Healthcare Provider Recommendation Research Articles

Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study.

Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients' quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA's effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA's potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA's role in enhancing patient engagement and disease management through a patient-centered digital solution. The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios.

A stepped wedge trial of a healthcare provider–focused intervention to increase human papillomavirus (HPV) vaccine initiation among survivors of childhood cancer.

10010 Background: Childhood cancer survivors are at increased risk for human papillomavirus (HPV)-related cancers. HPV vaccination is highly protective against HPV acquisition. However, we have previously shown that initiation rates among survivors are low, primarily due to lack of healthcare provider recommendation for the vaccine. Methods: We conducted a stepped wedge trial from 2021 to 2023 to evaluate the effectiveness of an evidence-based healthcare provider-focused intervention (HPV PROTECT; NCT04469569) in increasing HPV vaccine initiation rates 1y following implementation. The intervention includes provider communication training to enhance vaccine recommendation skills, audit/feedback regarding clinic vaccination rates, and patient-directed resources in multiple languages tailored to pediatric oncology settings. We measured the effectiveness of the intervention in a racially, ethnically, and geographically diverse sample of HPV vaccine naïve childhood cancer survivors, aged 9-17y, and ≥1y post-completion of therapy returning to pediatric oncology clinics for follow-up care at 6 sites. The primary outcome of interest was HPV vaccine initiation rates (abstracted from state vaccine registries) at end of each study year. Baseline data were collected for all sites in Y1, three sites were randomly selected to receive the intervention in Y2, and the remaining three in Y3. The intervention effect was tested using a longitudinal logistic regression model for initiation with intervention as the main fixed effect, adjusting for survivor age, cancer diagnosis, time off-therapy, sex, race, ethnicity, and receipt of hematopoietic cell transplantation. The secular trend (estimated using pre-intervention data from Y1 and Y2) was included as an offset, and site was included as a random effect. The intervention effect was reported as odds ratio (OR) for initiation with 95% confidence intervals (CI). Results: A total of 1779 unique vaccine naïve survivors (47.1 % leukemia; 55.1% male; 51.5% non-Hispanic white) completed 2689 clinic visits across 6 sites. Median (range) age at diagnosis was 5.1y (0-16.5), at study entry was 12.3y (9-17.9), and median time off-therapy was 5.5y (1.0-17.3). Overall incident HPV vaccine initiation was 16.0% at baseline. The adjusted odds of vaccine initiation were 1.3-fold (95%CI, 1.03-1.6; p = 0.03) higher post-intervention vs. pre-intervention, accounting for secular trend OR of 1.1. Overall prevalence of vaccine initiation increased from 51.9% pre-intervention to 61.3% post-intervention. Conclusions: The improvement in childhood cancer survivor HPV vaccine initiation rates in a diverse sample following implementation of a healthcare provider-focused intervention underscores the potential for pediatric oncology providers to positively impact HPV vaccine uptake in this vulnerable population. Clinical trial information: NCT04469569 .

Getting to the bottom of why children with spina bifida use the emergency department: A qualitative analysis of parent and stakeholder perspectives

