Online Questionnaire Research Articles

Exploring the attitudes and beliefs of women regarding the implementation of midwife-led care in India: A mixed methods study

ProblemDespite the recent introduction of midwifery services in India to improve maternal and newborn healthcare, there is limited research on women’s perspectives on midwife-led care. BackgroundThe Government of India initiated midwifery services guidelines in 2018 to improve the quality of care for pregnant women and newborns across the country. It is important to develop evidence-based strategies which can optimise the implementation of these new midwifery services. AimThis study explored women’s attitudes and beliefs towards the implementation of midwife-led care in two southern states of India. MethodsA convergent mixed methods design was employed using an online questionnaire and semi-structured online interviews. Quantitative data was analysed using descriptive statistics and qualitative analysis used a framework approach. Data from both sources were then integrated through merging techniques. FindingsA total of 307 women completed the online survey, and 23 participated in in-depth interviews. The study highlighted inadequate knowledge of midwife-led care among women. Despite this, 60 % expressed optimism about its benefits. Key factors to women’s acceptance included better understanding outcomes, having trust in midwives, receiving respectful care, and having autonomy in decision-making. They also required midwife-led birthing units would be clean, accessible, and well resourced. DiscussionMost participants perceived midwife-led care as beneficial, valuing its skilled, responsive and compassionate services. ConclusionInsights from this study have implications for the implementation of midwife-led care which should consider the informational needs, safety standards and cultural contexts of women and their families living in both urban and rural areas of India.

Scale of self-perceived listening, empathy, and presence (LEP) abilities in associate degree nursing students for aging care

This cross-sectional study involved 341 fifth-year associate degree nursing students who completed an online questionnaire survey from May 1 to July 31, 2020. Out of these, 196 effective responses were received, with participants' ages ranging from 19 to 29 years. Most were female, the eldest in their families, and had experience living with grandparents. They had also completed long-term care or elderly nursing courses, and had experience in practicing, volunteering, and caring for elders. The average scores for all listening and empathy items were above 4.0. The LEP self-perception abilities scale demonstrated expert content validity with a score of .94 and an internal consistency Cronbach's α of .96. Construct validity was confirmed with factor loadings ranging from .73 to .92, explaining 67.03% of the variance, indicating strong construct validity.

A New Test for Evaluating the Psychological Impact of COVID-19 in Nurses

Introduction During the COVID-19 pandemic, many health care workers were involved and suffered significant physical and psychological strain, and nursing was one of the main players. Clearly and objectively establishing the psychological impact on nurses during the pandemic is necessary for long-term recovery and to be prepared for new outbreaks in the future. Aim The aims of this study were to evaluate the perceived impact on nurses at risk of psychological stress at work during a major health care crisis and determine the psychological impact and its influencing factors. Methods An online questionnaire was designed and distributed between April 9 and April 19, 2020, in Spain. The comprehensive self-conducted questionnaire included demographic information and the Psychological Stress and Adaptation at work Score. For the analysis, descriptive statistics, logistic regressions, and receiver operating characteristic curves were determined. Results A total of 825 nurses (33% working in intensive care units and emergency departments) answered the questionnaire. A logistic regression analysis revealed that nurses with higher psychological stress scores experienced more physical overload (P = .02), higher psychological overload (P < .01), poor teamwork (P = .02), more distress due to new circumstances (P < .01), more personal impact of how society responded to COVID-19 (P < .01), anticipation of negative future consequences (P < .01), and worse balance between family and work (P < .01). The area under the curve for the cutoff point of Psychological Stress and Adaptation at work Score 40 was 0.82 (95% confidence interval, 0.79-0.91), with 70% sensitivity and 81% specificity. The positive predictive value was 72%, and the negative predictive value was 80%. Conclusion Psychological Stress and Adaptation at work Score is a rapid and accurate test for evaluating the psychological well-being of health care staff that can be used when crisis prevents the use of conventional stress diagnosis methods. Higher psychological impact was observed in nurses who worked in the intensive care unit and in the hospital ward.

Knowledge, Attitudes, and Perceptions of Quebec Nurses Relating to Climate Change in the Context of Their Practice with Children Aged 0 to 5 Years: A Cross-Sectional Descriptive Study.

