Public views of the benefits and barriers to the consumption of a plant-based diet

OBJECTIVE: The aim of this study was to examine consumers' perceived benefits and barriers to the consumption of a plant-based diet. DESIGN: Mail survey that included questions on perceived benefits and barriers to the consumption of a plant-based diet. SETTING: Victoria, Australia. SUBJECTS: Four hundred and fifteen randomly selected Victorian adults. RESULTS: The main perceived barrier to adoption of a plant-based diet was a lack of information about plant-based diets (42% agreement). Sex, age and education differences were present in over a quarter of the barrier items. For example, non-university-educated respondents and older people were less willing to change their current eating pattern than were university educated and younger respondents. The main benefits associated with plant-based diets were health benefits, particularly decreased saturated fat intake (79% agreement), increased fibre intake (76%), and disease prevention (70%). Age, sex and education differences with regard to benefits were apparent, although sex differences were more important than age or education differences.CONCLUSIONS: The majority of respondents perceived there to be health benefits associated with the consumption of a plant-based diet. Compared with the proportion of respondents who agreed that there were particular benefits of eating a plant-based diet, perceived barriers were relatively low. An understanding of the perceived benefits and barriers of consuming a plant-based diet will help formulate strategies that aim to influence beliefs about plant foods, plant food consumption, and, ultimately, public health.     

Hospice and primary care physicians: attitudes,knowledge, and barriers

Underuse of hospice services is a significant problem in the United States. Primary care physicians constitute an increasing referral base and have been hypothesized to be important barriers to increased use. We conducted a mail survey of 131 primary care physicians (overall response rate of 72 percent), examining their attitudes toward, knowledge about, and perceived benefits and barriers to hospice care. Physicians demonstrated very favorable attitudes towards hospice. They had correct knowledge about most aspects of hospice, and, where they did not, they were far more likely to be uncertain than erroneous. Primary care physicians perceived many benefits to hospice care and identified patient and family readiness as the major barrier to earlier hospice referrals. A significant subgroup had concerns about problems in interacting with hospices. There were very few differences between family practitioners and general internists. These findings have many implications for directing collaborative efforts between primary care physicians and hospices to improve end-of-life care.     

Utilization of colorectal cancer screening tests: a 1997 survey of Massachusetts internists.

BACKGROUND: Physician noncompliance with screening recommendations has been a major barrier to effective colorectal cancer control. The overall objectives of this study were to assess the current attitudes and screening behavior of primary care physicians in light of new efficacy data, revised guidelines, improved technology, and more widespread insurance coverage. METHODS: Questionnaires inquiring about knowledge, beliefs, and practice patterns related to colorectal cancer screening were mailed in mid-1997 to 700 randomly selected Massachusetts internists. RESULTS: The overall response rate was 63%. Nearly 60% of respondents reported an increase in screening behavior during the past 5 years. Most (80%) were aware of at least one set of screening guidelines and 90% reported utilizing one or more recommended screening strategies. Fecal occult blood testing (FOBT), alone (47%) or in combination with flexible sigmoidoscopy (50%), was the preferred strategy for most respondents. Colonoscopy was rarely utilized (5%) despite high perceived effectiveness. Concern about patient compliance was a significant determinant of FOBT utilization, whereas perceived effectiveness, concerns about time or efficacy data, prior procedural training, date of licensure, and use of instructional materials were independent determinants of sigmoidoscopy utilization. CONCLUSION: Massachusetts' internists report high rates of utilization of select colorectal cancer screening strategies. Future studies must validate self-reported compliance and explore barriers to screening colonoscopy.     

