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Ziel der Studie: Die Strategie Aktiv Altern der Weltgesundheitsorganisation (WHO) umfasst die Bereiche Gesundheit, Teilhabe am sozialen Leben sowie Sicherheit im Alter. Als politischer Aktionsrahmen unterstützt die Strategie die zukünftige Alterspolitik der Kommunen. Wie kommunale Akteurinnen und Akteure selbst die WHO-Strategie beurteilen, ist Gegenstand dieser Befragung.
Methodik: Wir haben fünf Expertinnen und Experten aus dem Landkreis Konstanz mittels systematisierenden, leitfadengestützten Interviews befragt. Grundlage des Leitfadens bildete eine selbst konzipierte Indikatorenliste, die die 102 Handlungsempfehlungen strukturiert bündelt. Die Bekanntheit der WHO-Strategie und eine gegebenenfalls kurze Einführung in die drei Bereiche bildeten den Intervieweinstieg, anschließend erfolgte der Abgleich kommunaler Aktivitäten mit der Indikatorenliste, die Erhebung des kommunalen Handlungsbedarfes sowie die Identifikation bislang unberücksichtigter Aspekte. Im Sinne einer Triangulation führten wir eine quantitative Befragung in weiteren Landkreisen durch. Die Auswertung erfolgte mittels qualitativer Inhaltsanalyse nach Gläser und Laudel mit dem Extraktionsprogramm MIA.
Ergebnisse: Keine der interviewten Personen kannte die WHO-Strategie Aktiv Altern. Nach einer kurzen Erläuterung zur WHO-Strategie und Indikatorenliste, stuften die Interviewpersonen die Strategie jedoch als praktikabel ein. Als gut umsetzbar schätzten sie vor allem Handlungsempfehlungen aus den Teilbereichen Teilhabe in der Gesellschaft (z.B. Schaffung von Seniorenbeiräten), sowie aus dem Bereich Sicherheit im öffentlichen Raum und Verkehr (z.B. Schutzmaßnahmen für ältere Fußgänger/innen) ein. In einzelnen Bereichen, wie der medizinischen Versorgung und der formellen Pflege, vermissten die Interviewpersonen Indikatoren, so dass wir die Neuaufnahme zusätzlicher Handlungsempfehlungen empfehlen.
Schlussfolgerung: Die Bekanntheit der WHO-Strategie Aktiv Altern sollte in Richtung der Kommunen, der eigentlichen Zielgruppe, verbessert werden. Aktiv Altern ist, unter Berücksichtigung des hier festgestellten Weiterentwicklungsbedarfes, eine praktikable Orientierungshilfe und bietet mehrere Chancen für die Alterspolitik im kommunalen Feld.
IntroductionVaccination readiness refers to psychological motives and beliefs that decisively determine individual and collective vaccination prevention behavior. Readiness to be vaccinated depends on expected individual and social benefits and harms. Differences exist in the perception of the threat of potential influenza vs. COVID-19 infection and its significance for the social environment. The study aimed to compare the 7C components of vaccination readiness for influenza and COVID-19 vaccination in adulthood.MethodsA total of 317 adults answered the 7C vaccination readiness scale in two vaccination-specific versions (influenza vs. COVID-19) in an online survey from September 2022 to March 2023. Data were analyzed using repeated measures, including analysis of covariance, correlations, and multiple regression.ResultsFor COVID-19, there is a higher readiness to be vaccinated compared to influenza regarding complacencyR (ηp = 0.683), constraintsR (ηp = 0.684), collective responsibility (ηp = 0.782), and compliance (ηp = 0.365). However, confidence (ηp = 0.161) and conspiracyR (ηp = 0.256) indicate an enhanced readiness for influenza vaccination (interaction scales × vaccination type: ηp = 0.602). Individual influenza vaccination recommendations and age do not or only marginally moderate these effects (interaction vaccination type × recommendation: ηp = 155).DiscussionThe 7C subscales reveal a differentiated pattern of readiness for the two vaccination types. This emphasizes the relevance of the multidimensional structure of the construct of vaccination readiness as well as the relevance of moderating effects of the respective vaccination type on the underlying motives and beliefs. Vaccination attitudes are influenced by cultural and social conditions as well as medical standards of care. Comparing attitudes to different vaccinations in different countries thus represents an important research desideratum in order to understand the concept of vaccination readiness more comprehensively.
