The public's considerations about implementing non-pharmaceutical interventions to manage a novel COVID-19 epidemic.

In the future, new variants of the SARS-CoV-2 virus might emerge and cause outbreaks. If this occurs, the implementation of non-pharmaceutical interventions (NPIs) can be reconsidered. Consideration of the potential benefits and harms of implementing NPIs, and ultimately deciding about implementing NPIs, is currently mainly executed by experts and governments. However, general literature on public engagement suggests that integrating public perspectives into decision-making can enhance the quality of decisions and foster greater public understanding of them. In this study, a deliberative mini-public was conducted to integrate this public perspective. The aim was to elicit public considerations regarding non-pharmaceutical interventions by asking a diverse group of citizens to participate as decision-makers and convene, learn and deliberate about implementing non-pharmaceutical interventions during a hypothetical outbreak of a new SARS-CoV-2 variant. Participants emphasized the importance of early implementation during the outbreak, to prevent exceeding healthcare capacity, long-term mental health issues, educational deficits, and bankruptcies. Additionally, participants stressed taking public support into account, and shared ideas on maintaining support. Furthermore, participants wanted to give citizens personal responsibility and freedom in making their own assessment regarding adherence to interventions and how much risk of infection they would be willing to accept. Participants also expressed the need for the government to adopt a learning attitude towards improvements in pandemic response, and to generate more focus on long-term strategies. The deliberative mini-public, revealed public considerations that reflected public values and needs. These considerations might be helpful in better aligning epidemic management policies with public perspectives. Regarding the deliberative mini-public, uncertainties remain about the design and impact on a bigger scale.

Cancer risks related to intellectual disabilities: A systematic review.

BACKGROUND: People with intellectual disabilities (ID) face barriers in cancer care contributing to poorer oncological outcomes. Yet, understanding cancer risks in the ID population remains incomplete. AIM: To provide an overview of cancer incidence and cancer risk assessments in the entire ID population as well as within ID-related disorders. METHODS: This systematic review examined cancer risk in the entire ID population and ID-related disorders. We systematically searched PubMed (MEDLINE) and EMBASE for literature from January 1, 2000 to July 15, 2022 using a search strategy combining terms related to cancer, incidence, and ID. RESULTS: We found 55 articles assessing cancer risks in the ID population at large groups or in subgroups with ID-related syndromes, indicating that overall cancer risk in the ID population is lower or comparable with that of the general population, while specific disorders (e.g., Down's syndrome) and certain genetic mutations may elevate the risk for particular cancers. DISCUSSION: The heterogeneity within the ID population challenges precise cancer risk assessment at the population level. Nonetheless, within certain subgroups, such as individuals with specific ID-related disorders or certain genetic mutations, a more distinct pattern of varying cancer risks compared to the general population becomes apparent. CONCLUSION: More awareness, and personalized approach in cancer screening within the ID population is necessary.

Effectiveness of educational interventions for healthcare workers on vaccination dialogue with older adults: a systematic review.

BACKGROUND: Healthcare workers (HCW) significantly influence older adults' vaccine acceptance. This systematic review aimed to identify effective educational interventions for HCWs that could enhance their ability to engage in a dialogue with older adults on vaccination. METHODS: Medline, Scopus, Cochrane library and grey literature were searched for comparative studies investigating educational interventions concerning older adult vaccinations. The search encompassed all languages and publication years. Analysis was performed on the outcomes 'vaccines offered or ordered' and 'vaccination rates'. Whenever feasible, a sub-analysis on publication year was conducted. Methodological limitations were assessed using the RoB 2 for RCTs and the GRADE checklist for non-randomized studies. Study outcomes were categorized according to the four-level Kirkpatrick model (1996) for effectiveness: reaction, learning, behaviour, and results. RESULTS: In total, 48 studies met all inclusion criteria. Most studies included reminder systems signalling HCWs on patients due for vaccination. Other interventions included seminars, academic detailing and peer-comparison feedback. Four articles reporting on the reaction-level indicated that most HCWs had a favourable view of the intervention. Two of the six articles reporting on the learning-level observed positive changes in attitude or knowledge due to the intervention. Seventeen studies reported on the behaviour-level. An analysis on eleven out of seventeen studies focusing on vaccines 'ordered' or 'offered' outcomes suggested that tailored reminders, particularly those implemented before 2000, were the most effective. Out of 34 studies reporting on the result-level, 24 were eligible for analysis on the outcome 'vaccination rate', which showed that compared to usual care, multicomponent interventions were the most effective, followed by tailored reminders, especially those predating 2000. Nonetheless, tailored reminders often fell short compared to other interventions like standing orders or patient reminders. In both the behaviour-level and result-level 'education only' interventions frequently underperformed relative to other interventions. Seventeen out of the 27 RCTs, and seven of the 21 non-randomized studies presented a low-to-medium risk for bias in the studies' findings. CONCLUSIONS: Tailored reminders and multicomponent interventions effectively assist HCWs in addressing vaccines with older adults. However, education-only interventions appear to be less effective compared to other interventions rates, attitude, knowledge.

