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Background: Vaccinations are a cornerstone of public health. However, reluctance to accepting vaccines is common. Using longitudinal data, we investigated which individual and contextual factors were associated with switching preferences from initial hesitancy or unwillingness toward acceptance of a first COVID-19 vaccination., Methods: 12,512 participants of a Dutch cohort study who initially indicated being hesitant or unwilling to get vaccinated were included (December 2020-June 2022). Cox regression was used to determine what sociodemographic factors (e.g., age), vaccination-specific beliefs (e.g., perceived efficacy) and contextual factors (e.g., stringency of COVID-19 measures) were associated with switching toward getting vaccinated. Analyses were stratified into (1) the active campaign phase (over time more people became eligible for vaccination), versus (2) the residual phase (everyone was eligible and could still get vaccinated)., Results: Over time, 86% of initially hesitant and 34% of initially unwilling participants got vaccinated or intended to do so. Switching was less likely for people aged 40-54y (adjusted hazard ratio [aHR] 0.76 [95%CI = 0.69-0.84]) in phase 1, while in phase 2 they were more likely to do so (aHR = 1.44; 95%CI = 1.08-1.92). In both phases, people were more likely to switch if they had positive beliefs about its efficacy (phase 1: aHR = 1.76; 95%CI = 1.70-1.83; phase 2: aHR = 1.65; 95%CI = 1.54-1.77), and perceived getting vaccinated as the descriptive norm (phase 1: aHR = 1.30; 95%CI = 1.26-1.34; phase 2: aHR = 1.19; 95%CI = 1.13-1.25). During stricter lockdown measures people were also more likely to switch (phase 1: aHR = 1.26; 95%CI = 1.25-1.28; phase 2: aHR = 1.09; 95%CI = 1.08-1.09)., Conclusion: A majority of initially hesitant people changed their minds about vaccination during the pandemic. Preference switches in favor of vaccination were most strongly associated with beliefs about the vaccine's efficacy in preventing illness. This study underlines the importance of providing up-to-date, balanced information and decisional support for people to weigh the benefits and risks of getting vaccinated versus not getting vaccinated., Competing Interests: Declarations. Ethics approval and consent to participate: The cohort study did not meet the requirements for ethical review as laid down in the Dutch Law for Research Involving Human Subjects (WMO) and was therefore exempted by the Centre for Clinical Expertise at RIVM from formal ethical review (Study number G&M-561). Written informed consent was provided by all participants. After completing their first questionnaire, participants were asked for consent to receive follow-up invitations. Participants were informed that they could withdraw from the study at any time. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Road crash injuries are significant public health issues in many low-and middle-income countries. Every year more than 1.35 million people lose their lives due to road crashes, making it one of the leading causes of death worldwide. In 2021, 1.19 million road traffic deaths occurred worldwide. Globally, India accounts for the second-largest number of fatal road traffic crashes. Riders in the age range of 18-25 years contribute to 41.4% of India's total road crash victims. An in-depth understanding of the current traffic density, violations, and behaviours of young riders is essential for enforcement agencies, in particular, the traffic police personnel. Their perspective is relevant as they have a unique position to judge and evaluate the riding behaviours and the efficiency of the existing intervention programmes. Furthermore, their suggestions can be highly effective in developing evidence-based risk reduction programmes. The present study was conducted in Manipal, which is a locality of Udupi district in Karnataka province of Southwestern India. Seventeen in-depth interviews were conducted from October 2018 to January 2019 among traffic police personnel. Thematic analysis was done using ATLAS.ti 8 software to identify, analyse, and report themes within the data. Respondents revealed that in recent times Manipal roads have become unsafe for young riders. Factors such as speeding, using a mobile phone while riding, reckless riding, and overtaking from the wrong side were the main reasons for road traffic crashes. Interventions like the installation of traffic barricades, closed-circuit television cameras, speed breakers, and signboards at the crash hotspots, together with strict enforcement of traffic laws, were suggested by the respondents to reduce crashes. The study findings highlight the importance of traffic police personnel's views in understanding the various determinants for road crashes observed among young riders. Future research can be taken up in other settings with broader age group involvement for the target population. There is a need