Perceived Social Norms Guide Health Care Decisions for Oneself and Others: A Cross-Sectional Experiment in a US Online Panel

Background: Global aging has increased the reliance on surrogates to make health care decisions for others. We investigated the differences between making health care decisions and predicting health care decisions, self-other differences for made and predicted health care decisions, and the roles of perceived social norms, emotional closeness, empathy, age, and gender. Methods: Participants ( N = 2037) from a nationally representative US panel were randomly assigned to make or to predict a health care decision. They were also randomly assigned to 1 of 5 recipients: themselves, a loved one 60 y or older, a loved one younger than 60 y, a distant acquaintance 60 y or older, or a distant acquaintance younger than 60 y. Hypothetical health care scenarios depicted choices between relatively safe lower-risk treatments with a good chance of yielding mild health improvements versus higher-risk treatments that offered a moderate chance of substantial health improvements. Participants reported their likelihood of choosing lower- versus higher-risk treatments, their perceptions of family and friends’ approval of risky health care decisions, and their empathy. Results: We present 3 key findings. First, made decisions involved less risk taking than predicted decisions, especially for distant others. Second, predicted decisions were similar for others and oneself, but made decisions were less risk taking for others than oneself. People predicted that loved ones would be less risk taking than distant others would be. Third, perceived social norms were more strongly associated than empathy with made and predicted decisions. Limitations: Hypothetical scenarios may not adequately represent emotional processes in health care decision making. Conclusions: Perceived social norms may sway people to take less risk in health care decisions, especially when making decisions for others. These findings have implications for improving surrogate decision making. Highlights People made less risky health care decisions for others than for themselves, even though they predicted others would make decisions similar to their own. This has implications for understanding how surrogates apply the substituted judgment standard when making decisions for patients. Perceived social norms were more strongly related to decisions than treatment-recipient (relationship closeness, age) and decision-maker (age, gender, empathy) characteristics. Those who perceived that avoiding health care risks was valued by their social group were less likely to choose risky medical treatments. Understanding the power of perceived social norms in shaping surrogates’ decisions may help physicians to engage surrogates in shared decision making. Knowledge of perceived social norms may facilitate the design of decision aids for surrogates.

Rural Versus Urban Variations on the Factors Associated with Early Initiation of Breastfeeding in Ethiopia.

Background: Early initiation of breastfeeding (EIBF) is defined as starting breastfeeding within the first hour of birth. It has clinical importance to reduce neonatal morbidity and mortality. Previously studies have been conducted in Ethiopia to identify factors associated with EIBF. However, those studies hadn’t investigated the variation of factors within rural versus urban populations. Therefore, this study is aimed to investigate the differences in factors associated with the early initiation of breastfeeding in rural-urban populations.Methods: This study was used Ethiopian Demographic and Health Survey data, 2016. A total of 3662 children aged less than 24 months were included in the study. Thus,2897 children were disaggregated into rural and the rest 765 of them were into urban. A multivariable logistic regression model was fitted to identify the determinant of EIBF. Finally, a statistically significant association was declared at a p-value of ≤0.05.Results: In rural populations, the study found that the age of mothers 15-24 years (AOR=1.50, 95%CI: 1.13,2.00), mothers not working (AOR=1.38,95%CI: 1.12,1.69), large birth size (AOR=1.44,95%CI:1.12,1.85), and participation of mothers in making health care decisions (AOR=1.43, 95%CI: 1.17,1.75) were positively associated with EIBF. Rural mothers having ≤2 children(AOR=0.55,95%CI: 0.45,0.67), living in larger to center regions (AOR=0.13,95%CI: 0.06, 0.27), and small peripheral regions (AOR=0.12,95%CI:0.06, 0.24) were negatively associated with EIBF. Irrespective of residence, the odds of EIBF were higher in vaginal delivery (RuralAOR= 4.38,95%CI:1.81,10.59; urban AOR= 3.19,95%CI:1.86, 5.48 ).In the urban population, having frequent ANC follow-ups was associated with a higher odds of EIBF.Conclusions: The study concludes that the age of mothers, working status of mothers, birth sizes, mothers participation in making health care decisions, numbers of children in the households, living in large to center regions and small peripheral regions were determinants of early initiation of breastfeeding, only rural residence. Mode of delivery was associated with EIBF, Irrespective of the residence. In the urban population, having frequent ANC follow-ups was associated with a higher odds of EIBF. Special emphases to mothers living in rural large to center and small peripheral regions should be given. Regardless of the residence, appropriate guidance and supports should be given for babies delivered through cesarean section.

