Adoption Of Prevention Practices Research Articles

EPH97 Application of Self-Protective Behaviors in Balancing Objective and Subjective COVID-19 Risk Assessments Among Residents in an Urban Setting

We examined the association between self-perceived and Latent Class Analysis (LCA) assessed risk of COVID-19 infection and evaluated their relationships with sociodemographic and modifiable behavioral factors among residents of Onitsha, an urban city in Nigeria. We analyzed data from a cross-sectional survey (n=140) conducted in March 2020. The survey elicited information on the participants’ demographic characteristics, COVID-19 knowledge, attitude, preventive practice, level of preparedness, misconceptions, and COVID-19 information gaps. Participants were classified as being “not at risk” or “at risk” based on self-perceived risk of COVID-19 infection (subjective) and LCA-segmented risk clusters (objective). We applied the Chi-square test and used Kendall rank correlation analysis to determine the relationship between demographic characteristics and self-protective behaviors by the risk assessment methods. There was a significant association between subjective (32.4%) and objective (50.7%) assessments of COVID-19 risk (X2=5.38, p<0.05) among the survey participants. However, those who perceived themselves at risk of COVID-19 were 58% less likely to be classified as such when assessed objectively (OR: 0.42, 95%CI: 0.20-0.88, p<0.05). In contrast, those who perceived themselves to be at no risk were 2.38 times (OR: 2.38, 95%CI: 1.13-4.99, p<0.05) more likely to be at risk when assessed objectively. Significantly negative and low correlation was observed between subjective and objective assessments ((Kendall's tau-b (τb)= -0.193,p<0.05). Relationship between knowledge and attitude of residents toward COVID-19 were in opposite direction (τb= 0.431,p<0.01 (subjective) and τb= -0.339,p<0.01 (objective)). Adoption of preventive practices was negatively correlated with information gap among persons assessed both subjectively (τb= -0.379,p<0.01) and objectively (τb= -0.404,p<0.001) for COVID-19 risks. Objective assessment allowed for the integration of self-protective behaviors in the model, making it a reliable framework for identifying at risk group and tailoring intervention program aimed at curbing the devastating impact of COVID-19 among the city residents.

Assessment of Knowledge, Attitude, and Practices (KAP) Toward Hepatitis B Infection, Its Prevention, and Vaccination Among Health Care Workers.

Health Care workers (HCWs) have an approximate four-fold increased risk of contracting hepatitis B infection than the normal population. A lack of knowledge and practicesregarding precautions has been frequently observed. We aimed to do a knowledge, attitude, and practices (KAP) study regarding hepatitis B prevention measures among HCWs. The study enrolled 250 HCWs.A questionnaire-based proforma regarding KAP towards hepatitis B, its causation, and prevention was filled out by each participant. Mean age (SD) of participants was 31.8 ± 9.1 years with 83 males and 167 females. Subjects were divided into two groups: Group I (House Surgeons and Residents) and Group II (Nursing staff, Laboratory Technicians, Operation Theatre Assistants). All Group I and 148 (96.7%) of Group II subjects had adequate knowledge regarding the professional risk of hepatitis B virus transmission.Knowledge regarding different modes of transmission was less in Group II subjects (Blood (96.1%), Sex (84.3%), percutaneous route (85.6%), and During Birth (83%)) as compared to Group I (100% in all).All subjects in Group I and 134 (90.9%) Group II subjects knew about vaccination as a preventive measure.There was a slight discordance between attitude and practices towards universal precautionary measures in Group II subjects (Use of gloves 96.1% vs 94.8%; Safe needle disposal 96.7% vs 96.1%; Vaccination 94.8% vs 67.9%). Of the subjects in Group I,94.8% were vaccinated and 67.9% were vaccinated in Group II, withcomplete vaccination rates being 76.3% and 43.1%, respectively, and the difference was statistically significant (P < 0.001). Better knowledge and attitude led to more adoption of preventive practices. But, still, there is a gap in the KAP towards hepatitis B preventive practices and knowledge is not getting transformed into practices. We recommend that all HCWs should be questioned about their vaccination status.In addition, vaccination coverage, various preventive campaigns, and the hospital infection control committee (HICC) need to be strengthened.

