Trust In Health Professionals Research Articles

7.1-O5Views on risk, prevention and management of type 2 diabetes among UK Black Caribbean

Background: Development of effective, culturally-tailored interventions to address excess risk of type 2 diabetes among Black Caribbeans in the United Kingdom (UK) requires understanding of the views and experiences of the target population. We explored the social context of views on risk, prevention and management of type 2 diabetes among this ethnic group. Methods: The Food, Diabetes and Ethnicity (FOODEY) study included 56 Black Caribbean men and women aged 24-90 years (21 (38%) diagnosed with diabetes or pre-diabetes). Nine focus groups were conducted in community hubs in Leeds, Bradford, Birmingham, and Huddersfield, UK. Inductive themes were identified through thematic analysis of transcripts. Results: While family history was considered a key risk factor, there was a clearly articulated view of the interaction between “bad genes” and unfavourable dietary and physical activity (PA) habits. Rich descriptions of food habits and food related negotiations among family and friends included cost and low availability as barriers to maintaining traditional foodways, and high intake of convenience foods. The perception that diabetes risk was greater in the UK than in home countries was widely held, and it was felt that this was due to the lack of PA, cold weather and stress due to racism experienced in the UK. The Caribbean was deemed a suitable setting for consuming traditional foods and high sugar intake as this was mitigated by active living, organic vegetable consumption, and the hot climate. Trust in health professionals’ diabetes advice was evident, however behaviour change was preferred to medication, and the need for choice regarding healthcare decisions was emphasised. Faith beliefs coincided with acceptability of health-related advice and underpinned views on personal responsibility for health. Conclusions: Complex explanatory models of risk, encompassing lifestyle, economic, cultural, religious and psychosocial contexts, have implications for developing interventions to address type 2 diabetes among UK Black Caribbeans.

An Unintended Consequence of Payment Reforms: Providers Avoiding Nonadherent Patients

Payment reforms that link health care providers’ reimbursements to their performance on various metrics incentivize providers to improve the quality and efficiency of care they provide to patients. Unfortunately, these reforms also create strong incentives for providers to reject patients who do not adhere to medical advice. This commentary argues that providers’ avoidance of non-adherent patients flouts the medical profession's commitment to patients’ best interests, undermines patients' trust in health professionals, and aggravates disparities in health. Moreover, the economic incentives under payment reforms that encourage quality and efficiency gains are weakened when providers can escape the financial penalties for poor outcomes by simply firing their non-adherent patients.

Use of UK health services by Gypsies, Roma, and Travellers: triangulation of two mixed methods studies

BackgroundGypsies, Roma, and Travellers (GRT) are less likely than the general population to access health services. The reasons are multiple, complex, and interlinked, and they exist at individual, provider, health system, and national levels. We report on two studies that explore GRT use of UK health services. Study 1 aimed to investigate barriers to, and facilitators of, immunisation, and identify interventions to promote uptake. Study 2 aimed to explore approaches that facilitate engagement and trust between GRT and health services, with maternity, early years, and child dental health services as exemplars. MethodsStudy 1, completed in 2016, involved in-depth interviews with 174 GRT from six communities and 39 service providers in Scotland and England, and intervention mapping and co-production workshops with 76 participants to prioritise interventions. Study 2, to be completed in 2017, involves systematic reviews and a realist synthesis; online consultation with 196 UK-based stakeholders; case studies involving interviews and focus groups with 44 GRT, 54 health-care professionals and 13 third sector staff in Scotland and England; and cross-sectoral workshops which will refine policy recommendations. Qualitative and quantitative analysis identified barriers and facilitators to receiving health care; and approaches to enhancing engagement and trust in health care. Ethics approval for study 1 was granted by National Research Ethics Service Committee Yorkshire and The Humber, Leeds East, and for study 2 by the NHS Health Research Authority East Midlands, Leicester Central Research Ethics Committee (16/EM/0028). FindingsBarriers to health care included discrimination, economic disadvantage, differences in cultural interpretations, language, and health literacy. Facilitators included trust in health professionals and intergenerational change towards valuing health services. Approaches to enhancing engagement included specialist workers and named professionals for GRT communities, cultural training for professionals, and tailored or flexible systems. Facilitating the research depended on collaborating with trusted gatekeepers, and both studies used co-production methods to ensure that study recommendations are grounded in practice realities and acceptable to stakeholders. InterpretationThe findings provide advice for practitioners and policy makers engaging with GRT people, as well as insight on supporting other marginalised populations. Exploring the experience of GRT, service provision, and policy offers a substantiated account enabling public health to reflect on success or otherwise of interventions aimed at tackling inequalities. FundingStudy 1 was funded by the National Institute for Health Research Health Technology Assessment Programme (12/17/05). Study 2 is funded by the Department of Health Policy Research Programme (Enhancing Gypsy/Travellers' trust: using maternity and early years' health services and dental health services as exemplars of mainstream service provision, PR-R8-0314-24002).

