Adoption Process Model Research Articles

Non-Vaccination Stage Model (NVST): The decision-making process among Israeli ultra-orthodox Jewish parents.

Although vaccination uptake is high in most countries, pockets of suboptimal coverage remain, such as those observed among ultra-orthodox Jews in Israel and elsewhere, posing a threat to both individual and public immunity. Drawing on the Precaution Adoption Process Model (PAPM), this study proposes a Non-Vaccination Stage Model (NVSM) to analyze the decision-making process among Non-Vaccinating Parents (NVPs), focusing on the ultra-orthodox Jewish population of Israel. In-depth interviews were conducted with 10 Israeli ultra-orthodox Jewish NVPs (mothers). The interviews revealed five stages in the participants' decision-making process: Being good mothers who vaccinate their children; Emergence of doubts regarding the risks of vaccination; Personal vaccination policy-hesitancy concerning vaccination; Decision not to vaccinate; Confirmation signs of what participants perceive as a wise decision. NVSM can help understand parents who consider non-vaccination to be healthier behavior and explore the various stages of their decision-making process. Differentiating among the various stages of NVPs' decision-making processes enables application of different intervention approaches by policymakers and healthcare practitioners.

What Makes Homeowners Consider Protective Actions to Reduce Disaster Risk? An Application of the Precaution Adoption Process Model and Life Course Theory

We hypothesize that for disaster risk mitigation, many households, despite being aware of their risk and possible mitigation actions, never seriously consider doing anything about them. In mitigation-focused decisions, since there is no equivalent to warning messages, the decision process is likely to evolve over an extended time. We explore what activates hurricane mitigation protective action decisions through three research questions: (1) to what extent are homeowners unengaged in protective action decision making? (2) What homeowner characteristics are associated with lack of engagement? And (3) to what extent do different life events trigger engagement in the decision-making process? We use the Precaution Adoption Process Model to conceptualize engagement as distinct from decision making; the broader protective action decision-making literature to explore drivers of engagement; and Life Course Theory to examine potential transitions from unengaged to engaged. We use survey data of homeowners in North Carolina to examine these questions empirically. Findings suggest that one-third of respondents had never engaged in protective action decisions, that life experiences differ in their occurrence frequency and effect on households’ mitigation decisions, and that some events, such as renovating, reroofing, or purchasing a home may offer critical moments that could be leveraged to encourage greater engagement in mitigation decision making.

High Schools' Adoption of Evidence-Based Practices for the Management of Exertional Heat Stroke.

Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. To investigate high schools' adoption of policies and procedures for recognizing and treating patients with EHS and the factors influencing the adoption of a comprehensive policy. Cross-sectional study. Online questionnaire. Athletic trainers (ATs) practicing in the high school (HS) setting. Using the National Athletic Trainers' Association position statement on exertional heat illness, we developed an online questionnaire and distributed it to ATs to ascertain their schools' current written policies for using rectal temperature and cold-water immersion. The precaution adoption process model allowed for responses to be presented across the various health behavior stages (unaware if have the policy, unaware of the need for the policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining). Additional questions addressed perceptions of facilitators and barriers. Data are presented as proportions. A total of 531 ATs completed the questionnaire. Overall, 16.9% (n = 62) reported adoption of all components for the proper recognition and treatment of EHS. The component with the highest adoption level was "cool first, transport second"; 74.1% (n = 110) of ATs described acting on or maintaining the policy. The most variability in the precaution adoption process model responses was for a rectal temperature policy; 28.7% (n = 103) of ATs stated they decided not to act and 20.1% (n = 72) stated they maintained the policy. The most frequently cited facilitator of and barrier to obtaining rectal temperature were a mandate from the state HS athletics association (n = 274, 51.5%) and resistance to or apprehension of parents or legal guardians (n = 311, 58.5%), respectively. Athletic trainers in the HS setting appeared to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing as the biggest challenge. Tailored strategies based on health behavior, facilitators, and barriers may aid in changing this paradigm.

High Schools Struggle to Adopt Evidence Based Practices for the Management of Exertional Heat Stroke.

Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. We investigated the adoption of policies and procedures for the recognition and treatment of EHS and the factors influencing the adoption of a comprehensive policy. Cross Sectional. Online questionnaire. Athletic trainers (ATs) practicing in the high school (HS) setting. Using the NATA Position Statement: Exertional Heat Illness, an online questionnaire was developed and distributed to ATs to ascertain their schools' current written policies for the use of rectal temperature and cold-water immersion (CWI). The Precaution Adoption Process Model (PAPM), allowed for responses to be presented across the various health behavior stages ("Unaware if have the policy", "Unaware for the need for the policy", "Unengaged", "Undecided", "Decided Not to Act", "Decided to Act", "Acting", and "Maintaining"). Additional questions included perceptions of facilitators and barriers. Data are presented as proportions. A total of 531 ATs completed this questionnaire. Overall, 16.9% (n=62) report adoption of all components for proper recognition and treatment of EHS. The policy component with the highest adoption was "cool first transport second" with 74.1% (n=110) of ATs reporting "Acting" or "Maintaining." The most variability in the PAPM responses was for a rectal temperature policy, with 28.7% (n=103) of ATs reporting "Decided not to Act" and 20.1% (n=72) reporting "Maintaining." The most commonly reported facilitator and barrier for rectal temperature included state mandate from state HS athletics association (n=274,51.5%) and resistance or apprehension from parents or legal guardians (n=311,58.5%), respectively. ATs in the HS setting appear to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing to appear as the biggest undertaking. Tailored strategies based on health behavior, facilitators and barriers may aid in changing this paradigm.

The Precaution Adoption Process Model in Describing Emergency Action Plan Adoption

Purpose: The purpose of this study was to identify the ability of the Precaution Adoption Process Model (PAPM) to classify athletic trainers (ATs) and athletic directors (ADs) readiness to act with regards to adopting an emergency action plan (EAP), and describe factors influencing PAPM stages. Method: We used a cross-sectional questionnaire design to evaluate readiness to act for developing an EAP among ATs and ADs working in United States high schools. The PAPM is a participant-driven model to identify someone’s readiness to act or change and has seven stages: Unaware, Unengaged, Undecided, Decided not to Act, Decided to Act, Acting and Maintaining. Prevalence ratios (PRs) with 95% confidence intervals (95% CI) were calculated. Results: A majority of ATs and ADs reported maintaining an EAP in their secondary school (AT “Maintaining” = 84.4%, AD “Maintaining” = 68.7%). ADs were more likely to be staged as “Decided not to Act” (PR=0.14, 95% CI= 0.05, 0.41) for the development of an EAP compared to ATs. ATs were more likely to be staged as “Maintaining” (PR=1.23, 95% CI = 1.16, 1.30) for the development of an EAP compared to ADs. Conclusions: The PAPM appears to be able to classify AT and AD readiness to act with adoption of an EAP. However, statistical modeling struggles to identify predictors for the various stages. Future research should aim to use the PAPM stages in the development of tailored interventions.

Pregnant Women's Intentions to Implement Safety Practices for Preventing Infant Injury: A Cross-Sectional Study.

Injury prevention education for pregnant women may be beneficial for infants’ safety. Currently, knowledge about the scope of an expectant mother’s intent to prevent injury is limited. The objective of this study was to determine pregnant women’s intentions to implement infant injury prevention strategies. From May to June 2017, a self-administered questionnaire based on the precaution adoption process model was distributed among pregnant women who participated in a parenting preparation class in a city, Tokyo. Pregnant women’s intentions to implement the following eight kinds of safety practices were measured: three practices regarding suffocation, two regarding falls, one safety practice for burns, one for accidental ingestion, and one for traffic accidents. Among 132 respondents (response rate: 83.5%; mean age: 33.4 years; mean gestational age: 29 weeks), the most common unawareness issue was “Make sure that there is no space between the mattress and bed frame” (68.2%), followed by “Use a firm mattress or futon” (38.5%) and “Keep soft objects away from the baby’s head in the baby’s sleep area” (31.8%); 58% or more women reported having already “decided to implement” the other five practices. Safety practices that pregnant women were mostly unaware of were for preventing suffocation, despite this being a leading cause of death in terms of unintentional infant injury. In comparison, the safety practices for falls, burns, and accidental ingestion were more known to pregnant women. The pregnant women’s intention to implement injury prevention for infants varied by safety practices. These findings could be used to improve the focus of antenatal education programs for the prevention of infant injury.