COVID-19 Preventive Practices and their Relation to Knowledge, Attitude, and Risk Perception: Results of a Telephone Survey in Ethiopia

The first case of coronavirus was reported in Ethiopia on March 13, 2020, and the number of cases has been rising continually. This study examined the level and correlates of risk perception, knowledge, and attitude in relation to COVID-19 in Ethiopia. It also assessed the level of adoption of various preventive practices and their association with risk perception, knowledge, and attitude. The rapid assessment was made using data collected in a telephone survey. Correlates of knowledge, attitude, and risk/impact perception were assessed using Poisson regression. Econometric estimation was used to identify the correlations of knowledge, attitude, and risk/impact perception scores with the adoption of preventive practices. A total of 1,037 respondents participated in the survey. Although the level of knowledge about the pandemic was generally good among the population, a significant proportion of the population (the elderly and less educated) still do not have correct knowledge about the disease symptoms and means of transmission. Some respondents revealed unfavorable attitudes about the virus, and around two-thirds of respondents did not perceive the fast-expanding pandemic to be a major risk. A significant correlation was found between the adoption of preventive practices and knowledge, attitude, and impact perception in relation to COVID-19. Health education interventions would be more effective if they were to target certain demographic groups, such as the elderly and less educated, whose overall average knowledge about COVID-19 is lower. The use of a multiple media outlet for disseminating information on COVID-19 may improve choices and enhance knowledge.

Assessing the Role of Trust in Information Sources, Adoption of Preventive Practices, Volunteering and Degree of Training on Biological Risk Prevention, on Perceived Risk of Infection and Usage of Personal Protective Equipment Among Italian Medical Students During the SARS-CoV-2 Pandemic.

Background: During the initial phase of the COVID-19 pandemic, the University of Bologna Medical School surveyed medical students to learn more about their preparation to confront challenges posed by the pandemic and whether it affects perceptions of viral infection risk. This information could help design risk-reduction interventions with training to mitigate possible viral exposure.Method: A cross-sectional online survey examining students' characteristics, volunteer status, adoption of evidence-based preventive measures, trust in information sources used, infectious disease training, and knowledge of PPE usage in relation to perceived risk of infection from SARS-CoV-2 in daily living, academic, and healthcare activities. A multivariate path model estimated the simultaneous influences of all exogenous factors on perceived risk. A Poisson regression model assessed the same multivariate effects on knowledge of PPE usage.Results: The analysis sample included 537 respondents. Perceived risk of infection was highest in hospital activities. On average, students were able to use only four out of seven types of PPE albeit they adopted most of the evidence-based preventive measures. Adoption of preventive measures was positively associated with perceived risk of COVID infection. Conversely, training on PPE usage and volunteer work were associated with lower perceived risk in healthcare setting and higher PPE knowledge.Conclusion: Implementing early safety-based educational programs remedy students' lack of knowledge in infectious disease prevention and mitigate their risk of infection. Voluntary work should be encouraged with potential benefit for both their continued medical training and strengthening the healthcare system's response to public health emergencies.

Knowledge, attitudes, practices, and the effects of COVID-19 among the youth in Kenya