Barriers and enablers in the implementation of a program to reduce cesarean deliveries

Conducting audits, implementing best practices and giving feedback to the professionals have shown considerable promise in reducing rates of cesarean delivery and mother-child morbidity. The purpose of the study is two-fold: a) to identify the factors that facilitate change in current practices and thus reduce the use of obstetric interventions, and b) to better understand the barriers to such changes. To reach these objectives, the study analyzed the experiences of professionals participating in a program to reduce cesarean rates in 20 hospitals in Andalusia (Spain). A qualitative exploratory study was conducted. Participants were 14 ob-gyns and 14 nurse-midwives who work for Spain’s National Healthcare System and have been involved in the program. To gather information, in-depth individual interviews were used. The interview was designed to examine factors affecting the quality of care, such as issues related to policy/management, hospitals, practitioners and patients. The barriers identified include: 1) At the policy/management level: limited influence of institutional policy and the scant political commitment perceived. 2) At the organizational level: separation of the hierarchical structure of doctors from that of nurse-midwives, few positive incentives and the strong threat of sanctions for malpractice, inappropriate reorganization of midwife/obgyns competences. 3) At the healthcare staff and facility level: reluctance to change accentuated by years of professional practice. 4) Physical resources: obsolete delivery rooms with a medical look. 5) At the professional level: medical and legal pressure, cesarean delivery considered safe in the event of a legal claim, low motivation due to decline in working conditions, convenience-based practices. 6) Woman giving birth and her family: fear of pain, impatience while waiting for process to occur, misinformation. The enablers include: 1) At the organizational level: good coordination with pediatrics and emergency departments, 2) Training: skills updates for a less-interventionist approach, increased awareness, 3) Health professionals: satisfaction for a job well done, recognition by patients. 4) Woman giving birth: information circuits for patients and their families, trust in health professionals. The results can contribute to the design of more effective knowledge translation interventions to reduce cesarean sections, based on overcoming obstacles, reinforcing enabling factors and attempting to (re)define the boundaries between research and practice.

Examining trust in health professionals among family caregivers of nursing home residents with advanced dementia.

In a context of increasing emphasis on shared decision-making and palliative care in dementia, research on family caregivers' trust in health professionals in advanced dementia is surprisingly scant. The aim of the present study was to assess trust in nursing home health professionals of family caregivers of nursing home residents with advanced dementia, and possible correlates, such as family caregivers' satisfaction, involvement in care, care burden and patients' symptom burden. A cross-sectional study was carried out using structured questionnaires administered through the telephone. Generalized estimating equation analyses with adjustment for nursing home clustering were applied to assess the most important associations with family caregivers' trust. A total of 214 family caregivers of persons with dementia residing in 25 nursing homes participated in the study. The majority of the participants (67%) were women and adult children (75%). The majority of the family caregivers trusted physicians, nurses and nurses' aides at a moderate-to-high level. Approximately half to one-third reported moderate-to-low levels of trust. Higher levels of trust were associated with more positive care outcomes, such as higher family satisfaction with care and more positive evaluations of physician-family communication. The present study showed the importance of family caregivers trusting nursing home health professionals for their experiences as caregivers. Although causation cannot be established, increased family caregivers' trust in nursing home health professionals by improving communication and exchange of information might provide a good basis for providing optimal palliative care in advanced dementia. Geriatr Gerontol Int 2017; 17: 2466-2471.