Determinants of Dutch public health professionals' intention to use digital contact tracing support tools: A cross-sectional online questionnaire study.

Contact tracing (CT) can be a resource intensive task for public health services. To alleviate their workload and potentially accelerate the CT-process, public health professionals (PHPs) may transfer some tasks in the identification, notification, and monitoring of contacts to cases and their contacts themselves, using 'digital contact tracing support tools' (DCTS-tools). In this study, we aimed to identify determinants of PHPs' intention to use DCTS-tools. Between February and April 2022, we performed a cross-sectional online questionnaire study among PHPs involved in CT for COVID-19 in the Netherlands. We built three random forest models to identify determinants of PHPs' intention to use DCTS-tools for the identification, notification, and monitoring of contacts, respectively. The online questionnaire was completed by 641 PHPs. Most respondents had a positive intention towards using DCTS-tools for the identification (64.5%), notification (58%), and monitoring (55.2%) of contacts. Random forest models were able to correctly predict the intention of 81%, 80%, and 81% of respondents to use DCTS-tools for the identification, notification, and monitoring of contacts, respectively. Top-determinants of having a positive intention are the anticipated effect of DCTS-tools on the feasibility and efficiency of CT (speed, workload, difficulty), the degree to which PHPs anticipated that cases and contacts may find it pleasant and may be willing to participate in CT using DCTS-tools, and the degree to which PHPs anticipated that cases and contacts are sufficiently supported in CT when using DCTS-tools. Most PHPs have a positive intention to involve cases and their contacts in the identification, notification, and monitoring stages of the CT-process through DCTS-tools. The identified top-determinants should be prioritized in the (future) development and implementation of DCTS-tools in public health practice. Citizens' perspectives on the use of DCTS-tools should be investigated in future research.

Development and validation of the MosquitoWise survey to assess perceptions towards mosquitoes and mosquito-borne viruses in Europe.

Due to climate change and the expanding geographical ranges of key mosquito species, several mosquito-borne viruses (MBVs) have recently emerged in Europe. Understanding people's perceptions and behaviours towards these viruses and the mosquitoes capable of transmitting them is crucial for implementing effective prevention measures and targeted communication campaigns. However, there is currently no appropriate validated survey for European populations to assess this. This study developed and validated a standardized survey, based on the Health Belief Model (HBM), to assess perceptions of mosquitoes and MBVs among Europe's residents. The survey was distributed online to United Kingdom (UK), Dutch and Spanish participants through panel providers. Survey validity and reliability were tested using confirmatory factor analysis (CFA) and Cronbach's alpha. The optimised survey was completed by 336 UK, 438 Dutch and 475 Spanish residents, respectively, and the HBM items passed our validity and reliability testing in all three countries. The final survey has 57 questions, including 19 validated HBM items, and questions to assess demographic characteristics, knowledge, prevention measures and behavioural determinants. Our MosquitoWise survey bridges researchers' understandings of European residents' perceptions and knowledge as a first step to improve preventive behaviour towards mosquitoes and MBVs and guide prevention and communication initiatives.

Kaleidoscopic integration: Advancing the integration of incommensurable knowledge in healthcare guidelines.

