Healthcare providers’ (HCPs) recommendations for the Human Papillomavirus (HPV) vaccine are likely to increase the vaccination uptake. However, little is known about Ghanaian HCPs’ general practices regarding HPV vaccination. We used Multi-Theory Model (MTM) constructs (i.e. participatory dialogue, behavioral confidence, environment, social and emotional transformation) to examine Ghanaian HCPs’ attitudes towards HPV vaccination and their vaccination recommendation practices.

We conducted three, 60-minute focus group discussions (FGDs) with HCPs in a hospital in Ghana. Sixteen semi-structured, open-ended questions based on MTM constructs were used to guide the FGDs. Data from the FGDs were transcribed and thematically coded using NVivo software.

The sample (n=29) included physicians (n=9), nurses (n=8), immunization officers (n=5), and others (n=7). We found that HCPs rarely offered HPV vaccination counseling and they showed varied understanding about HPV vaccination age eligibility and the recommended series of the vaccine doses. Barriers to HPV vaccination recommendation include (a) low urgency for vaccination education programs due to competing priorities such as malaria and HIV/AIDS; (b) lack of awareness about the safety and effectiveness of the vaccine; (c) vaccine cost, and (d) stigma, misconceptions and religious objections. HCPs’ motivating factors for counseling their clients about HPV vaccination include knowledge about the vaccine sources, vaccine efficacy and safety, and the involvement of the parents, chiefs, churches, and opinion leaders in the vaccination programs.

The study's findings underscore the need for a comprehensive HPV vaccination education for HCPs in Ghana. Future HPV vaccination programs should include information about the safety and efficacy of the vaccine and effective vaccination messages to help mitigate HPV vaccine-related stigma.

Issues of body image and ability to achieve intimacy are connected to body weight, yet remain poorly unexplored and understood. The purpose of this research was to determine if avoidant attitudes and perceptions of one’s body may hold implications toward its use in intimate interactions, and if an above average body weight would increase this avoidance. In 2015-16, the prevalence of overweight and obesity was 71.6%; the prevalence of obesity was 39.8%, and affected about 93.3 million of US adults. The increasing prevalence of overweight and obesity in men and women shows no reverse trend, nor have prevention and treatment proven effective in the long term. Self-reported height and weight data from 55 male and 58 female subjects to determine body mass index (BMI), determining a mean age of 21.6 years and mean BMI of 25.6. Survey instruments consisted of two scales that are germane to the variables being examined. They were (1) Descutner and Thelen of the University of Missouri’s (1991) Fear-of-Intimacy scale and (2) Rosen, Srebnik, Saltzberg, and Wendt’s (1991) Body Image Avoidance Questionnaire. Data indicated that as body mass index increases, fear of intimacy increases (p<0.05) and that as body mass index increases, body image avoidance increases (p<0.05). The results suggest that the relationship of body image avoidance and fear of intimacy bear consideration toward the escalating prevalence of overweight and obesity. These findings suggest that a framework for addressing excess body weight that includes a focus on body image and intimacy may prove effective in prevention and treatment of behaviors that escalate excess body weight.

Background:

Acute stroke treatments reduce the likelihood of post-stroke disability, but are vastly underutilized. In our work in Flint, MI, where acute stroke treatment rates are about half the national average, barriers delaying stroke response were identified. We describe the development of the Stroke Ready program – a Flint-based, community-wide, theory-based, stroke preparedness intervention—which addresses the community identified barriers.

Methods:

During our pilot study, we found the psychological factors of attitude, social norms, and self-efficacy toward calling 911 to be low in Flint. Exploring these constructs deeper we also found that a fatalistic attitude toward stroke, negative outcome expectations for seeking medical attention, and unawareness of stroke burden in Flint were also barriers. As a result, constructs from the Theory of Planned Behavior, Social Cognitive Theory, and elements of behavioral economics provided theoretical guidance in creating messaging to address behavioral factors that may improve stroke response.

Results:

Materials were fashioned to increase awareness that stroke is treatable, ability to recognize stroke signs, and that each person has the power to help someone they care about by calling 911. The resultant Stroke Ready program consists of print materials for peer-led workshops and mailers, as well as social and broadcast media campaigns. To maximize intervention fidelity and community exposure, all program materials exhibit the tailored, theory-based stroke preparedness messaging.

Conclusion:

The Stroke Ready program addresses community specific barriers which informed the selection of health behavior theories that guided our intervention content. If successful, Stroke Ready may serve as a model for development of interventions addressing community barriers to stroke response.

Introduction: Recent research in cancer prevention and survivorship has proffered a three domain conceptual model of financial hardship that includes material, psychological, and behavioral domains. The material domain refers to the lack of financial resources, the psychological domain refers to how one feels about the lack of financial resources, and the behavioral domain captures the financial adjustments made in response to hardship. Yet, there has been limited effort to develop a multidimensional measure of financial hardship. To address this gap, we tested whether multiple indicators of financial hardship fit the material-psychological-behavioral conceptual model in a community based sample to develop a multidimensional measure of financial hardship.

Methods: This study used data from the Money-Health Connection Study (N=582), which included 63 items to measure financial hardship. Exploratory factor analysis (EFA) was performed using a polychoric correlation matrix with oblimin rotation in a random half-split of the sample. A multidimensional graded response model (GRM) confirmatory factor analysis (CFA) was then conducted on the remaining participants to confirm the three-domain model fit.

Results: The polychoric EFA resulted in substantial item reduction (18 items). The EFA and the CFA GRM results revealed a 3-factor model, with overall acceptable CFA model fit (M₂=290.96, df=105, p<.0001; RMSEA = .08, CFI = .91, TLI = .89) supporting the material-psychological-behavioral conceptual model of financial hardship.

Conclusion: There is a dearth of multidimensional assessment tools of financial hardship. Material-psychological-behavioral measures of financial hardship provide greater explication of the socioeconomic environment beyond traditional measures of socioeconomic status and highlight potential intervention targets to address health disparities.