BACKGROUND: The COVID-19 pandemic prompted the launch of the US Department of Health and Human Services\' COVID-19 Public Education Campaign to boost vaccine confidence and uptake among adults, as vaccines are key to preventing severe illness and death.
OBJECTIVE: Past segmentation research relevant to COVID-19 behavior has found important differences in attitudes, sociodemographics, and subsequent COVID-19 prevention behaviors across population segments. This study extends prior work by incorporating a more comprehensive set of attitudes, behaviors, and sociodemographic variables to identify population segments by differing levels of COVID-19 vaccine confidence and evaluate differences in their subsequent uptake of COVID-19 prevention behaviors.
METHODS: Data were obtained from 5 waves (January 2021 to June 2022) of a web-based longitudinal, probability-based panel survey of US adults (N=4398) administered in English and in Spanish. Participants were recruited from NORC at the University of Chicago\'s national AmeriSpeak panel and were invited to participate across multiple waves. Latent class cluster analysis estimated segments of respondents based on over 40 COVID-19 attitudes, beliefs, behaviors, and sociodemographics as reported in wave 1. Survey-weighted cross-tabulations and bivariate regression analyses assessed differences in COVID-19 vaccine uptake, booster uptake, mask use, and social distancing in all segments across all 5 survey waves.
RESULTS: A total of 6 segments (hardline nonintenders, prevention-compliant nonintenders, burned-out waiters, anxious waiters, skeptical confidents, and ready confidents) were identified, which differed by their COVID-19 vaccine confidence, prevention-related attitudes and behaviors, and sociodemographics. Cross-tabulations and regression results indicated significant segment membership differences in COVID-19 vaccine and booster timing, mask use, and social distancing. Results from survey-weighted cross-tabulations comparing COVID-19 vaccine and booster uptake across segments indicate statistically significant differences in these outcomes across the 6 segments (P<.001). Results were statistically significant for each segment (P<.01 for booster uptake among burned-out waiters; P<.001 for all other coefficients), indicating that, on average, respondents in segments with lower intentions to vaccinate reported later receipt of COVID-19 vaccines and boosters relative to the timing of vaccine and booster uptake among ready confidents.
CONCLUSIONS: Results extend previous research by showing that initial beliefs and behaviors relevant to COVID-19 vaccination, mask use, and social distancing are important for understanding differences in subsequent compliance with recommended COVID-19 prevention measures. Specifically, we found that across respondent segments, the probability of vaccine and booster uptake corresponded with both COVID-19 vaccine confidence and mask use and social distancing compliance; more compliant segments were more likely to get vaccinated or boosted than less compliant segments given similar levels of vaccine confidence. These findings help identify appropriate audiences for campaigns. Results highlight the use of a comprehensive list of attitudes, behaviors, and other individual-level characteristics that can serve as a basis for future segmentation efforts relevant to COVID-19 and other infectious diseases.

OBJECTIVE: This descriptive qualitative study aimed to gain insights into the expectations of individuals with chronic shoulder pain and to investigate how different levels of disability may influence their beliefs and expectations regarding improvement.
METHODS: This qualitative study utilized the Common Sense Model (CSM) as its theoretical framework. Conducted within a public physical therapist clinic, individuals with chronic shoulder pain who were awaiting the initiation of the treatment were included. Participants, female and male [aged 30 to 69 years], were purposefully sampled. Thirty participants, categorized into 2 groups based on the Shoulder Pain and Disability Index (SPADI) scores, underwent semi-structured interviews. Group 1, lower SPADI scores (0 to 60), had 10 participants, and Group 2, higher SPADI scores (61 to 100), had 20 participants. Thematic analysis and inductive coding were employed to analyze the interviews.
RESULTS: Common themes emerged in both groups: the use of medical terms for understanding the diagnosis and the multidimensional impact of pain. The last 2 themes differed between groups. Notable differences included Group 1\'s focus on resources for pain relief and positive expectations with physical therapy, while Group 2 emphasized rest, religion as a resource for pain relief, and God\'s role in improvement.
CONCLUSIONS: These findings highlight the complexity of beliefs and expectations among patients with chronic shoulder pain. Individuals with greater disability often incorporated religious beliefs into their coping strategies, but they held lower recovery expectations and reported negative treatment experiences. These insights have implications for tailoring patient-centered care approaches.
CONCLUSIONS: This study underscores the need for health care providers to consider the multidimensionality of recovery expectations, which can significantly influence patient outcomes. Clinicians can reflect on this knowledge to optimize treatment strategies and improve patient prognosis.

