Improving patient-centred counselling skills among lay healthcare workers in South Africa using the Thusa-Thuso motivational interviewing training and support program.

We developed a motivational interviewing (MI) counselling training and support program for lay counsellors in South Africa-branded "Thusa-Thuso-helping you help", commonly referred to as Thusa-Thuso. We present the results of a pilot study to determine the program's impact on MI technical skills and qualitatively assess the feasibility of a training-of-trainers (TOT) scale-up strategy among counselling staff of non-governmental (NGO) support partners of the human immunodeficiency virus (HIV) treatment program in South Africa. We enrolled adult (≥ 18 years) lay counsellors from ten primary healthcare clinics in Johannesburg (South Africa) selected to participate in the Thusa-Thuso training and support program. Counsellors attended the ten-day baseline and quarterly refresher training over 12 months (October 2018-October 2019). Each counsellor submitted two audio recordings of mock counselling sessions held during the ten-day baseline training and two additional recordings of sessions with consenting patients after each quarterly contact session. We reviewed the recordings using the MI treatment integrity (MITI) coding system to determine MI technical (cultivating change talk and softening sustain talk) and relational (empathy and partnership) competency scores before and after training. After 12 months of support with pilot site counsellors, we were asked to scale up the training to NGO partner team trainers in a once-off five-day Training of trainers (TOT) format (n = 127 trainees from November 2020 to January 2021). We report TOT training experiences from focus group discussions (n = 42) conducted six months after the TOT sessions. Of the 25 enrolled lay counsellors from participating facilities, 10 completed the 12-month Thusa-Thuso program. Attrition over the 12 months was caused by death (n = 3), site exclusion/resignations (n = 10), and absence (n = 2). MI competencies improved as follows: the technical skills score increased from a mean of 2.5 (standard deviation (SD): 0.8) to 3.1 (SD: 0.5), with a mean difference of 0.6 (95% confidence interval (CI): 0.04, 0.9). The MI relational skills score improved from a mean of 3.20 (SD: 0.7) to 3.5 (SD: 0.6), with a mean difference of 0.3 (95% CI: -0.3, 8.5). End-point qualitative data from the counsellors highlighted the value of identifying and addressing specific skill deficiencies and the importance of counsellors being able to self-monitor skill development using the MITI review process. Participants appreciated the ongoing support to clarify practical MI applications. The TOT program tools were valuable for ongoing on-the-job development and monitoring of quality counselling skills. However, the MITI review process was perceived to be too involved for large-scale application and was adapted into a scoring form to document sit-in mentoring sessions. The Thusa-Thuso MI intervention can improve counsellor motivation and skills over time. In addition, the program can be scaled up using an adapted TOT process supplemented with fidelity assessment tools, which are valuable for skills development and ongoing maintenance. However, further studies are needed to determine the effect of the Thusa-Thuso program on patient ART adherence and retention in care. Trial registration: Pan African Clinical Trials Registry No: PACTR202212796722256 (12 December 2022).

Integrating 'undetectable equals untransmittable' into HIV counselling in South Africa: the development of locally acceptable communication tools using intervention mapping.

BACKGROUND: The global campaign for "Undetectable equals Untransmittable" (U = U) seeks to spread awareness of HIV treatment as prevention, aiming to enhance psychological well-being and diminish stigma. Despite its potential benefits, U = U faces challenges in Sub-Saharan Africa, with low awareness and hesitancy to endorse it. We sought to develop a U = U communications intervention to support HIV counselling in primary healthcare settings in South Africa. METHODS: We used Intervention Mapping (IM), a theory-based framework to develop the "Undetectable and You" intervention for the South African context. The six steps of the IM protocol were systematically applied to develop the intervention including a needs assessment consisting of a systematic review and qualitative research including focus group discussions (FGD) and key informant (KI) interviews. Program objectives and target population were determined before designing the intervention components and implementation plan. RESULTS: The needs assessment indicated low global U = U awareness, especially in Africa, and scepticism about its effectiveness. Lay counsellors and clinic managers stressed the need for a simple and standardized presentation of U = U addressing both patients' needs for encouragement and modelling of U = U success but also clear guidance toward ART adherence behaviour. Findings from each step of the process informed successive steps. Our final intervention consisted of personal testimonials of PLHIV role models and their partners, organized as an App to deliver U = U information to patients in primary healthcare settings. CONCLUSIONS: We outline an intervention development strategy, currently in evaluation stage, utilizing IM with formative research and input from key U = U stakeholders and people living with HIV (PLHIV).