Addressing spiritual concerns of patients: family physicians' attitudes and practices

BACKGROUND: Our goals were to assess family physicians' spiritual well-being, identify their perceived barriers to discussing spiritual issues with patients, and determine how often they have these discussions. METHODS: We mailed a questionnaire to 231 Missouri family physicians (80 residents, 43 faculty, and 108 community physicians). The questionnaire included the Ellison Spiritual Well-being Scale (ESWS), as well as questions about physicians' attitudes toward spirituality and the barriers to and frequency of discussions of spiritual issues with patients. RESULTS: The response rate was 74%. The mean ESWS score indicated that the physician respondents had a high level of spiritual well-being. Nearly all respondents (96%) considered spiritual well-being an important health component, 86% supported referral of hospitalized patients with spiritual questions to chaplains, and 58% believed physicians should address patients' spiritual concerns. Fear of dying was the spiritual issue most commonly discussed, and less than 20% of physicians reported discussing other spiritual topics in more than 10% of patient encounters. Barriers to addressing spiritual issues included lack of time (71%), inadequate training for taking spiritual histories (59%), and difficulty identifying patients who want to discuss spiritual issues (56%). CONCLUSIONS: Family physicians in this survey had high spiritual well-being scores. Most believed spiritual well-being is an important factor in health. Despite this belief, however, most reported infrequent discussions of spiritual issues with patients and infrequent referrals of hospitalized patients to chaplains. Lack of time and training were key barriers to spiritual assessment.     

The impact of perceived barriers on primary care physicians' screening practices for female partner abuse

OBJECTIVES: Our purpose was to examine primary care physicians' screening practices for female partner abuse in different clinical situations and to investigate the relationship between perceived barriers and screening practices. METHODS: A cross-sectional survey was mailed to Alaska physicians practicing in the following specialties: family practice, internal medicine, obstetrics/gynecology and general practice. RESULTS: The survey response rate was 80 percent (305/383). The majority (85.7%) of primary care physicians screened often or always when a female patient presents with an injury, but they rarely screened at initial visits (6.2%) or annual exams (7.5%). More than one-third of respondents estimated that 10% or more of their female patients had experienced some type of intimate partner abuse. Several barriers to screening described in the literature were not predictive of physicians' screening practice patterns. Physicians' perceptions that abuse is prevalent among their patients and physicians' beliefs that they have a responsibility to deal with abuse were the only variables independently associated with screening at initial visits and annual exams. The only variable predictive of screening when a patient presents with an injury was physicians' perceived prevalence of abuse. CONCLUSION: Primary care physicians have not integrated screening for partner abuse into routine care. Strategies to increase awareness of the high prevalence of abuse in the primary care setting and to educate providers on the negative health effects of victimization can help physicians to acknowledge their responsibility in addressing abuse and the importance of screening at routine visits. Further rigorous studies are needed to identify and evaluate predictors of screening for abuse.     

The Impact of Perceived Barriers on Primary Care Physicians' Screening Practices for Female Partner Abuse

ABSTRACT

Objectives: Our purpose was to examine primary care physicians' screening practices for female partner abuse in different clinical situations and to investigate the relationship between perceived barriers and screening practices.

Methods: A cross-sectional survey was mailed to Alaska physicians practicing in the following specialties: family practice, internal medicine, obstetrics/gynecology and general practice.

Results: The survey response rate was 80 percent (305/383). The majority (85.7%) of primary care physicians screened often or always when a female patient presents with an injury, but they rarely screened at initial visits (6.2%) or annual exams (7.5%). More than one-third of respondents estimated that 10% or more of their female patients had experienced some type of intimate partner abuse. Several barriers to screening described in the literature were not predictive of physicians' screening practice patterns. Physicians' perceptions that abuse is prevalent among their patients and physicians' beliefs that they have a responsibility to deal with abuse were the only variables independently associated with screening at initial visits and annual exams. The only variable predictive of screening when a patient presents with an injury was physicians' perceived prevalence of abuse.

Conclusion: Primary care physicians have not integrated screening for partner abuse into routine care. Strategies to increase awareness of the high prevalence of abuse in the primary care setting and to educate providers on the negative health effects of victimization can help physicians to acknowledge their responsibility in addressing abuse and the importance of screening at routine visits. Further rigorous studies are needed to identify and evaluate predictors of screening for abuse.     

