Self-reported Compliance Research Articles

Effect of Pharmacist-Led Interventions on Medication Adherence and Glycemic Control in Type 2 Diabetic Patients: A Study from the Chinese Population.

Medication adherence plays an important role in glycemic control in type 2 diabetes mellitus (T2DM) self-management. To analyze the factors influencing medication adherence in T2DM patients and the effect of pharmacist-led interventions, we conducted a study in Beijing, China. T2DM patients with hypoglycemic drugs for at least 6 months were enrolled. A pharmacist-led survey was conducted followed by individualized interventions for those non-adherent patients monthly within 3 months. FPG, HbA1c, and 2hPG were measured as the comprehensive glycemic control. Medication adherence was determined according to the patient's self-reported compliance with prescribed medication during the last 3 months. A total of 763 T2DM patients were included. The average age was 63.26±11.89 years, with 363 males. After pharmacist intervention, the patients with good adherence increased from 34.21% to 39.06%, while poor adherence decreased from 32.5% to 24.5% (p < 0.001). The average adherence score was a significant increase (p < 0.001) from 27.846±4.185 to 29.831±7.065. Furthermore, our study demonstrated that pharmacist-led interventions significantly increased glycemic control (FPG from 42.33% to 53.60%, p < 0.001; 2hPG from 41.68% to 48.75%, p = 0.005; HbA1c from 24.12% to 29.23%, p = 0.024). The results found that body mass index (OR 0.643, 95% CI 0.437-0.945), use of medications empirically (occasionally (OR=3.066, 95% CI 2.069-4.543); often (OR=2.984, 95% CI 1.107-8.044)), following the doctor's advice to visit (OR 2.129, 95% CI 1.079-4.202) and lifestyle compliance (OR 2.835, 95% CI 1.094-7.346) were the independent risk factors of non-adherence (p < 0.05), the area under the ROC curve was 0.716. Self-reported medication adherence and glycemic control in T2DM patients were poor which can be improved by pharmacist-led interventions. Interventions should focus on empirical medication behavior, non-adherence to lifestyle, and failure to follow the doctor's advice. The recall bias with self-reported results needs further objective data to verify.

From delta to omicron: The role of individual factors and social context in self-reported compliance with pandemic regulations and recommendations

As SARS-CoV-2 spreads especially when larger groups gather (e.g., at the workplace), it is crucial to understand compliance with regulations and recommendations in such settings. Using data from adults in Germany (N = 29,355) assessed between October 2021 and February 2022, we investigated factors associated with self-reported compliance in both private and working life and how these relate to each other. The results indicate that private compliance was stronger among older individuals and females; among those who worried more about the pandemic situation and assumed that infection was more severe; among those who trusted the government more; and among those who did not perceive public health measures as exaggerated. Private compliance was also associated with personality traits; in particular, individuals who followed regulations and recommendations were likely to be more introverted, conscientious, open, and agreeable. Compliance at work related to both private compliance and colleagues' behaviors. Individuals whose private compliance was high also complied at work. However, when private compliance was low, compliance at work aligned with colleagues’ behaviors; that is, compliance at work was high when colleagues complied and low when they did not. The observed effects were stable over time. In summary, they suggest that compliance with regulations and recommendations depends on individual risk perception, trust in government, perception of required or recommended measures, and social norms. To promote protective behaviors in contexts where larger groups gather (including workplaces), making positive social norms more salient (e.g., by supporting role models) may prove especially useful.

The feasibility of a flexible exercise participation programme (FEPP) for individuals with multiple sclerosis.