Reducing children's vulnerability to climate change (CC) depends firstly on parents having the ability to adapt. The purpose of this study was to describe knowledge, attitudes, and perceptions of nurses in support of parents' ability to adapt to CC to protect the physical and psychosocial health of 0-5 year olds. A cross-sectional descriptive study was used. A total of 127 pediatric nurses from the province of Quebec completed an online questionnaire documenting nurses' knowledge, attitudes, and perceptions about CC. A third of nurses have little or no knowledge of the health risks of CC for children, even though they consider it to be a major issue for children. Nurses perceive that parents don't generally consider their children to be among the most vulnerable to CC, trivialize their effects on their children's health, have little knowledge of the effects of CC mainly on their children's psychosocial health, know little about the means to use to protect them, and more readily seek help from family and friends to ensure their children's protection. Nurses affirm that they are responsible for discussing the health effects of CC with parents, introduce measures to reduce their effects, possess little knowledge and few skills for reducing their effects, and feel unprepared to deal with their effects in their practice. Greater access to training on CC-related concepts is needed to increase nurses' knowledge. Nurses' perceptions must be validated with parents to promote optimal protection of children from CC.

Curricular Redundancy in Medical Undergraduate Course: Critical Insights from Various Stakeholders in Medical Institutes in India

Background Medical education is continuously evolving to keep pace with the dynamic field of medicine. This study addresses the issue of curricular redundancy in medical education, highlighting the necessity for periodic reviews to eliminate outdated or irrelevant topics. Method A descriptive qualitative approach was employed, involving participants from various medical schools across India. An online questionnaire was used to gather data on redundant topics, suggested replacements, and improvements in the curriculum for both didactic and non-didactic subjects, along with inputs related to assessment and evaluation methods. Content analysis was used for thematic identification and qualitative interpretation. Results Out of 71 respondents from a wide geographic distribution, 30% were female, and 70% were male, with an age range of 17 to 36 years. Participants expressed concerns about redundant theoretical (32%) and practical (51%) topics. Qualitative analysis highlighted the need for integrating different subjects and placing a stronger focus on practical clinical skills. Participants emphasized the importance of a curriculum that keeps pace with advancements in medicine, such as genomics and artificial intelligence, while also addressing mental health. Specifically, they suggested combining anatomy and surgery courses, incorporating more active learning techniques, and utilizing ongoing assessments to gauge progress. Conclusion The study highlights the necessity of eliminating curricular redundancy in medical education. Recommendations include developing a flexible curriculum, emphasizing region-specific content, and implementing a formative assessment system. Additionally, the importance of faculty development and stakeholder involvement in curriculum design is emphasized. Key Message Key insights for updating the medical undergraduate curriculum include the following:

Patient and healthcare provider perspectives on a digital first general practice: mixed-method study

Abstract Background General practitioners (GPs) are facing an increased workload as a result of an aging population and a growing prevalence of chronic diseases. Utilizing eHealth may help to enhance healthcare accessibility and reduce costs. A digital platform was developed that integrates eHealth into the organizational aspects of general practices. This study aims to provide insight into the experiences of patients and healthcare professionals with this new, digital way of working. Methods A mixed-method study was conducted in three Dutch general practices working with the digital platform. The digital platform focuses on digital communication and remote healthcare delivery in primary care. Primary outcomes included acceptability, the implementation process, suggestions for improvement, and facilitators and barriers for future implementation. Patient perspectives were identified through online questionnaires and focus groups, and healthcare professionals’ experiences were explored through in-depth interviews. Results Five focus groups and ten in-depth interviews were held. The questionnaires were completed by 616 patients. Patient acceptability of the care concept was high (M = 3.9, SD = 1.0; on a scale from 1-5) and they were satisfied with received care (M = 30.1, SD = 3.4; on a scale from 8-32). Regarding the perceived quality of consults, patients were positive about the longer duration of physical consults (i.e., 20 instead of 10 minutes). Some participants indicated a less personal doctor-patient relationship, because care was provided by various GPs. Conclusions Overall, patients and healthcare professionals were positive about the digital platform. The study gives insights into how to improve the care concept, e.g., how to enhance the doctor-patient relationship. Key messages • Digital first general practices that integrate eHealth into the practice’s organizational aspects of are considered acceptable by patients and healthcare professionals. • Digital first general practices can help to improve healthcare accessibility for both patients and healthcare professionals.

