Precaution Adoption Process Model Research Articles

Promoting Lung Cancer Screen Decision-Making and Early Detection Behaviors: A Systematic Review and Meta-analysis.

Promoting lung cancer screening (LCS) is complex. Previous studies have overlooked that LCS behaviors are stage based and thus did not identify the characteristics of LCS interventions at different screening stages. The aims of this study were to explore the characteristics and efficacy of interventions in promoting LCS decision making and behaviors and to evaluate these interventions. We conducted a study search from the inception of each bibliographic database to April 8, 2023. The precaution adoption process model was used to synthesize and classify the evidence. The RE-AIM framework was used to evaluate the effectiveness of LCS programs. Heterogeneity tests and meta-analysis were performed using RevMan 5.4 software. We included 31 studies that covered 4 LCS topics: knowledge of lung cancer, knowledge of LCS, value clarification exercises, and LCS supportive resources. Patient decision aids outperformed educational materials in improving knowledge and decision outcomes with a significant reduction in decision conflict (standardized mean difference, 0.81; 95% confidence interval, -1.15 to -0.47; P < .001). Completion rates of LCS ranged from 3.6% to 98.8%. Interventions that included screening resources outperformed interventions that used patient decision aids alone in improving LCS completion. The proportions of reported RE-AIM indicators were highest for reach (69.59%), followed by adoption (43.87%), effectiveness (36.13%), implementation (33.33%), and maintenance (9.68%). Evidence from 31 studies identified intervention characteristics and effectiveness of LCS interventions based on different stages of decision making. It is crucial to develop targeted and systematic interventions based on the characteristics of each stage of LCS to maximize intervention effectiveness and reduce the burden of lung cancer.

Single-Legged Triple-Hop Propulsion Strategies in Females With and Those Without a History of Anterior Cruciate Ligament Reconstruction.

The single-legged triple hop is a commonly used functional task after anterior cruciate ligament reconstruction (ACLR). Recently, researchers have suggested that individuals may use a compensatory propulsion strategy to mask underlying quadriceps dysfunction and achieve symmetric hop performance. To evaluate the performance and propulsion strategies used by females with and those without ACLR during a single-legged triple hop. Cross-sectional study. Laboratory. A total of 38 females, 19 with ACLR (age = 19.21 ± 1.81 years, height = 1.64 ± 0.70 m, mass = 63.79 ± 7.59 kg) and 19 without ACLR (control group; age = 21.11 ± 3.28 years, height = 1.67 ± 0.73 m, mass = 67.28 ± 9.25 kg). Hop distance and limb symmetry index (LSI) were assessed during a single-legged triple hop for distance. Propulsion strategies were evaluated during the first and second hops of the single-legged triple hop. Separate 2-way analysis-of-variance models were used to examine the influence of ACLR, joint, and their interaction on mechanical joint work, moment impulse, and the relative joint contributions to total work and moment impulse in females with and those without a history of ACLR. Despite achieving a mean LSI of approximately 96%, the ACLR group produced less total work in the reconstructed than the uninvolved limb during single-legged triple-hop propulsion (first hop: t18 = -3.73, P = .002; second hop: t18 = -2.55, P = .02). During the first and second hops, the reconstructed knee generated 19.3% (t18 = -2.33, P = .03) and 27.3% (t18 = -4.47, P < .001) less work than the uninvolved knee. No differences were identified between the involved and uninvolved limbs of the ACLR group in moment impulse (first hop: t18 = -0.44, P = .67; second hop: t18 = -0.32; P = .76). Irrespective of limb or group, the ankle was the largest contributor to both work and moment during both the first and second hops (P < .001). Clinicians should exercise caution when using a single-legged triple hop as a surrogate for restored lower extremity function in females post-ACLR. This recommendation is driven by the compelling findings that knee-joint deficits persisted in the reconstructed limb despite an LSI of approximately 96% and, regardless of previous injury status, single-legged triple-hop propulsion was predominantly driven by the ankle.

