Opioid Access among Advanced Cancer Patients in Low- and Middle-Income Countries in Asia.

CONTEXT: Most cancer-associated pain is experienced in low- and middle-income countries (LMICs) due to inequitable access to opioids. OBJECTIVE: To determine opioid access as estimated by both patients and providers and to understand patient and facility-level factors influencing access among patients with advanced cancer in LMICs in Asia using the Behavioral Model of Health Services Use. METHODS: The APPROACH cross-sectional study was conducted in seven LMICs in Asia, involving in-depth surveys with providers and advanced cancer patients. A hierarchical logistic regression model was used to assess predisposing (i.e. individual factors), enabling (i.e. health care system and facility-level resources) and need (i.e. pain severity) factors predicting opioid access. RESULTS: Among patient participants (n=1,933), approximately 40% reported opioid use. Meanwhile 80% of facilities, as reported by providers, indicated at least half of their advanced cancer patients receive oral morphine prescriptions. Predisposing characteristics factored in the least in the model, with patient education positively associated with access (Odds ratio (OR): 1.01; 95% CI=1.00, 1.03). Facility-level enabling resources, factoring the most, included oral morphine prescription duration >14 days (OR: 1.27; 95% CI=1.05, 1.53) and the extent of physician palliative care training (extensive (>160 hours) OR: 3.95; CI=3.19, 4.88; basic (up to 40 hours) OR: 1.03; CI=1.03, 1.04). Patient need as indicated by greater pain severity predicted access (OR: 1.55; CI=1.47, 1.64). CONCLUSION: Study findings emphasize the importance of palliative care training-even a minimal amount-in supporting access to opioids for advanced cancer patients. This study also highlights pragmatic site-level policies, such as extended morphine prescription durations, enabling access.

Factors influencing senior care and living preferences among older adults in Jiangsu, China: a cross-sectional survey study.

BACKGROUND: As the population ages, senior care for older adults in China has become increasingly important and has attracted the attention of both government and society. This study aimed to explore preferences and influencing factors related to senior care among older Chinese adults and thus propose effective and targeted strategies for the development of a comprehensive care system for older adults in the aging Chinese population. METHODS: Data were obtained from a cross-sectional survey conducted in sixteen communities or villages in Jiangsu Province, China, from July to September 2021. Guided by the Andersen Behavioral Model, multivariate logistic regression was conducted to identify factors associated with preferences for senior care arrangements. RESULTS: A total of 870 respondents were included in the study, 60.11% of whom preferred receiving care in their own homes, while only 13.68% chose residential care facilities (RCFs). For predisposing factors, rural respondents preferred receiving care in their own homes compared to urban respondents (children's home: OR = 0.55, P < 0.01; RCF: OR = 0.58, P < 0.01). Concerning enabling factors, respondents who were not employed (OR = 2.30, P < 0.01) and those without financial support (OR = 2.73, P < 0.05) preferred RCFs to their own homes. Respondents receiving life assistance (sometimes: OR = 2.76, P < 0.001; regularly: OR = 2.57, P < 0.01; every day: OR = 3.57, P < 0.001) preferred their children's homes to their own homes. In terms of need factors, respondents with noncommunicable diseases (NCDs, OR > 1, P < 0.05), those who knew about RCFs (some: OR = 0.53, P < 0.005; no: OR = 0.10, P < 0.001) and those with a good impression of RCFs (fair: OR = 3.72, P < 0.05; good: OR = 11.91, P < 0.001) preferred receiving care in RCFs compared to their counterparts. CONCLUSIONS: Older Chinese adults' senior care preferences were affected by predisposing factors, enabling factors, and need factors. Policy-makers should consider targeted measures to identify more precise senior care services and thus address aging challenges in China.

Salud sin Fronteras: Identifying Determinants of Frequency of Healthcare Use among Mexican immigrants in Southern Arizona.

