What is ‘confidence’ and what could affect it?: A qualitative study of mothers who are hesitant about vaccines

BackgroundPublic confidence in immunization is critical to maintaining high vaccine-coverage rates needed to protect individuals and communities from vaccine-preventable diseases. Recent attention has been placed on factors influencing confidence in vaccination in the US and globally, but comprehensive understanding of what drives or hinders confidence in childhood vaccination is yet to be reached. As such, assessing parents' confidence in childhood vaccination and the ways in which educational materials affect confidence is needed.ObjectiveWe sought to (1) learn how mothers who are hesitant about vaccination characterize confidence in health-related products for young children, including the recommended vaccines; (2) gain insights on what influences vaccine confidence beliefs; and (3) assess whether short, education materials affect parental confidence in childhood vaccinations.MethodsEight moderator-lead focus groups (n = 61), stratified by socioeconomic status, were undertaken with mothers of children 5 years of age of less who are hesitant about vaccines. Four of the groups were held in the Philadelphia, PA area and four were held in the San Francisco/Oakland, CA area. Three educational material pairs, each consisting of a 2–3 min video and an infographic poster about an immunization-related topic, were reviewed and assessed for influence on confidence.ResultsQualitative data analysis was used to identify overarching themes across the focus groups. Themes, insights, and illustrative quotes were identified and provided for each of the major discussion areas: primary health concerns for young children; confidence beliefs and perceptions, including for recommended vaccines; facilitators and barriers to confidence; and reactions to the educational materials.ConclusionsResults provide helpful insights into how mothers who are hesitant about vaccines perceive confidence in childhood vaccines and health-related products, suggestions for how to improve confidence, and support for the value and use of short videos as part of vaccination education efforts. Findings can aid those developing vaccination education materials and resources designed to foster vaccine confidence.     

'I'll worry about that when it comes along': osteoporosis, a meaningful issue for women at mid-life?

This paper reports findings from a qualitative study of the health concerns and perceptions of health risks and osteoporosis of women in the age group 40-55 years. Osteoporosis has been increasingly put forward in the popular and scientific press as an important issue for women in mid-life. A variety of preventive measures, including use of hormone replacement therapy (HRT), are suggested. The medicalization of women's experiences and associated use of HRT at this point in the life course is the subject of considerable debate in the medical, social scientific and feminist literatures, although, to date, this issue has received less attention in health promotion. Much of this debate is informed by quantitative and survey data, and there is a lack of in-depth qualitative information on women's own views. This study casts doubt on the salience of osteoporosis for women at mid-life. Our qualitative research suggests that, unless they had experiential knowledge which had rendered osteoporosis particularly salient, most women in this study evidenced a surprising degree of disinterest in this health issue. To make sense of this disinterest we examined women's wider accounts of their lives, health and the lifecourse, and the menopause. These findings would appear to present a challenge for those in health promotion who might wish to emphasize early preventive strategies for osteoporosis.     

What is it they say about best intentions?: a life lesson in empathy and sympathy

This narrative exposes a critical communication lesson through a true account. In describing empathy and sympathy, it ushers readers on a brief journey where one vital exchange goes awry. A lesson emerges for clinical staff and patients communicating in sensitive circumstances. Empathy and sympathy both express feelings but differ in how these interwoven emotions emerge. It is suggested that sympathy shares feeling whereas empathy shares understanding. The narrative includes a dilemma and the consequence that results from ineffective communication, and concludes with suggestions to successfully manage similar communication encounters.     

Is it me or is it them? Factors that influence the passing of underperforming students

Context Research has found that clinical assessments do not always accurately reflect medical student performance. Barriers to failing underperformance in students have been identified in other vocational settings. Is ‘failure to fail’ an issue for medical educators in the UK, and, if so, what are its determinants? Methods We carried out a qualitative focus group study exploring the views of medical educators (general practitioners, hospital doctors and non‐clinical tutors) from two different UK medical schools. To make sense of a potential multitude of factors impacting on failure to fail, we selected the integrative model of behavioural prediction to underpin our data collection and analysis. Results Ten focus groups were carried out with 70 participants. Using both theory and data‐driven framework analysis, we identified six main themes relevant to the integrative model of behavioural prediction. These are: tutor attitudes towards an individual student; tutor attitudes towards failing a student; normative beliefs and motivation to comply; efficacy beliefs (self‐efficacy); skills and knowledge, and environmental constraints. Discussion Many different factors impact on medical educators’ failure to report underperformance in students. There are conflicts between these factors and the need to report competence accurately (i.e. duty to protect the public). Although some of the barriers identified are similar to those found in previous studies, using a theory‐based approach added value in that it facilitated a richer exploration of failure to fail. Insights offered in this study will be used to plan a questionnaire study and subsequent intervention to support medical educators in accurately reporting underperformance in students.     