Factors influencing emigration decisions among Bulgarian health professionals

Abstract Background Migration patterns of health professionals are influenced by a variety of factors, including personal, economic, social, political, and cultural ones. This study aims to investigate the factors that influence the emigration decisions of both Bulgarian health professionals who have been abroad and those without such experience. Methods A cross-sectional study was conducted in 2022 using an online questionnaire among 447 health workers in Bulgaria. The influence of factors on health professionals’ decision to migrate was measured on a 4-point scale (from “no influence” to “very strong influence”). The factors were grouped into three levels - macro (country and health system), meso (health facility) and micro (individual). Mann-Whitney U test was used to examine differences between the two groups of health professionals at a 0.05 significance level. Results At macro level, a higher standard of living in the destination country was the primary factor influencing the emigration decisions of the individuals who have been abroad (n = 109), with a mean value of 3.62 (p < 0.001). Conversely, the opportunity to work in a better-organized health system was the predominant motivator for those without such experience (3.36, p < 0.035). At meso level, remuneration received (3.70, p < 0.001) was the most significant driver for the individuals with a migration background, while better working conditions (3.31, p < 0.006) had the strongest influence for the other group. At micro level, both groups agreed on the importance of enhanced recognition of the medical profession abroad (3.69 vs. 3.49, p < 0.013) as a key determinant. Conclusions On the whole, health professionals with no migration experience exhibited lower mean values for the observed factors. Furthermore, economic drivers appeared to be more significant for respondents with a migration background, while the other group attached greater importance to the motives related to the health system and the profession. Key messages • Health workers migrate for a variety of reasons with economic motives playing a pivotal role in shaping migration decisions. • Recognizing the motives that predominantly impact migration attitudes is a crucial step in the development of appropriate retention policies.

Unintended pregnancies in the context of intimate partner violence: Findings from the ELSA-Study

Abstract Intimate partner violence against women (IPV) is a widespread problem with serious consequences for victims and for society. Women affected by IPV have an empirically proven particular risk of unintended pregnancies. ELSA “Experiences and Living Conditions of Unintended Pregnant Women - Counselling and Care Services” is the first study in Germany to analyse the connections between the situations of women and unintended pregnancies. Using an online questionnaire, women from 1) a random representative sample of residents with a child under 6 years of age and 2) a sample of 662 women from abortion facilities or counselling centres were surveyed in 2021. The data (n = 5,101) were analysed in order to compare the life situation and needs of victimized versus non-victimized women. 333 women (6.5% of the total sample; 95% CI [6.2, 7.6]) reported IPV. Victimized women had a 5.6 times higher risk for an unintended pregnancy (95% CI [4.2, 7.5]) and 3.2 times higher risk for an abortion (95% CI [2.0, 5.0]). The pregnancy was sig. more frequently the result of forced sex (CV= .210***). Victims with unintended pregnancies had a sig. poorer mental health before (t(510) = 7.081***), during (t(510) = 5.501***) and after birth (t(456) = 5.234***) as well as before (t(503) = 4.905***), during (t(224) = 3.408) and after (t(503) = 3.352***) abortion. They were sig. more likely to report feelings of guilt and shame (CV = .182***), self-blame (CV = .149***) and anxiety (CV = .190***) after the pregnancy was determined and they received sig. more unsolicited information from the medical staff (CV = .254**). The result shows that victimized women are in an increased risk situation in the context of unintended pregnancies. Health care professionals can play a special role in prevention and intervention. Nationwide awareness-raising training, protocols and commitment are required. Key messages • The study confirms international findings on IPV and unintended pregnancies for Germany. • There is a need for a sensitive approach within the health system to enhance prevention.