UNASSIGNED: This study evaluated physicians\' and patients\' beliefs about biosimilars in Hong Kong, India, Pakistan, Singapore, Taiwan, and Thailand.
UNASSIGNED: An onlne survey administered to physicians (dermatologists, n = 119; gastroenterologists, n = 148; rheumatologists, n = 161) between 22 October 2021 and 7 January 2022, and patients (n = 90) with rheumatic or inflammatory bowel disease between 25 October 2021 and 12 April 2022.
UNASSIGNED: Most (68%) physicians reported having a strong knowledge about biosimilars, yet 49% indicated that biosimilars are readily available to them. Physicians cited potential cost savings (81%) as the main benefit of biosimilars, and cost/coverage support (36%), patient support (25%), and increasing biosimilar awareness/education (24%) as main strategies for improving usage. Few (21%) patients reported having a strong knowledge about biosimilars. Patients cited offering alternatives in case of drug shortages (77%) as the main benefit of biosimilars, and cost/coverage support (53%), increasing awareness of product profile (22%), and providing biosimilars with a good efficacy profile/effective product (19%) as main strategies for improving usage.
UNASSIGNED: Programs focused on cost/coverage support, patient support, and biosimilar awareness could improve acceptance of biosimilars for chronic immune-mediated inflammatory diseases in Asian countries, thereby increasing patient access to essential biologic therapies.
Biologic medicines come from living organisms such as viruses, bacteria, and animal or plant cells. Biosimilars are approved biologic medicines that are highly similar in structure to original biologic medicines. This study was done to understand what people with diseases that cause long-lasting inflammation of the joints, intestines, or skin (inflammatory diseases for short) and their doctors think about biosimilars. Researchers focused on people and doctors living in six Asian countries (Hong Kong, India, Pakistan, Singapore, Taiwan, and Thailand) with economies and health systems that are advanced or becoming more advanced. Researchers used an online survey to ask people with inflammatory diseases (or people responders) (90 in total) and their doctors (428 in total) what they think about biosimilars. Most doctors (68%) and some people responders (21%) said they had a good understanding of biosimilars. Doctors thought the main benefit of using biosimilars was the possibility of achieving cost savings. People responders thought the main benefit was the possibility of having additional treatment options in case of shortages of the original biologic medicine. Doctors said they sometimes cannot prescribe biosimilars because the cost may still be too high for some patients or because they worry about the quality of biosimilars and how well they work. Programs that increase awareness of biosimilars and that provide financial and other support for biosimilars could improve biosimilar use as treatment for inflammatory diseases in Asian countries, giving more patients access to important biologic medicines in this region.

UNASSIGNED: Alternative tobacco products like midwakh are gaining popularity as potential substitutes for traditional cigarettes despite a misconception among smokers that they may be less harmful.
UNASSIGNED: To determine the prevalence, knowledge, beliefs, and predictors of midwakh smoking among adult smokers in Qatar during 2022.
UNASSIGNED: An analytic cross-sectional study was conducted from January 2022 to July 2022. A simple random sample (N = 1036) was employed to include participants from the list of adults 18 years and above obtained from Qatar\'s National Health Information System who were invited to participate in a telephone survey.
UNASSIGNED: Among the 806 participants (response rate 77.8%), 9.3% were current midwakh smokers, and 5.2% had ever smoked midwakh. The majority were male (97.2%), non-Qatari (70.9%), and aged over 24 years. Additionally, 66.7% of midwakh smokers reported having at least one family member or friend who smoked any tobacco product. Reasons for midwakh use included enjoyment, experimentation, cessation of other tobacco products, affordability, and lack of odor. Moreover, 70.9% believed midwakh smoking could lead to addiction, while 66.7% perceived it as more dangerous than other tobacco products, potentially causing severe health conditions like lung cancer. Multivariable logistic regression indicated a significant association between midwakh use and nationality, with Qataris being 0.21 times less likely to smoke midwakh than non-Qataris (adjusted odds ratio of 0.214, 95% confidence interval: 1.58-4.225, p value of 0.0001).
UNASSIGNED: Midwakh smoking poses health risks comparable to other tobacco products, with peer influence being significant. Urgent action is needed to heighten awareness and allocate resources for effective intervention.

UNASSIGNED: Newborn care practices and beliefs vary word-wide, country to country and region to region. These care practices play a vital role in morbidity and mortality of newborn. A descriptive cross-sectional study was conducted to assess the newborn care practices and beliefs of newborn care.
UNASSIGNED: Data was collected from 429 post-natal mothers, who delivered in selected government hospitals of Santhal parganas, Deoghar, Jharkhand. Convenience sampling technique was used to collect the data from February 2023 to April 2023.
UNASSIGNED: Findings of the study are, 86.9% mothers accepted that they massage the baby with oil before bath, 89.3% participants have given breastfeeding within one hour of delivery, 93.7% have given prelacteal feeds to the newborn. Applying Heeng (Asafoetida) over the umbilicus was found a common practice to cure the abdominal pain, 70.8% accepted that they apply ashes or powder or cow dung on the umbilical cord, and 88.3% rub the dough on baby\'s skin to remove excess hairs, 99.3% mothers had firm belief that hot and cold foods in their diet could harm the baby. In continuation 98.8% believed that tooth eruption is associated with diarrhoea, 95.6% are applying kajal in the eyes of new born. Majority 98.8% believed that baby\'s skin should be exposed to sunlight in case of jaundice and 94% avoid dressing of new born with yellow clothes.
UNASSIGNED: Continuous Health Education programs must be organized in Community to Educate the people about beneficial and harmful newborn care practices, which will help to reduce morbidity and mortality in newborn.