Willingness to use short-term oral pre-exposure prophylaxis (PrEP) by migrant miners and female partners of migrant miners in Mozambique

Abstract

Migrant miners from Mozambique who work in South Africa and their partners are at substantial risk for HIV infection. We conducted a cross-sectional study to assess the willingness of migrant miners and female partners of miners to take short-term pre-exposure prophylaxis (PrEP) for prevention of HIV acquisition. The study was conducted in Gaza Province, Mozambique, between September and October 2015. A total of 131 male miners and female partners of male miners completed a questionnaire. Subsequently, 48 in-depth interviews among male miners and female partners of miners and 3 focus-group discussions (6 participants each) among female partners of miners were conducted. Quantitative data were tabulated using Stata. A structured coding scheme was developed and qualitative data were analysed using Atlas.ti. Most participants (94%) were willing to take PrEP for short-term use. Facilitating factors for willingness to use PrEP were concerns about partner’s sexual behaviour, desire for pregnancy and one’s own sexual behaviour. The main barriers to PrEP use were concerns regarding side-effects, perceived difficulty adhering to daily pill taking and concern about partner/family disapproval. Overall, participants saw potential barriers for PrEP as minor obstacles that could be overcome. The male partner’s influence on PrEP use was significant.     

Perceived Risk of Intimate Partner Violence Among STI Clinic Patients: Implications for Partner Notification and Patient-Delivered Partner Therapy

Patient-delivered partner therapy (PDPT) is the practice of providing patients diagnosed with a bacterial sexually transmitted infection (STI) medication to give directly to their partner for treatment without requiring the partner to participate in diagnostic testing and counseling. Despite a growing body of evidence in support of PDPT, literature is limited to date on the influence of perceived risk of intimate partner violence (IPV) on PDPT use. We analyzed mixed-method data from 196 quantitative surveys (61% male, M age = 31.2, 92% Black or African-American) and 25 qualitative interviews to better understand the barriers and facilitators associated with PDPT delivery for patients attending a Midwestern, publicly funded STI clinic in the U.S. Nearly a third of surveyed patients (29; 34% of women, 26% of men) expressed worry about IPV when delivering PDPT. Patients had concerns about infidelity worry, embarrassment, and anxiety (referred to as IWEA hereafter) associated with partner notification and PDPT delivery. We found IWEA was highly correlated with IPV concerns in a fully adjusted logistic regression model. Women had 2.43 (95% CI = 1.09–5.42) times greater odds of worrying about IPV than men; other significant factors associated with IPV worry included higher condom use, no prior STI diagnosis, and being uninsured (as compared to having Medicare/Medicaid insurance). Encouraging communication between healthcare providers and their patients about the potential for IPV could facilitate patient triaging that results in the consideration of alternative partner referral mechanisms for patients or partners at risk of harm and better outcomes for patients and their partners.     

Mandatory reporting of intimate partner violence to police: views of physicians in California

OBJECTIVES: This study examined physicians' perspectives on mandatory reporting of intimate partner violence to police. METHODS: We surveyed a stratified random sample of California physicians practicing emergency, family, and internal medicine and obstetrics/gynecology. RESULTS: An estimated 59% of California primary care and emergency physicians (n = 508, 71% response rate) reported that they might not comply with the reporting law if a patient objects. Primary care physicians reported lower compliance. Most physicians agreed that the legislation has potential risks, raises ethical concerns, and may provide benefits. CONCLUSIONS: Physicians' stated noncompliance and perceived negative consequences raise the possibility that California's mandatory reporting law is problematic and ineffective.     

Satisfaction in the sex life of a general population sample

A questionnaire asking about satisfaction and problems in the sex lives of respondents and their partners was sent to 4,000 adults registered with general practices in England. A quarter of respondents said that they were dissatisfied with their sex lives, men more so than women, particularly with the frequency of intercourse. Respondents were more likely to be dissatisfied with their sex life if they perceived their partner to have a sexual problem. Respondents who were dissatisfied were more likely to report that their partner was dissatisfied with their sex life. The benefits of treating sexual problems have wide implications for both partners in a relationship.     

Patient referral alone is not an effective strategy to capture partners of patients with sexually transmitted infections in low-resource settings: a case-control study

Aim

Partner notification (PN) is a key public health intervention aimed at preventing re-infection and controlling the spread of STIs. However, only limited research has been conducted to investigate factors associated with PN in Ethiopia.