What is hormesis and why haven't we heard about it before?

Low doses of ionizing radiation are widely believed to produce effects similar to those observed at high doses; only the incidence (i.e. risk) varies with dose. Furthermore, it is assumed that effects other than those observed at high doses will not occur at low doses. Yet there have been frequent reports in the literature of "anomalies" at low doses--effects unrelated to and unpredictable from the high-dose exposure experiences. These have been referred to as "hormetic" effects. These effects have their parallel with other hormetic effects seen with many other agents generally considered toxic. It is postulated that hormesis has previously received scant attention because it conflicts with the conventional radiation science paradigm.     

Editorial: What is a nutrient?

Nutrient:a substance that an organism must obtain from its surroundings for growth and the sustenance of life.In the old days of food composition work, we took certain comfort in the simple characterization of the food components we measured--they were nutrients. But if they were not nutrients, they could still be neatly classified as antinutrients, toxicants, or just interesting non-nutrients. Of course, components are not so simply characterized these days. Polyphenols, measured in at least two of the studies in this issue of JFCA, were referred to as antinutrients in the not-too-distant past. In recent years, we rarely see that kind of characterization. Many of the polyphenols are now characterized as beneficial bio-active non-nutrients, with the occasional suggestions that some could even be called nutrients. The same is true for isoflavones and coumestrol, for which we have more new data in this issue.A further confounding situation exists with functional characterizations of food components. Let's take what many papers in the scientific literature refer to as "antioxidant nutrients". The provitamin A carotenoids show up on this list, but some of the most potent antioxidant carotenoids cannot be classified this way because they have no provitamin A activity, i.e. they are not antioxidant nutrients.We also have the reverse situation. Any essential divalent cation, for example iron, can be an antinutrient or toxicant, by inducing deficiencies of other essential divalent cations even at therapeutic levels, or by straightforward poisoning at toxic levels. By preventing absorption of nutrients in a meal, dietary fibre or various fractions of dietary fibre are characterized as antinutrients.For these and other reasons, many scientists have called for, and some have created, new definitions for the word nutrient. From a chemical and physiological point of view this is reasonable. It is also reasonable from a research point of view. Is dietary analysis different from an exposure or risk assessment? Not really. Is a food composition database different from an additive, contaminant or toxicant database? No, not fundamentally. Do we miss assessment opportunities in clinical and epidemiological research by not having extensive compositional data--beyond nutrients--in our food databases? Surely we do.Some national food composition database developers are including many food components in their databases. As long as all the samples and values are properly documented, there is no down-side to this activity; there is huge potential benefit. The new edition of the German Food Composition and Nutrition Tables by Souci, Fachmann and Kraut, reviewed in this issue of JFCA, is a good example of printed tables presenting a more comprehensive picture of the chemical composition of foods. This is to be encouraged and applauded.     

Clinicians on the board: What difference does it make?

Around the world clinical professionals have increased their involvement in the management of health services. However the evidence to suggest that these changes will lead to improved performance remains fragmented. In this paper we address this matter focussing on the impact of clinicians appointed to the boards of directors of English NHS hospital trusts. Although the number of clinicians involved in the strategic governance of hospital trusts is relatively low by international standards, they do appear to have an impact on overall performance. Drawing on published information from hospital trust annual reports, publicly available performance measures from the Healthcare Commission and data gathered by Dr Foster over a three year period (2006–9), the paper reports two main findings. First, the analysis reveals a significant and positive association between a higher percentage of clinicians on boards and the quality ratings of service providers, especially where doctors are concerned. This positive influence is also confirmed in relation to lower morbidity rates and tests to exclude the possibility of reverse causality (doctors joining boards of already successful organisations). Second, we do not find the same level of support for clinical professions such as nurses and other allied health professions turned directors.     

The nursing shortage: is it really about image?