Promoting informed decision making about maternal pertussis vaccination: the systematic development of an online tailored decision aid and a centering-based group antenatal care intervention.

Introduction: Maintaining and enhancing vaccine confidence continues to be a challenge. Making an informed decision not only helps to avoid potential future regret but also reduces susceptibility to misinformation. There is an urgent need for interventions that facilitate informed decision-making about vaccines. This paper describes the systematic development of two interventions designed to promote informed decision making and indirectly, acceptance of maternal pertussis vaccination (MPV) in the Netherlands. Materials and methods: The 6-step Intervention Mapping (IM) protocol was used for the development of an online tailored decision aid and Centering Pregnancy-based Group Antenatal Care (CP) intervention. A needs assessment was done using empirical literature and conducting a survey and focus groups (1), intervention objectives were formulated at the behavior and determinants levels (2), theoretical methods of behavior change were selected and translated into practical applications (3), which were further developed into the two interventions using user-centered design (4). Finally, plans were developed for implementation (5), and evaluation (6) of the interventions. Results: The needs assessment showed that pregnant women often based their decision about MPV on information sourced online and conversations with their partners, obstetric care providers, and peers. Responding to these findings, we systematically developed two interactive, theory-based interventions. We created an online tailored decision aid, subjecting it to four iterations of testing among pregnant women, including those with low literacy levels. Participants evaluated prototypes of the intervention positively on relevance and usability. In addition, a CP intervention was developed with midwives. Conclusion: Using IM resulted in the creation of an online decision aid and CP intervention to promote informed decision making regarding MPV. This description of the systematic development of the interventions not only serves to illustrate design rationales, it will also aid the interpretation of the evaluation of the interventions, the development of future interventions promoting informed decision and acceptance of vaccines, and comparisons with other interventions.

The end point of it is abstinence: a qualitative analysis of underlying factors influencing Christian leaders' adoption and implementation of sex and sexuality education in Bolgatanga, Ghana.

Adolescents' sexual and reproductive health challenges are of global public health concern and good quality sexual and reproductive health (SRH) education has an important role to play in addressing these negative sexual health outcomes. Yet in most Sub-Saharan African countries including Ghana, there is limited implementation of SRH education. Several environmental factors hinder the implementation of SRH education with the attitudes expressed by religious leaders having a major impact. We conducted semi-structured interviews with 15 Christian leaders in Bolgatanga, Ghana, to explore the factors influencing their decision to adopt and implement SRH education. Findings show that although Christian leaders were aware of (unsafe) sexual practices among adolescents, they held a conservative position on SRH education. While leaders were open to educating adolescents about sexual health, most held the opinion that SRH education for adolescents should be limited to abstinence-only and not acknowledge sexual activity or promote contraceptive use. Beliefs related to sexual morality, the perceived cause(s) of teenage pregnancy, and perceived responsibility for SRH education influenced Christian leaders' thinking about SRH education. Implementing SRH education programmes to address young people's sexual behaviour will require intervention programmes to change Christian leaders' beliefs and attitudes towards SRH education.

Promoting informed decision-making about maternal pertussis vaccination in Centering Pregnancy group-antenatal care: A feasibility study.

