Patients' attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists.

Purpose: Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients' beliefs and attitudes and identify facilitators of and barriers to deprescribing. Methods: As part of a larger study, we recruited patients ⩾18 years of age taking ⩾3 chronic medications. Participants were recruited from retail pharmacies associated with the University of Kentucky HealthCare system. They completed an electronic survey that included demographic information, questions about communication with their primary care clinician and pharmacists, and the revised Patients' Attitudes Toward Deprescribing (rPATD) questionnaire. Results: Our analyses included 103 participants (n = 65 identified as female and n = 74 as White/Caucasian) with a mean age of 50.4 years [standard deviation (SD) = 15.5]. Participants reported taking an average of 8.4 daily medications (SD = 6.1). Most participants reported effective communication with clinicians and pharmacists (66.9%) and expressed willingness to stop one of their medications if their clinician said it was possible (83.5%). Predictors of willingness to accept deprescribing were older age [odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.45-6.2], college/graduate degree (OR = 55.25, 95% CI = 5.74-531.4), perceiving medications as less appropriate (OR = 8.99, 95% CI = 1.1-73.62), and perceived effectiveness of communication with the clinician or pharmacist (OR = 4.56, 95% CI = 0.85-24.35). Conclusion: Adults taking ⩾3 chronic medications expressed high willingness to accept deprescribing of medications when their doctor said it was possible. Targeted strategies to facilitate communication within the patient-primary care clinician-pharmacist triad that consider patient characteristics such as age and education level may be necessary ingredients for developing successful deprescribing interventions. Plain Language Summary: Are patients willing to accept stopping medications? Sometimes, medicines that a patient takes regularly become inappropriate. In other words, the risks of adverse effects might be greater than a medicine's potential benefits. The decision to stop such medicines should involve the patient and consider their preferences. We surveyed a group of patients taking multiple medicines to see how they felt about having those medicines stopped. We also asked patients whether and how much they talk to their primary care clinician and pharmacists about their medicines. To qualify for this study, patients had to be at least 18 years old and to take three or more medicines daily; they also needed to speak English. Participants provided demographic information and answered questions about their medicines, their communication with primary care clinicians and pharmacists, and their feelings about having one or more of their medicines stopped. We recruited 107 people and were able to use responses from 103 of them. Their average age was 50 years; 65 of them identified as female, and 75 identified as White/Caucasian. Most of our participants mentioned having conversations with primary care clinicians and pharmacists and said they would be willing to stop a medication if their clinician said it was possible. Older participants, those with more years of education, those who thought their medications might lead to side effects, and those who communicated with their clinician or pharmacists were more willing to have one of their medicines stopped.Our results indicate that patient characteristics and communication with clinicians and pharmacists are factors to consider when designing interventions to reduce the use of inappropriate medicines.

Communicating a History of Sexual Trauma: Partner Responses to Women's Disclosure.

The study aimed to understand how women who experienced sexual trauma but are now in a healthy relationship perceive their partners' responses to their disclosure of sexual trauma. Forty-one women completed an in-depth semi-structured phone interview. Responses were analyzed using reflexive thematic analysis, identifying two overarching themes and six subthemes. The results provide a voice to the needs and preferences of women who experienced sexual trauma, but are navigating communication in a healthy relationship. Given that most women disclosed their experiences with partners, this sample provides valuable insight for clinicians, interventionists, and partners of survivors to navigate supportive interactions.

Message Fatigue to Bystander Intervention Messages: Examining Pathways of Resistance among College Men.

Bystander intervention programs are a feature on college campuses; however, the effectiveness of these programs among certain subsets of men has recently been questioned. The current study examines college men's resistance to bystander intervention efforts by investigating message fatigue as a theoretical explanation for how bystander intervention programs may fail among college men. Specifically, the current study examined both active (i.e., reactance) and passive (i.e., inattention) resistance to bystander intervention messages among a sample of college men (N = 518). Results were consistent with reactance as a mediating mechanism explaining message failure among fatigued audiences. The mediating role of inattention was not supported. Theoretical and practical implications of the current study are discussed.

Developing a health communication campaign for disposal of unused opioid medications.

