Women's trust in the healthcare system in Serbia: Validation of the Women's Trust and Confidence in Healthcare System scale.

BACKGROUND: Women's role as patients is associated with power relationships embedded in society. Although trust in the health care system is a general prerequisite for positive health outcomes, practices regarding women's agency in healthcare systems in Southeastern Europe reinforce women's passivity. Most of the current psychological measures of trust have been constructed and validated in "WEIRD" (samples that are drawn from populations that are White, Educated, Industrialized, Rich, and Democratic) countries, thus having a limited application in other social contexts. OBJECTIVES: We aimed to construct an instrument for assessing women's trust in healthcare systems to describe the structure of trust: Women's Trust and Confidence in the Healthcare System scale. DESIGN: Two independent samples (N1 = 329; N2 = 333) of adult women in Serbia voluntarily completed an online questionnaire. The questionnaire comprised 20 trust-related items which were selected from an extensive collection of women's experiences in the healthcare system and evaluated by experts on a 5-point Likert-type scale. METHODS: We used exploratory factor analysis of the Women's Trust and Confidence in the Healthcare System scale to analyze the structure of trust in the first sample data set and validated it with the second sample using confirmatory factor analysis. We tested concurrent validity by exploring how women's trust in the healthcare system predicts health-related behaviors (multigroup structural equation modeling). All analyses were conducted using R statistical software. RESULTS: The Women's Trust and Confidence in the Healthcare System scale (Cronbach's alpha = 0.86) indicated a three-factor structure of trust in the healthcare system: trust in healthcare professionals, distrust in the public healthcare system, and confidence in healthcare system. This was validated using an independent sample. Interpersonal trust positively predicted women's desirable health behaviors, while trust in the system had a negative impact. CONCLUSION: The Women's Trust and Confidence in the Healthcare System scale captures women's trust in a paternalistic healthcare system, is reliable, and has a stable three-factor structure. The study's findings reveal the relationship between women's trust and health-related behavior: in paternalistic environments, trust reinforces women's passivity.

Psychological Factors of Vaccination Intent among Healthcare Providers, Parents, and Laypeople.

The interrelatedness of social-structural aspects and psychological features with vaccination intention provides the context to explore personal psychological features related to vaccination. Specifically, we focused on general decision making and vaccine-related dispositions, and their contribution to the intention to vaccinate, within post-pandemic circumstances, after the imposed possibility of choosing a vaccine brand. Our study aimed to map the function (promotive, protective, risk, vulnerability) of a set of personal psychological aspects in the intention to vaccinate among people holding different social roles regarding the vaccination. We surveyed three samples of people: healthcare providers (HPs), parents, and laypeople, within the post-pandemic context. Negative vaccine attitudes lower intention to vaccinate in all regression models (all ßs ranging from -0.128 to -0.983, all ps < 0.01). The main results indicate that, regardless of the sample/social role, there is a shared attitudinal core for positive vaccination intention. This core consists of [high] trust in large corporations, government, and healthcare systems, as well as perceived consensus on vaccine safety/efficacy and experience of freedom (protective factors), and [low] vaccination conspiracy beliefs, trust in social media, and choice overload (risk and vulnerability factors, respectively). There are no common promotive factors of intention to vaccinate: for parents, perceived consensus on vaccines, and trust in corporations and the healthcare system, play such roles; for HPs, the experience of freedom is obtained as a unique promotive factor. In contrast, for laypeople, no unique promotive factors were found. Our findings provide insights into the function of psychological factors of vaccination intention across different social roles, particularly healthcare providers, parents, and laypeople, and emphasize the need for tailored immunization interventions in the post-pandemic landscape.

One Hundred and Sixty-One Days in the Life of the Homopandemicus in Serbia: The Contribution of Information Credibility and Alertness in Predicting Engagement in Protective Behaviors.

COVID-19 pandemic is a long-lasting process associated with dynamic changes within society and in individual psychological responses. Effective communication of measures by credible sources throughout the epidemic is one of the crucial factors for the containment of the disease, and the official communication about pandemics is straightforwardly directed toward changes in behavior via engagement in (self-)protective measures. Calls for the adherence to these measures are aimed at the general population, but people's reactions to these calls vary depending on, for example, their individual differences in cognitive and emotional responses to the situation. The focus of our study was the general narrative about the epidemic as conveyed by both state officials and media outlets in times of decreased social contacts due to the quarantine, in which relying on these sources of information is even more pivotal. Our aim was to explore the stability of the proposed mediational model during the course of the epidemic in Serbia. In the model, we tested the relationship between perceived credibility of information (PCI) and two types of protective behavior-the actual self-protective behavior (ASPB) and the hypothetical protective behavior (HPB), as well as the potential mediating role of alertness in these relationships time-wise. A cross-sectional study (N = 10,782, female = 79.1%) was being administered daily during the first epidemic wave and in three more 2-week time frames during the second wave. Based on the variability of these measures during the first epidemic wave, three stages of psychological responses were mapped (acute, adaptation, and relaxation stage), which were observed, with some deviations, also in the second wave. The mediational model was relatively robust after the initial few weeks, but the strength of pairwise relationships was more changeable. With both types of protective behaviors, the predictive power of PCI was partially mediated through alertness. This suggests that, while individual differences in cognitive and affective responses are important, so is coherent, focused, and credible communication in all stages of the epidemic, which emphasizes the communality aspect of the social containment of the infection. Our findings can thus be valuable in informing the planning of effective future communication.