Children with Spina Bifida (SB) have considerable healthcare utilization, including Emergency Department use (EDU). We aimed to elicit reasons for EDU using qualitative analysis of interviews with both patient-caregiver dyads and stakeholders. A cohort of children with SB followed at our institution between 2016 and 2020 was identified and patient and clinical characteristics abstracted. Purposeful sampling by age and degree of past EDU was performed. Semi-structured interviews of dyads were performed using iteratively revised interview guides. Spanish-language interviews were conducted by a native Spanish speaker and transcripts professionally translated. Supplemental interviews with stakeholders, namely knowledgeable healthcare professionals, were also conducted. A qualitative framework approach was used for analysis, including open followed by closed independent coding with calculation of inter-rater reliability. A final interpretation of coding reports assessing convergence, divergence, and variation in themes across participant characteristics. 116 families (4 Spanish-speaking) and 7 stakeholders were interviewed. Sampling yielded a heterogenous cohort for EDU (56% with 0-10, 44% with >10 visits) and age (25% 0-4, 44% 5-11, 31%>11 years). IRR was optimal (κ=0.9). Themes in perceived reasons for EDU were 1) desire for "one-stop-shop" care, 2) an emergent medical problem, 3) providers' instructions, 4) negative past healthcare experience, 5) intrinsic caregiver moderators, and 6) temporospatial influences. Themes 1, 2, and 5 predominated in dyads, whereas themes 6, 3, and 5 were most common in stakeholders. Stakeholders focused largely on negative institutional and patient characteristics. Among dyads only, theme #1 was disproportionately emphasized by Spanish-speaking patients. Families desired access to coordinated expert care, testing and imaging. The ED offers this for children with SB, regardless of clinical acuity. This may be especially valued by families with inherent challenges to navigating the healthcare system. Negative experiences in community clinical settings, healthcare provider recommendations and intrinsic parental factors were themes that seemed to contribute to seeking this "one-stop-shop" type of care. Care coordination may reduce ED reliance, but themes for the interviews suggest a systems-based efforts should weave in the community care setting. For both stakeholders and caregivers, the ED represented a valued form of immediate access to multispecialty, expert care and testing in the context of perceived lack of timely, coordinated outpatient care. This may be moderated by intrinsic caregiver factors and negative past experiences. Although stakeholders discussed ideas that fit into patient-caregiver themes, the also uniquely focused on systems-based and patient-caregiver limitations.

COVID-19 Vaccine Acceptance of Pregnant Women in Thailand.

This study investigated the COVID-19 vaccine acceptance rate among pregnant women in Thailand and explored factors influencing their willingness to receive the vaccine, to enhance vaccine uptake among hesitant pregnant women in the future. A prospective study was conducted at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, in October 2022. The data was collected using face-to-face questionnaires comprising 29 closed-end questions. Pregnant women aged 18 years old or over visiting the antenatal care clinic were included. The study included 200 participants, revealing a COVID-19 vaccine acceptance rate of 17%. Healthcare provider recommendations significantly increased vaccine acceptance by nearly two-fold (30.77%, p-value < 0.01). The major cause of vaccine hesitancy was the concern about vaccine safety that potentially harmed their babies (77.44%). The COVID-19 vaccine acceptance rate among pregnant women in Thailand was low. Healthcare provider recommendations played a pivotal role in positively impacting vaccine acceptance, highlighting their importance in increasing acceptance rates in the future.

Perceptions, Attitudes, and Barriers to Human Papillomavirus Vaccination Among Residents in Saudi Arabia: A Cross-Sectional Study.

Human papillomavirus (HPV) infection is a prevalent sexually transmitted infection globally, with significant associations with various cancers. Despite the availability of HPV vaccines, vaccination uptake remains suboptimal in many regions, including Saudi Arabia. This cross-sectional survey-based study aimed to assess perceptions, attitudes, and barriers related to HPV vaccination among residents in different regions of Saudi Arabia. Participants were recruited using a stratified sampling method, and data were collected through a structured questionnaire administered electronically. A total of 600 participants were included in the study, with diverse demographic profiles observed. The largest age group was 26-35 years old, comprising 42.7% (n = 256) of the sample. The distribution of gender was approximately equal, with 54.7% (n = 328) male participants. Notable perception and knowledge about HPV were observed, with 49.7% (n = 298) reporting being very familiar. Furthermore, 85.8% (n = 515) believed that HPV could cause serious health problems, and 63.7% (n = 382) perceived the vaccine to be very effective. Positive attitudes toward HPV vaccination were prevalent, with a significant proportion expressing a willingness to recommend the vaccine to themselves (70.0%, n = 420) and their children (65.0%, n = 390). Healthcare provider recommendation emerged as a key influencing factor, with 73.8% (n = 443) citing it as influential. Despite favorable attitudes, barriers to HPV vaccination were reported, including vaccine cost (22.5%, n = 135) and lack of awareness (13.7%, n = 82). However, a substantial proportion of unvaccinated participants cited not applicable reasons (57.2%, n = 343), indicating prior vaccination. Factors associated with HPV vaccination uptake included higher education levels, with those holding a master's degree or above exhibiting higher odds of vaccination uptake (OR (odds ratio): 1.80, 95% CI (confidence interval): 1.35-2.40, p < 0.001). Age (26-35 vs. 18-25) also showed a borderline significant association (OR: 1.25, 95% CI: 0.98-1.60, p = 0.074). The study highlights the importance of understanding perceptions and barriers to HPV vaccination to inform public health policies and programs in Saudi Arabia. Addressing identified barriers, such as educational campaigns and improving access to vaccination services, is essential for enhancing HPV vaccination coverage and reducing the burden of HPV-related diseases in the region.

