Confidentiality matters! Adolescent males' views of primary care in relation to psychosocial health: a structural equation modelling approach.

OBJECTIVE: To investigate to what degree adolescent males (1) value confidentiality, (2) experience confidentiality and are comfortable asking sensitive questions when visiting a general practitioner (GP), and (3) whether self-reported symptoms of poor mental health and health-compromising behaviours (HCB) affect these states of matters. DESIGN: Cross-sectional. SETTING: School-based census on life, health and primary care in Region Sörmland, Sweden. SUBJECTS: 2,358 males aged 15-17 years (response rate 84%). MAIN OUTCOME MEASURES: The impact of poor mental health and HCBs on adolescent males' valuing and experiencing private time with the GP, having professional secrecy explained, and being comfortable asking about the body, love and sex, analysed with structural equation modelling. RESULTS: Almost all respondents valued confidentiality regardless of their mental health or whether they engaged in HCBs: 86% valued spending private time with the GP, and 83% valued receiving a secrecy explanation. Among those who had visited a GP in the past year (n = 1,200), 74% had experienced private time and 42% a secrecy explanation. Three-quarters were at least partly comfortable asking sensitive questions. Adolescent males with HCBs were more likely to experience a secrecy explanation (approximative odds ratio [appOR] 1.26; p = 0.005) and to be comfortable asking about sex than their peers (appOR 1.22; p = 0.007). Respondents reporting experienced confidentiality were more comfortable asking sensitive questions (appOR 1.25-1.54; p ≤ 0.010). CONCLUSION: Confidentiality matters regardless of poor mental health or HCBs and makes adolescent males more comfortable asking sensitive questions. We suggest that GPs consistently offer private time and explain professional secrecy.Key PointsConfidentiality for adolescent males has been scantily studied in relation to mental health and health-compromising behaviours.In this study, most adolescent males valued confidentiality, regardless of their mental health and health-compromising behaviours.Health-compromising behaviours impacted only slightly, and mental health not at all, on experiences of confidentiality in primary care.When provided private time and an explanation of professional secrecy, adolescent males were more comfortable asking the GP sensitive questions.

How are various aspects of personal stigma related to secrecy about mental health problems among people diagnosed with psychotic disorders? A cross-sectional analysis.

OBJECTIVE: Service users commonly keep their mental illness secret in order to avoid rejection. However, this stigma-coping orientation is not necessarily effective and may lead to a number of negative psychological consequences. The purpose of the present study was to investigate the roles of various aspects of personal stigma in predicting secrecy about mental health problems among persons with psychosis. METHODS: A sample of 147 individuals diagnosed with psychotic disorders was recruited for the study. They were administered a set of questionnaires to gather data about sociodemographic and illness-related background characteristics, levels of social functioning, depressive symptoms, and overall psychopathology, elements of personal stigma (i.e., perceived stigma, experienced discrimination, self-stigma, and stigma-related stress), as well as the endorsement of secrecy as a way of coping with stigma. Hierarchical linear regression was utilized for data analysis. RESULTS: Personal stigma measures were entered into the regression equation as a block and explained as much as 29% of variance in the dependent variable over and above sociodemographic and clinical features. After accounting for all controls, higher perceived stigma (ß = 0.47, p < .01) and higher stigma stress (ß = 0.19, p < .05) were found to be independent predictors of secrecy, whereas experienced discrimination and self-stigma were not. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Perceived stigma and stigma stress appraisal should be considered as targets of interventions aiming to reduce the shame and fear of rejection associated with mental illness and to guide and support people's everyday decisions about coming out. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Consumer Willingness to Share Personal Digital Information for Health-Related Uses.