Awareness and perceptions of cardiologists towards systemic inflammation in atherosclerotic cardiovascular disease: A multi-national survey across 5 geographical regional sub-groups

Abstract Background Despite improvement in the management of atherosclerotic cardiovascular disease and chronic kidney disease (ASCVD+CKD), cardiovascular (CV) mortality remains unacceptably high. Evidence suggests that systemic inflammation (SI) is one of the key drivers for disease progression, yet clinical perceptions towards SI amongst cardiologists is poorly understood. Purpose FLAME-ASCVD (systemic inFLAMmation and rolE of hsCRP as a biomarker in AtheroSclerotic CardioVascular Disease) survey assessed cardiologist’s perceptions and awareness towards the role of SI and high sensitivity C-reactive protein (hsCRP) in patients (pts.) with ASCVD+CKD. Overall results were reported earlier1 and here we present results by sub-groups across 5 geographical regions. Methods This was a multinational, cross-sectional, online survey-based study conducted during March-May 2023. Eligible participants were cardiologists (interventional and general) who treated ≥15 ASCVD+CKD pts./month and practiced for ≥3 years. To minimize selection bias, specific study objective was not disclosed until eligibility criteria was met. An online questionnaire was used. Analysis included 5 sub-groups: Europe (EU: France, Germany, Italy, UK), Asia Pacific (AP: Australia, India), East Asia (EA: China, Japan), LatAm (LA: Brazil), Middle East (ME: Saudi Arabia). Descriptive statistics were used. Results Of the 1755 respondents, 602 eligible cardiologists (~60/country) completed the survey across the EU (n=241), AP (n=121), EA (n=120), LA (n=60), and ME (n=60). Hypertension, hyperlipidaemia, and lifestyle (diet/exercise) were consistently amongst the top 3-5 CV risk factors discussed with pts, across all regions. SI as a CV risk factor was discussed consistently less across regions (overall 10th at 43%, ³9th across regions, EU: 30%) (Table 1). Across regions, >70% of cardiologists acknowledged an intention to consider testing for SI, with the lowest being in the EU at 46%. Of those in the EU who did not consider testing, 53% (n=129) cited lack of medication as the reason. Across all regions, SI was consistently perceived as a risk factor for recurrent CV events (³65%) and residual inflammatory risk (47-85%), yet a noticeable proportion (52-92%) cardiologists acknowledged a need to learn more about SI in ASCVD+CKD (highest in ME, 92%). While overall (aided: 47% [n= 571]; unaided: 24%) considered hsCRP test for SI, few variations were observed (EA/AP/EU, aided: 55/52/33 and unaided: 22/24/03) (Table 2). Proven efficacy of hsCRP test, availability of medication for SI, and guideline recommendation were acknowledged as unmet needs to inform clinical care in ASCVD+CKD. Conclusion In this survey across regional sub-groups, discussion of SI as a CV risk factor was consistently low. Barring few noticeable variations in testing patterns in EU, perceptions towards SI were generally consistent. There is a need for better understanding and guidance on SI and hsCRP testing in practice.

Evaluating health system resilience testing; what makes this practice successful?

Abstract Issue Health system resilience is an important and desirable attribute of health systems. We have evaluated the operationalization of our step-by-step guide for conducting a resilience test. Description of the problem Preparedness planning is often siloed and does not take the entire health system into account. The objective was to develop a new methodology for policy making that is adaptable to any health system context and shock scenario. Resilience testing uses a mixed-method approach to assess resilience by understanding health system strengths and weaknesses in relation to a hypothetical shock scenario. A programme logic model, semi-structured interviews and an online questionnaire were used to evaluate the methodology and to answer the following questions: Can resilience tests be used to identify strengths and weaknesses in different health system contexts? What are the determinants for successful resilience testing? Results Three resilience tests were conducted in Finland, Greece and the Asturias region of Spain. All resilience tests identified health system strengths and weaknesses. 97% of participants agreed that the test identified broader vulnerabilities. However, 76% thought that a different scenario would identify different strengths and vulnerabilities. 94% of participants agreed or strongly agreed that the test was a valuable exercise. The semi-structured interviews consistently found that successful resilience testing requires neutral facilitation and carefully selected test participants. Lessons Resilience test results have been used in 2 out of 3 cases to develop health policy. Resilience testing needs to be initiated and supported by the ministry of health to ensure results are considered in the policy making process. Key messages • Health system resilience tests can identify health system strengths, weaknesses, and steps towards remedial policy action to improve resilience in different European health system contexts. • Successful health system resilience testing requires carefully selected facilitators and test participants as well as support from the Ministry of Health.