Factors associated with pregnant women’s willingness to receive maternal pertussis vaccination in Guizhou Province, China: An exploratory cross-sectional study

ABSTRACT The rise in pertussis incidence among infants in Guizhou, China underscores the need for maternal acellular pertussis vaccine (aP) immunization, a key strategy in protecting infants from severe health consequences. However, the willingness of pregnant women in Guizhou to receive this vaccine is not well-understood. This study aimed to explore pregnant women’s intentions toward maternal pertussis vaccination in Guizhou and identify the associated factors. A questionnaire based on the health belief model, was administered in an exploratory cross-sectional study from January to February 2022. Data from 564 participants were collected and analyzed. The chi-square test, Mann-Whitney U test, and Poisson regression were used to identify potential factors associated with vaccination intentions. Participants’ median age was 27 y (interquartile range (IQR): 24–31), and the median number of children per participant was one. The study found that only 36.0% of the participants intended to receive the aP vaccine while 64.0% were uncertain or negative in this regard. Significant factors associated with intentions to vaccinate included perceived barriers and cues for action and perceived benefits. The major barriers for low vaccination intentions were safety concerns for both the fetus and the mother, and family members’ negative attitudes. Free vaccines, perceiving preventive benefits, observing other pregnant women getting vaccinated, and healthcare provider recommendations may facilitate vaccination intentions. Multiple immune strategies should be developed or optimized to cope with the resurgence of pertussis.

Social Processes and COVID-19 Vaccination of Children of Hesitant Mothers.

Investigate relationships between pediatric COVID-19 vaccination and social processes of healthcare provider recommendations and school encouragement to provide insights into social processes that may support pediatric COVID-19 vaccination among hesitant mothers. We analyzed survey data from a subsample (n = 509) of vaccine-hesitant mothers to child patients (ages 2 to 17) in regional clinics across Arkansas. Data were collected between September 16th and December 6th, 2022. Full information maximum likelihood multivariable logistic regression was conducted to evaluate associations with pediatric COVID-19 vaccination. Adjusted odds of pediatric COVID-19 vaccination were more than three times greater when a child's healthcare provider recommended vaccination compared to when they did not (aOR = 3.52; 95% CI[2.06, 6.01]). Adjusted odds of pediatric COVID-19 vaccination were 85% greater when a child's school encouraged parents to vaccinate compared to when the school did not (aOR = 1.85; 95% CI[1.13, 3.03]). For pediatric COVID-19 vaccination, having a personal healthcare provider is not significantly different from having no personal healthcare provider if they do not recommend the child be vaccinated. Clinical and public health interventions should consider social processes of healthcare provider recommendations and school encouragement.

An Evaluation of Messages to Promote Parental Intent to Vaccinate Children Aged

Effective health communication can increase intent to vaccinate. We compared 8 messages that may influence parents' intent to vaccinate their children against COVID-19. In a cross-sectional survey of adults in the United States administered online in August 2021, 1837 parents and legal guardians were exposed to 8 messages (individual choice, gain/practical benefits, nonexpert, health care provider recommendation, altruism/community good, safety/effectiveness, safety, and effectiveness) to determine message reception and influence on intent to vaccinate their children. Parents responded to 10 questions using a Likert scale. We computed odds ratios (ORs) for each message, with an OR >1.0 indicating greater observed odds of participant agreement with the follow-up statement as compared with a reference message. We compared outcomes individually across messages with ordinal logistic regression fit using generalized estimating equations. The individual choice message had the highest odds of agreement for understanding intent (OR = 2.10; 95% CI, 1.94-2.27), followed by the health care provider recommendation message (OR = 1.58; 95% CI, 1.46-1.71). The individual choice message had the highest odds of memorability, relatability, and trustworthiness. The altruism/community good message was at or near second best. The altruism/community good message had the highest or near-highest odds of increasing parents' intent to vaccinate their children, asking friends and family for their thoughts, and searching for additional information. The message that most motivated parents to vaccinate their children depended on parental intent to vaccinate prior to being exposed to the tested messages. Messages with themes of individual choice, health care provider recommendation, and altruism/community good may be used in future message campaigns. Further research is needed to refine message concepts related to altruism/community good.