Balanced energy protein supplementation (BEP) is recommended for contexts of high maternal undernutrition by the World Health Organization. Despite recent improvements in undernutrition, Bangladesh remains a context where BEP could help accelerate progress towards nutrition goals. In preparation for an effective trial testing a fortified BEP, a qualitative study was undertaken to better understand sociocultural factors influencing dietary behaviours in pregnancy. Married women of reproductive age (n = 23), their husbands (n = 6) and mothers-in-law (n = 6) were interviewed, and focus group discussions were conducted with women (n = 4). Women had a clear understanding of which nutritious foods are important to consume during pregnancy, including green leafy vegetables, dairy and other animal-source foods. Many explained affordability as a barrier to consuming those foods with the desired frequency. Women acquired information about diet and nutrition in pregnancy from community health workers as well as other women in the community. Most preferred to seek information from their own networks before formal health care providers. Women and husbands generally had positive views about micronutrient supplements, although some mothers-in-law were more hesitant. Some food taboos relating to the consumption of certain foods like duck and pigeon meat persist, mainly stemming from concerns for the unborn child. Opportunities exist to build on existing perceptions of healthy diets, potentially framing food or nutrient supplements as a beneficial \'add-on\' to promote a healthy pregnancy. There is a scope to strengthen nutrition counselling, especially for the family members, to dispel myths and misconceptions and promote dietary and other support for pregnant women.

OBJECTIVE: To explore registered nurses\' beliefs regarding pain assessment in people living with dementia.
METHODS: A descriptive exploratory qualitative study informed by the Theory of Planned Behaviour.
METHODS: Online semi-structured in-depth interviews were conducted from January to April 2023 with a purposive sample of 15 registered nurses caring for people with dementia. Following transcription, data were analysed using direct content analysis.
RESULTS: Registered nurses believe pain assessment improves the well-being of people with dementia and informs and evaluates practice. However, there is a possibility of misdiagnosing pain as agitation or behavioural problems, leading to inaccurate pain management. Interpersonal factors, such as registered nurses\' knowledge and experience, beliefs and motivation to improve care provision, were the primary facilitators of pain assessment. Physical and behavioural dimensions of the pain of the dementia syndrome were the most reported barriers to pain assessment. Registered nurses reported that multidisciplinary team members expect them to do pain assessments. Most did not experience disapproval when performing pain assessments.
CONCLUSIONS: Registered nurses hold beliefs about pain assessment benefits, consequences, enablers, barriers, approvals and disapprovals regarding dementia. The findings could inform interventions to enhance pain assessment practices.
UNASSIGNED: Policymakers should provide education opportunities for registered nurses to improve their knowledge, skills and beliefs about pain assessment in dementia. Future research should develop and implement multidisciplinary, multifaceted pain assessment protocols to enhance the accuracy of pain assessment practices.
CONCLUSIONS: Pain is underassessed in dementia, and this could stem from registered nurses\' beliefs about pain assessment in dementia. The findings could inform interventions to enhance pain assessment beliefs and practices.
UNASSIGNED: This study adhered to the COREQ criteria.
UNASSIGNED: Registered nurses caring for people living with dementia participated as interview respondents.

BACKGROUND: Cervical cancer is the fourth most common cancer in women globally. It is the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Research has shown an association between low levels of risk perception and knowledge of the prevention, risks, signs, etiology, and treatment of cervical cancer and low screening uptake, as contributing to high rates of cervical cancer-related mortality. However, there is scant literature on the perspectives of a wider group of stakeholders (e.g., policymakers, healthcare providers (HCPs), and women at risk), especially those living in rural and semi-rural settings. The main objective of this study is to understand knowledge and perspectives on cervical cancer risk and screening among these populations.
METHODS: We adapted Risso-Gill and colleagues\' framework for a Health Systems Appraisal (HSA), to identify HCPs\' perspective of the extent to which health system requirements for effective cervical cancer screening, prevention, and control are in place in Tanzania. We adapted interview topic guides for cervical cancer screening using the HSA framework approach. Study participants (69 in total) were interviewed between 2014 and 2018-participants included key stakeholders, HCPs, and women at risk for cervical cancer. The data were analyzed using reflexive thematic analysis methodology.
RESULTS: Seven themes emerged from our analysis of semi-structured interviews and focus groups: (1) knowledge of the role of screening and preventive care/services (e.g., prevention, risks, signs, etiology, and treatment), (2) training and knowledge of HCPs, (3) knowledge of cervical cancer screening among women at risk, (4) beliefs about cervical cancer screening, (5) role of traditional medicine, (6) risk factors, and (7) symptoms and signs.
CONCLUSIONS: Our results demonstrate that there is a low level of knowledge of the role of screening and preventive services among stakeholders, HCPs, and women living in rural and semi-rural locations in Tanzania. There is a critical need to implement more initiatives and programs to increase the uptake of screening and related services and allow women to make more informed decisions on their health.