BackgroundCases of the Corona Virus Disease of 2019 (COVID-19) in Kenya have continued to increase rapidly, since the first case in the country was confirmed in March 2020. In the wake of the pandemic, the health and socio-economic challenges experienced by the youth in Kenya are likely to be elevated. We assessed knowledge, practices, perceived risk of infection, adoption of recommended behaviour and the effects of COVID-19 among the youth in Kenya.MethodsA cross sectional descriptive study was conducted between April 30th to May 7th, 2020 through a combined online survey and phone interviews. A total of 2156 youth across all 47 counties in Kenya completed the responses to the study questions. All survey responses analyzed using Stata version 15 were tabulated by gender, age, and education level to generate basic descriptive tables and tested for differences by category using chi-square tests. Where applicable, linear and logistic regression analysis model was conducted using covariates such as employment status, gender, and education level.ResultsKnowledge on symptoms of COVID-19 was generally high. Female respondents were more likely to identify more symptoms correctly compared to men (p < 0.001). However, youth reported very low levels of anyone being at risk of infection (7.1%). Most youth have adopted behavior necessary to slow down the infection. There were generally very low reported levels of inability to access health services related to sexual and reproductive health. About 50.0% of respondents reported significant decline in income during the pandemic period, nearly a third reported living in fear while 26.5% reported feeling stressed.ConclusionThere was high knowledge of COVID-19 symptoms, preventive strategies, and high adoption of preventive practices. Strategies to sustain behaviors positively adopted among young people will be critical to reduce the spread of COVID-19. Despite the low reported rates of inability to access sexual and reproductive health, response measures should include strategies that facilitate continuity of services among young people. The reported social effects of the pandemic show the need for interventions to meet the health and socio-economic needs of the youth and minimize the long-term consequences of the pandemic.

Knowledge, beliefs, mental health, substance use, and behaviors related to the COVID-19 pandemic among US adults: a national online survey

AimGiven the need for data to inform public health messaging to mitigate the COVID-19 pandemic, this national survey sought to assess the state of COVID-19-related knowledge, beliefs, mental health, substance use changes, and behaviors among a sample of U.S. adults.Subject and methodsIn the period March 20–30, 2020, we collected data on COVID-19-related knowledge, awareness and adoption of preventive practices, depression and anxiety (Patient Health Questionnaire-4), stress (Impact of Event Scale-6), pessimism, and tobacco and alcohol use. Differences between age groups (18–39 years, 40–59 years and ≥ 60 years) were tested using Pearson’s chi-squared tests or ANOVAs; associations between drinking and smoking and depression, anxiety, and stress were tested using adjusted logistic regression models.ResultsApproximately half of the sample (NTotal = 6391) were 50–69 years old and 58% were female. COVID-19 knowledge (mean = 12.0; SD = 1.2) and protective practice awareness (mean = 9.1; SD = 0.8) were high. Among respondents, 44% had a score consistent with depression and anxiety (PHQ-4 score ≥ 6), and 52% reported high stress scores (≥ median of 1.33). COVID-19-related anxiety and depression were associated with increased drinking (AOR = 1.79; 95% CI = 1.49, 2.15) and smoking (AOR = 2.17; 95% CI = 1.64, 2.88). High stress scores were also associated with increased drinking (AOR = 1.80; 95% CI = 1.49, 2.17, p < 0.001) and smoking (AOR = 1.75; 95% CI = 1.31, 2.33).ConclusionsIn spite of high knowledge levels, important gaps were identified. High prevalence of poor mental health outcomes and associated increases in drinking and smoking warrant ongoing risk communications tailoring to effectively disseminate information and expanding psychosocial services, particularly via telehealth, to mitigate the negative mental health impact of COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10389-021-01564-4.