Abstract: Background : Parents of infants need to be able to access valid health information to preventively protect their infants’ health development. Aims : To investigate the self-assessed literacy of parent couples in accessing information on general health, COVID-19 infection (COVID-19-IP), and early childhood allergy prevention (ECAP). To determine the dependence of the psychometric properties of the access items of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) on domain and gender. Method : N = 128 mothers and fathers of infants answered the 12 access items of the HLS-EU-Q47 in the original version and in COVID-19-IP and ECAP versions. Variance decomposition of the repeated measures 2 × 3 × 12-data was conducted. Results : Within the parent couples the individual Access items correlate at most weakly for COVID-19-IP ( r = .081–.180), moderately for General Health ( r = .096–.315), and partially highly for ECAP ( r = .179–.499). While there is no main effect of gender, self-assessed access literacy is generally highest for COVID-19-IP (variance component domain: 24.6%). For the two items on support, however, the highest approval ratings are obtained for general health (variance component domain × item: 13.5%). Limitations : Self-assessments are at most proxy indicators of the actual performance disposition. Conclusions : Health-literate Access to health information does not differ between mothers and fathers, although substantial concordance within couples exists only for ECAP and marked differences are evident between health domains. The validity of self-reported data on parents’ health literacy (HL) can be significantly improved by analyzing the concordance within couples for specific health domains and by focusing on specific facets of the multidimensional HL construct.
Abstract
Background
Allergic diseases are among the most common chronic diseases in childhood. Early childhood allergy prevention (ECAP) behaviors of those caring for the infant during pregnancy and the first months of life may influence the risk of allergy development over the life course. Motivation and intention to use appropriate primary ECAP measures are thus of critical importance.
Aims
To characterize parental ECAP motivation, (a) valid indicators will be developed and (b) typical parental characteristics will be identified. (c) According to socio-cognitive models, the predictive value of parental risk perception, control belief and self-efficacy for parental ECAP motivation shall be determined.
Method
A sample of N = 343 (expectant) mothers of infants completed a questionnaire on self-reported ECAP motivation, risk perception, control belief, and self-efficacy. The cross-sectional data were analyzed using latent class analysis and structural equation modelling including nominal regression models.
Results
Four typical maternal response profiles (motivated to a customary degree, 70%; motivated to use primary preventive measures, 17.8%; reluctant towards new prevention measures, 6.4%; highly motivated to apply preventive measures in case of an existing allergy, 5.8%) could be identified for the items on ECAP motivation. After splitting the model variables “risk perception” (allergy vs. allergy-associated general health problems) and “self-efficacy” (trust vs. insecurity) a satisfactory model-fit was achieved (CFI = .939; RMSEA = .064). Particularly, increased “risk perception-allergy” (OR = 1.655) and “self-efficacy-insecurity” (OR = 2.013) as well as lower “risk perception-general health” (OR = 0.555) and “control belief” (OR = 0.217), respectively, are associated with higher ECAP motivation.
Conclusion
The use of ECAP-measures by parents to protect their newborns from allergies is important, but there are deficiencies in their implementation. Based on a social cognitive model approach, predictive characteristics could be identified, which are associated with increased motivation to implement ECAP-measures. For public health our findings provide a promising basis for conception of behavioral and environmental ECAP prevention measures and their motivated implementation by parents.