Individuals with multiple sclerosis (MS) want health advice regarding participation in their choice of exercise. To address this need, a flexible exercise participation programme (FEPP) was developed, underpinned by the MS aerobic exercise guidelines and supported by a physiotherapist using behaviour change techniques. The aim of this study was to investigate the feasibility of the FEPP for individuals with minimal disability from MS. A feasibility study utilising a single group pre/post-intervention design was conducted. The 12-week FEPP was completed by 10 individuals with MS (EDSS 0-3.5). Exercise progression in duration, intensity or frequency of exercise (in line with MS exercise guidelines) was guided by a self-perceived weekly energy level score, and weekly telephone coaching sessions using behavioural change techniques. Trial feasibility was assessed via measures of process (recruitment and retention), resources/management (communication time; data entry) and scientific feasibility (safety; compliance). Secondary FEPP feasibility outcomes included the Goal Attainment Scale (GAS) T-score, exercise participation (weekly exercise diary), high-level mobility (HiMAT), vitality (Subjective Vitality Scale), biomarkers for inflammation (cytokines levels [IL2, IL4, IL6, IL10, TNF and IFNγ]), and acceptability (participant survey). Process: In total, 11 (85%) of 13 eligible participants enroled at baseline with 10 (91%) completing the study. Resources/management: Coaching sessions included a baseline interview-mean 39min (SD: 6.6) and telephone coaching-mean 10min (SD: 3.8) per week. Outcome measure data collection time-mean 44min (SD: 2.1). Scientific feasibility: Two participants experienced a fall during their exercise participation. Self-reported compliance was high (99%). GAS T-scores increased significantly, indicating achievement of exercise participation goals. Secondary outcomes showed trends towards improvement. The FEPP was feasible, safe and highly acceptable for use with individuals with MS and warrants a larger trial to explore effectiveness.

Do orthodontic treatments using fixed appliances and clear aligner achieve comparable quality of occlusal contacts?

Design Non-randomised cohort study.Cohort selection The inclusion criteria comprised patients who finished their comprehensive orthodontic treatment based on a camouflage non-extraction modality using self-ligating orthodontic appliances therapy (SPEED brackets, Canada or Empower brackets, American Ortho, Sheboygan, WI, USA) or clear aligner therapy (Invisalign, Align Technology, San Jose, CA, USA). Patients were recruited from a university orthodontic clinic and a senior orthodontist's practice. The exclusion criteria comprised patients presenting with hypodontia, microdontia, severe periodontal problems, heavily resorted teeth and patients who were using retainers with occlusal coverage.Data analysis Included patients were assessed at three points in time: at the end of active orthodontic treatment and the start of retention phase (T0); at three months post treatment (T3); and at six months post treatment (T6). The following three assessments were done for each patient at T0, T3 and T6: a T-Scan 10 digital occlusal analysis recording into maximum intercuspation position (MIP); self-report about retainer compliance; and self-assessment of occlusal comfort using a visual analogue scale (VAS) ranging from 0-10 (0 = very uncomfortable; 10 = maximum comfort).The digital occlusal analysis was performed using a 100μ thin, flexible, horseshoe-shaped Mylar sensor (Novus HD sensor, Tekscan Inc, S. Boston, MA, USA). This sensor contains 1,370 active pressure sensing cells, known as sensels, arranged in a compact grid, shaped as a dental arch. The patients were given instructions on how to bite on the sensor. With the sensor still in the patient's mouth, three consecutive self-intercuspated closure-into-MIP registrations were recorded. If there was a need to repeat the procedure, one minute was given as a rest. If several recordings were done for the same patient in the same visit, the most consistency between the three consecutive intercuspations was used for analysis. In addition, the same sensor was used in T0, T3 and T6, unless the sensor shown excessive wear.The following outcomes were assessed using the digital occlusal analysis: 1) an estimate of occlusal contact surface area based on the activated sensels on the sensor at MIP; 2) the total surface of contacts and the area ratio between anterior (canine to canine) to posterior (premolar to second molar) contact surfaces; 3) the overall relative force distribution based on the by the position of the centre of force (COF); 4) the symmetry of contact distribution was expressed as the percentage of contacts on the right side to the left side (%R/L); and 5) the time-simultaneity of the closure into MIP contacts was calculated by the occlusion time measurement which is the duration between first contact and the time MIP was reached.Results In total, 39 patients were enrolled in the study. The self-ligating fixed appliance group included 25 patients (mean age 18.7 ± 5.2; 6 women, 19 men) while the clear aligner therapy group included 14 patients (mean age 20.6 ± 7.3; ten women, four men). Both groups were matched in terms of age, Angle's classification, symmetry, retention protocol and total number of bonded lingual wires or facial type. However, they were not matched in terms of sex, with more women in the aligner group (p = 0.007). Moreover, eight patients (four in each group) were excluded from the study later on due to a change in the retention protocol or a missed visit. The results showed that self-reported compliance with a Hawley retainer was not different between groups. Occlusal comfort was similar in both groups at treatment completion, with a median score of eight in both groups.The results showed that were no statistically significant differences between the two groups regarding all outcomes assessed using the digital occlusal analysis. Although the %R/L (normal range = 50% ± 5%) was not significantly different between both groups, neither treatment resulted in ideal occlusal balance (ie symmetry). Indeed, ten patients finished their treatment with subtle asymmetry (%R/L >50 ± 10%), especially in the self-ligating fixed appliance group (nine patients) showing side force differences (five right dominant, four left dominant) versus only one patient in the clear aligner group (left dominant).The COF moved posteriorly in both groups from T0 to T6, in parallel with a decreased ratio of anterior to posterior surface area. A statistically significant difference was observed in the anteroposterior position of COF between sexes, being more anterior in women at all times (p <0.002).Conclusions The quality of the occlusal contacts in MIP was comparable in both groups at T0, T3 and T6. Neither treatment resulted in an ideal occlusal balance (that is, symmetry). Ten patients finished their treatment with subtle occlusal force asymmetry (that is, asymmetric left-to-right side occlusal force distribution), especially in the self-ligating fixed appliance group. Most occlusal changes happened during the first three months of the retention phase, with more posterior contacts forces developing in both groups. In this study, female patients maintained more anterior COF when compared to male patients.