INTRODUCTION: Communities throughout the United States have implemented medicine disposal programs to prevent diversion of unused opioid analgesics from homes but a general lack of awareness may contribute to low rates of utilization. The objective of this study was to develop and test community-based campaign messages promoting appropriate disposal of unused opioids at disposal programs. METHODS: In Fall 2019, 491 residents (79% female, 97% White, mean age: 40 years) of five rural, Appalachian counties (3 in Kentucky and 2 in North Carolina) completed a web-based, experimental survey. Participants were randomly exposed to two of four messages and rated each message separately. A pretest-posttest design was utilized to assess change in beliefs about retaining unused prescription opioids in the home following exposure to message sets. RESULTS: All messages favorably influenced participants' perceptions related to concerns and risks of retaining unused prescription opioids and importance of - and self-efficacy in disposing of unused opioid medications. After controlling for social and demographic characteristics and baseline beliefs in generalized linear mixed models, Message 1 outperformed other messages in increasing participants' concern about retaining unused prescription opioids in the home and Message 3 was most effective in increasing self-efficacy to dispose of unused prescription opioids. CONCLUSIONS: Messages including young children and pictorially demonstrate how to dispose of medications may have the greatest impact on behavioral actions related to medication disposal. The findings from this study can be used to inform community-based campaigns to facilitate disposal of unused prescription opioids.

Encouraging Disposal of Unused Opioid Analgesics in Appalachia.

The Appalachian region has been disproportionately impacted by the opioid epidemic. This study, informed by the Health Belief Model (HBM), explored Appalachian community members' perspectives on prescription opioid misuse and community-based programs to dispose of unused opioid analgesics. In 2018, we conducted ten focus groups (n=94 participants) in 5 Appalachian counties. Thirteen themes across 5 of the HBM constructs emerged from our analysis. Participants perceived that their communities are susceptible to the harms associated with opioid misuse, these harms are serious, suggesting they could be motivated to change disposal behaviors. Many participants recognized the benefit to disposing of unused prescription opioids including protecting household members from misusing and protecting the home from robbery. Nevertheless, participants identified barriers to proper disposal, including keeping the medications "just in case" for future ailments and the location of drop boxes near law enforcement (due to deep-seated mistrust of law enforcement agencies). Self-efficacy was difficult to assess as many participants were completely unaware of the presence of dropboxes in the community and also expressed concerns about the inconvenience of proper disposal using dropboxes These findings have implications for developing community-based campaign messages promoting proper disposal of unused opioids.

An Application of the Reasoned Action Approach to Bystander Intervention for Sexual Assault.

The high prevalence of sexual assault in US college campuses has led to a widespread implementation of bystander intervention programs aimed at preventing sexual assault. The current study examines predictors of college students' intentions to engage in bystander intervention through the theoretical lens of the reasoned action approach. An online survey with college students (N = 186) was conducted at a large Midwestern university. Our results indicated experiential attitudes, instrumental attitudes, descriptive norms, autonomy, and capacity, each positively associated with participants' intentions to intervene to stop a sexual assault. Against expectations, injunctive norms were unrelated to bystander intervention intentions. Finally, in addition to these main effects, an experiential attitude by autonomy interaction was also observed. The results are discussed with a focus on the theoretical and practical implications of our findings.

An application of the theory of normative social behavior to bystander intervention for sexual assault.

Objective: Given the high prevalence of sexual assault on U.S. college campuses, the current study examines predictors of college students' intentions to intervene to prevent sexual assault through the lens of the theory of normative social behavior (TNSB). Participants: One hundred eighty-six undergraduate students age 18-25 were recruited from an introductory course at a large Midwestern university. Methods: Data were collected through an online survey during the 2015-2016 academic year. Results: Results indicated that descriptive norms, injunctive norms, and outcome expectations had direct positive effects on behavioral intention. However, no direct effect of group identity on intention was found. In addition to these main effects, an interaction between descriptive and injunctive norms was also observed. Conclusions: The results of the current study speak to theoretical questions surrounding the nature of TNSB variables, as well as several practical implications for coordinated efforts to promote bystander intervention on college campuses.