Previous Experience Research Articles

Gender differences in preferences for mental health apps in the general population – a choice-based conjoint analysis from Germany

BackgroundMen and women differ in the mental health issues they typically face. This study aims to describe gender differences in preferences for mental health treatment options and specifically tries to identify participants who prefer AI-based therapy over traditional face-to-face therapy.MethodA nationally representative sample of 2,108 participants (53% female) aged 18 to 74 years completed a choice-based conjoint analysis (CBCA). Within the CBCA, participants evaluated twenty choice sets, each describing three treatment variants in terms of provider, content, costs, and waiting time.ResultsCosts (relative importance [RI] = 55%) emerged as the most critical factor when choosing between treatment options, followed by provider (RI = 31%), content (RI = 10%), and waiting time (RI = 4%). Small yet statistically significant differences were observed between women and men. Women placed greater importance on the provider, while men placed greater importance on cost and waiting time. Age and previous experience with psychotherapy and with mental health apps were systematically related to individual preferences but did not alter gender effects. Only a minority (approximately 8%) of participants preferred AI-based treatment to traditional therapy.ConclusionsOverall, affordable mental health treatments performed by human therapists are consistently favored by both men and women. AI-driven mental health apps should align with user preferences to address psychologist shortages. However, it is uncertain whether they alone can meet the rising demand, highlighting the need for alternative solutions.

Antecedents of Customer Participation on Sharing Platforms: A Meta‐analysis

AbstractGiven the substantive influence of the digital revolution on the sharing economy, it is timely and relevant to ask why some sharing platforms (e.g. Airbnb and Uber) achieve significant success while others fail. To determine which factors encourage customers to participate in sharing goods and services on sharing platforms, and when they do so, this study conducts a meta‐analysis of empirical findings from 192 independent samples, extracted from 167 studies involving 171,344 customers. As the results clarify, customer‐related factors (customer motives, customer competence, customer satisfaction and subjective norms) are key antecedents. However, platform‐related factors (service quality of the platform, trust in the platform, performance expectancy and effort expectancy) and service‐provider‐related factors (service quality of the provider, trust in the provider and provider gender) also exert meaningful effects. To assess the generalizability of these antecedents, the meta‐analysis includes contextual moderators, namely customer type (previous provider experience), provider type (private/professional supply), platform characteristics (rivalry on the platform, prestige of ownership and services/goods) and exchange type (for‐profit/non‐profit and ownership transfer). The findings advance the literature on the sharing economy and provide specific guidance for platform managers about when to focus on certain antecedents.

Exploring a learning model for knowledge integration and the development of critical thinking among nursing students with previous learning: a qualitative study protocol

Students often struggle to apply their knowledge of bioscience to their care practice. Such knowledge is generally learned through remembering and understanding, but retention quickly fades. They also experience difficulty progressing to higher-order cognitive skills such as applying, analyzing, evaluating, and even creating, which are necessary to develop soft skills, such as critical thinking, in the care profession. In order to improve existing programs, there is a need to better understand students' prior learning experiences and processes. The proposed study will explore the previous learning experiences of nurses enrolled in a two-year nursing program at a Taiwan university and identify the challenges they face in integrating multidisciplinary knowledge and developing critical thinking competency. The study will adopt a constructivist grounded theory methodology to collect interview data. The findings are expected to improve higher cognitive learning performance and inform the revision of the two-year nursing curriculum.

