Why are African immigrants in Montreal reluctant to use mental health services?: a systematic inventory of reasons.

PURPOSE: Previous research has shown that non-Caucasian immigrants in Western countries are less likely than native-born people to use mental health services. This study examined the reasons underlying reluctance to use mental health services among African immigrants in Montreal, Canada. METHODS: The study participants were 280 African immigrants who had experienced symptoms suggesting depression but did not use formal mental health services. They were presented with a questionnaire that contained 65 statements referring to reasons for not using formal mental health services while experiencing those symptoms and were asked to indicate their degree of agreement with each of the statements on a scale of 0-10. Responses were then analyzed using factor analysis. RESULTS: An eight-factor structure of reasons was found: "Minimizing symptoms and perceived self-efficacy" (61% of the sample), "Relying on spiritual care" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Lack of cultural competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants' demographics. CONCLUSION: Effectively addressing the underutilization of mental health services among African immigrants requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various barriers to care.

What motivates individuals to volunteer in Ebola epidemic response? A structural approach in Guinea.

BACKGROUND: The 2014-2016 Ebola epidemic in West Africa placed greater demands on the affected countries' already scarce health workforce. Consequently, governments in the most affected West African countries made appeals for volunteers to join Ebola response programs. Those volunteers played an important yet high-risk role in aiding the victims of the Ebola epidemic and in limiting its spread. However, little is known as to what motivated those volunteers to commit themselves to the Ebola response programs. This information is important for planning for volunteer recruitment strategies during future epidemics. The aim of the present study, therefore, was to identify and assess the motivations that led individuals to volunteer for Ebola response programs in West Africa. METHODS: The study participants were 600 persons who volunteered through the Guinean Ebola response program during the 2014-2016 epidemic. From February to May 2016, they were presented with a questionnaire that contained 50 assertions referring to possible motives for volunteering in the Ebola response program and indicated their degree of agreement with each of them on a scale of 0-10. The responses were analyzed using factor analysis. RESULTS: Seven separable volunteer motivations were identified. "Feeling of patriotic duty" (M = 9.02) and "Feeling of moral responsibility" (M = 8.12) clearly emerged as the most important. Second-tier motivations were "Compliance with authority" (M = 6.66), "Desire to use one's skills for a collective good" (M = 6.49), "Seeking personal growth" (M = 5.93), "Desire to gain community recognition" (M = 5.13), and "Hoping for a career reorientation" (M = 4.52). CONCLUSIONS: These findings strongly suggest that volunteer recruitment, if needed in future Ebola epidemics, must adopt a multifaceted motivational approach rather than focus on one single motivator. Putting relatively more emphasis on motivational messages referring to patriotic values, as well as to moral responsibility, would likely increase volunteering.

Why patients want to take or refuse to take antibiotics: an inventory of motives.

BACKGROUND: Inappropriate use of antibiotics is a worldwide issue. In order to help public health institutions and each particular physician to change patterns of consumption among patients, it is important to understand better the reasons why people accept to take or refuse to take the antibiotic drugs. This study explored the motives people give for taking or refusing to take antibiotics. METHODS: Four hundred eighteen adults filled out a 60-item questionnaire that consisted of assertions referring to reasons for which the person had taken antibiotics in the past and a 70-item questionnaire that listed reasons for which the person had sometimes refused to take antibiotics. RESULTS: A six-factor structure of motives to take antibiotics was found: Appropriate Prescription, Protective Device, Enjoyment (antibiotics as a quick fix allowing someone to go out), Others' Pressure, Work Imperative, and Personal Autonomy. A four-factor structure of motives not to take antibiotics was found: Secondary Gain (through prolonged illness), Bacterial Resistance, Self-defense (the body is able to defend itself) and Lack of trust. Scores on these factors were related to participants' demographics and previous experience with antibiotics. CONCLUSION: Although people are generally willing to follow their physician's prescription of antibiotics, a notable proportion of them report adopting behaviors that are beneficial to micro-organisms and, as a result, potentially detrimental to humans.