Abstract 15069: Perceived Susceptibility to and Severity of Cardiovascular Disease is Associated With Intent to Change Behavior Among Women 25-55 Years Old

Background: Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased while knowledge and awareness of CVD remain low. To reverse these trends, it is important to assess whether knowledge and awareness of CVD are associated with intent to change behavior. Aims: Describe the relationship between stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify the predictors of stage of behavior change. Methods: A cross-sectional, descriptive study of women ages 25-55 living in the United States without a self-reported CVD history was conducted. Participants were recruited through flyers and social media campaigns. Awareness was measured with the question, “What is the leading cause of death for women in the United States?” Knowledge, perceptions, and stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and the Precaution Adoption Process Model surveys, respectively. All data were collected online via REDCap. Results: A total of 149, primarily minority women, were included (mean=37.15±7.86 years). Over half (53.7%) of the sample had not decided to make changes in their behavior to reduce their likelihood of CVD. A binary logistic regression of stage of behavior change on awareness, knowledge, and perceptions of CVD showed that the perception subscales of susceptibility and severity were significantly associated with intent to change behavior (OR 1.247, p&lt;0.001 and OR .809, p=.004 respectively). Awareness and knowledge of CVD were not associated with stage of behavior change. There were no significant sociodemographic and health condition predictors of stage of behavior change, although susceptibility and severity remained significant when controlling for these covariates (OR 1.242, p=.002 and OR=.801, p=.004, respectively). Conclusions: Young and middle-aged women who believed that they were susceptible to CVD and did not perceive CVD as a serious condition were more likely to report an intent to change their behavior to reduce their risk of CVD. These may be key factors to leverage when educating young and middle-aged women on heart disease in order to facilitate heart healthy behaviors.

Assessing adherence to guidelines of media reporting on suicide based on the Precaution Adoption Process Model and Agenda-Setting Theory

The World Health Organization named suicide prevention a global imperative with the media playing an integral role in it. By employing the Precaution Adoption Process Model (PAPM) and Agenda-Setting Theory as the theoretical framework, this study aimed to examine the coverage on suicide by The Star, which is an English-language daily with the largest circulation in Malaysia. A five-year (2014–18) range of news coverage was assessed for its adherence to the Malaysian guidelines for media reporting on suicide. The findings showed that the coverage on suicide by The Star was mostly in the form of straight news, whereby articles performed the disseminator role of news media providing facts or quote sources, without including journalists’ interpretation on the suicide incidents. The most common source quoted in the coverage were authorities such as police and government officials. The overall adherence of The Star’s suicide coverage with Malaysian guidelines for media reporting on suicide was mixed. Adherence was adequate (&gt;60 per cent) on some items of the guidelines but extremely low (&lt;18 per cent) for other specific recommendations. The practical implications of the findings are discussed with regard to the implementation and monitoring of media guidelines for suicide reporting, as well as professional education and training of journalists and media–mental health professionals liaison.

Study of COVID-19 Protective Behaviors Based on the Precaution Adoption Process Model PAPM in Women (Marivan, Iran)

Background &amp; Aims: people’s responsibility for protection behaviors against COVID-19 has a vital role in stopping chaining of transmission and, Adherence to preventive measures can be affected by psychosocial factors. The aim of this study was to investigate the survey of corona protection behaviors based on the precaution adoption process model (PAPM) in women referred to Marivan health centers in 2021, Iran. Materials and Methods: This descriptive (cross-sectional) study, were carried out between 380 women referring to health centers in Marivan in 2021. The samples were selected by the random cluster sampling method. The research tool was a researcher-made questionnaire consisting of two parts of demographic information and the construct of PAPM. Results: Results showed that people in the fifth and sixth stages of the model obtained higher scores in the model construct and the second and fourth stages of the model received the lowest scores. Conclusion: Uniform education for the general public may not have the expected results for protective behaviors and prevention of diseases, so education should be based on step-by-step models of health education and variables affecting individual decisions.