Validation of the NEED assessment framework: an EU level Delphi study

Abstract The NEED (Needs Examination, Evaluation and Dissemination) assessment framework was developed to identify and measure health-related patient and societal unmet needs across different health conditions, supporting the creation of needs-driven healthcare policy and innovation. It includes 25 criteria of needs and 46 related indicators allowing to estimate if the needs are met. The current study aims to validate this framework on the EU level using a modified Delphi approach. The selection of national and European institutes invited to participate in the Delphi process was based on their respective roles; specifically, public health, health technology assessment (HTA), medicine authorisation, pricing and reimbursement (P&R), and patient advocacy. Through a modified Delphi approach, the experts were able to express their opinion on the framework structure (dimensions and domains), health-related needs criteria and indicators. Two Delphi rounds were performed using online questionnaires. Consensus was reached when 85% of the respondents agree or totally agree with a proposal and less than 5% of the respondents totally disagree. A panel of 27 experts participated in the first round of the study. The majority of the experts worked in HTA agencies (39%) and P&R agencies (24%), followed by national medicine authorities (9%) and umbrella patient organisations (9%). Seventeen EU Member States were represented, with a higher representation of experts from Austria, Belgium, France, Germany, The Netherlands, Spain and Sweden. Consensus was reached for 22 out of the 25 criteria and 41 out of the 46 indicators after the first round. The modified Delphi technique was an adequate approach to aid the validation of the NEED framework at the EU level. This represents an important first step in achieving consensus on how to define and identify unmet health-related needs and move towards a more needs-driven healthcare policy and innovation landscape. Key messages • Consensus on the definition and identification of unmet health-related needs is crucial to transform public health innovation. • Expert consultation by means of the Delphi technique assumed a pivotal role to reach consensus on the NEED framework.

Knowledge and beliefs about dietary inorganic nitrate in a representative sample of adults from the United Kingdom.

Evaluate knowledge and beliefs about dietary nitrate among United Kingdom (UK)-based adults. An online questionnaire was administered to evaluate knowledge and beliefs about dietary nitrate. Overall knowledge of dietary nitrate was quantified using a 21-point Nitrate Knowledge Index. Responses were compared between sociodemographic groups. UK. A nationally representative sample of three hundred adults. Only 19% of participants had heard of dietary nitrate prior to completing the questionnaire. Most participants (∼70%) were unsure about the effects of dietary nitrate on health parameters (e.g., blood pressure, cognitive function, cancer risk) or exercise performance. Most participants were unsure of the average population intake (78%) and acceptable daily intake (ADI) (83%) of nitrate. Knowledge of dietary sources of nitrate was generally low, with only ∼30% of participants correctly identifying foods with higher/lower nitrate contents. Almost none of the participants had deliberately purchased, or avoided purchasing, a food based around its nitrate content. Nitrate Knowledge Index scores were generally low (median[IQR]: 5[8]), but were significantly higher in individuals who were currently employed vs. unemployed (median[IQR]: 5[7]vs.4[7]; p<0.001), in those with previous nutrition education vs. no nutrition education (median[IQR]: 6[7]vs.4[8]; p=0.012), and in individuals who had heard of nitrate prior to completing the questionnaire vs. those who had not (median [IQR]: 9[8]vs.4[7]; p<0.001). This study demonstrates low knowledge around dietary nitrate in UK-based adults. Greater education around dietary nitrate may be valuable to help individuals make more informed decisions about their consumption of this compound.