English

BACKGROUND Human coronavirus (HCoV), 2019 novel coronavirus (2019-nCoV), was found in Wuhan, China, which has been responsible for an immense amount of morbidity and mortality world over. In India like in most parts of the world the fight against COVID-19 is an ongoing challenge. People’s adherence of the prevention measures is essential for controlling the spread of COVID-19, which is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. It has been established since the very onset of the pandemic that COVID-19 transmission between individuals occurs most importantly through direct contact as well as by droplets spread by coughing or sneezing of an individual who is infected. Therefore, the key to control of the disease lies having knowledge and adoption of preventive practices. Hence, the study was planned with the objective to assess knowledge, attitude and practice of coronavirus disease (Covid-19) among students in a medical college. METHODS This was a cross-sectional web-based study. A questionnaire designed on the basis of published literature and Centre for Disease Control and Prevention (CDC) guidelines was distributed online amongst students in a Medical College in North India. The mean knowledge, attitude, practices as well as demographics of the participants were assessed and scores were assigned for the same. Higher scores represented a better knowledge of COVID-19. Statistical analysis was carried out using Mann Whitney U test for gender and Kruskal Wallis test for age category. RESULTS Out of the total students with a non-response rate of 3 %, 398 participants responded, out of whom 54.52 % were males and majority (62.31 %) of the participants were in the age group of 21 - 23 years. Most of the participants were well aware about the modes of spread, main clinical symptoms and precautionary measures required for the prevention of COVID-19. CONCLUSIONS The levels of knowledge, attitude and practices were found to be positively adequate amongst most of the participants. Although encouraging, it needs to be reemphasized that continued emphasis on increasing knowledge, attitude and practices towards prevention of coronavirus disease is the key in containing this escalating pandemic. KEYWORDS Covid-19, Medical Students, Pandemic, North India

Development and validation of a questionnaire to assess preventive practices against COVID-19 pandemic in the general population.

Coronavirus Disease 2019 (COVID-19) pandemic has affected millions of people worldwide with far-reaching socio-economic implications in society. The adoption of preventive practices by the public remains the mainstay in reducing the spread of COVID-19 but there is a dearth of validated tools to assess such infection prevention practices related to pandemics. This study was conducted to develop and validate a questionnaire for the assessment of preventive practices against COVID-19 in the general population. It was done following a standardized protocol involving questionnaire development through literature review, focused group discussions, in-depth interviews, expert opinion, and pre-testing. This was followed by the validation of the questionnaire through a cross-sectional survey on 108 individuals from diverse backgrounds in New Delhi, India in July 2020. Exploratory factor analysis was used to evaluate construct validity. Internal consistency was assessed by Cronbach's alpha coefficient. The developed questionnaire for assessing preventive practices consists of two sections: the first section of 18 items to evaluate preventive practices and the second section of 19 items for assessing various reasons for deficiencies in the preventive practices. The first section has good content validity (CVR=0.81 and S-CVI/Av=0.97) and internal consistency (Cronbach's alpha coefficient 0.82). Thus, this questionnaire is a valid and reliable tool for the comprehensive assessment of preventive practices and barriers related to the COVID-19 pandemic. It will be useful in assessing the preparedness of the public and will be helpful to policymakers in designing appropriate interventions for protection against COVID-19.

Perceptions and knowledge of medical students about HIV and AIDS

Background and Objectives: The degree of information is not restricted to informative and&#x0D; opportunity issues of knowledge, but also to the development of a conscious individual&#x0D; perception for the adoption of preventive practices. This study aimed to assess the perception&#x0D; and knowledge of medical students about HIV and AIDS. Methods: This is a cross-sectional,&#x0D; observational, and unicentric study, through the application of a structured questionnaire and&#x0D; two referring to the attitude towards HIV and the individual risk perception and knowledge on&#x0D; modes of transmission. Student’s and Pearson’s Chi-Square Tests were applied, with p

The Lifestyle and Behavioural Risk Factors of Future Doctors in Universiti Teknologi MARA, Malaysia

Introduction: Lifestyle and behavioural risk factors in middle-aged adults are proven to have an impact on later-life outcomes; hence health promotion activities should aim at the population before they reach their mid-life. Medical students will be representing a community in promoting health, henceforth they should have a healthy lifestyle and behaviour in order to facilitate and adoption of preventive practices in their future life as physicians. Therefore, this study was aimed to determine the lifestyle and behavioural risk factors among future doctors in a public university in Malaysia. Methods: A cross-sectional study was conducted at the Faculty of Medicine, Universiti Teknologi MARA (Sungai Buloh Campus). Simple random sampling was used to select eligible subjects among undergraduate medical students (pre-clinical years). A self-administered pro forma checklist was given to the subjects who consented. Descriptive analysis was performed, and univariate analysis was done by Chi-square, Fisher’s Exact test and independent t-test. Results: A total of 252 subjects participated. The majority (96.8%) were of Malay ethnicity and three-quarter of the subjects were females (76.2%). A small number of subjects were smokers (2.4%) and alcoholic consumers (1.2%). Approximately half (57.3%) of the female subjects had normal body mass indices, while this was only seen in one-third (35.0%) of male subjects. Most subjects (72.2%) exercised at least once a week, however only 17.1% of the subjects exercised at the recommended levels. There was a significantly higher proportion of males who had adequate exercise compared to that of females. Conclusion: Inadequate physical activity and imperfect BMI of the study subjects warrant exclusive promotion and education of healthy lifestyle in this population. It would probably be beneficial if assessment of lifestyle and behavioural risk factors could be conducted before these subjects embark into their professional working life. KEYWORDS: lifestyle, behaviour, risk factors, future doctors, Selangor.

