Self-reported Compliance Research Articles

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<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.

Better than my neighbor? Testing for overconfidence in COVID-19 preventive behaviors in Latin America

BackgroundProcrastination and lack of attention may often hinder the implementation of preemptive actions necessary to mitigate the spread of COVID-19 like washing hands, covering nose and mouth with a mask, and keeping social distance. It is in such “easy” tasks that people (mistakenly) believe that they are better than others. In this paper we test for overconfidence bias in COVID-19 preventive behaviors in Latin America.MethodsUsing a phone survey in nationally representative samples from 10 Latin American countries where randomly, half of the sample in each country was asked about self-reported compliance to COVID-19 guidelines, and half about preventive behavior of fellow citizens compared to them; we tested: if the proportion of individuals claiming that others comply with a certain measure “Always more frequent than me” is higher than those stating that they “Never” or “Sometimes” comply with the same measure (i.e. people believe they are better at doing something than what they actually are).ResultsOver 90% of Latin-Americans claim to always wear a mask and sanitize their hands and more than 80% state to always keep social distance. We also find evidence of overconfidence in every behavior – except for keeping distance in public transportation. Moreover, the magnitude of such overconfidence is higher for behaviors such as wearing masks in public or washing hands than for those regarding keeping the 2-m distance.ConclusionsTo our knowledge, this is the first study to measure overconfidence in COVID-19 preventive behaviors in Latin America. Results show that more effort is needed to encourage people to comply with the regulation when it does not only depend on them: a better organization of closed stores and public transportation are, for instance, crucial to allow social distancing. It also suggests that a reinforcement of basic measures is essential, as individuals report to be performing them more frequently than when they have to think about such behaviors compared to others.

Local governance quality and law compliance: The case of Mozambican firms

In sub-Saharan Africa, many micro and small enterprises do not (or at least only partially) comply with official rules and regulations. Given that low compliance rates impede economic growth and human development, it is essential to identify mechanisms that can help improve abidance with laws. This paper investigates how the quality of governance (defined as comprising three dimensions: transparency, legal security and infrastructure quality) is related to firm-level compliance with business laws and regulations in the case of Mozambique. We utilise firms’ subjective perceptions of governance quality and their self-reported law compliance over time to study the governance–compliance nexus, taking into account unobserved firm-level heterogeneity. Furthermore, we examine whether political legitimacy acts as a mediator or a moderator between governance and compliance. Our results suggest that perceived improvements in transparency positively affect firms’ compliance with existing legislation. Requests from provincial government officials for firms to comment on local regulations seem to be especially important for law abidance. We find that legitimacy is independently associated with compliance, but does not seem to mediate or moderate the quality of governance. Overall, our results suggest that, even in one of the least developed and non-democratic parts of the world, active participation in political processes is positively associated with law compliance.

“Othering” by Consent? Public Attitudes to Covid-19 Restrictions and the Role of the Police in Managing Compliance in England

ABSTRACT The aim of this paper is to consider the relationship between an emergent decay of social trust created by the Covid-19 pandemic and the formation of “in” and “out” groups. Data from 37 extensive semi-structured interviews with members of the public in England found that identifying the “other” through normative conceptions of “security and order” was used by participants to legitimize their own presence within the “in” group, while self-reported compliance with restrictions was used to construct identities to be in line with that of the “in” group. These findings have important implications both for social trust within and between communities and toward the police.

Predictors of Self-Reported Compliance with COVID-19 Preventive Guidelines: A Quantile Regression Model

ABSTRACT The research used an online, convenience cross-sectional sample of adults aged ≥18 years old recruited from Shahroud County, Northeast of Iran. We measured the contribution of multiple determinants for association with behavioral compliance, at the time of the COVID-19 pandemic. The compliance score measured with this questionnaire can be within a range of 5 and 100. Compliance was bounded between 19 and 80 that has been distributed J-shape, so quantile logistic regression model has been fitted for that. Variables related to people’s knowledge, including self-reported knowledge and following the news related to COVID-19, were the two main factors that accompanied behavioral compliance at all of its levels in the period of pandemic.