High-risk pregnancy and risk of breastfeeding failure

BackgroundThere is growing evidence that supports the role of breastfeeding in reducing the burden of non-communicable diseases (NCDs). There are considerable gaps in breastfeeding outcomes in mothers with chronic diseases due to a lack of knowledge and support in the postpartum period. Mothers who have NCDs and pregnancy complications are at risk of breastfeeding failure.AimTo compare breastfeeding outcomes in mothers with NCDs with healthy mothers and determine the underlying challenges that lead to poor outcomes.MethodsA prospective cohort study was conducted among 150 women (50 with high-risk pregnancies (HRP) and 100 with normal pregnancies (NP)). They were recruited from those attending the immunization and outpatient clinics at Sohag General Hospital. Mothers were recruited at 34 weeks gestation and were followed up at 2 weeks, 6 weeks, and 6 months after delivery. A pretested and validated questionnaire was used to collect detailed epidemiological, personal, health-related status, medications, hospitalizations, reproductive history, current delivery, and previous breastfeeding experiences. On follow-up they were assessed for breastfeeding practices, their health and health and growth of their children, and social support.ResultsDelivery by cesarean section and postpartum bleeding were commoner among HRP patients. Initiation of breastfeeding in the 1st hour of delivery was significantly lower among women with HRP than those with normal pregnancies (48.0% versus 71.0%, p = 0.006). The most common reason for not initiating breastfeeding among the NP group was insufficient milk (34.5%), while in the HRP group, it was the mother’s illness (80.8%). Skin-to-skin contact with the baby after birth was significantly less practiced in the HRP than in the NP group (38.0% vs 64.0% at p = 0.003). Herbs (such as cumin, caraway, cinnamon, aniseed, and chamomile) were the most common pre-lacteal feeds offered (63.0% in NP vs 42.0% in HRP). Artificial milk was more used in HRP than NP (24.0% vs 4.0%). Breast engorgement was 3 times more common in the HRP compared to the NP group (61.5% vs19.6%). Stopping breastfeeding due to breast problems was 2.5 times higher in the HRP than in the NP group (38.5% vs. 15.2%, p = 0.003). Nipple fissures were twice as common among the NP than among the HRP group ((73.0%) vs. (38.5%), p = 0.026). Exclusive breastfeeding during the period of follow-up was lower in the HRP than in the NP group (40.0% vs 61.0%, p < 0.05) and formula feeding was twice as common in the HRP as in the NP group (34.0% vs. 18.0%, p = 0.015). Child illness was significantly higher among women with HRP than those with NP (66.0% vs 48.0%, p = 0.037).ConclusionsWomen with HRP are at a high risk of poor breastfeeding outcomes with increased lactation problems and formula feeding rates. Encouraging women especially those with HRP to achieve optimal breastfeeding practices is a simple intervention that can be included in daily practice and may have a positive impact on mothers’ health.

The effect of environmental stressors perceived by surgical intensive care unit patients on hopelessness level

The aim of the research was to determine the effects of environmental stressors perceived by patients hospitalized in the surgical intensive care unit on hopelessness level. This descriptive research was performed between September 2023 and February 2024. The population of the study included all adult patients hospitalized in the Surgical Intensive Care Clinic of a City Hospital in Eastern Türkiye. The sample of the study includes 230 patients selected by random sampling method from this population. We used Personal Information Form, Intensive Care Unit Environmental Stressors Scale (ICUESS) and Beck Hopelessness Scale (BHS) to collect the data. Descriptive statistics, t-test, ANOVA, and correlation analysis tests were used to evaluate the data. The ICUESS mean score of the patients participated in the study was found to be at a high level with 102.13±15.95. Beck hopelessness scale score mean was found to be at a mild level with 6.36±5.78. It was found that the patients' gender, age, educational status, chronic disease status and previous intensive care experience affected the level of hopelessness. The relationship between ICUESS and BHS scores of the patients included in the study was examined and it was found that there was a low level of positive significant relationship between them (r: 0.162, p: 0.014). The hopelessness level of patients in surgical intensive care units was found to increase as the level of exposure to environmental stressors increased. It may be recommended to identify environmental stressors affecting the hopelessness level of patients and to implement interventions to reduce them.

Experiences of clinical nurses with medication interruption: A systematic review and qualitative meta-synthesis.

Managing medication interruptions is considered one of the biggest dilemmas for nurses in clinical settings. To improve medication safety, it was imperative to conduct a systematic review to get a deeper understanding of nurses' experiences with medication interruptions. A systematic review and qualitative meta-synthesis aimed to explore clinical nurses' experiences of interruption during medication in hospitals. Systematic searches were conducted in PubMed, CINAHL, Ovid Medline, Embase, Web of Science, and The Cochrane Library from inception to January 2024. The search strategy included four groups of keywords: (1) qualitative research, (2) nurses, (3) medication interruption, and (4) experience. Critical Appraisal Skills Programme was used to assess the quality of the studies. Meta-ethnography was utilized to synthesize the findings of the included studies. Nine articles published between 2012 and 2023 were included; the number of participants varied from 5 to 40, aged 20-68 years, and the majority were female. Four synthesized findings were identified as follows: (1) an inevitable part of the routine, (2) a decision-making process, (3) working in a minefield, and (4) coping with interruption. Nurses embraced interruptions as an inherent component of clinical care. Previous experience and nursing culture, encompassing personal and professional aspects, significantly influence nurses' attitudes toward medication interruptions. It is crucial to incorporate the distinctive work experiences of nurses into techniques aimed at efficiently handling interruptions in future research. The registration number in PROSPERO is CRD42023470276.