Sexuality and HIV prevention: consensus and dissent of Catholic youths

To analyze the consensus and dissent of Catholics youths about HIV/AIDS prevention from their representations about sexuality. This is a quantitative and qualitative research based on the Theory of Social Representations carried out with 84 Catholics youths who answered online to the Free Word Association Test on Facebook and three questions about the influence of Catholic doctrine on the free exercise of sexuality and the adoption of practice safe sex. The techniques of Factorial Analysis of Correspondence and Semantic Content were used. On sexuality, only the young women with access to higher education represented the term as a free practice that should not lead to guilt. There was a consensus on chastity, virginity, and sex within marriage as effective means of HIV prevention. It is also representational consensus of the young people that sexual practice is pleasurable, however, condemned by the church, and that AIDS is a preventable disease. Social representations have revealed dissent between men and women, while they consider that the exercise of sexuality should be restricted to marriage, they advocate sexual freedom. As for AIDS, they represent that the syndrome stems from prejudice, and they consider that vulnerability favors contagion. In the consensuses among the young people studied, there are sexist prejudices and stereotypes that influence HIV/AIDS prevention actions. Therefore, health professionals, especially those of Nursing should propose actions aimed at this age group in educational activities about the adoption of preventive practices on safe sex, always considering the social representations around the subject.

Práticas preventivas realizadas por Técnicos em Saúde Bucal: um estudo qualitativo

A cárie dentária é uma doença comum que pode ser totalmente controlada. Entretanto, a percepção de técnicos em saúde bucal (TSBs) quanto sua prevenção ainda é pouco explorada. O objetivo desse estudo foi identificar a percepção dos TSBs com relação aos fatores facilitadores para adoção de práticas de prevenção no controle da cárie dentária. Participaram desta pesquisa 10 TSBs pertencentes à 15ª Regional de Saúde do Paraná. As entrevistas semiestruturadas foram realizadas face a face e gravadas. A transcrição das gravações foi realizada de forma manual e avaliada segundo a análise de conteúdo proposta por Bardin, utilizando-se o software Visual Qualitative Data Analysis 7.0. Os resultados apontaram 12 fatores facilitadores para a prevenção da cárie, dentre eles: capacitação profissional; consciência, satisfação e motivação em realizar procedimentos preventivos e trabalho em equipe. Além disso, a habilidade de trabalhar com educação em saúde e com educação permanente foram fatores relevantes destacados nas entrevistas. De modo geral, os fatores facilitadores quanto a adoção de práticas de prevenção no controle da cárie dentária, identificados na percepção dos TSBs foram a consciência de realizar a prevenção na sua prática diária; a habilidade de comunicação para realizar educação em saúde e a satisfação do profissional em trabalhar com prevenção. Todos esses fatores relatados parecem ser necessários para o desempenho adequado da função dos TSBs, superando o modelo biologicista e avançando no entendimento do processo saúde-doença, a fim de implementar estratégias para o controle da cárie dentária na população

Perception of adult men on their preventive practices and health support networks

Objectives: to know the preventive practices adopted by adult men in daily life and to identify health support networks.Methods: a descriptive qualitative study, made during the months of November and December 2012, at two emergency units,along with 32 men aged between 20 and 59 years. Data were collected through semi-structured interviews and subjected tocontent analysis with thematic modality. Results: men highlighted different preventive practices such as sanitizing hands,eating properly, having screening tests, avoiding psychoactive substance abuse, using personal protective equipment atwork and condoms during sex. Most of the participants had nuclear family and its members were their primary supportnetwork regarding the health-disease process. Conclusion: it is for health team members to try to leverage the adoption ofpreventive practices by adult men from the support networks they consider significant.

