Toward improved education of the public about methicillin-resistant Staphylococcus aureus: A Mental Models Approach
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Abstract:
Methicillin-resistant Staphylococcus aureus (MRSA) is ever more becoming a public health problem, due to its prevalence among cattle, raw meat, and otherwise healthy people. Therefore, it is essential that risk communication promotes awareness and recognition of MRSA among the general public, so they can adopt preventive health and infection control measures. In order to do so, a public website for the Dutch general public was developed. Because effective risk communication should be tailored to the public’s relevant beliefs and knowledge (“mental models”), we identified the mental models of the Dutch general public concerning MRSA by means of 17 interviews followed by a confirmatory questionnaire (n=239). Although the majority of the public (62%) heard of MRSA and its well-known risk factors and consequences before via the media, the public was only slightly aware of its threat to society. Misconceptions existed regarding origin and spread (e.g., that MRSA is caused by overburdened muscles). Besides, knowledge gaps were detected concerning prevention, reservoir, and origin (importance of hygiene measures, presence on the skin, MRSA among cattle). These misconceptions and knowledge gaps were corrected in the content of the public website next to basic scientific information about MRSA, which was evaluated by means of a usability test (n=18). Overall, our findings highlight the need for the systematic analysis of the public’s mental models prior to designing risk communication.Keywords:
Risk Communication
Mental hygiene
Public education
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Abstract Background Antibiotic misuse and other types of unnecessary use of antibiotics can contribute to accelerate the process of antibiotic resistance, which is considered a global concern, mostly affecting low-and middle-income countries (LMICs). In Mozambique there is limited evidence on community knowledge and practices regarding antibiotics and antibiotic resistance. As part of the ABACUS project, this paper describes knowledge and practices of antibiotic use among the general population in the semi-rural district of Manhiça to inform evidence-based communication intervention strategies for safer antibiotic use. Methods The study was conducted in Manhiça, a semi-rural district of Southern Mozambique. Sixteen in-depth interviews and four focus group discussions (FGDs) were conducted with community members to explore lay knowledge and practices regarding antibiotics and awareness of antibiotic resistance. The qualitative data was analysed using a combination of content and thematic analysis. The SRQR guidelines for reporting qualitative studies was performed. Results Although participants did not hold any consistent knowledge of antibiotics, their visual recognition of amoxicillin (distinct red yellow capsule) was acceptable, but less so for different types and brands of antibiotics. The majority of participants were aware of the term ‘antibiotic’, yet the definition they gave was rarely backed by biomedical knowledge. Participants associated antibiotics with certain colours, shapes and health conditions. Participants reported common habits that may contribute to resistance: not buying the full course, self-medication, sharing medicines and interruption of treatment. Most had never heard of the term ‘antibiotic resistance’ but were familiar with the phenomenon. They often understood the term ‘resistance’ as treatment failure and likened ‘resistance’ to non-compliance, ineffective medication, disease resistance or to an inability of the physical body to respond to it. Conclusion There is a broad understanding of the importance of medication compliance but not specifically of antibiotic resistance. In addition, there is a recognized gap between knowledge of responsible drug compliance and actual behaviour. Future qualitative research is required to further explore what determines this behaviour. The existing ability to visually identify amoxicillin by its distinct red and yellow appearance is informative for future awareness and behavioural change campaigns that may incorporate visual aids of antibiotics.
Thematic Analysis
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Recent infectious disease outbreaks have resulted in renewed recognition of the importance of risk communication planning and execution to public health control strategies. Key to these efforts is public access to information that is understandable, reliable and meets their needs for informed decision-making on protective health behaviours. Learning from the trends in sources used in previous outbreaks will enable improvements in information access in future outbreaks. Two separate random-digit dialled telephone surveys were conducted in Alberta, Canada, to explore information sources used by the public, together with their perceived usefulness and credibility, during the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic (n = 1209) and 2009–2010 H1N1 pandemic (n = 1206). Traditional mass media were the most used information sources in both surveys. Although use of the Internet increased from 25% during SARS to 56% during H1N1, overall use of social media was not as high as anticipated. Friends and relatives were commonly used as an information source, but were not deemed very useful or credible. Conversely, doctors and health professionals were considered credible, but not consulted as frequently. The use of five or more information sources increased by almost 60% between the SARS and H1N1 surveys. There was a shift to older, more educated and more affluent respondents between the surveys, most likely caused by a decrease in the use of landlines amongst younger Canadians. It was concluded that people are increasingly using multiple sources of health risk information, presumably in a complementary manner. Subsequently, although using online media is important, this should be used to augment rather than replace more traditional information channels. Efforts should be made to improve knowledge transfer to health care professionals and doctors and provide them with opportunities to be more accessible as information sources. Finally, the future use of telephone surveys needs to account for the changing demographics of the respondents accessed through such surveys.