Examining Empowerment Interventions With Families and Preschool Children: Systematic Review of Randomized Controlled Trials

Empowerment is a core construct in health behavior and an emerging trend in pediatrics. Although it has been suggested as an approach that may promote the person’s participation in health care decisions and positive outcomes, little is known about the nature and effectiveness of interventions to support empowerment in families and preschool-age children. The aim of this review is to identify, appraise, and synthesize the evidence on health interventions explicitly using empowerment as an orienting concept with families and their preschool-age children. We identified randomized controlled trials (RCTs) through systematic searches of eight databases for articles published between 1986 and January 2019 and included RCTs that addressed empowerment as a health intervention approach or outcome and that studied families with 3- to 5-year-old children. The application of empowerment theory, the family and child involvement, and the use of behavior change techniques (BCTs) were assessed through appropriate frameworks. Ten interventions were identified, and 50% of them showed positive outcomes. Most studies claimed a theoretical base. However, the studies provided limited details on theory application in intervention planning, implementation, and evaluation, and the children’s involvement in the interventions was generally scarce. The most commonly applied BCT was “instruction in how to perform the behavior.” We identified 16 potentially effective BCTs. The evidence was not sufficiently robust to determine the effectiveness of empowerment interventions with families and preschool-age children. Additional high-quality studies are needed to produce clearer conclusions. Our results are useful for the design and evaluation of future interventions.

Exploring Decisional Conflict With Measures of Numeracy and Optimism in a Stated Preference Survey

Objectives Low optimism and low numeracy are associated with difficulty or lack of participation in making treatment-related health care decisions. We investigated whether low optimism and low self-reported numeracy scores could help uncover evidence of decisional conflict in a discrete-choice experiment (DCE). Methods Preferences for a treatment to delay type 1 diabetes were elicited using a DCE among 1501 parents in the United States. Respondents chose between two hypothetical treatments or they could choose no treatment (opt out) in a series of choice questions. The survey included a measure of optimism and a measure of subjective numeracy. We used latent class analyses where membership probability was predicted by optimism and numeracy scores. Results Respondents with lower optimism scores had a higher probability of membership in a class with disordered preferences ( P value for optimism coefficient = 0.032). Those with lower self-reported numeracy scores were more likely to be in a class with a strong preference for opting out and disordered preferences ( P = 0.000) or a class with a preference for opting out and avoiding serious treatment-related risks ( P = 0.015). Conclusions If respondents with lower optimism and numeracy scores are more likely to choose to opt out or have disordered preferences in a DCE, it may indicate that they have difficulty completing choice tasks.

Tracking the time course of reproduction number and lockdown’s effect on human behaviour during SARS-CoV-2 epidemic: nonparametric estimation