Dietary habits and supplementation practices of young women during pregnancy: an online cross-sectional survey of young mothers and health care professionals

BackgroundNutrition is a modifiable factor affecting birth outcomes, particularly in adolescent pregnancies. This study explores diet and supplementation practices, information and advice before, during and after pregnancy from the perspectives of pregnant or new young mothers and healthcare professionals.MethodsTwo cross-sectional surveys used online questionnaires for young women who were currently pregnant or who had recently given birth, and health care professionals providing antenatal care. The surveys utilised a combination of question types including free text and multiple choice. Recruitment was conducted via the Tommy's website, online forums for young mothers and professional networks.ResultsA total of 205 young women and 146 health care professionals were included in the study.Most young women reported taking supplements at some stage of pregnancy (93.2%), with 54.6% taking it on a daily basis. Those who reported taking supplements less than 7 days a week stated it was mainly due to forgetting. Health care professionals however reported that some young women had difficulties accessing healthy start supplements. Young women reported positive dietary changes; however a significant proportion of participants indicated that they avoided some foods unnecessarily. Avoiding or reducing foods such as red meat (22.7%), eggs (40.6%), oily fish (60.4%) and soft cheese (36.2%) is of concern. Midwife/family nurse (38.0%) was young women's current favourite information source; smartphone applications (apps) and recipe booklets were suggested by over 50% of participants as a new addition to existing services. Health care professionals reported they included nutritional information and support as part of their role; however they felt there were some gaps in knowledge and confidence. Midwives in particular suggested a lack of sufficient time and resources as a main challenge in providing adequate support.ConclusionsAvoiding or reducing major food groups was reported which can indicate a poor dietary pattern. A positive change in dietary intake reported by the majority of young women in this survey indicates willingness to adopt a healthy lifestyle. This, in addition to their trust in health professionals particularly midwives, provides an opportunity for health interventions which support behaviour change to improve birth outcomes. Identified gaps in knowledge and confidence by health professionals in providing dietary advice highlight the need for some additional training for health professionals in delivering dietary and lifestyle behaviour change interventions. Independent and trustworthy online resources for women and their health professionals which can be accessed at any time to provide up to date information in between appointments are also required.

Experiences and perspectives of mothers of the pertussis vaccination programme in London

BackgroundIn 2012, a pertussis outbreak prompted a national vaccination programme for pregnant women, which provides passive protection for infants. Vaccine uptake in London is consistently lower than elsewhere in the UK. There are few studies looking at the reasons why pregnant women accept or refuse pertussis vaccination. Therefore, this study aimed to gain a better understanding of London women's views and experiences, to identify how services might be improved. Study designCross-sectional qualitative semi-structured interviews study. MethodsPurposive sampling of four London boroughs was made, taking boroughs in different geographical locations, with varying levels of deprivation and pertussis vaccine uptake. Participants were recruited through baby clinics and interviews conducted covering knowledge about pertussis, the vaccine, information given during pregnancy, factors influencing decision-making, experience of vaccination, future intentions in another pregnancy and recommendations for improving uptake. A thematic analysis approach was used. ResultsA total of 42 interviews were conducted. Five main themes were identified: (1) lack of discussion about pertussis; (2) desire to protect the baby; (3) trust in health professionals; (4) convenience of vaccination; and (5) help navigating ‘busyness of pregnancy’. This study found that, if offered, most women would accept vaccination. Although vaccination through the general practitioner was convenient, more options for vaccination, such as through antenatal clinics, might increase uptake. Despite usage of the internet to look up medical information, women wanted to discuss vaccination with their midwives or general practitioners. Women wanted a simple pregnancy ‘checklist’ to help ensure that they had received all recommended aspects of antenatal care including vaccination. ConclusionPoor uptake of vaccine is not always due to lack of demand or active refusals. Service providers have an important role to play in actively promoting vaccination services, ensuring women have access to the information they require and in increasing the availability and access to vaccination programmes.