The integration of different types of knowledge in epistemically hierarchical settings remains one of the greatest challenges when developing standards for healthcare practices. In this article, we open up the notion of knowledge integration and empirically examine the various ways in which different types of knowledge interact and can be integrated. To allow us to focus on the diverse forms of knowledge as well as their interaction and integration, we combine Moreira's work on repertoires of evaluation with that of Dewulf and Bouwen on frame interactions. We examine the quest for knowledge integration by studying interactions in the case of the development of the COVID-19 vaccination guideline in the Netherlands, a prime example of the encounter of a wide range and diversity of knowledge that needs to be appraised and integrated into guideline recommendations. Drawing on ethnographic observations of more than 70 guideline development meetings between 2021 and 2022, we first map the different types of knowledge and reasonings used by the guideline developers and subsequently analyze their interactions. We identified eight knowledge interaction patterns, being disconnection, polarization, accommodation, incorporation, reconnection, reconciliation, passive juxtaposition, and kaleidoscopic integration. We hereby draw attention to the various possible knowledge interactions encompassed in the concept of "knowledge integration", especially to those in which integration is achieved while differences and incompatibilities are maintained. Finally, we discuss potential ways to facilitate fruitful knowledge interactions during collaborative work which include the ability to accept and sustain tensions between different types of knowledge and making more explicit use of frame or rather repertoire reflection.

Preferences for public engagement in decision-making regarding four COVID-19 non-pharmaceutical interventions in the Netherlands: A survey study.

BACKGROUND: Worldwide, non-pharmaceutical interventions (NPIs) were implemented during the COVID-19 crisis, which heavily impacted the daily lives of citizens. This study considers public perspectives on whether and how public engagement (PE) can contribute to future decision-making about NPIs. METHODS: An online survey was conducted among a representative sample of the public in the Netherlands from 27 October to 9 November 2021. Perceptions and preferences about PE in decision-making on NPIs to control COVID-19 were collected. Preferences regarding four NPIs were studied: Nightly curfew (NC); Digital Covid Certificate (DCC); Closure of elementary schools and daycares (CED); and physical distancing (1.5M). Engagement was surveyed based on the five participation modes of the IAP2 Spectrum of Public Participation, namely inform, consult, advice, collaborate and empower. RESULTS: Of the 4981 respondents, 25% expressed a desire to engage in decision-making, as they thought engagement could improve their understanding and the quality of NPIs, as well as increase their trust in the government. Especially for the NPIs DCC and NC, respondents found it valuable to engage and provide their perspective on trade-offs in values (e.g. opening up society versus division in society by vaccination status). Respondents agreed that the main responsibility in decision-making should stay with experts and policy-makers. 50% of respondents did not want to engage, as they felt no need to engage or considered themselves insufficiently knowledgeable. Inform was deemed the most preferred mode of engagement, and empower the least preferred mode of engagement. CONCLUSION: We reveal large variations in public preferences regarding engagement in NPI decision-making. With 25% of respondents expressing an explicit desire to engage, and considering the benefit of PE in other areas of (public) health, opportunities for PE in NPI decision-making might have been overlooked during the COVID-19 pandemic. Our results provide guidance into when and how to execute PE in future outbreaks.

Capturing Emerging Experiential Knowledge for Vaccination Guidelines Through Natural Language Processing: Proof-of-Concept Study.