to establish a coordination committee that can locally organize awareness programmes involving all the stakeholders on road safety to increase the level of risk perception and reduce crashes., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the institutional ethical committee of Kasturba Medical College at Manipal Academy of Higher Education, Manipal, India (Reference number − 09/2018). Since the study involved human participants, the data collection was performed in accordance with the principles of the Helsinki Declaration. There was written informed consent before interviews on participating in the investigation. Information about the study was offered in a language understood by the informants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The global campaign for "Undetectable equals Untransmittable" (U = U) seeks to spread awareness of HIV treatment as prevention, aiming to enhance psychological well-being and diminish stigma. Despite its potential benefits, U = U faces challenges in Sub-Saharan Africa, with low awareness and hesitancy to endorse it. We sought to develop a U = U communications intervention to support HIV counselling in primary healthcare settings in South Africa., Methods: We used Intervention Mapping (IM), a theory-based framework to develop the "Undetectable and You" intervention for the South African context. The six steps of the IM protocol were systematically applied to develop the intervention including a needs assessment consisting of a systematic review and qualitative research including focus group discussions (FGD) and key informant (KI) interviews. Program objectives and target population were determined before designing the intervention components and implementation plan., Results: The needs assessment indicated low global U = U awareness, especially in Africa, and scepticism about its effectiveness. Lay counsellors and clinic managers stressed the need for a simple and standardized presentation of U = U addressing both patients' needs for encouragement and modelling of U = U success but also clear guidance toward ART adherence behaviour. Findings from each step of the process informed successive steps. Our final intervention consisted of personal testimonials of PLHIV role models and their partners, organized as an App to deliver U = U information to patients in primary healthcare settings., Conclusions: We outline an intervention development strategy, currently in evaluation stage, utilizing IM with formative research and input from key U = U stakeholders and people living with HIV (PLHIV)., (© 2024. The Author(s).)

Background: Women who are susceptible to rubella are advised to vaccinate against rubella to prevent infection in future pregnancies, and thus avert the risk of congenital rubella syndrome in their unborn child. Rubella outbreaks periodically occur in the under-vaccinated orthodox Protestant community in the Netherlands. The objective of this mixed-methods study was to determine and understand personal experience with rubella, perceived rubella susceptibility, and intention to accept rubella screening and vaccination among unvaccinated orthodox Protestant women. The ultimate aim of this study was to inform policy and practice and contribute to the prevention of cases of congenital rubella syndrome., Methods: A mixed-methods study was conducted combining an online survey and semi-structured interviews among unvaccinated Dutch orthodox Protestant women aged 18-40 years. Descriptive analysis was used for quantitative data. Qualitative data was analysed using codes and categories., Results: Results of the survey (167 participants) showed that most participants had personal experience with rubella (74%, 123/167) and 101 women (61%, 101/167) indicated they had had rubella themselves. More than half of the women were undecided whether to accept rubella susceptibility screening (56%; 87/156) or rubella vaccination (55%; 80/146). Qualitative findings (10 participants) showed that most women thought they were not susceptible to rubella. Indecisiveness and negative attitudes to accept rubella vaccination were related with religious arguments to object vaccination and with women's perception of absence of imminent threat of rubella. Furthermore, results showed presence of misconceptions among women in the interpretation of their susceptibility and high confidence in their parents' memory that they had experienced rubella as a child although no laboratory screening had been conducted., Conclusions: In light of an imminent rubella outbreak in the Netherlands, a tailored education campaign should be prepared aimed at and established in cooperation with the under-vaccinated orthodox Protestant community. Health care providers should provide adequate information on rubella and support decision-making in order to stimulate women to make a deliberate and informed decision on rubella screening and, if necessary, subsequent vaccination., (© 2023. The Author(s).)