Do we need a pandemic to improve hygiene routines in the ambulance service? A cross-sectional study

BackgroundWe know that ambulance staff may have sparse knowledge on how to comply with care approaches that ensure appropriate hygiene in the ambulance, but we do not know if and how the COVID-19 pandemic has affected ambulance staff’s perceived compliance with hygiene routines. AimTo investigate ambulance staff’s self-reported hand hygiene (HH) perceptions and compliance; and to explore if and how the COVID-19 pandemic has affected ambulance staff’s perceived compliance with hygiene routines. MethodsA cross-sectional study design using the WHO-validated Perception Survey for Healthcare Workers regarding hygiene. Thematic analysis and descriptive statistics were used for analysis. Results204 surveys were analysed, 92% of participants stated that their hygiene routine compliance had improved during the COVID-19 pandemic, and some participants also described that their colleagues’ practice had improved. These improvements were reportedly driven by the need to acquire new knowledge to deal with the pandemic and sometimes with fear. ConclusionsExperience acquired during the pandemic needs to be sustainable if we are to increase HH and hygiene routine compliance in ambulance services. Interventions aimed at changing ambulance staff’s perceived behaviour are warranted, and stakeholders should try and identify the personal motivations that lead these staff to seek self-betterment regarding HH and hygiene routine compliance. Otherwise, the risk of patients suffering from healthcare-associated infection may not decrease as wished.

COVID-19 vaccine acceptance among cold-chain workers in Shenzhen, China: A cross-sectional survey

ABSTRACT Given the high level of exposure to SARS-CoV-2, cold-chain workers are considered priority vaccination groups. To date, many studies have reported on the willingness within distinct populations to be vaccinated against COVID-19, whereas it has not been reported among cold-chain workers worldwide. To address this void, we conducted a cross-sectional survey to gather general information, COVID-19-related knowledge, attitudes, and practices (KAP), and willingness to receive a COVID-19 vaccine among cold-chain workers in Shenzhen, China. Binary logistic analyses were conducted to explore the associations between COVID-19-related KAP factors and the willingness for COVID-19 vaccination. Among 244 cold-chain workers, 76% indicated that they were willing to be vaccinated. Knowledge about SARS-CoV-2, comprehending the most effective prevention, understanding the transmission routes, and recognizing the priority vaccination groups were positively associated with willingness to be vaccinated against COVID-19. Regarding attitude factors, perceiving the social harmfulness and severity of COVID-19 were related to a higher willingness to vaccination. Participants considering themselves a priority group for COVID-19 vaccination were more likely to get vaccinated. For practice factors, attaining more knowledge and higher self-reported compliance with maintaining adequate ventilation were also positively associated with the dependent variable. Agreement on the importance of COVID-19 vaccination was the most frequent reason for accepting the COVID-19 vaccine; additionally, concerns about side effects and insufficient understanding of efficacy were the main factors contributing to vaccine refusal. Enhancing KAP levels related to COVID-19 helps promote vaccine acceptance. Health authorities should promptly implement educational activities following the updated vaccine status among cold-chain workers.

Compliance study of hip protector users for prevention of fragility fracture: A pilot randomized trial