BACKGROUND: Experience-based knowledge and value considerations of health professionals, citizens, and patients are essential to formulate public health and clinical guidelines that are relevant and applicable to medical practice. Conventional methods for incorporating such knowledge into guideline development often involve a limited number of representatives and are considered to be time-consuming. Including experiential knowledge can be crucial during rapid guidance production in response to a pandemic but it is difficult to accomplish. OBJECTIVE: This proof-of-concept study explored the potential of artificial intelligence (AI)-based methods to capture experiential knowledge and value considerations from existing data channels to make these insights available for public health guideline development. METHODS: We developed and examined AI-based methods in relation to the COVID-19 vaccination guideline development in the Netherlands. We analyzed Dutch messages shared between December 2020 and June 2021 on social media and on 2 databases from the Dutch National Institute for Public Health and the Environment (RIVM), where experiences and questions regarding COVID-19 vaccination are reported. First, natural language processing (NLP) filtering techniques and an initial supervised machine learning model were developed to identify this type of knowledge in a large data set. Subsequently, structural topic modeling was performed to discern thematic patterns related to experiences with COVID-19 vaccination. RESULTS: NLP methods proved to be able to identify and analyze experience-based knowledge and value considerations in large data sets. They provide insights into a variety of experiential knowledge that is difficult to obtain otherwise for rapid guideline development. Some topics addressed by citizens, patients, and professionals can serve as direct feedback to recommendations in the guideline. For example, a topic pointed out that although travel was not considered as a reason warranting prioritization for vaccination in the national vaccination campaign, there was a considerable need for vaccines for indispensable travel, such as cross-border informal caregiving, work or study, or accessing specialized care abroad. Another example is the ambiguity regarding the definition of medical risk groups prioritized for vaccination, with many citizens not meeting the formal priority criteria while being equally at risk. Such experiential knowledge may help the early identification of problems with the guideline's application and point to frequently occurring exceptions that might initiate a revision of the guideline text. CONCLUSIONS: This proof-of-concept study presents NLP methods as viable tools to access and use experience-based knowledge and value considerations, possibly contributing to robust, equitable, and applicable guidelines. They offer a way for guideline developers to gain insights into health professionals, citizens, and patients' experience-based knowledge, especially when conventional methods are difficult to implement. AI-based methods can thus broaden the evidence and knowledge base available for rapid guideline development and may therefore be considered as an important addition to the toolbox of pandemic preparedness.

Voices of society: the emergence of civil-society practices aiming to engage in the management of the COVID-19 pandemic in the Netherlands.

During the COVID-19 pandemic, public groups mobilised themselves in civil-society engagement practices (CSEPs) aiming to improve or suggest alternative epidemic management. This study explores the motivation to establish CSEPs and their perceived contributions to epidemic management, to gain insight whether integrating views of CSEPs could add value. A systematic online search was executed to identify CSEPs focused on COVID-19 management between January 2020 and January 2022 in the Netherlands. In order to create a comprehensible overview of the identified CSEPs, relevant characteristics were gathered and mapped, for example, local or national scope, subject of action and goals. A selection of CSEPs was interviewed between April and June 2022 to study their motivators to start the CSEPs and perceived contributions to management. The search resulted in the identification of 22 CSEPs, of which members of 14 CSEPs were interviewed. These members indicated several issues that motivated the start of their CSEP, namely; shortage of equipment, sense of solidarity, and a perceived lack of governmental action, lack of democratic values and lack in diversity of perspectives in epidemic management. All respondents believed to have contributed to policy or society, by influencing opinions, and occasionally by altering policy. However, respondents encountered obstacles in their attempts to contribute such as inability to establish contact with authorities, feeling unheard or undermined, and complications due to the interplay of political interests. In conclusion, CSEPs have fulfilled various roles such as providing alternative management policies, producing equipment, representing the needs of vulnerable populations, and supporting citizens and providing citizens with other viewpoints and information. The identified motivators to establish CSEPs in this study uncover room for improvements in policy. These insights, together with the identified perceived barriers of CSEPs, can be used to improve the connection between (future) epidemic management and public priorities and interests.

Getting ready to act: theorising a stepwise transition into crisis response at points of entry based on interviews with COVID-19 responders and a military preparedness framework.

