Understanding Factors Contributing to Nurses’ Intention to Care for COVID-19 Patients Using the Theory of Planned Behavior

Background: Globally, the nursing community has lost several colleagues during the Coronavirus Disease 2019 (COVID-19) battle. One of the negative consequences of the disease is the pressure on healthcare services and demands that exceed the system's capacity to provide sufficient resources. Similarly, the experiences of care providers might trigger emotional and physical stress, which could affect the healthcare system's readiness to manage infectious outbreaks. This study was aimed at investigating nurses’ intention to care for COVID-19 patients and determining factors contributing to their intentions to care at the Ministry of Health facilities in Saudi Arabia. Methods: This descriptive cross-sectional survey design was used to recruit 336 nurses working in Al Madinah Ministry of Health hospitals where COVID-19 patients received medical and nursing care. The instrument was created following the framework of the Theory of Planned Behavior. Results: Nurses’ intention to care for COVID-19 patients was significantly correlated with their education level, nationality, knowledge about COVID-19, and nurses’ exposure during their earlier education for emerging infectious diseases. Factors related to social pressure from friends, colleagues, and workplace administration support needed improvement. Examining the model fits through multiple regression revealed that the combination of six subscales – “attitude, subjective norms, perceived behavioral control, behavioral beliefs, normative beliefs, and control beliefs” – accounted for a significant (89%) variability of intention to care, R2 = 0.892, adjusted R2 = 0.793, F (6-329) = 201, p ≤ 0.000. Conclusion: Providing nursing education is the main predictor of higher nurses' intention to care for COVID-19 patients, it is imperative that nursing education courses should continue investing in enhancing nurses' capabilities in caring for COVID-19 patients.

The theory of planned behaviour in exploring dietary diversity practices among mothers in informal settlements in Kenya

One of the leading causes of malnutrition, which contributes to morbidity and mortality in children, is lack of dietary diversity. Despite remarkable improvement in exclusive breastfeeding in Kenya, there are still poor dietary diversity practices among children aged 6-24 months. Limited studies have applied the Theory of Planned Behaviour (TPB) to examine the factors that influence dietary diversity practices in informal settlements in Kenya. The objective of this qualitative study was to explore behavioral, normative, control beliefs, intention, and dietary diversity practices, based on the TPB. The study sites were Kibera in Nairobi, Manyatta A in Kisumu, and Kaptembwo in Nakuru. Participants were 64 mothers of children aged 6-24 months selected using purposive sampling. Nine focus groups, each comprising of 5-10 mothers were conducted and the data analyzed using thematic analysis. Using a focus group guide, based on the TPB, mothers described salient beliefs regarding their attitude, subjective norms and perceived control of dietary diversity. Analysis of the data showed that some mothers had intended to introduce solid foods at six months. However, barriers such as mother not feeding well, baby’s hunger, perceived insufficient breast milk production, and return to work led to earlier introduction of foods. Most mothers indicated their intention to give a variety of foods to their children but were hindered by barriers such as poverty/inadequate money, non-availability of food at home, and inadequate knowledge about complementary feeding. Friends, health professionals, fathers, neighbours and friends were cited as most salient referents that influenced the dietary diversity practices. The most frequently provided starchy foods were chappatis, mandazis, potatoes, rice, weetabix, porridge, and ugali. In conclusion, the results indicate that mothers had positive attitude towards dietary diversity. The ‘significant others’ who mostly influenced dietary diversity practices were health professionals, fathers, and friends. Future interventions need to target mothers' perceived child-feeding responsibilities, influence subjective norms, and increase parents' perceived control over child feeding.