The health literacy (HL) facet Access to health information is measured in the European Health Literacy Survey (HLS-EU-Q47) by 12 items. To assess Access, we developed adapted item formulations for COVID-19 infection prevention (COVID-19-IP) and early childhood allergy prevention (ECAP) in addition to the original 12 items on General Health (GH). N = 343 (expectant) mothers of infants answered the items in an online assessment. Confirmatory structural analyses for ordinal data were adopted (WLSMV-algorithm). Women’s item ratings varied significantly across domains (η2 = .017–.552). Bi-factor models exhibited the best data fit (GH/COVID-19-IP/ECAP: CFI = .964 /.968/.977; SRMR: .062/.069 /.035): The general factor Access most strongly determined item information. Additionally, three subfactors contributed significantly (but rather weakly) to the item information in each domain. The overall score Access proved to be internally consistent (McDonald’s ωGH/COVID-19-IP/ECAP = .874/.883 /.897) and was associated with socioeconomic state (McArthur scale; rGH/COVID- 19-IP/ECAP = .218 /.210/.146). Access correlated not or only weakly with the other HL facets Understand, Appraise, and Apply. The health domains GH, COVID-19-IP, and ECAP moderated both the difficulty and the dimensional structure of the 12 Access items. This suggests that in the HLS-EU Access reflects not only the search competence but also the availability of health information.
Introduction
Interprofessional collaboration of physicians and midwives is essential for appropriate and safe care of pregnant and parturient women as well as their newborns. The complexity of woman-centered care settings requires the continuous exchange of information and the coordinated implementation of multi-and interprofessional care concepts. To analyze the midwives’ perspective on the multi-and interprofessional care process during pregnancy, birth and postpartum period, we aimed to adapt and psychometrically evaluate the Interprofessional Collaboration Scale (ICS).
Methods
The ICS (13 items) was answered by 299 midwives for (i) prenatal and postpartum care as well as (ii) perinatal care. Three items on equitable communication (EC) identified in qualitative interviews with N = 6 midwives were added as further aspects of quality in collaborative midwifery care. Confirmatory factor analysis was used to test competing theoretically hypothesized factorial model structures, including both care settings simultaneously, i.e., birth and prenatal/postpartum.
Results
A two-dimensional structure assuming the 13 original ICS items and the 3 items on EC as psychometric distinct item groups accounts for the data best. After deleting 5 ICS items with insufficient indicator reliability, a very good-fitting model structure was obtained for both prenatal/postpartum as well as perinatal care: χ2df = 192 = 226.35, p = 0.045, CFI = 0.991, RMSEA = 0.025 (90%CI: [0.004; 0.037]). Both the reduced ICS-R and the EC scale (standardized response mean = 0.579/1.401) indicate significantly higher interprofessional collaboration in the birth setting. Responsibility in consulting, attitudes toward obstetric care and frequency of collaboration with other professional groups proved to be associated with the ICS-R and EC scale as expected.
Discussion
For the adapted ICS-R and the EC scale a good construct validity could be confirmed. Thus, the scales can be recommended as a promising assessment for recording the collaboration of midwives with physicians working in obstetric care from the perspective of midwives. The instrument provides a validated assessment basis in midwifery and obstetric care to identify potentially divergent perspectives within interprofessional care teams in woman’s centered care.
Abstract
Background
Ensuring motivated and successful study participation is a key challenge in the design and conduct of health research studies. Previously, recruitment barriers and facilitators have been identified mainly from experience, and rarely based on theoretical approaches. We developed a framework of intentional and actional components of engaged participation in public health research studies (INTACT-RS), informed by psychological behavioral models. We aimed a) to identify precise indicators for each framework component and b) to better understand which components and decision processes are essential for study participants.
Methods
Within a multicenter research network, we applied various approaches to recruit parents of newborns, pediatricians, and midwives. All recruitment processes were documented from the perspective of both participants and researchers. We used different qualitative and quantitative data material, which we applied in a multistage process according to the basic principles of qualitative content analysis.
Results
INTACT-RS encompasses pre-intentional, intentional and actional phases with a total of n = 15 components covering all aspects of an individual’s involvement with a research study. During intention formation, an understanding of efforts and benefits, why participation is valuable beyond contributing to research, and how others perceive the study, were particularly important to (potential) participants. Subsequently (intentional phase), participants consider how and when participation is compatible with their own resources, ability and availability, and hence seek for close communication with, and flexibility and support from the research team. During and after (initial) participation (actional phase), participants’ assessment of whether expectations and interests have been met impact crucial further steps, especially the willingness to continue and to recommend participation to others. A strong topic-wise and or supportive participation interest as well as active, continuous exchange with the researchers appeared to be central determinants of study completion and data validity.