INTRODUCTION: Points of entry (POE) have an important role in timely national response to infectious diseases threats. However, a guiding framework is lacking for the transition from generic preparedness into optimally specified response for an imminent infectious disease threat, a step called 'operational readiness'. OBJECTIVE: We aim to contribute to the conceptual closure of this preparedness-response gap for infectious disease control at POE by providing content to the operational readiness concept. DESIGN: We first explored the NATO Combat Readiness (NCR) concept for its applicability on infectious disease control at POE, as the military discipline faces the same need of being flexible in preparing for unknown threats. Concepts of the NCR that support the transition into response to a specific threat were integrated into the operational readiness concept. To explore the added value of the concept in practice, we conducted and analysed semistructured interviews of professionals at European POE (n=24) responsible for the early COVID-19 response. RESULTS: Based on the NCR, operational readiness builds on the fact that activating the response capabilities and capacities to a specific threat requires time. For professionals at POE, the transition from generic preparedness into the COVID-19 response led to challenges in specifying response plans, dealing with an overload of information, while experiencing shortages of public health staff. These challenges could be covered within operational readiness by defining the time and the specific staging needed to upgrade response capabilities and capacities. DISCUSSION: We conclude that a guiding framework for operational readiness seems appropriate in relation to the many activities and challenges POE have had to face during the COVID-19 response. Operational readiness is mainly defined by the time dimension required to deploy the response to a specific threat. However, integrating this conceptual framework into practice requires structural and sustainable investments in outbreak preparedness.

Rapid response screening for emerging zoonotic pathogens, barriers and opportunities: A study for enhanced preparedness of the Netherlands.

Background: Outbreaks of zoonotic emerging infectious diseases (EIDs) require rapid identification of potential reservoir hosts and mapping disease spread in these hosts to inform risk assessment and adequate control measures. Animals are often understudied when a novel EID is detected in humans and acquisition of animal samples is hampered by practical, ethical, and legal barriers, of which there is currently no clear overview. Therefore, the three aims of this study are (1) to map potentially available collections of animal samples, (2) to assess possibilities and barriers for reuse of these samples and (3) to assess possibilities and barriers for active animal and environmental sampling in the Netherlands. Methods: A literature search was performed to identify ongoing sampling activities and opportunities for reuse or active sampling. Semi-structured interviews with stakeholder organizations were conducted to gain further insight into the three research questions. Results: Various sample collections of surveillance, diagnostic and research activities exist in the Netherlands. Sample size, coverage, storage methods and type of samples collected differs per animal species which influences reuse suitability. Organizations are more likely to share samples, for reuse in outbreak investigations, when they have a pre-existing relationship with the requesting institute. Identified barriers for sharing were, among others, unfamiliarity with legislation and unsuitable data management systems. Active sampling of animals or the environment is possible through several routes. Related barriers are acquiring approval from animal- or property owners, conflicts with anonymization, and time needed to acquire ethical approval. Conclusion: The animal sample collections identified would be very valuable for use in outbreak investigations. Barriers for sharing may be overcome by increasing familiarity with legislation, building (international) sharing networks and agreements before crises occur and developing systems for sample registration and biobanking. Proactive setting up of ethical approvals will allow for rapid animal sample collection to identify EID hosts and potential spillovers.

Did the temporary suspension of Vaxzveria vaccinations influence COVID-19 vaccination intentions, vaccination perceptions and trust in the vaccination campaign? A repeated survey study in the Netherlands.

In spring 2021, several countries, among which the Netherlands, suspended vaccinations against COVID-19 with the Vaxzevria vaccine from AstraZeneca after reports of rare but severe adverse events. This study investigates the influence of this suspension on the Dutch public's perceptions of COVID-19 vaccinations, trust in the government's vaccination campaign, and COVID-19 vaccination intentions. We conducted two surveys in a population of general Dutch public (18 + ), one shortly before the pause of AstraZeneca vaccinations and one shortly thereafter (N eligible for analysis = 2628). Our results suggest no changes in perceptions nor intentions regarding the COVID-19 vaccines in general but do suggest a decline in trust in the government's vaccination campaign. In addition, after the suspension, perceptions of the AstraZeneca vaccines were more negative in comparison to those of COVID-19 vaccinations in general. AstraZeneca vaccination intentions were also considerably lower. These results stress the need to adapt vaccination policies to anticipated public perceptions and responses following a vaccine safety scare, as well as the importance of informing citizens about the possibility of very rare adverse events prior to the introduction of novel vaccines.

Evaluating intra-action reviews at points of entry: ongoing learning opportunities during the COVID-19 pandemic.