Hip protectors have been widely used for hip fracture prevention in the elderly, but its efficacy remains controversial. Users' compliance to hip protector is an important factor for its efficacy. However, the assessment of users' compliance tended to be subjective and unreliable in the past. To quantify the elderly's compliance to hip protectors and investigate the effect of different underpant designs on the elderly's compliance. A pilot randomized trial. Thirty-one participants were recruited and provided with hip protectors in which compliance monitors were installed and delivered with three pairs of either the conventional underpants or the purpose-design underpants randomly. Participants were encouraged to use the hip protectors with the assigned underpants for whole day. After 4 weeks, compliance data were downloaded from the compliance monitors. Participants were also asked to fill a survey form for acceptance analysis. The Spearman correlation coefficient and the Wilcoxon signed-rank test/2 independent samples t test/Mann-Whitney U test were used for the corresponding statistical analyses. Thirty-one participants were recruited initially. Eighteen participants were excluded from instrumented compliance analysis because of limited or no data collection. The data of the resting 13 participants (six in the conventional underpants group and seven in purpose-design underpants group) were analyzed and showed an average instrumented compliance of 77.5% which was lower than the average self-reporting compliance (83.3%) of all the available 23 participants (eight of 31 became wheelchair-bounded). Participants' compliance was positively correlated with their acceptance to the hip protectors and significantly higher in the purpose-design underpants group than in the conventional underpants group ( P < 0.05). This pilot study demonstrated a feasible protocol for compliance quantification of the elderly to the hip protectors, the importance to have an objective compliance measure to assess users' actual compliance, and purpose-design underpants could improve the users' compliance. Future studies with long-term observation and large sample size deserve further proof of the current findings.

Preventive behaviours during the pandemic: The role of collective rituals, emotional synchrony, social norms and moral obligation.

The present research focuses on the role of collective, social influence and intraindividual processes in shaping preventive behaviours during the COVID-19 pandemic. In two correlational studies conducted in Spain, we explored the impact of participation in the ritual of collective applause (carried out daily for over 70days during the lockdown) and perceived social norms in fostering behavioural adherence to public health measures, as well as the mediating role of perceived emotional synchrony and a sense of moral obligation. The first study (general population, N=528) was conducted in June 2020, just after the end of the lockdown, and the second study (students, N=292) was carried out eight months later. The results of the structural equations modelling (SEM) consistently confirmed that active participation in collective applause was linked to more intense emotional synchrony and indirectly predicted self-reported preventive behaviour. Perceived social norms predicted self-reported behavioural compliance directly and also indirectly, via feelings of moral obligation. The discussion addresses some meaningful variations in the results and also focuses on the implications of the findings for both theory and psychosocial intervention.

Fostering compliance with physical distancing by interactive feedback in the context of the COVID-19 pandemic: A web-based randomized controlled trial

BackgroundTo slow down the spread of COVID-19, the observance of basic hygiene measures, and physical distancing is recommended. Initial findings suggest that physical distancing in particular can prevent the spread of COVID-19. ObjectivesTo investigate how information to prevent the spread of infectious diseases should be presented to increase willingness to comply with preventive measures. MethodsIn a preregistered online experiment, 817 subjects were presented with either interactively controllable graphics on the spread of COVID-19 and information that enable them to recognize how much the spread of COVID-19 is reduced by physical distancing (experimental group) or text-based information about quantitative evidence (control group). It was hypothesized that participants receiving interactive information on the prevention of COVID-19 infections show a significantly higher willingness to comply with future containment measures than participants reading the text-based information. Explorative analyses were conducted to examine whether other factors influence compliance. ResultsAs predicted, we found a small effect (d = 0.22, 95% CI: 0.11; 0.23, p < .001) for the tested intervention. The exploratory analysis suggests a decline in compliance later in the study (r = −0.10, 95% CI: −0.15; −0.07). Another significant predictor of change in compliance was health-related anxiety, but the effect was trivial. ConclusionsWhen presented interactively, information on how the own behavior can help prevent infectious diseases can lead to slightly stronger changes in attitude towards behavioral prevention measures than just text-based information. Given the scalability of this simple internet-based intervention, it could play a role in fostering compliance during a pandemic within universal prevention strategies. Future work on the predictive validity of self-reported compliance and the real-world effects on the intervention is needed.