Duty to provide care to Ebola patients: the perspectives of Guinean lay people and healthcare providers.

AIM: To examine the views of Guinean lay people and healthcare providers (HCPs) regarding the acceptability of HCPs' refusal to provide care to Ebola patients. METHOD: From October to December 2015, lay people (n=252) and HCPs (n=220) in Conakry, Guinea, were presented with 54 sample case scenarios depicting a HCP who refuses to provide care to Ebola patients and were instructed to rate the extent to which this HCP's decision is morally acceptable. The scenarios were composed by systematically varying the levels of four factors: (1) the risk of getting infected, (2) the HCP's working conditions, (3) the HCP's family responsibilities and (4) the HCP's professional status. RESULTS: Five clusters were identified: (1) 18% of the participants expressed the view that HCPs have an unlimited obligation to provide care to Ebola patients; (2) 38% held that HCPs' duty to care is a function of HCPs' working conditions; (3) 9% based their judgments on a combination of risk level, family responsibilities and working conditions; (4) 23% considered that HCPs do not have an obligation to provide care and (5) 12% did not take a position. CONCLUSION: Only a small minority of Guinean lay people and HCPs consider that HCPs' refusal to provide care to Ebola patients is always unacceptable. The most commonly endorsed position is that HCPs' duty to provide care to Ebola patients is linked to society's reciprocal duty to provide them with the working conditions needed to fulfil their professional duty.

Haitian people's expectations regarding post-disaster humanitarian aid teams' actions.

The way people at the receiving end of humanitarian assistance perceive this intervention may provide invaluable bottom-up feedback to improve the quality of the intervention. We analyzed and mapped Haitians' views regarding international humanitarian aid in cases of natural disaster. Two hundred fifty participants-137 women and 113 men aged 18-67-who had suffered from the consequences of the earthquake in 2010 were presented with a series of vignettes depicting a humanitarian team's action and were asked to what extent these actions corresponded to what ought to be expected from an international aid mission. Four factors were considered in the vignettes (a) whether the team worked in close association with local institutions, (b) whether it was composed of competent people who were prepared for their mission, (c) whether they treated people as a function of immediate needs, and (d) whether they behaved in a respectful way. Through cluster analysis, five qualitatively different positions were found: (a) Complete hostility to any kind of humanitarian aid (6%); (b) Strong hostility to humanitarian aid in the case of disrespectful attitudes or behaviors (4%); (c) Technical competence is the only factor that matters (25%); (d) Both manifestation of respect for the population and technical competence matter (38%) and (e) Undetermined (27%). Most Haitians expect humanitarian teams to be technically competent, but even very competent aid is not considered adequate if provided in an arrogant and disrespectful manner.

Allocation of antiretroviral drugs to HIV-infected patients in Togo: perspectives of people living with HIV and healthcare providers.

AIM: To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. METHOD: From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs. The stories were composed by systematically varying the levels of four factors: (a) the severity of HIV infection, (b) the financial situation of the patient, (c) the patient's family responsibilities and (d) the time elapsed since the first consultation. RESULTS: Five clusters were identified: 65% of the participants expressed the view that patients who are poor and severely sick should be treated as a priority, 13% prioritised treatment of patients who are poor and parents of small children, 12% expressed the view that the poor should be treated as a priority, 4% preferred that the sickest be treated as a priority and 6% wanted all patients to get treatment. CONCLUSIONS: WHO's guideline regarding antiretroviral therapy allocation (the sickest first as the sole criterion) currently in use in many African countries does not reflect the preferences of Togolese people living with HIV. For most HIV-infected patients in Togo, patients who cannot get treatment on their own should be treated as a priority.

Breaking Bad News to Togolese Patients.