Engaging Turkish immigrants in psychotherapy: Development and proof-of-concept study of a culture-tailored, web-based intervention

Background Culturally tailored interventions can increase the engagement and the success rate of psychotherapy in immigrant and ethnic minority patients. In this regard, the integration of the patients’ illness beliefs is a key element. Applying principles of Motivational and Ethnographic Interviewing, we developed a culture-tailored, web-based intervention to facilitate engagement of Turkish immigrant inpatients in psychotherapy. Method The different aspects of the engagement intervention development are described and its acceptance and usefulness were tested in a proof-of-concept trial with an experimental control group design (active control condition: progressive muscle relaxation) in a sample of Turkish immigrant inpatients in Germany (N = 26). Illness perception, illness-related locus of control, and self-efficacy were assessed pre and post intervention. Results The engagement intervention was rated better than the control condition (p = .002) and in particular, participants felt better prepared for therapy after working with it (p = .013). By working with the engagement intervention, self-efficacy increased (p = .034) and external-fatalistic control beliefs diminished (p = .021). However, half of the participants needed assistance in using the computer and web-based interventions. Conclusion The developed intervention provides a first step towards feasible culture-tailored psychotherapeutic elements that can be integrated into routine clinical care. The first results regarding acceptance and usefulness are promising.

A Qualitative Study Exploring Barriers and Facilitators to Establishing Nurse-led, Multidisciplinary Psychological Care for Trauma Patients: Experiences From Doctors and Nurses

BackgroundTrauma patients are often in a state of psychological stress, experiencing helplessness, sadness, frustration, irritation, avoidance, irritability and other adverse emotions. Doctors and nurses are at the forefront of caring trauma patients and they play a crucial role in psychological supports and mental health care. However, few qualitative studies had based on the framework of the Theory of Planned Behavior (TPB) to explore the experiences in providing psychological care for trauma patients. We examined attitudinal, normative, and control beliefs underpinning medical staffs’ decisions to perform psychological care.MethodA qualitative study of in-depth semi-structured interviews was conducted among 14 doctors and nurses engaging in trauma care. The participants came from six tertiary hospitals in Chongqing, China. Data analysis was performed using the approach of Colaizzi. According to the framework of TPB, the researchers identified and summarized the themes.ResultsImportant advantages (mutual trust, patients' adherence and recovery), disadvantages (workload, short-term ineffective, practice unconfidently), referents (supportive: managers, patients, kinsfolk, nursing culture; unsupportive: some colleagues and patients), barriers (insufficient time or energy, resources situations), and facilitators (access to psychologist, training/education, reminders) were identified. Some demands, such as training diversity, multidisciplinary cooperation and families' support, reflected by doctors and nurses were important for them to carry out psychological care.ConclusionAccording to the TPB, this article explored the internal and external promotion and hindrance factors that affecting the intentions and behaviors of doctors and nurses in implementing psychological care for trauma patients. We also focused on the experience and demands of health professionals in conducting psychological care, which could provide references for managers to formulate corresponding psychological care procedures and norms.

Vaccinating to protect others: The role of self-persuasion and empathy among young adults

Direct persuasion (providing arguments) is usually a less effective influence technique than self-persuasion (self-creation of arguments). As most young adults are unafraid to contract COVID-19, self-persuasion focused on protecting the health of others may be an effective method of increasing vaccination rates in this population. Thus, empathy seems to be a crucial factor affecting vaccination intentions. We conducted two experiments using the theory of planned behavior. Study 1 (N = 366) compared the effectiveness of self-persuasion targeted at others' health versus personal health and direct persuasion in encouraging COVID-19 vaccination intention. Results indicate that among young adults, self-persuasion targeted at others' health (compared to other forms of persuasion) has an indirect effect on vaccination intention through utility and social norms beliefs. Moreover, as empathy increases, utility, social norms, and control beliefs increase, which is associated with a greater COVID-19 vaccination intention. Study 2 (N = 375) investigated the applicability of self-persuasion in health communication through a poster framed as an open-ended question. We found that the poster with self-persuasion targeted at others’ health, enhanced vaccination intention, compared with a direct persuasion poster. Together, our findings demonstrate the potential of self-persuasion targeted at others' health in increasing COVID-19 vaccination uptake among young adults.