Do task and item difficulty affect overestimation of one’s hand hygiene compliance? A cross-sectional survey of physicians and nurses in surgical clinics of six hospitals in Germany

BackgroundOne barrier to hand hygiene compliance is overestimation of one’s own performance. Overconfidence research shows that overestimation tends to be higher for difficult tasks, which suggests that the magnitude of overestimation also depends on how it is assessed. Thus, we tested the hypothesis that overestimation was stronger for hand hygiene indications with low compliance (i.e., high difficulty), and the hypothesis that self-reported overall compliance based on a single item is higher than based on “5 Moments of Hand Hygiene” (WHO-5) items, since the single item implies an aggregation across indications.MethodsIn the WACH trial (German Clinical Trials Register [DRKS] ID: DRKS00015502), a questionnaire survey was conducted among physicians and nurses in nine surgical clinics (general/visceral surgery or orthopedics/trauma surgery) of six German hospitals. Self-reported compliance was assessed both by a single item and the WHO-5-items using percentage scales. These were compared with each other and with direct observations. Relative frequencies of the WHO-5 indications used to calculate the WHO-5-based self-reported overall compliance rate were estimated by a systematized review of the literature (see appendix). In analysis, t-tests, Chi2-tests and multiple linear regressions were used.ResultsNinety-three physicians (response rate: 28.4%) and 225 nurses (30.4%) participated. Significant compliance differences between physicians and nurses were found for direct observations and were in favor of nurses, while no such differences were found for self-reports. Across the WHO-5, overestimation showed inverse correlations with observed compliance (physicians: r = −0.88, p = 0.049; nurses: r = −0.81, p = 0.093). Support for the hypothesis that the self-reported overall compliance based on one item is higher than that based on WHO-5 items was found for physicians (M = 87.2 vs. 84.1%, p = 0.041; nurses: 84.4 vs. 85.5%, p = 0.296). Exploratory analyses showed that this effect was confined to orthopedic/trauma surgeons (89.9 vs. 81.7%, p = 0.006).ConclusionAmong physicians, results indicate stronger hand hygiene overestimation for low-compliance indications, and when measurements are based on a single item versus the five WHO-5 items. For practice, results contribute to infection prevention and control’s understanding of overestimation as a psychological mechanism that is relevant to professional hand hygiene.