BACKGROUND: Guided by Andersen's Behavioral Model of Health Services Use (BMHSU), this study aimed to identify determinants of post-migration healthcare use among a sample of Mexican immigrants in a US-Mexico border region in Southern Arizona, while considering pre-migration health and healthcare experiences. METHODS: A non-probabilistic convenience sample of 300 adult Mexican immigrants completed a telephone survey to assess healthcare practices. Multivariable logistic regressions were fitted to determine adjusted relationships between frequency of care and predisposing, enabling, need, and contextual factors as well as personal health practices. RESULTS: Overall, participants had a 79% probability of receiving healthcare "at least once a year" after migrating to Southern Arizona. Receiving post-migration healthcare was associated with predisposing, enabling, need, contextual factors, and personal health practices (p < 0.05). DISCUSSION: Consistent with BMHSU, our findings suggest that frequency of healthcare is not only a function of having post-migration health insurance but is also shaped by a complex array of other factors. The results of this study shed light onto potential areas to be leveraged by multifactorial sociocultural interventions to increase Mexican immigrants' frequency of healthcare services use.

Do health literacy, physical health and past rehabilitation utilization explain educational differences in the subjective need for medical rehabilitation? Results of the lidA cohort study.

BACKGROUND: Medical rehabilitation can be helpful for maintaining workers' health and work ability. Its contribution to longer working lives is of high economic relevance in aging populations. In Germany, individuals must apply for rehabilitative measures themselves. Therefore, the subjective need for rehabilitation (SNR) is a prerequisite for rehabilitation access. A low education level is associated with poor health, lower health literacy and more frequent utilization of health services. In the present study, we investigated whether lower educational levels are also associated with a greater SNR and whether health literacy, past rehabilitation utilization and physical health play a mediating role in this path in older employees. METHODS: 3,130 socially insured older employees (born in 1959 or 1965) who participated in the German prospective lidA (leben in der Arbeit) cohort-study in 2011, 2014 and 2018 were included. A causal mediation analysis with an inverse odds weighting approach was performed with the SNR as the dependent variable; educational level as the independent variable; and health, health literacy and past rehabilitation utilization as the mediating variables. Sociodemographic variables were adjusted for. RESULTS: The SNR was significantly greater in subjects with a low education level, poor physical health, inadequate health literacy and those who had utilized rehabilitation in the past. For health literacy, past rehabilitation utilization and physical health, a significant partial mediating effect on the SNR was found for employees with low compared to those with high education levels. However, the combined mediating effect of all the mediators was lower than the sum of their individual effects. Among those with medium or high education levels, none of the variables constituted a significant mediator. CONCLUSIONS: The path between a low education level and a high SNR is mediated by inadequate health literacy, past rehabilitation utilization and poor physical health; these factors do not act independently of each other. Promoting health education may lower the SNR by improving physical health and health literacy. While improving physical health is beneficial for individuals, improved health literacy can be economically advantageous for the health system by reducing inappropriate expectations of rehabilitation benefits and subsequent applications for rehabilitation.

Factors Associated with the Uptake of HIV Testing in Canada: Evidence from a Nationally Representative Study.

In this study, we explore the factors associated with the uptake of HIV testing at the national level in Canada. Using the 2015-16 Canadian Community Health Survey and applying logistic regression analysis, we examine the associations between HIV testing and factors identified by the Andersen's behavioral model of healthcare utilization. We find that a range of predisposing, enabling, and need factors are significantly associated with HIV testing. For example, compared to the oldest respondents (i.e. 55-64), their younger counterparts (i.e. 45-54, 35-44, and 25-34) are more likely to have been tested for HIV. Compared to those in Atlantic Canada, respondents in Quebec (OR = 1.96, p < .001), Ontario (OR = 1.44, p < .001), Prairies (OR = 1.37, p < .001), British Columbia (OR = 1.99, p < .001), and the Territories (OR = 2.22, p < .001) are all more likely to have been tested for HIV. Based on these findings, we provide several important suggestions for policymakers and future research.

Non-use and inadequate use of cervical cancer screening among a representative sample of women in the United States.