The aim of this study was to map Togolese people's positions regarding the breaking of bad news to elderly patients. Two hundred eleven participants who had in the past received bad medical news were presented with 72 vignettes depicting communication of bad news to elderly female patients and asked to indicate the acceptability of the physician's conduct in each case. The vignettes were all combinations of five factors: (a) the severity of the disease, (b) the patient's wishes about disclosure, (c) the level of social support during hospitalization, (d) the patient's psychological robustness, and (e) the physician's decision about how to communicate the bad news. Five qualitatively different positions were found. Two percent of the participants preferred that the physician always tell the full truth to both the patient and her relatives, 8% preferred that the truth be told depending on the physician's perception of the situation, 15% preferred that the physician tell the truth but understood that in some cases nondisclosure to the patient was not inappropriate, 33% preferred that the physician tell the full truth to the relatives but not as much information to the patient, and 42% preferred that the physician tell the full truth to the relatives only. These findings present a challenge to European physicians taking care of African patients living in Europe or working in African hospitals, and to African physicians trained in Europe and now working in their home countries. If these physicians respect the imperative of always telling the truth directly to their patients, their behavior may trigger anger and considerable misunderstanding among African patients and their families.

Togolese lay people's and health professionals' views about the acceptability of physician-assisted suicide.

AIM: To study the views on the acceptability of physician-assisted-suicide (PAS) of lay people and health professionals in an African country, Togo. METHOD: In February-June 2012, 312 lay people and 198 health professionals (75 physicians, 60 nurses and 63 health counsellors) in Togo judged the acceptability of PAS in 36 concrete scenarios composed of all combinations of four factors: (a) the patient's age, (b) the level of incurability of the illness, (c) the type of suffering and (d) the patient's request for PAS. In all scenarios, the patients were women receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Most lay people (59%) were not systematically opposed to PAS, whereas most health professionals (80%) were systematically opposed to it. The most important factors in increasing acceptability among people not systematically opposed were advanced age of the patient and incurability of the illness. Additional acceptability was provided by the patient's request to have her life ended, although much less so than in studies in Western countries, and by suffering characterised by complete dependence rather than by extreme physical pain. CONCLUSIONS: These empirical findings--the first ones gathered in the African continent--suggest that most Togolese lay people are not categorically for or against PAS, but judge its degree of acceptability as a function of concrete circumstances.

Is it acceptable for a physician to request informal payments for treatment? Lay people's and health professionals' views in Togo.

The people's views regarding informal payments for healthcare is essential if we are able to develop publicly supported interventions to address this phenomenon. We recruited a convenience sample of 300 lay people and health practitioners in Togo, a developing country experiencing this practice, and asked them how acceptable it would be for a physician to request informal payments for treatment in 36 scenarios. The scenarios were all combinations of three levels of the physician's income (relatively well-paid, average, or underpaid); two levels of the patient's wealth (wealthy vs. poor); two levels of the frequency of the practice in the area (common vs. rare); and three levels of the amount of payment requested ($50, $30, or $10). Two contrasting positions were found. A substantial minority of participants rejected the practice of informal payments, irrespective of circumstances. In contrast, a majority of them were of the opinion that when patients were wealthy and physicians were underpaid, this practice was acceptable. Health practitioners more frequently adhered to the ethical position than lay people. Implications for health policy are discussed.

Criminal prosecution of a male partner for sexual transmission of infectious diseases: the views of educated people living in Togo.

OBJECTIVE: To examine the views of educated people in Togo on the acceptability of criminal prosecution of a male partner for sexual transmission of infectious diseases (STIDs) to his female partner. METHODS: 199 adults living in Kara, Togo judged acceptability of criminal prosecution for STID in 45 scenarios composed of combinations of five factors: (a) severity of disease; (b) awareness and communication of one's serological status; (c) partners' marital status; (d) number of sexual partners the female partner has and (e) male partner's subsequent attitude (supportive or not). RESULTS: Acceptability was lower (a) when the male partner decided to take care of his female partner he had infected than when he decided to leave, (b) when both partners were informed but decided not to take precautions than when none of them was informed or when only the male partner was informed and (c) when the female partner has had several male sexual partners than when she has had only one. Two qualitatively different views were identified. For 66% of participants, when the male partner accepts to take care of his partner, he should not be sued, except when he did not disclose his serological status. For 34%, when both partners were informed, the male partner should not be sued, irrespective of other circumstances. CONCLUSIONS: Regarding criminal prosecution for STID, most people in the sample endorsed the position of the Joint United Nations Programme on HIV/AIDS that urges governments not to apply criminal law to cases where sexual partners disclosed their status or were not informed of it.