Navigating formula shortages: associations of parental perspectives on transitioning to alternative infant formulas for cow's milk protein allergy during the 2022 national formula shortage.

The COVID-19 pandemic led to supply chain disruptions causing a severe shortage of infant formula. The shortage impacted parents of infants with cow's milk protein allergy (CMPA) who rely on specialized formulas. However, research on parent perspectives during formula shortages is limited. We aimed to understand the factors guiding parents' decisions when transitioning to alternative amino acid formula (AAF) or extensively hydrolyzed formula (eHF) during the national formula shortage. We conducted a survey using the ZSMoments platform and found that before the shortage, parents valued safety (83%), tolerability (78%), and reputability (78%) as primary factors in selecting eHFs and AAFs. Post-shortage, formula tolerability (86%), assurance (84%), and safety (80%) gained more importance. Among those switching eHF (n = 54), health care provider recommendations (81%), reputability (78%), taste (78%), and tolerability (78%) were rated as "extremely important." Among those switching AAF (n = 26), top factors included tolerability (77%), assurance (73%), safety (73%), cost-effectiveness (73%), and formula trustworthiness (73%). These data suggest that parents carefully weigh various factors when managing their child's CMPA and transitioning to different AAF or eHF options.

Qualitative Evaluation of Treatment Partners for People With HIV in Botswana: Current Healthcare Provider Practices and Recommendations for Improvement.

Botswana has an adult HIV prevalence of 20.8% and annual incidence of 0.2%. We aimed to evaluate current practices and advance recommendations for treatment partners (informal adherence supporters) for people with HIV in Botswana. In January-February 2020, we conducted seven focus groups with 36 healthcare providers at seven HIV clinics in Gaborone, Botswana. Providers perceived treatment partners to be critical for quality patient care. They shared that in the new era of universal antiretroviral therapy (ART) initiation immediately after diagnosis ("test-and-treat"), providers no longer require patients to select treatment partners at ART initiation. Providers suggested a renewed emphasis on treatment partners. They believed that standard guidance for providers around treatment partner selection would ensure that providers cover similar topics across patients and endorsed implementation of workshops to educate treatment partners on how to support patients. However, streamlined ART initiation policies require innovative strategies, including eHealth interventions, to engage treatment partners.

Effect of Tobacco Use during Pregnancy on Fetal Birth Weight Born to Women between 18-35 years in Thatta District

Background: Consumption of tobacco in its various forms is widespread and a serious public health issue globally. Although smoking is the predominant common method of tobacco use, the consumption of smokeless tobacco has increased in recent decades. Smokeless tobacco products are becoming more popular among women. In Pakistan, the overall prevalence of smokeless tobacco among males and females is 7%, out of which 10% are women which may be linked to poor reproductive outcomes and other health issues. Objective: The purpose of the study was to determine the effect of smokeless tobacco use during pregnancy on fetal birth weight. Methods: A case-control study was conducted at the five basic health units (BHU) of Thatta District, which were Garho, Ghora Bari, Dhabeji, Chattochand, and Jhimpeer from October 2022 – January 2023. A total of 300 mothers were included by consecutive sampling technique in the study and among them, 150 mothers who gave birth to a low-birth-weight baby i.e., birth weight &lt; 2.5 kg were enrolled as a case, and another 150 mothers who gave birth to a normal birth weight baby i.e., birth weight ≥ 2.5 kg were enrolled as a control. Data collection involved face-to-face interviews utilizing a validated questionnaire, with strict adherence to ethical considerations throughout the study. Results: In a study of 300 participants from Thatta District's five basic healthcare units, multivariate logistic regression revealed significant factors influencing tobacco use during pregnancy. Housewives had 1.862 times higher odds of tobacco use than employed individuals, and individuals aged 20–35 had 1.802 times higher odds than those aged 36-50. Smokeless tobacco, particularly most of the mothers in this study used gutka (47.3%) and chaliya (26%). Smokeless tobacco Gutka and Chaliya, increased the likelihood of tobacco use during pregnancy. Considering the frequency of smokeless tobacco use and healthcare provider recommendations emerged as important determinants. Conclusion: Our study underscores the prevalence of smokeless tobacco use during pregnancy in Thatta, Karachi, Pakistan, with significant implications for low-birth-weight babies. This highlights the need for targeted public health interventions, like antenatal care, alongside further research to inform evidence-based strategies for maternal and child health promotion in the region.