PROBLEM: Effective interventions are needed to promote informed decision making about vaccination. BACKGROUND: We developed a group-antenatal care (CP; Centering Pregnancy) intervention, i.e., a session about MPV within existing group-care settings, to promote informed decision making about Maternal Pertussis Vaccination in the Netherlands. AIM: This study aimed to assess (1) to what extent the intervention was implemented as intended, (2) to what extent the intervention met the needs and wishes of pregnant individuals and midwives facilitating CP. METHODS: We conducted exploratory interviews with 6 CP facilitators and 10 CP participants to assess the implementation of the intervention, and how the intervention and its different components were perceived. Interviews were analysed using thematic analysis. In addition, we conducted a pre- and post-intervention survey amongst 35 participants, measuring knowledge about MPV, and MPV attitude and intention. RESULTS: The CP intervention was implemented as intended in 6 out of 7 groups. Participants were positive about the interactive CP-methods used to discuss MPV. Participants and facilitators evaluated the intervention as positive and relevant, although the intervention was time-consuming, and some participants had already made the de decision about MPV. Those who had not yet decided indicated that the session was helpful for their decision. DISCUSSION AND CONCLUSION: Discussing MPV in CP care settings is a feasible strategy to support decision making about MPV during pregnancy. The intervention could be improved by discussing the MPV sooner than 16-18 weeks of pregnancy. A larger-scale study is needed to assess effects on MPV uptake and informed decision making.

Who is providing HIV testing services? The profile of lay counsellors providing HIV testing services in Johannesburg, South Africa in the treat-all era.

BACKGROUND: Lay counsellors are critical in sustaining access to HIV testing services (HTS) and psychosocial support for persons living with HIV (PLHIV). We aimed to describe the professional and psychosocial profiles of lay counsellors in primary healthcare (PHC) clinics in Johannesburg, South Africa under the universal-test-and-treat (UTT) policy context. METHODS: We conducted a descriptive analysis of a cross-sectional survey among adult (≥ 18 years) lay counsellors from 20 PHC facilities (2-3/ clinic) in Johannesburg, South Africa. Consenting counsellors were interviewed between June 2018 and March 2019. We report on counsellors' demographic profiles, training, work experience, and mental and emotional well-being. RESULTS: Overall, 55 consenting adult (≥ 18 years) lay counsellors (92.7% female, median age 37 years, interquartile range [IQR]: 33-44, and 27.3% HIV diagnosed) were surveyed. Most (85.5%) were Department of Health lay counsellors receiving a volunteer stipend at the time. Overall, 56.4% had been working as counsellors for five years or longer. The majority (87%) had completed the National HIV Testing Services Policy Guidelines-recommended 10-day basic counselling training, but 45.2% had not completed refresher training within the guideline's required 24 months. Reported operational barriers include lack of designated space for counselling (56.4%), inadequate professional supervision and support (40.7%) and insufficient emotional support (over 56.4%), and 60% were overwhelmed by their workload. A total of 18.2% had major depressive symptoms, and the same proportion scored low for psychological well-being. While most (87.3%) reported moderate job satisfaction, 50.9% actively sought alternative employment. CONCLUSION: Despite lay counsellors' significant role in delivering HIV care in South Africa, there has been minimal investment in their skills development, emotional support, and integration into the formal health workforce. Counsellors' persisting unmet psychosocial, training, and professional needs could impact their efficacy in the UTT era.

Effects of an online tailored decision aid to promote informed decision making about maternal pertussis vaccination in the Netherlands: A randomized controlled trial.