‘It gets into your head as well as your body’: The experiences of patients with cancer during oncology treatment with curative intent

This study explored the psychosocial experiences of patients with cancer during the course of oncology treatment with curative intent. Our aim was to gather in-depth insights into the shared elements of oncology treatment across a range of cancer types. A total of 10 individuals undergoing oncology treatment participated in semi-structured interviews. Six themes were identified using interpretative phenomenological analysis: diminished well-being, perceived role changes in intimate relationships, heightened awareness of limited time, a new order of priorities, taking things as they come and development of trust in health professionals. These themes indicate relevant areas of patients' well-being, which might be enhanced through psychosocial support services.

HPV testing: a mixed-method approach to understand why women prefer self-collection in a middle-income country.

BackgroundHPV test self-collection has been shown to reduce barriers to cervical screening and increase uptake. However, little is known about women’s preferences when given the choice between self-collected and clinician-collected tests. This paper aims to describe experiences with HPV self-collection among women in Jujuy, the first Argentinean province to have introduced HPV testing as the primary screening method, provided free of cost in all public health centers.MethodsBetween July and December 2012, data on acceptability of HPV self-collection and several social variables including past screening were collected from 2616 self-collection accepters and 433 non-accepters, and were analyzed using multivariate regression. In addition, in-depth interviews (n = 30) and 2 focus groups were carried out and analyzed using thematic analysis.ResultsQuantitative findings indicate that main reasons for choosing self-collection are those reducing barriers related to women’s roles of responsibility for domestic work and work/family organization, and to health care services’ organization. No social variables were significantly associated with acceptability. Among those who preferred clinician-collection, the main reasons were trust in health professionals and fear of hurting themselves. Qualitative findings also showed that self-collection allows women to overcome barriers related to the health system (i.e. long wait times), without sacrificing time devoted to work/domestic responsibilities.ConclusionsFindings have implications for self-collection recommendations, as they show it is the preferred method when women are given the choice, even if they are not screening non-attenders. Findings also highlight the importance of incorporating women’s needs/preferences in HPV screening recommendations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3474-2) contains supplementary material, which is available to authorized users.

How much information about antibiotics do people recall after consulting in primary care?

Background. Sharing information with patients within a consultation about their infection and value of antibiotics can help reduce antibiotic prescriptions for respiratory tract infections. However, we do not know how often information is given about antibiotics or infections, and if this is related to knowledge and attitudes.Objectives. To determine the public’s reported use of antibiotics, receipt of information from health professionals about antibiotics and resistance, trust in health professionals and knowledge levels about antibiotics and resistance.Methods. Face-to-face computer-assisted survey with 1625 adults over 15 years in randomly selected households using multistage sampling. Rim weighting was used to correct for any selection biases.Results. About 88% trusted their GP to determine the need for antibiotics. Of those who took antibiotics in the past year, 62% were for a throat infection, 60% for sinus infection and 42% for a cough. Although 67% who had been prescribed an antibiotic recalled being given advice about their infection or antibiotics, only 8% recalled information about antibiotic resistance. Those in lower social grades were less likely to recall advice. About 44% correctly indicated that antibiotics effectively treat bacterial rather than viral infections. Only 45% agreed that ‘healthy people can carry antibiotic resistant bacteria’.Conclusion. GPs and health carers are trusted decision-makers, but could share more information with patients about the need or not for antibiotics, self-care and antibiotic resistance, especially with younger patients and those of lower social grade. Better ways are needed for effective sharing of information about antibiotic resistance.

