The role of non-COVID-specific and COVID-specific factors in predicting a shift in willingness to vaccinate: A panel study.

Although declines in intent to vaccinate had been identified in international surveys conducted between June and October 2020, including in the United States, some individuals in the United States who previously expressed reluctance said, in spring 2021, that they were willing to vaccinate. That change raised the following questions: What factors predicted an increased willingness to inoculate against COVID-19? And, to what extent was the change driven by COVID-specific factors, such as personal worry about the disease and COVID-specific misinformation, and to what extent by background (non-COVID-specific) factors, such as trust in medical authorities, accurate/inaccurate information about vaccination, vaccination history, and patterns of media reliance? This panel study of more than 8,000 individuals found that trust in health authorities anchored acceptance of vaccination and that knowledge about vaccination, flu vaccination history, and patterns of media reliance played a more prominent role in shifting individuals from vaccination hesitance to acceptance than COVID-specific factors. COVID-specific conspiracy beliefs did play a role, although a lesser one. These findings underscore the need to reinforce trust in health experts, facilitate community engagement with them, and preemptively communicate the benefits and safety record of authorized vaccines. The findings suggest, as well, the need to identify and deploy messaging able to undercut health-related conspiracy beliefs when they begin circulating.

A commercial tobacco and alcohol use intervention for urban Native American youth.

OBJECTIVE: Westernized alcohol and commercial tobacco use prevention approaches for Native Americans have not been effective, or sustainable. The overall objective of this study examined the effect of the culturally based Urban Talking Circle (UTC) intervention versus standard education (SE) program for the prevention of alcohol and commercial tobacco use among urban Native American youth. DESIGN: The study employed a 2-condition quasi-experimental design and utilized convenience and snowball sampling methods for recruiting 100 urban Native American youth participants in two urban Native American community program locations in Florida. Study participants were randomized by their urban Native American community program location to one of the 2-conditions. These included the standard education (SE) program used within United States school systems (drug abuse resistance education) and the Urban Talking Circle (UTC) intervention, culturally tailored and developed for urban Native American youth from the culturally based Talking Circle Intervention for rural Native American Youth. The Native American Alcohol Measure for Youth (NAAMY) and Native Reliance Questionnaire were utilized to collect participants' data. Participants' data was analyzed using multivariate analysis of variance to determine differences between the scores on all measures at pre/post-intervention for the 2-conditions. RESULTS: Study findings indicate that a culturally based intervention was more effective for the reduction of commercial tobacco and alcohol use than a non-culturally based intervention for urban Native American youth. CONCLUSION: The study findings emphasized that the utilization of the culturally tailored UTC intervention reduced involvement associated with alcohol and commercial tobacco use.

Be strong, be confident: the rise of China and the 2022 Beijing Winter Games.

Drawing on promotional materials in 2007-2008 and in 2021-2022, this article examines both Olympics to explore how the state has evolved in its governmental rationalities, and the related cultural and political implications. The 2022 Winter Games, despite its comparatively low profile and challenges posed by Covid-19, provided the Chinese state with a key moment to advance its confidence doctrine. Three discourses were mobilised pertaining to, first, the CCP's superb leadership and problem-solving skills; second, China's mega-infrastructure; and, third, created + made in China. The 2022 Olympics thus mobilised three confidence-driven discourses: leadership confidence, techno-scientific confidence, and creative confidence. In doing so, the 2022 Olympics envisioned, narrated, and materialised the popular discursive signifiers - technology, green and sustainability, and the future - the authorities already actively promoted in its political initiatives and policies. This contributed to the inward-oriented beliefs of self-reliance and self-improvement. Where we witnessed in 2008 a sense of curiosity and openness, within China and the world at large, we now face the complexities, dangers, and cultural essentialism, if not narcissism, of a confident China.

Seeing does not mean processing: where we look and the visual information we rely on change independently as we learn a novel walking task.

