Baseline Attitudes Research Articles

Film intervention increases empathic understanding of formerly incarcerated people and support for criminal justice reform

Nuanced portrayals of stigmatized groups in media have been shown to reduce prejudice. In an online experiment (N = 749), we tested whether a feature film depicting incarcerated peoples' experiences in the criminal justice system can increase a) empathic accuracy and compassion toward people who have been incarcerated and b) support for criminal justice reform. We measured baseline empathic accuracy via a well-validated task, where participants infer the emotions of people sharing stories about difficult life events. All storytellers were formerly incarcerated and students. However, in half the videos we labeled them as "formerly incarcerated" and in the remaining half as "college student." We then surveyed people's baseline attitudes toward criminal justice reform. Next, we assigned participants to watch one of three films. The intervention film chronicled the true stories of Black men on death row. Two docudramas of similar length served as control films. Finally, participants completed the empathic accuracy task and survey again and were given the opportunity to sign a petition. Compared to those who watched a control film, participants who watched the intervention film more accurately inferred the emotions of storytellers labeled "formerly incarcerated," and increased their support for criminal justice reform. These effects held for conservative and liberal participants alike. However, the film had no effect on feelings of compassion. Together, these results demonstrate the power of narrative interventions to not only increase empathic accuracy for members of a severely stigmatized group, but to increase support for reforms designed to improve their lives.

Abstract A090: Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas

Abstract Introduction: Tobacco use intervention in healthcare settings is consistent with best practice guidelines and has been shown to facilitate tobacco cessation. Such intervention is particularly important in rural and medically underserved areas (MUAs), where tobacco use is elevated, as is cancer mortality. Providers’ knowledge and attitudes about the danger of tobacco use and their role in mitigating the same may play a role in whether their patients receive guideline-compliant care. This study investigates knowledge and attitudes toward tobacco use and cessation care delivery among providers at substance use treatment centers (SUTCs) and medical healthcare centers (MHCs; e.g., Federally Qualified Health Centers) in rural and/or MUAs of Texas to identify modifiable barriers to effective tobacco cessation treatment. Methods: Providers from healthcare centers (12 SUTCs, 9 MHCs) participating in a tobacco-free workplace program responded to a baseline solicitation assessing, among other things, their interest in receiving tobacco cessation care training and resources. In total, 347 providers from SUTCs (n=174) and MHCs (n=173) serving 49.6% of Texas’ counties responded to face-valid items assessing their knowledge and attitudes about tobacco use and provision of tobacco cessation care. Generalized or linear mixed models were used to analyze differences between SUTCs and MHCs. Results: More SUTC than MHC providers accurately identified that adults with mental health and/or non-nicotine substance misuse disorders are 2x more likely to smoke cigarettes than the general population (69% vs. 57%, p<0.008) and that quitting smoking can improve associated mental health symptomatology/substance misuse (61% vs. 54%, p<0.05), but also that patients’ tobacco product use is a personal decision that does not concern the direct service provider (30% vs. 19%, p<0.03). Conversely, more MHC than SUTC providers agreed that smoking cessation counseling is an important part of their job (66% vs. 41%, p<0.001), that their patients who smoke want to quit (38% vs. 21%, p<0.002), that providers should advise patients to quit even if it is not the reason for the visit (65% vs. 43%, p<0.001), that counseling by a provider motivates tobacco product users to quit (68% vs. 50%, p<0.005), and that providers should make appointments to specifically help patients quit tobacco product use (59% vs. 39%, p<0.003). Overall, only 48.4% of providers felt somewhat or completely prepared to help patients quit (56% MHC vs. 41% SUTCs, p<0.03). Conclusion: Addressing tobacco use in rural and/or MUAs of Texas where patients receive healthcare is critical to cancer prevention and achieving health equity. Responding SUTC and MHC providers evinced a need for training to enhance their understanding of tobacco use and to elevate the importance of cessation care provision. This is particularly the case in SUTCs, where providers primarily treat addiction. Findings will inform workplace interventions and their adaptation for use in each setting to facilitate guideline-compliant care provision. Citation Format: Sriya N. Kakarla, Brian J. Carter, Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Teresa Williams, Kathleen Casey, Hector Sanchez, Lorraine R. Reitzel. Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A090.