Adoption of Lightning Safety Best-Practices Policies in the Secondary School Setting.

Lightning-related injuries are among the top 10 causes of sport-related death at all levels of sport, including the nearly 8 million athletes participating in US secondary school sports. To investigate the adoption of lightning safety policies and the factors that influence the development of comprehensive lightning safety policies in United States secondary schools. Cross-sectional study. Secondary school. Athletic trainers (ATs). An online questionnaire was developed based on the "National Athletic Trainers' Association Position Statement: Lightning Safety for Athletics and Recreation" using a health behavior model, the precaution adoption process model, along with facilitators of and barriers to the current adoption of lightning-related policies and factors that influence the adoption of lightning policies. Precaution adoption process model stage (unaware for need, unaware if have, unengaged, undecided, decided not to act, decided to act, acting, maintaining) responses are presented as frequencies. Chi-square tests of associations and prevalence ratios with 95% CIs were calculated to compare respondents in higher and lower vulnerability states, based on data regarding lightning-related deaths. The response rate for this questionnaire was 13.43% (n = 365), with additional questionnaires completed via social media (n = 56). A majority of ATs reported maintaining (69%, n = 287) and acting (6.5%, n = 27) a comprehensive lightning safety policy. Approximately 1 in 4 ATs (25.1%, n = 106) described using flash to bang as an evacuation criterion. Athletic trainers practicing in more vulnerable states were more likely to adopt a lightning policy than those in less vulnerable states (57.4% versus 42.6%, prevalence ratio [95% CI] = 1.16 [1.03, 1.30]; P = .009). The most commonly cited facilitator and barrier were a requirement from a state high school athletics association and financial limitations, respectively. A majority of ATs related adopting (eg, maintaining and acting) the best practices for lightning safety. However, many ATs also indicated continued use of outdated methods (eg, flash to bang).

Pengaruh Pelatihan Terhadap Pengambilan Keputusan Skrining Kanker Serviks Berdasarkan The Precaution Adoption Process Model

Decision making for taking screening is an important component in preventing cervical cancer, but still many women who have not yet done it due to a lack of knowledge and decision-making ability. Development of intervention tailored to the stages of decision-making based on the Precaution Adoption Process Model, such as training, is able to improve decision-making ability to do the screening. This study aimed to determine the differences in the effect of training on decision-making for cervical cancer screening based on PAPM in the UPT Griya Antapani Health Center Bandung. This quasi-experimental study with two group pre-test post-test design involved 84 women aged 30-49 years who were chosen by purposive and proportional cluster sampling from two villages divided into 42 respondents each. Group A received training with PowerPoint media, leaflets, videos, and WhatsApp while group B received training with PowerPoint media, leaflets, and videos. The data of decision-making was collected using the Precaution Adoption Process Model checklist: before, after training, and 15 days after training then analyzed using Friedman test and Mann Whitney test. The results showed that there were differences in decision-making in each group before and after training with p <0.001 but Mann Whitney test showed that there was no difference in decision-making between groups after training (p = 1,000 and p = 0.316). This depicted that any method and media can be used to change decision-making. Providing training and counseling is needed according to the stages of decision-making taking into account the factors that influence it. Keywords: Cervical Cancer, Decision-making, Screening, the Precaution Adoption Process Model

Determinants of dietary and physical activity behaviours among women of reproductive age in urban Uganda, a qualitative study.

To explore determinants of dietary and physical activity behaviours among women of reproductive age. Data were collected through focus group discussions (FGD). The FGD guide was based on a modified theoretical framework; theory of planned behaviour was incorporated with constructs of health belief model, precaution adoption process model, social cognitive and social support theory. Discussions were audio recorded, transcribed verbatim and analysed thematically. Kampala, Uganda. Women were categorised into young adults; 18-34 years and adults; 35-45 years. Separate FGD with independent participants were conducted for dietary and physical activity behaviours until data saturation was achieved. Six FGD were conducted per behaviour. Determinants of dietary behaviours at intra-individual level included gaps in food skills, knowledge and self-efficacy, food safety concerns, convenience, finances and physiological satisfaction. The social-cultural norms were relationship between vegetable consumption and low social status, consideration of fruits as a snack for children and not food and habitual orientation towards carbohydrate foods. At environment level, social networks and increased availability of energy-dense, nutrient poor, street and processed foods influence dietary behaviour. For physical activity, intra-individual determinants were knowledge gaps and self-efficacy, while socio-cultural norms included gender stereotypes. Home (limited space and sedentary entertainment like social media and TV) and physical environment (cheap motorised transportation) influence physical activity. The existing cultural beliefs promote dietary and physical activity behaviours which are divergent from healthy recommendations. Therefore, a comprehensive intervention is needed to address socio-cultural misconceptions, financial and time limitations in urban Uganda.

