Predicting COVID-19 vaccination uptake in Armenia using the Health Belief Model: Results from a nationwide survey.

Health behavior theories have been effectively used for studying populations' awareness, attitudes, and beliefs related to COVID-19 preventative behaviors. The aim of this study was to explore the factors associated with the intention to get vaccinated against COVID-19 in the Armenian population using the Health Belief Model (HBM) as a framework. We applied stratified two-stage random sampling to conduct a telephone survey of 3,483 adults in 2021. The multi-domain survey instrument included questions on socio-demographic characteristics, COVID-19-related knowledge, COVID-19 susceptibility, severity and self-efficacy beliefs, sources of information on COVID-19, COVID-19 vaccination practice, and its benefits and barriers. We performed bivariate and hierarchical multivariate regression analysis with the entry of variables in blocks. In total, about 12% of the sample (n = 393) was vaccinated against COVID-19. Of 2,838 unvaccinated participants, about 53% (n = 1516) had an intention to get vaccinated. The final hierarchical logistic regression model containing socio-demographic characteristics, knowledge about COVID-19, and HBM constructs explained 43% of the variance in the intention to get vaccinated against COVID-19. Participants' age, employment status, average monthly expenditures, perceived threat, benefits, perceived barriers, self-efficacy, and cues to action were significant and independent predictors of the intention to get COVID-19 vaccination. This study confirmed the utility of the HBM in highlighting drivers of an important health-protective behavior in the context of pandemics. Health policy makers, communication specialists, and healthcare providers should particularly stress the effectiveness and safety of the vaccines in their efforts to increase vaccination rates and focus on unemployed and low-income population groups.

Main Barriers to Optimal Breastfeeding Practices in Armenia: A Qualitative Study.

BACKGROUND: In 2015, the median duration of exclusive breastfeeding was 2.2 months in Armenia, and only 15% of 4-5-month-old children were exclusively breastfed, indicating an issue with breastfeeding knowledge and practices. RESEARCH AIM: To identify the main barriers to optimal breastfeeding practices in Armenia. METHODS: We used qualitative research methods via focus group discussions and in-depth interviews with four groups of providers from different levels of care, and mothers of young children, from Yerevan city and two provinces, Lori and Shirak. Overall, eight in-depth interviews and 13 focus group discussions were conducted with a total of 99 participants. Qualitative content analysis was applied, with elements of both inductive and deductive approaches. RESULTS: We identified two main categories of barriers to optimal breastfeeding-systemic barriers and knowledge deficiencies. The main themes within systemic barriers were lack of skilled breastfeeding support services and low motivation of providers-mainly related to inadequate recognition of their role in breastfeeding counseling and low remuneration. The main knowledge-related barriers were insufficient counseling of mothers, lack of reliable information sources about infant feeding, and misconceptions among both mothers and providers. CONCLUSION: Optimal breastfeeding is crucial for the best start to an infant's life; however, there were a number of barriers to optimal breastfeeding practices in Armenia. Our findings and recommendations could help policymakers apply effective strategies for improving breastfeeding rates in Armenia. Considering the similar historical backgrounds of the post-Soviet countries, our findings could also be applicable to other Commonwealth of Independent States countries.

National Scale-Up of Results-Based Financing in Primary Health Care: The Case of Armenia.

Abstract-Results-based financing (RBF) has been integrated into the national health care financing system of Armenia covering all primary health care (PHC) facilities in the country. The RBF program contributed to a substantial increase in the utilization of PHC services and improved provider performance. Based on document and literature review and key informant interviews and focus group discussions, this article describes the successful scale-up and integration of RBF into Armenia's primary health care system throughout the period 2000-2015. The article shows how an interaction of contextual factors, actors, and processes contributed to the successful scale-up and integration of RBF into Armenia's primary health care system. Though international agencies, in this case the United States Agency for International Development (USAID), had a significant influence on the introduction and initial design of the RBF scheme, an important enabler was a well-sequenced reform process that included the most politically important stakeholders, including the State Health Agency. Embedding of RBF in national regulatory frameworks and the provision of funds from the national budget were also key contributors to success. Finally, an important enabler to the subsequent scale-up and integration of RBF into the PHC system was its introduction as part of a larger reform of the primary health care system.

Risk factors for children's blood lead levels in metal mining and smelting communities in Armenia: a cross-sectional study.

BACKGROUND: Children's exposure to lead poses a significant risk for neurobehavioral consequences. Existing studies documented lead contamination in residential soil in mining and smelting communities in Armenia. This study aimed to assess blood lead levels (BLL) in children living in three communities in Armenia adjacent to metal mining and smelting industries, and related risk factors. METHODS: This cross-sectional study included 159 children born from 2007 to 2009 and living in Alaverdi and Akhtala communities and Erebuni district in Yerevan - the capital city. The BLL was measured with a portable LeadCare II Blood Lead Analyzer; a survey was conducted with primary caregivers. RESULTS: Overall Geometric Mean (GM) of BLL was 6.0 µg/dl: 6.8 for Akhtala, 6.4 for Alaverdi and 5.1 for Yerevan. In the sample 68.6 % of children had BLL above CDC defined reference level of 5 µg/dl: 83.8 % in Akhtala, 72.5 % in Alaverdi, and 52.8 % in Yerevan. Caregiver's lower education, dusting furniture less than daily, and housing distance from toxic source(s) were risk factors for higher BLL. Additional analysis for separate communities demonstrated interaction between housing distance from toxic source(s) and type of window in Erebuni district of Yerevan. CONCLUSIONS: The study demonstrated that children in three communities adjacent to metal mining and smelting industries were exposed to lead. Investigation of the risk factors suggested that in addition to promoting safe industrial practices at the national level, community-specific interventions could be implemented in low- and middle-income countries to reduce BLL among children.