People use vision to inform motor control strategies during walking. With practice performing a target stepping task, people shift their gaze farther ahead, transitioning from watching their feet contact the target to looking for future target locations. The shift in gaze focus suggests the role of vision in motor control changes from emphasizing feedback to feedforward control. The present study examines whether changing visual fixation location is accompanied by a similar change in reliance upon visual information. Twenty healthy young adults practiced stepping on moving targets projected on the surface of a treadmill. Periodically, participants' visual reliance was probed by hiding stepping targets which inform feedback or feedforward (targets < or > 1.5 steps ahead, respectively) motor control strategies. We calculated visual reliance as the increase in step error when targets were hidden. We hypothesized that with practice, participant reliance on feedback visual information would decrease and their reliance on feedforward visual information would increase. Contrary to our hypothesis, participants became significantly more reliant on feedback visual information with practice (p < 0.001) but their reliance on feedforward visual information did not change (p = 0.49). Participants' reliance on visual information increased despite looking significantly farther ahead with practice (p < 0.016). Together, these results suggest that participants fixated on feedback information less. However, changes in fixation pattern did not reduce their reliance upon feedback information as stepping performance still significantly decreased when feedback information was removed after training. These findings provide important context for how the role of vision in controlling walking changes with practice.

Autonomy versus support: self-reliance and help-seeking for mental health problems in young people.

PURPOSE: Many young people with mental ill-health do not seek support, and developmental growth in self-reliance may be a barrier to help-seeking. Increasing autonomy is a positive developmental task for youth and a key aspect of resilience. This study examined the influence of perceived social support and resilience on the previously unexamined relationship between self-reliance and intentions to seek help from informal, professional, and self-help sources for mental health problems. METHODS: An online survey was completed by a representative Australian community sample of 5,203 young people aged 12-25 years (half female), in May-June 2020. RESULTS: Path analysis showed the hypothesised conceptual model did not fit the data well, but a modified model was a good fit. Higher self-reliance was associated with lower intentions to seek informal and professional help, as expected, but not with greater intentions for self-help. The relationship between self-reliance and informal help-seeking intentions was fully mediated by perceived social support, whereas the relationship between self-reliance and professional help-seeking was also direct. Perceived social support fully mediated the relationship between self-reliance and resilience. Intentions to use self-help were not influenced by variables in the study, but higher self-help intentions were associated with higher professional help-seeking intentions. Associations were consistent across age and gender groups. CONCLUSION: The results show the critical role of social support for combating some of the unhelpful aspects of self-reliance for mental health help-seeking in young people. Future research should explore how self-reliance can hinder or be harnessed to facilitate accessing appropriate mental health.

Telemedicine Use by Age in Louisiana Medicaid During COVID-19: Claims-Based Longitudinal Analysis.

BACKGROUND: Limited availability of in-person health care services and fear of contracting COVID-19 during the pandemic promoted an increased reliance on telemedicine. However, long-standing inequities in telemedicine due to unequal levels of digital literacy and internet connectivity among different age groups raise concerns about whether the uptake of telemedicine has exacerbated or alleviated those inequities. OBJECTIVE: The aim of this study is to examine changes in telemedicine and in-person health service use during the COVID-19 pandemic across age groups for Medicaid beneficiaries in the state of Louisiana. METHODS: Interrupted time series models were used on Louisiana Medicaid claims data to estimate trends in total, in-person, and telemedicine monthly office visit claims per 1000 Medicaid beneficiaries between January 2018 and December 2020. Changes in care pattern trends and levels were estimated around the infection peaks (April 2020 and July 2020) and for an end-of-year infection leveling off period (December 2020). Four mutually exclusive age categories (0 to 17, 18 to 34, 35 to 49, and 50 to 64 years) were used to compare the differences. RESULTS: Prior to the COVID-19 pandemic, telemedicine services accounted for less than 1% of total office visit claim volume across the age groups. Each age group followed similar patterns of sharp increases in April 2020, downward trends until sharp increases again in July 2020, followed by flat trends thereafter until December 2020. These sharp increases were most pronounced for older patients, with those aged 50 to 64 years seeing increases of 184.09 telemedicine claims per 1000 Medicaid beneficiaries in April 2020 (95% CI 172.19 to 195.99) and 120.81 in July 2020 (95% CI 101.32 to 140.31) compared with those aged 18 to 34 years, seeing increases of 84.47 (95% CI 78.64 to 90.31) and 57.00 (95% CI 48.21 to 65.79), respectively. This resulted in overall changes from baseline to December 2020 levels of 123.65 (95% CI 112.79 to 134.51) for those aged 50 to 64 years compared with 59.07 (95% CI 53.89 to 64.24) for those aged 18 to 34 years. CONCLUSIONS: Older Medicaid beneficiaries in Louisiana had higher rates of telemedicine claim volume during the COVID-19 pandemic compared with younger beneficiaries.

