Caregiver Attitudes Research Articles

Palliative and Supportive Care for Patients with End-Stage Hepatocellular Carcinoma: Perspectives of Egyptian Domestic Caregivers.

Palliative care is a holistic, patient-centered approach to improving the quality of life for those with terminal diseases and their families. The main objective of the current study was to evaluate the Egyptian domestic caregivers' knowledge, attitudes, and competencies related to palliative and supportive care. Three hundred and thirty-five family caregivers in total were recruited. A descriptive research design was used. Four tools were used to collect data; structured interview questionnaire to collect demographic questions, palliative care knowledge questionnaire, Palliative Attitude Scale, and Competence Scale. The study was conducted in oncology outpatient and pain clinics located at the Damietta Cancer Institute in Damietta Governorate, Egypt. Nearly two-thirds of the informal family caregivers are aged between 30-40 years old; 54% are female, and 83% are married. Also, sixty-seven point eight of the informal family caregivers were working (part-time). Furthermore, 65 % of them had insufficient knowledge, 68 % had a positive attitude, and 58% of the informal family caregivers had non-competency skills regarding palliative and supportive care. Approximately two-thirds of informal care providers had insufficient total knowledge scores, more than half possessed a positive attitude, and more than half reported non-competency skills regarding palliative care of hepatocellular patients. It is highly advisable to launch extensive health education programs and campaigns aimed at all of the unpaid informal family careers of patients with serious terminal illnesses, including hepatocellular carcinoma, at various governments with greater sample sizes.

Caregivers' Experiences Regarding Antibiotic Usage in Treating Children's Upper Respiratory Tract Infections in Southern Tanzania.

Upper respiratory tract infections (URTIs) are common illnesses, especially in children and account globally for a substantial proportion of consultations with family doctors. The objective of this study was to assess knowledge, attitude and practice of caretakers regarding antibiotic usage in treating URTIs in Southern Tanzania. A cross-sectional hospital-based study was conducted at Iringa Regional Referral Hospital in Southern Tanzania from March to June 2022 involving 300 caregivers. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 23. About two-thirds (71.7%) of the caregivers had poor knowledge regarding antibiotic usage in treating children's URTIs. In this study, 96.7% of the caregivers correctly identified amoxicillin as the most prescribed medication for treatment of children's URTIs. However, about two-thirds (65.0 %) of the parents were aware of the antibiotic resistance that could be caused by misuse of antibiotics. In this study 50.7% of the respondents had poor attitude while 49.3% had good attitude regarding antibiotic usage in treating children's URTIs. Similarly, 53% of the respondents thought local medications are better than antibiotics in treatment of URTIs. Regarding practices, 75.3% of the respondents used to complete the dose of antibiotics when prescribed for treatment of URTIs and 69.7% used to treat their children at home when having URTIs. A significant association was found between the majority of the socio-demographic characteristics of the respondents and the level of knowledge. Similarly, there was a statistically significant association between knowledge and attitude of caregivers pertaining to antibiotic usage in treating children's URTIs. There is lack of knowledge among caregivers regarding antibiotic usage for treating children's URTIs at the regional hospital and also more than half of the caregivers had poor attitude towards antibiotic usage. Therefore, caregiver's educational interventions should be implemented through health promotions and educational campaigns that should be mainly conducted by medical doctors since they were reported by the caregivers to be the commonest source of information.

Parental knowledge and attitudes toward asthma in Jordanian children with asthma, a multi-center cross-sectional study

Objective We explored Jordanian caregivers’ knowledge, attitudes, and practices (KAP) toward asthma in their children. Methods This cross-sectional investigation was conducted on caregivers visiting the pediatrics clinic at the Jordan University Hospital and King Abdullah University Hospital between December 2021 and January 2023. KAP were measured using a literature-validated questionnaire. Differences in KAP scores across participants’ characteristics were examined using the student-t test and ANOVA. Results A total of 108 caregivers were included in the final analysis. Caregivers were aged 30 to 40 years (54.6%) and had at least secondary education (90.7%). The majority of participants displayed appropriate knowledge with respect to asthma’s clinical course. Furthermore, the greater portion of caregivers were knowledgeable about preventing asthma attacks and treating their children during said attacks. Factors affecting knowledge of asthma included age of mothers (p < .05). On the other hand, attitude scores were affected by occupation, type of medication, and family history of asthma (all p < .05). Moreover, employee mothers, children well controlled on both Asthma Control Test and Global Initiative for Asthma scores, and having no pediatric intensive care unit admissions were associated with higher practice treatment scores (all p < .05). Overall practice score was weakly, yet positively correlated with knowledge scores (r = 0.195, p = .043). Similarly, negative attitudes were weakly correlated with higher knowledge scores (r = 0.199, p = .039). Conclusion While the knowledge and practice scores were satisfactory, the clinical status of children with asthma was unsatisfactory. Future studies should examine factors associated with caregiver insecurity and measure their extent of applying asthma prevention guidelines.