Willingness to seek malaria treatment among Togolese people.

The way Togolese people judge their willingness to seek malaria treatment in health facilities as a function of a set of concrete circumstances was examined. Three hundred and thirty-one people in Lomé, Togo, were presented with 32 scenarios of a few lines depicting a situation of illness strongly suggestive of malaria, and were instructed to judge their willingness to consult in each case. The scenarios were developed according to a five within-subject factor design: (1) severity of symptoms, (2) cost of treatment, (3) caregivers' attitudes, (4) availability of traditional treatment and (5) family's attitude with regards to use of formal health services. All these factors had significant effects. The severity factor had the strongest effect, and attitude of the family had the weakest effect. The other three factors had more or less the same impact. Implications for health policy are discussed.

Judging the possibility of the onset of diabetes mellitus type 2 from reported behavioral changes and from family history.

BACKGROUND: Undiagnosed type 2 diabetes is common and can lead to unrecognized health complications. Given that earlier detection can reduce the damage to vital organs, it is important for all persons to be able to make the connection between certain new manifestations in their bodies and the possibility of diabetes. This study examined the extent to which people use the behavioral changes they observe in others (or in themselves), as well as relevant family history, to judge the possibility of the onset of diabetes. METHODS: One hundred and fifty-six adults living in France examined a set of realistic vignettes describing a person with (or without) signs suggestive of diabetes (e.g., increased thirst, family antecedents) and judged the possibility of the disease in each case. RESULTS: Overall, 36% of participants focused on reported symptoms when judging the possibility of diabetes, 37% focused on family history, and 29% were not able to use the information or tended systematically to minimize the possibility of diabetes. CONCLUSIONS: People in France and probably around the world need a greater awareness not only of the factors putting them at risk of diabetes, but also of the specific signs and symptoms suggesting that they might be developing it.

Patients' Positions on the Degree of Trust to be Placed in Physicians.

Patient-physician relationship is ideally based on mutual trust. Trust usually takes times to build but can quite instantaneously be destroyed as a result of a single action or a single misperception. This study examined the way patients conceptualize the relationship between trust in a physician and perceived competency, honesty and openness, and personal involvement in care. One hundred sixty-seven patients aged 18-85 years were presented with a set of 27 three-item realistic vignettes that described situations in which participants could find themselves if hospitalized because of illness or accident. These scenarios resulted from the complete crossing of the three factors mentioned above. Participants were asked to assess the level of trust they would feel in each case. Through cluster analysis, three positions were found. For a minority of participants, trust was either unconditionally high (4%) or always quite low (8%). For a majority (75%), however, trust depended interactively on competency and honesty, on the one hand, and involvement, on the other hand; that is, the impact of competency and honesty on trust always depended on the level of involvement in care. In particular, when involvement had a low level, trust was always quite low, irrespective of the levels of both other factors. These findings are fully consistent with the view that, for a majority of patients, trust is inherently brittle: A breach in any one of participants' expectations regarding physicians' professionalism is enough to result in a more than proportional reduction in trust level.

French lay Persons' judgments of the possibility of a heart attack when experiencing various physical manifestations.