Exertional Heat Illness Preparedness Strategies: Environmental Monitoring Policies in United States High Schools.

Background and objectives: Environmental monitoring allows for an analysis of the ambient conditions affecting a physically active person’s ability to thermoregulate and can be used to assess exertional heat illness risk. Using public health models such as the precaution adoption process model (PAPM) can help identify individual’s readiness to act to adopt environmental monitoring policies for the safety of high school athletes. The purpose of this study was to investigate the adoption of policies and procedures used for monitoring and modifying activity in the heat in United States (US) high schools. Materials and Methods: Using a cross-sectional design, we distributed an online questionnaire to athletic trainers (ATs) working in high schools in the US. The questionnaire was developed based on best practice standards related to environmental monitoring and modification of activity in the heat as outlined in the 2015 National Athletic Trainers’ Association Position Statement: Exertional Heat Illness. The PAPM was used to frame questions as it allows for the identification of ATs’ readiness to act. PAPM includes eight stages: unaware of the need for the policy, unaware if the school has this policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining. Invitations were sent via email and social media and resulted in 529 complete responses. Data were aggregated and presented as proportions. Results: Overall, 161 (161/529, 30.4%) ATs report they do not have a written policy and procedure for the prevention and management of exertional heat stroke. The policy component with the highest adoption was modifying the use of protective equipment (acting = 8.2%, maintaining = 77.5%). In addition, 28% of ATs report adoption of all seven components for a comprehensive environmental monitoring policy. Conclusions: These findings indicate a lack of adoption of environmental monitoring policies in US high schools. Secondarily, the PAPM, facilitators and barriers data highlight areas to focus future efforts to enhance adoption.

Effects of a multidisciplinary team-led school-based human papillomavirus vaccination health-promotion programme on improving vaccine acceptance and uptake among female adolescents: A cluster randomized controlled trial.

Introduction:Evidence has consistently shown the high efficacy of human papillomavirus (HPV) vaccines in preventing cervical cancers. However, the HPV vaccine uptake rate in Hong Kong is very low. We will develop and evaluate an innovative, theory-based multidisciplinary team-led school-based HPV vaccination health-promotion program (MDL-SHPVP), engaging female adolescents, parents/guardians, and secondary school personnel in multicomponent educational strategies and interactive discussions.Methods and analysis:A cluster randomized controlled trial is proposed. We will recruit 2520 female adolescents and their parents/guardians from 18 secondary day schools. The MDL-SHPVP is underpinned by the Health Belief Model and Precaution Adoption Process Model. Multicomponent interventions will be offered, including education sessions with small group dialogues with a registered nurse and trained healthcare and lay volunteers, and educational computer games. A team of volunteers will be established to raise HPV, cervical cancer, and HPV vaccine awareness. Outcomes include adolescents’ uptake of the HPV vaccine, adolescents’ intention to receive HPV vaccination, vaccine acceptance among parents/guardians, and parents’/guardians’ and adolescents’ HPV knowledge, attitudes, and beliefs. Data will be collected at baseline, 1 month, and 1 year after intervention. The generalized estimating equations analysis will be used for comparing the outcomes between the 2 groups.Ethics and dissemination:Ethical approval was obtained from the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (Ref. no.: 2019.055). We will disseminate the study findings via peer-reviewed publications and presentations at relevant events and international and local conferences.Trial registration number:ClinicalTrials.gov NCT04438291

Knowing Your Audience: A Typology of Smoke Sense Participants to Inform Wildfire Smoke Health Risk Communication.

