Formative Research to Inform College Health Communication Campaigns About COVID-19 Prevention Behaviors.

This research aimed to inform the development of a health communication campaign to increase the uptake of COVID-19 prevention behaviors among university students. Twenty-eight students attending a mid-sized public university in the southeastern United States and 84 parents or guardians of university students were recruited. The study included an online survey assessing COVID-19 prevention behaviors, perceived susceptibility to COVID-19, perceived severity of COVID-19, and semi-structured interviews to elicit beliefs on COVID-19 prevention behaviors. Students and parents/guardians reported that getting COVID-19 was possible but not necessarily likely. COVID-19 was seen as serious and at least somewhat severe. Dominant interview themes for benefits, barriers, response efficacy, and self-efficacy related to prevention behaviors are reported. Overall, perceptions of behavioral benefits, barriers, and response efficacy were often shared by parents and students but varied across behaviors. These data provide insights for future campaign development for the control of infectious diseases among college students.

Development and Pretesting of Prescription Opioid Misuse Prevention Messages: Results and Implications for Practice.

Well-designed health communication campaigns can contribute to the uptake of preventive behaviors, but there has been a lack of attention on using communication research to develop opioid misuse prevention messages. We report the results of two studies designed to inform the development of prescription opioid misuse prevention messages for adults ages 30-59. In Study 1, 16 adults across 4 counties participated in semi-structured interviews to provide input on message concepts addressing six key prescription opioid misuse prevention behaviors. In Study 2, 1,335 adults completed an online, survey-based between-subjects experiment in which participants were randomized to a no message control condition or a message condition that aligned with a prevention behavior. The survey examined Reasoned Action Approach (RAA) predictors of intention in no message control participants and examined differences in intention to perform prevention behaviors among experimental conditions. The qualitative interviews yielded insights about message preferences and perceived facilitators and barriers related to the prevention behaviors. The online survey demonstrated that attitude and descriptive norms are important determinants of preventive behaviors and potential targets for communication interventions. Message testing results demonstrated that the draft messages were effective in changing intentions to safely store, securely dispose of, and monitor the use of prescription opioids, but they were not effective in increasing intentions to talk to healthcare providers, older adults, or children about proper opioid use. A communication campaign addressing attitudes and perceived descriptive norms may be successful in increasing intentions to engage in opioid misuse prevention behaviors.

Increasing Uptake of Prescription Drug Take-Back Boxes: Eliciting Preferences and Applying the Theory of Planned Behavior to Predict Use.

This study assesses adults' perceptions of and predictors of intention to use prescription drug take-back boxes. This mixed methods study utilized focus groups and an online survey to examine factors related to intention to use a prescription drug take-back box. This study was conducted in [State] during the spring and summer of 2018. Themes identified in focus group data included the importance of take-back box location, benefits of take-back box use (such as reducing opportunities for medication misuse), and barriers to take-back box use (such as lack of awareness, stigma associated with law enforcement). Survey results indicate that pharmacies are the most preferred take-back box location and that attitudes, subjective norms, and perceived behavioral control are statistically significant predictors of intention to use a take-back box. Results suggest that individuals are open to using take-back boxes in secure, convenient locations, but many are unaware of take-back boxes as an option for safe disposal. These findings have implications for health communication and policy efforts designed to increase the use of take-back boxes for prescription drug disposal.

Do They Really Work? Quantifying Fabric Mask Effectiveness to Improve Public Health Messaging.

The purpose of this study is to compare masks (non-medical/fabric, surgical, and N95 respirators) on filtration efficiency, differential pressure, and leakage with the goal of providing evidence to improve public health messaging. Masks were tested on an anthropometric face filtration mount, comparing both sealed and unsealed. Overall, surgical and N95 respirators provided significantly higher filtration efficiency (FE) and differential pressure (dP). Leakage comparisons are one of the most significant factors in mask efficiency. Higher weight and thicker fabric masks had significantly higher filtration efficiency. The findings of this study have important implications for communication and education regarding the use of masks to prevent the spread of COVID-19 and other respiratory illnesses, specifically the differences between sealed and unsealed masks. The type and fabric of facial masks and whether a mask is sealed or unsealed has a significant impact on the effectiveness of a mask. Findings related to differences between sealed and unsealed masks are of critical importance for health care workers. If a mask is not completely sealed around the edges of the wearer, FE for this personal protective equipment is misrepresented and may create a false sense of security. These results can inform efforts to educate health care workers and the public on the importance of proper mask fit.