Estimation of Subjectively Reported Trust, Mental Workload, and Situation Awareness Using Unobtrusive Measures.

OBJECTIVE: We use a set of unobtrusive measures to estimate subjectively reported trust, mental workload, and situation awareness (henceforth "TWSA"). BACKGROUND: Subjective questionnaires are commonly used to assess human cognitive states. However, they are obtrusive and usually impractical to administer during operations. Measures derived from actions operators take while working (which we call "embedded measures") have been proposed as an unobtrusive way to obtain TWSA estimates. Embedded measures have not been systematically investigated for each of TWSA, which prevents their operational utility. METHODS: Fifteen participants completed twelve trials of spaceflight-relevant tasks while using a simulated autonomous system. Embedded measures of TWSA were obtained during each trial and participants completed TWSA questionnaires after each trial. Statistical models incorporating our embedded measures were fit with various formulations, interaction effects, and levels of personalization to understand their benefits and improve model accuracy. RESULTS: The stepwise algorithm for building statistical models usually included embedded measures, which frequently corresponded to an intuitive increase or decrease in reported TWSA. Embedded measures alone could not accurately capture an operator's cognitive state, but combining the measures with readily observable task information or information about participants' backgrounds enabled the models to achieve good descriptive fit and accurate prediction of TWSA. CONCLUSION: Statistical models leveraging embedded measures of TWSA can be used to accurately estimate responses on subjective questionnaires that measure TWSA. APPLICATION: Our systematic approach to investigating embedded measures and fitting models allows for cognitive state estimation without disrupting tasks when administering questionnaires would be impractical.

Measuring transition readiness in adolescents and young adults with sickle cell disease using the transition readiness assessment questionnaire.

BACKGROUND/OBJECTIVES: Adolescents and young adults (AYA) with sickle cell disease (SCD) face challenges related to the disease and its treatment. The Transition Readiness Assessment Questionnaire (TRAQ) is a self-report tool for assessing transition readiness for youth with special health care needs (YSHCN), including SCD. This study uses the TRAQ to understand transition readiness in patients with SCD treated at the Boston Medical Center and evaluates associations between TRAQ scores and transition outcomes (e.g., emergency department reliance [EDr] and emergency department utilization [EDu]). METHODS: We reviewed electronic medical records of AYA with SCD who completed the TRAQ in the pediatric hematology clinic between January 1, 2019, and March 1, 2020, and categorized healthcare encounters to calculate EDu and EDr.  We used t tests and ANOVA models to analyze mean TRAQ scores, sex, age, genotype, EDu, and EDr. RESULTS: The sample was 45 AYA patients with SCD between 13 and 22 years old. The mean TRAQ score for the overall patient sample was 3.67. Mean TRAQ scores did not significantly vary by sex or genotype but did significantly increase with age. TRAQ scores did not correlate to EDu or EDr. CONCLUSIONS: AYA patients with SCD have low transition readiness. The age of 18 may not be the most reliable attribute of readiness, though older patients do have higher readiness. The relationship between TRAQ scores, EDr, and EDu is not clear and requires further evaluation.

