluate and select the sources that they use, and more specifically, how they assess their credibility and trustworthiness. OBJECTIVE: The aim of this study was to review empirical studies on trust and credibility in the use of WHI. The article seeks to present a profile of the research conducted on trust and credibility in WHI seeking, to identify the factors that impact judgments of trustworthiness and credibility, and to explore the role of demographic factors affecting trust formation. On this basis, it aimed to identify the gaps in current knowledge and to propose an agenda for future research. METHODS: A systematic literature review was conducted. Searches were conducted using a variety of combinations of the terms WHI, trust, credibility, and their variants in four multi-disciplinary and four health-oriented databases. Articles selected were published in English from 2000 onwards; this process generated 3827 unique records. After the application of the exclusion criteria, 73 were analyzed fully. RESULTS: Interest in this topic has persisted over the last 15 years, with articles being published in medicine, social science, and computer science and originating mostly from the United States and the United Kingdom. Documents in the final dataset fell into 3 categories: (1) those using trust or credibility as a dependent variable, (2) those using trust or credibility as an independent variable, and (3) studies of the demographic factors that influence the role of trust or credibility in WHI seeking. There is a consensus that website design, clear layout, interactive features, and the authority of the owner have a positive effect on trust or credibility, whereas advertising has a negative effect. With regard to content features, authority of the author, ease of use, and content have a positive effect on trust or credibility formation. Demographic factors influencing trust formation are age, gender, and perceived health status. CONCLUSIONS: There is considerable scope for further research. This includes increased clarity of the interaction between the variables associated with health information seeking, increased consistency on the measurement of trust and credibility, a greater focus on specific WHI sources, and enhanced understanding of the impact of demographic variables on trust and credibility judgments.

Prognostic accuracy of eight triage scores in suspected COVID-19 in an Emergency Department low-income setting: An observational cohort study.

Introduction: Previous studies deriving and validating triage scores for patients with suspected COVID-19 in Emergency Department settings have been conducted in high- or middle-income settings. We assessed eight triage scores' accuracy for death or organ support in patients with suspected COVID-19 in Sudan. Methods: We conducted an observational cohort study using Covid-19 registry data from eight emergency unit isolation centres in Khartoum State, Sudan. We assessed performance of eight triage scores including: PRIEST, LMIC-PRIEST, NEWS2, TEWS, the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS in suspected COVID-19. A composite primary outcome included death, ventilation or ICU admission. Results: In total 874 (33.84 %, 95 % CI:32.04 % to 35.69 %) of 2,583 patients died, required intubation/non-invasive ventilation or HDU/ICU admission . All risk-stratification scores assessed had worse estimated discrimination in this setting, compared to studies conducted in higher-income settings: C-statistic range for primary outcome: 0.56-0.64. At previously recommended thresholds NEWS2, PRIEST and LMIC-PRIEST had high estimated sensitivities (≥0.95) for the primary outcome. However, the high baseline risk meant that low-risk patients identified at these thresholds still had a between 8 % and 17 % risk of death, ventilation or ICU admission. Conclusion: None of the triage scores assessed demonstrated sufficient accuracy to be used clinically. This is likely due to differences in the health care system and population (23 % of patients died) compared to higher-income settings in which the scores were developed. Risk-stratification scores developed in this setting are needed to provide the necessary accuracy to aid triage of patients with suspected COVID-19.

Can all healthy adults use the current evidential breath alcohol analysers? An investigation using a large spirometry database.

People failing to give a specimen of breath at a police station are assumed to be deliberately obstructive and are charged with Failure to Provide under the Road Traffic Act 1988. However, spirometry records of 281,210 healthy individuals from UK BioBank showed that a significant minority cannot use existing evidential breath analysis machines. Women were three times more likely to be unable to use them than men (1.64% vs 0.54%) with the risk rising with age six-fold from those in their 40s (0.43%) to 2.7% in their 70s, with women more affected (0.65% to 3.8%). Short stature was a further risk factor: 2.6% of men and 3.8% of women below the 2nd percentile of height could not use the current machines, with almost one in ten elderly, short women unable to do so, while smokers aged 50+ were twice as likely as non-smokers of the same age to be unable to provide breath specimens.

LMIC-PRIEST: Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19 in a middle-income setting.

