Medicine Beliefs Research Articles

Patients’ trust in the Indian healthcare system and its impact on the intention to use artificial intelligence-based healthcare chatbots

Purpose Indian patients have different medicine systems available at the service that alter their healthseeking behaviour (HSB). This study aims to examine the beliefs and behaviour of patients in India towards the healthcare system and how it affects their intention to use healthcare chatbots. Design/methodology/approach A survey instrument was developed from standard scales and validated by experts. The data was collected from 397 respondents in an urban area and tested using a structural equation model in SAS JMP software. Findings The study found that awareness and perception of chatbots and distrust on doctors and health systems impact trust in a chatbot. The results show that trust in chatbots influences the intention to use chatbots. The belief in alternative medicine systems and HSB also influence the intention to use chatbots. The study findings also imply that health-care chatbots should cater to HSB and the belief in alternative medicine. Research limitations/implications The study was conducted only among the urban population because services based on technology are more available in metro cities. Bengaluru is considered the representative population of urban India. Practical implications The level of disruption that chatbots can provide to the healthcare system makes this study significant. The study findings will help to manage the factors that can enable chatbot inclusivity, as the current system is inaccessible to many patients. Originality/value This paper addresses an identified need to study patients’ trust in the Indian healthcare system and their intention to use chatbots. The level of disruptions these chatbots can cause in the health-care system is undeniable and patients’ trust in these chatbots will eventually transform the health-care sector.

Association between the use of herbal medicines during pregnancy and adverse fetal outcomes among mothers in eastern Ethiopia, 2023.

Nowadays, pregnant women around the world use herbal remedies extensively. Evidence illustrated that the association between the use of herbal medicines and unfavorable fetal outcomes is not well established. Furthermore, much of the existing research is conducted within medical facilities, which may result in excluding mothers who do not receive antenatal follow-up care. Therefore, this study aimed to explore the association between the use of herbal medicine and adverse fetal outcomes in eastern Ethiopia. A community-based cross-sectional study was conducted among 882 randomly selected mothers from February 1, 2023 to November 1, 2023. Data were collected through face-to-face interviews using structured questionnaires adapted from previous literature. The dataset was analyzed using Stata version 18, and a modified Poisson regression model was applied. Adjusted prevalence ratios (APR) with 95% confidence intervals were estimated. The prevalence of herbal medicines use among pregnant women in eastern Ethiopia was 43.2% (95% CI: 39.9, 46.5). The most commonly used herbal medicines were Ocimum lamiifolium 109 (29.1%), pumpkin fruit 68 (18.2%) and Rutachalepensis 61(16.3%). Factors such as rural residency [APR=1.27, 95%CI (1.01,1.59)], having obstetric complications in recent pregnancy [APR=1.42, 95% CI: (1.14,1.78)], and experiencing adverse fetal outcomes [APR=1.59, 95%CI: (1.05,2.2)] were significantly associated with the use of herbal medicine. More than two out of five mothers used herbal remedies during their recent pregnancy. The study identified a significant association between the use of herbal medicines and various sociodemographic and obstetric factors. Consequently, it is essential to establish the safety and effectiveness of herbal medications before their use during pregnancy. To address the diverse health needs of pregnant women and mitigate the risks associated with the indiscriminate use of herbal remedies, a collaborative strategy should be developed involving herbalists, communities with strong beliefs in herbal medicine, and healthcare professionals.

The credence of statistical generalisations should not categorically license outright rational belief

In this paper, I am expressly concerned with issues emanating from the taking of p to be the case in evidence-based medicine. I interrogate the tenability of statistical generalisations with regard to reference classes and, in particular, demographic groups. Upon the grounds of my estimations, I contrarily make a moral argument that the credence of statistical generalisations should not categorically license outright rational belief in evidence-based medicine as supported by the opacity of bare statistical generalisations, the problem of reference classes and inappropriate credence projection, even when such generalisations may appear epistemologically sound.