Pandemic
Information source (mathematics)
Information Dissemination
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Background: Tuberculosis is highly prevalent in developing countries like India and several strategies have been implemented by the World Health Organization and Government of India in order to minimize its burden. However, effectiveness of these strategies is best achieved when there is adequate awareness among the general population regarding the cause and spread of the disease. This study was carried out to evaluate the knowledge, attitude and practices regarding tuberculosis among general population.Methods: This cross sectional study was carried out among 500 adults visiting our tertiary care center as patients or attenders for a period of one year between April 2018 and March 2019. A structured interview schedule was used to collect information regarding the knowledge, attitude and practices regarding the cause, spread and management of tuberculosis infection.Results: About 73.6% of the study participants felt that tuberculosis was a genetic disorder, while only 12.4% of them were aware that the infection was transmitted through coughing, etc. Moreover, 18% of the participants believed that the medications for treating tuberculosis could be stopped without the supervision of the health care provider.Conclusions: This study has elicited the prevailing misconception regarding the cause, transmission, treatment and prevention of tuberculosis. It is important for policy makers and public health program implementation experts to develop health literacy campaigns to specifically create awareness among the population, so as to facilitate successful mitigation of the disease.
Health Literacy
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Objectives As governments attempt to navigate a path out of COVID-19 restrictions, robust evidence is essential to inform requirements for public acceptance of technologically enhanced communicable disease surveillance systems. We examined the value of core surveillance system attributes to the Australian public, before and during the early stages of the current pandemic. Design A discrete choice experiment was conducted in Australia with a representative group of respondents, before and after the WHO declared COVID-19 a Public Health Emergency of International Concern. We identified and investigated the relative importance of seven attributes associated with technologically enhanced disease surveillance: respect for personal autonomy; privacy/confidentiality; data certainty/confidence; data security; infectious disease mortality prevention; infectious disease morbidity prevention; and attribution of (causal) responsibility. Specifically, we explored how the onset of the COVID-19 outbreak influenced participant responses. Setting and participants 2008 Australians (general public) completed the experiment: 793 before COVID-19 outbreak onset (mean age 45.9 years, 50.2% male) and 1215 after onset (mean age 47.2 years, 49% male). Results All seven attributes significantly influenced respondents’ preferences for communicable disease surveillance systems. After onset, participants demonstrated greater preference for a surveillance system that could prevent a higher number of illnesses and deaths, and were less concerned about their personal autonomy. However, they also increased their preference for a system with high data security. Conclusions Public acceptance of technology-based communicable disease surveillance is situation dependent. During an epidemic, there is likely to be greater tolerance of technologically enhanced disease surveillance systems that result in restrictions on personal activity if such systems can prevent high morbidity and mortality. However, this acceptance of lower personal autonomy comes with an increased requirement to ensure data security. These findings merit further research as the pandemic unfolds and strategies are put in place that enable individuals and societies to live with SARS-CoV-2 endemicity.
Pandemic
Communicable disease
Social distance
Disease Surveillance
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Coronavirus disease (COVID-19) has spread very fast worldwide as a pandemic causing unprecedented morbidity and mortality. Most countries in the world have undergone emergency lockdown in an attempt to flatten the curve and reduce the load on healthcare systems.This study was done to assess the knowledge, attitude, and perception toward the disease among the home-bound Indian population during the lockdown.This was a questionnaire-based descriptive cross-sectional study conducted online. Compilation and assessment of the online data in the form of responses were done as for descriptive studies.Among the 320 participants of the study, the awareness about the epidemiological features, including the signs and symptoms of the disease, was very good (more than 99% in some aspects). The attitude toward the measures for prevention of disease at home and outside was also very good (more than 97%) in some aspects, with a scope of improvement in a few others. Only one-third had the knowledge of online (e-consultation) services floated by governments and hospitals for medical advice. Ten percent had the potential to misuse drugs as prophylaxis. Most of the participants perceived that they had no predictable idea about the shape of disease epidemiology in the near future and only hoped for things to get better.This study reflects that aggressive awareness drives have played an important role in the dissemination of knowledge and the development of informed positive attitude toward COVID-19. Few gaps in knowledge and practices related to disease epidemiology, safe practices, mobile app for tracking and the availability of e-resources for medical advice, still remain. These should be addressed more aggressively, to strengthen the efforts to overcome this unprecedented crisis.