BACKGROUND: Long-lasting crises, such as the COVID-19 pandemic, require proper interim evaluation in order to optimize response. The World Health Organization and the European Center for Disease Control have recently promoted the in(tra)-action review (IAR) method for this purpose. We systematically evaluated the added value of two IARs performed in the Dutch point of entry (PoE) setting. METHODS: Two online, 4-hour IAR meetings were organized in March 2021, for ports and airports respectively, to reflect on the ongoing COVID-19 response. Topics discussed were selected through a survey among participants. Participants were mainly self-selected by the (air)port public health service. Evaluation of the IAR method consisted of participant evaluation through a questionnaire, and hot and cold debriefs of the organizing team. Evaluation of the impact of the IAR was done through analysis of the meeting results, and a 3-month follow-up of the actions proposed during the meetings. RESULTS: Thirty-nine professionals joined the IAR meetings. In the participant evaluation (n = 18), 89% agreed or totally agreed the IAR made it possible to identify challenges and problems in the COVID-19 response at PoE. Participants especially appreciated the resulting insight in regional and national partners. Regarding the online setting of the meeting, participants suggested to choose accessible and familiar online tools. After 3 months, all national actions and actions for ports had been executed; some regional actions for airports required further attention. A major result was a new meeting structure for all ports and the participating national authorities in which remaining and newly occurring issues were discussed. CONCLUSIONS: Based on the evaluations, we conclude that the IAR method can be of value during long-term crises, such as the COVID-19 pandemic response. Although it is challenging to dedicate time and effort to the organization and attendance of IAR meetings during crisis, the IAR method is feasible in an online setting if appropriate organizing and technical capacity is available. A participatory set-up supports the IAR method as a starting point for continuous exchange and learning during ongoing crises.

Risk for Severe COVID-19 Outcomes among Persons with Intellectual Disabilities, the Netherlands.

The COVID-19 pandemic has disproportionately affected persons in long-term care, who often experience health disparities. To delineate the COVID-19 disease burden among persons with intellectual disabilities, we prospectively collected data from 36 care facilities for 3 pandemic waves during March 2020-May 2021. We included outcomes for 2,586 clients with PCR-confirmed SARS-CoV-2 infection, among whom 161 had severe illness and 99 died. During the first 2 pandemic waves, infection among persons with intellectual disabilities reflected patterns observed in the general population, but case-fatality rates for persons with intellectual disabilities were 3.5 times higher and were elevated among those >40 years of age. Severe outcomes were associated with older age, having Down syndrome, and having >1 concurrent condition. Our study highlights the disproportionate COVID-19 disease burden among persons with intellectual disabilities and the need for disability-inclusive research and policymaking to inform disease surveillance and public health policies for this population.

Nursing care for patients carrying multi-drug resistant organisms: Experiences, intention to use protective equipment and ability to comply with measures.

AIMS: The aims of the study were to explore the impact of caring for patients carrying multi-drug resistant organisms on nursing staff and identify factors predicting their intention to use personal protective equipment and their ability to comply with advised infection prevention and control measures. BACKGROUND: Carriage of multi-drug resistant organisms and corresponding infection prevention and control measures have a major impact on patients. Limited research has been done to investigate the impact of caring for these patients on nursing staff. DESIGN: A cross-sectional design. METHODS: Online survey among Dutch nursing staff in various healthcare settings. Prediction analyses were conducted using random forest. The STROBE checklist was used preparing the manuscript. RESULTS: 974 respondents were included. The majority of nursing staff reported to have experience in caring for patients carrying multi-drug resistant organisms. Relevant dilemmas in daily practice were identified. Important predictors of the intention to use protective equipment were practicing hand hygiene, usable protocols, favourable attitudes and perceptions, as well as knowledge. Important predictors of the ability to comply with advised measures were usable and findable protocols, a suitable work environment and practicing hand hygiene. CONCLUSION: We have gained comprehensive insight into experiences, attitudes, perceptions, knowledge and dilemmas in daily practice of nursing staff caring for patients carrying multi-drug resistant organisms. To enhance their intention to use protective equipment and their ability to comply with advised measures, activities should focus on improving hand hygiene and the usability of protocols. Additionally, efforts are needed to improve knowledge, provide better resources and a more supportive work environment. All of which need to be specifically tailored to each healthcare setting. RELEVANCE TO CLINICAL PRACTICE: The results can be used in the development of interventions to improve nursing care while reducing the unfavourable impact on nursing staff and supporting adherence to advised measures.