“Doctors are in the best position to know…”: The perceived medicalization of contraceptive method choice in Ibadan and Kaduna, Nigeria

ObjectivesThe medicalization and clinic-based distribution of contraceptive methods have been criticized as barriers to increasing levels of contraceptive use in Nigeria and other settings; however, our understanding of how clients themselves perceive the contraceptive method decision-making process is very limited. MethodsFocus group discussions among men and women in Ibadan and Kaduna, Nigeria, were used to examine attitudes and norms surrounding contraceptive method decision-making in September and October of 2010. ResultsChoosing a family planning method was presented as a medical decision: best done by a doctor who conducts clinical tests on the client to determine the best, side effect free, contraceptive method for each client. An absolute trust in health professionals, hospitals, and governments to provide safe contraception was evident. ConclusionThe level of medicalization placed on contraceptive method choice by urban Nigerians is problematic, especially since a test that can determine what contraceptive methods will cause side effects in an individual does not exist, and side effects often do occur with contraceptive method use. Practice implicationsProvider and client education approaches would help to improve client involvement in contraceptive decision-making and method choice.

Increasing the acceptability and rates of organ donation among minority ethnic groups: a programme of observational and evaluative research on Donation, Transplantation and Ethnicity (DonaTE)

BackgroundBlack, Asian and minority ethnic (BAME) groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks.ObjectiveTo identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent.MethodsThree-phase programme comprising (1) community-based research involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; (2) hospital-based research examining staff practices and influences on family consent through ethics discussion groups (EDGs) with staff, a study on intensive care units (ICUs) and interviews with bereaved ethnic minority families; and (3) development and evaluation of a training package to enhance cultural competence among ICU staff.SettingCommunity focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts (three in London and two in Midlands).Participants(1) Community studies: 228 focus group participants; (2) hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and (3) evaluation: 66 health professionals.Data sourcesFocus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation.Review methodsSystematic review and narrative synthesis.Results(1) Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. (2) Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation (SNOD) reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory (or cardiac) death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. (3) Evaluation: professional development package – a digital versatile disc-based training package was developed to promote confidence and skills in cross-cultural communication (available at:www.youtube.com/watch?v=ueaR6XYkeVM&feature=youtu.be). Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation.LimitationsParticipants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families.ConclusionsThe research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS.Future workGreater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Adolescentes embarazadas víctimas de violencia intrafamiliar en Brasil: consecuencias psicológicas y sociales

Adolescence pregnancy is a complex issue that must be studied, considering the social, economic, family and the psychological aspects of each adolescent. There is more complexity when these adolescents have suffered domestic violence. Domestic violence is a serious public health problem because affects the physical and psychological integrity of the victims. Many women who become pregnant have been victims of some form of domestic violence by their partners along the married life. This paper paper presents data of research as is part of a larger project entitled ´Domestic Violence Study against Adolescents Pregnant Attended at the University Hospital of Sao Paulo: Basis for Intervention´. The objectives are to identify the accumulated incidence and the experience of pregnant adolescents in face of domestic violence, in special he psychosocial vulnerability, understanding and comparing the lived experience on the pregnant adolescents victims and not victims of domestic violence. Forty pregnant adolescents have participated in this study, being 20 victims of domestic violence (Group 1) and 20 non-victims (Group 2) attending the University Hospital of Sao Paulo and another institutions partner of Psychology Institute of USP. This is an exploratory and descriptive research, quantitative and qualitative. The instruments used were: a form to characterize the profile of production and social reproduction, semi-structured interview. The qualitative data analysis was performed according to Bardin proposal (2013). How results were found: In the group 1 drug use during pregnancy, and lack of trust in health professionals. The showed lack of confidence and support of family, partner abandonment and violence, insecurity, low self esteem and hopelessness. In the group 2 were found: high self-esteem; confidence and family support; security in the relationship with the partner; good prospects for the future; some unfavorable aspects were found in group 2 that were related to the fragility and vulnerability of pregnancy, as well as the inherent immaturity to the period of adolescence. This study deepened knowledge about the reality of this population, as well as contributed to the debate on the needs of pregnant adolescents victims of domestic violence. Therefore, it was observed that the group of higher risk and psychological vulnerability is that of pregnant adolescents victims of domestic violence and requires greater attention and availability of health professionals.