A study of the impact of ChatGPT self-efficacy on the information seeking behaviors in ChatGPT: the mediating roles of ChatGPT characteristics and utility

PurposeThe purpose of this study was to examine the factors that influence the information seeking behaviors of ChatGPT users. Specifically, we investigated how ChatGPT self-efficacy, ChatGPT characteristics and ChatGPT utility affect the frequency and duration of information seeking via ChatGPT. We also tested the mediating roles of ChatGPT characteristics and utility in the relationship between ChatGPT self-efficacy and information-seeking behaviors.Design/methodology/approachThis study adopts a quantitative approach and collects data from 403 ChatGPT users using an online questionnaire. The data are analyzed using linear regression and structural equation modeling (SEM).FindingsThe linear regression analyses revealed that ChatGPT self-efficacy is positively and significantly related to the information seeking behaviors in ChatGPT. Second, mediation analyses also showed that ChatGPT characteristics and utility significantly mediate the relationship between ChatGPT self-efficacy and information-seeking behaviors in ChatGPT independently and sequentially.Originality/valueThis study is the first to investigate the factors and mechanisms that influence information-seeking behaviors in ChatGPT, a new phenomenon in the media landscape. The findings in this study suggest that ChatGPT self-efficacy acts as an important motivator for information-seeking behaviors in ChatGPT and that ChatGPT characteristics and utility provide information regarding potential mechanisms in the relationship between ChatGPT self-efficacy and information-seeking behaviors in ChatGPT. The study contributes to the literature on information seeking, self-efficacy and generative AI.

Assessment of the level of health literacy in students with specific learning disorders

Abstract Background Specific Learning Disorders (SLDs) include dyslexia, dysorthography, dysgraphia, and dyscalculia and are referred to as specific educational learning disabilities. For students with SLDs, the issue of health literacy (HL) arises because understanding, evaluating and utilising health information are critical to making informed decisions about one’s health. This study aims to determine the level of HL in students with a certified SLD. Methods From November 2023 to April 2024, students with an SLD studying at the University of Udine (Italy) who agreed to participate, were surveyed using an online questionnaire on the EUSurvey platform. This consisted of the HLS-EU-Q47 to measure HL, followed by a socio-demographic section. The HLS-EU-Q47 classified HL into 4 levels: inadequate, problematic, sufficient and excellent; descriptive analysis was performed and the correlation with the sociodemographic data was examined using χ² test. Results 38 students participated (mean age 24 years, 60.5% female), 60% of whom are in an undergraduate degree program. 42% of the sample had a single SLD (26% dyslexia, 13% dysgraphia), while 58% of them have multiple SLDs. Overall, 42% of students were found to have a problematic HL level, 24% inadequate, only 24% sufficient and 11% excellent. No statistically significant association was found between) HL level and gender, number of SLDs, school attended at the time of SLD certification, and use of supports (all p-values&amp;gt;0.05). Conclusions The level of HL in students with SLDs appears to be consistent with data from the Italian population (58% inadequate or problematic) from the 2019-HLS19 Health Literacy Survey. This suggests that the presence of an SLD does not affect the level of HL and that it is likely that the university degree is able compensate for HL difficulties that could be related to the presence of an SLD. A larger sample is needed to see if it is confirmed that there is no association between the investigated variables. Key messages • Despite the presence of SLDs, the HL of academic students follows the same trend compared to the general Italian population. • The structural use of supportive measures by these students probably bridges the gap in access to and correct use of health information.

The Effects of Post-Earthquake Trauma Levels of Nursing Students on their Academic Motivation and Career Decisions.

This study was carried out to determine the effects of post-earthquake trauma levels of nursing students on their academic motivation and career decisions. The sample of this descriptive study consisted of 228 students studying at Gaziantep Islamic Science and Technology University, Department of Nursing. The data were collected using an online questionnaire created by the researchers. This online questionnaire form consists of seven questions about socio-demographic characteristics, and it also includes the Determination of Post-Earthquake Trauma Levels Scale, Academic Motivation Scale, and Career Decision Scale. SPSS 23.0 package program was used for the analysis of the data, and P < 0.05 was accepted for the level of significance. It was determined that the post-earthquake trauma level of the students was above the moderate level (63.49 ± 17.29) and that the extrinsic motivation-identified regulation, extrinsic motivation-external motivation, and intrinsic-knowledge levels were more affected by the earthquake (P < 0.05). In addition, it was determined that the mean Career Decision Scale score of the students (74.20 ± 17.35) was below the average. It was determined that post-earthquake trauma level had positive effects on intrinsic motivation-stimulation, extrinsic motivation, and amotivation, but had no effect on career decision.

