The Dynamic Relationship between the Intention and Final Decision for the COVID-19 Booster: A Study among Students and Staff at the University of Liège, Belgium.

While many studies have documented the intentions for the COVID-19 vaccine booster, few have explored the change from intention to final decision. This study explores the COVID-19 booster intentions and the change from intention to decision in a primo-vaccinated university population, with a distinction between staff members and students. It looks at the sociodemographic and medical characteristics, health literacy, personal COVID-19 infection and vaccination history, and attitudes/intentions regarding the booster, among the 1030 participants (64.4% staff members, 61.3% female, median age 36.0 years). Of the 8.7% who were initially hesitant, 72.7% ultimately got a booster and 27.3% did not. Another 84.2% intended to get a booster and 7.1% did not. Among the latter two groups, 88.9% maintained their intention and 11.1% changed their minds. The determinants associated with the intentions were health literacy and previous intentions regarding the COVID-19 primo-vaccination. The determinants associated with the change to non-vaccination were a previous COVID-19 infection, a past COVID-19 primo-vaccination intention, and a neutralizing antibody level. The results point to an opening for the support in decision-making, with a significant percentage of the study population potentially changing their mind between intention and final decision; this process should start early and be tailored to the individual's COVID-19 history. A personalized approach seems necessary in order to ensure that individuals make an informed choice.

Factors influencing the adoption and participation rate of nursing homes staff in a saliva testing screening programme for COVID-19.

Testing strategies are crucial to prevent and control the spread of covid-19 but suffer from a lack of investment in understanding the human factors that influence their implementation. The aim of this study was to understand the factors that encourage participation and the level of engagement of nursing homes staff in a routine saliva testing programme for COVID-19 In December 2020, nursing homes (n = 571) in Wallonia (Belgium) were invited to participate in a saliva testing programme for their staff. The directors were questioned by telephone at the end of a 3-week pilot phase. 445 nursing homes took part in the evaluation questionnaire, of which 36(8%) answered that they chose not to participate in the testing programme. The average participation rate of nursing staff was 49(±25)%. Perception of the justification of the efforts required for testing and perception of practicability of the procedure were significantly associated with the adoption of the system by the nursing homes directors (OR(95%CI): 5.96(1.97-18.0), p = 0.0016); OR(95%CI): 5.64(1.94-16.4), p = 0.0015 respectively). Staff support, incentives and meetings increased the level of engagement in testing (p<0.05). While the adoption of the programme confirmed the acceptability of salivary testing as a means of screening, the participation rate confirmed the need for studies to understand the factors that encourage health care staff to take part. The results suggested rethinking strategies to consider staff engagement from a health promotion perspective.

Acceptability of Community Saliva Testing in Controlling the COVID-19 Pandemic: Lessons Learned from Two Case Studies in Nursing Homes and Schools.

Current public health debate centers on COVID-19 testing methods and strategies. In some communities, high transmission risk may justify routine testing, and this requires test methods that are safe and efficient for both patients and the administrative or health-care workers administering them. Saliva testing appears to satisfy those criteria. There is, however, little documentation on the acceptability of this method among beneficiaries. This article presents the lessons learned from a pilot study on the use of saliva testing for routine screening of nursing home and secondary school personnel in Wallonia (the French-speaking part of Belgium), conducted in December 2020 to April 2021, respectively. Administrators at the facilities in question seemed to think highly of saliva testing and wished to continue it after the pilot study was over. This result reinforces the criteria (the noninvasive aspect, in particular) supporting a key role for saliva testing in monitoring community spread of the virus. Nevertheless, wider-scale deployment of this particular method will only be possible if the testing strategy as a whole takes a health promotion approach.

CEdRIC: Strategy for Patient Education During COVID-19 Triage.

The current coronavirus disease 2019 (COVID-19) pandemic is forcing healthcare systems around the word to organise care differently than before. Prompt detection and effective triage and isolation of potentially infected and infectious patients are essential to preventing unnecessary community exposure. Since there are as yet no medications to treat or vaccines to prevent COVID-19, prevention focuses on self-management strategies, creating patient education challenges for physicians doing triage and testing. This article describes a five-step process for effectively educating, at discharge, patients who are suspected of being infectious and instructed to self-isolate at home. We are proposing the CEdRIC strategy as a practical, straightforward protocol that meets patient education and health psychology science requirements. The main goal of the CEdRIC process is to give patients self-management strategies aimed at preventing complications and disease transmission. The COVID-19 pandemic is challenging clinicians to rapidly teach their patients self-management strategies while managing the inherent pressures of this emergency situation. The CEdRIC strategy is designed to deliver key information to patients and standardize the discharge process. CEdRIC is currently being tested at triage centres in Belgium. Formal assessment of its implementation is still needed.

Adjusting insulin doses: from knowledge to decision.

The aim of this study was to analyze the absence of adjustment of insulin doses in type 1 diabetic patients with poorly controlled diabetes. Twenty-eight patients (HbA(1)c higher than 8.5% during the last 6 months, performing at least three capillary blood glucose determinations per day), completed a questionnaire on the degree of confidence in their own knowledge, the nature of their health beliefs, their fear of hypoglycemia, their own appreciation on how they adjust their insulin doses (subjective score). An analysis of their diabetes logbook provided an objective score of the adjustment of doses actually performed. The results show that the subjective and objective scores of adjustment were not significantly correlated. Further there was a significant negative correlation between the score of uncertainty on knowledge and the subjective score of adjustment of the insulin doses, but not with the objective score. There was a significant correlation between the score of positive health beliefs and the subjective score of adjustment of the insulin doses, but not with the objective score. No correlation was found between the score of fear of hypoglycemia and the subjective score of adjustment of the insulin doses. Correlation with the objective score was higher, but not significant. Actually, the fear of hypoglycemia was the most frequently given reason for not adjusting the insulin doses, when the question was asked to the patients with an open answer. This study illustrates the difference between thinking and doing. It also shows that the degree of confidence in one's own knowledge, the health beliefs, and the fear of hypoglycemia differently influence the perception that the patients have of their behavior, and what they really do.

The use of degrees of certainty to evaluate knowledge.

In patients with chronic diseases education should improve knowledge about the disease and increase certainty in knowledge. We present here a technique to measure changes in certainty after an educational intervention. For this purpose, before and after a course, patients answer a questionnaire in which answers are accompanied by an estimate of the degree of certainty. Answers are then assigned to areas of knowledge defined a priori: mastered (certainty > or = 90%, correctness > or = 90%), hazardous (certainty > or = 90%, correctness < or = 50%), uncertain (certainty < or = 50%, correctness > or = 90%) and residual. Finally differences in the distribution of answers among different areas are analysed statistically. Using this technique in a group of patients with type I diabetes who followed a course on insulin use, we found significant changes in the distribution of answers among different areas of knowledge. Thus changes in certainty can be analysed quantitatively and used to evaluate better the effect of therapeutic education.