Central to public health risk communication is understanding the perspectives and shared values among individuals who need the information. Using the responses from a Smoke Sense citizen science project, we examined perspectives on the issue of wildfire smoke as a health risk in relation to an individual's preparedness to adopt recommended health behaviors. The Smoke Sense smartphone application provides wildfire-related health risk resources and invites participants to record their perspectives on the issue of wildfire smoke. Within the app, participants can explore current and forecasted daily air quality, maps of fire locations, satellite images of smoke plumes, and learn about health consequences of wildfire smoke. We used cluster analysis to identify perspective trait-clusters based on health status, experience with fire smoke, risk perception, self-efficacy, access to exposure-reducing resources, health information needs, and openness to health risk messaging. Differences between traits were examined based on demographics, health status, activity level and engagement with the app. We mapped these traits to the Precaution Adoption Process Model (PAPM) to indicate where each trait lies in adopting recommended health behaviors. Finally, we suggest messaging strategies that may be suitable for each trait. We determined five distinct perspective traits which included individuals who were Protectors and have decided to engage on the issue by adopting new behaviors to protect their health; Cautious, Proactive, and Susceptible individuals who were at a Deciding stage but differed based on risk perceptions and information needs; and the Unengaged who did not perceive smoke as a health issue and were unlikely to change behavior in response to messaging. Across all five traits, the level of engagement and information needs differed substantially, but were not defined by demographics. Individuals in the Susceptible trait had the highest level of engagement and the highest information needs. Messaging that emphasizes self-efficacy and benefits of reducing exposure may be effective in motivating individuals from the deciding stage to taking health protective action. Shared perspectives define an individual's propensity for acting on recommended health behaviors, therefore, health risk message content should be tailored based on these perspectives.

Factors associated with the contemplative stage of readiness to initiate osteoporosis treatment.

Understanding factors associated with reaching the contemplative stage of readiness to initiate osteoporosis treatment may inform the design of behavioral interventions to improve osteoporosis treatment uptake in women at high risk for fracture. We measured readiness to initiate osteoporosis treatment using a modified form of the Weinstein Precaution Adoption Process Model (PAPM) among 2684 women at high risk of fracture from the Activating Patients at Risk for OsteoPOroSis (APROPOS) clinical trial. Pre-contemplative participants were those who self-classified in the unaware and unengaged stages of PAPM (stages 1 and 2). Contemplative participants were those in the undecided, decided not to act, or decided to act stages of PAPM (stages 3, 4, and 5). Using multivariable logistic regression, we evaluated participant characteristics associated with levels of readiness to initiate osteoporosis treatment. Overall, 24% (N = 412) self-classified in the contemplative stage of readiness to initiate osteoporosis treatment. After adjusting for age, race, education, health literacy, and major osteoporotic fracture in the past 12months, contemplative women were more likely to report previously being told they had osteoporosis or osteopenia (adjusted odds ratio [aOR] (95% CI) 11.8 (7.8-17.9) and 3.8 (2.5-5.6), respectively), acknowledge concern about osteoporosis (aOR 3.5 (2.5-4.9)), and disclose prior osteoporosis treatment (aOR 4.5 (3.3-6.3)) than women who self-classified as pre-contemplative. For women at high risk for future fractures, ensuring women's recognition of their diagnosis of osteoporosis/osteopenia and addressing their concerns about osteoporosis are critical components to consider when attempting to influence stage of behavior transitions in osteoporosis treatment.

A questionnaire on factors affecting the precaution adoption process model for cervical cancer – Psychometric properties