INTRODUCTION: In 2019, maternal pertussis vaccination (MPV) during pregnancy was introduced in the Netherlands. New interventions to promote informed decision making (IDM) about vaccinations are highly needed, especially for new vaccinations. Decision aids (DAs) have the potential to support IDM. This study evaluates the effects of an online DA on IDM and MPV uptake. METHODS: Pregnant individuals, recruited for the randomized controlled trial (RCT), who gave informed consent (N = 1,236) were randomly assigned to the control (N = 650; no information) or intervention condition (N = 586; DA at 18 weeks pregnancy). MPV uptake and IDM were primary outcomes, decisional certainty and psychological determinants of MPV uptake were secondary outcomes. Measures were taken at 18 weeks of pregnancy (baseline) and at 20 weeks of pregnancy (post-test); intervention use was logged. Data were analysed using intention-to-treat analyses, logistic regression, and linear mixed regression models. RESULTS: Uptake of MPV was high in our sample (92.3 %). No significant effect of the DA condition on MPV uptake was found compared to the control condition. We found that the DA increased IDM (ß = 0.24, p < .004) and one of its components level of knowledge about MPV (ß = 0.31, p < .004). We also found an increase in decisional certainty (ß = 0.24, p < .004), perceived susceptibility (ß = 0.24, p < .004), severity of pertussis (ß = 0.41, p < .004), and positive affect about MPV (ß = 0.15, p < .004). There was a positive association between dose of the intervention and MPV uptake (ß = 0.05, p < .004). DISCUSSION: The DA seemed effective in promoting IDM about and determinants of MPV uptake. No main effect was found on MPV uptake, but MPV uptake was related to the level of exposure to the DA. People with high intentions towards MPV were overrepresented in the sample. However, effects on IDM were consistent among participants with different levels of MPV intention at baseline.

Social-psychological determinants of hormonal contraceptive use intentions among adolescent girls in the Bono East Region of Ghana.

Introduction: The correct and consistent use of hormonal contraceptive (HC) methods by sexually active adolescent girls can prevent pregnancy and avert the health and social consequences of unwanted pregnancy for both the mother and her child. Despite these benefits, research shows that HC use is rather low among adolescent girls globally and especially among those in low and middle-income countries. This study was carried out to assess the social-psychological determinants of HC use intentions among adolescent girls and young women. Methods: A cross-sectional survey was conducted among 1,203 young women aged 15-24 years from 70 communities within the Kintampo North Municipality and Kintampo South District in the Bono-East Region of Ghana from April 2021 to September 2021. Multiple linear regression analysis was used to identify factors associated with the intention to use HC among the entire sample of 1,203 respondents and among two sub-samples of young women based on HC use experience. Results: Attitude toward personal HC use (ß = 0.268; p < 0.001), self-efficacy toward access and use of HC (ß = 0.341; p < 0.001), and HC use experience (ß = 0.647; p < 0.001) were found to be significant and unique correlates of HC use intention among the entire sample of adolescent girls. Attitude toward personal HC use and self-efficacy toward access and use of HC were also associated with HC use intention in the two sub samples significantly (p's < 0.001). In addition, among participants with no HC experience, being a Christian as opposed to participants that affiliate themselves with Islam, Traditional religion or being non-religious positively predicts future HC use (ß = 0.230; p < 0.01). Conclusion: Our results demonstrate that different groups of adolescent girls need different interventions, focusing on different determinants for the motivation to use HC. Comprehensive sexuality education, informing all adolescent girls about the personal benefits of HC use and enhancing their skills in accessing and using HCs, can support their HC use intentions to promote their reproductive health and general wellbeing.

A qualitative analysis of factors influencing the implementation of antiretroviral treatment adherence policy in Ghana: stakeholders perspective.

BACKGROUND: The Joint United Nations Programme on HIV/AIDS launched the 90-90-90 initiative. Failure to meet the target reflects the difficulties in successfully implementing HIV treatment policy. There are research gaps in exploring personal and external factors influencing HIV treatment in Ghana. To fill this gap, we explored individual and environmental (interpersonal, community and structural) factors influencing stakeholders' HIV treatment policy implementation in Ghana. METHODS: Fifteen qualitative semi-structured in-depth interviews were conducted among representatives in different management positions at hospitals, health directorates, the Ghana AIDS Commission, the National AIDS and STI control program, and the National Association of People Living with HIV. RESULTS: Using thematic analysis, the findings suggest that individual and environmental factors such as attitude towards policy, awareness of HIV treatment policy, training received on policy implementation, difficulties related to patient factors, alternate sources of HIV care, inefficient policy decision-making, monitoring and evaluation of HIV treatment policy, lack of HIV treatment policy implementation training, poor availability of logistics, policy and guidelines, infrastructure, organization of training, and staff availability may hinder successful HIV treatment policy implementation. CONCLUSION: Several individual and environmental (interpersonal, community and structural) factors seem to influence HIV treatment policy implementation. To ensure successful policy implementation stakeholders need to receive training on new policies, availability of sufficient supplies of material resources, inclusive decision-making, receive supportive monitoring of policy implementation, and oversight.