Subject and methods

A nested case-control study was undertaken within a cohort of individuals being treated for STIs in public health facilities in Ethiopia. Hierarchical binary logistic regression was used to identify socio-demographic, behavioral and psychosocial factors associated with PN.

Results

A total of 250 patients on STI treatment who notified their partners (cases) were compared with 185 patients who did not notify their partners (controls). STI patients were less likely to notify their partner if they were single [AOR = 0.33, 95% CI: (0.15–0.73)], in a casual partnership [adjusted odds ratio (AOR) = 0.33, 95% CI: (0.15–73)], not knowledgeable about a partner’s sexual behavior [AOR = 0.43, 95% CI: (0.24–0.77)], had poor knowledge of risky sexual behavior [AOR = 0.23, 95% CI: (0.12–0.43)] and had no intention of notifying partners [AOR = 0.19, 95% CI: (0.10–0.36)]. The odds of PN were higher among highly educated respondents [AOR = 5.16; 95% CI: (1.83–14.54)].

Conclusion

Capturing STI cases through patient referral partner notification is less likely to be successful among patients who are single and in a casual relationship.

     

Discussing STIs: doctors are from Mars,patients from Venus

BACKGROUND: Primary care plays an important role in promoting sexual health, but in this setting counselling regarding sexually transmitted infections (STIs) is rarely performed and often inadequate. OBJECTIVE: Our aim was to identify and quantify the barriers physicians encounter in discussing STIs with their patients. METHODS: A postal questionnaire-based survey was carried out in a random sample of 200 primary care physicians in Antwerp, Belgium. RESULTS: The response rate was 68%. Among the 122 respondents, only 44.3% provide some form of counselling (asking about sexual history, informing about safe sex or informing about STIs) regularly, at least once a week. Major barriers are language and comprehension problems (for 74.2% of respondents), ethnic differences (68.4%), insufficient training (69.4%), lack of time (60.8%), presence of the patient's partner (89.2%) or mother (94.2%), first contact with a patient (60.8%), fear of embarrassing the patient (30.6%) and a patient without genital complaints (71.4%). About half of the GPs fail to counsel an asymptomatic patient with obvious STI risk, and as many give no safe sex advice in a first contraception consultation. CONCLUSIONS: Physicians have many and various barriers to discussing STIs with their patients. Features of contemporary STI counselling and solutions to its problems are discussed. Education of health care providers should be given priority.     

Self-reported risk factors and perceived chance of getting HIV/AIDS in the 1990s in Alberta

This paper examines self-reported risk factors and perceived chance of getting HIV/AIDS using five representative surveys of adult Albertans obtained in 1990, 1992, 1994, 1995, and 1996. The findings from this trend analysis demonstrate that less than 10% of respondents perceived their chance of getting HIV/AIDS to be medium or high. Persons with multiple sex partners tended to perceive themselves to be at risk. Almost 20% of respondents reported one or more new sex partners in the last two years prior to the survey. Condom use with new sex partners increased substantially. Fifteen percent of respondents reported two or more sex partners in total in the last two years prior to the survey. Fourteen percent reported having two or more sex partners including at least one casual sex partner, and of these 61% reported always using condoms with their casual sex partner(s). Finally, the most striking finding is the perception among health care workers that they are at risk for contracting HIV/AIDS.     