Evaluation of Hand Hygiene Facilities and Compliance of Healthcare Workers at The University of Medical Sciences Teaching Hospital, Ondo

Hand Hygiene (HH) is the leading measure for preventing the spread of pathogens and reducing health care associated infections, health care providers’ adherence to recommended practices remains suboptimal in most settings, and maintaining its standards is difficult to sustain. However, Healthcare-associated infections (HAIs) remain the most common adverse event in healthcare, resulting in a significant burden on patients, their families, and health care systems. This study examines evaluation of hand hygiene facilities and compliance of health care workers at the University of Medical Sciences Teaching Hospital, Ondo. This was a cross-sectional descriptive study that was made up of 324 participants. Multi-stage sampling technique was used for the selection of participants. Self-administered questionnaire and observational checklists were used as tools for data collection. The reliability value of the questionnaire eliciting responses on self-reported compliance to hand hygiene technique techniques ranges from 0.703 to 0.764. Data were analysed using SPSS version 27. Inferential statistics of Chi Square was used test the hypothesis generated at 0.05 level of significance. The results revealed that none of the wards met the standard for hand hygiene facilities set by the WHO. 83.3% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 100% had at least one handwash sink; 100% had flowing tap water all day; and 100% had no hand drying facilities. Assessment of self-reported hand hygiene compliance showed that 86.42% of the respondents have good compliance to hand washing technique guideline with a mean score is 23.72 of 27 (87.85%) and 90.1% of the respondents have good compliance to hand hygiene using alcohol-based hand rub technique with a mean score is 19.68 of 21 (93.71%). A total of 1,016 hand hygiene opportunities were observed during the three-week period with an overall compliance rate of 29.9%. The compliance rate among nurses (31.2%) is higher than among doctors (21.8%). In recorded hand hygiene actions, hand washing is used slightly more frequently than alcohol-based hand rubs. The use of gloves is a major reason for missed opportunities in hand hygiene, responsible for 39.3% of missed opportunities.The study concluded that the availability of hand hygiene facilities and HCWs compliance at the University of Medical Sciences Teaching Hospital, Ondo is poor. The study also confirmed that while the self-reported hand hygiene compliance is high, the observed compliance with hand hygiene techniques is low. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.

Self-Reported Patient Compliance With Physician Advised Lifestyle Behavior Changes Among Adults With Musculoskeletal Conditions.

IntroductionApproximately half of adult Americans suffer from musculoskeletal disorders (MSD). Significant risk factors for musculoskeletal disorders include poor diet, obesity, and insufficient physical activity. Studies show that lifestyle change education and interventions reduce MSD risk factors. However, little is known about the relationship between physician advice for behavior change and reported behavior change by MSD patients. This study explored the association between physician advice for lifestyle change and reported change in MSD patients, as well as the effects that patient education levels have on compliance.MethodsThis study used data from the 2017 National Health Interview Survey, a nationally representative cross-sectional survey of non-institutionalized US adults. The research team limited analysis to adults who reported a limitation due to musculoskeletal problems (n = 2,672). Outcomes included physician recommendations to increase physical activity, reduce fat/calories, or lose weight, and whether they enacted these behavioral changes. Adjusted logistic regression models examined whether compliance with doctor's instructions differed by education level.ResultsAdjusted models show patients advised to change physical activity, diet, and weight were more likely to report attempted behavior change. Education was positively associated with likelihood of complying with physician advice to increase physical activity. Among patients not advised to change behaviors by a physician, education was positively associated with current behavior change attempts.ConclusionThis study suggests that physician recommendations are relevant predictors of reported behavior change in individuals with MSD. Although education plays an important role in this association, the relationship is complex and multifaceted. Future studies should explore how compliance may be impacted by other factors, such as physician message type.

Compliance versus Risk Awareness with Contact Lens Storage Case Hygiene and Replacement.