Compliance with hand hygiene practices among nursing staff in secondary healthcare hospitals in Kuwait

BackgroundHand hygiene (HH) among healthcare workers, especially nurses, is the main preventive measure to control healthcare associated infections but compliance with hand hygiene (CwHH) remains low in various settings including Kuwait. This study aimed to assess the knowledge of, attitudes towards, and CwHH among nursing staff in secondary care hospitals in Kuwait.MethodsA cross-sectional study was conducted on nursing staff in all six secondary care hospitals in Kuwait. Data on knowledge of, attitudes towards, and self-reported CwHH were collected through a self-administered questionnaire that was developed based on WHO’s questionnaire, while the data on actual compliance were objectively collected through direct observation of nurses during routine care by two independent observers using WHO’s observation form.ResultsOf 829 nurses approached, 765 (92.2%) responded and participated. Of all participants, 524 (68.5%) were able to list “My Five Moments for Hand Hygiene” fully and appropriately. However, several misconceptions (e.g. air circulation in hospital is the main route of infection) about HH were found among the nurses. CwHH was (25.0%) by direct observation while self-reported compliance was (69.5%) each varied significantly (p < 0.001) between different hospitals. Female nurses compared to male nurses and non-Arab compared to Arab nationalities were more likely to report CwHH in multivariable analysis. Several items on knowledge of and attitudes towards HH were also associated with self-reported CwHH.ConclusionObserved CwHH among nursing staff in secondary care hospitals in Kuwait was low, which highlights the need to make more efforts to improve HH practices. Interventions that have been used elsewhere and found to be effective may be tested in Kuwait. Despite the good overall knowledge on HH among nurses, there are several misconceptions that need to be corrected.

COVID-19 Restrictions and Adolescent Cigarette and E-cigarette Use in California

Shelter-in-place orders altered facilitators and barriers to tobacco use (e.g., outlet closures, restricted social gatherings). This study examined whether the duration of time in shelter in place and compliance with different shelter-in-place orders influenced adolescent cigarette and E-cigarette use and how the use may differ by demographic characteristics. Shelter-in-place policy data obtained from government websites were merged with cross-sectional 2020 survey data on adolescents in California. Treatment variables included the proportion of time in shelter in place and self-reported compliance with shelter-in-place orders (for essential businesses and retail spaces and social and outdoor contexts). Multilevel logit models for dichotomous past 6-month cigarette and E-cigarette use and multilevel negative binomial regression models for past 6-month frequency of use were used. Moderation analyses were conducted on demographic measures. The sample included 1,196 adolescents (mean age=15.8 years, age range=13-19 years, 49.2% female, 50.0% White). Analyses were conducted in 2022. No associations were found between the proportion of time in shelter in place and outcomes. Shelter-in-place compliance with essential business and retail space orders was associated with lower odds of using cigarettes and E-cigarettes in the past 6 months. Compliance with social and outdoor context-related orders were associated with lower odds of using E-cigarettes and fewer days using cigarettes and E-cigarettes. Being aged ≥18 years moderated the associations between essential business/retail space and social/outdoor context-related shelter-in-place compliance orders and past 6-month frequency of cigarette smoking. Findings support tailored interventions for less compliant and older adolescents for future pandemic mitigation measures.

Effect of electronic reminders on patients’ compliance during clear aligner treatment: an interrupted time series study

Patient compliance is relevant to achieving therapeutic goals during clear aligner therapy (CAT). The aim of this study was to evaluate the efficacy of remote electronic (e-)reminders and e-feedback on compliance during CAT using an interrupted time series (ITS) analysis. We used routinely collected mobile application data from a German healthtech company (PlusDental, Berlin). Our primary outcome was self-reported compliance (aligner wear time min. 22 h on 75% of their aligners were classified as fully compliant, min. 22 h on 50–74.9% of their aligners: fairly compliant; min. 22 h on < 50% of their aligners: poorly compliant). E-reminders and e-feedback were introduced in the 1st quarter of 2020. Compliance was assessed at semi-monthly intervals from June-December 2019 (n = 1899) and June-December 2020 (n = 5486), resulting in a pre- and post-intervention group. ITS and segmented regression modelling were used to estimate the effect on the change in levels and trends of poor compliance. Pre-intervention, poor compliance was at 24.47% (95% CI: 22.59% to 26.46%). After the introduction of e-reminders and e-feedback (i.e., post-intervention), the percentage of poorly compliant patients decreased substantially, levelling off at 9.32% (95% CI: 8.31% to 10.45%). E-reminders and e-feedback were effective for increasing compliance in CAT patients.Clinical Significance: Orthodontists and dentists may consider digital monitoring and e-reminders to improve compliance and increase treatment success.