Physicians' Screening Practices for Female Partner Abuse During Prenatal Visits

Objective: Our purpose was to examine physicians' screening practices for female partner abuse during prenatal visits and to identify barriers to screening. Methods: A self-administered questionnaire was developed to collect data on physicians' screening practices and their beliefs about screening for female partner abuse. The survey was mailed to all primary care physicians practicing in Alaska. The response rate was 80% (305/383). These analyses were limited to physicians who indicated that they provided prenatal care (n = 157). Results: More than one-half of respondents providing prenatal care estimated that 10% or more of their female patients had experienced abuse. Less than one-half of respondents had recent training on partner abuse. Only 17% of respondents routinely screened at the first prenatal visit and 5% at follow-up visits. Respondents were more likely to screen at the first prenatal visit compared to follow-up visits. Multivariate analyses failed to support any associations between physicians' characteristics and screening practices. Physicians' perception that abuse was prevalent among their patients and physicians' belief that they have a responsibility to deal with abuse were the only variables that were independently associated with screening at prenatal visits. Other barriers frequently cited in the literature were not predictive of screening. Conclusion: Most Alaskan physicians do not routinely screen for abuse during prenatal visits. Medical education should increase physicians' index of suspicion for abuse, emphasize physicians' responsibility to address partner abuse, and reinforce the importance of routine screening throughout the pregnancy. More research is needed to identify barriers to screening and strategies for integrating routine screening into prenatal care.     

Shared Decision Making and Patient Decision Aids: Knowledge,Attitudes, and Practices Among Hawai‘i Physicians

Background: As the health care field moves toward patient-centered care (PCC), increasing emphasis has been placed on the benefits of patient decision aids for promoting shared decision making (SDM). This study provides a baseline measure of knowledge, attitudes, and practices (KAP) among Hawai‘i''s physicians with respect to patient decision aids (DAs). Physicians throughout the State of Hawai‘i were invited to complete a survey assessing their knowledge, attitudes, and practices with respect to the clinical use of DAs.One hundred and seventy four valid surveys were analyzed. Reported awareness and use of DAs were low, but recognition of the benefits of SDM and openness to the use of DAs were very high. The leading perceived barriers to the implementation of DAs were lack of awareness, lack of resources, and limited physician time to learn about DA technology. However, a significant majority of the respondents reported that DAs could empower patients by improving knowledge (88%), increasing satisfaction with the consultation process (81%), and increasing compliance (74%). Among physicians currently employing DAs, use of brochures or options matrix sheets was the most common aid tool. However, leading recommended DA formats were paper-based brochures for clinic use (75%) and interactive online website programs for outside clinic use (73.5%). Given growing emphasis on the PCC model and the recognized desire of many patients to participate in the medical decision making process, positive responses toward SDM and the use of DAs by Hawai‘i physicians are promising.     

Parents’ Decisions About HPV Vaccine for Sons: The Importance of Protecting Sons’ Future Female Partners

Parents’ decisions about human papillomavirus (HPV) vaccine for sons may be influenced by potentially protecting sons’ future female partners from HPV. We sought to identify characteristics of parents likely to consider future partner protection in vaccine decisions, and to determine if parents likely to consider future partners in vaccine decisions had greater intention to vaccinate. We performed a cross-sectional survey of parents with sons in a pediatric clinic in 2010. We used Fisher’s exact tests to identify demographics associated with consideration of future female partners in vaccine decisions. We used adjusted logistic regression to determine if parents likely to consider future partner protection in vaccine decisions had greater intention to vaccinate sons. Most parents (76 %, 187/246) reported vaccine decisions for sons were likely to be influenced by preventing HPV transmission from sons to their female partners. Parents 40 years and older, White and Black parents (vs other race), non-Hispanic, and college-educated parents were significantly more likely to indicate female partner protection may influence vaccine decisions (p < 0.05). Parents likely to be influenced by female partner protection in vaccine decisions had greater intention to vaccinate sons than their counterparts (adjusted odds ratio 2.54, 95 % CI 1.22, 5.28). Overall, many parents were likely to consider sons' female partners in vaccine decisions. Because parents likely to consider female partners had increased intention to vaccinate sons, future efforts to improve vaccine uptake in boys should explore the benefits of highlighting potential female partner protection, as this concept may resonate with many parents.     