The predictors of uncertainty in mothers of children with autism spectrum disorder

ABSTRACTThis study sought to investigate the predictors of uncertainty in mothers of children with autism spectrum disorder. Sixty-seven participants were evaluated via self-reported measurements with respect to their levels of uncertainty, social support, and trust in health professionals, as well as in terms of the developmental levels and occupational performance of their children. Data regarding the mothers’ educational levels and the length of time each mother had known her child’s diagnoses were also collected. The results showed that the mothers’ appraisal support was the best predictor of their levels of uncertainty, accounting for 22.4% of the variance in uncertainty (F(1,65) = 18.75, p < .001). Appraisal support together with both the level of trust in health professionals and educational level accounted for 36.1% of the variance in uncertainty (F(3,63) = 11.86, p < .001). These findings suggest that much of such mothers’ uncertainty is preventable.

Public Attitudes and Beliefs About Living Kidney Donation: Focus Group Study.

Background: With the rising prevalence of end-stage kidney disease worldwide, the proportion of the general community who might subsequently be called upon to consider living related kidney donation is also increasing. Knowledge about the attitudes and beliefs among the general public about living kidney donation is limited. We aimed to describe public perspectives on living kidney donation. Methods: Participants were recruited from three states in Australia to participate in 12 focus groups (n=113). Transcripts were analyzed thematically. Results: We identified five themes: expected benefits (saving and improving life, societal gain, donor satisfaction, reassurance and control); consciousness of donor risks (compromised health, lifestyle limitations, financial consequences, relationship tensions, devastation); social precariousness (fear of the unknown, exploitative connotation, recipient deservingness, protecting conscience, potential regret); upholding fairness (equal access to transplantation, reciprocity, prevent prejudice, donor safety net); decisional autonomy (body ownership, right to know, valid relationships); and assumed duty of care (facilitate informed decision-making, safeguard against coercion, ensure psychological safety, justifiable risk, objectivity, warranted disclosure). Conclusion: The expected benefits for recipients bolsters public support for living kidney donor transplantation, however ethical dilemmas and concerns for the donor instilled ambivalence about living donation. Protecting equity and autonomy, and an implicit trust in health professionals to protect donors and recipients mitigated some of these uncertainties. Developing interventions, practices and policies that address community skepticism and values may promote awareness and trust in living kidney donation.

Public Attitudes and Beliefs About Living Kidney Donation

With the rising prevalence of end-stage kidney disease worldwide, the proportion of the general community who might subsequently be called upon to consider living related kidney donation is also increasing. Knowledge about the attitudes and beliefs among the general public about living kidney donation is limited. We aimed to describe public perspectives on living kidney donation. Participants were recruited from three states in Australia to participate in 12 focus groups (n=113). Transcripts were analyzed thematically. We identified six themes: expected benefits (saving and improving life, societal gain, donor satisfaction, reassurance and control), consciousness of donor risks (compromised health, lifestyle limitations, financial consequences, relationship tensions, devastation), social precariousness (fear of the unknown, exploitative connotation, recipient deservingness, protecting conscience, potential regret), upholding fairness (equal access to transplantation, reciprocity, prevent prejudice, donor safety net), decisional autonomy (body ownership, right to know, valid relationships), and assumed duty of care (facilitate informed decision-making, safeguard against coercion, ensure psychological safety, justifiable risk, objectivity, warranted disclosure). The expected benefits for recipients bolster public support for living kidney donor transplantation; however, ethical dilemmas and concerns for the donor instilled ambivalence about living donation. Protecting equity and autonomy, and an implicit trust in health professionals to protect donors and recipients mitigated some of these uncertainties. Developing interventions, practices, and policies that address community skepticism and values may promote awareness and trust in living kidney donation.

Bariatric surgery for obese children and adolescents: a review of the moral challenges.