The National Response for Preventing Healthcare–associated Infections

Healthcare-associated infections (HAIs) have long been the subject of research and prevention practice. When findings show potential to significantly impact outcomes, clinicians, policymakers, safety experts, and stakeholders seek to bridge the gap between research and practice by identifying mechanisms and assigning responsibility for translating research to practice. This paper describes progress and challenges in HAI research and prevention practices, as explained through an examination of Health and Human Services (HHS) Action Plan's goals, inputs, and implementation in each area. We used the Context-Input-Process-Product evaluation model, together with an HAI prevention system framework, to assess the transformative processes associated with HAI research and adoption of prevention practices. Since the introduction of the Action Plan, HHS has made substantial progress in prioritizing research projects, translating findings from those projects into practice, and designing and implementing research projects in multisite practice settings. Research has emphasized the basic science and epidemiology of HAIs, the identification of gaps in research, and implementation science. The basic, epidemiological, and implementation science communities have joined forces to better define mechanisms and responsibilities for translating HAI research into practice. Challenges include the ongoing need for better evidence about intervention effectiveness, the growing implementation burden on healthcare providers and organizations, and challenges implementing certain practices. Although these HAI research and prevention practice activities are complex spanning multiple system functions and properties, HHS is making progress so that the right methods for addressing complex HAI problems at the interface of patient safety and clinical practice can emerge.

A cross sectional survey of knowledge, attitude and practices related to house flies among dairy farmers in Punjab, Pakistan

BackgroundHouse flies are of major public health concerns in areas with poor sanitation and hygienic conditions. Unfortunately, sanitation and hygiene have always been ignored in dairy farms particularly in the developing or low-income countries. Management of these flies mostly depends on the awareness regarding associated hazards and protective measures taken by the people to minimize risks associated with flies. The present study therefore explores the knowledge, attitude and practices taken by dairy farmers in Punjab, Pakistan against house flies.MethodsThe present study was based on a cross sectional self administered survey to a convenience sample of 173 small scale dairy farmers in four localities – Multan, Lahore, Shorkot and Faisalabad – of Pakistan. The relationships between socio-demographics, knowledge and preventive practices were investigated through logistic regression analysis and chi-square test of association.ResultsConsiderable number of dairy farmers 71/173 (41.04%) had no idea about the problems associated with house flies. Although 77/173 (44.51%) dairy farmers reported house flies as disease transmitters, only 23 (29.87%) farmers were familiar with diseases and 22 (28.57%) had somewhat idea of the mode of disease transmission. We found a positive association between dairy farmer’s education level and overall knowledge of house flies in multivariate analysis. Farmer’s education level and knowledge of the house flies breeding sites had a positive association with the adoption of house fly prevention practices by the respondents. However, knowledge of the problems associated with house flies and preventive measures had no association with house fly prevention practices.ConclusionThe present ethnoentomological survey provides information about knowledge, attitude and practices of dairy farmers related to house flies in Punjab, Pakistan. We conclude that the farmers’ education level and knowledge of the breeding sites had a positive association with the adoption of prevention practices against house flies. The study also highlights the need of targeting the lack of knowledge of dairy farmers for the successful management of house flies.

