Evaluating the impact of continuing professional development courses on physician behavioral intention: a pre-post study with follow-up at six months.

BACKGROUND: Continuing professional development (CPD) for health professionals includes educational activities to maintain or improve skills. We evaluated the impact of a series of CPD courses by identifying factors influencing physicians' intention to adopt targeted behaviors and assessing self-reported behavior adoption six months later. METHODS: In this pre-post study, eligible participants attended at least one in-person course at the Fédération des Médecins Spécialistes du Québec annual meeting in November 2019. Before and afterwards, participants completed CPD-REACTION, a validated questionnaire based on Godin's integrated model for health professional behavior change that measures intention and psychosocial factors influencing intention. We used Wilcoxon signed-rank test to compare pre- and post-course intention scores and linear regression analyses to identify factors influencing intention. We also compared the post-course intention scores of participants reporting a behavior change six months later with the scores of those reporting no behavior change six months later. Qualitative data was collected only six months after courses and responses to open-ended questions were analyzed using the Theoretical Domains Framework. RESULTS: A total of 205/329 course attendees completed CPD-REACTION (response rate 62.3%). Among these participants, 158/329 (48%) completed the questionnaire before CPD courses, 129/329 (39.2%) only after courses and 47/329 (14.3%) at 6 months. Study population included 192 physicians of whom 78/192(40.6%) were female; 59/192(30.7%) were between 50 and 59 years old; and 72/192 (37.5%) were surgical specialist physicians. Mean intention scores before (n = 158) and after (n = 129) courses were 5.74(SD = 1.52) and 6.35(SD = 0.93) respectively. Differences in mean (DM) intention before and afterwards ranged from - 0.31(p = 0.17) to 2.25(p = 0.50). Multivariate analysis showed that beliefs about capabilities (ß = 0.15, p = 0.001), moral norm (ß = 0.75, p < 0.0001), and beliefs about consequences (ß = 0.11, p = 0.04) influenced post-course intention. Post-course intention was correlated with behavior six months later (DM = 0.63; p = 0.02). Qualitative analysis showed that facilitators to behavior adoption after six months were most often related to the TDF domains of beliefs about capabilities. Most frequent barriers to adoption related to lack of resources. CONCLUSIONS: Overall, scores for intention to adopt targeted behaviors increased after the courses. CPD providers could increase participants' intention by including interventions that emphasize beliefs about capabilities, moral norm and beliefs about consequences.

Impact of Educational Activity Formats, Online or In-Person, on the Intention of Medical Specialists to Adopt a Clinical Behaviour: A Comparative Study.

COVID-19 accelerated continuing professional development (CPD) delivered online. We aimed to compare the impact of in-person versus online CPD courses on medical specialists' behavioural intentions and subsequent behaviour. In this comparative before-and-after study, medical specialists attended in-person courses on nine clinical topics. A second group attended an adapted online version of these courses. Behavioural intention and its psychosocial determinants were measured before and immediately after the courses. Behaviour change was measured six months later. Generalised estimating equation (GEE) models were used to compare the impact of course formats. A total of 82/206 in-person registrants (mean age: 52±10 years; 50% men) and 318/506 on-line registrants (mean age: 49±12 years; men: 63%) participated. Mean intention before in-person courses was 5.99±1.31 and 6.43±0.80 afterwards (average intention gain 0.44, CI: 0.16-0.74; p=0.003); mean intention before online courses was 5.53±1.62 and 5.98±1.40 afterwards (average intention gain of 0.45, CI: 0.30-0.58; p<0.0001). Difference in intention gain between groups was not statistically significant. Behaviour reported six months later was not significantly associated with post-course intention in either group. However, the intention difference increased significantly among those who said they had adopted the targeted behaviour (paired wilcoxon test: n = 40 and p-value=0.002) while it did not increase significantly in the group of those who had not adopted a targeted behaviour (paired wilcoxon test: n = 16 and p-value=0.223). In conclusion, the increase in intention of specialists after CPD courses was similar whether the course was in-person or online. Also, an increase in intention in both groups signalled more likelihood of adoption.

Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey.

BACKGROUND: Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision. OBJECTIVE: We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention. METHODS: We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ≥65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA. RESULTS: Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (ß=.30; P<.001), objective eHealth literacy (ß=-.06; P=.03), performance expectancy (ß=.55; P<.001), social influence (ß=.37; P<.001), and facilitating conditions (ß=.15; P<.001). CONCLUSIONS: Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA.

Biological monitoring of exposure to rare earth elements and selected metals in the Inuit population of Nunavik, Canada.