Importance: Consumers routinely generate digital information that reflects on their health. Objective: To evaluate the factors associated with consumers' willingness to share their digital health information for research, health care, and commercial uses. Design, Setting, and Participants: This national survey with an embedded conjoint experiment recruited US adults from a nationally representative sample, with oversampling of Black and Hispanic panel members. Participants were randomized to 15 scenarios reflecting use cases for consumer digital information from a total of 324 scenarios. Attributes of the conjoint analysis included 3 uses, 3 users, 9 sources of digital information, and 4 relevant health conditions. The survey was conducted from July 10 to 31, 2020. Main Outcomes and Measures: Participants rated each conjoint profile on a 5-point Likert scale (1-5) measuring their willingness to share their personal digital information (with 5 indicating the most willingness to share). Results reflect mean differences in this scale from a multivariable regression model. Results: Among 6284 potential participants, 3543 (56%) responded. A total of 1862 participants (53%) were female, 759 (21%) identified as Black, 834 (24%) identified as Hispanic, and 1274 (36%) were 60 years or older. In comparison with information from electronic health care records, participants were less willing to share information about their finances (coefficient, -0.56; 95% CI, -0.62 to -0.50), places they visit from public cameras (coefficient, -0.28; 95% CI, -0.33 to -0.22), communication on social media (coefficient, -0.20; 95% CI -0.26 to -0.15), and their search history from internet search engines (coefficient, -0.11; 95% CI, -0.17 to -0.06). They were more willing to share information about their steps from applications on their phone (coefficient, 0.22; 95% CI, 0.17-0.28). Among the conjoint attributes, the source of information (importance weight: 59.1%) was more important than the user (17.3%), use (12.3%), and health condition (11.3%). Four clusters of consumers emerged from the sample with divergent privacy views. While the context of use was important, these 4 groups expressed differences in their overall willingness to share, with 337 participants classified as never share; 1116 classified as averse to sharing (mean rating, 1.64; 95% CI, 1.62-1.65); 1616 classified as uncertain about sharing (mean rating, 2.84; 95% CI, 2.81-2.86); and 474 classified as agreeable to sharing (mean rating, 4.18; 95% CI, 4.16-4.21). Respondents who identified as White and non-Hispanic, had higher income, and were politically conservative were more likely to be in a cluster that was less willing to share (ie, never or averse clusters). Conclusions and Relevance: These findings suggest that although consumers' willingness to share personal digital information for health purposes is associated with the context of use, many have strong underlying privacy views that affect their willingness to share. New protections may be needed to give consumers confidence to be comfortable sharing their personal information.

Identifying the dimensions of secrets to reduce their harms.

How does the content of secrets relate to their harms? We identified a data-driven model (across five empirical steps), which suggested that secrets are generally seen to differ in how immoral, relational, and profession/goal-oriented they are (Study 1). The more a secret was consensually perceived to be immoral, relational, and profession/goal-oriented, the more that secret was reported to evoke feelings of shame, social connectedness, and insight into the secret, respectively. These three experiences independently predicted the extent to which the secret was judged as harmful to well-being (Studies 2a-c and 3). Reciprocally, reminding participants of the ways in which a secret does not need to be harmful (i.e., across the three dimensions of secrets) bolstered participants' feelings of well-being and efficacy with regard to coping with that secret (Study 4). A final study that examined secrets from romantic partners replicated the effect on perceived coping efficacy, which in turn predicted daily indicators of relationship quality (Study 5). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The barriers and enablers to downloading the COVIDSafe app - a topic modelling analysis.

OBJECTIVE: We report a survey in regional Queensland to understand the reasons for suboptimal uptake of the COVIDSafe app. METHODS: A short five-minute electronic survey disseminated to healthcare professionals, mining groups and school communities in the Central Queensland region. Free text responses and their topics were modelled using natural language processing and a latent Dirichlet model. RESULTS: We received a total of 723 responses; of these, 69% had downloaded the app and 31% had not. The respondents' reasons for not downloading the app were grouped under four topics: lack of perceived risk of COVID-19/lack of perceived need and privacy issues; phone-related issues; tracking and misuse of data; and trust, security and credibility. Among the 472 people who downloaded the app and provided text amenable to text mining, the two topics most commonly listed were: to assist with contact tracing; and to return to normal. CONCLUSIONS: This survey of a regional population found that lack of perceived need, concerns around privacy and technical difficulties were the major barriers to users downloading the application. Implications for public health: Health promotion campaigns aimed at increasing the uptake of the COVIDSafe app should focus on promoting how the app will assist with contact tracing to help return to 'normal'. Additionally, health promotors should address the app's impacts on privacy, people's lack of perceived need for the app and technical barriers.