Pandemic
Medical advice
Computer-assisted web interviewing
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Background: The last decade witnessed turbulent events in public health. Emerging infections, increase of antimicrobial resistance, deliberately released threats and ongoing battles with common illnesses were amplified by the spread of disease through increased international travel. The Internet has dramatically changed the availability of information about outbreaks; however, little research has been done in comparing the online behavior of public and professionals around the same events and the effect of media coverage of outbreaks on information needs. Objective: To investigate professional and public online information needs around major infection outbreaks and correlate these with media coverage. Questions include (1) How do health care professionals' online needs for public health and infection control information differ from those of the public?, (2) Does dramatic media coverage of outbreaks contribute to the information needs among the public?, and (3) How do incidents of diseases and major policy events relate to the information needs of professionals? Methods: We used three longitudinal time-based datasets from mid-2006 until end of 2010: (1) a unique record of professional online behavior on UK infection portals: National electronic Library of Infection and National Resource of Infection Control (NeLI/NRIC), (2) equivalent public online information needs (Google Trends), and (3) relevant media coverage (LexisNexis). Analysis of NeLI/NRIC logs identified the highest interest around six major infectious diseases: Clostridium difficile (C difficile)/Methicillin-resistant Staphylococcus aureus (MRSA), tuberculosis, meningitis, norovirus, and influenza. After pre-processing, the datasets were analyzed and triangulated with each other. Results: Public information needs were more static, following the actual disease occurrence less than those of professionals, whose needs increase with public health events (eg, MRSA/C difficile) and the release of major national policies or important documents. Media coverage of events resulted in major public interest (eg, the 2007/2008 UK outbreak of C difficile/MRSA). An exception was norovirus, showing a seasonal pattern for both public and professionals, which matched the periodic disease occurrence. Meningitis was a clear example of a disease with heightened media coverage tending to focus on individual and celebrity cases. Influenza was a major concern during the 2009 H1N1 outbreak creating massive public interest in line with the spring and autumn peaks in cases; although in autumn 2009, there was no corresponding increase in media coverage. Online resources play an increasing role in fulfilling professionals' and public information needs. Conclusions: Significant factors related to a surge of professional interest around a disease were typically key publications and major policy changes. Public interests seem more static and correlate with media influence but to a lesser extent than expected. The only exception was norovirus, exhibiting online public and professional interest correlating with seasonal occurrences of the disease. Public health agencies with responsibility for risk communication of public health events, in particular during outbreaks and emergencies, need to collaborate with media in order to ensure the coverage is high quality and evidence-based, while professionals' information needs remain mainly fulfilled by online open access to key resources.
Information Overload
Health Professionals
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Background: The appearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) triggered a severe global pandemic and is a major public health issue. As of now, there's no approved antiviral treatment or vaccine present for this disease. Thus, proper management of such patients and strict practice of precautions by the general public is critical in saving the lives of people affected and stopping the transmission of the disease to those unaffected by it. Methods: This is a cross-sectional descriptive study and was carried out in Sindh, Pakistan. 588 people from different cities of Sindh were asked to fill a questionnaire that tested their attitudes, knowledge and practices related to SARS-CoV-2 pandemic. Results: Television and other social media platforms have led to increased dissemination of knowledge among our population. Their increased understanding has led them to be more compliant with adopting precautionary measures, as frequent handwashing was seen in 89.8% and social distancing in 87.2%. Our results also showed greater prevalence of myths among our population. Conclusion: Increased access to correct knowledge can help to dissipate misconceptions and help spread the accurate knowledge about the role that the public should play in reducing disease transmission.