Knowledge of HPV and HPV Vaccination among Polish Students from Medical and Non-Medical Universities.

Human papillomavirus (HPV) is a common sexually transmitted infection that can cause both benign and malignant lesions. HPV vaccines, preferably administered before the onset of sexual activity, have demonstrated remarkable efficacy in preventing HPV-related cancers. The impact of a healthcare provider's recommendation on HPV vaccine acceptance is substantial. Therefore, medical students must undergo thorough training in this domain. This study compares fundamental understanding and viewpoints regarding HPV and anti-HPV vaccines among Polish students pursuing medical and non-medical sciences. This study was based on the authors' questionnaire, and the results were statistically analyzed. The participants in this study were 1025 students (medical sciences students-520 respondents in total; and non-medical sciences students-505 respondents in total). According to the results, medical students' knowledge about the consequences of HPV infection and vaccination against HPV was significantly greater. To date, numerous publications have investigated the understanding of particular social, gender, parental, etc., groups about vaccination, but the knowledge of students at different universities-medical and other-has not been compared. Social awareness is still insufficient, even in groups of medical students. There is much to be done to educate and encourage preventive behavior in those not receiving primary prevention in early childhood.

Does children’s healthcare seeking change after participation in a musculoskeletal study? A register-based study

BackgroundParticipating in research studies often involves interactions with healthcare professionals, potentially influencing the participant’s future help-seeking behaviour. We investigated whether participating in the Childhood Health Activity and Motor Performance School Study – Denmark (CHAMPS) (2008–2014), which involved telephone consultations and clinical assessments by healthcare professionals with participants experiencing musculoskeletal complaints, changed frequency of contacts with primary public healthcare services among participants over the subsequent five-years-period, compared to non-participating children.MethodsUsing Danish health register data from 1998 to 2020, we compared CHAMPS participant’s and two control group’s contacts with private physiotherapists, chiropractors (outside hospitals), and general practitioners: a random 10% sample of children from Denmark (National Controls), and a secondary local control group (Local Controls) during three periods: Before (1998–31.10.2008), during (01.11.2008–20.06.2014), and after (21.06.2014–31.12.2019) the CHAMPS-study. Separate multivariable Poisson regression models were used to assess the differences between groups for the outcome variables: contacts with physiotherapists, chiropractors, and general practitioners, and overall contacts.ResultsCompared to National Controls, the CHAMPS-Group had fewer physiotherapy contacts before the study with an estimated mean of 0.01 vs 0.02 per person-year, and after (0.13 vs 0.18 per person-year), corresponding to a crude incidence rate ratio (IRR) of 0.69 (95% confidence intervals (CI): 0.58–0.83) after the study period. However, they had more chiropractor contacts before (0.05 vs 0.03), and after (0.21 vs 0.09) the study, with a crude IRR of 2.29 (95% CI: 1.93–2.71) after the study period. General practice contacts were equal for the CHAMPS-group compared to national controls (5.84 vs 5.84) before the study but reduced during and after (3.21 vs 3.71), with a crude IRR of 0.86 (95% CI: 0.83–0.90) after the study. Comparable patterns of contacts changes from before to after the study were observed between the CHAMPS-group and the Local Controls except for physiotherapy which was equal between the two groups after the study.ConclusionOur findings suggest that research studies involving systematic engagement with participants experiencing musculoskeletal complaints can influence subsequent healthcare-seeking behaviour. Future research should address the influence of health literacy, health education, and healthcare provider recommendations on healthcare decisions during such research studies.