Protective Effects of Perceived Control on Prescription Drug Misuse 10-years Later in the MIDUS Study

The current study examined if control beliefs predict prescription drug misuse (PDM) 10-years later and how problem drinking status moderates this relationship. PDM refers to taking medications without a prescription or in a manner not intended by the prescriber. Older adults are especially vulnerable to PDM due to drug sensitivity, comorbid health conditions, and high rates of polypharmacy. Participants were adults (n=2162, 56% female, mean age=54, range=30-84) who completed Waves 2 and 3 of the Midlife Development in the United States (MIDUS) study. At Wave 2, participants reported on two subscales of perceived control (personal mastery and constraints) and past 12-month problem drinking behaviors. At Wave 3, participants reported past 12-month PDM of five substances (painkillers, sedatives, stimulants, tranquilizers, and depression medications). Results indicated that at Wave 3, 10% of the sample reported misusing at least one prescription drug in the past year. Logistic Regression analysis revealed that problem drinking was associated with higher odds of PDM (p<0.001), and perceived control was associated with lower odds of PDM (p<0.05) after controlling for previous PDM and sociodemographic, health behavior, and health status covariates. However, there was an interaction effect such that perceived control was not protective for those individuals who engaged in problem drinking at Wave 2 (p<0.05). Future analyses will explore the meaning of this interaction. Identifying psychosocial protective factors, such as perceived control, predicting PDM will be critical for designing interventions that prevent the adverse consequences of PDM among this population.

Cohort Differences and Similarities in Women's Attitudes About Self and Aging

This panel focuses on four complementing and international views of women’s aging, with a special emphasis on cohort comparisons and using three different studies of women, with contrasting methodological frameworks. In so doing, we present evidence related to trends in social percepetions of aging, attitudes about aging and identity, and ideas about control and objectification. Dr. Newton presents data on older Canadian women showing the connection between physical aging and identity maintenance, using both qualitative and quantitative data and using the lifecourse perspective. Dr. Ryan, using data from the Health and Retirement Study to compare cohorts of women from the 2008 and 2018 HRS waves, reports cohort differences in negative self-perceptions of aging, and that both cohort and negative self-perfections are associated with life satisfaction, using the life course developmental framework. Ms. Tran compares younger and older cohorts of women on a measure of self-objectification, finding that the older cohort reported lower objectification, consistent with a selection, optimization, and compensation (SOC) model. Finally, Dr. Sherman, using the same data set as Ms. Tran, shows that control beliefs are associated with objectification, regardless of cohort, consistent with objectification theory predictions of consistency over time regarding the impact of objectification experiences. Dr. Jamila Bookwala will provide discussion of this group of papers.

Control Beliefs, Age, and Objectification Experiences in Younger and Older Women

Control beliefs show age-related patterns; mastery decreases in adulthood, while constraints beliefs often increase. However, there is a great deal of individual variation. This paper addresses antecedents of control beliefs, with attention to experiences and beliefs related to sexual objectification, which have particular impact for women. In this study, younger women (N = 132, M = 20.93) and older women (N = 86, M = 67.83) were surveyed regarding their experiences with sexual objectification and constraints beliefs. Multiple regression analyses revealed higher self-objectification was associated with higher constraints (R2 = .09**) and lower mastery (R2 = .11**) but reports of body evaluation and sexual advances were not associated with control beliefs. Further, there were no interactions of either objectification scale with age. These results suggest that objectification may be an important part of the aging experience across the life course, not just in young adulthood.

Perceiving More Age-Related Losses? The Role of General Control Beliefs and Daily Disturbance to Plans

We examined daily fluctuations in future time perspective within the daily stress and awareness of aging processes. Awareness of age-related change (AARC) focuses on everyday experiences that highlight changes in behavior and functioning as a result of growing older. We integrated individual differences in control beliefs because those with higher control tend to be more resilient to stressors. We conducted a daily diary study of 112 older adults (aged 60-90) who completed measures of control beliefs at baseline and then daily measures of stressor exposure, appraisal (e.g., threats to future plans), and AARC for eight consecutive days. Increases in threats to future plans were associated with increases in AARC losses, and those with low control were especially vulnerable to increases in threats to future plans. With a constricted future time perspective, any threats to future plans may be especially harmful for older adults who are low in control beliefs.