Introduction: Women's adherence to the United States (U.S.) Preventive Services Task Force guidelines for cervical cancer screening was determined by examining predisposing, enabling, and needs factors from Andersen's Behavioral Model of Health Services Use conceptual framework. Methods: The outcome was operationalized as cervical cancer screening use, non-use, and inadequate-use. Multinomial logistic regression was conducted on data from the 2019 National Health Interview Survey of 7,331 eligible women aged 21-65. Results: Compared with women who used cervical cancer screening services, women aged 30-65 were less likely to be Non-Users than those aged 21-29. Hispanic, Asian, and American Indian/Alaska Native (AIAN) women were more likely to be Non-Users than White women. More educated women were less likely to be Non-Users. Foreign-born women <10 years in the U.S. were more likely to be Non-Users than U.S.-born women. Women with financial hardship were less likely to be Non-Users. Poorer women and uninsured women were more likely to be Non-Users. Women with children in their household were less likely to be Non-Users than those without children. Women who had a well-visit in the past year were less likely to be Non-Users. Women with a history of human papillomavirus (HPV) vaccination were less likely to be Non-Users. Compared with women who used cervical cancer screening services, women aged 30-65 were less likely to be Inadequate-Users. AIAN women were more likely to be Inadequate-Users. Women of other races were less likely to be Inadequate-Users. Employed women were less likely to be Inadequate-Users. Uninsured women were more likely to be Inadequate-Users. Women who had a well-visit within a year were less likely to be Inadequate-Users. Women with past HPV vaccination were more likely to be Inadequate-Users. Smokers were less likely to be Inadequate-Users. Discussion: Predisposing, enabling, and needs factors are differently associated with non-use and inadequate use of cervical cancer screening. Understanding factors associated with the use, non-use, and inadequate use of cervical cancer screening is crucial to avoid or curb unnecessary tests, increased costs to both society and individuals, and the ill-allocation of limited resources.

Oral Healthcare Utilization Factors Shaping the Perceived Oral Health Outcome Among Gond Tribes of Chhattisgarh: A Cross-Sectional Study Based on Andersen's Behavioral Model.

INTRODUCTION: The Gonds are a highly ancient and expansive tribal community, ranking among the largest in the world. A review of the literature has suggested that they are more vulnerable to oral diseases and are less inclined to utilize oral health services due to the comprehensive approach that considers the socioeconomic, cultural, and structural factors affecting the Gond community's access to oral health services. Tribal health requires action in the health sector. Utilization is an essential marker of the health status of any population and is necessary to bridge the gap between tribes and the wider portion of the community. Hence, this study was conducted among the Gond tribes of Chhattisgarh to evaluate the oral healthcare utilization factors shaping the perceived oral health outcome using Andersen's behavior model. MATERIALS AND METHODS: This cross-sectional study was carried out among 400 Gond tribes residing in villages of Chhattisgarh. Data was collected through a standardized questionnaire, adapted from Andersen's behavioral model of healthcare utilization during house-to-house survey. The questionnaire included predisposing, enabling, perceived, and evaluated need factors. Oral health status for evaluated need was assessed using the World Health Organization (WHO) Oral Health Assessment form (1997), and the perceived oral health outcome was measured using Oral Health Impact Profile-14 (OHIP-14). Results were computed using descriptive statistics, chi-square test, and one-way analysis of variance (ANOVA). Multivariate analysis was done using binomial logistic regression. RESULTS: The dental visit in the past one year was only 14%. The findings of logistic regression revealed that the perceived oral health outcome was significantly associated with age, occupation, and positive belief in the efficacy of dentist, perceived need, and presence of dental caries. CONCLUSION: The findings of the present study support Andersen's behavioral model and suggest that there is an interrelationship of predisposing characters, predisposing health beliefs, and enabling need factors that determine the likelihood of use of services, which in turn determines the good or bad oral health outcome.

HIV Services Uptake Among People Living with HIV in Jiangsu Province, China: A Cross-Sectional Study.