Measuring Vaccine Literacy in Switzerland: How is the situation after COVID-19?

Abstract Background Vaccinations are one of the most effective medical health interventions and one of the most important preventive measures. However, the population is often unsure about vaccination, and the roles and responsibilities of the key actors seem often unclear. To adequately protect the population against vaccine-preventable diseases, the Swiss Confederation, the Cantons and other stakeholders have developed the National Vaccination Strategy and an associated action plan. For its implementation, studies on the population’s knowledge, attitudes, skills, and vaccination behavior are crucial. Thus, the Swiss Federal Office of Public Health launched a study to assess vaccine literacy and its relation to vaccination readiness and behavior in the adult population in Switzerland. Methods A representative sample of 2,500 people living in Switzerland will be surveyed in summer 2024. The online questionnaire will include validated instruments, e.g. the HLS19-VAC Instrument to measure vaccine literacy or the 7C Vaccination Readiness Scale, as well as questions on correlates of vaccine literacy, vaccination readiness and behavior. Results The results of the survey will be presented, with a focus on vaccine literacy, vaccination readiness and behavior and their correlates. Specifically, differences among the three main language regions and between specific population groups will be shown. Further, a comparison with data from previous studies will be presented. Conclusions Despite having an advanced healthcare system, to date Switzerland has only partially reached its objectives in terms of vaccination, both for individual protection and collective immunity. New data on vaccine literacy, vaccination readiness and behavior as well as on the influencing factors are needed, especially after the pandemic, to guide effective future actions and measures to improve the vaccine coverage and public health in Switzerland. Key messages • Due to the COVID-19 pandemic the topic of vaccination in general has received increasing attention and may has changed people’s knowledge and attitudes towards vaccination. • Newest data on vaccine literacy, vaccination readiness and behavior are necessary to inform future, targeted actions and increase vaccine uptake.

Mediterranean diet adherence and food waste among university students

Abstract Introduction The Mediterranean diet (MD) is widely acknowledged as both a nutritious and sustainable dietary option. Growing research indicates that dietary habits can impact the amount of food waste produced. The aim of the study was to assess the correlation between adherence to the MD and food waste behavior among university students. Methods A cross-sectional study employing a validated, anonymous, online questionnaire was conducted among students at the University of Milan. Food waste was measured using the Italian version of the Household Food Waste Behavior (HFWB) questionnaire, while adherence to the MD was assessed through the Medi-Lite questionnaire. The questionnaire was developed in Microsoft Forms. Data were collected between July and October 2023. Responses to the HFWB were scored from 1 for disagreeing responses to 7 for agreeing resposes. Pearson correlation (ρ) between MD adherence and anti-waste behavior, stratified by gender and for the overall population was calculated. Results A total of 2,617 students (70% females, age 18-23 years 52%) completed the questionnaire. The average MD adherence score was 10.2 (± 2.2), with 65% of the sample being adherent to the MD. MD score was higher among female (10.4), compared to males (10.1, p &amp;lt; 0.001). Females show a more anti-waste behavior (score=5.3±0.8) compared to males (score=5.2±0.7, p &amp;lt; 0.001). MD adherence statistically significant correlated with anti-waste behavior in the overall sample (ρ = 0.27; 95% CI 0.24-0.31, p &amp;lt; 0.001) and within each gender group (Females: ρ = 0.27; 95% CI 0.22-0.35, p &amp;lt; 0.001; Male: (ρ = 0.28; 95% CI 0.22-0.35, p &amp;lt; 0.001) Conclusions This study provides evidence of the weak, positive correlation between adherence to the MD and household food waste behavior. Advocating for the MD could enhance health while simultaneously lowering food waste levels, which may have beneficial effects on environmental sustainability and the management of food resources. Key messages • Adherence to the Mediterranean diet linked to lower food waste among university students. • Mediterranean diet promotes health and less waste, aiding environmental sustainability.