Paths to social licence for tracking-data analytics in university research and services.

While tracking-data analytics can be a goldmine for institutions and companies, the inherent privacy concerns also form a legal, ethical and social minefield. We present a study that seeks to understand the extent and circumstances under which tracking-data analytics is undertaken with social licence-that is, with broad community acceptance beyond formal compliance with legal requirements. Taking a University campus environment as a case, we enquire about the social licence for Wi-Fi-based tracking-data analytics. Staff and student participants answered a questionnaire presenting hypothetical scenarios involving Wi-Fi tracking for university research and services. Our results present a Bayesian logistic mixed-effects regression of acceptability judgements as a function of participant ratings on 11 privacy dimensions. Results show widespread acceptance of tracking-data analytics on campus and suggest that trust, individual benefit, data sensitivity, risk of harm and institutional respect for privacy are the most predictive factors determining this acceptance judgement.

Clients' satisfaction with HIV care and treatment centres in Dar es Salaam, Tanzania: A cross-sectional study.

BACKGROUND: HIV is a major global public health challenge, claiming the lives of over 32 million people so far. The satisfaction of HIV-affected clients with the quality of their HIV services at treatment centres is crucial for quality improvement. This article assesses clients' satisfaction with different aspects of the overall care experience and seeks to determine if the type of health facility ownership is a predictor of satisfaction. METHODS: A cross-sectional study involving 430 respondents was conducted between September and October 2019. Purposeful and convenient sampling techniques were used to select health facilities and potential respondents, respectively. A pre-tested, interviewer-administered questionnaire was used to collect data. Binary logistic regression was used to assess the association between type of health facility and clients' satisfaction based on the six assessed aspects of care, and p˂0.05 was considered statistically significant. RESULTS: The general clients' satisfaction with HIV/AIDS services at care and treatment centres was 92.3%. Respondents from public health facilities were most satisfied with privacy and confidentiality (100%), physical environment (100%), counseling (99.5%) and drug availability (99.5%); respondents from private health facilities were most satisfied with the time spent in the facility (95.9%); while respondents from faith-based health facilities were most satisfied with staff-patient communication (99.2%). However, after adjusting for confounders, only one aspect of care, that of "time spent in the facility," showed significant association with the type of health facility. CONCLUSION: Generally, clients' satisfaction with HIV/AIDS services at care and treatment centres in the Ubungo District, Dar es Salaam was high. This finding should encourage health care providers to maintain high-quality services to sustain clients' satisfaction.

Cultural Viewpoints of Nursing Students on Patient Privacy: A Qualitative Study.

The purpose of this study was to determine the feelings, thoughts, perceptions and cultural standpoint of nursing students concerning patient privacy. This study was conducted as a qualitative descriptive design. The homogeneous sampling method, purposive sampling method for qualitative research samples, was used to determine the study group. Data were collected from 17 nursing students at a state university in Turkey. Individual semi-structured interviews were conducted, and content analysis was used to analyze data. Three main themes emerged from the data: perception of privacy, factors affecting patient privacy and suggested solutions. Four sub-categories emerged: religion, gender, culture and reassuring communication. The perceptions of many of the students relating to the concept of privacy coincided with the concepts of confidentiality and all kinds of information concerning the patient. It was seen that the most effective intervention among the students' solution proposals to ensure privacy was the necessity to make physical improvements in hospitals.