Environmental Consequences of Potential Strategies for China to Prepare for Natural Gas Import Disruptions.

Worldwide efforts to switch away from coal have increased the reliance on natural gas imports for countries with inadequate domestic production. In preparing for potential gas import disruptions, there have been limited attempts to quantify the environmental and human health impacts of different options and incorporate them into decision-making. Here, we analyze the air pollution, human health, carbon emissions, and water consumption impacts under a set of planning strategies to prepare for potentially fully disrupted natural gas imports in China. We find that, with China's current natural gas storage capacity, compensating for natural gas import disruptions using domestic fossil fuels (with the current average combustion technology) could lead up to 23,300 (95% CI: 22,100-24,500) excess premature deaths from air pollution, along with increased carbon emissions and aggravated water stress. Improving energy efficiency, more progressive electrification and decarbonization, cleaner fossil combustion, and expanding natural gas storage capacity can significantly reduce the number of excess premature deaths and may offer opportunities to reduce negative carbon and water impacts simultaneously. Our results highlight the importance for China to increase the domestic storage capacity in the short term, and more importantly, to promote a clean energy transition to avoid potentially substantial environmental consequences under intensifying geopolitical uncertainties in China. Therefore, mitigating potential negative environmental impacts related to insecure natural gas supply provides additional incentives for China to facilitate a clean and efficient energy system transition.

Effects of balance training with stroboscopic glasses on postural control in chronic ankle instability patients.

Individuals with chronic ankle instability (CAI) are believed to rely more on visual information during postural control due to impaired proprioceptive function, which may increase the risk of injury when their vision is limited during sports activities. OBJECTIVES: To compare (1) the effects of balance training with and without stroboscopic glasses on postural control and (2) the effects of the training on visual reliance in patients with CAI. DESIGN: A randomized controlled clinical trial. METHODS: Twenty-eight CAI patients were equally assigned to one of 2 groups: strobe or control group. The strobe group wore stroboscopic glasses during a 4-week balance training. Static postural control, a single-leg hop balance test calculated by Dynamic Postural Stability Index (DPSI), and the Y-Balance test (YBT) were measured. During the tests, there were different visual conditions: eyes-open (EO), eyes-closed (EC), and strobe vision (SV). Romberg ratios were then calculated as SV/EO, and EC/EO and used for statistical analysis. RESULTS: The strobe group showed a higher pretest-posttest difference in velocity in the medial-lateral direction and vertical stability index under SV compared with the control group (p < .05). The strobe group showed higher differences in EC/EO for velocity in the medial-lateral and anterior-posterior directions, and 95% confidence ellipse area (p < .05), and in SV/EO for velocity in the medial-lateral, 95% confidence ellipse area, and YBT-anterior direction (p < .05). CONCLUSION: The 4-week balance training with stroboscopic glasses appeared to be effective in improving postural control and altering visual reliance in patients with CAI.

Reliability but not bias: Developing a scale to measure preferred channels for risk information during the COVID pandemic.

To develop a new measure of preferred sources for risk information, two studies asked respondents to indicate what channels they were reliant on for information about COVID-19, from 25 news channels ranging across the political spectrum. Unexpectedly, dependencies clustered around level of reliability rather than the political orientation of the news channel. In other words, each cluster included media channels from both the left and right side of the political spectrum, while dependencies clustered into sources that varied by the degree to which their content is reliable. Participants who turned to lower reliability channels indicated lower risk perceptions, less accurate probability estimations, reduced vaccination intentions, and lower protective behavioral intentions. Those inclined to use higher reliability channels indicated higher risk perceptions, more accurate probability estimations, increased vaccination intentions, and higher protective behavioral intentions. These relationships are discussed in terms of implications for our understanding of source reliance and risk perception, information sufficiency, and implications for both future research and public health interventions.