The Current Status of Traditional Chinese Medicine Health Care Literacy of the Elderly and Its Influencing Factors--Based on a Survey of 460 Elderly People

Objective: To understand the current status of knowledge and beliefs of Chinese medicine health care and its influencing factors among the elderly in Henan Province, and to provide reference for improving their Chinese medicine health care literacy. Methods: Using convenience sampling, 460 elderly people in Henan Province were selected to carry out a questionnaire survey on the current status of knowledge and beliefs of Chinese medicine and health care, and their influencing factors were analysed. Results: The standard score of knowledge of TCM health care for the elderly in Henan Province was (56.72±15.35), the standard score of attitude was (79.57±15.91), and the standard score of behaviour was (42.17±22.25); the residence place, education level, monthly disposable income, previous occupation, type of medical insurance, the presence of old-age insurance, the presence of chronic diseases, and the presence of relatives engaged in TCM-related occupations were statistically significant (P<0.05) in terms of the scores on the three dimensions of knowledge, attitude, and behaviour of TCM health care and the total score; senior high school/vocational high school/junior college (OR= 0.329, 95% CI: 0.137-0.791), workers (OR= 4.295, 95% CI: 1.023-18.044), and those who suffered from chronic diseases ( OR= 1.964, 95% CI: 1.171~3.294) significantly affect the knowledge score; business unit (OR= 0.135, 95% CI: 0.024~0.754), and having chronic disease (OR= 1.918, 95% CI: 1.168~3.151) significantly affect the attitude score; and 3001~5000 yuan (OR= 0.292, 95% CI: 0.105~0.812), workers (OR= 5.180, 95% CI: 1.311~20.47), others (OR= 4.698, 95% CI: 1.112~19.839), having old age insurance (OR= 1.641, 95% CI: 1.028~2.620), and suffering from chronic diseases (OR= 2.152, 95% CI: 1.280~3.617) and so on significantly influenced the behavioural scores. Conclusion: The attitude level of TCM health care among the elderly in Henan Province is good, and the knowledge and behaviour level needs to be improved. Long-term and stable health knowledge education for the elderly population should be carried out to strengthen the elderly's knowledge of TCM health care and further strengthen their beliefs in TCM health care in order to promote the formation of their TCM health care health behaviours.

TRADITIONAL AND COMPLEMENTARY MEDICINE BELIEFS INVENTORY IN ADULTS: A METHODOLOGICAL STUDY

Aims: This study was conducted to establish the Turkish validity and reliability of the Complementary and Alternative Medicine Beliefs Inventory (CAMBI) used to measure adults' beliefs about complementary and alternative medicine practices. Methods: The study was designed as a methodological study. The population of the study consisted of individuals receiving services from a family health center in Ankara. The sample consisted of 354 individuals who agreed to participate in the study and met the inclusion criteria. Descriptive statistics (number, percentage, mean, standard deviation, minimum, and maximum) of the data obtained in the study were calculated. Exploratory Factor Analysis and Confirmatory Factor Analysis were conducted to test validity. The reliability of the scale was assessed through item-total correlation, item analysis, Cronbach α, and test-retest correlation. Results: The results of the Exploratory Factor Analysis revealed that there is only one factor with an eigenvalue above 1, explaining 73.11% of the total variance. Additionally, fit indices obtained from the results of the Confirmatory Factor Analysis yielded a χ2/df fit index of 3.214, a Root Mean Square Error of Approximation (RMSEA) of 0.079, a Comparative Fit Index (CFI) of 0.901, and an Adjusted Goodness-of-Fit Index (AGFI) of 0.854. The Cronbach’s α value of the scale in our study was 0.97. Conclusion: The adapted Turkish version of the 16-item scale has been determined to be a measurement tool that adheres to validity and reliability criteria. It serves as an assessment instrument usable by healthcare professionals to evaluate adult individuals' beliefs regarding complementary and alternative medicine (CAM) methods.

Beliefs of physician directors on the management of devastating brain injuries at the Canadian emergency department and intensive care unit interface: a national site-level survey.