Avaliação da qualidade de vida de pessoas vivendo com HIV/AIDS: revisão integrativa / Evaluating the quality of life of people living with HIV/AIDS: integrative review / Evaluación de la calidad de vida de personas que viven con VIH/SIDA: revisión integradora

Objetivo: analisar estudos referentes à avaliação da qualidade de vida de pessoas vivendo com HIV no Brasil, por meio de uma revisão integrativa da literatura. Método: trata-se de revisão integrativa que incluiu 22 artigos científicos publicados no período de 2011 a 2019. Resultados: os principais instrumentos utilizados na avaliação da qualidade de vida foram o WHOQOL-HIV bref e o HAT-QOL. Os domínios com maiores escores na avaliação foram confiança no médico, psicológico e espiritualidade; as piores avaliações relacionavam-se com os domínios meio ambiente e preocupação com o sigilo. A exposição do diagnóstico impacta negativamente para a qualidade de vida bem como as condições de vida e saúde. Considerações finais: a qualidade de vida é um construto multidimensional e subjetivo com implicação direta na saúde e tratamento das pessoas vivendo com HIV, portanto, compreender os fatores que impactam sua avaliação é primordial na elaboração de políticas públicas e melhores condições de vida.

Objective: to analyze studies on evaluating the quality of life of people living with HIV in Brazil, by integrative literature review. Method: this integrative review included 22 scientific articles published from 2011 to 2019. Results: the instruments most used to assess quality of life were the WHOQOL-HIV bref and the HAT-QOL. The highest-scoring domains were trust in the doctor, psychology and spirituality, while the lowest scores related to the environment and confidentiality concerns. Exposing the diagnosis has adverse impacts on both quality of life and conditions of life and health. Final considerations: quality of life is a multidimensional, subjective construct with direct implications for the health and treatment of people living with HIV. Accordingly, in order to develop public policies and improve conditions of life, it is essential to understand the factors that impact on its assessment.

Objetivo: analizar estudios sobre la evaluación de la calidad de vida de las personas que viven con el VIH en Brasil, mediante revisión integradora de la literatura. Método: esta revisión integradora incluyó 22 artículos científicos publicados entre 2011 y 2019. Resultados: los instrumentos más utilizados para evaluar la calidad de vida fueron el WHOQOL-HIV bref y el HAT-QOL. Los dominios de mayor puntuación fueron la confianza en el médico, la psicología y la espiritualidad, mientras que las puntuaciones más bajas se relacionaron con el medio ambiente y las preocupaciones de confidencialidad. Exponer el diagnóstico tiene impactos adversos tanto en la calidad de vida como en las condiciones de vida y salud. Consideraciones finales: la calidad de vida es un constructo subjetivo multidimensional con implicaciones directas para la salud y el tratamiento de las personas que viven con el VIH. En consecuencia, para desarrollar políticas públicas y mejorar las condiciones de vida, es fundamental conocer los factores que inciden en su evaluación.

Preferences for Accessing Electronic Health Records for Research Purposes: Views of Parents Who Have a Child With a Known or Suspected Genetic Condition.

OBJECTIVES: The purpose of this study was to examine parental preferences for researchers accessing their child's electronic health record across 3 groups: those with a child with (1) a known genetic condition (fragile X syndrome FXS), (2) a suspected genetic condition (autism spectrum disorder [ASD]), and (3) no known genetic condition (typically developing). METHODS: After extensive formative work, a discrete choice experiment was designed consisting of 5 attributes, each with 2 or 3 levels, including (1) type of researcher, (2) the use of personally identifiable information, (3) the use of sensitive information, (4) personal importance of research, and (5) return of results. Stratified mixed logit and latent class conditional logit models were examined. RESULTS: Parents of children with FXS or ASD had relatively higher preferences for research conducted by nonprofits than parents of typically developing children. Parents of children with ASD also preferred research using non-identifiable and nonsensitive information. Parents of children with FXS or ASD also had preferences for research that was personally important and returned either summary or individual results. Although a few child and family characteristics were related to preferences, they did not overall define the subgroups of parents. CONCLUSIONS: Although electronic health record preference research has been conducted with the general public, this is the first study to examine the opinions of parents who have a child with a known or suspected genetic condition. These parents were open to studies using their child's electronic health record because they may have more to gain from this type of research.

Going against patients' will? A qualitative study of how palliative health-care professionals handle competing considerations when children are excluded from parental illness and death.