Women's Information Needs and Educational Preferences Regarding Lung Cancer Screening.

Background: Physicians are less likely to discuss lung cancer screening (LCS) with women, and women have lower awareness of LCS availability. The objective of this qualitative study was to determine information needs, patient-provider communication barriers, and preferences for LCS education among women. Materials and Methods: Eight semistructured qualitative focus groups were conducted with 28 self-identified women meeting LCS eligibility criteria. Participants were recruited through a large health system, from a community-based LCS program, and through a national online database between October 2020 and March 2021. Focus groups were led by a trained moderator via Zoom. Audio recordings were transcribed and analyzed using thematic analysis by investigators. Results: LCS decision-making influences included: (1) Health care provider recommendation; (2) Self-advocacy; (3) Insurance coverage and cost; (4) Family; and (5) Interest in early detection. Participants preferred video and print materials, available at physician's office or shared by physician, without scare tactics or shaming about smoking, use clear language, with diverse participants and images. Preferred content focused on: (1) Benefits of early detection; (2) Lung cancer definition, statistics, and risk factors; (3) Benefits of quitting smoking; (4) Demonstration or explanation of how LCS is done; and (5) Availability of other tests and potential harms of screening. Conclusion: Women in our study had limited awareness of LCS and their eligibility and wanted recommendation and support for LCS from their health care providers. We identified addressable information needs about lung cancer and the screening process that can be used to improve LCS uptake in women and shared decision-making processes.

A cross-sectional study on adherence to treatment and life-style modifications in hypertensive patients attending the urban health centre of a teaching hospital in Hyderabad.

The burden of hypertension is expected to double by 2025 and adherence to treatment has a key role in disease outcome. The World Health Organization defines adherence as the extent to which a person's behaviour of taking medication, following a diet and/or exceeding life-style changes, corresponds with the agreed recommendations of health care providers. The study tries to assess the level of adherence to medication and life-style modifications in hypertensive patients. It is a cross-sectional study among patients attending urban health centres of a teaching hospital. The study population included all hypertensive patients above 30 years. Based on the prevalence of non-adherence to hypertensive medication, 70% of the sample size is calculated as 182. A Morisky medication adherence scale is used to find adherence to treatment. Life-style modification was also assessed. Scoring was done based on their adherence to treatment and life-style modifications and quantified. The mean age of the study population was 55 years (38-80 years). In total, 58.33% were illiterate and 21% were retired from work. Around 87.5% had to spend money on medication. Mean weight, height, hip and waist circumference was 66 kg, 157 cm, 108 cm and 100 cm, respectively. Mean BMI was 26.6. Prevalence of good adherence to medication was 129 (70.83%) and that of good life-style modifications was 127 (70.17%). The adherence to medication and life-style modification was satisfactory. Family physicians have a key role in Non communicable diseases (NCD) management and should focus on ongoing education programmes for treatment adherence and life-style modifications at a community level, and grass-root level workers should conduct regular follow-up activities.

SCD and COVID-19 Vaccines: What Do Pediatric Patients Want to Know?