A Cue for Rational Reasoning: Introducing a Reference Point in Cognitive Reflection Tasks.

The dual process framework posits that we reason using the quick System 1, and the deliberate System 2, both of which are part of our "adaptive toolbox". The Cognitive Reflection Test (CRT) estimates which system was used to solve a reasoning problem. Usually, the CRT tasks are solved incorrectly by using System 1, and correctly through System 2. We have applied the reference point hypothesis to the tasks of the CRT and proposed that this change would facilitate the switch between systems, resulting in better performance on the version of the test with a reference point, compared to the CRT without one. The results confirmed our assumptions, as evidenced by a generally higher score on the CRT with a reference point, albeit with different effects between items.

Refinement of Outcome Bias Measurement in the Parental Decision-Making Context.

The aim of this study was twofold: one was to test the impact of the involvement on the parental outcome bias, and the second was to refine the measurement of outcome bias, normally reported as the difference between evaluations of a single decision, with different outcomes assigned to it. We introduced the evaluation of a decision without an outcome, to induce theoretically normative evaluation, unbiased by outcome, from which the evaluation shift could be calculated in either direction. To test this refinement in the parental decision-making context, we produced childcare dilemmas with varying levels of complexity, since the rise of complexity induces stronger bias. Complexity was determined by the particular combination of two factors: parental involvement in a decision - the amount of motivation, interest and drive evoked by it - and whether the decision was health-related or not. We presented parents with the decisions for evaluation, followed by a positive and a negative outcome, and without an outcome. The results confirm the interaction between involvement and domain on decision evaluation. Highly involving decisions yielded weaker outcome bias than low-involvement decisions in both health and non-health domain. Results also confirm the validity of the proposed way of measuring OB, revealing that in some situations positive outcomes skew evaluations more than negative outcomes. Also, a highly-involving dilemma followed by negative outcome did not produce significantly different evaluation compared to evaluation of a decision without outcome. Thus, adding a neutral position rendered OB measurement more precise and our involvement-related insights more nuanced.

Parental Decision-Making on Childhood Vaccination.

A growing number of parents delay vaccinations or are deciding not to vaccinate their children altogether. This increases the risk of contracting vaccine-preventable diseases and disrupting herd immunity, and also impairs the trust in the capacities of health care systems to protect people. Vaccine hesitancy is related to a range of both psychological and demographic determinants, such as attitudes toward vaccinations, social norms, and trust in science. Our aim is to understand those determinants in parents, because they are a special group in this issue-they act as proxy decision makers for their children, who are unable to decide for themselves. The fact that deciding to vaccinate is a socially forced choice that concerns a child's health makes vaccine-related decisions highly important and involving for parents. This high involvement might lead to parents overemphasizing the potential side effects that they know to be vaccine-related, and by amplifying those, parents are more focused on the potential outcomes of vaccine-related decisions, which can yield specific pattern of the outcome bias. We propose two related studies to investigate factors which promote vaccine hesitancy, protective factors that determine parental vaccination decisions, and outcome bias in parental vaccination intentions. We will explore demographic and psychological factors, and test parental involvement related to vaccine hesitancy using an online battery in a correlation panel design study. The second study is an experimental study, in which we will investigate the moderating role of parents' high involvement in the specific domain of vaccination decision making. We expect that higher involvement among parents, compared to non-parents, will shape the pattern of the proneness to outcome bias. The studies will be conducted across eight countries in Europe and Asia (Finland, Germany, Hong Kong, the Netherlands, Serbia, Slovenia, Spain, and the United Kingdom), rendering findings that will aid with understanding the underlying mechanisms of vaccine hesitancy and paving the way for developing interventions custom-made for parents.

Application of the multiscale FEM to the modeling of cancellous bone.

This paper considers the application of multiscale finite element method (FEM) to the modeling of cancellous bone as an alternative for Biot's model, the main intention of which is to decrease the extent of the necessary laboratory tests. At the beginning, the paper gives a brief explanation of the multiscale concept and thereafter focuses on the modeling of the representative volume element and on the calculation of the effective material parameters, including an analysis of their change with respect to increasing porosity. The latter part of the paper concentrates on the macroscopic calculations, which is illustrated by the simulation of ultrasonic testing and a study of the attenuation dependency on material parameters and excitation frequency. The results endorse conclusions drawn from the experiments: increasing excitation frequency and material density cause increasing attenuation.