Effect of Health Education on the Knowledge and Attitude Regarding the Human Papillomavirus Vaccine among Adolescent School Girls of a City in Western Maharashtra

Background: Human papillomavirus vaccine is effective in preventing cervical cancer and is especially recommended for girls above nine years of age. Understanding the level of awareness and attitude of the target population towards the HPV vaccine is imperative to create awareness where necessary. Aim and Objectives: To assess the baseline knowledge, attitudes, and behaviours concerning HPV vaccine among adolescent school girls in urban area, and to investigate the impact of health education on these parameters. Study design: Quasi-experimental Study setting: Secondary school in Pune city Target population: Adolescent girls Methods and Material: Calculated sample size was 200. A school was chosen randomly. All the willing female students from 8th-10th standards were enrolled. Awareness about HPV infection and vaccination, attitude and practices were assessed at the baseline and two weeks after the health education intervention, using a self-administered structured questionnaire. Results: Initially, only 2.5% had heard about the HPV vaccine and none had received it. Following health education, the proportion of students who correctly answered the questions regarding the HPV vaccine, diseases prevented and who can take the vaccine increased significantly by 94%, 71.5% and 72% respectively. Positive attitude regarding the risk of HPV infection and age for vaccination improved significantly by 78.5% and 48% respectively. Vaccine seeking behaviour improved significantly by 17.5%. Conclusions: Adolescent school girls had poor baseline knowledge and attitude regarding the HPV vaccine and health education significantly improved the same.

Impact of educational interventions on hepatitis B and C awareness among school students of Delhi NCR, India

BackgroundViral hepatitis, particularly B and C, is a major cause of liver cirrhosis and cancer, leading to about 1.4 million deaths annually. Alarmingly, less than 20% of those with hepatitis are aware of their status, with only 6.3% receiving treatment. School children can play a pivotal role in raising awareness and preventing the spread of infections. This intervention study focuses on understanding and enhancing the knowledge, attitudes, and practices related to Hepatitis B and C, among school children in Delhi NCR to foster dialogue and awareness.MethodsAn intervention study was conducted in selected schools across Delhi NCR between September and October 2022 to assess baseline knowledge, attitudes, and practices related to Hepatitis B and C. Three of seven schools were randomly selected by probability sampling, representing 9–12 grade students, and 901 students participated. Following this, an educational interventional program was conducted using educational material, interactive sessions, and audiovisual aids. Post-intervention assessments were done to measure the impact on knowledge improvement.ResultsThe study is expected to provide insights into the current level of awareness regarding Hepatitis B and C. Furthermore, the intervention’s effectiveness was analysed using the pre-formed questionnaire. The average pre-test knowledge score was 8.9 ± 3.2, while the post-test average was 15.6 ± 4.4, indicating a substantial increase of 6.7 ± 4.7 points (+ 75.2%). There was a positive correlation of 0.240 between pre and post-test scores. Attitude change before and after the session showed a positive percentage change of + 38.0% with a correlation of 0.351. The study indicated substantial improvements in knowledge about hepatitis B and C, notably regarding awareness about transmission methods and risk factors.ConclusionThis interventional study seeks to bridge the knowledge gap among school children regarding Hepatitis B and C in Delhi NCR, fostering a proactive approach towards prevention, detection, and treatment. The considerable rise in awareness and favourable changes in perspectives post-intervention say that specific health education initiatives are pivotal in raising awareness and comprehension of infectious diseases, ultimately contributing to improving community health.

Identifying Strategies to Improve Shared Decision Making for Pregnant Patients' Decisions about Prenatal Genetic Screens and Diagnostic Tests.