Healthcare disparities are common among people living with HIV (PLWH) in China and likely impact access to HIV services. This study aimed to assess the current status of access to HIV services among PLWH and explore the correlates of service uptake using baseline data from a prospective cohort study among PLWH in Jiangsu Province. Guided by Andersen's behavioral model, univariable and multivariable logistic regressions were conducted to identify factors associated with access to HIV services. Out of 8989 eligible PLWH included in this study, 46.4% perceived difficulty in seeing a healthcare professional for HIV treatment services in 2021-2022. PLWH aged 18-34 years (adjusted odds ratio [AOR] = 1.69, 95% CI 1.32-2.15), 35-39 years (AOR = 1.33, 95% CI 1.08-1.65), identified as a bisexual/other (AOR = 1.14, 95% CI 1.01-1.29), had a college and above education (AOR = 1.32, 95% CI 1.07-1.63), and perceived moderate (AOR = 1.70, 95% CI 1.51-1.91) and severe (AOR = 2.20, 95% CI 1.94-2.49) levels of HIV stigma were more likely to perceive difficulty in seeing healthcare professionals for HIV treatment in 2021-2022. Living in northern Jiangsu was also associated with increased odds of perceiving difficulty in seeing healthcare professionals for HIV treatment (AOR = 1.12, 95% CI 1.00-1.26). These findings underscore the need for innovative solutions to eliminate the practical barriers to HIV services utilization among PLWH who are bisexual, well-educated, and effective HIV-related stigma reduction interventions.

Twenty years of research on borderline personality disorder: a scientometric analysis of hotspots, bursts, and research trends.

Borderline personality disorder (BPD), a complex and severe psychiatric disorder, has become a topic of considerable interest to current researchers due to its high incidence and severity of consequences. There is a lack of a bibliometric analysis to visualize the history and developmental trends of researches in BPD. We retrieved 7919 relevant publications on the Web of Science platform and analyzed them using software CiteSpace (6.2.R4). The results showed that there has been an overall upward trend in research interest in BPD over the past two decades. Current research trends in BPD include neuroimaging, biological mechanisms, and cognitive, behavioral, and pathological studies. Recent trends have been identified as "prevention and early intervention", "non-pharmacological treatment" and "pathogenesis". The results are like a reference program that will help determine future research directions and priorities.

Using the integrated behavioral model to explain and predict cannabis vaping among college students.

Background: Cannabis vaping has become increasingly popular among college students. The purpose of this study was to use the Integrated Behavioral Model to better understand students' motivations for engaging in this high-risk behavior. Methods: A survey instrument was developed to assess six IBM constructs, as well as past use of cannabis and nicotine, and cannabis vaping behavior changes related to COVID-19. A structural equation model was used to assess the effects of IBM predictors on Behavioral Intention. Results: The IBM predictors accounted for 54.2% of the variance in Behavioral Intention. The strongest path coefficients on Behavioral Intention were Perceived Norm and Experiential Attitude. Conclusion: The results from this study can be used to design interventions to decrease cannabis vaping use among college students. More specifically, social norm interventions and addressing other misconceptions about vaping cannabis, appears to be a promising theoretical approach to help ameliorate this unique public health challenge.

Factors Explaining the Use of Web-Based Consultations With Physicians by Young and Middle-Aged Individuals in China: Qualitative Comparative Analysis.