Background: The aim of the study was to characterize the different ways in which, based on certain physical manifestations that an individual suddenly experiences, people judge the possibility that these manifestations indicate the onset of a heart attack. Methods: One hundred ninety-four French adults--plus six physicians--were presented with a set of realistic vignettes composed by orthogonally crossing the levels of four factors: the type of pain felt, and the presence or absence of nausea, excess sweating, and of difficulty breathing. Results: Four qualitatively different reactions were found among the lay people. The majority reaction (54%) was close to the physicians' reaction. It consisted of suspecting a heart attack as soon as intense pain occurs in the chest or back. The second reaction (25%) retained from the first one only the idea that a heart attack should be suspected if the pain is localized to the chest. The third reaction (14%) reflected some people's uncertainty in the face of disturbing manifestations that they find difficult to interpret. The fourth reaction (7%) was that no set of symptoms could mean, for them, the onset of a heart attack. Conclusion: Only about half of the participants appeared to be able to consider unpleasant physical manifestations as a whole and integrate that information into an overall warning judgment that can lead into prompt life-saving actions. We recommend that judgment training on warning symptoms and signs be performed, especially for high-risk patients, in the offices of primary care providers and specialists.

Mapping Colombians' positions on sentencing for substance offenses.

BACKGROUND: In Colombia, a person caught in possession of an illicit substance is not judicially sanctioned as long as the quantity does not exceed the maximum allowable amounts. Given that the public is divided on the appropriateness of this policy, an examination of the various public positions was undertaken. METHOD: A convenience sample of 302 adults were presented with 48 vignettes depicting a situation of everyday life easily recognizable by all in Colombia; that of a male person who is apprehended in the street by the police because he is suspected of illicit trafficking. These vignettes were created by orthogonal variation of four factors: Type of substance, amount of substance, type of charge against the offender, and offender's age. RESULTS: Through cluster analysis, six qualitatively different positions were found. These positions corresponded to three distinct, classical philosophies (a) a libertarian, free-market philosophy - punishment should never be extremely severe because the trade in psychotropic substances is a trade like any other (6%), (b) a moralistic, conservative philosophy - punishment should always be extremely severe except perhaps in certain cases (52%), and (c) a progressive, human rights-inspired philosophy - punishment should always be proportional to the seriousness of the facts (42%). CONCLUSION: Half of Colombian people supported a control policy according to which the use of psychotropic substances is considered profoundly immoral. Most of the other segment of the population express views similar to those of international organizations. It is therefore desirable that legislators rely on progressive international legislation to support domestic policies that are not strictly moralistic and conservative.

Young Indians' Willingness to Make a Living Organ Donation.

BACKGROUND: The large unmet need in India for organs to transplant calls for an increase in living organ donations. This study examined the positions of Indian university students on making a living organ donation. METHODS: A convenience sample of 339 students from Karnatak University rated willingness to be a living donor in 48 scenarios consisting of all combinations of 5 factors: recipient's identity (close family member vs stranger), level of surgical risk for the donor, possible long-term health consequences for the donor, probability of transplant success, and likelihood of finding other donors (the subject is one of the rare compatible donors or one donor among others). RESULTS: Cluster analyses showed the existence of 4 qualitatively distinct positions called nondonors (9%); family donors (21%), for whom willingness was very high when recipients were family members and very low when they were strangers; universal donors (30%), for whom willingness was also quite high when a stranger was involved; and conditional donors (23%), who took a risk-benefit perspective. CONCLUSIONS: These finding suggest that the fundamental reason for the current shortage of organs in India is neither psychological nor cultural but more likely organizational.

Willingness to Use Mental Health Services for Depression Among African Immigrants and White Canadian-Born People in the Province of Quebec, Canada.