The Low-Income and Middle-Income Countries' Perspective on Global Neurosurgery Collaborations.

Access to neurosurgical care is limited in low-income and middle-income countries (LMICs) and in marginalized communities in high-income countries (HICs). International partnerships represent one possible means of addressing this issue. Insights from surgeons in HICs have been explored, but data from LMICs' counterparts are scarce. We aimed to study the perspectives of neurosurgeons and trainees from LMICs regarding global neurosurgery (GN) collaborations and interests, motivators, and challenges in participating. An online survey was conducted targeting neurosurgeons and trainees from LMICs. The survey explored demographics, previous experiences, ongoing activities, interests, and barriers related to GN activities. Data were collected between July 2022 and December 2022 and analyzed. Responses involved 436 individuals. The most represented region (25%) was sub-Saharan Africa, and most respondents were male (87.8%) aged 35-49 years. Interest in GN was high, with 91% after its developments. Most respondents (96.1%) expressed interest in training, professional, or research experience in HICs, but only 18.1% could cover the expenses. A majority (73.2%) strongly agreed to return to their home country for work after HIC training. Ongoing HIC-LMIC partnerships were reported by 27.8% of respondents. Clinical exposure emerged as the most relevant motivating factor (87%), while financial concerns, lack of opportunities, and lack of program support were identified as important barriers. Funding and dedicated time were highlighted as the most crucial facilitators. Understanding the perspectives of neurosurgeons and trainees from LMICs is essential to expanding HICs-LMICs collaborations and improving access to neurosurgical care worldwide. Financial support and targeted interventions are needed to address barriers and promote equitable partnerships in GN.

Changes in Trait Mindfulness after a Brief Mindfulness Training Program of Self-Breathing.

Developing and cultivating mindfulness exerts a positive effect on psychological and cognitive performance. Sharpening the skill requires continuous mindfulness-based training (MT), which can be challenging for people leading busy lives. Therefore, the current study examined whether trait mindfulness can be improved by a flexible and brief MT program of self-breathing using a pre-post intervention design. Trait mindfulness was assessed using the Japanese version of the Five Facet Mindfulness Questionnaire (FFMQ) before the intervention (pre), after 2 weeks (during), and 4 weeks after the intervention started (post). Data were analyzed using the Friedman test followed by the Dunn-Bonferroni correction. The study sample consisted of 22 healthy participants aged from 20 to 60 years with no previous experience with yoga or meditation equivalent to MT. The mean number of days of MT practice was 26.4, and 11 participants had interruptions. The median values of pre-, during-, and post-total FFMQ scores were 115.5, 123, and 129, respectively. Significant differences were observed in the total pre and post (p < 0.001) and during and post (p = 0.002) FFMQ scores, though a medium effect was found (r = 0.30) only between the pre and post scores. Of the five sub-scales of FFMQ, significant differences were observed only between pre and post Observing (p = 0.01), Nonreactivity (p < 0.001), and Describing (p = 0.01), and during and post Nonjudging (p = 0.016), and Nonreactivity (p = 0.025). Our findings suggest that the simple, brief, and flexible self-breathing method employed in this study has a substantial effect on fostering trait mindfulness and, therefore, can be adopted by people with hectic daily schedules.

Admissions pathways and international undergraduates’ academic achievement

ABSTRACT Background There are a number of pathways available for international students to gain admission into universities in English-speaking countries. While many international students for whom English is not their first language succeed academically, there is concern that some do not cope with the demands of university which can affect their retention and academic success. This study considers the effects of different admissions pathways on international undergraduate students’ academic success in one New Zealand university. Purpose Findings from the first phase of this research revealed that international students who entered university with the National Certificate of Educational Achievement (NCEA) gained at high school in New Zealand performed significantly worse academically than their peers who entered through three other admissions pathways. This study aimed to ascertain whether there were salient features of students’ prior education and undergraduate experiences which contributed to this outcome. Method In-depth interviews were conducted with nine students who entered a university in New Zealand via two admissions pathways: NCEA or the International English Language Testing System (IELTS). The data generated through these interviews was analysed to enable qualitative comparisons between the two groups. Findings Results suggest that the IELTS group outperformed their NCEA peers due to maturity and prior education in their home countries. While the NCEA students had spent some years at high school in the host country, they did not, in general, demonstrate the same level of academic literacy as their IELTS peers. Conclusion International students’ outcomes appear to differ due to previous educational experiences. Students who enter via NCEA are potentially more likely to need support, as they may still be dealing with language proficiency issues, whereas those who enter via IELTS with prior higher-level education in their home country may be more academically prepared. It is important that institutions promote learning support opportunities for all international students, to ensure they experience a positive social and learning experience, which can ultimately contribute to their retention in learning, and their academic success.