Insufficient evidence-based recommendations to guide care for patients with devastating brain injuries (DBIs) leave patients vulnerable to inconsistent practice at the emergency department (ED) and intensive care unit (ICU) interface. We sought to characterize the beliefs of Canadian emergency medicine (EM) and critical care medicine (CCM) physician site directors regarding current management practices for patients with DBI. We conducted a cross-sectional survey of EM and CCM physician directors of adult EDs and ICUs across Canada (December 2022 to March 2023). Our primary outcome was the proportion of respondents who manage (or consult on) patients with DBI in the ED. We conducted subgroup analyses to compare beliefs of EM and CCM physicians. Of 303 eligible respondents, we received 98 (32%) completed surveys (EM physician directors, 46; CCM physician directors, 52). Most physician directors reported participating in the decision to withdraw life-sustaining measures (WLSM) for patients with DBI in the ED (80%, n=78), but 63% of these (n=62) said this was infrequent. Physician directors reported that existing neuroprognostication methods are rarely sufficient to support WLSM in the ED (49%, n=48) and believed that an ICU stay is required to improve confidence (99%, n=97). Most (96%, n=94) felt that providing caregiver visitation time prior to WLSM was a valid reason for ICU admission. In our survey of Canadian EM and CCM physician directors, 80% participated in WLSM in the ED for patients with DBI. Despite this, most supported ICU admission to optimize neuroprognostication and patient-centred end-of-life care, including organ donation.

A qualitative inquiry on drivers of COVID-19 vaccine hesitancy among adults in Kenya.

COVID-19 vaccination rates have been low among adults in Kenya (36.7% as of late March 2023) with vaccine hesitancy posing a threat to the COVID-19 vaccination program. This study sought to examine facilitators and barriers to COVID-19 vaccinations in Kenya. We conducted a qualitative cross-sectional study in two purposively selected counties in Kenya. We collected data through 8 focus group discussions with 80 community members and 8 in-depth interviews with health care managers and providers. The data was analyzed using a framework approach focusing on determinants of vaccine hesitancy and their influence on psychological constructs. Barriers to COVID-19 vaccine uptake were related to individual characteristics (males, younger age, perceived health status, belief in herbal medicine, and the lack of autonomy in decision making among women - especially in rural settings), contextual influences (lifting of bans, myths, medical mistrust, cultural and religious beliefs), and COVID-19 vaccine related factors (fear of unknown consequences, side-effects, lack of understanding on how vaccines work and rationale for boosters). However, community health volunteers, trusted leaders, mandates, financial and geographic access influenced COVID-19 vaccine uptake. These drivers of hesitancy mainly related to psychological constructs including confidence, complacency, and constraints. Vaccine hesitancy in Kenya is driven by multiple interconnected factors. These factors are likely to inform evidence-based targeted strategies that are built on trust to address vaccine hesitancy. These strategies could include gender responsive immunization programs, appropriate messaging and consistent communication that target fear, safety concerns, misconceptions and information gaps in line with community concerns. There is need to ensure that the strategies are tested in the local setting and incorporate a multisectoral approach including community health volunteers, religious leaders and community leaders.

Perspectives regarding cannabis use: Results from a qualitative study of individuals engaged in substance use treatment in Georgia and Connecticut

Cannabis use is increasingly pervasive throughout the U.S. People in treatment for substance use disorders (SUD) may be especially at-risk of harm due to this changing context of cannabis in the U.S. This study's objective was to qualitatively describe experiences and beliefs around cannabis among people who had entered treatment for any SUD in the past 12-months. From May to November of 2022, we conducted 27 semi-structured interviews (n=16 in Georgia, n=11 in Connecticut) with individuals in treatment for SUD in Georgia and Connecticut. Interviews were recorded, transcribed, and thematically analyzed using an emergent approach. All participants had used cannabis in the past. Four themes emerged from the interviews. Participants: (1) perceived cannabis as an important contributor to non-cannabis substance use initiation in adolescence; (2) viewed cannabis as a substance with the potential to improve health with fewer side effects than prescription medications; (3) expressed conflicting opinions regarding cannabis as a trigger or tool to manage cravings for other non-cannabis substances currently; and 4) described concerns related to negative legal, social service, and treatment-related consequences as well as negative peer perception relating to the use of cannabis. Although participants described cannabis's important role as an initiatory drug in adolescence and young adulthood, many felt that cannabis was a medicinal substance for a range of health challenges. These findings suggest SUD treatment clinicians should address medicinal beliefs related to cannabis among their clients and emphasizes the need for research on cannabis use and SUD treatment outcomes.

Does Western or Chinese Zodiac Sign Predict COVID Infections and Death?

