Let's talk about COVID-19 vaccination: Relevance of conversations about COVID-19 vaccination and information sources on vaccination intention in Switzerland.

BACKGROUND: COVID-19 vaccine hesitancy is known to be more pronounced among young people. However, there are a lack of studies examining determinants of COVID-19 vaccination intention in the general population in this young age-group in Switzerland, and in particular, studies investigating the influence of information sources and social networks on vaccination intention are missing. METHODS: The cross-sectional study "COVIDisc - Discussion with young people about the corona pandemic" provided the opportunity to investigate COVID-19 vaccination intention in 893 individuals aged 15-34 years from the cantons of Zurich, Thurgau, and Ticino in Switzerland. An online survey was administered between 10 November 2020 and 5 January 2021. Associations of public information sources and conversations about COVID-19 with COVID-19 vaccination intention were analyzed with multivariable logistic regression and mediation analysis using generalized structural equation modeling. RESULTS: 51.5% of the participants intended or probably intended to get vaccinated once the vaccine would be available. Using print or online news (AOR 1.50, 95% CI 1.09-2.07) as an information source and having conversations about the COVID-19 vaccine (AOR 2.09, 95% CI 1.52-2.87) increased participants' COVID-19 vaccination intention. The effects of female gender (b = -0.267, p = 0.039) and risk perception (b = 0.163, p = 0.028) were partially mediated by having conversations about the COVID-19 vaccine. The effects of age (b = -0.036, p = 0.016), secondary educational level (b = 0.541, p = 0.010) and tertiary educational level (b = 0.726, p = 0.006) were fully mediated via having conversations about the COVID-19 vaccine. CONCLUSIONS: Conversations and campaigns should start even before vaccines become available. Our data support interventions for young women and less educated people using social norms and supporting information seeking with news. Trust and risk perceptions are essential foundations for vaccine intentions.

Young people's media use and adherence to preventive measures in the "infodemic": Is it masked by political ideology?

BACKGROUND: Navigating in the COVID-19 "infodemic" and adhering to preventive measures is especially challenging for young people. The use of information sources and political ideology are empirically important factors for adherence behavior. How these two are interconnected and if political ideology on its own contributes to adherence is not yet well established in young people. OBJECTIVE: This study investigates what role political ideology and political extremism, use of information sources, trust and risk perception play for adhering to preventive measures in young people. METHODS: Cross-sectional online survey in a representative random sample of young people aged 15-34 in two German-speaking and one Italian-speaking canton of Switzerland. The hypotheses were tested with logistic regression and multivariate regression analysis. RESULTS: The odds for using the following information sources decreases for young people positioning themselves towards the right pole of the ideology scale: health-based sources 0.90 (CI: 0.84-0.97), news sources 0.93 (CI 0.87-0.997) and other websites 0.83 (CI: 0.75-0.92). In contrast, the odds of using broadcasting sources increases for young people positioning themselves towards the right pole of the ideology scale (OR: 1.08, CI 1.01-1.15). The odds of using social media decreases with higher political extremism (OR 0.88, CI 0.78-0.99). Political extremism was related with lower adherence to preventive measures in young people with low trust in the government, scientists, and journalists. CONCLUSION: Young peoples' use of information sources is associated with their political ideology and political extremism needs to be taken in account in conjunction with low trust.

Parents' health information seeking behaviour - does the child's health status play a role?