Prenatal genetic screens and diagnostic tests are vital components of prenatal care. The first prenatal visit is a critical time in the decision-making process when patients decide whether to use these tests in addition to address a series of other essential prenatal care aspects. We conducted this study to examine the role of a shared decision-making (SDM) instrument to support these discussions. We conducted a cluster randomized controlled trial of patients allocated to an SDM tool or usual care at their first prenatal visit. Participants completed a baseline survey to measure decision-making needs and preferences. Direct observation was conducted and analyzed using the OPTION scale to measure SDM during prenatal genetic testing discussions. Levels of SDM were similar across groups (P = 0.081). The highest levels of SDM were observed during screening test discussions (NEST 2.4 ± 0.9 v. control 2.6 ± 1.0). Lowest levels were observed in discussions about patients' preference for risk versus diagnostic information (NEST 1.0 ± 1.1 v. control 1.2 ± 1.3). Study findings demonstrate the need for targeted patient-focused and provider-focused efforts to improve SDM to enhance patients' informed decision making about these options. Importantly, patients' baseline knowledge and attitudes need to be considered given that patients with less knowledge may need more carefully crafted communication. Choices about whether, when, and how to use prenatal genetic tests are highly preference-based decisions, with patients' baseline attitudes about these options as a major driver in health care discussions.The decision-making process is also shaped by patient preferences regarding a shared or informed decision-making process for medical decisions that are highly personal and have significant ramifications for obstetric outcomes.There is a need to develop targeted efforts to improve decision making and enhance patients' ability to make informed decisions about prenatal genetic tests in early pregnancy.

Retuning Ears & Rewiring Brains for Effective Communication: Foreign-Accent Perception & Sensitivity Training (FAPST)™

Purpose: Communication and psychosocial challenges are associated with processing regional or foreign accents. These challenges result in discrimination, marginalization, and reduced opportunities for culturally, linguistically, or racially diverse people. As a departure from the controversial approaches of training speakers to speak more effectively, this paper presents an innovative and effective methodology to train listeners instead and make the communication environment more “accent friendly”. Built upon two decades of testing and evidence, the Foreign Accent Perception & Sensitivity Training (FAPST)TM is used to develop skills in listening to accents, reducing implicit biases, and increasing appreciation and enjoyment for interacting with accents and cultures. Methodology: 320 undergraduate students from eight sections of a Diversity Issues course were provided the FAPST training online that included 15-20 minutes of gamified experience, over four weeks, in listening and identifying 54 varieties of accent in a structured, multimedia procedure. Assessments included weekly Accent Identification Scores as well as a pre- and post-survey using the CCQ tool to assess listeners’ baseline knowledge, attitudes, stereotypes, preferences, and skills related to processing accents. They also received formative assessments, feedback, and engaged in self-reflections. Results: Paired t-tests showed significant improvement in Accent Identification Scores which increased from 52% in week 1 and reached 75% by week 4, significant at p <0.05 level. The post-training CCQ survey results showed that Factual Knowledge scores improved significantly from 42% to 78%, Stereotypes scores reduced significantly from 89% to 22%, and Competence scores improved significantly from 23% to 76%. Participants reported increased confidence in listening accuracy and improvement in noticing details in accent patterns. Participants reported increased interest and willingness to interact with diversity. Participants also reported increased awareness of discrimination, and willingness to show allyship and advocacy for diverse individuals. Conclusion: This project confirmed that students have preconceived attitudes and biases as well as lower skills and confidence in interacting with diversity and accents which factor in their decisions and preferences to communicate with people with certain accents. It becomes imperative to set students up for success and engagement in a globalized world by training them with skills to navigate diversity. Results show that such a training improves listening accuracy as well as develops increased confidence and interest in engaging with diversity, while reducing implicit biases and stereotypes, along with increased factual knowledge of, and competence with accents.

Anti-Dengue Sanitation Practices: A Health Education Approach for Municipal Sanitary Workers in Puducherry, India.