Caregiver knowledge and attitudes relating to paediatric pneumonia and antimicrobial stewardship: a qualitative study

ObjectiveThe objective of this study was to understand caregiver perspectives and experiences relating to the treatment of paediatric community-acquired pneumonia (CAP).Design, setting and patientsThis was a phenomenological qualitative study involving...

1734. Influenza, SARS-CoV-2, and routine childhood vaccines – trends in vaccine hesitancy in hospitalized children before and during the COVID-19 pandemic

Abstract Background Vaccine hesitancy (VH) is adversely affecting the public health response to the COVID-19 pandemic. Similarly, influenza vaccine uptake is suboptimal. We monitored trends in VH to influenza, COVID-19, and routine childhood vaccines. Methods A repeated cross-sectional survey in English and Spanish of caregiver influenza and COVID-19 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 mo-18 yrs at a pediatric hospital. We enrolled over 4 seasons (S); ‘19-20 (S1), ‘20-21 (S2), ‘21-22 (S3), ‘22-23 (S4). In S4, we targeted caregivers of children 6 mo-11 yrs. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥ 50 denoted VH. In S4, a messaging intervention was piloted. Caregivers were randomized to watch 1 of 2 COVID-19 educational videos; half watched a second video featuring a family adversely impacted by COVID-19. All caregivers completed a survey to assess acceptance and efficacy of the video(s) in changing intent to vaccinate their child. Figure 1. Participant flow chart from 2019-2023 Results Across all seasons, ≥ 92% of caregivers approached were enrolled. Most (48%) identified as Hispanic/Latino, 35% as White, and 19% as Black. By parental report, 94% of children in S1, 91% in S2, 91% in S3, and 89% in S4 were up-to-date with routine vaccines. Based on PACV score, 13% were VH in S1, 17% in S2, 19% in S3, and 20% in S4 (p=0.14). During S2-3, fewer caregivers endorsed “flu can be a dangerous infection in children” and “I am scared of my child getting the flu” (p&amp;lt; 0.01). Decreased concern recovered in S4 but did not translate to increased vaccine uptake (Table 1). Caregivers were less scared of their child getting COVID-19 and more scared of the vaccine in S4. Fewer caregivers in S4 were willing to receive the COVID-19 vaccine; 46% in S2, 54% in S3, and 29% in S4 had/planned to vaccinate their child (Table 2). Of 800 caregivers, 74% liked the educational videos and 54% thought they were helpful when considering the COVID-19 vaccine for their child. Of 399, 73% liked the family story and 50% thought it was helpful. Table 1. Trends in caregiver attitudes regarding the influenza vaccine Table 2. Trends in caregiver attitudes and vaccine acceptance during the COVID-19 pandemic Conclusion Parental concern regarding influenza is largely back to pre-pandemic levels but vaccine acceptance has not recovered. Vaccine uptake against COVID-19 remains suboptimal. Educational videos may help caregivers when deciding about the COVID-19 vaccine for their child. Disclosures C.Mary Healy, MD, Dexcom Inc: Stocks/Bonds|Intuitive: Stocks/Bonds|Quidel Corporation: Stocks/Bonds|Up to Date: Honoraria|Vapotherm: Stocks/Bonds Claire Bocchini, MD, Pfizer: Local sub-I for pediatric SARS-CoV-2 vaccine trials

Who Cares About Caregiving?: Identity and Caregiving Policy Perspectives

Abstract Using original data collected from YouGov panelists in July of 2021, we examine caregiving experiences and attitudes toward caregiving policies, taking into consideration how intersecting identities shape the perspectives of caregivers. We examine the racial, ethnic and gender dimensions of who provides care, and how the pandemic affected caregiving commitments. We find that communities of color, especially women of color, experienced pandemic caregiving pressures differently than their White counterparts. We further consider public opinion on caregiving policies and explore whether and how these attitudes vary between men and women and across racial, ethnic groups and partisan groups. We find that while interesting differences do exist among different populations, and these differences are worth reflection, policies that support caregivers and caregiving recipients are, on balance, very popular.