Perspective on the Prevention of Suicide among School Learners by School Management.

BACKGROUND: Adolescents in South Africa have higher suicide rates than older people. A suicide or unexpected death of a fellow student can result in increased copycat behavior. Previous studies have placed emphasis on the significance of school involvement in the prevention of suicide. The study sought to explore the perspective on the prevention of suicide among school learners by school management. A qualitative phenomenological design was applied. The study used purposive sampling to select six high schools. In-depth interviews were conducted with six focus group discussions comprising fifty school management. A semi-structured interview guide guided the interviews. Data were analyzed using a general inductive approach. Findings revealed that school management should be supported through workshops to increase their skills in handling stressful situations at school. Support for learners through audio-visuals, professional counseling, and awareness campaigns also emerged. Parents-school partnership was said to be effective in preventing suicide among learners as both parties will be free to discuss the problems faced by the learner. In conclusion, empowering school management in the prevention of suicide is critical for Limpopo learners. Awareness campaigns conducted by suicide survivors where they can share their testimonies is necessary. School-based professional counseling services should be established to benefit all learners, particularly those experiencing financial challenges. Pamphlets in local languages should be developed for students to convey information about suicide.

Considerable doubt about rubella screening and vaccination among unvaccinated orthodox protestant women: a mixed-methods study.

BACKGROUND: Women who are susceptible to rubella are advised to vaccinate against rubella to prevent infection in future pregnancies, and thus avert the risk of congenital rubella syndrome in their unborn child. Rubella outbreaks periodically occur in the under-vaccinated orthodox Protestant community in the Netherlands. The objective of this mixed-methods study was to determine and understand personal experience with rubella, perceived rubella susceptibility, and intention to accept rubella screening and vaccination among unvaccinated orthodox Protestant women. The ultimate aim of this study was to inform policy and practice and contribute to the prevention of cases of congenital rubella syndrome. METHODS: A mixed-methods study was conducted combining an online survey and semi-structured interviews among unvaccinated Dutch orthodox Protestant women aged 18-40 years. Descriptive analysis was used for quantitative data. Qualitative data was analysed using codes and categories. RESULTS: Results of the survey (167 participants) showed that most participants had personal experience with rubella (74%, 123/167) and 101 women (61%, 101/167) indicated they had had rubella themselves. More than half of the women were undecided whether to accept rubella susceptibility screening (56%; 87/156) or rubella vaccination (55%; 80/146). Qualitative findings (10 participants) showed that most women thought they were not susceptible to rubella. Indecisiveness and negative attitudes to accept rubella vaccination were related with religious arguments to object vaccination and with women's perception of absence of imminent threat of rubella. Furthermore, results showed presence of misconceptions among women in the interpretation of their susceptibility and high confidence in their parents' memory that they had experienced rubella as a child although no laboratory screening had been conducted. CONCLUSIONS: In light of an imminent rubella outbreak in the Netherlands, a tailored education campaign should be prepared aimed at and established in cooperation with the under-vaccinated orthodox Protestant community. Health care providers should provide adequate information on rubella and support decision-making in order to stimulate women to make a deliberate and informed decision on rubella screening and, if necessary, subsequent vaccination.

Moderators of the Effectiveness of UPcomplish on Office Workers' Sedentary Behaviour, Quality of Life, and Psychosocial Determinants: A Stepped Wedge Design.