Introduction: Recent polls reported that only 49% of adults plan to receive a COVID-19 vaccine, while 31% reported being uncertain and 20% reporting they would not receive a vaccine citing safety as a major concern. There are disparities related to intention to receive a vaccine with 56% of whites, 25% of Blacks, and 37% of Hispanics citing they would receive a vaccine. Individuals living with sickle cell disease (SCD) were noted to be an at-risk population for higher morbidity and mortality with COVID-19 infection. Health disparities in COVID-19 outcomes could become exacerbated if racial and ethnic minorities like those with sickle cell disease (SCD) are less likely to receive a vaccine. While polls provide insight into the public's intention to receive COVID-19 vaccines, most of them include only adults. Further, there are limited empirical data on what influences people's intent to get vaccinated. Thus, there is a need to examine educational needs and preferences with respect to COVID-19 vaccines among adolescents and young adults with SCD and caregivers of children with SCD. This research is significant because it is essential to developing targeted educational interventions to promote COVID-19 vaccine uptake in pediatric patients with SCD. Methods: We conducted N=17 qualitative interviews with parents/caregivers (N=6), young adults 18 years and older (n=8), and adolescents ages 12-17 years (n=3) receiving care at one of two sickle cell centers in the US. After achieving thematic saturation, a directed content analysis approach was used to code interview data into themes related to four categories: a) COVID-19 vaccine concerns; b) key influencers for decision-making about COVID-19 vaccines; c) sources of trustworthy COVID-19 vaccine information; and d) preferred methods of receiving COVID-19 vaccine information. Two authors independently coded all the transcripts (AL, CM), and a third author served as a reliability coder. To promote rigor, interrater reliability was assessed (&amp;gt;90%) and themes were reviewed with clinical staff and patients (member checking). Results: Participants' top COVID-19 vaccine concerns were side effects and that they are understudied in sickle cell disease. Key influences for getting the vaccine included healthcare provider recommendation, a desire to increase protection and decrease worry, and the ability to return to normal activities. Sources of trustworthy information included the healthcare team, reputable websites (e.g., CDC) and personal recommendations. Preferred methods were talking directly with and asking follow-up questions to their hematology team and vaccine experts. Least preferred methods included the media and conducting one's own research which some found overwhelming. Using an iterative design process, themes were then converted into educational interventions which will be featured in this poster (e.g., patient vaccine question cards, expert videos, and provider scripts). Conclusions: Study results support that educational efforts about COVID-19 vaccines for pediatric patients with SCD should involve the hematology team who is viewed as a trustworthy source of information. Given vaccine concerns, teams may benefit from tools that help them foster conversations about vaccine protection and specific data about SCD and the vaccines. Results further indicate that clear and concise information about COVID-19 vaccines presented in a variety of formats (e.g., expert videos, websites) may be beneficial.

2340. COVID-19 Vaccine Hesitancy among Faculty Members, College Students and Health Care Workers in Lebanon

Abstract Background The COVID-19 pandemic has caused significant morbidity, mortality, and economic losses worldwide. Despite the efficacy of several vaccines in reducing SARS-CoV-2 infections, vaccination hesitancy remains a challenge. This study aimed to examine COVID-19 vaccination perceptions, beliefs, attitudes, and knowledge in Lebanon and identify unique predictors of vaccine hesitancy. Methods We conducted a cross-sectional online survey between March and June 2021 at the American University of Beirut and its Medical Center targeting faculty members, students, and healthcare workers. The survey included four sections, covering socio-demographics, COVID-19 perceptions, attitudes, and knowledge, with a primary focus on vaccination intent. We used a multivariate logistic regression model to investigate potential determinants of vaccine hesitancy. Results We had 422 respondents with an overall response rate of 94%. A large proportion of the study population were females (69%) and individuals with at least undergraduate college education (93%). Healthcare workers comprised 29.4% of all survey respondents. Of the respondents, 368 (87%) were definitely willing to take the COVID-19 vaccine, and 13% expressed various forms of vaccine hesitancy (1% definitely not willing; 8% undecided likely; 4% undecided unlikely). The most important independent predictors of vaccine hesitancy were the perception that the COVID-19 vaccine is more dangerous that the COVID-19 infection, that the vaccine development was rushed, and being a healthcare worker. Knowledge about COVID-19 infection, level of education, age, and recommendation from the respondent’s healthcare provider were negatively correlated with vaccine hesitancy. The multivariable analysis is shown in the Table. Conclusion We found a high COVID-19 vaccine acceptance rate and some of the factors associated with hesitancy were modifiable, including knowledge and perceptions about the disease and the vaccine, and healthcare provider recommendation. Addressing these factors is crucial for successful vaccination programs, as combatting vaccine hesitancy may be as crucial as developing a safe and effective vaccine. Disclosures All Authors: No reported disclosures

Decision-making experiences regarding kidney transplant among older adults in South Korea: A qualitative descriptive study