Compliance with hygiene and replacement of contact lens (CL) storage cases is key to avoid CL contamination and anterior ocular surface complications. However, compliance levels with these accessories remain low, even in patients with awareness of the risk associated with noncompliance. This study aimed to determine level of compliance with common practices regarding CL storage case hygiene and replacement, type of information provided by practitioners, and risk perception. An ad hoc self-reported survey was used to collect demographic and CL wear details, compliance with storage case care, type of received information, and risk perception (in a 1-to-5 scale). Inferential statistics explored the relationship of demographic details and type of received information with compliance and risk perception. Nondaily disposable wearing participants returned 299 completed surveys, with a median age of 24 years (76.9% females). Monthly replacement silicone hydrogel CLs and multipurpose solutions were predominant. Self-reported compliance with storage case care was poor, with 19.1% of respondents never cleaning their cases, 68.6% exposing them to tap water, and 26.4% failing to replace them within 6 months of acquisition. Two-thirds of respondents received specific information on case maintenance, mainly in oral form. Perceived risk associated with poor-compliance practices was high (median values of 4 and 5), and increased with educational level (P = .02, regarding handwashing; P = .03, regarding case hygiene), with years of CL wear experience (P < .001, regarding handwashing), in those patients provided with specific information on CL case care (P = .01, regarding case replacement). Compliance with CL storage case hygiene and replacement was generally poor, although awareness of risk associated with noncompliance was high and influenced by factors related to demographic details, CL experience, and patient-practitioner communication. Strategies must be explored to increase risk awareness through education because this may lead to better compliance practices.

What drives forest rule compliance behaviour in the Congo Basin? A study of local communities in Cameroon

Forest law compliance can play an important role in enhancing natural resource governance and advancing sustainable development. The role of compliance and the factors that affect it require better consideration in the planning and implementation of international forest policies. This study presents an analysis of factors that influence forest law compliance behaviour among local communities in Cameroon. The analysis is based on forest communities’ self-reported compliance with two forest rules in Cameroon, both of which are part of formal state forestry law. Original field data from 151 individual respondents in 6 villages located in easter and south-eastern Cameroon are analysed using logistic regression analysis. We find that several instrumental, normative, legitimacy and contextual factors affect the forest law compliance behaviour of local communities. A number of factors, including the perceived probability of detection and sanctions (instrumental), tradition/religion (normative), participatory rule making (procedural legitimacy) and property rights (contextual and governance related factors) are found to significantly influence local communities’ forest rule compliance behaviour. Our findings carry implications for the design and implementation of existing and future forest policies and interventions to manage forest resources sustainably in many parts of the world.

Self-reported compliance with drug therapy during the first SARS-CoV-2 Italian lockdown in patients with respiratory disease.

Low compliance with drug therapy in patients with chronic respiratory diseases was a well-known issue even before the coronavirus pandemic, but its causes are not yet fully defined. To verify the adherence to drug therapy in patients with respiratory disease during the COVID-19 pandemic. From June to September 2020, about 700 patients of the Forlanini Hospital who had been unmonitored during the March-May 2020 lockdown in Italy received a questionnaire during the pneumological check-up based on self-reported information on compliance with therapy during lockdown. 284 out of the 418 returned questionnaires could be used in this study: 179 patients (63.0%) responded positively to the continuation of therapy, 18 (6.3%) reduced the dosage of their medication and 82 (28.9%) interrupted the therapy. The low percentage of patients that reduced their drug dosage may be due to an increased awareness of drug treatment benefits, and may also be ascribed to the Government healthcare strategy during lockdown.

Phenylketonuria Patients' and Their Caregivers' Perception of the Pandemic Lockdown: The Results of a National Online Survey.

The first pandemic lockdown dramatically impacted many aspects of everyday life, including healthcare systems. The purpose of this study was to identify problems of patients with phenylketonuria (PKU) and their parents/caregivers during that time. We aimed to analyse potential differences in the self-reported compliance and characteristics of contacts with a doctor/dietitian before and during the pandemic lockdown and the perception of access to special food and opinions on remote contacts between a particular group of respondents. All participants (n = 614) were asked to complete an online questionnaire that consisted of 31 questions on pandemic-related events and circumstances which may have directly or indirectly impacted health and treatment. The people who completed the survey were divided into three groups: parents of PKU children (n = 403), parents of PKU adults (n = 58) and PKU patients older than 16 years (n = 153). The differences among the three analysed groups were found in the number of contacts, the way of contacting a doctor/dietitian during the pandemic and satisfaction with remote contact. Caregivers of children with PKU reported better therapy compliance, more frequent contacts with specialists and more satisfaction with remote visits than adult patients. We also observed a relationship between satisfaction from remote contact and self-reported frequency of contacts with a doctor/dietitian, as well as a relationship between satisfaction from remote contact and recommended blood Phe levels reported by both patients and caregivers. Travel time exceeding three hours from the respondents’ location to their doctor was associated with higher odds of their recognition of remote contact as a method of PKU treatment only in the group of caregivers. In the caregiver groups, the reported worse access to low-Phe products during the lockdown was linked to the perceived difficulty of maintaining the diet. However, such a relationship was not found among patients. In conclusion, significant differences in the perception of the pandemic lockdown and its impact on health and treatment-related issues were found.