Use of Flexible Carbon Fiber Insoles for Hallux Rigidus: A Randomized Controlled Trial

Category: Midfoot/Forefoot Introduction/Purpose: Rigid orthotics play an important role in the non-operative management of hallux rigidus. However, compliance can be low due to pain and discomfort. We hypothesized that patients with hallux rigidus who wear a carbon fiber orthotic that maintains some flexibility will report reduced pain, higher physical function, and higher compliance rates when compared with a more traditional, rigid Morton's extension insole. Methods: Four males and nine females (mean age of 56 years; range 35-79) diagnosed with unilateral 1st metatarsophalangeal arthritis were included in this randomized controlled trial. Participants randomly received either bilateral flexible carbon fiber insoles (VKTRY) (n=7) or unilateral Morton's extension insole (n=6). Outcome measures included patient self-reported compliance, comfort rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires Global Health, Pain Interference, v1.0 Pain Intensity, v2.0 Physical Function, and v1.0 Depression. Participants filled out questionnaires at the onset of the study and at two, six, and twelve weeks follow-up. Results: Compared to Morton's extension insole, use of flexible carbon fiber insole led to reduction of pain interference score at 6 and 12 weeks (median ∆∆ -9.5 vs 0.0 p=0.015; and median ∆∆ -15.1 vs -2.3 p=0.015, respectively), as well as reduction of pain intensity score at 6 and 12 weeks (median ∆∆ -11.9 vs -2.3 p=0.018; and median ∆∆ -11.9 vs -2.3 p=0.010, respectively). The compliance rate in flexible carbon fiber insole group was 100% at 2, 6 and 12 weeks, compared to 83%, 83% and 50% in the Morton group. In addition, patients wearing carbon fiber insoles experienced higher comfort levels (p-values ranging from &lt;0.001 to p=0.007). There were no differences between the comparison groups at 2, 6, and 12 weeks in terms of the global health, physical function, and depression scores. Conclusion: Patients diagnosed with hallux rigidus may benefit from wearing more flexible carbon fiber insoles as compared to the traditionally used rigid orthotic insoles, such as the Morton's extension. Such inserts may better balance the need for mechanical shielding of the hallux while allowing some motion as, for example, occurs in the interphalangeal after fusion procedures.

The Issue of Noncompliance in Attention Check Questions: False Positives in Instructed Response Items

Attention checks detect inattentiveness by instructing respondents to perform a specific task. However, while respondents may correctly process the task, they may choose to not comply with the instructions. We investigated the issue of noncompliance in attention checks in two web surveys. In Study 1, we measured respondents’ attitudes toward attention checks and their self-reported compliance. In Study 2, we experimentally varied the reasons given to respondents for conducting the attention check. Our results showed that while most respondents understand why attention checks are conducted, a nonnegligible proportion of respondents evaluated them as controlling or annoying. Most respondents passed the attention check; however, among those who failed the test, 61% seem to have failed the task deliberately. These findings reinforce that noncompliance is a serious concern with attention check instruments. The results of our experiment showed that more respondents passed the attention check if a comprehensible reason was given.

Self-reported tax compliance in post-transition Estonia

This paper contributes to the empirical literature that investigates the predictive power of different theories on the tax compliance of individuals. Data stem from a detailed survey of Estonian residents collected in three rounds from 2018 to 2020. Principal component analysis reveals that the survey replies are mutually consistent and form distinct clusters that align with the key theories on tax evasion. Logit estimations of the probability of full tax compliance use the principal components and various control variables as covariates. Theories of individual rational choice do not gain support. Factors associated with personal norms and with social norms and customs are important predictors of tax compliance. Noticeably, theories of reciprocity that prescribe a positive relation between approval of the government and its tax policies and tax compliance do not receive support, possibly reflecting the limited role of the government and individualist attitudes in post-transition Estonia.