Implementation and analysis of clinically-relevant anatomy imaging for first-year dental students.

Radiographic imaging interpretation is a central competency of the dental profession. Previous research has determined that radiographic interpretations vary across dentists. In addition, the efficacy of empirical learning within the realm of medical imaging analysis remains understudied. This project aimed to improve an existing anatomy curriculum as well as students' radiographic interpretation skills via implementation of medical radiographic case studies with scaffolded exercises. Three medical imaging activities were developed by the authors and presented in the anatomy laboratory for 60 first-year dental students. Each module included identical pre-activity and post-activity questionnaires, radiographic images with corresponding lesson plans, and open-response questions on the activity's valuable and challenging components. Pre-activity and post-activity questionnaire scores were compared via a Wilcoxon signed rank test. Kruskal-Wallis tests were conducted to determine the impact of previous anatomy experience and previous medical imaging experience on student performance. Thematic analysis was applied to open response comments. A statistically significant improvement in questionnaire scores was observed in the first medical imaging activity. No significant change in scores was observed for the other two activities. Students valued the activities' interactive structure, review of course material, and application to the dental profession. Students reported challenges in radiographic image interpretation and lack of previous knowledge on course concepts. While medical imaging activities failed to consistently improve student-learning outcomes, they introduced skill development in radiographic analysis and increased student confidence. These findings suggest a need for additional research on experiential methodologies within medical imaging education.

Discovery and Characterization of Brigimadlin, a Novel and Highly Potent MDM2-p53 Antagonist Suitable for Intermittent Dose Schedules.

p53 is known as the guardian of the genome and is one of the most important tumor-suppressors. It is inactivated in most tumors, either via tumor protein p53 (TP53) gene mutation or copy number amplification of key negative regulators, e.g., mouse double minute 2 (MDM2). Compounds that bind to the MDM2 protein and disrupt its interaction with p53 restore p53 tumor suppressor activity, thereby promoting cell cycle arrest and apoptosis. Previous clinical experience with MDM2-p53 protein-protein interaction antagonists (MDM2-p53 antagonists) have demonstrated that thrombocytopenia and neutropenia represent on-target dose-limiting toxicities that might restrict their therapeutic utility. Dosing less frequently, while maintaining efficacious exposure, represents an approach to mitigate toxicity and improve the therapeutic window of MDM2-p53 antagonists. However, to achieve this, a molecule possessing excellent potency and ideal pharmacokinetic properties is required. Here, we present the discovery and characterization of brigimadlin (BI 907828), a novel, investigational spiro-oxindole MDM2-p53 antagonist. Brigimadlin exhibited high bioavailability and exposure, as well as dose-linear pharmacokinetics in preclinical models. Brigimadlin treatment restored p53 activity and led to apoptosis induction in preclinical models of TP53 wild-type, MDM2-amplified cancer. Oral administration of brigimadlin in an intermittent dosing schedule induced potent tumor growth inhibition in several TP53 wild-type, MDM2-amplified xenograft models. Exploratory clinical pharmacokinetic studies (NCT03449381) showed high systemic exposure and a long plasma elimination half-life in cancer patients who received oral brigimadlin. These findings support the continued clinical evaluation of brigimadlin in patients with MDM2-amplified cancers, such as dedifferentiated liposarcoma.