Rural adults' perceived role of family members in prescription opioid misuse prevention: Implications for family-based approaches.

PURPOSE: This study explored and documented rural adults' perceptions of family roles in prescription opioid misuse prevention and the predisposing, reinforcing, and enabling factors that influence family members from taking those roles. METHODS: Nine focus groups with rural adults (n = 55) were conducted to evoke discussion about family roles in prescription opioid misuse prevention. Transcripts were coded based on common ideas that arose during the focus groups, previous literature, and the PRECEDE-PROCEED program planning model. FINDINGS: Findings suggest that rural adults perceive the opioid epidemic as partially a family problem. Additionally, rural adults perceive themselves as having a critical role in preventing prescription opioid misuse among family members. Participants identified specific predisposing, reinforcing, and enabling factors that influence whether or not family members take responsibility in preventing prescription opioid misuse within their families. Rural adults also perceive that family-based education is important in preventing prescription opioid misuse. CONCLUSIONS: These results suggest that there is an interest in family-based approaches that enable or foster the skills and resources necessary to engage in prescription opioid misuse prevention behaviors. Specifically, family-based prevention programming should include efforts to shape knowledge and attitudes about prescription opioid misuse, increase resources to facilitate prevention behaviors, and build skills related to prevention.

Measuring veterinary client preferences for autonomy and information when making medical decisions for their pets.

OBJECTIVE: To adapt the 3 scales of the Autonomy Preference Index to veterinary medicine and validate the 3 new scales to measure pet owner preferences for autonomy and information when making medical decisions for their pets. SAMPLE: 10 small-animal veterinarians and 10 small-animal clients at a veterinary school-based community practice (pilot study) and 311 small-animal clients of the practice (validation study), of which 47 participated in a follow-up survey. PROCEDURES: Wording of items in the Autonomy Preference Index was adapted, and instrument wording was finalized on the basis of feedback obtained in the pilot study to create 3 scales: the Veterinary General Decision-Making Preferences Scale (VGDMPS), Veterinary Clinical Decision-Making Preferences Scale (VCDMPS), and Veterinary Information-Seeking Preferences Scale (VISPS). The 3 scales were then validated by means of administering them to small-animal clients in a clinical setting. RESULTS: The 3 scales had acceptable reliability and validity, but clients expressed concern over item wording in the VGDMPS during the pilot study. Overall, results showed that clients had a very high preference for information (mean ± SD VISPS score, 4.78 ± 0.36 on a scale from 1 to 5). Preferences for autonomy varied, but mean values reflected a low-to-moderate desire for autonomy in clinical decision-making (mean ± SD VCDMPS score, 2.04 ± 0.62 on a scale from 1 to 5). CONCLUSIONS AND CLINICAL RELEVANCE: The VCDMPS was a reliable and valid instrument for measuring client preferences for autonomy in clinical decision-making. Veterinarians could potentially use this instrument to better understand pet owner preferences and tailor their communication approach accordingly.

Goals of Care Discussions and Moral Distress Among Neonatal Intensive Care Unit Staff.

CONTEXT: The relationship between quality of Goals of Care (GOC) conversations and moral distress among neonatal intensive care unit (NICU) providers is not known. OBJECTIVES: We sought 1) to explore levels of moral distress in providers, 2) to evaluate how staff moral distress changes in relation to GOC discussions, and 3) to identify elements of GOC discussions associated with change in moral distress. We hypothesized that staff moral distress would change after GOC discussions and that change would vary with presence of key discussion elements. METHODS: Prospective cohort study in a level IV NICU in an urban teaching hospital. We administered validated instruments at baseline and following GOC discussions including the Moral Distress Thermometer (MDT) and Williams Instrument (a measure of end-of-life care) to physicians, nurses, and social workers. RESULTS: We collected data on 79 GOC conversations over a 1-year period from 2018 to 2019. Most providers experienced an increase in moral distress following a GOC discussion. Providers experienced an average increase in moral distress, as measured by the MDT, of 0.84 (+/-3.15; P = 0.002). Physicians experienced an average change in moral distress of 1.1 (+/-3.52; P = 0.01) while nurses experienced an average change of 0.55 (+/-2.66; P = 0.07). Several elements of discussions were associated with the degree of increase in moral distress after the conversation. CONCLUSION: Change in moral distress among providers may be a useful metric of quality of GOC discussions. There are identifiable elements of GOC conversations that are associated with high-quality discussions. These elements warrant further study.