BACKGROUND: In the earlier developed and evaluated 12-week UPcomplish intervention, the aim was to reduce sedentary behaviour (SB) among office workers and increase their quality of life (QoL). In the current study, we explored moderators of effectiveness. METHOD: We applied a stepped wedge design with five intervention groups starting with time lags of seven weeks (n = 142, 96 females). Participants wore the VitaBit to continuously measure SB and received surveys about QoL and psychosocial determinants at the beginning, middle, and end of the intervention. We regressed baseline participant characteristics and behaviours onto intra-individual improvements (centred around calendar week means) in determinants, SB, performance objectives, and QoL. RESULTS: Those scoring high in baseline intention, task performance, stress, vitality, and emotional well-being improved less in these variables. Baseline stress (ß = - 0.05 [SE = 0.01; 95% CI = - 0.08, - 0.02; pcorrected = .02]) and emotional well-being (ß = 0.02 [SE = 0.01; 95% CI = 0.01, 0.03; pcorrected = .02]) were associated with improvement in contextual performance. Baseline attitude (ß = - 12.92 [SE = 3.93; 95% CI = - 20.80, - 5.04; pcorrected = .02]) and perceived behavioural control (PBC; ß = - 9.27 [SE = 3.04; 95% CI = - 15.37, - 3.16; pcorrected = .03]) were negatively associated with improvements in emotional well-being. Post hoc analyses with a sub-group scoring lower in determinants revealed that improvement in PBC was positively associated with SB registration. CONCLUSION: Participants scoring low in baseline determinants might profit from UPcomplish via an increase in PBC. In combination with changes within organizations (e.g. the implementation of standing desks), UPcomplish might potentially reduce SB. TRIAL REGISTRATION: NL7503 - registered 1 February 2019.

Just-in-Time, but Still Planned: Lessons Learned From Speeding up the Development and Implementation of an Intervention to Promote COVID-19 Vaccination in University Students.

The process of developing a behavior change intervention can cover a long time period. However, in times of need, this development process has to be more efficient and without losing the scientific rigor. In this article, we describe the just-in-time, planned development of an online intervention in the field of higher education, promoting COVID-19 vaccination among university students, just before they were eligible for being vaccinated. We demonstrate how intervention development can happen fast but with sufficient empirical and theoretical support. In the developmental process, Intervention Mapping (IM) helped with decision-making in every step. We learned that the whole process is primarily depending on the trust of those in charge in the quality of the program developers. Moreover, it is about applying theory, not about theory-testing. As there was no COVID-19-related evidence available, evidence from related fields helped as did theoretical knowledge about change processes, next to having easy access to the target population and important stakeholders for informed qualitative and quantitative research. This project was executed under unavoidable time pressure. IM helped us with systematically developing an intervention, just-in-time to positively affect vaccine acceptance among university students.

The effect of emotion regulation strategies on decision-making about the maternal pertussis vaccination among pregnant women in the Netherlands: an experimental study.

OBJECTIVE: To assess whether cognitive reappraisal and acceptance are effective emotion regulation strategies to decrease the influence of negative affect on intention to accept maternal pertussis vaccination (MPV) among pregnant women in the Netherlands. METHODS: An experimental study with baseline and two follow-up measurements was conducted. Participants selected after baseline (N = 382) were randomized into two experimental groups (cognitive reappraisal, acceptance) and a control group. The effect of the experimental manipulations on negative affect was examined with multilevel analyses. A moderation analysis was performed to examine whether the manipulations moderated the association between negative affect and intention. RESULTS: All groups showed a decrease in negative affect (all p's < 0.001), with no differences between groups. A small decrease in the influence of negative affect on intention was found among those who used acceptance. CONCLUSION: No additional value of the emotion regulation strategies was found compared to the control group. However, exploratory analyses showed that acceptance seemed a promising strategy to decrease the influence of negative affect on intention to accept MPV. PRACTICE IMPLICATIONS: This study stressed the relevance for communication strategies to consider the emotions pregnant women experience during the decision-making process about the MPV.

Promoting children's sleep health: Intervention Mapping meets Health in All Policies.