Sperm depletion and mate choice of the crab spider, Ebrechtella tricuspidata (Fahricius)

Abstract Mounting evidence suggests that male sperm may be gradually depleted after consecutive matings, resulting in the decline of female reproductive output in insect species. It is predicted that females may employ adaptive strategies to avoid the sperm-depleted males, such as mating multiply with different males and/or discriminating against previously mated males (MMs). Similarly, males may exhibit adaptive behaviors toward females varying in mating status. However, in spiders with males lacking primary copulatory organs and their pedipalps modified to transfer sperm, there are few studies on male mating potential and previous mating experience on their subsequent mate choice. In this study, we used a polyandrous crab spider, Ebrechtella tricuspidata, a sit-and-wait predator with female-biased sex ratio as a model system to ascertain whether 1) male mating experiences influence female reproductive fitness; 2) females respond differently to males varying in mating status; and 3) males respond differently to females varying in mating status. Our results showed that female fecundity was independent of male mating experiences, but female fertility markedly declined with the increase of male previous mating experiences in the first eggsac. Counter to our predictions, females preferred to choose and mate with the larger males, regardless of their mating status. In contrast, male mating status influenced their mating preference toward females. Virgin males did not show any preference between virgin and mated females; however, MMs were more likely to prefer the virgin females over the mated ones. Overall, our results indicated that female choice depended primarily on male relative size rather than male mating status, whereas male choice depended on female mating status. Depending on the investigation of reproductive dynamics and mate choice in E. tricuspidata, the study will provide valuable insights into the adaptive behaviors of both males and females exhibiting toward mates varying in mating status.

Autonomy & advocacy in planning for a medical emergency: Adults with a learning disability and family carers' experiences and perceptions of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process.

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is designed to facilitate meaningful discussions between healthcare professionals, patients, and their family about preferences for treatment in future medical emergencies. People with a learning disability may face particular barriers in completing health care plans and receiving emergency treatment, however little is known about their preferences towards emergency care treatment planning. This study explores the views of people with a learning disability, and family carers about ReSPECT. A reference group of 5 people with a learning disability contributed to the design of the workshops and evaluation of outputs. Online, arts-based interactive workshops were held with 2 groups of 6 people with a learning disability to explore how they felt about emergency care treatment planning, and to co-produce materials to support ReSPECT conversations. Carers of people with a learning disability participated in focus groups or interviews. Data from workshops, focus groups and interviews were analysed thematically. Themes were; Getting the Process Right, Lack of trust a barrier to ReSPECT planning, and Person-Centred Care. All groups supported the ReSPECT process feeling that ReSPECT plans could support person-centred care, enhancing the autonomy of a person with a learning disability and supporting the advocacy of carers. However, drawing on their previous experiences of the health care system some expressed doubt that their wishes would be carried out. Suggestions were made for improving the ReSPECT process and used to develop resources to support ReSPECT planning. Emergency care planning and ReSPECT are viewed positively by people with a learning disability and family carers. To ensure this works well for people with a learning disability attention should be given to reasonable, personalised adjustments to support their participation in planning conversations. There is a wider challenge of fostering trust in the health care system.

Knowledge of aging, attitudes toward older people and willingness to engage in geriatric rehabilitation among rehabilitation students in southwestern China: a cross-sectional study

BackgroundAs the global elderly population rises, providing quality care for older adults is increasingly challenging. Rehabilitation technicians are crucial in this effort. Their knowledge and attitudes significantly impact care quality and their willingness to work with the elderly. While many studies have examined healthcare professionals’ attitudes toward older adults, few focus on rehabilitation students. This study assesses Chinese rehabilitation students’ knowledge of aging, attitudes toward older individuals, willingness to care for them, and the factors influencing these aspects.MethodsA sample of 890 rehabilitation students from three colleges and universities in southwestern China was investigated with a self-administered questionnaire, which included socio-demographic information, the Palmore Facts on Aging Quiz, the Kogan’s Attitude towards Older People Scale and the Chinese Version of the Interpersonal Reactivity Index. Data analyses were conducted using SPSS version 25.0. Descriptive statistics were used to illustrate the demographic characteristics of the respondents. The frequency and percentage of responses was calculated. Means and standard deviations were computed for general knowledge of aging, attitudes toward older people, and empathy. Independent t-tests and one-way ANOVA assessed differences in FAQ, KAOP, and IRI-C scores between groups. Pearson’s correlation examined correlations among general knowledge of aging, attitudes toward older people and empathy ability. Chi-square or Fisher’s exact tests compared willingness to engage in geriatric rehabilitation across different respondent characteristics. Hierarchical multiple regression analysis explored the independent effect of different variables on attitudes toward older people.ResultsThe Chinese rehabilitation students from three colleges and universities in southwestern China displayed a relatively low level of knowledge about aging, but a generally positive attitude towards older people. Females had significantly more positive attitudes toward older people than males(p<0.01). The students who had previous experience of being cared for by (maternal) grandparents, living with the elderly, and taking care of the elderly showed significantly more positive attitudes toward older people (p = 0.001, 0.007 and 0.007, respectively) and a significantly stronger willingness to engage in geriatric rehabilitation(p = 0.013, <0.01 and <0.01, respectively) than those who had not had these experiences. Students with good relationships with older people had more positive attitudes toward the elderly (p < 0.01) and greater willingness to engage in geriatric rehabilitation (p < 0.01). Those with frequent contact with the elderly also showed more positive attitudes (p < 0.01) and a stronger willingness to engage in geriatric rehabilitation (p = 0.002) compared to those with less contact. Knowledge of aging and empathy ability were both significantly positively related to attitudes toward older people and both independent predictors of attitudes toward older people(r = 0.143, p<0.01 and r = 0.337, p<0.01).ConclusionsIt is crucial to prepare rehabilitation students with adequate knowledge and positive attitudes to ensure the quality of rehabilitation and care provided to older people. Educators should adopt effective strategies to promote rehabilitation students’ geriatric rehabilitation knowledge and increase their positive attitudes toward older people.