A Mixed Methods Analysis of Parental Perspectives on Diagnosis and Prognosis of Neonatal Intensive Care Unit Graduates With Cerebral Palsy.

This study aimed to evaluate how parents of former neonatal intensive care unit patients with cerebral palsy perceive prognostic discussions following neuroimaging. Parent members of a cerebral palsy support network described memories of prognostic discussions after neuroimaging in the neonatal intensive care unit. We analyzed responses using Linguistic Inquiry and Word Count, manual content analysis, and thematic analysis. In 2015, a total of 463 parents met eligibility criteria and 266 provided free-text responses. Linguistic Inquiry and Word Count analysis showed that responses following neuroimaging contained negative emotion. The most common components identified through the content analysis included outcome, uncertainty, hope/hopelessness, and weakness in communication. Thematic analysis revealed 3 themes: (1) Information, (2) Communication, and (3) Impact. Parents of children with cerebral palsy report weakness in communication relating to prognosis, which persists in parents' memories. Prospective work to develop interventions to improve communication between parents and providers in the neonatal intensive care unit is necessary.

The Impact of a Risk-Based Breast Cancer Screening Decision Aid on Initiation of Mammography Among Younger Women: Report of a Randomized Trial.

Background. Guidelines recommend that initiation of breast cancer screening (BCS) among women aged 40 to 49 years include a shared decision-making process. The objective of this study is to evaluate the effect of a breast cancer screening patient decision-aid (BCS-PtDA) on the strength of the relationship between individual risk and the decision to initiate BCS, knowledge, and decisional conflict. Methods. We conducted a randomized clinical trial of a BCS-PtDA that included individual risk estimates compared with usual care. Participants were women 39 to 48 years of age with no previous mammogram. Primary outcomes were strength of association between breast cancer risk and mammography uptake at 12 months, knowledge, and decisional conflict. Results. Of 204 participants, 65% were Black, the median age (interquartile range [IQR]) was 40.0 years (39.0-42.0), and median (IQR) breast cancer lifetime risk was 9.7% (9.2-11.1). Women who received mammography at 12 months had higher breast cancer lifetime risk than women who had not in both intervention (mean, 95% CI): 12.2% (10.8-13.6) versus 10.5% (9.8-11.2), P = 0.04, and control groups: 11.8% (10.4-13.1) versus 9.9% (9.2-10.6), P = 0.02. However, there was no difference between groups in the strength of association between mammography uptake and breast cancer risk (P = 0.87). Follow-up knowledge (0-5) was greater in the intervention versus control group (mean, 95% CI): 3.84 (3.5-4.2) versus 3.17 (2.8-3.5), P = 0.01. There was no change in decisional conflict score (1-100) between the intervention versus control group (mean, 95% CI): 24.8 (19.5-30.2) versus 32.4 (25.9-39.0), P = 0.07. Conclusions. The BCS-PtDA improved knowledge but did not affect risk-based decision making regarding age of initiation of BCS. These findings indicate the complexity of changing behaviors to incorporate objective risk in the medical decision-making process.

Explaining the effects of a decision intervention on mammography intentions: The roles of worry, fear and perceived susceptibility to breast cancer.

OBJECTIVE: This study examines the effects of a mammography decision intervention on perceived susceptibility to breast cancer (PSBC) and emotion and investigates how these outcomes predict mammography intentions. DESIGN: Randomised between-subjects online experiment. Participants were stratified into two levels of risk. Within each stratum, conditions included a basic information condition and six decision intervention conditions that included personalised risk estimates and varied according to a 2 (amount of information: brief vs. extended) × 3 (format: expository vs. untailored exemplar vs. tailored exemplar) design. Participants included 2465 US women ages 35-49. MAIN OUTCOME MEASURES: PSBC as a percentage, PSBC as a frequency, worry, fear and mammography intentions. RESULTS: The intervention resulted in significant reductions in PSBC as a percentage for women in both strata and significant increases in worry and fear for women in the upper risk stratum. Of the possible mediators examined, only PSBC as a percentage was a consistent mediator of the effect of the intervention on mammography intentions. CONCLUSION: The results provide insight into the mechanism of action of the intervention by showing that PSBC mediated the effects of the intervention on mammography intentions.

Estimating Acceptability of Financial Health Incentives.