A poor public "image" of the nurse is believed to contribute to nurse shortages. We surveyed more than 3,000 college students in science and math courses in a seven-county region of California's Central Valley to assess their perceptions of a career as a nurse in relation to a career as a physical therapist, a high school teacher, or a physician. Students generally had favorable perceptions of nursing, with two-thirds agreeing that nursing has good income potential, job security, and interesting work. However, nursing lagged behind the other occupations in perceptions of independence at work and was more likely to be perceived as a "women's" occupation. Our findings suggest that these college students have generally gotten the message that nursing is a financially rewarding and desirable career, although they also perceive nursing to be less attractive on some important occupational characteristics such as job independence. Unless nursing training capacity expands substantially, the projected nurse shortage will occur. With continued aggressive marketing of nursing as a career, there is a risk of engendering a backlash from prospective students frustrated in their effort to find a slot in a nursing training program. Much work remains to be done to alter the image of nursing as a women's occupation and to transform the work environment of nurses to make a career in nursing more attractive.     

What do abused women expect from their family physicians? A qualitative study among women in shelter homes

OBJECTIVE: To gain insight into the needs and expectations of abused women in shelter homes, with regard to family physicians. METHODS: Twelve women in two shelter homes were interviewed. The interview focused on women's experiences and expectations of family physicians regarding the abuse situation. RESULTS: Eight women did not disclose intimate partner abuse to their family physicians. The main reasons were shame and fear of retaliation. Six women suffered from extreme controlling behavior by their partners, which made it impossible to seek help. Four women were not aware of the relationship between abuse by a partner and physical symptoms. Women mainly wanted a solution for physical problems and were ambivalent about help to tackle their problems with abuse. The majority of the women found the family physician's attitude of great importance and considered it a task of the family physician to provide assistance. CONCLUSION: Although the family physician did not play an important role in solving the problems for victims of intimate partner abuse living in shelter homes, an open and empathic attitude was of great importance to these women. Women also expressed the need for assistance by their physician and emphasized that it was important to keep asking about partner abuse, even in case of denial.     

Does gender make a difference? Factors that influence salary level in health information management

The article examines factors that influence salary level among health information management professionals. Specifically, it addresses questions related to whether gender makes a difference in salary level or whether factors such as education and size of the organization are important. Findings suggest that education and size of the organization are the most important factors influencing salary level. The one notable exception is among newly credentialed registered record administrators. Here, men earn more than women when education and size of the organization are controlled variables.     

Hernia: is it a work-related condition?

BACKGROUND: Development of hernias among active workers is a major occupational problem, however, the work-relatedness of hernias has not been well investigated. It is a difficult question for occupational and primary care physicians who must often address whether a worker with an inguinal hernia should be restricted from work requiring lifting of heavy objects. METHODS: To evaluate the possible work-relatedness of inguinal hernias, a cross-sectional study was performed. The goal of the study was to determine hernia incidence according to occupation with the Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics in 1994. Hernia incidence rates (per 10,000 workers) for industry and occupation categories were calculated with the estimates of the number of hernias in males and the employed male workers from the Current Population Survey. Rate ratios (RR) of hernia incidence rates were calculated. RESULTS: In 1994, an estimated 30, 791 work-related hernias in males were reported by US private establishments. The occupation groups with the highest RR were laborers and handlers (RR, 2.47; 95% confidence interval (CI), 2.14-2.80), machine operators (RR, 2.13; 95% CI, 1.81-2.44), and mechanics and repairers (RR, 1.72; 95% CI, 1.43-2.00). CONCLUSIONS: Rate ratios for hernias vary considerably within industries and occupations, with the highest ratios found in industries and occupations involving manual labor. This provides support for the hypothesis that the hernias are work-related, especially in work involving strenuous, heavy manual labor. Am. J. Ind. Med. 36:638-644, 1999. Published 1999 Wiley-Liss, Inc.     

What is a 'planned' pregnancy? Empirical data from a British study

The terms "planned", "unplanned", "intended", "unintended", "wanted" and "unwanted" are often used in relation to pregnancy in health policy, health services and health research. This paper describes the findings relating to women's understanding of these terms from the qualitative stage of a British study. We found that when discussing the circumstances of their pregnancies, women tended not to use the above terms spontaneously. When asked to explain the terms, women were able to do so but there was considerable variation in understanding. Most, but not all, were able to apply the terms. Women applied the term "planned" only if they had met four key criteria. Intending to become pregnant and stopping contraception were not sufficient criteria, in themselves, to apply the term; partner agreement and reaching the right time in terms of lifestyle/life stage were also necessary. In contrast, "unplanned" was a widely applied term and covered a variety of circumstances of pregnancy. The other terms were less favoured, "unwanted" being positively disliked. We recommend that survey questions eliciting information on women's circumstances of pregnancy do not rely on the above terms in isolation and, further, that a more circumspect use of the terms in policy and clinical settings is required.