BACKGROUND:Implementing a cervical cancer prevention program requires an exploration of certain behaviors concerning this disease. This study is aimed to evaluate the psychometrics of a questionnaire that enquired about the factors involved in Precaution Adoption Process Model (PAPM) for cervical cancer among suburban women in Bandar Abbas, south of Iran.MATERIALS AND METHODS:The primary draft of the questionnaire was developed with a review of the related literature on cervical cancer and the constructs affecting PAPM, with 68 items. The face validity, content validity ratio (CVR), and content validity index (CVI) of the questionnaire were approved by a panel of 10 experts. The internal consistency and test-retest reliability of the questionnaire were estimated too. Field testing sample included 300 women recruited from a women's healthcare center in suburban areas of Bandar Abbas in the south of Iran. Exploratory factor analysis was used to evaluate validity, and Cronbach's alpha coefficient was estimated for reliability.RESULTS:After the face validation, 11 items were eliminated. Once CVR was estimated, two items were discarded. The remaining items had a CVR >0.79. All had a CVI >0.79. Six items were eliminated in the factor analysis. The final questionnaire included 49 items organized in 8 factors including awareness, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, social norms, fear, and self-efficacy. Principal component analysis with varimax rotation indicated eight main components that explained 56.25% of the variance. Reliability assessment showed a good internal consistency for all subscales and the Cronbach's alpha score ranged between 0.82 and 0.90. The test-retest reliability showed that the correlation coefficients (between 0.81 and 0.89) were significant at the 0.01 level for all sub-scales.CONCLUSIONS:The final questionnaire was a new instrument comprised the effective constructs of PAPM and had a high reliability and validity. Thus, this questionnaire is recommended to be used to explore and enhance preventive behaviors of cervical cancer.

Smokers who do not quit: Can the precaution adoption process model help identify hard-core smokers?

AbstractIntroductionHard-core smokers have been identified as a potential public health challenge. The trans-theoretical model lacks the specificity to identify hard-core smokers. The precaution adoption process model (PAPM) is a stage-based behaviour change model which includes ‘no intent to quit’ as a distinct stage and so may be useful in identifying hard-core smokers.AimsThe aim of this study was to apply the PAPM to a community based sample of smokers to determine whether it provides a useful approach to identifying hard-core smokers.MethodsWe surveyed smokers in Australia who were recruited through social media and an online data collection agency.ResultsThe sample included 336 current smokers, 11.9% were in Stage 4 of the PAPM – i.e. had decided not to quit. Stage 4 smokers are more resistant to quitting and marked by their similarities to hard-core smokers. This is further amplified when addressing Stage 4 smokers with no previous quit attempt.ConclusionsStage 4 smokers with no previous quit attempts are aligned with a hard-core smoker profile with higher levels of nicotine dependence, greater cigarette consumption and low socio-economic status. Further research is required to determine if PAPM is a valid predictive model for identifying hard-core smokers in clinical practice.

Generic and SME-specific factors that influence the BIM adoption process: an overview that highlights gaps in the literature

Building information modeling/management (BIM) is an emerging technological and procedural shift in the architecture, engineering, construction and operation industry. In this study, we use an extensive state-of-the-art method to clarify the BIM adoption process and the factors that can influence the success or failure of BIM adoption, particularly during the implementation stage, which are not frequently found in the literature. As an innovation, the lexical field allocated to the spread of innovations is assigned to BIM (diffusion, adoption, and implementation). After recalling the definition of relevant terms and then removing the resulting inconsistencies in vocabularies, we investigate various studies to identify factors that influence BIM adoption and then unify all these studies in one coherent and consistent BIM adoption process model. We focus on factors that play a role in the adoption of BIM in small- and medium-sized enterprises (SMEs) because SMEs constitute the majority of companies in the construction sector. This research highlights and intends to fill in some gaps found in the current BIM adoption literature.

Socio-demographic correlates of cervical cancer risk factor knowledge among screening non-participants in Great Britain

This study explored knowledge of cervical cancer risk factors among cervical screening non-participants in Great Britain. The aim was to identify knowledge gaps that could be targeted in screening information materials or public education campaigns. We used a cross-sectional design to survey women aged 25 to 64 years living in Great Britain, identified as cervical screening non-participants through self-report questions. Data were collected via a household survey. Survey questions measured awareness of risk factors for cervical cancer and socio-demographic factors. Screening non-participants were included in the study (n = 793) and classified into non-participant groups based on the Precaution Adoption Process Model. Across the sample, 57% of participants identified ‘not going for regular smear tests’ as a risk factor for cervical cancer. Women who intended to be screened were more likely to identify this risk factor than other non-participant groups (OR = 2.13, 95% CI: 1.51–2.99). Women age 55–64 years (OR = 0.60, 95% CI: 0.39–0.93) and women from non-white ethnic backgrounds (OR = 0.70, 95% CI: 0.52–0.94) were less likely to recognise this risk factor. Recognition was lower for ‘infection with human papillomavirus’ (41%). Just over half the sample were aware that screening non-attendance is associated with increased cervical cancer risk, suggesting that non–attendance at screening is not always based on an accurate understanding of the offer. Overall, non-participants are poorly informed about cervical cancer risk factors and further work is needed to ensure that women are making informed choices about (non-) participation.