Introduction Dengue is a mosquito-borne disease of global health concern, especially in tropical areas. Aedes aegypti, its vector, thrives in inadequate sanitation conditions. The role of sanitary workers is pivotal in dengue control and prevention efforts; hence, educating them is essential for enhancing their vector control awareness. Methods This study was conducted among 109 municipal sanitary workers in selected areas of Puducherry, India. Their baseline knowledge, attitudes, and practices (KAP) regarding dengue were assessed through a pretested, semi-structured questionnaire, followed by a targeted health education intervention incorporating novel communication methods such as pocket awareness cards. The impact of the intervention was assessed through an increment in KAP scores, qualitative interviews, and surprise visits to the field during their work hours. Results The mean (± SD) scores in terms of knowledge (4.29 ± 1.77 vs. 7.17 ± 1.02; p < 0.01), attitudes (3.58 ± 1.42 vs. 4.69 ± 0.71; p < 0.01), and practices (1.98 ± 0.84 vs. 4.28 ± 1.12; p < 0.01) significantly increased post-intervention. Qualitative interviews revealed the utility of the intervention, with additional insights on implementation barriers and strategies for the future. Conclusion The study's findings imply that the targeted health education intervention for sanitary workers was effective in improving their knowledge and practices on dengue control. These results demonstrate the potential of future educational initiatives to promote vector control measures among sanitary staff and thereby combat dengue transmission in the community.

Predictors of Nicotine Replacement Therapy Adherence: Mixed-Methods Research With a Convergent Parallel Design.

Few studies have examined the effect of baseline attitudes toward nicotine replacement therapy (NRT) on its actual adherence in a smoking cessation intervention. This study (i) examined the predictability of baseline variables (quantitative data) on NRT adherence and (ii) explored the congruence of participants' statements about NRT products (qualitative data) during counseling sessions with their baseline attitudes. This is a mixed-methods research study using a convergent parallel design. Participants included 74 individuals in the treatment group who received behavioral counseling and combination NRT. A Poisson regression analysis was performed to identify baseline variables predicting NRT adherence. Thematic analysis was completed with a subset of participants (n = 38) who varied in NRT attitude scores and adherence. A joint display was created to integrate quantitative and qualitative data and discover convergence. Approximately 59% of the participants (41/74) used NRT continuously for ≥5 weeks. Having negative attitudes toward NRT and depressive symptoms predicted NRT adherence even after controlling for education and anxiety symptoms. Thematic analysis revealed that NRT adherence is a learning process that consists of the following three distinctive but interrelated phases: (i) information needs, (ii) comprehensive readiness, and (iii) experiential learning. Of the 38 participants, 34 (89.5%) showed convergence between baseline attitude scores and statements about NRT made during counseling sessions. Individuals who have negative attitudes toward NRT are less likely to use the products in a smoking cessation intervention. Counselors should assess attitudes toward NRT at baseline and address them proactively during counseling sessions.

Cohort assessment of medical and pharmacy student interprofessional attitudes at an academic medical centre from baseline to programme completion

Background: Interprofessional interactions between pharmacy and medical students have been emphasised by accreditation standards. This study aimed to document medical and pharmacy student cohorts’ baseline and longitudinal interprofessional attitudes across four years of pre-licensure education. Methods: Student cohorts shared two structured interprofessional learning experiences within the first two years, then unstructured/variable learning experiences during the final two years. The 27-item Interprofessional Attitudes Scale comprising five subscales was administered upon programme entry, then towards the end of each programme year. Results: Baseline response rates were 73.5% and 90% for 136 medicine and 57 pharmacy students, respectively; pharmacy student responses were significantly higher for teamwork, roles, and responsibilities and significantly lower for interprofessional biases subscales. Longitudinal medical and pharmacy student responses only showed a significant increase in interprofessional biases, while medical student responses showed significant decreases in teamwork, roles, responsibilities, and community-centredness. Conclusion: Compared to pharmacy students, baseline responses from medical students confirm significantly lower scores for teamwork, roles, and responsibilities on programme entry, which may further decrease by the end of the first pre-clinical year. Though significant subscale changes mirrored the completion of structured pre-clinical interprofessional curricula and/or clinical education for both student cohorts, further research is needed secondary to study limitations.