Humans have been fascinated by and studying the sky since the beginning of time. Beliefs in Chinese and Western astrology persist in modern society and have gained increasing interest in light of the COVID-19 pandemic. Zodiac signs are typified by certain qualities, for example, obsessive-compulsive traits in Libras and Virgos or the highly social traits in Leos and Geminis. We investigate whether the various characteristics or personalities purported of assigned birth signs may alter the predisposition to COVID-19 infections or mortality. This is a retrospective, single-center cohort study of 2545 adult patients with confirmed COVID-19 infection presenting to the emergency room over a 14-month period (September 2020 to November 2021). COVID-19 infectivity was determined based on polymerase chain reaction (PCR) testing. Western and Chinese Zodiac signs were designated using date of birth. Both Zodiac signs were evaluated for risk of infection and death. Mortality rates across the zodiac and astrology signs showed no statistical difference using the 12-sample test for equality of proportions. Coincidentally, the mean age for the deceased was 74.5 years, and it was 53.9 years for those alive, resulting in a difference of 20.6 years. A two-sample t-test confirms that the observed difference of 20.6 years of age between the two groups is statistically significant with a p-value <0.05. The coefficient of the predictor age is statistically significant. The odds ratio estimate of age is 1.06, with the corresponding 95% confidence interval (CI) being (1.048, 1.073). This means that the odds of dying increase by 6% for every additional year. Astrology once held a significant impact on beliefs in medicine and continues in Chinese and Ayurvedic medicine. Our study utilized local data to determine if COVID-19 infection rates and mortality might have a relationship to astrological designations of Chinese and Western zodiac signs. Data analysis demonstrated that there was no statistical significance found between Western and Chinese Zodiac signs and mortality or infections. Similar to many previous studies, age can be a risk factor for mortality.

Knowledge, attitude, and utilization of traditional medicine within the plural medical system in West Java, Indonesia

BackgroundThe concept of ‘medical pluralism’ has become more popular among scholars in applied health science and prevalent in societies where one medical system alone cannot adequately meet the health care needs of the entire population.MethodsThe data collection is focused on the knowledge-belief-practice and the utilization of three medical systems in Kabupaten Bandung, West Java, Indonesia. Participants were purposively selected from households with at least one member experienced one of the listed diseases in the questionnaire. The extensive survey using a structured questionnaire has been undertaken to collect data on people’s health care utilization behaviour. The dataset is further analyzed using multivariate analysis through non-canonical correlation, with the analytical data provided by Statistical Package for Social Sciences (SPSS).ResultsWith regards to the total utilization by patients, the traditional medical system presents as the dominant medical system in the research area, accounting for 59.3% (n = 419) of total utilization, followed by the modern medical system (33.0%, n = 233), and transitional medical system (7.7%, n = 54). This study identified that village category, illness, illness duration, occupation, belief in traditional medicine, knowledge of modern medicine, accessibility, cost, proximity to the medical service, and insurance have significant (χ2 = 0.000) relationship with the utilization of medical systems. The results of the multivariate analysis show that the block of the predisposing socio-demographic factors and the block of the predisposing psycho-social factors correlate strongly with the utilization of medical systems.ConclusionsIn general, people in Kabupaten Bandung, West Java, Indonesia seeks treatment from various sources, which in the context of the medical system, consists of the traditional, transitional, and modern medical system; therefore, it adopts the patterns of transcultural health care utilization. In terms of the knowledge, beliefs, and practices of traditional medicine in West Java, the inhabitants of the five research villages were commonly familiar with medicinal plants and speak profoundly about their knowledge of traditional medicine, which in the research area is perceived as accessible, efficacious, affordable and culturally appropriate with Sundanese community.

Beyond Moral Injury - Can We Reclaim Agency, Belief, and Joy in Medicine?

Beyond Moral Injury - Can We Reclaim Agency, Belief, and Joy in Medicine?