Using the precaution adoption process model and the health belief model to understand radon testing and mitigation: a pre-post quasi-experimental study

BackgroundDespite being the leading cause of lung cancer for non-smokers, few Canadians take action to test for and mitigate radon. This study’s aim was twofold: (1) to investigate predictors of radon testing and mitigation using the Precaution Adoption Process Model (PAPM) and Health Belief Model (HBM); and (2) to assess the impact on beliefs of receiving radon results above health guidelines.MethodsA convenience sample within Southeastern Ontario households was recruited to test their homes for radon (N = 1,566) for a pre-post quasi-experimental study. Prior to testing, participants were surveyed on risk factors and HBM constructs. All participants whose homes tested above the World Health Organization’s radon guideline (N = 527) were surveyed after receiving their results and followed for up to 2 years after. Participants were classified into PAPM stages and regression analyses were conducted to determine predictors between different stages (from deciding to test onwards). Paired bivariate analyses compared responses before and after receiving results.ResultsPerceived benefits from mitigating was associated with progressing through all stages in the study’s scope. Perceived susceptibility to and severity of illness and perceptions of cost and time to mitigate were associated with progression through some PAPM stages. Homes with smokers or individuals under 18 were associated with not progressing through some stages. Home radon level was associated with mitigation. Attitudes towards many HBM constructs significantly decreased after receiving a high radon result.ConclusionsPublic health interventions should target specific radon beliefs and stages to ensure households test and mitigate for radon.

Factors Impacting COVID-19 Vaccine Hesitancy and Resistance Among College Students in Northwest Ohio

Background: Vaccination is a critical strategy for controlling the transmission of COVID-19 and for returning to normalcy on college campuses; however, vaccine hesitancy and resistance persist as a significant barrier. This study utilized the integrated behavior model (IBM) and the precaution adoption process model (PAPM) to identify factors predictive of COVID-19 vaccine willingness (receptive, hesitant, and resistant) among college students. Methods: A sample of 1248 students at 2 universities in northwest Ohio were surveyed online in 2021. Stata/SE, version 17 (StataCorp) software was used to conduct stepwise logistic regression to investigate the association of theoretical constructs with vaccine willingness, after controlling for COVID-19 related factors and sociodemographic factors. Results: Most students (82.5%) were vaccine receptive, 6.9% were vaccine hesitant, and 10.6% were vaccine resistant. Vaccine hesitancy was higher among students aged 18 to 22 years (9.3%), undergraduates (16.5%), and students who identified as Black (13%) or Middle Eastern (14.3%). Lower vaccine hesitance was significantly predicted by IBM constructs of positive attitudes, high self-efficacy, and high salience. Not getting an influenza vaccine in the past 3 years and viewing vaccination as a personal choice were significantly associated with higher vaccine hesitancy. Lower odds of vaccine resistance were predicted by higher subjective norms. Descriptive norms, not getting an influenza vaccine in the past 3 years, agreeing with conspiracies, and viewing vaccination as a personal choice were strongly predictive of higher vaccine resistance. Conclusion: Identifying the factors that predict vaccine hesitancy and resistance among college students is critical for college administrators, and for those who are designing health communication campaigns, to increase vaccination among this priority population.

Predictors of Dengue Preventive Practices Based on Precaution Adoption Process Model among Health Care Professionals in Northwest of Iran.