Factors influencing the engagement of older adults with neurocognitive disorders in the design of decision aids: A qualitative descriptive study

ObjectiveTo identify factors influencing the engagement of older adults with neurocognitive disorders (NCDs) in the design of decision aids (DAs). MethodsWe conducted a qualitative descriptive study using semi-structured interviews with 23 older adults with NCDs who were accompanied by 27 caregivers. This is a secondary analysis of a published study to identify the features of DAs designed for this population and their caregivers. ResultsSeveral behaviours and attitudes of caregivers and researchers hindered the older adults’ engagement in the DA design process. Specific communication strategies can be employed to support their engagement and overcome the communication challenges inherent to this population, such as memory, attention, hearing, or visual impairments. Adopting the appropriate attitude, taking the time, and providing guidance to the older person can help them focus on the topic, while developing trust between participants is a facilitator to obtain their feedback. ConclusionFindings from this project could serve to inform the communication and co-design of DAs with older people with NCDs and their caregivers. Practice implicationsCaregivers and researchers have key roles to play in facilitating communication with older persons with NCDs so they are empowered to help in co-designing DAs.

Caregivers’ Perception and Attitude towards Child Mental Health in Beni Suef Governorate, Egypt

Background: The World Health Organization recognizes the lack of public information about children and adolescents’ mental health (CAMH) disorders as a barrier to seeking help. This study assessed the current knowledge and attitudes of caregivers about CAMH problems in Egypt. Methods: A total of 1937 caregivers attending primary health care centers in Beni Suef, Egypt, were surveyed using the Arabic version of the University of Chicago Behavior Health Questionnaire (UCBHQ). Results: We found a statistical significance of positive attitude towards CAMH in parents’/caregivers’ who were females, relatively young, or had a higher educational degree. Due to the influence of media and negative publicity, caregivers were wary of the adverse effects of psychoactive medications and MH treatment. We also identified participants who had previously attended MH workshops or had a family member with mental illness were skeptical about existing MH services. Cultural background and spirituality were not a barrier to seeking MH care in this study. Conclusion: Findings highlight the need to utilize social media, television ad campaigns, and print fora to raise awareness about stigma, etiology of MH problems, and evidence-based treatments targeting gender and age-specific population.

Understanding caregivers' decision to vaccinate childhood cancer survivors against COVID-19.

Vaccination against COVID-19 is recommended for childhood cancer survivors (CCS). This study aimed to identify antecedents contributing to caregivers' decisions to vaccinate CCS aged 5-17 years against COVID-19 by applying the Theory of Planned Behavior. Participants in this cross-sectional study completed an online survey assessing caregiver attitudes, subjective norms, perceived behavioral control, intention to vaccinate CCS, CCS vaccination status, COVID-19 health literacy, and frequency of COVID-19 information-seeking. Surveys were completed between May and June 2022 following approval for the emergency use of COVID-19 vaccines among children aged ≥5 years in the U.S. Data were analyzed using unadjusted linear regressions and structural equation modeling. Participants were caregivers (n = 160, 87.5% biological mothers, 75.6% white/non-Hispanic) of CCS (n = 160, 44.4% female, mean (M) = 12.5 years old, M = 8.0 years off treatment). 70.0% (n = 112) of caregivers and 53.8% (n = 86) of CCS received a COVID-19 vaccine. Over one-third (37.5%) of caregivers reported disagreement or indecision about future COVID-19 vaccination for the CCS. Caregivers' intention (β = 0.962; standard error [S.E.] = 0.028; p < 0.001) was highly related to CCS vaccination status. Attitudes (β = 0.568; S.E. = 0.078; p < 0.001) and subjective norms (β = 0.322; S.E. = 0.062; p < 0.001) were associated with intention. Higher frequency of COVID-19 information-seeking (β = 0.313; S.E. = 0.063; p < 0.001) and COVID-19 health literacy (β = 0.234; S.E. = 0.059; p < 0.001) had a positive indirect effect on intention through attitudes and subjective norms. Caregivers' vaccination intentions for minor CCS are highly related to vaccination behavior and shaped by attitudes, subjective norms, COVID-19 health literacy, and frequency of COVID-19 information-seeking. Promoting tailored communication with caregivers of CCS and encouraging them to review reputable sources of information can address their vaccine hesitancy.