Background: To design a comprehensive approach to promote children's sleep health in Amsterdam, the Netherlands, we combined Intervention Mapping (IM) with the Health in All Policies (HiAP) perspective. We aimed to create an approach that fits local infrastructures and policy domains across sectors. Methods: First, a needs assessment was conducted, including a systematic review, two concept mapping studies, and one cross-sectional sleep diary study (IM step 1). Subsequently, semi-structured interviews with stakeholders from policy, practice and science provided information on potential assets from all relevant social policy sectors to take into account in the program design (HiAP and IM step 1). Next, program outcomes and objectives were specified (IM step 2), with specific objectives for policy stakeholders (HiAP). This was followed by the program design (IM step 3), where potential program actions were adapted to local policy sectors and stakeholders (HiAP). Lastly, program production (IM step 4) focused on creating a multi-sector program (HiAP). An advisory panel guided the research team by providing tailored advice during all steps throughout the project. Results: A blueprint was created for program development to promote children's sleep health, including a logic model of the problem, a logic model of change, an overview of the existing organizational structure of local policy and practice assets, and an overview of policy sectors, and related objectives and opportunities for promoting children's sleep health across these policy sectors. Furthermore, the program production resulted in a policy brief for the local government. Conclusions: Combining IM and HiAP proved valuable for designing a blueprint for the development of an integrated multi-sector program to promote children's sleep health. Health promotion professionals focusing on other (health) behaviors can use the blueprint to develop health promotion programs that fit the local public service infrastructures, culture, and incorporate relevant policy sectors outside the public health domain.

Facebook use intensity and depressive symptoms: a moderated mediation model of problematic Facebook use, age, neuroticism, and extraversion.

BACKGROUND: Research on the relationship between Facebook use intensity and depressive symptoms has resulted in mixed findings. In contrast, problematic Facebook use has been found to be a robust predictor of depressive symptoms. This suggests that when intense Facebook use results in a problematic usage pattern, it may indirectly predict depressive symptoms. However, this mediation pathway has never been examined. Moreover, it remains unclear whether the possible indirect relationship between Facebook use intensity and depressive symptoms through problematic Facebook use is moderated by demographic (age), and personality (neuroticism and extraversion) characteristics. METHODS: To address these gaps, we conducted an online cross-sectional study (n = 210, 55% female, age range: 18-70 years old, Mage = 30.26, SD = 12.25). We measured Facebook use intensity (Facebook Intensity Scale), problematic Facebook use (Bergen Facebook Addiction Scale), depressive symptoms (Center for Epidemiologic Studies Depression Scale Revised), and neuroticism and extraversion (Ten Item Personality Inventory). RESULTS: A mediation analysis revealed that problematic Facebook use fully mediates the relationship between Facebook use intensity and depressive symptoms. Moreover, a moderated mediation analysis demonstrated that this indirect relationship is especially strong among young users and users scoring high on neuroticism. CONCLUSIONS: These findings expand our understanding of the mechanisms underlying the relationship between Facebook use intensity and depressive symptoms and describe user characteristics that act as vulnerability factors in this relationship.

The Future Positive micro-intervention protocol: A program aiming to increase a healthy life-style among employees with a low socio-economic position.

This paper describes the development of a Dutch micro-intervention, Future Positive, that aims to increase health behaviors among employees with a low socio-economic position (SEP), with the ultimate aim to decrease socio-economic health inequalities. Intervention Mapping (IM) was used to adapt previously developed psychological capital interventions into a micro-intervention suitable to be delivered in the work context for employees with a low socio-economic position. The first 4 steps of IM including the results of pre-testing the developed intervention program are described. Step 1 consists of the needs assessment, and investigated (a) the individual determinants of health behavior and health inequalities, and (b) the needs of employees with a low SEP and their employers regarding the implementation of the intervention at the worksite. Matrices-of-change were produced in Step 2, and relevant methods and applications were selected in step 3. Step 4 involved the intervention development, resulting in a brief micro-intervention that will be delivered in small groups, guided by trained facilitators using motivational interviewing techniques. Program materials include informative video-clips and active and cooperative learning exercises. The intervention was pre-tested among three groups of employees. The IM process, as well as the pre-testing, revealed that emphasizing autonomy and using easy to understand and mostly visual materials offered in chunks is essential for a well-tailored intervention that is suitable for people with low SEP. Also, participation should be facilitated by employers: It should be free of costs, offered during working hours, and take place at the job site. Results showed that the Future Positive micro-intervention is substantiated by theory, applicable in a work setting (high reach), and tailored to the needs of employees with a low SEP. We therefore fill the gap in this existing range of interventions aimed to improve life-style behaviors and contribute to theory-based interventions aimed to decrease the SEP-Health gradient.