Background: Motorcycles are one of the most commonly used transportation modes in low and middle-income countries. In India, motorized two-wheelers comprise 70% of the total vehicle population, and motorcycle users are considered the most vulnerable road users. It is essential to understand the risky riding behaviour and associated factors among the motorcyclists to develop evidence-based traffic safety programs targeting motorcycle riders. The purpose of the current study was two-fold. First, it aimed to determine the appropriate structure of a modified version of the MRBQ among young riders in Manipal, India. Second, it assessed to what extent MRBQ factors were associated with self-reported crash involvement and violations., Methods: The motorcycle rider behaviour questionnaire (MRBQ) is a 43-item scale that assesses five aspects of risky motorcycle rider behaviour, i.e., violations, control errors, traffic errors, stunts, and protective equipment. The MRBQ, along with measures of socio-demographic variables and the number of motorcycle crashes, was filled out by 300 young motorcycle riders who were in the age group of 18-25 years and had been riding for at least the past three years (93% males, 92.3% students)., Results: Five factors emerged out of the MRBQ after an exploratory factor analysis: traffic errors, control errors, stunts, protective equipment, and violations. Cronbach's alpha for these factors ranged from .66 to .82. Reports of performing stunts and committing violations were positively associated with self-reported near-crash experiences over the past three months. Riders reporting stunts, violations and using a motorcycle of 125-200 cc reported having received more fines in the last three months. These findings were confirmed in both univariate and multivariate binary logistic regression models., Conclusion: The study assessed the factor structure of a modified version MRBQ and the extracted factors associations with self-reported crash involvement. The factor structure revealed in the current study is consistent with MRBQ factor structures found in other countries. However, the support for a relationship between MRBQ factors and self-reported crashes was less significant. The findings suggest that if replicated by future studies, local policymakers are advised to focus on the five MRBQ factors while planning future interventions to achieve a reduction in the number of road crashes among motorcyclists., (© 2021. The Author(s).)

Background: People with a condition subject to stigmatisation, such as chronic hepatitis B, face the dilemma of whether or not to disclose their status. In Ghana, 12.3% of the adult population has the hepatitis B virus (HBV). One key strategy for breaking the cycle of hepatitis B transmission is the disclosure of hepatitis B status by people with chronic hepatitis B (PWHB). Disclosure can facilitate preventive actions to reduce hepatitis B transmission (e.g., not sharing personal items and avoiding contact with blood and body fluids). Disclosure can also motivate family members of PWHB to get tested, linked to care and clinically managed in order to reduce the progression of hepatitis B to liver cirrhosis and cancer. Given the importance of disclosure, we set out to explore reasons for and against disclosure of chronic hepatitis B status in the Greater Accra and Upper East region of Ghana., Methods: In this exploratory qualitative study, 18 participants (10 from the Greater Accra region and 8 from the Upper East region) were recruited for semi-structured interviews. Interviews were recorded and transcribed verbatim. Data were then processed using QSR Nvivo version 10.0 and analysed for themes., Results: Participants were selective disclosers, disclosing in some contexts and not in others. Reasons for non-disclosure of chronic hepatitis B status were: 1) fear of stigmatisation and 2) previous negative experiences with disclosure. Reasons for disclosure were: 1) wanting close contacts to get tested or vaccinated, 2) trusting the disclosure target(s), and 3) needing social and/or financial support., Conclusions: Our findings highlight various reasons for and against disclosure of chronic hepatitis B status in Ghana. Because anticipated, observed, and experienced stigma were important motivations for non-disclosure of chronic hepatitis B status, we recommend the development and implementation of theory and evidence-based stigma reduction interventions that are culturally appropriate, and that prioritize the participation of target populations. We also recommend the provision of counselling and support services that assist PWHB in their disclosure decision-making processes.