Dengue fever as a mosquito-borne disease, has rapidly spread due to climate change, globalization, and human behavior. Iran is prone to dengue fever, as its vector recently has been found in the country. This study aimed to assess predictors of dengue preventive practices based on Precaution Adoption Process Model (PAPM) factors in West Azerbaijan province, northwest of Iran. This cross-sectional study conducted on 405 health professionals of communicable disease sector who were interested in study participation. Data-gathering instrument was an online researcher-made questionnaire consisting of demographic characteristics (11 items), questions based on PAPM, and dengue preventive practices (85 items). Content validity and reliability of the instrument, content validity ratio, content validity index, and Cronbach α were utilized, respectively. Descriptive, analytical, and regression analysis using SPSS and STATA were examined. Regression analysis revealed that awareness of appropriate actions for dengue prevention was a stronger predictor of preventive practice in borderline and appropriate categories (β= 4.09, p< 0.001) and (β= 4.42, p< 0.001), respectively. Among factors of PAPM, beliefs about precaution effectiveness and difficulty in borderline (β= 1.04, p= 0.04) and appropriate (β= 1.12, p= 0.03) groups had direct and significant relation with dengue preventive practice. The highest mean score of beliefs about hazard likelihood and severity factor was related to dengue prevention. Therefore, theory-based interventions that address beliefs about precaution effectiveness and difficulty can lead to assistance in acting. To improve dengue preventive practices, a well-designed promotive intervention that addresses associated factors in a context-specific manner is essential.

Abstract P1-08-09: DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women

Abstract Breast cancer is now the most common cancer. Thirty years of increased awareness, early diagnosis, and treatment access contributed to a 40% decline in breast cancer deaths. Yet, in 2021, more than 281,550 new cases of invasive and 49,290 new cases of non-invasive breast cancer will be diagnosed in U.S. women. Black women are 40% more likely to die of breast cancer - the highest breast cancer death rate across racial and ethnic groups. Today, the Black-white breast cancer mortality gap persists, and Black metastatic breast cancer (MBC) patients have a poorer prognosis. The pandemic exacerbated breast cancer disparities. In 2020, delays and avoidance contributed to an 85% breast cancer screening drop while MBC patients’ risk of severe illness and death from COVID-19 elevated. Therapy interruptions and abandonment increased, and conversely, clinical trial enrollment decreased. COVID-19 has accelerated the digital platform shift to telemedicine, online psychosocial support programs, virtual patient navigation, and digital engagement across the oncology care continuum. DC Pink Divas Intervening Virtually to Advance Saving Lives (DIVAS) is an award-winning evidence-based training, outreach, and patient navigation program developed to address the educational needs of Black early-stage, MBC breast cancer patients, survivors, and caretakers and provide strategies to educate, empower and impact women by increasing breast health knowledge, decreasing gaps in screenings and access, increasing awareness of MBC to ensure that where a woman lives, will not determine if she lives through a 1-year commitment of attendance in 8 cohort-based education modules where Black breast cancer mortality is highest. The DIVAS Health Behavioral Change Model adapts the Precaution Adoption Process Model, Health Behavior Model, and Social-Ecological Model. DIVAS implements innovative virtual outreach programs, training, and intervention strategies to empower Advocates to educate peers, providers, and policymakers. 3 Cohorts of Black women impacted by breast cancer trained as Lay Breast Health Advocates from 2011, 2020, and 2021 (N = 57; 77.5 % 45 years or younger; 36.7% early-stage 0-II, 50% late stage III-IV, 10.3% caretakers) self-reported their lifestyle behaviors, breast cancer diagnosis, breast health education, social media use, and interest in a digital-based lifestyle intervention. Participants completed pre-and post-surveys, interviews, and journaling over 10.5+ hours of education modules to understand their breast health, provider-related challenges, and community-related resources. Findings provide evidence that cohort-tailored education is a successful method of supporting Black women in a behavioral-health intervention. The provision of printed culturally attuned information along with the digital-based instruction from a Black woman health care provider or public health expert is effective in helping Black breast cancer survivors transition into patient empowerment, improve QOL and contribute to better patient outcomes. After the intervention and completion of breast health modules, participants reported increased: self-efficacy in communicating with providers (70%) and self-efficacy in making treatment decisions (70%) self-confidence (85%), and a decrease in lifestyle risk factors (87%). Patient-centric behavioral health interventions in breast cancer education must be advanced digitally to address the pandemic’s compounded crisis. DC Pink Divas provides insights to combat rising disparities by educating, empowering, and mobilizing Black lay breast health advocates to improve outcomes. Collaborative digital interventions across the care continuum to improve awareness, access, adherence, infrastructure, culturally attuned training, and support are evidence-based methods for navigating the cancer care transformation accelerated by COVID-19 to advance breast health equity. DIVAS Logic Model 2011- 2022 Logic model demonstrating inputs, activities, outputs and short and long term outcomes 2020- 2021 Cohort Sentiments and Behaviors Cohort outcomes from DC Pink Divas DIVAS In-Person vs Virtual Training Lay Breast Health Advocates recorded outcomes from cohorts 2011, 2020, and 2021 Citation Format: Falasha Zuend, Shyrea Thompson, Lori Wilson. DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-09.