Study to Assess the Knowledge and Attitude of Caregivers Regarding Selected Old Age Health Problems in Selected Rural Areas of Bagalkot District

Study to Assess the Knowledge and Attitude of Caregivers Regarding Selected Old Age Health Problems in Selected Rural Areas of Bagalkot District

Gender differences in caregiver attitudes and unmet needs for activities of daily living (ADL) assistance among older adults with disabilities

BackgroundWith a rapidly ageing population and a decline in the availability of family caregivers, the number of older adults with disabilities who have unmet long-term care needs is gradually increasing worldwide. However, whether there are gender differences in the association between primary caregivers or their attitudes and unmet needs for activities of daily living (ADL) assistance remains largely unknown.MethodsThis study used the latest 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), containing the data of 1187 older adults with disabilities aged 65 and older, to identify gender differences in the attitudes of primary caregivers toward the unmet needs for ADL assistance among with disabilities adults in China. Binary logistic regression analysis was conducted to determine the effects of primary caregivers and their caregiving attitudes on the unmet care experiences of older adults with ADLs. In addition, a gender-stratified analysis was conducted to compare the differences based on older adults’ gender.ResultsThe results revealed that the lack of positive attitudes from primary caregivers might create a situation of unmet needs for ADL assistance among older adults. When family members carry the main burden of care, older adults with disabilities, especially older women, have a lower level of unmet needs for ADL assistance. Therefore, it is important to consider gender-specific interventions to improve ADL assistance among older adults.ConclusionsThe findings suggest that the presence of a family member as a caregiver has a significant effect on unmet needs for ADL assistance in women, highlighting the importance of developing an emotional bond with the caregiver. Given that the availability of informal caregivers, such as family members, is declining, it is crucial to provide financial assistance and formal services, such as paid home services and community-based care services, and reduce the burden on family caregivers to address the unmet needs for ADL assistance among older adults with disabilities in China.

Nigerian parents and caregivers knowledge, attitude and willingness to vaccinate their children against COVID-19.

In order to achieve herd immunity against COVID-19, a significant proportion of the population will need to be vaccinated. Experts have recommended that African children be allowed to get vaccinated to protect them from emerging variants of COVID-19 infection. This study investigated Nigerian parents and caregivers' knowledge, attitude, and willingness to vaccinate their children against COVID-19 once the vaccines are made available to them. A cross-sectional online survey of 500 parents/caregivers was conducted in Nigeria. Participants were asked to complete a questionnaire about their sociodemographic characteristics, knowledge of and attitude toward COVID-19 infection and vaccination, willingness to vaccinate their child and factors that could influence their decision to vaccinate their child. A scoring system was used to classify the level of knowledge and attitude of participants into 2 categories, namely poor, and good. We analyzed data obtained using SPSS Version 22. Majority of the participants were females (63.6%). Analysis of responses revealed good knowledge and attitude in 265 (53.0%) and 266 (53.2%) respondents, respectively. Overall, less than half of the parents/caregivers (48.4%) expressed intention to vaccinate their children against COVID-19. Factors associated with willingness to vaccinate children against COVID-19 included age greater than 40 years, male gender, residing in Southern Nigeria, having good knowledge, knowing an infected person or a vaccinated person, feeling they or their child is at risk of contracting COVID-19 infection, willingness to vaccinate self against COVID-19 and good attitude. Significant predictors of willingness to vaccinate their child include age greater than 40 years [AOR: 2.56; 95% CI = (1.14-5.76)], willingness to vaccinate self [AOR: 1016.81; 95% CI = (128.51-8045.60)] and good attitude [AOR: 6.21; 95% CI = (2.83-13.64)]. This study revealed that parental willingness to vaccinate their children against COVID-19 is low and identified factors influencing it. It is important to develop and implement health education programs iterating the risk of children getting infected with SARS-CoV-2 and its emerging variants to ensure optimal uptake of the COVID-19 vaccine in Nigerian children.