ObjectivesTo explore the decision-making experiences of older patients with end-stage renal disease who chose to undergo kidney transplantation. MethodsThis was a qualitative descriptive study.Twelve participants aged over 60 years who underwent kidney transplantation were recruited from a kidney transplant clinic in a hospital in South Korea. Individual in-depth interviews were conducted from March to April 2021. The data were analysed using inductive thematic analysis. ResultsFour main themes were identified: 1) hesitation towards complex and risky kidney transplant, 2) internal suffering due to social prejudice and limits, 3) taking a step back from the decision-making process, and 4) being rushed into a decision on the brink of death. ConclusionOlder patients with end-stage renal disease experience hesitation and difficulties and are passive in the decision-making process for a kidney transplant. They lacked sufficient relevant information and decided to receive transplant surgery, feeling pressured by the recommendations of family and healthcare providers. Practice ImplicationsHealthcare professionals should help older patients with end-stage renal disease make proactive decisions by providing tailored education programs and improving communication between the patients and their family members. Changing negative social perceptions and implementing supportive policies are necessary to resolve the difficulties experienced by such patients. Patient or Public ContributionPatients were involved in the data collection as interview participants in this study.

Pregnant women’s attitudes and behaviours towards antenatal vaccination against Influenza and COVID-19 in the Liverpool City Region, United Kingdom: Cross-sectional survey

ObjectivesInfluenza poses a serious health risk to pregnant women and their babies. Despite this risk, influenza vaccine uptake in pregnant women in the UK is less than 50%. Little is known about how COVID-19 affects pregnant women, but its management may affect attitudes and behaviours towards vaccination in pregnancy. The study objectives were to establish attitudes and knowledge of pregnant women towards influenza disease and influenza vaccination and to compare these to attitudes and knowledge about COVID-19 and COVID-19 vaccination. DesignA cross-sectional survey was conducted using an online questionnaire distributed through local advertisement and social media outlets. Information was sought on attitudes and knowledge of influenza and COVID-19 and their respective vaccines. Participants and settingPregnant women residing in Liverpool City Region, UK. ResultsOf the 237 respondents, 73.8% reported receiving an influenza vaccine. Over half (56.5%) perceived themselves to be at risk from influenza, 70.5% believed that if they got influenza, their baby would get ill, and 64.6% believed getting influenza could hurt their baby, 60.3% believed that the influenza vaccine would prevent their baby from getting ill, and 70.8% believed it would protect their baby. Only 32.9% of respondents stated they would receive the COVID-19 vaccine if it were available to them. However, 80.2% stated they would receive a COVID-19 vaccine if they were not pregnant. Most of the women stated that they would accept a vaccine if recommended to them by healthcare professionals. ConclusionsAcceptance of the influenza and COVID-19 vaccines during pregnancy seems to be more related to the safety of the baby rather than the mother. Women perceived their child to be more at risk than themselves. Information about influenza and COVID-19 vaccine safety as well as healthcare provider recommendations play an important role in vaccine uptake in pregnant women.

Screening for High-Risk Oral Human Papillomavirus (HPV31, HPV33, HPV35) in a Multi-Racial Pediatric and Adult Clinic Patient Population.

Many human papillomavirus (HPV) strains induce cancer in the cervix and the oral cavity. Although high-risk strains including HPV16 and HPV18 are commonly known, additional high-risk strains including HPV31, HPV33, and HPV35 may also induce carcinogenesis, and much less is known about their prevalence. Using an approved protocol, samples from a salivary biorepository were screened to find pediatric and adult samples from a multi-ethnic, university-based patient clinic population. A total of N = 86 samples from the saliva biorepository met the quality and concentration standards and were screened for high-risk HPV. qPCR screening of adult samples revealed n = 10/45 or 22% were HPV31- or HPV33-positive. In addition, a total of n = 9/41 or 21.9% of pediatric samples were either HPV31- or HPV33-positive (or both). No samples harbored HPV35. Most samples were derived from patients within the recommended vaccination or catch-up age range (age 9-45 years). These results demonstrated that a significant percentage of patients harbor additional high-risk HPV strains within the oral cavity, including HPV31 and HPV33. These data support oral healthcare provider recommendations for the newer nine-valent vaccine, which includes both HPV31 and HPV33.