BACKGROUND: It was only upon the occurrence of the COVID-19 pandemic that the demand for web-based consultations with physicians grew at unprecedented rates. To meet the demand, the service environment developed rapidly during the pandemic. OBJECTIVE: This study aimed to identify the current status of the use of web-based consultations with physicians among young and middle-aged Chinese individuals and explore users' perspectives on key factors that influence its use in terms of optimizing benefits and compensating for disadvantages. METHODS: We conducted semistructured interviews with 65 individuals (aged 18 to 60 years) across China between September and October 2022. The interviewees were selected through snowball sampling. They described their experiences of using web-based physician consultations and the reasons for using or not using the service. Based on the Andersen Behavioral Model, a qualitative comparative analysis was used to analyze the factors associated with the use of web-based physician consultations and explore the combinations of these factors. RESULTS: In all, 31 (48%) of the 65 interviewees used web-based consultation services. The singular necessary condition analysis revealed that the complementary role of the service and perceived convenience are necessary conditions for the use of web-based consultation services, and user's confidence in the service was a sufficient condition. Based on the Andersen Behavioral Model, the configuration analysis uncovered 2 interpretation models: an enabling-oriented model and a need-oriented model. The basic combination of the enabling-oriented model included income and perceived convenience. The basic combination of the need-oriented model included complementary role and user's confidence. CONCLUSIONS: Among the factors associated with the use of web-based consultations, perceived convenience, complementary role, and user's confidence were essential factors. Clear instructions on the conduct of the service, cost regulations, provider qualifications guarantee, privacy and safety supervision, the consultations' application in chronic disease management settings, and subsequent visits can promote the positive development of web-based consultations.

Childhood environmental unpredictability and hoarding: Mediating roles of attachment and security.

Life history theory provides a unified perspective for understanding human behaviors as adaptive strategies to specific environmental conditions. Within this theoretical framework, hoarding emerges as a behavior reflecting an evolved strategy in response to unpredictable environmental challenges, serving as a buffer against resource scarcity and enhancing survival prospects. This study aimed to explore the key roles of childhood environmental unpredictability, attachment, and sense of security in the development of hoarding. 662 participants completed scales on childhood environmental unpredictability, Revised Experiences in Close Relationships (ECR-R), sense of insecurity, and Savings Inventory-Revised (SI-R). The results showed that childhood environmental unpredictability was significantly positively correlated with hoarding. Attachment anxiety and sense of security individually mediate the effect of childhood environmental unpredictability on hoarding. Additionally, 'attachment anxiety--sense of security' and 'attachment avoidance--sense of security' serve as chain mediators in this relationship separately. This study offers insights into the cognitive-behavioral model of hoarding, highlighting the importance of life history theory in examining childhood environmental unpredictability's relationship with hoarding. It also integrates insights from the psychosocial acceleration theory into our comprehension of hoarding's development. Future research directions are also discussed.

Low-dimensional interference of mid-level sound statistics predicts human speech recognition in natural environmental noise.

Recognizing speech in noise, such as in a busy street or restaurant, is an essential listening task where the task difficulty varies across acoustic environments and noise levels. Yet, current cognitive models are unable to account for changing real-world hearing sensitivity. Here, using natural and perturbed background sounds we demonstrate that spectrum and modulations statistics of environmental backgrounds drastically impact human word recognition accuracy and they do so independently of the noise level. These sound statistics can facilitate or hinder recognition - at the same noise level accuracy can range from 0% to 100%, depending on the background. To explain this perceptual variability, we optimized a biologically grounded hierarchical model, consisting of frequency-tuned cochlear filters and subsequent mid-level modulation-tuned filters that account for central auditory tuning. Low-dimensional summary statistics from the mid-level model accurately predict single trial perceptual judgments, accounting for more than 90% of the perceptual variance across backgrounds and noise levels, and substantially outperforming a cochlear model. Furthermore, perceptual transfer functions in the mid-level auditory space identify multi-dimensional natural sound features that impact recognition. Thus speech recognition in natural backgrounds involves interference of multiple summary statistics that are well described by an interpretable, low-dimensional auditory model. Since this framework relates salient natural sound cues to single trial perceptual judgements, it may improve outcomes for auditory prosthetics and clinical measurements of real-world hearing sensitivity.

Identifying behavioral determinants and stage of readiness for performing knee massage among individuals with knee osteoarthritis: An observational study.