Breastfeeding knowledge, attitudes, beliefs and practices of refugee, migrant and asylum seeker women in Portugal

BackgroundThe World Health Organization recommends exclusive breastfeeding for the first six months after childbirth. However, breastfeeding is influenced by organizational, social, geopolitical, and cultural factors, which are understudied in the migrant population. This study aimed to assess the knowledge, attitudes, beliefs, and practices of refugee, migrant, and asylum-seeking mothers living in Lisbon.MethodsA sociodemographic questionnaire and a Breastfeeding Knowledge, Attitudes, and Beliefs, and Practices questionnaire were used to gather information regarding baseline breastfeeding knowledge, attitudes and beliefs, and practices towards breastfeeding.ResultsOnly 40% of the mothers received antenatal counselling regarding the benefits and management of breastfeeding. Of the 20 responses, 10 (50%) mothers were found to have fair breastfeeding knowledge, 14 (70%) had fair attitudes and beliefs, and 12 (60%) had fair breastfeeding practices. Correlation analysis indicated a positive correlation between mothers’ breastfeeding attitudes (r = 0.531, p < 0.05) and their breastfeeding knowledge. There was no statistically significant correlation between the mothers’ breastfeeding attitudes, beliefs, and practices.ConclusionsThe findings of this study suggest that healthy breastfeeding behaviours can be stimulated by receiving proper counselling from health professionals. Countries must focus on improving breastfeeding practices, as they still fail to do all they can to promote, protect, and support breastfeeding globally. Universal interventions are necessary to improve breastfeeding, regardless of migrant or refugee status.

Understanding Nurse Perceptions of Caring for Patients With Alcohol Use Disorder: A Cross-Sectional Study.

Alcohol use disorder (AUD), the problematic consumption of alcohol, affects 107 million people worldwide. Individuals with AUD experience high morbidity and increased mortality. Nurses practicing in acute care are ideally positioned to deliver quality interventions to patients with AUD, including screening and brief intervention; formal training and assessment of baseline knowledge, attitudes, and perceptions are necessary. The aim of this study was to explore the knowledge, attitudes, and perceptions of acute care nurses caring for patients with AUD. This study used a cross-sectional survey design. The Survey of Attitudes and Perceptions was completed by 93 nurses working in six acute care centers (seven medicine units) across Alberta. Data were analyzed using descriptive and inferential statistics. Few participants reported receiving any prior structured training on AUD, with the majority reporting limited knowledge of alcohol and the effects of alcohol consumption. Although most participants said that caring for patients with AUD was a part of their professional role, few felt satisfied or motivated to work with this group of patients. Responses to individual questions or subdomains of the survey did not significantly differ by length of time in professional role, employment status, or sex. Our results indicate that nurses need to learn more about caring for patients with AUD. Developing tailored educational interventions that are mindful of the importance of knowledge, support, satisfaction, and motivation is necessary to improve the quality of care for patients with AUD.

Attitudes of medical students to electroconvulsive therapy

PurposeThis study aims to explore medical students’ attitudes to electroconvulsive therapy (ECT). The authors sought to determine correlates of baseline attitudes to ECT and whether specific forms of ECT teaching improved attitudes to ECT during students’ psychiatry placement.Design/methodology/approachAt the beginning of their placement, fourth-year medical students completed a questionnaire capturing background information and baseline attitudes. A second questionnaire, in the second half of the placement, recorded educational and clinical experience gained on ECT during placement, in addition to attitudes at this timepoint. The authors measured attitude using a five-point Likert scale and defined a positive shift in attitude as an improvement of ≥ 1 point between the two time points.FindingsAt Timepoint 1, 66% reported a positive attitude to ECT. This was associated with having attended a lecture and with having read a professional article on ECT at some time before the psychiatry placement. Attitudes significantly improved during the placement (66% vs 95% positive). Students who attended a lecture on ECT were more likely to have a positive shift in attitude, as were students who experienced three or more teaching modalities.Practical implicationsPersonal, social and medical problems arise from treatment-resistant psychiatric disorders. ECT is a safe and effective treatment for such disorders.Originality/valueIt is hoped that this study will contribute to the development of medical education, so that lectures on ECT, and three or more teaching modalities, are incorporated into the undergraduate medical curriculum.