Hygiene Behaviors and SARS-CoV-2-Preventive Behaviors in the Face of the COVID-19 Pandemic: Self-Reported Compliance and Associations with Fear, SARS-CoV-2 Risk, and Mental Health in a General Population vs. a Psychosomatic Patients Sample in Germany

Background: During the COVID-19 pandemic, hygiene behaviors such as keeping distance, avoiding masses, wearing face masks, and complying with hand hygiene recommendations became imperative. The current study aims to determine factors interrelating with hygiene behaviors. Methods: A total of 4049 individuals (1305 male, 2709 female, aged 18–80 years) were recruited from rehabilitation clinics or freely on the internet. They were surveyed via online questionnaires between May 2020 and August 2021. Sociodemographics, hygiene behaviors, and fear of COVID-19 infection were assessed. Results: Overall prevalence for hygiene behaviors was: keeping a distance—88.1%; avoiding mass gatherings—88.0%; wearing face masks—96.9%; and hand hygiene—81.6%, with 70% of the study participants complying with all four researched behaviors. Hygiene behaviors were significantly related to fear in a linear and quadratic fashion. Conclusion: Patients are more compliant according to their self-reported responses than the general population. To improve hygiene behavior, hand hygiene in particular provides options for improvements. A medium level of fear seems to be more functional than too-elevated fear. Behavioral interventions and targeted communication aiming at improving different behaviors in orchestration can help individuals to protect their health and to remain healthy. Accordingly, communication is required to ensure high hygiene standards and patient safety, and to prevent adverse effects.

Mixed Method Integration Using Participant Selection Variant and Principle of Maximum Variation in Investigating Self-Reported Medication Compliance among Older Jamaicans Adults Diagnosed with Hypertension, Diabetes and Arthritis

The general objective of this study was to use a mixed methods approach to study the behavioural aspects of medication compliance among older Jamaican adults, diagnosed with hypertension, diabetes and arthritis. This article focusses on the methodological aspects of the research process. Specifically, we explored how the principle of maximum variation was used in tandem with the participant selection variant as a mixed-method integration technique. Method: A two-strand explanatory sequential mixed-method design was employed. In the first strand, secondary analysis was performed on an existing data set. From the findings, the maximum variation was used to create diverse character categories or dimensions, using demographic variables that have statistically significant associations with the outcome variable. Those characteristic dimensions were then used to inform the selection of participants for the second qualitative strand of the study. Finding: The Principle of Maximum Variation is a good fit for seamless blending of methods when conducting research using mixed methodology. Conclusion: Mixed methodology is often simplified as the use of both quantitative and qualitative approaches in a study. However, by employing the principle of maximum variation as a qualitative method to inform the participant selection variant of the explanatory sequential design, a perfect blend of methods is achieved to exemplify the essence of mixed methodology.