Focus group study on perceptions and information needs regarding vaccines targeting the older population: a cross-country comparison in four European countries.

The increasing life expectancy leads to more older adults suffering from infectious diseases. Vaccines are available against diverse infections such as influenza, pneumococcal disease, herpes zoster and tetanus. However, vaccine acceptance is crucial for optimal preventive effect. The objective of the study is to perform a cross-country analysis of the perceptions and decision-making behaviour of older adults regarding vaccinations and their information needs. Focus groups with older adults were conducted in four countries: France, Hungary, Italy and the Netherlands. Data were analysed using thematic analysis. Demographic characteristics of participants were gathered with a questionnaire. Influenza and tetanus vaccines were commonly known, as was the disease influenza. On the contrary, the awareness of the vaccines against pneumococcal disease and herpes zoster were low. Participants also expressed a need for more information on vaccines, such as possible side effects, contra-indications and duration of protection, emphasizing that information is a condition for decision-making on vaccination. General practitioners were found to be the most important in information provision on vaccines. Perceptions on vaccines, such as effectiveness, side effects and safety, as well as perceptions on infectious diseases, such as severity, susceptibility and experiencing an infectious disease, played a role in the decision-making of older adults on vaccines. More awareness of the information needs among older adults with regard to vaccines should be raised among general practitioners and other healthcare providers. This requires appropriate knowledge about the vaccines among healthcare providers as well as communication skills to meet the information needs of older adults.

Evaluation of a Web-Based Culturally Sensitive Educational Video to Facilitate Informed Cervical Cancer Screening Decisions Among Turkish- and Moroccan-Dutch Women Aged 30 to 60 Years: Randomized Intervention Study.

BACKGROUND: In the Netherlands, since 1996, a national cervical cancer (CC) screening program has been implemented for women aged 30 to 60 years. Regional screening organizations send an invitation letter and information brochure in Dutch to the home addresses of targeted women every 5 years. Although this screening is free of charge, Turkish- and Moroccan-Dutch women, especially, show low screening participation and limited informed decision-making (IDM). As Turkish- and Moroccan-Dutch women indicated their need for information on the practical, emotional, cultural, and religious aspects of CC screening, we developed a culturally sensitive educational video (CSEV) as an addition to the current information brochure. OBJECTIVE: In this study, we aimed to evaluate the added effect of the CSEV on IDM regarding CC screening participation among Turkish and Moroccan women aged 30 to 60 years in the Netherlands through a randomized intervention study. METHODS: Initial respondents were recruited via several social media platforms and invited to complete a web-based questionnaire. Following respondent-driven sampling, respondents were asked to recruit a number of peers from their social networks to complete the same questionnaire. Respondents were randomly assigned to the control (current information brochure) or intervention condition (brochure and CSEV). We measured respondents' knowledge and attitude regarding CC screening and their intention to participate in the next CC screening round before and after the control or intervention condition. We evaluated the added effect of the CSEV (above the brochure) on their knowledge, attitude, intention, and IDM using intention-to-treat analyses. RESULTS: The final sample (n=1564) included 686 (43.86%) Turkish and 878 (56.14%) Moroccan-Dutch women. Of this sample, 50.7% (793/1564) were randomized to the control group (350/793, 44.1% Turkish and 443/793, 55.9% Moroccan) and 49.3% (771/1564) to the intervention group (336/771, 43.6% Turkish and 435/771, 56.4% Moroccan). Among the Turkish-Dutch women, 33.1% (116/350) of the control respondents and 40.5% (136/336) of the intervention respondents consulted the brochure (not statistically significant). Among Moroccan-Dutch women, these percentages were 28.2% (125/443) and 37.9% (165/435), respectively (P=.003). Of all intervention respondents, 96.1% (323/336; Turkish) and 84.4% (367/435; Moroccan) consulted the CSEV. The CSEV resulted in more positive screening attitudes among Moroccan-Dutch women than the brochure (323/435, 74.3% vs 303/443, 68.4%; P=.07). Women, who had never participated in CC screening before, showed significantly more often a positive attitude toward CC screening compared with the control group (P=.01). CONCLUSIONS: Our short and easily implementable CSEV resulted in more positive screening attitudes, especially in Moroccan-Dutch women. As the CSEV was also watched far more often than the current brochure was read, this intervention can contribute to better reach and more informed CC screening decisions among Turkish- and Moroccan-Dutch women. TRIAL REGISTRATION: International Clinical Trial Registry Platform NL8453; https://tinyurl.com/2dvbjxvc.