Using the precaution adoption process model to understand decision-making about the COVID-19 booster vaccine in England

BackgroundCOVID-19 continues to pose a threat to public health. Booster vaccine programmes are critical to maintain population-level immunity. Stage theory models of health behaviour can help our understanding of vaccine decision-making in the context of perceived threats of COVID-19. PurposeTo use the Precaution Adoption Process Model (PAPM) to understand decision-making about the COVID-19 booster vaccine (CBV) in England. MethodsAn online, cross-sectional survey informed by the PAPM, the extended Theory of Planned Behaviour and Health Belief Model administered to people over the age of 50 residing in England, UK in October 2021. A multivariate, multinomial logistic regression model was used to examine associations with the different stages of CBV decision-making. ResultsOf the total 2,004 participants: 135 (6.7%) were unengaged with the CBV programme; 262 (13.1%) were undecided as to whether to have a CBV; 31 (1.5%) had decided not to have a CBV; 1,415 (70.6%) had decided to have a CBV; and 161 (8.0%) had already had their CBV. Being unengaged was positively associated with beliefs in their immune system to protect against COVID-19, being employed, and low household income; and negatively associated with CBV knowledge, a positive COVID-19 vaccine experience, subjective norms, anticipated regret of not having a CBV, and higher academic qualifications. Being undecided was positively associated with beliefs in their immune system and having previously received the Oxford/AstraZeneca (as opposed to Pfizer/BioNTech) vaccine; and negatively associated with CBV knowledge, positive attitudes regarding CBV, a positive COVID-19 vaccine experience, anticipated regret of not having a CBV, white British ethnicity, and living in East Midlands (vs London). ConclusionsPublic health interventions promoting CBV may improve uptake through tailored messaging directed towards the specific decision stage relating to having a COVID-19 booster.

Theory-based behavioral change interventions to improve periodontal health.

Periodontal disease is a significant global health burden affecting half of the world's population. Given that plaque and inflammation control are essential to the attainment of periodontal health, recent trends in preventive dentistry have focused on the use of behavioral models to understand patient psychology and promote self-care and treatment compliance. In addition to their uses in classifying, explaining and predicting oral hygiene practices, behavioral models have been adopted in the design of oral hygiene interventions from individual to population levels. Despite the growing focus on behavioral modification in dentistry, the currently available evidence in the field of periodontology is scarce, and interventions have primarily measured changes in patient beliefs or performance in oral hygiene behaviors. Few studies have measured their impact on clinical outcomes, such as plaque levels, gingival bleeding and periodontal pocket reduction, which serve as indicators of the patient's disease status and quality of oral self-care. The present narrative review aims to summarize selected literature on the use of behavioral models to improve periodontal outcomes. A search was performed on existing behavioral models used to guide dental interventions to identify their use in interventions measuring periodontal parameters. The main models were identified and subsequently grouped by their underlying theoretical area of focus: patient beliefs (health belief model and cognitive behavioral principles); stages of readiness to change (precaution adoption process model and transtheoretical model); planning behavioral change (health action process approach model, theory of planned behavior and client self-care commitment model); and self-monitoring (self-regulation theory). Key constructs of each model and the findings of associated interventions were described. The COM-B model, a newer behavioral change system that has been increasingly used to guide interventions and policy changes, is discussed with reference to its use in oral health settings. Within the limitations of the available evidence, interventions addressing patient beliefs, motivation, intention and self-regulation could lead to improved outcomes in periodontal health. Direct comparisons between interventions could not be made due to differences in protocol design, research populations and follow-up periods. The conclusions of this review assist clinicians with implementing psychological interventions for oral hygiene promotion and highlight the need for additional studies on the clinical effects of behavioral model-based interventions.