Mixed-methods study in England and Northern Ireland to understand young men who have sex with men’s knowledge and attitudes towards human papillomavirus vaccination

ObjectivesMen who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when...

Survey the Effect of Educational Program Based on Precaution Adoption Process Model on Screening Cervical Cancer Behaviors among Rural Women, Mixed Method Development

Background and Objectives: Cervical cancer is considered as a preventable cancer in women. Pap smear test is an effective screening program for diagnosing cervical cancer, but for some reasons its use is low. The purpose of this study was to determine the factors affecting the women's participation in the Pap smear test based on precaution adoption process model and effect of educational program based on model on doing the Pap test with a Mixed Method approach.
 Materials and Methods: This study was a Mixed Method approach. Thirty women voluntarily participated in this study in sarvabad city of Iran. The sampling began purposefully and continued until saturation. Semi-structured interviews were the primary method of data collection. Data were analyzed using qualitative content analysis and continuous comparisons. Quantitative study was conducted implementing a quasi-experimental method. Participants were divided into two groups as experimental and control groups using Precaution Adoption Process Model (PAPM) among 180 rural females in Sarvabad. In treating the experimental group, the methods of lecturing with question and answer, playing videos, specialized consulting and pamphlet were used. The questionnaire including a demographic characteristic and variables that affecting the stages of the Precaution Adoption Process Model (PAPM). Data analysis was performed using the Mann-Whitney, chi-square and descriptive statistical methods. P <0.05 was considered as the significance level.
 Results: In qualitative study Model-based themes included, awareness, perceived susceptibility, perceived severity, social norms. Women`s awareness about cervical cancer and Pap smear test is not enough, but, they perceived the severity of the disease. In quantitative study in comparison of the means of the scores of psychological variables affecting the decision process in Pap smear test, there was a significant relationship between the experimental and control groups based on Mann-Whitney test and control groups based on variables, perceived susceptibility, awareness and social norms. But the perceived severity was not statistically significant.
 Conclusion: Findings of this study will help health managers and health planners to plan and train ways to facilitate the participation of women in the Pap smear test.

Using the precaution adoption process model to clarify human papillomavirus vaccine hesitancy in canadian parents of girls and parents of boys

ABSTRACT Background: Achieving optimal human papillomavirus (HPV) vaccine uptake can be delayed by parents’ HPV vaccine hesitancy, which is as a multi-stage intention process rather than a dichotomous (vaccinated/not vaccinated) outcome. Our objective was to longitudinally explore HPV related attitudes, beliefs and knowledge and to estimate the effect of psychosocial factors on HPV vaccine acceptability in HPV vaccine hesitant parents of boys and girls. Methods: We used an online survey to collect data from a nationally representative sample of Canadian parents of 9–16 years old boys and girls in September 2016 and July 2017. Informed by the Precaution Adoption Process Model, we categorized HPV vaccine hesitant parents into unengaged/undecided and decided not. Measures included sociodemographics, health behaviors and validated scales for HPV and HPV vaccine related attitudes, beliefs and knowledge. Predictors of HPV vaccine acceptability were assessed with binomial logistic regression. Results: Parents of boys and girls categorized as “flexible” hesitant (i.e., unengaged/undecided) changed over time their HPV related attitudes, behaviors, knowledge and intentions to vaccinate compared to “rigid” hesitant (i.e., decided not) who remained largely unchanged. In “flexible” hesitant, greater social influence to vaccinate (e.g., from family), increased HPV knowledge, higher family income, white ethnicity and lower perception of harms (e.g., vaccine safety), were associated with higher HPV vaccine acceptability. Conclusions: HPV vaccine hesitant parents are not a homogenous group. We have identified significant predictors of HPV vaccine acceptability in “flexible” hesitant parents. Further research is needed to estimate associations between psychosocial factors and vaccine acceptability in “rigid” hesitant parents.