A growing body of evidence suggests that financial incentives can influence health behavior change, but research on the public acceptability of these programs and factors that predict public support have been limited. A representative sample of U.S. adults ( N = 526) were randomly assigned to receive an incentive program description in which the funding source of the program (public or private funding) and targeted health behavior (smoking cessation, weight loss, or colonoscopy) were manipulated. Outcome variables were attitude toward health incentives and allocation of hypothetical funding for incentive programs. Support was highest for privately funded programs. Support for incentives was also higher among ideologically liberal participants than among conservative participants. Demographics and health history differentially predicted attitude and hypothetical funding toward incentives. Incentive programs in the United States are more likely to be acceptable to the public if they are funded by private companies.

Effects of a risk-based online mammography intervention on accuracy of perceived risk and mammography intentions.

OBJECTIVE: This experiment tested the effects of an individualized risk-based online mammography decision intervention. The intervention employs exemplification theory and the Elaboration Likelihood Model of persuasion to improve the match between breast cancer risk and mammography intentions. METHODS: 2918 women ages 35-49 were stratified into two levels of 10-year breast cancer risk (<1.5%; ≥1.5%) then randomly assigned to one of eight conditions: two comparison conditions and six risk-based intervention conditions that varied according to a 2 (amount of content: brief vs. extended) x 3 (format: expository vs. untailored exemplar [example case] vs. tailored exemplar) design. Outcomes included mammography intentions and accuracy of perceived breast cancer risk. RESULTS: Risk-based intervention conditions improved the match between objective risk estimates and perceived risk, especially for high-numeracy women with a 10-year breast cancer risk ≤1.5%. For women with a risk≤1.5%, exemplars improved accuracy of perceived risk and all risk-based interventions increased intentions to wait until age 50 to screen. CONCLUSION: A risk-based mammography intervention improved accuracy of perceived risk and the match between objective risk estimates and mammography intentions. PRACTICE IMPLICATIONS: Interventions could be applied in online or clinical settings to help women understand risk and make mammography decisions.

Assessing the Consequences of Implementing Graphic Warning Labels on Cigarette Packs for Tobacco-Related Health Disparities.

INTRODUCTION: Population-level communication interventions, such as graphic warning labels (GWLs) on cigarette packs, have the potential to reduce or exacerbate tobacco-related health disparities depending on their effectiveness among disadvantaged sub-populations. This study evaluated the likely impact of nine GWLs proposed by the US Food and Drug Administration on (1) African American and (2) Hispanic smokers, who disproportionately bear the burden of tobacco-related illness, and (3) low education smokers, who have higher smoking rates. METHODS: Data were collected online from current smokers randomly assigned to see GWLs (treatment) or the current text-only warning labels (control). Participants were stratified by age (18-25; 26+) in each of four groups: general population (n = 1246), African Americans (n = 1200), Hispanics (n = 1200), and low education (n = 1790). We tested the effectiveness of GWLs compared to text-only warning labels using eight outcomes that are predictive of quitting intentions or behaviors including negative emotion, intentions to hold back from smoking, intentions to engage in avoidance behaviors, and intentions to quit. RESULTS: Across all outcomes, GWLs were significantly more effective than text-only warning labels more often than expected by chance. Results suggested that African Americans, Hispanics and smokers with low education did not differ from the general population of smokers in their reactions to any of the nine individual GWLs. CONCLUSIONS: The nine GWLs were similarly effective for disadvantaged sub-populations and the general population of smokers. Implementation of GWLs is therefore unlikely to reduce or exacerbate existing tobacco-related health disparities, but will most likely uniformly increase intentions and behaviors predictive of smoking cessation.

Efficiently and Effectively Evaluating Public Service Announcements: Additional Evidence for the Utility of Perceived Effectiveness.

Recent research has made significant progress identifying measures of the perceived effectiveness (PE) of persuasive messages and providing evidence of a causal link from PE to actual effectiveness (AE). This article provides additional evidence of the utility of PE through unique analysis and consideration of another dimension of PE important to understanding the PE-AE association. Current smokers (N =1,139) watched four randomly selected anti-smoking Public Service Announcements (PSAs). PE scores aggregated by message were used instead of individual PE scores to create a summed total, minimizing the likelihood that PE perceptions are consequences of an individual's intention to quit, supporting instead the PE→AE order. Linear regression analyses provide evidence of PE's positive and significant influence on smoking cessation-related behavioral intentions.