Preventing falls of the elderly at home: Applying the precaution adoption process model.

Falling in the elderly causes a variety of issues such as dependence, decreased self-efficacy, depression and limitation in daily activities, hospitalization and imposition of costs on the individual and society. The aim of this study was to investigate the prevention of falls in the elderly at home by applying the Precaution Adoption Process Model. In this quasi-experimental study, 200 elderly people participated, 100 of whom were in the intervention group and 100 in the control group. The sample was provided via stratified random sampling. The data collection instruments were a researcher-made questionnaire including demographic details, as well as the Precaution Adoption Process Model (PAPM) questionnaire. Educational intervention was performed during four 45-minute sessions, following which the data was analyzed through SPSS 20 software and was evaluated based on the Chi-squared, Mann-Whitney U, Wilcoxon, and Fisher's exact tests. Investigating the distribution of participants in the phases of the PAPM indicated that most participants of both the intervention and control groups were in the passive fall prevention phase before treatment. However, after the intervention, most participants of the intervention group were in the active phases of fall prevention, while there were not any significant changes in the control group. Moreover, comparing the mean of the structures of knowledge, sensitivity, severity, benefits, perceived self-efficiency, and the cues to action in terms of preventing falls after the intervention, showed a significant increase in these structures in the intervention group compared to the control group (P < 0.001). Eventually, the findings of the study showed a significant decrease in the percentage of falls of the participants of the intervention group compared to that of the control group after the intervention (P = 0.004). Educational intervention on the basis of the PAPM promoted the elderly precaution from passive phases to active phases of preventing falls, thereby resulting in a decrease in the number of falls of elderly people.

Understanding of Cervical Screening Adoption among Female University Students Based on the Precaution Adoption Process Model and Health-Belief Model

This study aimed to identify the decisional stages for cervical screening and corresponding cognitive factors in female university students. A cross-sectional study was conducted among Korean female university students aged 20-29 years through an online survey. The main outcome was the decisional stage of cervical screening adoption using the precaution adoption process model. The stages were classified into pre-adoption (the unawareness, unengaged, and undecided stages), adoption (the decided to act and acting stages), and refusal (the decided not to act stage). The cognitive factors in each stage were analyzed using the key concepts of the health-belief model. Cervical screening was defined as a clinical Papanicolaou (Pap) smear performed by a physician in a clinic. The final analysis included 1024 students. Approximately 89.0%, 1.0%, and 10.2% were classified as the pre-adoption, refusal, and adoption stages, respectively. Compared to the pre-adoption stage group, the adoption stage group was more likely to be older and have higher self-efficacy and knowledge. Most participants belonged to the pre-adoption stage-those unaware of cervical screening. Furthermore, most had a low level of knowledge and perception of cervical cancer and its screening. Therefore, our study highlighted the need for education to increase awareness and knowledge of cervical screening in this population.

Assessing Barriers to Advance Care Planning Engagement among Young Adults Using the Precaution Adoption Process Model

Purpose Assess the stage of readiness and barriers to ACP engagement among young adults in the United States utilizing the Precaution Adoption Process Model (PAPM). Methods A cross-sectional survey design was utilized to survey U.S. adults aged 18–35 through an online marketplace workforce (N = 414). Results Most (94.7%) had not engaged in comprehensive ACP. Young adults aged 18–29 reported higher perceived barriers scores to complete ACP than those aged 30–35. The perceived barriers score was significantly associated with stage of readiness for ACP ( p = .004); those who were unaware (stage 1) or did not want to engage in ACP (stage 4) reported more barriers to ACP engagement. Conclusion The PAPM is a useful framework for assessing barriers and tailoring programs for ACP engagement. Future research should further assess barriers for young adults to engage in ACP, particularly relating to stages of readiness.