Time scale analysis of enzymatic reduction of uric acid in a microfluidic biomedical device

Time Scale Analysis (TSA) is an investigative tool used in engineering design to identify locations in processes that should be a focus of Process Intensification (PI). Furthermore, TSA points to process variables and parameters that could be used to advance and measure PI improvement. However, TSA cannot suggest any specific design solution to intensify process performance. Instead, design engineers should use their fundamental knowledge and creative intelligence to specify detailed design transformations. TSA will then provide a specific quantitative measure of the improvement. TSA implementation improves an explicitly defined process performance, thus helping achieve process intensification goals. TSA is based on first principles, and it utilizes Characteristic Times (CT) such as diffusion, mean residence, and reaction times to improve an existing process. In this study, we specifically consider microfluidic biomedical devices. To illustrate the genesis of CT and TSA, we start by developing a mathematical model of an enzymatic degradation process in a biomedical device called iCore based on mass, momentum, and kinetic equations. After introducing user-defined scaling parameters, we extract CTs pertinent to the enzymatic degradation of uric acid in this microfluidic biomedical device. Diffusion coefficients, microchannel architectural characteristics, enzyme loading, hydrogel thickness, and characteristic parameters of enzyme kinetics are the parameters and process variables incorporated in this analysis. Finally, we compared the extracted CTs with a COMSOL Multiphysics parametric study to demonstrate how time scale analysis as a design tool and adjusting design parameters, such as diffusion coefficient, hydrogel layer thickness, substrate concentration, and enzyme concentration, can enhance the enzymatic reaction process without a need for complex computational modeling. It is crucial to recognize that pertinent CTs can be determined by understanding the type and nature of the observed process, previous experience, published data, and other foundational engineering design work. There is no need for mathematical modeling and numerical simulations to identify and acknowledge the CTs relevant and essential to the observed process; in this work, we only illustrate the principal origin of CTs via a detailed mathematical model of the process, as previously reported by Jovanovic et al. Therefore, in a routine application of TSA, it is important to remember that mathematical modeling and detailed numerical simulations are not necessary. This is a very comforting fact when TSA is deployed as a tool in higher-level process design functions. The investigations on how best to apply TSA in these higher level design functions such as Process Intensification, scale-up/numbering-up, change of device architecture, change of operating conditions, change of process feed characteristics, change of material physical and chemical properties, parametric optimization of the system for various objective functions, and techno-economic analysis, are yet to be studied and reported.

Process evaluation of a breastfeeding support intervention to promote exclusive breastfeeding and reduce social inequity: a mixed-methods study in a cluster-randomised trial