Public engagement in decision-making regarding the management of the COVID-19 epidemic: Views and expectations of the 'publics'.

BACKGROUND: In the management of epidemics, like COVID-19, trade-offs have to be made between reducing mortality and morbidity and minimizing socioeconomic and political consequences. Traditionally, epidemic management (EM) has been guided and executed attentively by experts and policymakers. It can, however, still be controversial in the public sphere. In the last decades, public engagement (PE) has been successfully applied in various aspects of healthcare. This leads to the question if PE could be implemented in EM decision-making. METHODS: From June to October 2020, seven deliberative discussion focus groups were executed with 35 Dutch citizens between 19 and 84 years old. Their views on PE in COVID-19 management were explored. The deliberative approach allows for the education of participants on the topic before the discussion. The benefits, barriers, timing and possible forms of PE in EM were discussed. RESULTS: Almost all participants supported PE in EM, as they thought that integrating their experiences and ideas would benefit the quality of EM, and increase awareness and acceptance of measures. A fitting mode for PE was consultation, as it was deemed important to provide the public with possibilities to share ideas and feedback; however, final authority remained with experts. The publics could particularly provide input about communication campaigns and control measures. PE could be executed after the first acute phase of the epidemic and during evaluations. CONCLUSIONS: This paper describes the construction of an empirically informed framework about the values and conditions for PE in EM from the perspective of the public. Participants expressed support to engage certain population groups and considered it valuable for the quality and effectiveness of EM; however, they expressed doubts about the feasibility of PE and the capabilities of citizens. In future studies, these results should be confirmed by a broader audience. PATIENT OR PUBLIC CONTRIBUTION: No patients or members of the public were involved in the construction and execution of this study. This study was very exploratory, to gain a first insight into the views of the public in the Netherlands, and will be used to develop engagement practices accordingly. At this stage, the involvement of the public was not yet appropriate.

A qualitative study examining the impact of multidrug-resistant organism (MDRO) carriage on the daily lives of carriers and parents of carriers with experiences of hospital precautionary measures.

BACKGROUND: Multidrug-resistant organism (MDRO) carriage may have an adverse impact on the quality of life of carriers, in particular those who have experienced hospital precautionary measures. This study aims to gain a deeper understanding of how MDRO carriage has affected the daily lives of carriers with these experiences. METHODS: This was a qualitative study based on 15 semi-structured interviews with MDRO carriers or parents of carriers, which were analysed by thematic analysis. RESULTS: Three main themes were identified: (1) Feeling dirty and unworthy portrays the feelings that MDRO carriers often expressed and how these were related to the language usage describing the MDRO, the perceived avoidance by staff and those in their personal networks, and the effects of the precautionary measures implemented in the hospital. (2) MDROs are invisible, but impact is visible covers how the microbe, despite its apparent invisibility, still impacted carriers in their physical and psychological health. MDRO carriage disrupted their lives, by affecting their other unrelated medical conditions at times and by causing varying levels of fear for their own and others' health. (3) Carrying the burden on one's own shoulders describes the lingering questions, uncertainties and confusion that carriers continued to live with and the perceived burden and responsibility that lay on their own shoulders with respect to carrying and preventing the transmission of the MDRO. CONCLUSIONS: MDRO carriage can negatively influence the quality of people's lives in various ways. Improved support and sensitivity from health care providers (HCPs) are needed to address feelings of unworthiness among MDRO carriers and the fears that many experience. Clearer information and guidelines are also needed from HCPs to address the many questions and uncertainties that MDRO carriers face outside of the hospital in their daily lives.