Automating body-worn camera footage review through AI: baseline attitudes from a multisite randomized control trial

Abstract Body-worn cameras (BWCs) have been widely adopted as a tool to promote police reform. However, studies have shown that most of the footage recorded by BWCs (about 95 per cent) is never reviewed or seen, which undercuts the core benefits of BWCs. Artificial Intelligence-driven analytics may overcome this problem. One example is Truleo, which uses natural language processing to analyse the audio footage and produce metrics of risk and professionalism. However, there is virtually no research examining its use and impact in policing. In the current study, we describe preliminary findings from ongoing randomized controlled trials testing the implementation and impact of Truleo in the Apache Junction and Casa Grande Police Departments. We draw on focus groups of officers, sergeants, and upper-level management and officer perceptions via surveys administered pre-deployment of the technology. We conclude with a discussion of policy implications related to the use of AI for BWC footage review, particularly with regard to how the technology may promote professionalism, intensify supervision, and increase organizational efficiency.

Examining the relationship between officer attitudes and behaviour in a multi-site trial of procedural justice training

Abstract While reformers view police training as an important means for improving performance, the training evidence base has historically been weak. Little research has focussed on how training impacts both attitudes and behaviour in the field, and the extent to which changes in attitudes following a training program are linked to officer behaviour in the field. This paper uses data from a multi-site randomized trial of procedural justice training in hot spots to assess the attitude–behaviour link. We ask to what extent do officers’ attitudes about procedural justice impact their behaviour in the field? We find no support for officer baseline attitudes being predictive of their use of procedural justice with the public. But for trained officers, we do find evidence that attitudes following training are related to behaviour in observed interactions in the field. We conclude with a discussion of the implications for police training and training evaluation studies.

Readiness to Implement a Doula–Hospital Partnership Program

ObjectiveTo assess obstetric clinicians’ and leaders’ baseline knowledge, attitudes, and experience with doulas and their readiness to implement a novel doula–hospital partnership program. DesignSurvey of obstetric clinicians and leaders before implementation of the doula program. Setting/Local ProblemAcademic medical center in Western Massachusetts that was preparing to pilot a doula–hospital partnership program with Black doulas for Black women to address racial disparities in maternal morbidity and mortality. ParticipantsObstetric clinicians and leaders (N = 48). Intervention/MeasurementsWe used established questions from the Organizational Readiness for Implementing Change (ORIC) scale and original questions to assess participants’ knowledge, attitudes, and experiences with doulas and their readiness to implement the planned doula program. We distributed the questionnaire to 103 potential respondents. We conducted descriptive and bivariate analyses and analyzed open-ended responses using content analysis. ResultsForty-eight participants responded to the survey. Of those who provided intrapartum care (n = 45), all were familiar with doula roles. Respondents who reported having experience working with a doula, 47.3% (n = 18/38) had at least one prior negative experience with a doula and 76.3% (n = 29/38) reported positive experiences with doulas. However, there was a mean score of 12.62 on the attitude toward doulas (scale range: 3-15). The mean score on the ORIC change commitment subscale was 20.65 (range: 15-25) and on the ORIC change efficacy subscale, mean score was 29.31 (range: 19-35). Results did not differ by participants characteristics. ConclusionOur findings suggested strong support for and readiness to implement the doula–hospital partnership program.