BackgroundBreastfeeding is a powerful public health intervention that produces long-term health benefits. However, in high-income countries such as Denmark, breastfeeding rates are suboptimal and unequally distributed across socio-economic positions. The ‘Breastfeeding – a good start together’ intervention, to promote longer duration of exclusive breastfeeding and reduce social inequity, was implemented in a cluster-randomised trial during 2022–2023 across 21 municipalities in two Danish regions. A process evaluation was conducted to assess the implementation, mechanisms of impact, and possible contextual factors affecting the intervention.MethodsThe study was guided by the Medical Research Council’s guidance for conducting process evaluations and employed a mixed-methods approach in a convergence design. Quantitative data: contextual mapping survey (n = 20), health visitor survey (n = 284), health visitor records from 20 clusters and intervention website statistics. Qualitative data: dialogue meetings (n = 7), focus groups (n = 3) and interviews (n = 8).ResultsOverall, the intervention was delivered as planned to intended recipients, with few exceptions. Health visitors responded positively to the intervention, noting that it fitted well within their usual practice and enhanced families’ chances of breastfeeding. Mothers expressed having received the intervention with few exceptions, and reacted positively to the intervention. Although health visitors were concerned about the potential stigmatisation of mothers receiving the intensified intervention, none of the interviewed mothers felt stigmatised. Contextual factors impacting the intervention implementation and mechanisms included staff and management turnover, project infrastructure and mothers’ context, such as resources, social networks and previous experiences. The overall fidelity of the intervention delivery was high.ConclusionsHealth visitors and families responded well to the intervention. Interventions aimed at enabling health care providers to deliver simplified and structured breastfeeding support, in alignment with support provided in other sectors of the health care system, may increase breastfeeding rates and reduce social inequity in breastfeeding, even in international contexts.Trial registrationClinical Trials: NCT05311631. First posted April 5, 2022.

Online Plain Language Tool and Health Information Quality

Complex and ineffective health communication is a critical source of health inequity and occurs despite repeated policy directives to provide health information that is easy to understand and applies health literacy principles. To evaluate the effectiveness of the Sydney Health Literacy Lab Health Literacy Editor, an easy-to-use online plain language tool that supports health information providers to apply health literacy guidelines to written health information. This randomized clinical trial, conducted online in Australia from May 2023 to February 2024, included a convenience sample of health information providers with no previous experience using the Health Literacy Editor. Analysts were blinded to study group. Participants were randomized 1:1 to the intervention or control group. Participants in the intervention group were provided access to the Health Literacy Editor and a 30-minute online training program prior to editing 3 prespecified health texts. The Health Literacy Editor gives objective, real-time feedback on words and sentences. Control participants revised the texts using their own standard health information development processes. The preregistered primary outcome was the text school grade reading score (using a validated instrument, the Simple Measure of Gobbledygook). Secondary outcomes were text complexity (percentage of text using complex language), use of passive voice (number of instances), and subjective expert ratings (5-point Likert scale corresponding to items on the Patient Education Materials Assessment Tool). A total of 211 participants were randomized, with 105 in the intervention group and 106 in the control group. Of 181 participants in the intention-to-treat analysis (mean [SD] age, 41.0 [11.6] years; 154 women [85.1%]), 86 were in the intervention group and 95 in the control group. Texts revised in the intervention group had significantly improved grade reading scores (mean difference [MD], 2.48 grades; 95% CI, 1.84-3.12 grades; P < .001; Cohen d, 0.99), lower text complexity scores (MD, 6.86; 95% CI, 4.99-8.74; P < .001; Cohen d, 0.95), and less use of passive voice (MD, 0.95 instances; 95% CI, 0.44-1.47 instances; P < .001; Cohen d, 0.53) compared with texts revised in the control group in intention-to-treat analyses. Experts rated texts in the intervention group more favorably for word choice and style than those in the control group (MD, 0.44; 95% CI, 0.25-0.63; P < .001; Cohen d, 0.63), with no loss of meaning or content. In this randomized clinical trial, the Health Literacy Editor helped users simplify health information and apply health literacy guidelines to written text. The findings suggest the tool has high potential to improve development of health information for people who have low health literacy. As an online tool, the Health Literacy Editor is also easy to access and implement at scale. ANZCTR Identifier: ACTRN12623000386639.

Self-efficacy as a psychological resource in the management of stress suffered by ICU nurses during the COVID-19 pandemic: A prospective study on emotional exhaustion.