OBJECTIVE: Patients who experience knee osteoarthritis or chronic knee pain can alleviate their symptoms by performing self-knee massage. Understanding the readiness and types of determinants needed to facilitate self-knee massage is needed to design effective, theory-informed interventions. The primary objective of this study was to apply the transtheoretical model of behavior change to identify how factors, which include the type of knee condition and pain level, predict an individual's readiness to adopt self-knee massage. The secondary objective employed the capability, opportunity and motivation-behavior (COM-B) model to identify relevant determinants that are predictive of an individual's readiness to undertake self-knee massage. METHODS: An observational study design was used to recruit individuals with knee osteoarthritis (n = 270) and chronic knee pain (n = 130). Participants completed an online survey that assessed the transtheoretical model of behavior change stages, COM-B determinants (capability, opportunity and motivation), along with self-administered massage behavior. Multivariate analysis of covariance and structural equation modeling were used to test the primary and secondary objective, respectively. RESULTS: Participants who had knee osteoarthritis scored higher on the action stage compared to those with chronic pain (P = 0.003), and those who experienced greater level of pain scored higher in the contemplation (P < 0.001) and action phases (P < 0.001) of performing knee massage compared to those with milder pain. The COM-B structural equation model revealed self-administered knee massage to be predicted by capability (ß = 0.31, P = 0.004) and motivation (ß = 0.29, P < 0.001), but not opportunity (ß = -0.10, P = 0.39). Pain level predicted motivation (ß = 0.27, P < 0.001), but not capability (ß = 0.09, P = 0.07) or opportunity (ß = 0.01, P = 0.83). Tests for mediating effects found that determinants of COM-B (motivation and capability) mediate between pain level and self-administered massage behavior (ß = 0.10, P = 0.002). CONCLUSION: Clinicians and researchers can expect that patients diagnosed with knee osteoarthritis or who have chronic knee pain are ready (action stage) or are considering the behavior (contemplation stage) of self-knee massage. Individuals who report having knee osteoarthritis or chronic knee pain should be coached to develop the skills to perform self-knee massage and helped to develop the motivation to carry out the therapy. Please cite this article as: Nemati D, Munk N, Kaushal N. Identifying behavioral determinants and stage of readiness for performing knee massage among individuals with knee osteoarthritis: an observational study. J Integr Med. 2024; 22(1): 54-63.

Determinants of health poverty vulnerability in rural areas of Western China in the post-poverty relief era: an analysis based on the Anderson behavioral model.

BACKGROUND: Although China has eliminated absolute poverty, the effects of sickness still pose a threat to the prospect of returning to poverty in western rural areas. However, poverty governance extends beyond solving absolute poverty, and should enhance the family's ability to resist risks, proactively identify the existence of risks, and facilitate preventive measures to reduce the probability of falling into poverty again. This study aimed to assess the health poverty vulnerability of rural households in western China and decompose its determinants. METHODS: Based on survey data from 2022, the three-stage feasible generalized least squares method was used to calculate the health poverty vulnerability index. Then, Anderson's health behavior theory model was extended to analyse various influencing factors using binary logistic regression, and the contribution of each influencing factor was decomposed using the Shapley index. Finally, Tobit regression and the censored least absolute deviations estimation (clad) method were used to test the model's robustness. RESULTS: A total of 5455 families in the rural Ningxia region of western China were included in the study. The health poverty vulnerability index of the sample population in 2022 was 0.3000 ± 0.2223, and families with vulnerability ≥0.5 accounted for 16.9% of the sample population. From the Anderson behavioral model, the three models including propensity, enabling, and demand factors had the best fit, and the AIC and BIC values were the smallest. The Shapley decomposition showed that the dimensions of the propensity factor, number of residents, age and educational level of the household head, and dependency ratio were the most important factors influencing vulnerability to health poverty. Tobit regression and the clad method proved the reliability of the constructed model through a robustness test. CONCLUSION: Rural areas still face the risk of becoming poor or falling into poverty owing to residents' health problems. Health poverty alleviation should gradually change from a focus on treatment to prevention, and formulate a set of accurate and efficient intervention policies from a forward-looking perspective to consolidate the results of health poverty alleviation and prevent widescale poverty return.

Determinants of Human Papillomavirus Vaccine Acceptance among Caregivers in Nigeria: A Fogg Behavior Model-Based Approach.