P828 Evaluation of adherence and beliefs about medication in patients with Inflammatory Bowel Disease following a novel microlearning programme (The ADEII project)

Abstract Background Information and communication technologies (ICTs) represent a novel approach to chronic disease management. However, their use in Inflammatory Bowel Disease (IBD) is lacking and their results as far unknown, because no specific tools are available. The rate of non-adherence in IBD ranges from 30 to 40%, with medication concerns being one of the main factors. Our aim was to evaluate the outcomes of a novel microlearning programme for IBD patients in adherence and beliefs about medication. Methods Prospective cohort study in adult patients with IBD (18 to 70 years old) who underwent a microlearning programme over a 2-month period, throught 4-minute videos organised in individualised video pathways that were sent via mobile phone using a Telegram bot. All patients received the 4-video main pack, consisting of 2 videos with information about their disease (ulcerative colitis or Crohn's disease), 1 video on adherence and another one on steroid treatment. To these were added as many videos as the number of drugs used by the patient to control IBD. Before starting the programme and at 6 months, patients completed the Medicines Beliefs Questionnaire (BMQ). Adherence was defined as a medication possession ratio (MPR≥80%) at these same dates. MPR values were computed separately for each drug, and patients on combination therapy were considered adherents if they got MPR≥0.8 in every prescribed medication. Results Between 1 June and 31 October 2022, 1226 videos were sent to 200 IBD patients: 51.5% female (103), UC 52.5% (105), mean age 46.1 (13.2) years (Table 1). Median number of videos per patient was 6 (6-7). Attendance to ADEII programme ranged between 78% and 90%. Prior to the study, Initial non-adherence was 29.8% (59 patients), decreasing significatively to 18.1% (36) after the programme (p=0.02). Regarding BMQ test, we also found significant differences between the pre-intervention versus post-intervention medians and IQR of General BMQ score 18 (15 -21,8) vs. 17 (13.3 - 20) (p=0,001), BMQ-Overuse score 8 (7 -9) vs. 8 (6 -9) (p=0,027), BMQ-Harm score 10 (8 -12) vs 9.5 (7-11) (p=0,002) and BMQ-Concern score 13,5 ( 11-16) vs 13 (10-16) (p=0,001), with no changes in BMQ Global Specific and BMQ-Necessity scores. Conclusion Patients with IBD widely accepted an ICT-based educational program, which improved adherence, along with a decrease in negative ideas or beliefs about medications.

Who Beliefs in Alternative Medicine?

Who Beliefs in Alternative Medicine?

Eksplorasi Pengaruh Pandemi COVID-19 Terhadap Diagnostic Delay Dan Treatment Delay Pada Pasien Kanker Payudara

The COVID-19 pandemic has had an impact on health services for breast cancer patients. During the COVID-19 pandemic, there were new government regulations, namely PSBB or large-scale social restrictions. During the PSBB, activities in public facilities are limited to only urgent interests. Therefore, breast cancer patients have difficulties during examination and treatment during the COVID-19 pandemic. The obstacles for breast cancer patients are difficulties in mobilizing to the hospital, health protocol regulations such as maintaining distance, discomfort when wearing masks and swabs before treatment, the emergence of fear and anxiety, expensive transportation costs during examination and treatment, and psychological disorders. So the impact is delay in examination (diagnostic delay) and delay in treatment (treatment delay) of breast cancer patients. This study uses a qualitative descriptive method with an in-depth interview approach that is guided by semi-structured questions and triangulates the perspectives of patients, patients' families, and health workers. The study was conducted from November 2021 to August 2022. The sample used was 27 respondents by purposive sampling. Analysis using condensed text system. There are breast cancer patients who express fear of seeking treatment during the COVID-19 pandemic because of the increasing number of pandemic cases and the stigma of being "covided". However, there are patients who express that they are not afraid to seek treatment during the pandemic because they have an optimistic and strong faith. Patients have problems seeking treatment during the pandemic due swab before treatment, feeling uncomfortable when wearing a mask, and transportation costs constraints. Patients experience diagnostic and treatment delays during the pandemic due to fear of being infected with the corona virus, lack of knowledge about symptoms and treatment of breast cancer, belief in alternative medicine, shyness to carry out initial examinations, fear of medical action, and queue lists. Based on the results of the study, it can be concluded that there are internal and external factors that influence the COVID-19 pandemic on diagnostic delay and treatment delay in breast cancer patients

Hybridization between biomedicine and alternative medicine in COVID-19 care in a neo-rural population of Córdoba, Argentine