The audience impact of an ethnodrama based on the lived experiences of family caregivers of loved ones with a mental illness

There is paucity of research on the issues concerning family caregivers of loved ones with mental illness despite an increasing awareness of the importance of caregiving as an essential component of care. In this study, we examine the impact of an ethnodrama to (1) authentically reflect the experience of caregivers for people diagnosed with a mental illness and (2) impact audience beliefs and feelings about mental health and caregiver realities. Two focus group sessions were held with 21 family caregivers from a community support group from which an ethnodrama was developed and then presented across four performances to a total of 110 audience members. Audience members completed pre- and post-performance questionnaires containing items related to stigma, respect, caregiving attitudes and self-evaluation. Results indicated that audience members reported the play to realistically reflect the reality of caregiving for a loved one with mental illness, and statistical analyses revealed significant pre-post changes in the four categories of beliefs and feelings examined. The results indicate that witnessing the performance was a valuable educational experience and that ethnodrama has a place in mental health and mental illness education.

Awareness and Attitude of Parents and Caregivers Regarding Harmful Traditional Medical Practices Towards Children in Aseer Region of Saudi Arabia.

Traditional medicine has potential benefits, but distinguishing safe from risky procedures is crucial for safeguarding children's health. Harmful practices in Aseer Region of Saudi Arabia, deeply rooted in cultural heritage, require scrutiny of parental attitudes and awareness. The study aims to investigate and analyze the awareness, attitudes, and associated factors contributing to Harmful Traditional Medical Practices towards children in Aseer Region of Saudi Arabia. This study employed a cross-sectional design, using an online survey to collect data via a structured questionnaire developed from an extensive literature review on harmful traditional child medical practices in Aseer Region of Saudi Arabia. The study found that most respondents were aged 41-49 years (42.4%), lived in cities (77%), had at least an undergraduate degree (50.1%), and favored traditional medicine (55.9%). Common traditional medicine choices included "Herbs" (28.4%) and "Belly massage" (27.6%). Age significantly affected treatment preferences, while "Place of Resident" and "Education Level" hinted at potential differences. Personal experiences (37.2%) and family networks (31.4%) were key sources of information. Logistic regression analysis uncovered intricate links between sociodemographic and traditional medicine practices. Respondents' views on "Awareness", "Effectiveness", and "Complications" demonstrated notable statistical significance, influencing parents' and caregivers' perspectives in the study. The study's outcomes underscore the imperative for heightened awareness and education concerning the potential hazards and complications tied to harmful traditional medical practices among parents and caregivers in Aseer Region of Saudi Arabia, particularly with regard to their children's well-being. The evident inclination towards traditional medicine, reliance on personal experiences and familial networks for healthcare insights, and reservations regarding contemporary medical approaches underline the significance of addressing cultural beliefs.

잠재계층분석을 이용한 한국 청소년 사이버불링 가해행태 분석

This study aims to categorize adolescent cyberbullying perpetration using a person-centered approach, as opposed to the conventional variable-centered method. The goal is to create an academic foundation for tailoring cyberbullying prevention strategies that align with unique perpetration patterns shown by individual adolescents. To achieve this goal, the study utilized data from the 「Korean Children and Youth Welfare Panel Study 2018」conducted by the Korea Institute of Child and Adolescent Welfare. Using Latent Class Analysis (LCA), we identified latent groups of adolescents with comparable cyberbullying perpetration patterns. These groups were then studied to uncover distinctions in demographic charateeristics (gender), mental health factors (aggression, depression, grit), antisocial behaviors (delinquency), and relational factors (teacher relationships, friendships, parental caregiving attitudes). The key findings are as follows: First, a statistically significant model has been derived, which includes two to five latent groups, each displaying unique patterns of cyberbullting perpetration behavior. Second, considering model fit, types of perpetration behavior, and sample sizes, a four-group latent model has been determined as the most appropriate for achieving the research objectives. These four latent groups are labeled as: 'Low-Level Perpetration Group (n=2,087)', 'Verbal Aggression · Cyber Prison · Flaming Concentrated Group (n=36)', 'Verbal Aggression Concentrated Group (n=74)', and 'High-Level Perpetration Group (n=5)'. Third, there are no significant differences observed in the characteristics of the members within each latent cyberbullying perpetration group. However, unexpected outcomes are noted concerning delinquency, teacher relationships, and positive parental caregiving attitudes (warmth, autonomy support, structure). Consequently, the need for further research on categorizing types of adolescent cyberbullying perpetration and conducting detailed analyses for each type is proposed.