Human papillomavirus (HPV) vaccine uptake among adolescent girls is critical to reducing the burden of HPV-related cancers in Nigeria. This study assesses the factors influencing caregivers' acceptance of HPV vaccination for their charges, using the Fogg Behavior Model (FBM) as a theoretical framework. We analyzed cross-sectional data from 1429 caregivers of girls aged 9-17 in six Nigerian states, using a survey instrument based on the FBM. Participants were recruited via Facebook and Instagram advertisements and interviewed through Facebook Messenger in August and September 2023. The study received ethical clearance from Nigeria's National Health Research Ethics Committee. We applied bivariate and multivariate analyses to assess the relationships between the caregiver's perception of how likely their adolescent girl was to get vaccinated in the next 12 months and motivation, ability, social factors (such as discussions with family and friends), injunctive norms, previous COVID-19 vaccination, and respondents' sociodemographic characteristics. Adjusted odds ratios derived from logistic regression analyses revealed that caregivers' motivation and ability, as well as social factors, were significantly associated with their perception that the adolescent girl in their care would get vaccinated within the next 12 months. Our findings suggest that behavioral interventions tailored to enhance motivation, ability, and social support among caregivers could significantly increase HPV vaccine uptake among adolescent girls in Nigeria.

A Quantitative Framework for Medication Non-Adherence: Integrating Patient Treatment Expectations and Preferences.

Introduction: Medication non-adherence remains a significant challenge in healthcare, impacting treatment outcomes and the overall effectiveness of medical interventions. This article introduces a novel approach to understanding and predicting medication non-adherence by integrating patient beliefs, efficacy expectations, and perceived costs. Existing theoretical models often fall short in quantifying the impact of barrier removal on medication adherence and struggle to address cases where patients consciously choose not to follow prescribed medication regimens. In response to these limitations, this study presents an empirical framework that seeks to provide a quantifiable model for both individual and population-level prediction of non-adherence under different scenarios. Methods: We present an empirical framework that includes a health production function, specifically applied to antihypertensive medications nonadherence. Data collection involved a pilot study that utilized a double-bound contingent-belief (DBCB) questionnaire. Through this questionnaire, participants could express how efficacy and side effects were affected by controlled levels of non-adherence, allowing for the estimation of sensitivity in health outcomes and costs. Results: Parameters derived from the DBCB questionnaire revealed that on average, patients with hypertension anticipated that treatment efficacy was less sensitive to non-adherence than side effects. Our derived health production function suggests that patients may strategically manage adherence to minimize side effects, without compromising efficacy. Patients' inclination to manage medication intake is closely linked to the relative importance they assign to treatment efficacy and side effects. Model outcomes indicate that patients opt for full adherence when efficacy outweighs side effects. Our findings also indicated an association between income and patient expectations regarding the health of antihypertensive medications. Conclusion: Our framework represents a pioneering effort to quantitatively link non-adherence to patient preferences. Preliminary results from our pilot study of patients with hypertension suggest that the framework offers a viable alternative for evaluating the potential impact of interventions on treatment adherence.

Intimate partner violence and antenatal care utilization predictors in Uganda: an analysis applying Andersen's behavioral model of healthcare utilization.