In Nunavik (Northern Quebec, Canada), some mining projects are envisioned, that could increase the contamination of the environment by various chemicals, including rare earth elements (REEs), and implicitly Inuit population exposure. The objective of this study was to determine the baseline biological exposure of the population to these elements, before the potential mining development occurs. In the framework of the 2017 Qanuilirpitaa? Inuit health survey, urine samples were obtained from a representative sample of the adult Nunavik population, which were used to constitute 30 pooled samples according to age, sex and Nunavik subregions. Pooled samples were analyzed using sensitive and accurate methods involving ICP-MS platforms to quantify urinary concentrations of 17 REEs and 7 elements of interest in Nunavik (arsenic, antimony, chromium, cobalt, nickel, thallium and uranium). REEs were mostly not detected in pooled samples from this population. Detectable concentrations were found in some samples for cerium (range: 0.5-0.7 nmol/L; 27% > method detection limit (MDL) and lanthanum (range: 0.2-0.4 nmol/L; 33% > MDL). As for the other elements of interest, antimony, arsenic, cobalt and thallium were detected in 100% of the samples, whereas chromium and nickel were detected in 83% and 80% of the samples, respectively. Concentrations of arsenic (geometric mean (GM) = 0.5 µmol/L) and cobalt (GM = 5.2 nmol/L) were greater than in the general Canadian population; the opposite was observed for nickel (GM = 8.9 nmol/L). Arsenic concentrations increased significantly with age, whereas the opposite trend was observed for nickel and thallium. In this first biomonitoring study focusing on REEs and carried out in a representative sample of the Nunavik population, we found no evidence of significant exposure from pooled samples analysis. These results could eventually be used as baseline values in future studies aiming to assess temporal trends of exposure to REEs.

COVID-19 vaccination attitudes and intention among Quebecers during the first and second waves of the pandemic: findings from repeated cross-sectional surveys.

The availability of safe and effective vaccines is a major breakthrough in controlling the COVID-19 pandemic. However, the success of the COVID-19 vaccination campaign relies on high uptake by the public. We monitored Quebecers' attitudes and intention toward COVID-19 vaccination during the first and second waves of the pandemic. Since March 2020, online surveys are conducted every week in Quebec (Canada) to assess Quebecers' adherence to recommended public health measures (3,300 respondents are surveyed every week through an online panel; respondents are not invited to answer the survey for 21 days after responding). Ten items measured respondents' attitudes and intentions regarding COVID-19 vaccination. Logistic regression models were used to identify determinants of intention to be vaccinated against COVID-19. Intention to be vaccinated against COVID-19 ranged from 76%-66% between the first and second waves. The proportion of undecided adults remained stable (12%). Being a man; being 60 years of age and over; having a university education level; having or living with someone with chronic medical conditions and increased risk perceptions of COVID-19 were the strongest predictors of COVID-19 vaccine acceptance in multivariate analysis. During data collection, COVID-19 vaccine supply was very limited. It was reassuring to note that intention to be vaccinated is the highest among older age groups that are prioritized to be vaccinated first. As more doses and vaccines will be available it will be important to enhance vaccine acceptance and uptake, especially among adults younger than 60 years of age and Quebecers with lower risk perceptions of COVID-19.

Covid-19 vaccine acceptance, hesitancy, and refusal among Canadian healthcare workers: A multicenter survey.

BACKGROUND: Determinants of COVID-19 vaccine acceptance among healthcare workers (HCW) remains poorly understood. We assessed HCWs' willingness to be vaccinated and reasons underlying hesitancy. METHODS: Cross-sectional survey across 17 healthcare institutions. HCWs eligible for vaccination (Pfizer-BioNTech mRNA) in December 2020 were invited to receive immunization. Multivariate logistic regression was performed to identify predictors of acceptance. Reasons for refusal among those who never intended to be vaccinated (ie, firm refusers) and those who preferred delaying vaccination (ie, vaccine hesitants) were assessed. RESULTS: Among 2,761 respondents (72% female, average age, 44), 2,233 (80.9%) accepted the vaccine. Physicians, environmental services workers and healthcare managers were more likely to accept vaccination compared to nurses. Male sex, age over 50, rehabilitation center workers, and occupational COVID-19 exposure were independently associated with vaccine acceptance by multivariate analysis. Factors for refusal included vaccine novelty, wanting others to receive it first, and insufficient time for decision-making. Among those who declined, 74% reported they may accept future vaccination. Vaccine firm refusers were more likely than vaccine hesitants to distrust pharmaceutical companies and to prefer developing a natural immunity by getting COVID-19. CONCLUSIONS: Vaccine hesitancy exists among HCWs. Our findings provide useful information to plan future interventions and improve acceptance.