Prehabilitation in high-risk patients scheduled for major abdominal cancer surgery: a feasibility study

BackgroundPatients presenting for major surgery with low cardiorespiratory fitness (deconditioning) and other modifiable risk factors are at increased risk of postoperative complications. This study investigated the feasibility of delivering prehabilitation in high-risk patients scheduled for major abdominal cancer surgery.MethodsEligible patients in this single-center cohort study included patients with poor fitness (objectively assessed by cardiopulmonary exercise testing, CPET) scheduled for elective major abdominal cancer surgery. Patients were recruited to participate in a prehabilitation program that spanned up to 6 weeks pre-operatively and comprised aerobic and resistance exercise training, breathing exercise, and nutritional support. The primary outcome assessed pre-specified feasibility targets: recruitment >70%, retention >85%, and intervention adherence >70%. Secondary outcomes were assessed for improved pre-operative functional status and health-related quality of life and for postoperative complications.ResultsEighty-two (34%) out of 238 patients screened between April 2018 and December 2019 were eligible for recruitment. Fifty (61%) patients (52% males) with a median age of 71 (IQR, 63–77) years participated in the study. Baseline oxygen consumption the at anaerobic threshold and at peak exercise (mean±SD: 9.8±1.8 and 14.0±2.9 mL/kg/min, respectively) confirmed the deconditioned state of the study cohort. The retention rate within the prehabilitation program was 84%, with 42 participants returning for repeat CPET testing. While >60% of participants preferred to do home-based prehabilitation, adherence to the intervention was low—with only 12 (28%) and 15 (35%) of patients having self-reported compliance >70% with their exercise prescriptions.ConclusionOur prehabilitation program in high-risk cancer surgery patients did not achieve pre-specified targets for recruitment, retention, and self-reported program adherence. These findings underpin the importance of implementation research and strategies for the prehabilitation programs in major surgery.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12620000073909) retrospectively registered.

Risk perception, but also political orientation, modulate behavioral response to COVID-19: A randomized survey experiment.

Prior work has shown that accurately perceiving the risk for COVID-19 is associated with higher adherence to protective health behaviors, like face mask use, and more acceptance of governmental restrictive measures such as partial or complete banning of indoor activities and social gatherings. In this study we explored these associations at the beginning of the second wave of COVID-19 in Argentina through a national representative probabilistic survey that evaluated personal and contextual risk perception, self-reported compliance with protective health behaviors, attitude to governmental restrictive measures, and political orientation and psychological distress as potential modulators. Also, going beyond measures of association, here we sought to test whether messages highlighting potential risks increased acceptance of restrictive measures. Three types of messages were randomized to the participants. Two messages conveyed risk-related content (either through emotional arousal or cognitive appraisal) and the third a prosocial, altruistic content. Between March 29th and 30th, 2021, 2,894 participants were recruited (57.57% female). 74.64% of those surveyed evaluated the current health situation as “quite serious” or “very serious” and 62.03% estimated that the situation will be “worse” or “much worse” in the following 3 months. The perception of personal risk and the level of adherence to protective behaviors gradually increased with age. Through a regression model, age, perceived personal risk, and contextual risk appraisal were the variables most significantly associated with protective behaviors. In the case of the acceptance of restrictive measures, political orientation was the most associated variable. We then found messages aimed at increasing risk perception (both emotionally or cognitively focused) had a significantly greater effect on increasing the acceptance of restrictive measures than the prosocial message, mainly for government supporters but also for non-supporters. However, the level of response was also modulated by the political orientation of the participants. We propose a mechanism of “ideological anchoring” to explain that participants were responsive to risk modulation, but within the limits established by their pre-existent political views. We conclude that messages highlighting risk can help reinforce the acceptance of restrictive measures even in the presence of polarized views, but must be calibrated by age and political orientation.

Effects of combining electrical stimulation of the calf and thigh muscles in patients with osteoarthritis of the knee: protocol for a double-blind, randomised, sham-controlled trial

IntroductionKnee osteoarthritis (KOA) is a leading cause of disability and is characterised by degenerative changes causing pain and loss of function. Neuromuscular electrical stimulation (NMES) has been shown to influence...