PURPOSE: The Norwegian Health Personnel Act (HPA §10a) obliges health professionals to contribute to meeting minor children's need for information about their parents' illness and prognosis. Previous research has shown that many parents withhold information about illness and anticipated death from their children. This study explored main considerations for palliative health-care professionals in these situations, and how they negotiate conflicting considerations of confidentiality and child involvement. METHOD: This qualitative exploratory study involved semi-structured interviews with 11 palliative health-care professionals. Hermeneutics informed the data analysis. RESULTS: The health professionals' main considerations were sustaining patients' hope and building trust in the professional-patient relationship. Both concerns were grounded in respect for patient autonomy. The health professionals negotiated patient autonomy and child involvement in different ways, defined in the present analysis on a continuum ranging from granting full patient autonomy to going directly against patients' will. CONCLUSIONS: The professional-patient relationship is the primary consideration in the health care context, and decision making on the degree of children's involvement happens in a dialogical process between health professionals and patients. Close professional-patient relationships might increase the emotional impacts on health professionals, who consequently might give greater relative weight to patients' will. We propose that procedures for initiating collaboration with professionals in the child's everyday life context help health professionals involving the child without threatening trust.

Adolescents' right to confidential health care: knowledge, attitudes and practice of pediatricians and gynecologists in the primary healthcare sector in Belgrade, Serbia.

OBJECTIVES: Confidential counseling is a critical condition of the healthcare quality in adolescent medicine. This study aimed at assessing knowledge, attitudes and practice of primary healthcare pediatricians and gynecologists regarding adolescents' rights to confidentiality. METHODS: A cross-sectional study was conducted in a sample of 152 pediatricians and gynecologists who are employed at 13 primary healthcare centers in Belgrade, Serbia, in 2017-2018. Data were collected by a self-administered questionnaire purposefully constructed for this study. The questionnaire examined knowledge and attitudes toward adolescents' right to confidentiality as well as whether participating physicians practice confidential health care with adolescents. RESULTS: Physicians scored 4 out of 7 on a knowledge scale, but they overall supported adolescents' right to confidential health care (average attitude score was 71 out of 95). On average, physicians scored 21 out of 30 on practice of confidentiality scale. Multivariate analysis showed that better knowledge and stronger positive attitudes toward duty of confidentiality were associated with consistent practice of confidential health care. CONCLUSIONS: Knowledge about adolescents' rights to confidentiality and attitudes toward keeping adolescents' information confidential influence the practice of providing confidential services.

Providing personal information to the benefit of others.

Personal information is a precious resource, not only for commercial interests but also for the public benefit. Reporting personal location data, for example, may aid efficient traffic flows and sharing one's health status may be a crucial instrument of disease management. We experimentally study individuals' willingness to contribute personal information to information-based public goods. Our data provide evidence that-compared to monetary contributions to public goods-information may be substantially under-provided. We show that the degree of information provision is strongly correlated to the information's implicit (emotional and cognitive) costs. Individual's reluctance to share personal information with high implicit, in particular emotional costs, may seriously limit the effectiveness of information-based public goods.

Keep the cat in the bag: Children understand that telling a friend's secret can harm the friendship.

Secrets play a powerful role in human social relationships. Here, we examine the developmental trajectory of 3- to 10-year-old children's (N = 630) expectations about (a) how relationships impact whether people will keep secrets, and (b) how relationships are impacted when a confidee keeps versus tells a confider's secret. Sophisticated expectations about the role of secrets in relationship maintenance develop across childhood. In particular, school-age children (6- to 10-year-olds) expect friends to be more likely to keep each other's secrets than nonfriends (Study 1), and expect that if a friend breaks this norm and shares his friend's secret with a third-party, it will harm the friendship (Studies 2 and 3). These expectations were specific to inferences about secrets: school-age children did not expect that sharing (or keeping) a friend's fact or surprise would impact the friendship strength (Studies 2 and 3). These findings did not hold for preschoolers (3- to 5-year-olds), who did not have clear expectations linking secret sharing to friendship strength. Taken together, our results indicate that by 6 years of age, children understand that social relationships can increase people's obligations to keep each other's secrets, and that failing to do so can harm the relationship. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Self-concealment and suicidality: Mediating roles of unmet interpersonal needs and attitudes toward help-seeking.