BACKGROUND: Digital media are increasingly abundant providing a wide scope of health information. To date, very little is known about parental health information seeking behaviour for child health outside of English-speaking and Nordic countries. Our study "Digital parental counsellors" examines how parents search for health information in digital media, print media and among "personal contacts", distinguishing between the search for information about general child health and development and child's acute illness, and comparing information seeking behaviour by disability status of the child. METHODS: The population-based sample consisted of 769 parents with children aged 0-2 in the German-speaking region of Switzerland returning the study questionnaire (30% response rate). We developed a frequency score of use of different information sources and conducted bivariate and multivariate linear regression analyses to describe parental search behaviour and the association with child's disability status. RESULTS: The sample consists of 88% mothers (mean age: 35.7 years SD 4.33). Children's mean age is 16 months (SD 7.1), 49% of the children are female and 6% have a disability. Parents use digital media significantly more frequently to search for information about general health and development questions than about an acute child's illness (p < 0.001). In case of acute child's illness, parents refer to their paediatrician, family members and other personal contacts significantly more frequently than other information sources (p < 0.001). The use of digital media and "personal contacts" does not significantly vary between parents with and without a disabled child, whereas the use of print media does (p < 0.02). Moreover, irrespective of disability, 45% of parents resort to the Internet prior to a paediatric visit and 27% after a visit when a visit did not answer all questions. CONCLUSIONS: Despite the high prevalence of digital media, personal contacts are still the most frequent health information resource for parents with young children, irrespective of the child's health. Parents combine all information resources (online, print, personal network) to improve their understanding or check the validity of information received regarding their child's health. It is thus of utmost importance, that the increasingly accessed digital information parents search for is correct, understandable and addresses parent's concerns. TRIAL REGISTRATION: BASEC Req-2017-00817 (30 October 2017).

Electronic Health Literacy in Swiss-German Parents: Cross-Sectional Study of eHealth Literacy Scale Unidimensionality.

BACKGROUND: Parents often use digital media to search for information related to their children's health. As the quantity and quality of digital sources meant specifically for parents expand, parents' digital health literacy is increasingly important to process the information they retrieve. One of the earliest developed and widely used instruments to assess digital health literacy is the self-reported eHealth Literacy Scale (eHEALS). However, the eHEALS has not been psychometrically validated in a sample of parents. Given the inconsistency of the eHEALS underlying factor structure across previous reports, it is particularly important for validation to occur. OBJECTIVE: This study aimed to determine the factor structure of the German eHEALS measure in a sample of parents by adopting classic and modern psychometric approaches. In particular, this study sought to identify the eHEALS validity as a unidimensional index as well as the viability for potential subscales. METHODS: A cross-sectional design was used across two purposive sampling frames: online and paper administrations. Responses were collected between January 2018 and May 2018 from 703 Swiss-German parents. In addition to determining the sampling characteristics, we conducted exploratory factor analysis of the eHEALS by considering its ordinal structure using polychoric correlations. This analysis was performed separately for online-based and paper-based responses to examine the general factor strength of the eHEALS as a unidimensional index. Furthermore, item response theory (IRT) analyses were conducted by fitting eHEALS to a bifactor model to further inspect its unidimensionality and subscale viability. RESULTS: Parents in both samples were predominantly mothers (622/703, 88.5%), highly educated (538/703, 76.9%), of Swiss nationality (489/703, 71.8%), and living with a partner (692/703, 98.4%). Factor analyses of the eHEALS indicated the presence of a strong general factor across both paper and online samples, and the Wilcoxon rank-sum test indicated that the eHEALS total sum score was not significantly different between the paper and online samples (P=.12). Finally, the IRT analyses indicated negligible multidimensionality, insufficient subscale reliability after accounting for the eHEALS general factor, and a reduced subset of items that could serve as a unidimensional index of the eHEALS across the paper and online samples. CONCLUSIONS: The German eHEALS evidenced good psychometric properties in a parent-specific study sample. Factor analyses indicated a strong general factor across purposively distinct sample frames (online and paper). IRT analyses validated the eHEALS as a unidimensional index while failing to find support for subscale usage.

Parental digital health information seeking behavior in Switzerland: a cross-sectional study.