Relationship between the adoption of preventive practices and the metabolic profile of women with prior gestational diabetes mellitus

Women with prior gestational diabetes mellitus (GDM) are encouraged to adopt healthy lifestyle behaviours to prevent or delay type 2 diabetes. The objective was to examine the association between the adoption of preventive practices and the metabolic profile of women with prior GDM. Analyses included 181 women who had GDM between 2003 and 2010. The preventive practices examined included (i) regular physical activity (≥150 min·week(-1)) assessed with the International Physical Activity Questionnaire; (ii) a healthy diet (score derived from the Alternate Healthy Eating Index and associated with a lower metabolic risk) evaluated from a food frequency questionnaire; and (iii) exclusive breastfeeding (≥6 months). Women were classified according to the number of preventive practices adopted. Waist circumference, weight, and height were measured and body mass index (BMI) was calculated. Fasting insulinemia and glycemia were obtained and Matsuda index for insulin sensitivity was calculated. Nearly one-third of women adopted none of the listed preventive practices. For each increase of 1 preventive practice adopted, women were 30% less likely to have a BMI ≥ 25 kg·m(-2) (odds ratio (OR): 0.70, 95% confidence interval (CI) (0.50-0.98)), they were 34% less likely to have a waist circumference ≥ 88 cm (OR: 0.66, 95%CI (0.47-0.92)) and they were 33% less likely to have a Matsuda index for insulin sensitivity < 9.69 (OR: 0.67, 95%CI (0.48-0.94)). These results suggest that women with prior GDM who adopt the recommended preventive practices in the years following delivery are less likely to have lower insulin sensitivity, less likely to be overweight-obese, and less likely to be characterized by abdominal obesity.

Adoption of safer infant feeding and postpartum sexual practices and their relationship to maternal HIV status and risk of acquiring HIV in Zimbabwe

To examine the relationships between maternal knowledge and concern about HIV status, adoption of preventive practices and risk of acquiring HIV in Zimbabwe. Knowledge and behavioural data were collected via interview from 2595 mothers enrolled in ZVITAMBO, a randomized trial of postpartum vitamin A supplementation that also offered education on safer infant feeding and sexual practices. Mothers were tested for HIV at delivery; those uninfected at baseline were retested during study follow-up. Logistic regression methods were used to identify variables associated with adoption of preventive behaviours and, for HIV-negative mothers, their relationship to risk of acquiring HIV post-delivery. A total of 518 mothers (20%) reported practicing safer sex and 289 mothers (11%) reported modifying their feeding behaviour because of HIV. Fear of transmitting HIV (50.4%) and protecting the baby's health (30.9%) were the most frequently cited reasons for behaviour change. Forty-nine HIV-negative mothers acquired HIV during the first postpartum year. After taking into account other significant covariates, mothers who were concerned about their own HIV status were 1.9 times more likely (95% CI: 1.05-3.52; P = 0.03), and those reporting safer sex practices were 58% less likely to become infected (adjusted odds ratio: 0.42; 95% CI: 0.17-1.04; P = 0.06). Married women who reported practicing abstinence to prevent HIV were 3.2 times more likely to become infected than non-abstaining mothers (P = 0.01), while there were no new HIV infections among abstaining single mothers. Greater emphasis should be given to safer sex practices among women who test negative in mother-to-child HIV prevention programmes.

Communication skills for preventive interventions.

Effective communication relevant to preventive services and practices has at its basis the physician's skills in not only basic history taking and data collection but also relationship building, facilitation, negotiation, and partnership. These skills, fundamental to doctor-patient communication, are now routinely and systematically taught in many U.S. medical schools. This article defines and examines a communication model for enhancing the provision and adoption of preventive practices in the primary care setting and discusses teaching that model in the medical school context. Within the office visit, broad areas for communication tasks important to providing preventive services are defined as: (1) the medical interview and preventive counseling; (2) working with patients to change unhealthy behaviors, promote healthy behaviors, and enhance adherence; and (3) communication related to office procedures for screening and prevention. Within each of these areas, communication and counseling skills and approaches are defined, and examples of associated prevention activities are provided. Methods for integrating communication skills for prevention into the medical school curriculum are discussed, and examples at Dartmouth, Brown, and MCP Hahnemann medical schools are presented.