OBJECTIVE: We investigated the relationship between self-concealment-a tendency to hide distressing information-and suicidality, via two mediators: (a) unmet interpersonal needs and (b) help-seeking attitudes. METHOD: A sample of young adults (18-25 years) was recruited online to complete a self-report survey questionnaire (n = 245). A parallel multiple mediation model was analyzed using the PROCESS macro (Hayes, 2013, Methodology in the social sciences. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press) in SPSS. RESULTS: There was a significant positive relationship between self-concealment and suicidality. This relationship was partially mediated by unmet interpersonal needs. Although self-concealment was associated with more negative attitudes toward seeking professional psychological help, these help-seeking attitudes were not significantly related to suicidality. CONCLUSIONS: Our results highlight the importance of interpersonal factors in suicide. Unmet interpersonal needs emerged as a mechanism by which self-concealment contributes to increased suicidality. We review implications for research, clinical practice, and prevention.

[Legitimate resistance without technophobia: Analysis of electronic medical records impacts on the medical profession]. / Résistance légitime sans technophobie : analyse des impacts de l'informatisation du dossier du patient sur le cœur du métier médical.

The objective of this short narrative literature review is to highlight the different difficulties encountered by medical doctor in the daily use of EMR. We show that these are not simple transitional phenomena related to a "resistance to change", but rather the fact of a deeper and unfinished transformation. Beyond the "perception of misfit with work processes" or the threat of a loss of autonomy, we propose to analyze this so-called "resistance" in relation to the formalization of medical work induced by EMR. Our question concerns the compatibility of the multiple objectives of EMR, the potential influence of computerization on the steps of entering and consulting medical information, the impact on the clinical reasoning, the reality of assistance to medical "performance". The question is not so much what EMRs do less well than the paper record, but to provide insights into how tomorrow's EMRs will do better than today's.

Confidentiality and Capacity.

This article focuses on confidentiality and capacity issues affecting patients receiving care in the emergency department. The patient-physician relationship begins with presumed confidentiality. The article also clarifies instances where a physician may be required to break confidentiality for the safety of patients or others. This article then discusses risk management issues relevant to determining a patient's capacity to accept or decline medical care in the emergency department setting. Situations pertaining to refusal of care and discharges against medical advice are examined in detail, and best practices for mitigating risk in informed consent and barriers to consent are reviewed.

Privacy, confidentiality, security and patient safety concerns about electronic health records.

AIMS: This study explored concerns among nurses working in the United Arab Emirates associated with the use of electronic health records, including privacy, confidentiality, security and patient safety. BACKGROUND: Given the widespread implementation of electronic health records, there are concerns about data integrity that could jeopardize healthcare quality. Addressing nurses' concerns about data integrity and safety is critical to inform health policies and promote public trust. METHODS: Nurses working in healthcare settings in the United Arab Emirates (N = 562) were invited to share their concerns about data integrity and patient safety using a mixed-method approach. Data were collected between January and June 2018 via questionnaires and focus group interviews. Following a survey of nurses' concerns about privacy, confidentiality, security and patient safety in electronic health records, six focus groups were held to gain deeper insights about their concerns. Major themes that emerged from the focus groups were extracted to align with the main sections of the questionnaire. RESULTS: Nurses expressed concern over the security of electronic health records (n = 270, 48%). Administrative-related security, inadequate training and access by unauthorized users were the most frequently reported concerns. The main patient safety concerns were associated with non-technological factors, including lack of audit by staff, poor communication with technology vendors and length of time required for documentation. The focus group results reflected similar issues, with an additional theme being inconsistency in data integrity policies. CONCLUSIONS AND IMPLICATIONS FOR NURSING/HEALTH POLICY: Frontline nurse managers need to integrate pragmatic policies to support staff compliance with the code of ethics when using online data. Nurses must follow workplace policies that foster reporting of risks to online incident systems to ensure data integrity. A unified health policy based on multidisciplinary partnership is critical to safeguard online data and promote public trust.