Intensive care unit (ICU) nurses have experienced a high degree of stress during the COVID-19 pandemic. While the literature on the consequences on emotional symptomatology is abundant, studies on the protective psychosocial variables that have contributed to buffering these consequences are scarcer. This study analyses the role of self-efficacy as a protective personality trait in ICU nurses during the COVID-19 pandemic, using a moderated mediation model that begins with the stress and anxiety experienced at the onset of the pandemic and concludes with the emotional exhaustion experienced 6 months later. Prospective longitudinal study with two data collection periods during the COVID-19 pandemic: (1) from 5 May to 21 June 2020 and (2) a follow-up 6 months after the state of alarm finalized (January-April 2021). These were both very stressful periods for ICU staff because of the COVID-19 pandemic. This study was conducted with 129 ICU nurses (a non-probabilistic convenience sample in the Spanish health care system). Socio-demographic, occupational and psychosocial variables (i.e. stress, anxiety, self-efficacy and emotional exhaustion) were assessed. Descriptive analyses, Pearson correlations, covariate analyses (i.e. Student's t-test, one-factor ANOVA) and moderated mediation analyses were carried out (SPSS PROCESS macro, model 7). STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) reporting guidelines were followed. It shows that the higher the self-efficacy score, the lower the effect of stress on anxiety (p < .001); likewise, the moderating role of self-efficacy was equally valid for the whole final model (F = 8.790, p < .001), showing self-efficacy to be a good buffer for emotional exhaustion derived from the stress suffered in the ICU. Self-efficacy (i.e. the belief of being able to do certain tasks successfully) is shown to be a highly relevant trait to enhance among ICU nurses during the COVID-19 pandemic, allowing them to manage work stress effectively and thus buffering the development of anxiety in the short term and emotional exhaustion in the long term. Our results point to the need to assess and take action on self-efficacy in ICU nurses in highly stressful situations such as the COVID-19 pandemic. As a psychological variable, self-efficacy refers to beliefs and therefore has to be trained by evidence-based psychological techniques, such as cognitive behavioural therapy. In addition, previous literature has pointed out that previous experience or specific training is an influential (although not a determining) factor in self-efficacy, so specialization for ICU nurses could also be considered.

Construct validity and applicant reactions of a gamified personality assessment

This study introduces the HEXACO-RUSH, a gamified version of the HEXACO Situational Judgment Test developed by Oostrom and her colleagues (2019). HEXACO-RUSH is a new fantasy-adventure, narrative game, where the player makes a series of decisions in a similar format like a situational judgment test. We first present evidence on the construct validity (N = 240) of the game in relation to an existing traditional personality assessment (HEXACO-60), and in a second study (N = 160), we explore perceptions towards the game using a repeated measures, within-samples research design, again compared to HEXACO-60, with a sample of participants who assumed the role of a job applicant. Our results provided preliminary support for a moderate alignment between the new game and the HEXACO model, with average correlations of .43 across the six dimensions. It also exhibited positive participants' reactions, compared to HEXACO-60, although these were moderated by previous video-gaming experience (but not age). Overall, this study provides some initial evidence for an alternative assessment of the six personality factors with improved participants’ reactions and higher resistance to faking, but further research is required to confirm its test re-test reliability and criterion-related validity, with larger employee or applicant samples.

Design Insights for Developing Deepfakes Awareness Games for Adolescents

Around a decade ago, significant advancements in the deep learning domain like Generative Adversarial Networks (GANs) started to facilitate the creation of new synthetical content. The development of deepfake algorithms gained momentum due to the increase in computing power and open-source available resources which facilitated broader access to advanced deep learning methods. While initially deepfakes were created by creative pursuits in various media and marketing campaigns, they started to be misused driven by malicious purposes in various social media manipulation campaigns. These campaigns imply spreading disinformation and misinformation for discrediting individuals and creating confusion in relation to specific topics and events and are meant to altering users’ beliefs and behaviours. Such facts raised important ethical and societal concerns. Although deepfakes still represent a recent research area, a large body of studies is dedicated to, on the one hand, generation, and detection of deepfakes, and on the other hand, to understanding their implications and consequences for society. At the same time, governmental and practitioner efforts are devoted to containing their use and impact on society by proposing various strategies and programs. Nevertheless, both academic and societal efforts are in an incipient stage and often adopt a generalist perspective. This represents a crucial point in relation to the fact that many users in various social media platforms like TikTok is represented by adolescents that are known to be unaware and more vulnerable to media content in general, and deepfakes content, in particular. This represents the knowledge gap that this research aims to tackle by synthesizing design insights as requirements and guidelines that can be used when developing and deploying deepfakes awareness games for producing and/or enhancing awareness of adolescents. Accordingly, a systematic literature review is conducted and merged with previous experience in this domain by adopting a transdisciplinary research approach that merges methods and techniques from the deepfakes, AI, social media, cyber security, and gamification domains.