A-36 Tracking Compliance To A Home Exercise Program For Concussion Using Ecological Momentary Assessment: A Pilot Study

Abstract Purpose: The management of pediatric concussions creates a clinical challenge due to unknown patient compliance with prescribed therapies and interventions. The purpose of this pilot study was to describe the logistical use of ecological momentary assessment (EMA) to track compliance to a physical therapy facilitated vestibular/ocular motor home exercise program (HEP) in patients diagnosed with concussion. Methods: A convenience sample of 20 concussed patients (aged 13–18 years [mdn = 14.5, IQR = 14.0–16.8]) was included in this initial pilot study. All participants were evaluated within seven days of injury. Participants were instructed to complete one daily HEP compliance log until medical clearance on their parent or guardians’ mobile device using an EMA application. Results: Participants were evaluated a median 3.5 (IQR = 1.3–6.5) days post injury, recovered in a median 15.5 (IQR = 11.0–25.0) days, and completed a mean 5.85 (SD = 3.9) total EMA logs representing a 47% completion rate. Participants reported completing a mean 1.21 (SD = 0.77) HEPs per day with a range of 0.0 to 3.0. Self-reported HEP compliance did not significantly correlate with recovery time in days (P = 0.26). Conclusions: The overall response rate for EMA logs was 47% and participants reported completing 1.2 HEPs per day. Analysis of this preliminary data did not reveal a correlation between HEP compliance and recovery time in days. Participants reported the primary barrier to completing daily questionnaires was access to their parent or guardians’ mobile device at the time of the prompt. Overall, the data derived from EMA appears useful for tracking the progression of this heterogenous injury.

Differences in observed and self-reported compliance with ‘Five Moments for Hand Hygiene’ as a function of the empathy of healthcare workers

Hand hygiene at critical time-points (as established by the World Health Organization's model 'Five Moments for Hand Hygiene') remains the leading measure for minimizing the risk of healthcare-associated infections. While many interventions have been tested to improve hand hygiene compliance (HHC) of healthcare workers (HCWs), little is known about the relationship between HHC and empathy of HCWs. To investigate the relationship between moment-specific HHC rates and empathy of HCWs at both individual and ward levels. HHC data were collected via observation and self-report, and empathy levels were measured using an established questionnaire. The survey was conducted on 38 wards of three tertiary care hospitals in Germany. Observation data were obtained via in-house observations conducted ≤8 months before or after the survey. Evidence for the expected correlation between empathy of HCWs and moment-specific HHC was found for both observed HHC (Moment 1: r=0.483, P=0.031; Moment 2: r=588, P=0.006) and self-reported HHC (Moment 1: r=0.093, P=0.092; Moment 2: r=0.145, P=0.008). In analyses of variance, the critical interaction effect between empathy (i.e. lower vs higher empathy) and designated time-point of hand hygiene (i.e. before vs after reference task) was also significant. Empathy of HCWs should be considered as an important factor in explaining differences between moment-specific HHC rates. In consequence, empathy comes into focus not only as a crucial factor for high-quality patient care, but also as an important contributor to improving HHC.

Prophylaxis With Iron and Folate Supplementation in Pregnancy; A Health Facility-Based Assessment of Its Role for Prevention of Anaemia at Delivery

Objective: Presumptive Iron and folate supplementation, (IFS), for both healthy and irondeficient pregnant women in developing countries, is aimed to ameliorate the high prevalence of maternal anaemia.1 This may be valuable only in selected women.13 Its role for averting maternal anaemia at delivery is therefore analysed.Methodology: The hospital-based cross-sectional study enrolled 413 ANC attendant parturients, exposed to IFS prior to delivery. Anaemia in pregnancy was classified by specifications of the Indian Council of Medical Research (ICMR) using maternal pre-deliveryhaemoglobin concentrations. Maternal haemoglobin concentrations and differential patterns of exposure to IFS were analysed across various maternal and environmental variables with epi info 3.5.4.Results: Parturients were mostly aged 25-34 years and largely exposed to IFS for ≥ 6 months during pregnancy. Anaemic parturients, (typically defined by lower maternal age), initiated ANC attendance later than non-anaemic parturients. Patterns of maternal anaemia varied insignificantly despite differential patterns of duration of IFS and subjectively assessed degree of compliance. Self-reported full compliance with IFS weakly correlated with higher maternal Hgb concentrations. Mean maternal Hgb concentrations remained consistent with mild anaemia irrespective of duration of IFS.Conclusion: Despite weak correlates between maternal anaemia and degree of compliance, the capacity of IFS to prevent mild, moderate or severe maternal anaemia remains unclear.Recommendation: Indiscriminate IFS for all pregnant women, regardless of their Hgb concentrations, should be reviewed while investigation of factors that may underlie maternal non-response to routine IFS should be prioritized.