Awareness of and participation in maintenance of professional certification: a prospective study

INTRODUCTION: National health care concerns have led to the emergence of maintenance of certification (MOC) as a means to ensure the competence of practicing physicians. Little is known about physician perceptions of the barriers and/or benefits of MOC or proportions of physicians who participate in MOC programs. The purposes of this study were to assess physicians' plans for participating in MOC and to identify influences on decisions to participate. METHODS: A geographically stratified, random sample of 755 licensed practicing physicians in the state of Oregon were surveyed regarding certification status, awareness of MOC requirements, influences on decision to participate in MOC, and resources available and/or desired to assist with MOC. RESULTS: Three hundred seventy-six of 755 surveys were returned for +/-5% margin of error at 95% confidence level. Of the respondents 91% were board certified; 95% with time-limited certificates planned to recertify. Factors rated "extremely important" in decisions to recertify were to "demonstrate expertise in my specialty" (50%), to "demonstrate my medical knowledge is up to date" (52%), and to "demonstrate my competency to provide patient care in my specialty" (51%). Practice groups provided physicians with few resources for MOC; 29% report that their practices provided no resources for the MOC process. DISCUSSION: These results are important for hospitals, medical institutions, medical educators, and CME program planners. Although the large majority of physicians with time-limited certificates plan to participate in maintenance of certification, lack of some resources (time, money, and administrative support) and reluctance to utilize others (systems-based care) are identified as barriers to the success of MOC.     

Use and Perceived Benefits of Mobile Devices by Physicians in Preventing Adverse Drug Events in the Nursing Home

Objective

Although mobile devices equipped with drug reference software may help prevent adverse drug events (ADEs) in the nursing home (NH) by providing medication information at the point of care, little is known about their use and perceived benefits. The goal of this study was to conduct a survey of a nationally representative sample of NH physicians to quantify the use and perceived benefits of mobile devices in preventing ADEs in the NH setting.

Design/Setting/Participants

We surveyed physicians who attended the 2010 American Medical Directors Association Annual Symposium about their use of mobile devices, and beliefs about the effectiveness of drug reference software in preventing ADEs.

Results

The overall net valid response rate was 70% (558/800) with 42% (236/558) using mobile devices to assist with prescribing in the NH. Physicians with 15 or fewer years of clinical experience were 67% more likely to be mobile device users, compared with those with more than 15 years of clinical experience (odds ratio = 1.68; 95% confidence interval = 1.17–2.41; P = .005). For those who used a mobile device to assist with prescribing, almost all (98%) reported performing an average of 1 or more drug look-ups per day, performed an average of 1 to 2 lookups per day for potential drug-drug interactions (DDIs), and most (88%) believed that drug reference software had helped to prevent at least 1 potential ADE in the preceding 4-week period.

Conclusions

The proportion of NH physicians who use mobile devices with drug reference software, although significant, is lower than in other clinical environments. Our results suggest that NH physicians who use mobile devices equipped with drug reference software believe they are helpful for reducing ADEs. Further research is needed to better characterize the facilitators and barriers to adoption of the technology in the NH and its precise impact on NH ADEs.     

Physician practices and attitudes regarding adult immunizations

OBJECTIVES: To assess immunization practices and attitudes of U.S. primary care physicians regarding adult influenza and pneumococcal immunizations. METHODS: Mailed survey of primary care internists and family physicians across the United States; four follow-up contacts by mail and telephone. Bivariate and multivariate analyses assessed immunization practices and attitudes and differences by physician characteristics. RESULTS: Three hundred and sixteen of 668 eligible physicians responded (50 refused, response rate of 266 = 40%); 220 provided adult vaccinations. More than 64% indicated they routinely vaccinated patients >/=65 years and those <65 years with chronic disease indications with both influenza and pneumococcal vaccine. Reported barriers for influenza vaccination included vaccine safety concerns by patients (58%), urgent concerns dominating visits (43%), and inadequate reimbursement (26%). Reported barriers for pneumococcal vaccination included urgent concerns during office visits (44%), no patient immunization history (36%), patient concerns about vaccine safety (31%), and inadequate reimbursement (25%). Many physicians indicated willingness to try tracking systems (72%), chart reminders (55%), patient reminders (53%), standing orders (36%), external lists of unimmunized patients for pneumococcal vaccination (74%), external patient reminders (70%), and office training of physicians (36%) or staff (46%). CONCLUSIONS: While most physicians favored adult vaccinations, practical barriers to vaccination exist. Most physicians would adopt evidence-based strategies to improve immunization delivery.