BACKGROUND: Uneven vaccination and less resilient health care systems mean hospitals in LMICs are at risk of being overwhelmed during periods of increased COVID-19 infection. Risk-scores proposed for rapid triage of need for admission from the emergency department (ED) have been developed in higher-income settings during initial waves of the pandemic. METHODS: Routinely collected data for public hospitals in the Western Cape, South Africa from the 27th August 2020 to 11th March 2022 were used to derive a cohort of 446,084 ED patients with suspected COVID-19. The primary outcome was death or ICU admission at 30 days. The cohort was divided into derivation and Omicron variant validation sets. We developed the LMIC-PRIEST score based on the coefficients from multivariable analysis in the derivation cohort and existing triage practices. We externally validated accuracy in the Omicron period and a UK cohort. RESULTS: We analysed 305,564 derivation, 140,520 Omicron and 12,610 UK validation cases. Over 100 events per predictor parameter were modelled. Multivariable analyses identified eight predictor variables retained across models. We used these findings and clinical judgement to develop a score based on South African Triage Early Warning Scores and also included age, sex, oxygen saturation, inspired oxygen, diabetes and heart disease. The LMIC-PRIEST score achieved C-statistics: 0.82 (95% CI: 0.82 to 0.83) development cohort; 0.79 (95% CI: 0.78 to 0.80) Omicron cohort; and 0.79 (95% CI: 0.79 to 0.80) UK cohort. Differences in prevalence of outcomes led to imperfect calibration in external validation. However, use of the score at thresholds of three or less would allow identification of very low-risk patients (NPV ≥0.99) who could be rapidly discharged using information collected at initial assessment. CONCLUSION: The LMIC-PRIEST score shows good discrimination and high sensitivity at lower thresholds and can be used to rapidly identify low-risk patients in LMIC ED settings.

Training and testing of a gradient boosted machine learning model to predict adverse outcome in patients presenting to emergency departments with suspected covid-19 infection in a middle-income setting.

COVID-19 infection rates remain high in South Africa. Clinical prediction models may be helpful for rapid triage, and supporting clinical decision making, for patients with suspected COVID-19 infection. The Western Cape, South Africa, has integrated electronic health care data facilitating large-scale linked routine datasets. The aim of this study was to develop a machine learning model to predict adverse outcome in patients presenting with suspected COVID-19 suitable for use in a middle-income setting. A retrospective cohort study was conducted using linked, routine data, from patients presenting with suspected COVID-19 infection to public-sector emergency departments (EDs) in the Western Cape, South Africa between 27th August 2020 and 31st October 2021. The primary outcome was death or critical care admission at 30 days. An XGBoost machine learning model was trained and internally tested using split-sample validation. External validation was performed in 3 test cohorts: Western Cape patients presenting during the Omicron COVID-19 wave, a UK cohort during the ancestral COVID-19 wave, and a Sudanese cohort during ancestral and Eta waves. A total of 282,051 cases were included in a complete case training dataset. The prevalence of 30-day adverse outcome was 4.0%. The most important features for predicting adverse outcome were the requirement for supplemental oxygen, peripheral oxygen saturations, level of consciousness and age. Internal validation using split-sample test data revealed excellent discrimination (C-statistic 0.91, 95% CI 0.90 to 0.91) and calibration (CITL of 1.05). The model achieved C-statistics of 0.84 (95% CI 0.84 to 0.85), 0.72 (95% CI 0.71 to 0.73), and 0.62, (95% CI 0.59 to 0.65) in the Omicron, UK, and Sudanese test cohorts. Results were materially unchanged in sensitivity analyses examining missing data. An XGBoost machine learning model achieved good discrimination and calibration in prediction of adverse outcome in patients presenting with suspected COVID19 to Western Cape EDs. Performance was reduced in temporal and geographical external validation.

Evaluating a pedagogical approach to promoting academic integrity in higher education: An online induction program.

Academic integrity is at the heart of excellent education. However, resources explaining the concept tend to be definition-driven, while using complex language and sometimes even an austere tone designed to discourage students from breaches. This study aims to design and evaluate an online module at a UK University across 2 years, designed to improve students' understanding of concepts of academic integrity and practice. The module includes a range of interactive resources (e.g., gamified quizzes and e-booklets) and was made available to a large cohort of postgraduate students (448). The study adopts a mixed-methods approach composed of three sequential phases involving first collecting students' views on existing academic integrity resources (7 students participating in a focus group and 39 competing a questionnaire), then developing a range of new ones based on students' feedback to form the content of the module, and finally gathering students' evaluation on the newly created resources (sample size: 361 students). Results illustrate a clear improvement in relation to the accessibility, usefulness and understandability of new resources. Results also highlight a remarkable increase in student confidence levels regarding academic integrity. Students also considered the new module as more appealing and informative. This manuscript offers a good example of a pedagogical approach aimed at promoting academic integrity in an innovative and engaging fashion.

LMIC-PRIEST: Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19 in a middle-income setting.