Business and Customer-Based Chatbot Activities: The Role of Customer Satisfaction in Online Purchase Intention and Intention to Reuse Chatbots

In the online shopping context, brands aim to achieve a high level of profit by providing better customer satisfaction by using various artificial intelligence tools. They try creating a satisfactory customer experience by creating a system that provides never-ending customer support by using dialog-based chatbots, especially in the field of customer service. However, there is a lack of research investigating the impact of business and customer-based chatbot activities together on online purchase intention and the intention to reuse chatbots. This research considers the use of chatbots as a marketing tool from both customer and business perspectives and aims to determine the factors that affect the customers’ intention to purchase online and reuse chatbots. Accordingly, the impact on customer satisfaction with chatbot usage, which is based on chatbots’ communication quality and customers’ motivations to use chatbots, on online purchase intention and intention to reuse chatbots was examined. Through an online questionnaire with two hundred and ten participants, employing structural equation modeling, we revealed that customer satisfaction with chatbot usage has a greater impact on the intention to reuse chatbots than on online purchase intentions. In addition, chatbot communication quality has a greater impact on customer satisfaction with chatbot usage than customers’ motivation to use chatbots. To solidify these findings, confirmatory factor analysis, along with reliability and validity assessments, were implemented within the analytical framework to provide robust support for the study’s hypotheses. These findings not only provide empirical evidence and implications for companies in online shopping but also extend the understanding of AI tools in marketing, highlighting their subtle impact on consumer decision-making in the dynamic digital marketplace.

NIpple Position to Pinpoint Localization of Chest Drain Insertion in FEmale Trauma Patients: The NIPPLE-Trial—A Landmark Study

Background: The insertion of chest drains (CD) in trauma patients is a lifesaving, albeit high-risk intervention. Safe insertion of CD in settings where aids like ultrasound are not available relies on a landmark technique defining the so-called triangle of safety. The inferior margin of this triangle is identified by nipple height, which is thought to correspond to the fifth intercostal space (ICS). Training manikins are modeled after a lean male body and oftentimes insinuating jokes fuel uncertainty about the height of the nipple as a reliable landmark in female trauma patients. This study aims to prove that the nipple can be considered a safe landmark for CD insertion in women: even if larger breasts follow the force of gravity, it should not act towards the direction of the feet, but to the sides of the thorax in a flat-lying trauma patient. Methods: An online questionnaire was designed and distributed amongst female surgeons. Epidemiological data (age, nr of pregnancies, history of breastfeeding) was collected. Height, weight, and body mass index (BMI) were reported. Chest circumference and underbust girth were self-measured. The nipple position in relation to the ICS was measured by the women while lying in a supine position. Results: 237 female surgeons completed the questionnaire. Nine questionnaires were excluded due to incomplete data sets. 20 women were excluded due to previous breast surgery. Thus, 208 participants (or 416 nipples) were included in analysis. In supine position, both nipples were located in the 5th (±0.8) intercostal space. Age, BMI, height, weight, and status post-pregnancy had no significant impact on nipple position. Interestingly, a history of breastfeeding correlated with lower nipple position. Conclusions: The nipple is a safe landmark for identifying the correct insertion position of chest drains in supine-lying female trauma patients.

Consumer Preferences for Health Services Offered by Health Insurance Companies in Germany

Abstract German health insurance companies increasingly strive to position themselves as health partners to their customers to improve customers’ health and contain costs. However, there is uncertainty about customers’ preferences for health services offered by health insurance companies. Therefore, this paper studies consumer preferences for health services that are or could be provided by health insurance companies in Germany. An online survey was conducted using two stated preference techniques to collect and analyze the data (namely, rating and ranking of health services considered by insurance companies). A sample of 880 German health insurance customers between 18 and 65 years old filled out the online questionnaire, of which 860 submitted complete responses. Ordinal logistic regression analysis was used for the rating and ranking. Preliminary examinations, care management, and health programs were the three health services most important to the respondents. The results suggest that people want their health insurance to support them with preventive health services that offer direct therapeutic value and not just informational, economic, access-related, or convenience-related benefits. These preferences for health services are homogeneous for most subgroups of the population, implying that health insurance companies could consider an overall strategy to address these preferences for all clients by focusing on the important health services. Key messages • People value health services provided by health insurers that offer direct therapeutic value over those that offer only informational, economic, access or convenience benefits. • As preferences are homogeneous across the population, insurers could consider an overall strategy by focusing on the important health services.