BETWEEN ISLANDS—A CREATIVE PRACTICE AND INTERGENERATIONAL CONTACT INTERVENTION

Abstract Addressing ageism is a serious social issue in need of targeted, empirically based solutions (WHO, 2021). Facilitating intergenerational contact is one promising means of reducing ageism (Lytle et al., 2020). Between Islands were a creative practice and intergenerational contact intervention designed to promote creativity and intergenerational connection between younger and older adults while challenging stereotypes about aging. Over a four-week intervention, younger and older adults meet virtually (on zoom) for an hour each Wednesday to learn, create, and discuss with one another. Before the intervention began, participants received two 2.5 lb blocks of air-drying clay, paints, and paintbrushes. During the four-week intervention, participants engaged in creative practice (designed, sculpted, and decorated two hand-weights out of the provided clay). In addition, participants learned about the history of hand-weights and circuit training and got to know one another through group-based discussion as well as smaller group prompts and breakout rooms. Prior to the start of the intervention, baseline attitudes and stereotyping toward older adults were assessed among the younger adult participants. Attitudes and stereotypes were again measured after the intervention concluded. Younger adults reported a significant decrease in benevolent ageism and intergenerational tension after the Between Islands intervention. In addition, themes that emerged from the open-ended responses illustrated that the intervention challenged younger adults’ stereotypes about older adults, encouraged recognition of similarities between younger and older adults, and facilitated the connection between participants.

Exposure to the Death of Others during the COVID-19 Pandemic: Growing Mistrust in Medical Institutions as a Result of Personal Loss.

The prominence of death during the COVID-19 pandemic was heightened by the potential of personally knowing someone who lost their life to the virus. The terror management theory (TMT) suggests that the salient presence of death has a pronounced effect on behavior and may result in the ossification of beliefs and actions aligned with one's worldview (i.e., the mortality salience hypothesis). In this study, we evaluated how death exposure early in the COVID-19 pandemic could enact the process of firming up held beliefs and attitudes related to health and safety. Specifically, we tested the hypothesis that exposure to a personal loss during the pandemic would strengthen participants' baseline attitudes and behaviors regarding COVID-19 safety guidelines. Data were analyzed from a prospective, regional survey administered at two time points during the pandemic, June-July 2020 and May 2021, in five United States northeastern states. Baseline and follow-up surveys were administered approximately 12 months apart, with adherence to public guidance and death exposure measured at both timepoints and other safety measures at follow-up only. Our results indicated that there were significant main effects of death exposure on guideline adherence and support for COVID-related public policy. Contrary to the mortality salience hypothesis, death exposures after baseline were related to higher medical mistrust at follow-up for those high in adherence at baseline, rather than those with low adherence. Our results offer some conflicting evidence to the mortality salience hypothesis. Rather than entrench people in their worldviews, death in the context of the COVID-19 pandemic appeared to sway people away from their initial stances. This finding has important implications for TMT literature and for the COVID-19 pandemic response.

Seeking and reaching emergency care: A cross sectional household survey across two Liberian counties.

The overwhelming burden of morbidity and mortality from injury and medical conditions requiring acute care are borne by low- and middle-income countries lacking accessible, quality care systems. Current evidence suggests the lack of prehospital care systems likely contributes to this disproportionate burden. As an initial step in a longitudinal, collaborative effort to strengthen the chain of survival for emergency conditions in Liberia, baseline attitudes and behaviors in accessing and utilizing emergency care were characterized. A multistage, proportional, cluster sampling frame was employed to conduct a cross-sectional, community-based survey of 800 households across rural Lofa County and the greater capital (Monrovia) metropolitan area. The primary outcome was facility-based utilization of emergency care within the 12 months prior to survey administration. 43.9% of individuals surveyed reported a visit to an emergency unit in the last year. Multivariable logistic regression revealed increased adjusted odds of facility-based emergency care utilization in households that were low-income, non-English-speaking, lacking electricity, or had a non-durable roof. Among these individuals, 23.6% had sought care from a community health worker, family/friend, clinic, pharmacy, or traditional healer prior. The majority of persons seeking care do so without ambulance services. 34.8% of all households have called a community member for a medical emergency, but 88.9% of survey respondents report no first aid training and cite barriers to rendering aid. This represents the first household survey to assess the perceptions and utilization of emergency care in Liberia. Formal pre-hospital care provision is limited and substantial barriers to emergency care access exist. First aid training and acceptance is lacking, despite frequent reliance on community-based aid during emergencies.

Improving Nurses' Attitudes Toward Substance Use Disorder: Screening, Brief Intervention, and Referral to Treatment.