Understanding the SARS-CoV-2 dynamics has been subject of intense research in the last months. In particular, accurate modeling of lockdown effects on human behaviour and epidemic evolution is a key issue in order e.g. to inform health-care decisions on emergency management. In this regard, the compartmental and spatial models so far proposed use parametric descriptions of the contact rate, often assuming a time-invariant effect of the lockdown. In this paper we show that these assumptions may lead to erroneous evaluations on the ongoing pandemic. Thus, we develop a new class of nonparametric compartmental models able to describe how the impact of the lockdown varies in time. Our estimation strategy does not require significant Bayes prior information and exploits regularization theory. Hospitalized data are mapped into an infinite-dimensional space, hence obtaining a function which takes into account also how social distancing measures and people’s growing awareness of infection’s risk evolves as time progresses. This also permits to reconstruct a continuous-time profile of SARS-CoV-2 reproduction number with a resolution never reached before in the literature. When applied to data collected in Lombardy, the most affected Italian region, our model illustrates how people behaviour changed during the restrictions and its importance to contain the epidemic. Results also indicate that, at the end of the lockdown, around $$12\%$$ 12 % of people in Lombardy and $$5\%$$ 5 % in Italy was affected by SARS-CoV-2, with the fatality rate being 1.14%. Then, we discuss how the situation evolved after the end of the lockdown showing that the reproduction number dangerously increased in the summer, due to holiday relax, reaching values larger than one on August 1, 2020. Finally, we also document how Italy faced the second wave of infection in the last part of 2020. Since several countries still observe a growing epidemic and others could be subject to other waves, the proposed reproduction number tracking methodology can be of great help to health care authorities to prevent SARS-CoV-2 diffusion or to assess the impact of lockdown restrictions on human behaviour to contain the spread.

Best Interest Standard in School Health: A Concept Analysis

The bioethical concept of best interest standard is cited in courts across America and considered to be an effective method of managing pediatric health care decision-making. Although the best interest standard is referred to in an abundance of nursing, medical, legal, and bioethical literature, refinement and a clear definition of the concept are lacking in the context of school health. An exhaustive and methodical search was conducted across six databases revealing 41 articles from the past decade. The Wilsonian methodology was used to analyze, refine, and clarify the concept of best interest standard by presenting original case vignettes (model, contrary, related, and borderline) and an innovative conceptual model as it applies to school nursing. This concept analysis provides school nurses with a deeper understanding of the best interest standard to navigate the complex nature of making school health care decisions.

Individual-and community-level determinants of neonatal mortality in the emerging regions of Ethiopia: a multilevel mixed-effect analysis

Background Unlike infant and child mortality, neonatal mortality has declined steadily in Ethiopia. Despite the large-scale investment made by Ethiopia to improve the health of newborns and infants, it is among the regions with the highest burden of neonatal mortality. Although there are studies done on neonatal mortality in different areas of Ethiopia, as to our search of pieces of literature there is no study in Emerging regions of the country. Therefore, this study aimed to investigate the individual and community-level determinants of neonatal mortality in the Emerging regions of Ethiopia. Methods Using the 2016 Ethiopian Demographic and Health Survey (EDHS) data, secondary data analysis was done. A total weighted sample of 4238 live births in Emerging regions were included for the final analysis. A multilevel binary logistic regression was fitted to identify the significant determinants of neonatal mortality. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV) were used for assessing the clustering effect, and deviance for model comparison. Variables with a p-value < 0.2 in the bi-variable analysis were considered in the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare statistically significant determinants of neonatal mortality. Results The neonatal mortality rate in Emerging regions of Ethiopia was 34.9 per 1000 live births (95% CI: 29.8, 40.9). Being born to a mother who had no formal education (AOR = 1.79, 95% CI: 1.12, 2.88), being born to a mother who did not participate in making health care decisions (AOR = 1.25, 95% CI: 1.14, 1.79), and being twin birth (AOR = 6.85, 95% CI: 3.69, 12.70) were significantly associated with higher odds of neonatal mortality. On the other hand, being female (AOR = 0.67, 95% CI: 0.47, 0.95), having 1–3 Antenatal Care (ANC) visits (AOR = 0.34, 95% CI: 0.15, 0.74), high community media exposure (AOR = 0.64, 95% CI: 0.41, 0.98), and preceding birth interval of two to 4 years (AOR = 0.38, 95% CI: 0.24, 0.58) were significantly associated with lower odds of neonatal mortality. Conclusion Neonatal mortality in Emerging regions of Ethiopia was unacceptably high. Maternal education, women’s autonomy in making decisions for health care, sex of a child, type of birth, preceding birth interval, ANC visit, and community media exposure were found significant determinants of neonatal mortality. Therefore, empowering women in making health care decisions and increasing access to mass media play a major role in reducing the incidence of neonatal mortality in Emerging regions of Ethiopia.