Studies suggest that non-Caucasian immigrants to Canada are less likely than Canadian-born people to use mental health services. To meet the mental health needs of ethnocultural minorities, insights into their help-seeking attitudes are of great concern. This study examined the willingness of African immigrants and White Canadian-born to seek care for depression from conventional mental health services.  African immigrants (N = 262) and White Canadian-born people (N = 250) living in Montreal, Canada, indicated their willingness to use mental health services under different conditions varying as a function of four factors: the severity of symptoms, the waiting time for first consultation, the type of care offered in the mental health service, and whether informal sources of help were available.  Seven qualitatively different positions were identified: Never Consult (18% of the African immigrants and 1% of the White Canadian-born people); Hesitant (18% of the African immigrants and 7% of the White Canadian-born people); Depends on Waiting Time (16% of the African immigrants); Depends on Waiting Time and Symptoms (22% of the African immigrants); Depends on Symptoms (36% of the White Canadian-born people and 6% of the African immigrants); Willing to consult (33% of the White Canadian-born people and 2% of the African immigrants); Certain to Consult (9% of the White Canadian-born people and 4% of the African immigrants), while 14% of participants in each group did not express any position. African immigrants were more likely to underuse mental health services, compared with White Canadian-born people. The above diversity of positions strongly suggests that the design and implementation of interventions to reduce disparities in African immigrants' use of mental health care must not be "one size fits all" but must be tailored to address these immigrants' differing attitudes and needs.

French People's Views on the Allocation of Organs for Transplantation.

BACKGROUND: French laypeople's views on the allocation of organs for transplantation were examined. METHODS: A total of 199 adults make judgments of priority for a liver transplant in 48 realistic scenarios composed of all combinations of 4 factors: 1. probability of success, 2. life expectancy without transplant, 3. level of responsibility for liver failure (eg, substance abuse in the past), and 4. social situation (eg, young mother with 2 young children). In all scenarios, the patients were in need of liver transplant. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Six qualitatively different positions were found that were termed Probability of Success and Life Expectancy (6%), Family Responsibilities (8%), Family Responsibilities and Risky Behavior (28%), Risky Behavior and Family Responsibilities (22%), Risky Behavior (11%), and Always a Priority (25%). Regular church attendees expressed more often the Risky Behavior and Family Responsibilities position and less often the Always a Priority position than atheists. Female participants expressed more often the Risky Behavior position than male participants. CONCLUSIONS: The French laypeople in our sample think that when assessing priority for transplant, criteria additional to medical urgency or the estimated utility in terms of expected life span after transplant should be taken into account. These criteria are the patient's lack of responsibility for the liver failure (ie, not causing it by drinking or using drugs) and the extent of the patient's social responsibilities (with active employment and dependents to care for).

French People's Views Regarding Xenotransplantation.

BACKGROUND: French laypeople's views on xenotransplantation were examined. METHODS: A convenience sample of 224 adults (among them, 37 nurses) judged of the acceptability of xenotransplantation in 50 realistic scenarios composed of various combinations of 4 factors: 1. the type of graft (eg, pig cardiac valve), 2. the level of urgency (eg, critical condition with very high risk of death in the short term), 3. the patient's or the family's level of consent (eg, the members of the family are divided on the issue), and 4. whether the transplantation was temporary or definitive. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Seven qualitatively different positions were found that were termed Never acceptable (12%), Urgency (4%), Family consent (33%), Religious concerns (15%), Family consent and urgency (10%), Depends on all circumstances (4%), and Always acceptable (11%). Vegans and vegetarians expressed the Never acceptable position more often than nonvegetarians. Health professionals expressed the Family consent position more often than the public. Regular church attendees expressed the Religious concerns position more often than atheists did. CONCLUSIONS: Few participants, mostly vegetarians, were opposed to xenotransplantation on principle. About one-third expressed positive views regarding xenotransplantation, either irrespective of circumstances or at least in those cases in which the patient's death is imminent and the family is not opposed for religious reasons. About one-half expressed positive views but deferred to the wishes of the family. The type of xenograft proposed had practically no effect on participants' views.

Judgments of risk of becoming HIV-infected through sexual contact in Lomé, Togo.

The way Togolese people estimate the risk of becoming HIV-infected as a result of sexual contact was examined. The participants were presented with scenarios depicting a number of sexual acts, use of protective devices, and the probability that the partner is infected. Findings support the appropriate use of protective behavior information, as well as the appropriate use of probability information. Number of sexual acts was, however, perceived to have minimal impact on risk. Togolese people should be made aware, through systematic information campaigns, of the relationship between number of sexual acts and risk.