Conclusions
A theoretical framework is now available to plan and conduct recruitment of different target groups, which accounts for essential motivational and volitional decision-making processes. Based on empirically specified constructs, possible barriers can be addressed even before the initial recruitment process. Therefore, recommendations for scientific practice have been formulated.
Abstract
Background
For quality-oriented evaluation of prenatal and obstetric care, it is important to systematically consider the perspective of the women receiving care in order to comprehensively assess and optimize quality in a woman-centered manner. Empathy and Shared Decision Making (SDM) are essential components of woman-centered midwifery care. The aim of the study was to analyze measurement invariance of the items of the Consultation and Relational Empathy (CARE) and Shared Decision Making-Questionnaire (SDM-Q-9) scales depending on the prenatal versus obstetric care setting.
Methods
One hundred fifty women retrospectively assessed aspects of woman-centered midwifery care in both prenatal and obstetric care setting. The birth of the child was a maximum of 12 months ago. A structural equation modelling approach was adopted to separate true effects from response shift (RS) effects depending on care setting. The latter were analyzed in terms of recalibration (changing women’s internal measurement standards), Reprioritization (changing associations of items and construct) as well as Reconceptualization (redefining the target construct).
Results
A response shift model was identified for both assessments (pregnancy/birth: CFI = .96/.96; SRMR = .046/.051). At birth, both scales indicated lower quality of care compared with prenatal care ( SDM-Q-9-M/CARE-8-M :|d| = 0.190/0.392). Although no reconceptualization is required for the items of both scales, RS effects are evident for individual items. Due to recalibration and reprioritization effects, the true differences in the items are partly underestimated ( SDM-Q-9-M/CARE-8-M : 3/2 items) or overestimated (4/2 items).
Conclusion
The structure of the constructs SDM and Empathy , indicating woman-centered midwifery care, are moderated by the care settings. To validly assess midwives’ empathy and shared decision making from women’s perspective, setting-dependent response shift effects have to be considered. The proven item-specific response effects contribute to a better understanding of construct characteristics in woman-centered care by midwives during pregnancy and childbirth.
The COVID-19 pandemic has posed significant challenges to (expectant) mothers of infants in terms of family health protection. To meet these challenges in a health literate manner, COVID-19 protective measures must be considered important and must also be implemented appropriately in everyday life. To this end, N = 343 (expectant) mothers of infants indicated (a) how important they considered 21 COVID-19 infection prevention measures, and (b) how well they succeeded in implementing them in their daily life (20 measures). We performed data analysis using exploratory factor analysis for ordinal data and latent class analysis. One- and two-dimensional models (CFI = .960 / .978; SRMR = .053 / .039) proved to appropriately explain maternal importance ratings. The items on successfully applying COVID-19 measures in daily life can be modeled by the 5 factors hygiene measures, contact with other people, public transportation, staying at home, and checking infection status (CFI = 0.977; SRMR = .036). Six latent classes can be distinguished. Despite the largest class (39 %), classes are characterized by selective or general applicability problems. Classes reporting problems in the applicability of the measures rated them as generally less important (η = .582). Assessing and modelling importance and applicability of COVID-19 prevention measures allows for a psychometrically sound description of subjective perceptions and behaviors that are crucial for health literate practice in maternal daily life.
Appropriate parental health literacy (HL) is essential to preventively maintain and promote child health. Understanding health information is assumed to be fundamental in HL models. We developed N = 67 items (multiple-choice format) based on information materials on early childhood allergy prevention (ECAP) and prevention of COVID-19 infections to assess the parental HL facet Understand. N = 343 pregnant women and mothers of infants completed the items in an online assessment. Using exploratory factor analysis for ordinal data (RML estimation) and item response models (1-pl and 2-pl model), we proved the psychometric homogeneity of the item pool. 57 items assess the latent dimension Understand according to the assumptions of the 1-pl model (weighted MNSQ < 1.2; separation reliability = .855). Person parameters of the latent trait Understand correlate specifically with subjective socioeconomic status (r = .27), school graduation (r = .46), allergy status (r = .11), and already infected with COVID-19 (r = .12). The calibrated item pool provides a psychometrically sound, constructvalid assessment of the HL facet Understand Health Information in the areas of ECAP and prevention of COVID-19 infections.