BACKGROUND: Optimal utilization of antenatal care (ANC) services improves positive pregnancy experiences and birth outcomes. However, paucity of evidence exists on which factors should be targeted to increase ANC utilization among women experiencing intimate partner violence (IPV) in Uganda. OBJECTIVE: To determine the independent association between IPV exposure and ANC utilization as well as the predictors of ANC utilization informed by Andersen's Behavioral Model of Healthcare Utilization. METHODS: We analyzed 2016 Uganda Demographic and Health Survey data that included a sample of 1,768 women with children aged 12 to 18 months and responded to both ANC utilization and IPV items. Our outcome was ANC utilization, a count variable assessed as the number of ANC visits in the last 12 months preceding the survey. The key independent variable was exposure to any IPV form defined as self-report of having experienced physical, sexual and/or emotional IPV. Covariates were grouped into predisposing (age, formal education, religion, problem paying treatment costs), enabling (women's autonomy, mass media exposure), need (unintended pregnancy, parity, history of pregnancy termination), and healthcare system/environmental factors (rural/urban residence, spatial accessibility to health facility). Poisson regression models tested the independent association between IPV and ANC utilization, and the predictors of ANC utilization after controlling for potential confounders. RESULTS: Mean number of ANC visits (ANC utilization) was 3.71 visits with standard deviation (SD) of ± 1.5 respectively. Overall, 60.8% of our sample reported experiencing any form of IPV. Any IPV exposure was associated with lower number of ANC visits (3.64, SD ± 1.41) when compared to women without IPV exposure (3.82, SD ± 1.64) at p = 0.013. In the adjusted models, any IPV exposure was negatively associated with ANC utilization when compared to women with no IPV exposure after controlling for enabling factors (Coef. -0.03; 95%CI -0.06,-0.01), and healthcare system/environmental factors (Coef. -0.06; 95%CI -0.11,-0.04). Predictors of ANC utilization were higher education (Coef. 0.27; 95%CI 0.15,0.39) compared with no education, high autonomy (Coef. 0.12; 95%CI 0.02,0.23) compared to low autonomy, and partial media exposure (Coef. 0.06; 95%CI 0.01,0.12) compared to low media exposure. CONCLUSION: Addressing enabling and healthcare system/environmental factors may increase ANC utilization among Ugandan women experiencing IPV. Prevention and response interventions for IPV should include strategies to increase girls' higher education completion rates, improve women's financial autonomy, and mass media exposure to improve ANC utilization in similar populations in Uganda.

Exploring the inherent mechanism of residents' participation behavior in neighborhood regeneration projects: an empirical study using an extended IMB model in China.

Introduction: Resident participation has gained increasing prominence and significance in the pursuit of sustainable neighborhoods regeneration. However, the current state of resident participation practices remains beset by several challenges, which present formidable impediments to the initiation and execution of neighborhood regeneration initiatives. This study aims to investigate the underlying mechanisms of residents' participation behavior to enhance resident participation in neighborhood regeneration projects. Methods: The present study employs the extended Information-Motivation-Behavioral (IMB) model to examine the determinants and mechanisms influencing residents' willingness and participation in neighborhood regeneration projects, with a specific focus on the Chinese context. Drawing upon data from 477 meticulously validated questionnaires administered to residents, the study applies structural equation modeling (SEM) to unravel the intrinsic dynamics of residents' participation behavior. Results: The empirical findings of this research reveal that information, motivation, and the perceived local government support all exert a significant impact on residents' participation willingness. Notably, motivation emerges as the most influential factor. Discussion: This study uncovers a direct influence of local government organizations on both residents' willingness and their actual participation, suggesting that government organizations can spearhead innovative strategies to bolster residents' willingness and furnish avenues for translating willingness into tangible participation. The outcomes of this study furnish an indispensable theoretical framework and offer policy recommendations that hold paramount importance for the deployment of novel interventions geared toward stimulating active involvement of residents in neighborhood regeneration.

Predicting COVID-19 and Influenza Vaccination Confidence and Uptake in the United States.

This study investigates and compares the predictors of COVID-19 and influenza vaccination confidence and uptake in the U.S. Vaccine hesitancy is defined as the reluctance or refusal (i.e., less than 100% behavioral intention) to vaccinate despite the availability of effective and safe vaccines. Vaccine hesitancy is a major obstacle in the fight against infectious diseases such as COVID-19 and influenza. Predictors of vaccination intention are identified using the reasoned action approach and the integrated behavioral model. Data from two national samples (N = 1131 for COVID-19 and N = 1126 for influenza) were collected from U.S. Qualtrics panels. Tobit regression models were estimated to predict percentage increases in vaccination intention (i.e., confidence) and the probability of vaccination uptake (i.e., intention reaching 100%). The results provided evidence for the reasoned approach and the IBM model and showed that the predictors followed different patterns for COVID-19 and influenza. The implications for intervention strategies and message designs were discussed.