Patients with substance use disorder (SUD) encounter many barriers to healthcare, including negative attitudes of healthcare personnel. Compared with other healthcare professions, nurses have been reported as having less tolerant attitudes toward patients with SUD. Knowledge acquisition combined with role support has been shown to improve therapeutic attitudes of nurses toward patients with SUD. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based educational intervention aimed to improve the outcomes of patients at risk and with SUD. SBIRT education has been shown as an effective educational tool with licensed nurses. Therefore, the aim of this study was to evaluate whether a 2-hour educational session on SBIRT (Mitchell et al., 2013) improved the therapeutic attitudes of nurses toward patients with SUD. Peplau's theory of interpersonal relations guided this study with an emphasis on the nurse-patient relationship. A quasi-experimental pretest/posttest design was used to evaluate nurses' attitudes pre and post a 2-hour educational session. Participants included 65 registered nurses employed in a 247-bed teaching hospital in New England. Attitudes were measured before and after the educational session using the 20-item, five-subscale Drug and Drug Problems Perceptions Questionnaire. A paired t test was performed, showing statistically significant improvements in attitudes postintervention. Prior education on SUD significantly correlated with baseline attitudes. A standard regression model, with practice setting, family history of SUD, and prior education as dependent variables, was not predictive of baseline attitudes. The results suggest conducting SBIRT should be considered a mandatory nursing competency, both in undergraduate curriculum and among licensed nurses.

Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study.

Lower limb amputation (LLA) impacts physical activity (PA) participation and quality of life (QoL). To minimize the effects of these challenges, LLA survivors need to have opportunities to engage in appropriately tailored rehabilitation throughout their lives. However, in Sri Lanka, where a 3-decade civil war resulted in trauma-related LLA among young male soldiers, access to rehabilitation was limited to the immediate postinjury period. Developing rehabilitation interventions for these veterans requires an understanding of their current health status and rehabilitation perceptions. This study was conducted to evaluate the QoL and PA participation of veterans with LLA and explore perceptions of factors influencing their PA participation and expectations for a future community-based physical rehabilitation (CBPR) intervention. This mixed methods study combined a comparative cross-sectional quantitative survey with qualitative semistructured interviews in 5 districts of Sri Lanka. QoL and PA participation were assessed among community-reintegrated veterans with LLA (n=85) and compared with a matched able-bodied cohort (control; n=85) using Mann-Whitney U and Chi-square tests. PA was assessed in terms of metabolic equivalent of task (MET) minutes per week and was computed for walking, moderate-intensity, and vigorous-intensity activities. PA was classified as sufficiently active, low, or sedentary. The design of interview questions was guided by the Theoretical Domains Framework and followed a phenomenological approach. Interviews were conducted with 25 veterans and were analyzed thematically, and the perceptions regarding PA participation and CBPR were codified using the Consolidated Framework for Implementation Research (CFIR). Based on the quantitative survey findings, scores for both physical (P<.001) and psychological (P<.001) well-being and participation in walking (P=.004) and vigorous-intensity activities (P<.001) were significantly lower among veterans than among controls. A "sedentary" classification was made for 43% (34/79) of veterans and 12% (10/82) of controls. Veterans mostly engaged in moderate-intensity PA inside the house (49/79, 62%) and in the yard (30/79, 38%). Qualitative interviews revealed that barriers to PA exist at individual (eg, comorbidity burden), primary care (eg, absence of community rehabilitation services), and policy levels (eg, limited resources) and facilitators exist primarily at societal (eg, inclusive community) and individual levels (eg, preinjury activity baseline and positive attitudes toward exercise). Expectations regarding CBPR included individualized rehabilitation parameters; functional exercises; and involvement of peers, amputee societies, and community health care providers. The nonresponse rate for interviews was 7% (2/27). The findings of reduced PA participation, poor QoL, and physical and psychological impairments among relatively young veterans reveal the long-term impacts of living with LLA in the absence of long-term rehabilitation. Policy-level changes need to be implemented along with behavior-change strategies to promote PA participation and minimize physical inactivity-induced health issues. Veterans' perceptions regarding future CBPR programs were positive and centered on holistic, individualized, and peer-led activities.