Under-Vaccination in Adults: Qualitative Insights Into Perceived Barriers Reported by Vaccine Supporters, Undecided and Refuters.

Although vaccination is one of the most cost-effective ways of preventing disease, vaccine hesitancy has been included among the ten threats of global health. Addressing low adult vaccination rates requires an adequate understanding of people's views. We explored perceived barriers to immunization among under-vaccinated adults to identify potential differences among vaccine supporters, refuters, and those who are undecided. We conducted a multi-center, mixed-methods study at 23 primary care practices in Greece. Each day, we asked three new randomly-selected adult healthcare users who attended the practice over the course of 30 consecutive working days. We used thematic content analysis to analyze their written answers to open-ended questions that addressed reasons for not getting vaccinated. Out of 1571 participants, two-thirds reported they were under-vaccinated as adults, thus accounting for three out of five of the supporters and the vast majority of the undecided and refuters. "Concerns/fears," a "perception of low susceptibility to disease due to good health status," the "absence of healthcare professional's recommendation," and "previous negative experiences" were four themes common to all three groups. Additional barriers reported by supporters and the undecided included "knowledge gaps about the necessity of adult vaccination," "negligence," and lack of "accessibility." Among refuters, additional themes identified were "mistrust in pharmaceutical companies" and "disbelief in vaccine effectiveness." In conclusion, under-vaccination is common, not only among refuters or the undecided, but also among supporters of adult vaccination. We found similarities and differences in under-vaccinated adults' perceived barriers, depending on their individual perspectives. Physicians and public health services should take into consideration the impact of the wide range of attitudes and beliefs in their effort to address the underlying barriers to vaccination compliance as they attempt to increase vaccination coverage in adults.

Understanding what people think and feel about adult vaccinations and the associated barriers in Greece: Development and validation of the attitude towards adult vaccination (ATAVAC) scale.

Despite the unequivocal value of vaccination in reducing the global burden of infectious diseases, the anti-vaccination movement thrives. The vast majority of the existing validated tools explore attitudes regarding vaccination in children. The aim of our study was to develop and validate a scale assessing attitudes towards adult immunisation. This national cross-sectional study included adult healthcare users who visited 23 Greek Primary Healthcare Units. The development of the scale was the result of literature review, semi-structured interviews and pilot testing of its preliminary versions. The initial version contained 15 items measuring respondents' attitudes on a 6-point Likert scale. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multi-item scales; confirmatory factor analysis was used in the second sample to assess goodness of fit. Moreover, concurrent validity, internal consistency reliability, test-retest reliability and ceiling and floor effects were explored. The total sample consisted of 1,571 individuals. Overall 'Cronbach's alpha' (0.821) indicated good internal consistency. The initial exploratory factor analysis resulted in a three-factor model. The subsequent confirmatory factor analysis indicated that an 11-item version of the scale provided the best fit of the model to the data (RMSEA = 0.050, SRMR = 0.053, TLI = 0.937, CFI = 0.955, AIC = 24,999.949). All subscales ('value of adult vaccination', 'safety concerns' and 'perceived barriers') demonstrated strong concurrent associations with participants' attitudes and behaviour regarding vaccination (p < .001). No ceiling or floor effects were noted for any of the subscales (0.13%, 2.61% and 0.51%; 0.13%, 0.57% and 0.45% respectively). The 11-item ATAVAC scale proved to be a reliable and valid tool, suitable for assessing attitudes towards adult vaccination.

Modeling patients' choice between a primary care physician or a diabetes specialist for the management of type-2 diabetes using a bivariate probit analysis.

AIMS: To determine the prevalence of type-2 diabetes patients that were initially and currently being treated by primary care physicians (PCPs) or diabetes specialists and assess predictors influencing their choice. METHODS: This cross-sectional study was conducted in nine Greek primary healthcare units. Patients' choices were modeled using a bivariate probit analysis. RESULTS: A total of 225 patients participated (84% response rate). Only 15.9% and 11.9% of the respondents acknowledged having chosen a diabetes specialist for their initial or current treatment, respectively. The family history of diabetes in siblings and the screening for diabetic retinopathy during the past year were significantly positively associated with choosing a diabetes specialist (initially p=0.033 or currently p=0.007), and resulted in a statistically significant reduction of the joint probabilities of choosing a PCP by 15.6% and 13.6%, respectively. Younger age (p=0.040), female sex (p=0.017), higher HbA1c (p=0.004), experience of hypoglycemia (p=0.029) and low cardiovascular morbidity index (p=0.016) emerged as important predictors for choosing a diabetes specialist for their treatment. CONCLUSIONS: Our findings provide a better insight in diabetes patients' choices regarding the category of their treating physicians and their predictors. More studies are required to replicate them and identify patient subpopulations that may favor diabetes specialists' guidance.

Uremic versus idiopathic restless legs syndrome: impact on aspects related to quality of life.

Restless legs syndrome (RLS) affects both the general population and patients with chronic renal failure. Even though it has been suggested that all forms of RLS share a common pathophysiology, not much evidence exists on how RLS of different etiology could affect aspects related to quality of life (QoL). The aim of this study was to investigate whether patients with uremic RLS (uRLS) experience lower QoL, mental health, and sleep quality, compared with their idiopathic RLS (iRLS) counterparts. Fifteen iRLS patients, 26 uRLS patients, and 15 age-matched healthy individuals participated in the study. The RLS diagnosis and severity, the depression levels, the perception of sleep, and perceived health-related QoL levels were assessed through validated questionnaires. Sleep status was not different between the two RLS groups. In contrast, the uRLS patients scored higher in RLS symptoms severity, depression, while they scored lower in QoL levels compared with iRLS patients. QoL levels were significantly lower in both RLS groups compared with healthy individuals. In conclusion, the uRLS patients experienced lower QoL levels and more severe RLS symptoms, compared with the idiopathic group, possibly leading to the observed higher depression symptoms score.