We propose to investigate if the use and knowledge of medicinal plants and alternative medicine influence the adoption of biomedical strategies in dealing with COVID-19 - such as the use of masks, social isolation, and vaccination - in a context of a neo-rural population. We collected data through online questionnaires, using the Google Forms platform in the “Paravachasca Valley”, Córdoba, Argentine. The questionnaires, anonymous, contained multiple choice questions about attitudes and opinions concerning prophylactic strategies against COVID-19. To test whether the use or knowledge of medicinal plants is associated with trust in the efficiency and adoption of biomedical strategies, we used a chi-square test of independence. We saw that this neo-rural population does not differ from urban populations in terms of the proportion of people who deny biomedical strategies to prevent COVID-19. Furthermore, we verified that the knowledge about medicinal plants is related to distrust and reluctance to the adoption of the use of masks, social isolation, and vaccination. Also, our results suggest that alternative medicine users are afraid of the vaccine effects. In this plural medical context of a neo-rural population, belief in alternative medicines for the treatment of COVID-19 can be an obstacle to immunization programs.

Nutritional Knowledge and Dietary Habits among Diabetic Patients at the Bono Regional Hospital, Sunyani, Ghana

Background: The rising mortality rate of diabetes mellitus and the upsurge in diabetes complications is very alarming. This has been attributed to the poor knowledge patients living with diabetes have on diabetes and its management, especially the nutritional management.&#x0D; Objective: This study sought to explore the knowledge on knowledge on diabetes and nutrition among patients living with diabetes mellitus who attended clinic at the Bono Regional Hospital.&#x0D; Methods: A cross-sectional descriptive quantitative research design was used for this study. Simple random sampling was used to recruit 150 participants for the study. The participants were interviewed using a semi-structured questionnaire. Respondents were recruited from the clinic until the desired sample size was obtained. A pre-tested interviewer-administered questionnaire was used to collect data. Dietary habits were assessed using food frequency questionnaire and BMI was assessed following standard procedure and compared with the World Health Organization (WHO) standards. Data was analyzed using IBM SPSS (Version 20). Chi-square test was used to determine the association between variables. The level of significance was set at p-value less than 5%.&#x0D; Results: The study revealed that the participants have adequate knowledge on DM and Nutrition. Majority of Participants in had high knowledge on diabetes and nutrition, 77.3%. This was associated with adequate education by their health care providers and with strong beliefs in modern medicines as well as diet therapy, which influenced attitudes and practices on Diabetes. Overall, good dietary practice among the participants was 57.3%. Age and level of education were found to be significantly associated with knowledge of diabetes and nutrition whiles gender, religion, occupation, ethnicity, marital status were not significantly associated with knowledge level of diabetes and nutrition.&#x0D; Conclusion and Recommendation: Dietary counselling will be necessary to improve the dietary pattern and nutritional status of the diabetic patients.

THE BELIEFS OF HEALTH SEEKING BEHAVIOR FISHERMEN IN COASTAL PUGER JEMBER REGENCY

The high health risks of working as fishermen increase the potential for health seeking behavior of fishermen. Health seeking behavior is also applied by the Puger community, which is a southern coastal area in Jember Regency, although based on a preliminary study not a few of them ignore their health problems. This type of research is a quantitative research with a cross sectional approach. A sample of 110 respondents was taken by simple random sampling from a population of 5247 fishermen and domiciled in Mandaran Hamlet and Krajan Hamlet, Puger Wetan Village, Puger District, Jember Regency. The resulting data were tested using logistic regression. The result showed that trust has a significant effect with p &lt;α value of 0.000 &lt;0.05. Someone who has a belief in modern medicine tends to have a 21.333 greater influence in determining treatment seeking behavior compared to respondents who have a belief in traditional medicine. Suggestions need to be explored more deeply in each type of belief in fisherman's health seeking behavior using qualitative methods.and health promotion on safe treatment seeking behavior for fisherman's health.