Developing a sense of self-reliance: caregivers of infants with single-ventricle heart disease during the interstage period.

BACKGROUND: Caring for infants after the first-stage palliative surgery for single-ventricle heart disease bring challenges beyond the usual parenting responsibilities. Current studies fail to capture the nuances of caregivers' experiences during the most critical "interstage" period between the first and second surgery. OBJECTIVES: To explore the perceptions of caregivers about their experiences while transitioning to caregiver roles, including the successes and challenges associated with caregiving during the interstage period. METHODS: Constructivist Grounded Theory methodology guided the collection and analysis of data from in person or telephonic interviews with caregivers after their infants underwent the first-stage palliative surgery for single-ventricle heart disease, and were sent to home for 2-4 months before returning for their second surgery. Symbolic interactionism informed data analyses and interpretation. RESULTS: Our sample included 14 parents, who were interviewed 1-2 times between November, 2019 and July, 2020. Most patients were mothers (71%), Latinx (64%), with household incomes <$30K (42%). Data analysis led to the development of a Grounded Theory called Developing a Sense of Self-Reliance with three categories: (1) Owning caregiving responsibilities despite grave fears, (2) Figuring out how "to make it work" in the interstage period, and (3) Gaining a sense of self-reliance. CONCLUSIONS: Parents transitioned to caregiver roles by developing a sense of self-reliance and, in the process, gained self-confidence and decision-making skills. Our study responded to the key research priority from the AHA Scientific Statement to address the knowledge gap in home monitoring for interstage infants through qualitative research design.

Self-Reliance and Postoperative Hand Recovery After Simultaneous, Bilateral Endoscopic Carpal Tunnel Release: A Prospective Study.

PURPOSE: Outcomes and recovery of endoscopic carpal tunnel release (ECTR) have been broadly examined in studies. The total recovery time can potentially be reduced by performing simultaneous, bilateral ECTR. In this study we prospectively investigated days to self-reliance. As secondary outcomes, we investigated direct postoperative recovery of hand function and pre and postoperative symptom severity after simultaneous, bilateral ECTR. METHODS: In this single-center prospective case series, we included all patients willing to participate after undergoing bilateral ECTR between December 2015 and July 2019. Every patient recorded days to self-reliance (when a patient could perform basic activities of daily living without the need for assistance from another person) and completed a preoperative and postoperative Boston Carpal Tunnel Questionnaire (BCTQ) evaluating postoperative hand function and pre and postoperative symptom severity. RESULTS: In total, 81 patients received simultaneous, bilateral ECTR. Median days until self-reliance was 4; mean number of days was 4.9. Concerning BCTQ scores, postoperative functional status increased significantly each day, and mean BCTQ score decreased gradually from intense difficulty to little difficulty in daily tasks over a period of 7 days. Preoperative BCTQ symptom severity showed significant improvement compared to postoperative symptoms, evolving from medium to slight symptoms. CONCLUSIONS: Simultaneous, bilateral ECTR offers recovery to self-reliance in 4 to 5 days with a gradual and significant increase of hand function in the following postoperative days. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Mapping Men's Mental Health Help-Seeking After an Intimate Partner Relationship Break-Up.

Deleterious effects of separation and divorce on men's mental health are well-documented; however, little is known about their help-seeking when adjusting to these all-too-common life transitions. Employing interpretive descriptive methods, interviews with 47 men exploring their mental health help-seeking after a relationship break-up were analyzed in deriving three themes: (1) Solitary work and tapping established connections, (2) Reaching out to make new connections, and (3) Engaging professional mental health care. Men relying on solitary work and established connections accessed relationship-focused self-help books, online resources, and confided in friends and/or family. Some participants supplemented solitary work by reaching out to make new connections including peer-based men's groups and education and social activities. Comprising first-time, returning, and continuing users, many men responded to relationship break-up crises by engaging professional mental health care. The findings challenge longstanding commentaries that men actively avoid mental health promotion by illuminating wide-ranging help resources.