Pandemic
Social distance
Cross-sectional study
Coronavirus
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ver the past two decades, healthcare-associated infections (HCAI) have emerged as a significant threat to high quality health care. The technological advances made in the treatment of many diseases and disorders are being undermined by the transmission of infections within healthcare settings, especially the emergence of antimicrobial resistant strains of Staphylococcus aureus and enterococci that are now endemic in some healthcare environments. The financial and personal costs of HCAI in terms of the economic consequences to the National Health Service (NHS) and the physical, social and psychological costs to patients and their relatives have increased both government and public awareness of the risks associated with healthcare interventions and in particular the consequences of HCAI. The risk of acquiring HCAI continues to attract intense media interest. Reports of dirty hospitals and stories of healthcare workers failing to observe even the most rudimentary hygiene and other infection prevention and control measures are causing profound anxiety among service users. The public is fast losing confidence in the NHS to safely care for them and this dissatisfaction has propelled HCAI to the top of an increasingly urgent political healthcare agenda. The Department of Health (DH) has focused a number of initiatives on combating HCAI, including the development of national evidence-based infection prevention and control guidelines for acute and primary care settings (Pratt et al, 2001; Pellowe et al, 2003), a research programme to identify a range of effective strategies for combating antimicrobial resistance and more recently setting out a strategy for reducing HCAI and improving environmental hygiene in healthcare settings (DH, 2002; DH, 2004). DH strategy emphasises the importance of ensuring that infection prevention and control training is included in the induction programme for all NHS staff, both clinical and nonclinical, including agency and locum staff, and that this training becomes part of their continuing personal development plans. Professor Christine Beasley, the chief nursing officer at the DH has since taken responsibility for actualising many aspects of this strategy, especially ensuring that the required training is made available for all 1.3 million NHS staff by the end of 2005. Providing that training became the responsibility of the NHS University (NHSU), which commissioned the Richard Wells Research Centre at Thames Valley University London (TVU) along with their Dublin-based educational development partner, Intuition Publishing Ltd, to develop an appropriate and accessible state-of-the-art blended e-learning training programme. In this article, we describe how we designed and structured the programme so that it can be used as an essential tool in orientation/induction, staff development and in-service education programmes for all NHS staff.
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Public reporting of healthcare-associated infections is pervasive, with 33 states and the District of Columbia mandating public disclosure. We surveyed hospital epidemiologists on the perceived value of state public reports. Respondents believed consumers are unaware and do not consider the information important, but they indicated that epidemiologists have a role in consumer education.
Public healthcare
Value (mathematics)
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DEAR EDITOR,
Oral cancer is a significant cause of public health concern in both developing and developed nations. Global estimates reveal that incidence of oral cancer varies from 1 to 10 cases per 100,000 people in most countries.[1] It is ranked as the eleventh most common cancer world-wide, accounting for 130,000 deaths every year.[2] Almost 50% of oral cancer patients present to the health centers in advanced stage of the disease.[2] An inequitable geographical distribution of the oral cancer has been observed due to the regional differences in prevalence of disease-specific risk factors, accessibility and availability of screening/diagnostic measures, socio-economic factors and demographic parameters of the population.[3]
Multiple socio-demographic and habit related risk factors such as male gender;[1] older people;[1] poor education status and socio-economic class;[1,4] smoked/non-smoked forms of tobacco;[1,5] alcohol;[5] human papilloma virus infection;[6] oral sex;[6] and genetic susceptibility;[6] have been attributed in the causation of oral cancer. In the global campaign to minimize the burden of oral cancer, diversified challenges such as low awareness among people;[7] poor knowledge among doctors;[8] diagnosis in advanced stages;[3] unaffordable treatment modalities;[3] poor utilization of mass-media;[9] inaccessibility to health centers/trained health professionals;[3] and dilemma associated with screening methods;[10] have been encountered. These barriers have restricted the scope of public health benefit to a great extent as sooner the patient realizes the lesion and comes for treatment; better are the chances of survival.[10]
To ensure early detection of oral cancer measures such as mass screening or screening of high-risk group population;[10] reducing the delay from patients’ side by creating awareness about signs/symptoms of oral cancer, involvement of community members;[2,9] and reducing the delay from doctors’ side by training health professionals to have a high index of suspicion in high-risk groups and routine oral screening during health check-ups;[1,4] should be strategically formulated and implemented.
Large scale studies should be planned for obtaining the epidemiological data regarding the distribution, potential risk-factors and barriers that have limited the utilization of health-care services. Based on the study findings, measures should be directed against the risk-factors and the identified barriers for minimizing the morbidity and mortality associated with oral cancer.[1,4,7] For designing public health solutions, best results will be obtained when oral health screening services are integrated with other national health programs.[1] Sustained political commitment is an indispensable component in building effective oral health policies; establishing linkage with the technical support agencies/international organizations/non-governmental organizations; for ensuring the mandatory display of pictorial warning and messages on tobacco products; and for the implementation of community-based screening projects for facilitating early detection of oral cancer.[1,3,4] Further, expansion of diagnostic aids and adoption of newer modes of treatment can also be looked upon as the potential solutions to counter the problem of oral cancer.[1,2,4]
To conclude, the need of the hour is to develop evidence-based strategies focusing on primary prevention, health education strategies for the community, early detection through screening methods and initiation of appropriate treatment at the earliest.
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