Knowledge and Attitude of Caregivers in Paediatrics’ HIV Management and Viral Suppression in Lagos State, Nigeria

This study assessed the knowledge, attitude and practices of caregivers of children living with HIV (Human Immuno-Deficiency Virus) in Lagos State, Nigeria. A cross-sectional study was conducted among 500 caregivers of children living with HIV who reside and are receiving treatment in a government health facility in Lagos State. The Sampling technique was purposive sampling based on some inclusion and exclusion criteria, data collection was administered by telephone interview, and the questionnaire was deployed using CAPI (Computer Assisted Personal Interviews) (Kobo Collect) for ease and time management. The study discovered that caring for children living with HIV is demanding. As most of the caregivers are married, and self-employed. The majority of the children living with HIV in this study have been on antiretroviral therapy (ART) for at least 5 years. Most caregivers are parents of the infected child/children living with HIV. Additionally, most caregivers had a good knowledge of HIV transmission and prevention, but they had limited knowledge of paediatric HIV management and had negative attitudes towards HIV. They also reported experiencing stigma and discrimination. These findings suggest that there is a need to improve the knowledge and attitudes of caregivers in order to improve the management of paediatric HIV, Interventions should be designed to address the stigma and discrimination experienced by caregivers. Accurate information should be provided to caregivers about paediatric HIV and paediatric HIV management. The results from this study may not be generalizable to other settings as this study was conducted in Lagos State. In addition, the study relied on self-reported data, which may be subject to bias. Keywords: Attitude, Caregiver, HIV, Knowledge, Practice and Viral Load.

Knowledge, attitudes, and practices of caregivers on childhood immunization in Okaikoi sub-metro of Accra, Ghana.

Immunization remains one of the most cost-effective health interventions. However, there are still issues of vaccine hesitancy especially in caregivers who are required to protect their children from vaccine-preventable diseases. This thwarts the overall vaccine coverage in disease-endemic areas such as sub-Saharan Africa. Therefore, to determine the factors that promote vaccine hesitancy in caregivers, this study sought to assess the knowledge, attitude, and practices of caregivers on childhood immunization in Okaikoi, a sub-metro of Accra in Ghana. A cross-sectional study on childhood immunization was conducted to determine the knowledge, attitudes, and practices of caregivers. A total of 120 caregivers with infants aged 12 months to 23 months were interviewed with a structured questionnaire containing open-ended and closed-ended queries. From the community, infants whose caregivers had adhered completely to immunization constituted 53.3% while the rest were partially immunized. The two main deterrents to complete immunization were time constraints (25.8%) and forgetfulness (17.5%). It was observed that vaccination uptake and maternal level of education, as well as vaccination adverse reaction, did not impact the completion of the EPI program by these caregivers. Unfortunately, it was noted that caregivers with higher education levels were unable to complete their vaccination schedules due to their busy work schedules. Nonetheless, the main deterrent to adhering to complete childhood immunization was poor maternal knowledge (58%). The study revealed that, the caregivers in the community had poor knowledge on vaccination and its benefits, and therefore, with no strict adherence to vaccination schedules. This promoted the incomplete immunization of children in the community by their caregivers. Also, since the main source of information with regard to immunization in the sub-metro was through the antenatal and postnatal child welfare clinics and the media, we recommend that the health workers collaborate with media personnel to ensure that standardized information is disseminated.