Knowing When to Pass: The Effect of AI Reliability in Risky Decision Contexts.

OBJECTIVE: This study manipulates the presence and reliability of AI recommendations for risky decisions to measure the effect on task performance, behavioral consequences of trust, and deviation from a probability matching collaborative decision-making model. BACKGROUND: Although AI decision support improves performance, people tend to underutilize AI recommendations, particularly when outcomes are uncertain. As AI reliability increases, task performance improves, largely due to higher rates of compliance (following action recommendations) and reliance (following no-action recommendations). METHODS: In a between-subject design, participants were assigned to a high reliability AI, low reliability AI, or a control condition. Participants decided whether to bet that their team would win in a series of basketball games tying compensation to performance. We evaluated task performance (in accuracy and signal detection terms) and the behavioral consequences of trust (via compliance and reliance). RESULTS: AI recommendations improved task performance, had limited impact on risk-taking behavior, and were under-valued by participants. Accuracy, sensitivity (d'), and reliance increased in the high reliability AI condition, but there was no effect on response bias (c) or compliance. Participant behavior was only consistent with a probability matching model for compliance in the low reliability condition. CONCLUSION: In a pay-off structure that incentivized risk-taking, the primary value of the AI recommendations was in determining when to perform no action (i.e., pass on bets). APPLICATION: In risky contexts, designers need to consider whether action or no-action recommendations will be more influential to design appropriate interventions.

Understanding the Impact of Time Pressure and Automation Support in a Visual Search Task.

OBJECTIVE: To understand the impact of time pressure and automated decision support systems (DSS) in a simulated medical visual search task. BACKGROUND: Time pressure usually impairs manual performance in visual search tasks, but DSS support might neutralize this negative effect. Moreover, understanding the impact of time pressure and DSS support seems relevant for many real-world applications of visual search. METHOD: We used a visual search paradigm where participants had to search for target letters in a simulated medical image. Participants performed the task either manually or with support of a highly reliable DSS. Time pressure was varied within-subjects by either a trialwise time-pressure manipulation (Experiment 1) or a blockwise manipulation (Experiment 2). Performance was assessed based on signal detection measures. To further analyze visual search behavior, a mouse-over approach was used. RESULTS: In both experiments, results showed impaired sensitivity under high compared to low time pressure in the manual condition, but no negative effect of time pressure when working with a highly reliable DSS. Moreover, participants searched less under time pressure and when receiving DSS support, indicating participants followed the automation without thoroughly checking recommendations. However, the human-DSS team's sensitivity was always worse than that of the DSS alone, independent of the strength of time pressure. CONCLUSION: Negative effects of time pressure can be ameliorated when receiving support by a DSS, but joint overall performance remains below DSS-alone performance. APPLICATION: Highly reliable DSS seem capable of ameliorating the negative impact of time pressure in complex detection tasks.

Human Performance Consequences of Automated Decision Aids: The Impact of Time Pressure.

OBJECTIVE: The study addresses the impact of time pressure on human interactions with automated decision support systems (DSSs) and related performance consequences. BACKGROUND: When humans interact with DSSs, this often results in worse performance than could be expected from the automation alone. Previous research has suggested that time pressure might make a difference by leading humans to rely more on a DSS. METHOD: In two laboratory experiments, participants performed a luggage screening task either manually, supported by a highly reliable DSS, or by a low reliable DSS. Time provided for inspecting the X-rays was 4.5 s versus 9 s varied within-subjects as the time pressure manipulation. Participants in the automation conditions were either shown the automation's advice prior (Experiment 1) or following (Experiment 2) their own inspection, before they made their final decision. RESULTS: In Experiment 1, time pressure compromised performance independent of whether the task was performed manually or with automation support. In Experiment 2, the negative impact of time pressure was only found in the manual but not in the two automation conditions. However, neither experiment revealed any positive impact of time pressure on overall performance, and the joint performance of human and automation was mostly worse than the performance of the automation alone. CONCLUSION: Time pressure compromises the quality of decision-making. Providing a DSS can reduce this effect, but only if the automation's advice follows the assessment of the human. APPLICATION: The study provides suggestions for the effective implementation of DSSs in addition to supporting concerns that highly reliable DSSs are not used optimally by human operators.