Trajectories of Compliance With COVID-19 Related Guidelines: Longitudinal Analyses of 50,000 UK Adults.

BackgroundGovernments have implemented a range of measures focused on changing citizens’ behaviors to lower the transmission of COVID-19. While international data shows that compliance did decline from the start of the pandemic, average trends could mask considerable heterogeneity in compliance behaviors.PurposeTo explore trajectories of compliance with COVID-19 guidelines.MethodsWe used longitudinal data on self-reported compliance from 50,851 adults in the COVID-19 Social Study collected across two waves of the pandemic in the UK (April 01, 2020–February 22, 2021). We modeled typical compliance trajectories using latent class growth analysis (LCGA) and used multinomial logistic regression to examine whether individual personality and demographic characteristics were related to compliance trajectories.ResultsWe selected a four-class LCGA solution. Most individuals maintained high levels of compliance and reported similar levels of compliance across the first and second waves. Approximately 15% of participants had decreasing levels of compliance across the pandemic, reporting noticeably lower levels of compliance in the second wave. Individuals with declining compliance levels were younger on average, in better physical health, had lower empathy and conscientiousness and greater general willingness to take risks.ConclusionsWhile a minority, not all individuals have maintained high compliance across the pandemic. Decreasing compliance is related to several psychological traits. The results suggest that targeting of behavior change messages later in the pandemic may be needed to increase compliance.

Political orientation, moral foundations, and COVID-19 social distancing.

During the COVID-19 pandemic, governments have advocated numerous social distancing measures, and compliance with these has likely saved millions of lives globally. In an online sample drawn from the U.S. and Canada (N = 209), participants completed measures of political orientation, moral foundations, and COVID-19 social distancing attitudes and behaviours. A more left-wing political orientation, and greater endorsement of the individualizing moral foundations were significantly related to more positive social distancing attitudes, and greater self-reported compliance with relevant restrictions. A more right-wing political orientation, and greater endorsement of the binding and economic liberty foundations were associated with less positive attitudes and reduced compliance. In a series of mediation analyses, the relationships between political orientation and various social distancing measures were significantly mediated by variations in participants’ moral foundations, particularly their endorsement of economic liberty and the individualizing foundations. Further data indicated that the perceived persuasiveness of messages based on each moral foundation advocating for continued social distancing was significantly related to both participants’ moral values and their political orientation. Findings are discussed in terms of understanding politicized differences around social distancing as partly reflecting differential valuation of the moral foundations, and in creating effective public health messaging regarding compliance.

Does COVID-19 pandemic change hand hygiene compliance among the medical students and residents? A comparative study from a university hospital

Aim: We aimed to find out if there is statistically significant difference in self-reported hand hygiene compliance among Year-5 medical students, Year-6 medical students, and residents in Gazi University Faculty of Medicine between right before and after the first confirmed case of COVID-19 in Turkiye. Materials and Methods: Two cross-sectional surveys were carried out to reveal self-reported hand hygiene compliance among participants right before and after the first confirmed case of COVID-19 in Turkiye. Participants were Year-5 and Year-6 medical students and residents in Gazi University Faculty of Medicine. Convenience sampling was used. There were 833 participants in total. The survey form consists of 10 items that were constituted by examining World Health Organization guidelines on hand hygiene. The compliance scores before and after the first confirmed case were compared by performing T-Test. Results: Out of 10 items, there was significant difference in Year-5 medical students’, Year-6 medical students’ and residents’ self-reported hand hygiene compliance scores between before and after the first confirmed case of COVID-19 in 6 items, 10 items, and 8 items, respectively (p&amp;lt;0.05). Conclusion: Significant increase in hand hygiene compliance was found right after the COVID-19 outbreak when it compared to before. The main factor behind the improvement would be extremely high levels of perceived risk created by outbreak.