"Our Work, Our Health, No One's Concern": Domestic Waste Collectors' Perceptions of Occupational Safety and Self-Reported Health Issues in an Urban Town in Ghana.

Domestic waste collectors face major public health hazards that result in injuries and morbidity globally. This study explored domestic waste collectors' perceptions of occupational safety and self-reported health issues in a city in Ghana using a phenomenological qualitative research design. In-depth interviews and focus group discussions were held with 64 domestic waste collectors from two waste companies. The transcribed data were imported into NVivo 11.0 software (QSR International, Burlington, MA, USA) for coding, and a content analysis was applied to analyze all the transcribed data using the processes of induction and deduction. The consensual views from the domestic waste collectors showed the waste-company employers' non-interest in the domestic waste collectors' occupational safety and health. Poor communication from employers to domestic waste collectors and huge workloads were identified as the causes of the poor implementation of occupational safety practices, which exposed the domestic waste collectors to occupational health hazards. The domestic waste collectors reported that they suffered from occupational injuries, psychosocial disorders, work-related stress, and frequent burnout. The domestic waste collectors adopted coping strategies, such as self-medication, to deal with these occupational hazards, since most of them were not covered by guaranteed health insurance. In addition, the study revealed the non-compliance and non-enforcement of occupational health and safety policies by the employers to guide health and safety training and practices among the domestic waste collectors. In conclusion, the findings suggest that DWCs are exposed to occupational safety and health hazards in their work. Waste-company employers should extend welfare benefits to DWCs, such as health insurance and social security benefits, to ensure their security, health, and well-being. The findings could inform the design of intervention programs and policies to guide training and practices for domestic waste collectors.

Psychosocial and organizational barriers and facilitators of meningococcal vaccination (MenACWY) acceptance among adolescents and parents during the Covid-19 pandemic: a cross-sectional survey.

BACKGROUND: This study aimed to identify differences and similarities among adolescents and parents in various psychosocial factors influencing meningococcal ACWY (MenACWY) vaccination acceptance. Besides, the impact of the Covid-19 pandemic was assessed as well as resulting organizational adjustments. METHODS: We conducted a cross-sectional survey among adolescents that attended the appointment for the MenACWY vaccination in South Limburg between May and June 2020, and their parents. Independent t-tests and χ2 test were performed to explore differences in psychosocial and organisational factors between adolescents and parents. RESULTS: In total, 592 adolescents (20%) and 1197 parents (38%) filled out the questionnaire. Adolescents scored lower on anticipated negative affect towards MenACWY vaccination refusal [t (985.688) = - 9.32; ρ < 0.001], moral norm towards MenACWY vaccination acceptance [t (942.079) = - 10.38; ρ < 0.001] and knowledge about the MenACWY vaccination and meningococcal disease [t (1059.710) = - 11.24; ρ < 0.001]. Both adolescents and parents reported a social norm favouring accepting childhood vaccinations, but adolescent scored higher [t (1122.846) = 23.10; ρ < 0.001]. The Covid-19 pandemic did barely influence the decision to accept the MenACWY vaccination. Only 6% of the participants indicated that Covid-19 influenced their decision. In addition, the individual vaccination appointment was rated very positive. Most adolescents (71.5%) and parents (80.6%) prefer future vaccinations to be offered individually rather than having mass vaccinations sessions. CONCLUSIONS: This study provides an indication of which psychosocial and organisational factors should be addressed in future MenACWY vaccination campaigns. Individual vaccination appointments for adolescents should be considered, taking the costs and logistical barriers into account.