COVID-19 Vaccine Hesitancy

In this article, hesitancy towards COVID-19 vaccinations is investigated as a phenomenon touching upon existential questions. We argue that it encompasses ideas of illness and health, and also of dying and fear of suffering. Building on a specific strand within anti-vaccination studies, we conjecture that vaccine hesitancy is, to some extent, reasonable, and that this scepticism should be studied with compassion. Through a mixed methods approach, vaccine hesitancy, as it is being expressed in a Swedish digital open forum, is investigated and understood as, on the one hand, a perceived need of protecting one’s body from techno-scientific experiments, and thus the risk of becoming a victim of medicine itself. On the other hand, the community members express what we call a tacit belief in modern medicine by demonstrating their own “expert” pandemic knowledge. The analysis also shows how the COVID-19 pandemic triggers memories of another pandemic, namely the swine flu in 2009–2010, and what we term a medical crisis that occurred then, due to a vaccine that caused a rare but severe side effect in Sweden and elsewhere.

Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India-a community-based mixed methods study.

Evidence suggests that healthcare utilization among tribal communities in isolated regions can be influenced by social determinants of health, particularly cultural and geographical factors. The true mortality and morbidity due to these factors in remote tribal communities are often underestimated due to facility-dependent reporting systems often difficult to access. We studied the utilization of health services for maternal and newborn care and explored how cultural beliefs, perceptions, and practices influence the health-seeking behavior (HSB) of an indigenous tribal community in Northeast India. Within a concurrent triangulation design, the combined results from 7 focus group discussions and 19 in-depth interviews, and the 109 interviews of mothers from a community-based survey were interpreted in a complementary manner. The qualitative data were analyzed using a conceptual framework adapted from the socio-ecological and three-delays model, using a priori thematic coding. Multivariable logistic regression was carried out to identify factors associated with home delivery. Only 3.7% of the interviewed mothers received the four recommended antenatal check-ups in health centers, and 40.1% delivered at home. Mothers residing in the villages without a health center or one that was not operational were more likely to deliver at home. HSB was influenced significantly by available finances, the mother's education, low self-esteem, and a strong belief in traditional medicine favored by its availability and religious affiliation. The community sought health services in facilities only in emergency situations, determined primarily by the tribe's poor perception of the quality of health services provided in the irregularly open centers, locally available traditional medicine practitioners, and challenges in geographical access. National schemes intended to incentivize access to facilities failed to impact this community due to flawed program implementation that did not consider this region's cultural, social, and geographical differences. The health-seeking behavior of the tribe is a complex, interrelated, and interdependent process framed in a medical pluralistic context. The utilization of health centers and HSBs of indigenous communities may improve when policymakers adopt a "bottom-up approach," addressing structural barriers, tailoring programs to be culturally appropriate, and guaranteeing that the perceived needs of indigenous communities are met before national objectives.

Development and validation of a Medication Adherence Universal Questionnaire: the MAUQ

BackgroundDifferent questionnaires assess self-reported medication adherence and others quantify aspects of patients attitudes towards medication, but not together in a single instrument. Gathering these two aspects in a single instrument could reduce patients survey burden.AimThe aim of this study was to develop the Medication Adherence Universal Questionnaire (MAUQ) using the Maastricht Utrecht Adherence in Hypertension short version (MUAH-16) factorial structure as the hypothesized model.MethodA multistep process started with the modification of the MUAH-16 to obtain the MAUQ. Patients using at least one antihypertensive medicine were recruited. The two questionnaires, the MUAH-16 and MAUQ, were applied. A confirmatory factor analysis (CFA) was performed using the initial MUAH-16 s-order 4-factor model. An additional bifactor model with four uncorrelated factors and an overall score was tested. The comparative fit index (CFI), root mean square error of approximation (RMSEA) with confidence intervals (CIs), and standardized root mean squared residual (SRMR) were used to assess both models.ResultsA sample of 300 hypertensive patients completed the instruments. The CFA with the second-order 4-factor solution resulted in similar results for the MUAH-16 and MAUQ: CFIs of 0.934 and 0.930, RMSEAs of 0.043 [CI 0.030–0.056] and 0.045 [CI 0.031–0.057] and SRMRs of 0.060 and 0.061, respectively. The CFA with the bifactor model showed slightly better results for both the MUAH-16 and MAUQ: CFIs of 0.974 and 0.976, RMSEAs of 0.030 [CI 0.005–0.046] and 0.028 [CI 0.001–0.044], and SRMRs of 0.043 and 0.044, respectively.ConclusionCFA demonstrated that the MAUQ presented a better fit to both models than the MUAH-16, obtaining a robust universal free instrument to assess medicine-taking behaviour and four medicine beliefs components.