Uptake and impact of COVID-19 preventive measures amongst migrant populations in the Netherlands

Abstract Uptake of preventive measures to reduce transmission of viruses such as SARS-CoV-2, is crucial in the control of pandemics. To ensure equitable uptake we explored contextual factors that shaped uptake of COVID-19 preventive measures amongst smaller, albeit substantial, migrant populations in the Netherlands. 39 persons of Eritrean, Ghanaian, Indonesian and Filipino origin, with diverse legal status and length of stay in the Netherlands, participated in five online focus group discussions. Thematic analysis of data was informed by concepts from the Precaution Adoption Process Model and Protection Motivation Theory. Awareness and knowledge of preventive measures was shaped by limited Dutch proficiency, access to understandable information and interference of misinformation. Engagement by preventive measures was subject to COVID-19 threat appraisal and the ease with which complex behavioural messages could be translated to individual situations. Perceived vulnerability of undocumented migrants in particular, motivated information-seeking. A strong social norm to keep with cultural and religious practices, and limited opportunity for preventive behaviour in work and home context hindered uptake of preventive behaviour. Preventive measures brought about job, food, and housing insecurity, and increased barriers in access to healthcare for undocumented migrants. Migration-related, sociocultural, and socioeconomic factors shape uptake of preventive measures. Preventive measures negatively impact work, housing and access to healthcare of undocumented migrants. Our results suggest importance of multilingual information tailored to literacy needs; education and modelling of behaviour; and, regulations to ensure continued access to financial and material resources to minimise negative spill-over effects. Results were incorporated in two policy briefs advising local and national government. Collaboration with municipal health services lead to multilingual public health information. Key messages • Migration-related, sociocultural, and socioeconomic factors shape uptake of preventive measures. • Preventive measures negatively impact work, housing and access to healthcare of undocumented migrants.

Stages of HPV Vaccine Hesitancy Among Guardians of Female Secondary School Students in China

PurposeFemale secondary school students are the primary recommended population for human papillomavirus (HPV) vaccines. However, vaccine hesitancy may affect uptake. In this study, we assessed the vaccine hesitancy levels among the guardians of female secondary school students in China. MethodsWe developed a questionnaire and conducted cross-sectional surveys among guardians of secondary school girls aged 12–19 years in mainland China based on the Increasing Vaccination Model and the Precaution Adoption Process Model. ResultsWe collected 3,225 valid samples. Among the participating guardians, 53.9% were vaccine hesitant, although only 0.9% had refused HPV vaccines. Some individual characteristics of guardians (e.g. sex, education/income level) were associated with understanding HPV vaccines. Better knowledge of HPV vaccines and communication with reliable sources of information were associated with vaccine nonhesitancy. Practical barriers such as vaccine shortage and busy schedules prevented nonhesitant guardians from vaccinating their children. DiscussionA substantial proportion of the guardians surveyed were HPV vaccine hesitant. Promoting HPV knowledge and communication with reliable sources (e.g. clinical doctors) could help fight against vaccine hesitancy.

Motivation is not enough: A qualitative study of lung cancer screening uptake in Australia to inform future implementation.