UNASSIGNED: Arterial and venous thromboembolism are a leading cause of mortality. Direct oral anticoagulants (DOACs) are highly effective in both stroke prevention and prevention of venous thrombotic events. Medication adherence is a prerequisite for optimal protection against thromboembolic complications. Recent studies have shown that good adherence cannot be taken for granted by DOACs. In this cross-sectional study adherence among DOAC users was investigated and associations between beliefs about medication, perceived side effects and adherence were explored.
UNASSIGNED: We included 100 randomly selected adult DOAC users visiting one of the two participating Dutch community pharmacies in the summer of 2020. The self-reported adherence (primary outcome) was assessed with the Medication Adherence Rating Scale-5 (MARS-5) using three different cut-off scores. Beliefs about DOACs were assessed with the Beliefs about Medicine Questionnaire Specific (BMQ-S), while side effects and side effect burden were assessed with a self-developed questionnaire based on the Lareb Intensive Monitoring (LIM) system.
UNASSIGNED: Of the participants, 9% reported non-adherence on the primary MARS-5 cut-off score <24. For the MARS-5 scores <23 and <25 non-adherence percentages of, respectively, 3 and 33% were calculated. Associations were found between adherence and both side effects and side effect burden, regardless of the MARS-5 cut-off score. Bruising and minor bleeds were the most reported side effects (both 20%). For all patients, the necessity beliefs outweighed the concern beliefs. No associations were found between adherence and either gender, indication, DOAC or dosage.
UNASSIGNED: This study confirms that adherence in patients on DOACs cannot be taken for granted. High necessity beliefs do not guarantee good adherence, as side effects impair adherence even in patients having high necessity beliefs. Therefore, we recommend that both physicians and pharmacists evaluate both adherence and side effects with these patients on a regular base.
The issue Thrombosis affects many people. Complications like stroke and lung embolism are a major cause of health damage, disability and even death. Direct oral anticoagulants (DOACs) are highly effective drugs at preventing these complications. However, patients need to take their medication properly to get the best protection. Recent studies showed that not all patients consistently take their DOACs. What’s new? In this study, we discovered that patients experiencing bothersome side effect were less likely to stick to their medication schedule. The most common side effects reported were bruising and minor bleeding, by 20% each. There were no differences in how well patients took their medication based on gender, medical condition, type of DOAC or prescribed dosage. Most patients believed their medication was necessary for their health. Why is this important? This study shows that side effects hinder patients taking their medication correctly even when they believe their medication is necessary for their health. This means that patients on DOAC therapy who experience side effects may be less protected against stroke and lung embolism. Therefore, we recommend that doctors and pharmacists regularly check in with patients about any side effects they experience and how consistently they take their DOACs. What’s next? This study highlights the importance of developing, testing, and implementing practical tools to find and help patients who do not take their DOACs correctly, to ensure they are better protected against blood clots.

Rheumatoid arthritis is a debilitating inflammatory condition which has a high disease burden. While there is emerging evidence that certain foods and diets could have anti-inflammatory properties and there are published \'anti-inflammatory\' diets, there is very little understanding of patient beliefs and perceptions about the impact of diet on symptom management or attitudes to particular dietary interventions. This scoping review aims to summarize the existing literature around the beliefs that patients with rheumatoid arthritis hold regarding the impact of diet on disease activity and joint pain. It also examines the current state of evidence regarding the impact of specific dietary interventions on patient reported and objective parameters of RA disease activity. A search was conducted across seven databases for studies which included reporting on dietary beliefs related to disease management or investigations on the effect of particular diets on disease activity or joint pain. Articles were excluded if they examined extracted compounds or individual dietary supplements. Included studies were synthesized narratively. We retrieved 25,585 papers from which 68 were included in this review: 7 assessed dietary beliefs, 61 explored dietary interventions. The available literature on patient beliefs has been largely limited to quantitative studies with limited qualitative exploration. The Mediterranean, fasting and vegan diets appear to have the most benefit with regards to rheumatoid arthritis outcomes for patients. Research which examines RA patient\'s beliefs and attitudes about the impact of diet on their RA symptoms and disease is currently lacking.