Perceptions of the influence of a mobile phone-based messaging platform on caregiver ECD knowledge, attitudes and practices: a qualitative exploration in an informal settlement in Nairobi

BackgroundPrograms supporting initiatives for children younger than three years are inadequate and not accessible to many families, particularly in resource-limited settings. Many primary caregivers have little knowledge on how to monitor the development of their children or the importance of engaging children in stimulative activities during the course of early development. Health system limitations make it difficult for health workers to educate and demonstrate stimulative engagement to caregivers. The massive use of technology can be used to facilitate access to growth and development programs for children. We developed and implemented a mobile phone technology to help caregivers monitor and stimulate their children’s development in real-time. This study explored the influence that this intervention had on the caregivers’ early child development (ECD) knowledge, attitudes and practices.MethodsIn this qualitative cross-sectional study, we conducted interviews through eight (8) focus group discussions, three (3) key informant interviews and 9 indepth interviews among a total of 111 participants including primary caregivers (n = 87), community health volunteers (CHVs) (n = 21) health managers and workers (n = 3) to determine their attitudes and experience with the intervention with regards to improving their KAP. Interviews were audio-recorded, transcribed, and analyzed thematically.ResultsCaregivers and CHVs reported that the intervention had provided them with new knowledge that positively influenced their ECD caregiving attitudes and practices. CHVs and health workers and managers reported that the intervention had provided caregivers with confidence in caring for their children while increasing their knowledge on how to monitor and stimulate their children’s development.ConclusionMobile phone technology can be effectively used to enhance caregivers’ knowledge of ECD and enable them to monitor and support their children’s development in real-time.Trial registrationThe trial was registered with the Pan African Clinical Trial Registry (www.pactr.org) database (ID number: PACTR201905787868050 Date: 6/05/2019.

Generic substitution of epinephrine autoinjectors: Patient and caregiver perceptions and attitudes

It is important to understand and address patient and caregiver perceptions about and attitudes toward generic substitution of drug-device combination products. The goal of this study was to explore how differences in design and usability features of epinephrine autoinjectors (EAIs) affect patients' and caregivers' views of product quality, efficacy, and device usability in an emergency setting and to better understand attitudes about and perceptions of EAI substitution. This qualitative, enhanced focus group study was conducted in the United States among adult and adolescent EAI users. Ajourney mapping exercise was used to explore patient and caregiver perceptions of and barriers to switching to a generic EAI. Discussion topics also focused on questions participants would ask, challenges they would face, and actions they would take if they were switched to a generic EAI. While patients and caregivers were interested in the potential cost savings and increased access to treatment offered by generic EAIs, they wanted to be informed by their prescriber or pharmacist about generic substitution before or when it occurs. In terms of design differences, participant feedback most often related to differences in look and feel (eg, size, force to execute user tasks, hand grip) or functionality and design differences (eg, the generic version has a twist-off cap at the needle end, and the brand-name EpiPen does not). Outcomes from these focus groups suggest opportunities for the US Food and Drug Administration, health care professional organizations, and patient advocacy organizations to improve generic drug literacy among adults, adolescents, and health care providers.

Improving Dementia Caregiver Activation With a Brief Communication Module.

Objective: Palliative care often plays a pivotal role in supporting informal caregivers of persons living with dementia who experience a lack of continuity in care. Dementia caregiver activation, the caregiver's willingness and ability to navigate care needs, requires communication skills for developing relationships with healthcare providers. Communication activation is important because caregivers facilitate physician and patient information exchange. This study aimed to explore changes in communication outcomes (attitude, knowledge, and skills) and impact on caregiver communication activation (confidence, self-report) following completion of a brief communication module. Methods: A 15-minute asynchronous online module was developed to provide caregivers with communication skills for working with doctors and nurses. Caregivers completed pre/post module measures of communication outcomes, a vignette for applying communication strategies and were interviewed within a week of module completion to assess self-reported communication activation. Module acceptability was also evaluated. Results: Communication knowledge (P < .01) significantly increased and nearly all participants (99%) demonstrated use of module-specific communication skills after completing the module. While not statistically significant, caregiver attitudes were in the expected direction. Caregiver self-reported communication confidence (P < .001) significantly increased and 84% of caregivers described communication activation at post-module. Caregivers (83%) were likely to recommend the module. Conclusions: The brief communication module for dementia caregivers in this project offers an online resource with low time-burden that results in caregiver communication activation. Future testing in the clinical setting will increase understanding of its efficacy and integration and could be a viable resource for palliative care providers.