BackgroundBariatric surgery for children and adolescents is becoming widespread. However, the evidence is still scarce and of poor quality, and many of the patients are too young to consent. This poses a series of moral challenges, which have to be addressed both when considering bariatric surgery introduced as a health care service and when deciding for treatment for young individuals. A question based (Socratic) approach is applied to reveal underlying moral issues that can be relevant to an open and transparent decision making process.DiscussionA wide range of moral issues with bariatric surgery for children and adolescents is identified in the literature. There is a moral imperative to help obese minors avoiding serious health problems, but there is little high quality evidence on safety, outcomes, and cost-effectiveness for bariatric surgery in this group. Lack of maturity and family relations poses a series of challenges with autonomy, informed consent, assent, and assessing the best interest of children and adolescents. Social aspects of obesity, such as medicalization, prejudice, and discrimination, raise problems with justice and trust in health professionals. Conceptual issues, such as definition of obesity and treatment end-points, present moral problems. Hidden interests of patients, parents, professionals, industry, and society need to be revealed.SummaryPerforming bariatric surgery for obese children and adolescents in order to discipline their behavior warrants reflection and caution. More evidence on outcomes is needed to be able to balance benefits and risks, to provide information for a valid consent or assent, and to advise minors and parents.

Sources and Reasons for Seeking Health Information by Lithuanian Adults

The aim of this study was to assess the attitudes of Lithuanian adults aged 20-64 years toward the reasons for accessing health information and to determine the main health information sources and their relation to sociodemographic factors. The data for this study were gathered in 2008 within the framework of the International Project Finbalt Health Monitor evaluating health behavior in a Lithuanian adult population. More than half of respondents searched for health information during the last year. Men were 2.7 times more likely to trust friends and family as a health information source compared with women. For each 1-year increase in age, the odds of using friends and family, and the Internet as the main sources of health information decreased, while the odds of using people with the same condition and different means of media increased. Marital status was associated with greater trust in health professionals and the Internet as health information sources. Higher education was positively associated with more frequent reporting courses and lectures, and the Internet as the sources of health information, while those with lower education preferred television and radio. This study revealed the characteristics of the "risk group" in terms of the sources of health information that people, assigned to it, tend to use, and it is especially important when providing health information.

Multifaceted determinants of online non-prescription drug information seeking and the impact on consumers’ use of purchase channels

The growing importance of the Internet as an information and purchasing channel is drawing widespread attention from marketing decision makers. Nevertheless, the relevance of the Internet to the so-called self-medication market in Germany has been paid barely enough attention. Our study aims to contribute insights concerning the penetration of the Internet in this market, as well as to give an overview of the critical determinants of Internet use for non-prescription drug information seeking, such as the accessibility of professional information, trust in health professionals' opinion and the ability to search online, as well as the perceived usefulness and credibility of online non-prescription drug information. Furthermore, we demonstrate that the preferred use of the Internet as a non-prescription drug information source positively influences the choice of unconventional purchase channels for non-prescription drugs and negatively affects the use of stationary pharmacies.

Risks, trust and knowledge: determinants of pregnant women's decisions regarding participation in a future Q fever screening and treatment program during a large epidemic in The Netherlands

Contracting Q fever during pregnancy carries a risk of developing obstetric complications. The aim of this study was to gain insight into pregnant women's decisions regarding participation in a future Q fever screening and treatment program. Pregnant women (N = 148) in Q fever high-risk areas in The Netherlands were recruited via midwives' practices and via an online panel for a cross-sectional questionnaire survey. The outcome measures included intention to participate in the program, Q fever exposure risk, perceived Q fever risk, trust in health professionals and authorities, disease-related knowledge and additional outcome measures. Fifty-six percent of the respondents intended to participate in the screening and treatment program. The sole determinant of a higher intended program uptake was a more positive appraisal of program efficacy and convenience. This appraisal was in turn associated with perceived risk and knowledge. Women's appraisal of program efficacy and convenience, their disease-related knowledge and perceived Q fever risk seem to be crucial for their intended program uptake. A successful implementation of a Q fever screening and treatment program may thus depend on the benefits and downsides of the program, and on securing that women are aware of the risks of the disease.