Walking meditation versus balance training for improving balance abilities among older adults with history of fall: A randomized controlled trial

Objective To investigate improvement in balance abilities compared between walking meditation and balance training among older adults with history of fall. Interventions Walking meditation or mindfulness meditation whilst standing and moving (n = 35) or balance training (n = 33) 20–30 min/day, 5–7 days/week for 24 weeks was performed at home. Main outcomes The primary outcomes were dynamic balance abilities as assessed by Timed Up and Go test (TUGT), and static balance as assessed by Functional Reach Test (FRT) and Single Leg Stance Test (SLST). The secondary outcomes were quality of life as measured by the EuroQOL 5-dimensions 5-levels (EQ-5D-5L), and mental health as evaluated by the Thai Geriatric Mental Health Assessment Tool-15 (TGMHA-15). All outcomes were assessed at baseline, 6 months, and 9 months. Self-reported compliance, adverse events, and patient satisfaction were recorded at 6 and 9 months. Results The mean age was 69 years (range: 60–85). No significant difference was observed between groups for the 3 primary outcome measures. The mean difference (95% confidence interval) between groups was −0.48 (-1.40, 0.44) for TUGT, −1.11 (-3.66, 1.45) for FRT, and 0.82 (-5.03, 6.67) for SLST. The EQ-5D-5L and TGMHA-15 also showed no significant difference between groups. Most participants were in good compliance with the exercise protocol (48.3–68.0%), and no serious adverse events were reported. Conclusion Our results showed walking meditation to be comparable to balance training for improving balance abilities in older adults with history of fall. Walking meditation may be considered an alternative treatment for improving balance abilities in this patient population.

91. Knowledge, Attitudes, and Practice of Antibiotic Prescribing among Nurse Practitioners

BackgroundAntibiotic overuse (AO) in ambulatory care is an important public health problem. Nurse practitioners (NPs) account for a growing proportion of outpatient antibiotic prescriptions: 14.6% in 2016. Our objective was to assess NPs’ attitudes about antibiotic prescribing practices and knowledge and use of antibiotic prescribing guidelines (APG) in their practice. MethodsWe distributed a survey via email to NPs listed as licensed by the North Carolina Board of Nursing. Surveys were distributed three times; duplicate responses were not permitted. Respondents who reported not prescribing antibiotics in the outpatient setting were ineligible. Three randomly selected respondents received gift cards. Questions assessed degree type, practice type, years in practice, and attitudes about antibiotic prescribing practices antibiotic stewardship. Respondents answered four questions assessing knowledge of APG. Analyses were descriptive; scores on knowledge questions were compared using T-tests.ResultsSurvey requests were sent to 10,094 listed NPs; there were 846 completed responses (8.4%), of which 672 respondents (79.4%) reported prescribing antibiotics in outpatient care. Of those, 595 (88.5%) treat adult patients. Most respondents agreed that AO is a problem in their state (84.5%); 41.3% agreed that it was a problem in their practice. Patient/family satisfaction was the most frequently reported driver of AO (90.1%). Most respondents agreed that national APG are appropriate (95.4%) and that quality improvement (QI) is warranted (93.4%). Respondents reported following APG always (18.5%) or more than half the time (61.0%). Respondents answered a mean of 1.89 out of 4 knowledge questions correctly, with higher scores among those reporting following APG more than half the time (1.97 vs 1.58, p< 0.0001). Overall attitudes about antibiotic prescribing, antibiotic prescribing guidelines, and acceptance of Quality Improvement. N=595. Respondents’ reported drivers of antibiotic overuse. Respondents were permitted to select more than one driver. Content question performance by self-reported guideline compliance; scores represent the number correct out of four questions.ConclusionRespondents agree that AO is a problem but place responsibility externally. Confidence in APG was high; most respondents endorsed following APG most of the time. Performance on knowledge questions suggests a need for education. Most respondents would welcome QI focused on AO, including education and personalized feedback. Similar work is needed in other regions and among other prescriber groups. The results will inform outpatient antibiotic stewardship.Disclosures Elizabeth Walters, DNP, CPNP-PC, RN, Merck (Consultant, Other Financial or Material Support, I am a trainer for the Nexplanon product.) Ravi Jhaveri, MD, AstraZeneca (Consultant)Dynavax (Consultant)Elsevier (Other Financial or Material Support, Editorial Stipend as Co-editor in Chief, Clinical Therapeutics)Seqirus (Consultant)