Barriers inhibiting effective detection and management of postpartum hemorrhage during facility-based births in Madagascar: findings from a qualitative study using a behavioral science lens.

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries, and is the most common direct cause of maternal deaths in Madagascar. Studies in Madagascar and other low-income countries observe low provider adherence to recommended practices for PPH prevention and treatment. Our study addresses gaps in the literature by applying a behavioral science lens to identify barriers inhibiting facility-based providers' consistent following of PPH best practices in Madagascar. METHODS: In June 2019, we undertook a cross-sectional qualitative research study in peri-urban and rural areas of the Vatovavy-Fitovinany region of Madagascar. We conducted 47 in-depth interviews in 19 facilities and five communities, with facility-based healthcare providers, postpartum women, medical supervisors, community health volunteers, and traditional birth attendants, and conducted thematic analysis of the transcripts. RESULTS: We identified seven key behavioral insights representing a range of factors that may contribute to delays in appropriate PPH management in these settings. Findings suggest providers' perceived low risk of PPH may influence their compliance with best practices, subconsciously or explicitly, and lead them to undervalue the importance of PPH prevention and monitoring measures. Providers lack clear feedback on specific components of their performance, which ultimately inhibits continuous improvement of compliance with best practices. Providers demonstrate great resourcefulness while operating in a challenging context with limited equipment, supplies, and support; however, overcoming these challenges remains their foremost concern. This response to chronic scarcity is cognitively taxing and may ultimately affect clinical decision-making. CONCLUSIONS: Our study reveals how perception of low risk of PPH, limited feedback on compliance with best practices and consequences of current practices, and a context of scarcity may negatively affect provider decision-making and clinical practices. Behaviorally informed interventions, designed for specific contexts that care providers operate in, can help improve quality of care and health outcomes for women in labor and childbirth.

Consumer Response to Novel Foods: A Review of Behavioral Barriers and Drivers.

There is a pressing need for a transition toward more sustainable diets, which has become a shared priority for both consumers and businesses. Innovation is becoming increasingly widespread across all facets of the food supply chain. This innovation spans various domains related to production, including sustainable cultivation methods as well as new food technologies like gene editing, new product development like functional foods, and revitalizing underutilized and genetically diverse varieties to preserve biodiversity. However, not all innovative efforts are accepted by consumers and survive in markets. The interwoven and long agri-food supply chains often obscure the feedback loop between production and consumption. Consequently, it is important to understand to what extent consumers embrace these food innovations and form new eating habits. This review aims to investigate the consumer response to novel foods, focusing on behavioral factors, which have yet to receive as much attention as sensory factors. Peer-reviewed empirical articles from the last decade are examined inductively to develop a bird's-eye view of the behavioral barriers to and drivers of consumer acceptance of novel foods. In addition, strategies to overcome the identified challenges associated with the behavioral barriers are reviewed and examined. Based on this, the study links cognitive biases with behavioral factors influencing consumer acceptance of novel foods. This study concludes that the inconvenience associated with abandoning established eating habits is typically perceived as a loss, and avoiding this inconvenience is deemed more worth the risk than the potential gains associated with novel food consumption. This study suggests that framing and placing pro-diversity labels could serve as effective behavioral interventions for marketing strategists and food policymakers.

Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study.

BACKGROUND: In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold. OBJECTIVE: The purpose of this observational study was to examine Marines' self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination. METHODS: As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines' written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good (κ=0.81). RESULTS: A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45%), low estimates of risk (33/235, 14%), and fear of physical discomfort (29/235, 12%). Resulting interventions directly targeted Marines' self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine). CONCLUSIONS: Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors.

Capability, Opportunity, and Motivation Model for Behavior Change in People With Asthma: Protocol for a Cross-Sectional Study.

BACKGROUND: Asthma is a common lung condition that cannot be cured, but it can usually be effectively managed using available treatments. Despite this, it is widely acknowledged that 70% of patients do not adhere to their asthma treatment. Personalizing treatment by providing the most appropriate interventions based on the patient's psychological or behavioral needs produces successful behavior change. However, health care providers have limited available resources to deliver a patient-centered approach for their psychological or behavioral needs, resulting in a current one-size-fits-all strategy due to the nonfeasible nature of existing surveys. The solution would be to provide health care professionals with a clinically feasible questionnaire that identifies the patient's personal psychological and behavioral factors related to adherence. OBJECTIVE: We aim to apply the capability, opportunity, and motivation model of behavior change (COM-B) questionnaire to detect a patient's perceived psychological and behavioral barriers to adherence. Additionally, we aim to explore the key psychological and behavioral barriers indicated by the COM-B questionnaire and adherence to treatment in patients with confirmed asthma with heterogeneous severity. Exploratory objectives will include a focus on the associations between the COM-B questionnaire responses and asthma phenotype, including clinical, biological, psychosocial, and behavioral components. METHODS: In a single visit, participants visiting Portsmouth Hospital's asthma clinic with a diagnosis of asthma will be asked to complete a 20-minute questionnaire on an iPad about their psychological and behavioral barriers following the theoretical domains framework and capability, opportunity, and motivation model. Participants' data are routinely collected, including demographics, asthma characteristics, asthma control, asthma quality of life, and medication regime, which will be recorded on an electronic data capture form. RESULTS: The study is already underway, and it is anticipated that the results will be available by early 2023. CONCLUSIONS: The COM-B asthma study will investigate an easily accessible theory-based tool (a questionnaire) for identifying psychological and behavioral barriers in patients with asthma who are not adhering to their treatment. This will provide useful information on the behavioral barriers to asthma adherence and whether or not a questionnaire can be used to identify these needs. The highlighted barriers will improve health care professionals' knowledge of this important subject, and participants will benefit from the study by removing their barriers. Overall, this will enable health care professionals to use effective individualized interventions to support improved medication adherence while also recognizing and meeting the psychological needs of patients with asthma. TRIAL REGISTRATION: ClinicalTrials.gov NCT05643924; https://clinicaltrials.gov/ct2/show/NCT05643924. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44710.

Behavioral Barriers to Stop Female Genital Mutilation/Cutting in South Ethiopia: An Exploratory Qualitative Study of the Perspective of Women.

Background: Female genital mutilation or cutting (FGM/C) is an act that violates the rights of girls and women and causes serious medical complications. Approximately 200 million women have undergone circumcision in 31 countries. Ethiopia, in particular, has the largest number of women who undergone FGM/C. Unfortunately, there has been minimal research into the reasons for this high prevalence in the country. Hence, this study has been conducted to explore behavioral barriers to stopping FGM/C in Southern Ethiopia. Methods: An exploratory qualitative study was employed from October to November 2021 in two purposively selected zones of Southern Ethiopia. A purposive sampling technique was used to select respondents from the two zones. A total of fourteen study participants were selected and interviewed in-depth to obtain responses from various perspectives. A thematic content analysis was conducted to analyze the data collected from the field. Findings: The study revealed that FGM/C is widely practiced in the study area. Respondents were found to have poor awareness and positive attitude towards continuation of FGM/C. This is possibly due to the social and cultural acceptability of the practice and influences from peers, families, future marriage partners and the community. The study shows that women are more likely to be circumcised because they want to be respected by their community, to be considered eligible for marriage and to avoid stigma and discrimination. Conclusion: The continued practice of FGM/C was in considerable state to require the development of intervention strategies in order to eliminate it by 2030. The study's findings recommend stronger legal actions against those who perform FGM/C, alongside behavior change communication interventions, to improve awareness of its risks and encourage the community to stop FGM/C.