BACKGROUND: Digital media are increasingly abundant and used to seek health information, however, to date very little is known on parents' seeking behavior in the context of child's health and development outside English-speaking and Scandinavian countries. By investigating the prevalence of, and reasons for use, we studied parents' perception of the Internet as a resource for improving their health-related knowledge. METHODS: The survey was conducted in a random sample of 2573 Swiss-German parents with at least one child aged less-than 2 years old. Parents received a mailed invitation to fill in an online questionnaire. Two reminders were sent, the later with a paper questionnaire attached. The questionnaire included questions on use of print, digital, and personal information sources, as well as different information situations: general health and development or illness. We ran descriptive analyses on information seeking behavior, type of digital media used, reasons of use. We also conducted regression analyses to explore factors associated with parental perceptions with regard to the Internet's utility as a source for health information. RESULTS: A total of 769 questionnaires were returned (response rate 30%). Nearly all parents (91%) used digital media for seeking information on their child's health and development, and the main reason for use was indicated as being the 24/7 availability of information. Search engines (55%) and webpages for parents (47%) were by far the most frequently used digital media. Generally, the internet is perceived as a good resource, especially by fathers (OR = 1.80, 95% CI: 1.03-3.16). However, a large percentage of parents are skeptical about the correctness of online info (91%), are unsure about their interpretive understanding, and ask for guidance from their pediatrician (67%). CONCLUSIONS: The Internet has become a highly frequented source of information for Swiss-German parents on children's health with largely valuable perceptions of its utility. Digital media are used in addition to and not in replacement of print media and personal contacts. Increasing parental guidance by health and public health professionals could improve parental digital health utilization and empower parents in the new role they adopt.

Development and cognitive testing of the Nottwil Environmental Factors Inventory in Canada, Switzerland and the USA.

OBJECTIVE: To develop and pre-test the Nottwil Environmental Factors Inventory (NEFI), a questionnaire assessing the perceived impact of environmental factors on specific areas of participation (productive life, social life, and community life) experienced by people with spinal cord injury. SUBJECTS/PATIENTS: Thirty-seven participants with spinal cord injury in Canada, Switzerland and the USA. METHODS: A first draft of the NEFI was developed based on a new theoretical model, the International Classification of Functioning, Disability and Health (ICF) Core Sets for spinal cord injury, and expert consultation. Three rounds of cognitive testing were conducted to examine participants' comprehension of the conceptual framework and items, to identify challenges in cross-cultural measurement, and iteratively to refine the questionnaire. RESULTS: Participants were able to differentiate well between environmental factors influencing productive life and those influencing social life or community life, but not between environmental factors influencing social life and community life. Items intended to capture avoidance of participation due to barriers or overcoming of obstacles were generally well understood. CONCLUSION: For people with spinal cord injury, the NEFI may help to identify limiting and helpful environmental factors, while considering avoiding and overcoming behaviours. Quantitative validation and exploration of the possible use of the NEFI in other diagnostic groups is recommended.

Participation and integration from the perspective of persons with spinal cord injury from five European countries.

OBJECTIVE: To examine the subjective understanding of participation and integration of persons with spinal cord injuries from 5 European countries and to compare these findings with the International Classification of Functioning, Disability and Health (ICF)'s conceptualization of participation. METHODS: Semi-structured interviews with 54 persons with acquired spinal cord injuries and 3 with spina bifida from 5 countries were examined using qualitative content analysis. RESULTS: Integration was most often associated with social acceptance and, furthermore, with ordinary performance, equality and freedom of choice. Participation was most often described as ordinary performance, with less emphasis on social acceptance and equality. However, participation and integration overlapped in people's narratives and were difficult to separate. The perception of participation and integration was largely similar across countries. In contrast to others, however, Finnish interviewees were more likely to associate participation with contributing to society. A variety of life domains was identified, of which recreation and leisure, work life, sports and going out were the most prevalent. CONCLUSION: While participation domains are well covered by the ICF, as is the notion of ordinary performance, interviewees also referred to a rights (e.g. acceptance) and duties (e.g. contribution) perspective.