Background: Uneven vaccination and less resilient health care systems mean hospitals in LMICs are at risk of being overwhelmed during periods of increased COVID-19 infection. Risk-scores proposed for rapid triage of need for admission from the emergency department (ED) have been developed in higher-income settings during initial waves of the pandemic. Methods: Routinely collected data for public hospitals in the Western Cape, South Africa from the 27 th August 2020 to 11 th March 2022 were used to derive a cohort of 446,084 ED patients with suspected COVID-19. The primary outcome was death or ICU admission at 30 days. The cohort was divided into derivation and Omicron variant validation sets. We developed the LMIC-PRIEST score based on the coefficients from multivariable analysis in the derivation cohort and existing triage practices. We externally validated accuracy in the Omicron period and a UK cohort. Results: We analysed 305,564, derivation 140,520 Omicron and 12,610 UK validation cases. Over 100 events per predictor parameter were modelled. Multivariable analyses identified eight predictor variables retained across models. We used these findings and clinical judgement to develop a score based on South African Triage Early Warning Scores and also included age, sex, oxygen saturation, inspired oxygen, diabetes and heart disease. The LMIC-PRIEST score achieved C-statistics: 0.82 (95% CI: 0.82 to 0.83) development cohort; 0.79 (95% CI: 0.78 to 0.80) Omicron cohort; and 0.79 (95% CI: 0.79 to 0.80) UK cohort. Differences in prevalence of outcomes led to imperfect calibration in external validation. However, use of the score at thresholds of three or less would allow identification of very low-risk patients (NPV ≥0.99) who could be rapidly discharged using information collected at initial assessment. Conclusion: The LMIC-PRIEST score shows good discrimination and high sensitivity at lower thresholds and can be used to rapidly identify low-risk patients in LMIC ED settings. What is already known on this subject: Uneven vaccination in low- and middle-income countries (LMICs) coupled with less resilient health care provision mean that emergency health care systems in LMICs may still be at risk of being overwhelmed during periods of increased COVID-19 infection.Risk-stratification scores may help rapidly triage need for hospitalisation. However, those proposed for use in the ED for patients with suspected COVID-19 have been developed and validated in high-income settings. What this study adds: The LMIC-PRIEST score has been robustly developed using a large routine dataset from the Western Cape, South Africa and is directly applicable to existing triage practices in LMICs.External validation across both income settings and COVID-19 variants showed good discrimination and high sensitivity (at lower thresholds) to a composite outcome indicating need for inpatient admission from the ED. How this study might affect research practice or policy: Use of the LMIC-PRIEST score at thresholds of three or less would allow identification of very low-risk patients (negative predictive value ≥0.99) across all settings assessedDuring periods of increased demand, this could allow the rapid identification and discharge of patients from the ED using information collected at initial assessment.

Electronic Health Record and Problem Lists in Leeds, United Kingdom: Variability of general practitioners' views.

Data sharing of Electronic Health Records from general practices to secondary care in Leeds occurs through the so-called Leeds Care Records, which collects a specific set of codes from primary care, known as 'Active Problems', and presents it to the user. Variability on its content is a known issue. To explore general practitioners' views on their use of 'Active Problems' and on sharing data, so lessons could be learnt on how to homogenise and improve shared data. Assessing Leeds general practitioners' views through two parallel processes (60 online surveys and 17 interviews). General practitioners feel they do not have the time nor the training required for keeping a shared approach to concise and current Problem Lists in electronic patient records. Action is needed to reduce current variability, and to improve the quality of shared information. Some types of codes currently present in Problem Lists have very little support among general practitioners who consider the focus should be on long-term conditions and probably adding current acute diagnoses and life expectancy items and not omitting sensitive information. There is a perceived need of training and time to update Problem Lists if their quality is to improve.

Online Support Groups as a Source of Empowerment for People with Type 2 Diabetes.

People with Type 2 Diabetes (T2D) control much of their illness by making daily decisions regarding their health behaviours. They require certain skills, information, and support, which might not be obtainable from healthcare providers, and they may seek support through other media, such as online support groups (OSGs). This study seeks to understand the role of OSGs in empowering people with T2D by thematically analysing threads and posts from two UK OSGs.

Cross-Classified Multilevel Modelling of the Effectiveness of Similarity-Based Virtual Screening.

The screening effectiveness of a chemical similarity search depends on a range of factors, including the bioactivity of interest, the types of similarity coefficient and fingerprint that comprise the similarity measure, and the nature of the reference structure that is being searched against a database. This study introduces the use of cross-classified multilevel modelling as a way to investigate the relative importance of these four factors when carrying out similarity searches on the ChEMBL database. Two principal conclusions can be drawn from the analyses: that the fingerprint plays a more important role than the similarity coefficient in determining the effectiveness of a similarity search, and that comparative studies of similarity measures should involve many more reference structures than has been the case in much previous work.

Students' trust judgements in online health information seeking.

As one of the most active groups of Internet users, students and other young people are active users of digital health information. Yet, research into young people's evaluation of health information is limited, and no previous studies have focused on trust formation. In addition, prior studies on adults' use of digital information do not reach a consensus regarding the key factors in trust formation. This study seeks to address this gap. A questionnaire-based survey was used to collect data from undergraduate students studying a variety of disciplines in one UK university. The Trust in Online Health Information Scale is proposed, and it includes the following dimensions: authority, style, content, usefulness, brand, ease of use, recommendation, credibility, and verification. In addition, inspection of responses to specific items/questions provides further insights into aspects of the information that were of specific importance in influencing trust judgements.