Understanding help-seeking in rural counties: A serial mediation analysis.

OBJECTIVE: Rural areas in the Southern United States are characterized by certain cultural values that may delay or prevent mental health service utilization. The present study examined a four-stage chain of serial mediation where higher levels of general self-reliance would be related to greater levels of public stigma, which would in turn be related to higher levels of self-stigma, followed by greater self-reliance about managing mental health problems, and finally, more negative attitudes toward seeking help from psychologists. METHOD: Community members who lived in rural counties in the Southern United States (N = 783) completed measures of these constructs online. RESULTS: Mediation analyses supported a direct association between general self-reliance and attitudes toward help-seeking that was explained in serial by higher levels of public stigma, self-stigma, and mental health self-reliance. CONCLUSIONS: Clinical implications for rural practitioners are suggested including instilling policy changes, increasing provider visibility, and addressing barriers in therapy.

Investigating the use of support in secondary school: the role of self-reliance and stigma towards help-seeking.

Purpose: Adolescents are the least likely to seek help for their mental health problems. School may be an important route to improve early recognition of adolescents with mental health problems in need for support, but little is known about the barriers to school support.Materials and methods: Data were collected in a longitudinal cohort study of Dutch adolescents (age 12-16) in secondary school (n = 956). We assessed the relation between level of psychosocial problems at the beginning of the school year (T1) and the support used in school at the end of that school year (T2), whether the willingness to talk to others (measured at T1) mediates this relation, and whether stigma towards help-seeking (T1) moderates this mediation.Results: Adolescents with more psychosocial problems were more likely to use support in school and were less willing to talk to others about their problems, but the willingness to talk to others was not a mediator. Stigma moderated the relationship between psychosocial problems and willingness to talk to others.Conclusions: Most adolescents with psychosocial problems get support in Dutch secondary school regardless of their willingness to talk to others about their problems. However, perceiving stigma towards help-seeking makes it less likely for someone to talk about their problems.

Factors influencing the emergence of self-reliance in primary health care using traditional medicine: A scoping review.

Self-reliance is the responsible behavior and the ability of an individual to take care of one's own health using local resources. A substantial proportion of the population use traditional medicine (TM) for primary health care (PHC) in low- and middle-income countries (LMIC). The underlying philosophy of the TM approach is self-reliance due to its emphasis on culture, traditions, customs, and local resources. Given the complexity and ambiguity of how self-reliance emerges, there is a need to have clarity in its understanding and the practice in relation to TM. Hence, we conducted this review to synthesize the factors determining the emergence of self-reliance in PHC using TM in resource-poor settings with a specific focus on LMICs. We searched PubMed, Google scholar, and the Social Science Research Network databases, and conducted reference tracking of selected articles. We included articles published between 2000 and 2020 May. Thematic analysis was done using QDA-miner Lite software version 2.1. We retained 29 papers for review and analysis. A conceptual framework was developed that located factors influencing the emergence of self-reliance. Self-reliance manifests through a socially constructed interaction between factors from the macro (policy and environment) to the micro context (community and household). Due to the lack of explanatory models, there is a substantial gap between understanding self-reliance and its application in health policy and practice. Achieving comprehensive PHC and universal health coverage requires policy provisions to create an enabling environment in health-care facilities, communities, and households that allows the emergence of self-reliance.