IntroductionParticipation in lung cancer screening (LCS) trials and real-world programs is low, with many people at high-risk for lung cancer opting out of baseline screening after registering interest. We aimed to identify the potential drivers of participation in LCS in the Australian setting, to inform future implementation.MethodsSemi-structured telephone interviews were conducted with individuals at high-risk of lung cancer who were eligible for screening and who had either participated (‘screeners’) or declined to participate (‘decliners’) in the International Lung Screening Trial from two Australian sites. Interview guide development was informed by the Precaution Adoption Process Model. Interviews were audio-recorded, transcribed and analysed using the COM-B model of behaviour to explore capability, opportunity and motivation related to screening behaviour.ResultsThirty-nine participants were interviewed (25 screeners; 14 decliners). Motivation to participate in screening was high in both groups driven by the lived experience of lung cancer and a belief that screening is valuable, however decliners unlike their screening counterparts reported low self-efficacy. Decliners in our study reported challenges in capability including ability to attend and in knowledge and understanding. Decliners also reported challenges related to physical and social opportunity, in particular location as a barrier and lack of family support to attend screening.ConclusionOur findings suggest that motivation alone may not be sufficient to change behaviour related to screening participation, unless capability and opportunity are also considered. Focusing strategies on barriers related to capability and opportunity such as online/telephone support, mobile screening programs and financial assistance for screeners may better enhance screening participation. Providing funding for clinicians to support individuals in decision-making and belief in self-efficacy may foster motivation. Targeting interventions that connect eligible individuals with the LCS program will be crucial for successful implementation.

Analyzing Factors Associated with the Behavior-Change Stage of Colorectal Cancer Screening.

This study attempted to identify the stages of colorectal cancer screening (CRCS) behavior change by applying the precaution adoption process model (PAPM) and to examine the factors affecting each stage. A quantitative, descriptive, cross-sectional design was used. A total of 305 workers at one of the largest industrial complexes in South Korea were allocated using convenience sampling. Data were analyzed using independent t-test, one way ANOVA and multi-nominal logistic regression using SPSS 25.0 (SPSS Inc., Chicago, IL, USA). Most of the subjects were in the undecided-to-act stage. The factors affecting each stage were gender, marital status, family history, private insurance subscription, perceived barrier, and self-efficacy. It is critical to select a target group considering the behavioral change stage to establish a strategy for improving the CRCS rate. Developing and implementing a CRCS education program in consideration of the behavioral change stage will be a strategy to increase the examination of effectiveness of CRCS.

The Efficacy of a Brief, Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial.

BackgroundHigh COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance.ObjectiveThis study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures.MethodsUsing a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention.ResultsAnalyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ21=20.55, P<.001). The between-group difference in postintervention intentions (χ23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate.ConclusionsAlthough the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases.Trial RegistrationClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228

Use and Effect of Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Randomized Controlled Trial.

BackgroundEmbodied conversational agents (ECAs) have been proposed as a promising interaction modality for the delivery of programs focused on promoting lifestyle changes. However, it is not understood what factors influence the health effects of ECAs or their use.ObjectiveWe aimed to (1) identify whether ECAs could persuade community-dwelling older adults to change their dietary behavior and whether ECA use could decrease loneliness, (2) test the pathways to these effects, and (3) understand factors influencing the use of ECAs.MethodsA randomized controlled trial was conducted. The intervention group received access to the PACO service for 8 weeks. The waitlist group started PACO use after waiting for 4 weeks. Two primary outcomes (eating behavior and loneliness) were assessed via online questionnaires at intake, upon joining the waitlist, after 4 weeks, and after 8 weeks. The third primary outcome (use) was assessed via data logs. Secondary outcomes were measured at the same time points, via questionnaires or an optional interview.ResultsIn total, 32 participants completed the intervention. We found a significant correlation between use in minutes on the one hand, and perceived usefulness (r=0.39, P=.03) and enjoyment on the other (r=0.38, P=.03). However, these did not predict use in the full regression model (F2,29=1.98, P=.16, R2=0.12). Additionally, PACO use did not lead to improvement in eating behavior (χ22=0.34, P=.85) or a decrease in loneliness (χ22=0.02, P=.99).ConclusionsOur study did not provide any concluding evidence about factors that are linked to the use or health effects of ECAs. Future service design could benefit from either creating a functional design catering to the predominant stage in the precaution adoption process model of the targeted population, or by personalizing the service based on an intake in which the end user’s stage is determined.Trial RegistrationClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883International Registered Report Identifier (IRRID)RR2-10.2196/22186