Background: Violence victimisation and violence perpetration may co-occur in adolescents. Understanding the sociodemographic correlates of the independent and joint profiles of victimisation and perpetration may inform preventive interventions. This study examined the associations of sociodemographic factors with four violence typologies, namely, 1) non-involvement in both victimisation and perpetration, 2) victims only, 3) perpetrators only, and 4) victim-perpetrators. Trends in the prevalence of the four violence typologies over the three survey years were also examined., Methods: We used data from the three nationally representative South African Youth Risk Behaviour Surveys conducted in 2002, 2008, and 2011 and included a multi-ethnic sample of adolescents (n = 30,007; boy: 46.9%, girls: 53.1%; M age = 16 years, SD = .06)., Results: The sample consisted of 8030 (30.8%) adolescents who had non-involvement in both victimisation and perpetration, 8217 were victims only (29.8%), 2504 were perpetrators only (9.0%), and 7776 were victim-perpetrators (24.6%). Logistic regression analyses showed that being a girl increased the odds of non-involvement (OR: 1.47, 99% CI: 1.36-1.58) and being victims only (OR: 1.90, 99% CI: 1.76-2.05). Being a boy increased the odds of being perpetrators only (OR: 0.42, 99% CI: 0.37-0.47) and victim-perpetrators (OR: 0.51, 99% CI: 0.47-0.55). Adolescents who did not have an absent mother had higher odds of non-involvement (OR: 0.78, 99% CI: 0.62-0.97). Lower monthly allowance increased the odds of victimisation only (OR: 0.99, 99% CI: 0.97-1.00), whereas higher monthly allowance increased the odds of perpetration only (OR: 1.05, 99% CI: 1.03-1.08). Trend analysis showed that between 2002 to 2011, there was an increase in the prevalence of non-involvement in adolescents (p < .001), a decrease in the prevalence of victims only (p < .05) and victim-perpetrators (p < .001), and no changes in the prevalence of perpetrators only (p > .05)., Conclusions: Sociodemographic factors are uniquely associated with different violence typologies suggesting the need for tailored interventions to target adolescents with differed risks to violence victimisation and perpetration. Strengthening family relations, particularly between mother and child, may protect adolescents from the experiences of victimisation and perpetration.

Background: Breast cancer has become one of the most common causes of mortality among Indonesian women. Many women in Indonesia present with late-stage breast cancer, negatively affecting prognosis and treatment outcomes. Better prognosis of breast cancer will be achieved if it is diagnosed in an earlier stage, thus efforts to detect breast cancer earlier are important. Breast Self-Examination (BSE) is considered as an important first step to encourage women to actively be responsible for their own health, especially for women in low-and middle-income countries with limited resources and access to other forms of preventive healthcare (e.g., screening programs). The present study aimed to predict BSE practice among women in Surabaya, Indonesia using the Health Belief Model (HBM)., Methods: This investigation was a cross-sectional survey which was distributed among 1967 women aged 20-60 years. The Indonesian version of Champion's Health Belief Model Scale (I-CHBMS) was used to explain self-reported BSE practice. Logistic regression analysis was used to examine the association of HBM variables with BSE practice., Results: 44.4% of the respondents indicated they had performed BSE. Further, the results indicated that the HBM variables were significantly associated with BSE practice. Specifically, higher perceived benefits and self-efficacy, lower perceived barriers and less cues to action were unique correlates of BSE practice. The result also showed that perceived severity and susceptibility were not associated with BSE practice., Conclusion: This study indicated that several HBM constructs significantly associated with BSE practice among Indonesian women, suggesting that BSE health education programs should emphasize the perceived benefits of BSE, focus on increasing women's self-efficacy to address and overcome perceived barriers in performing BSE, and help them in identifying personally relevant cues to action.

Background: School dropouts are at heightened risk of tobacco use compared to in-school learners. School dropouts are described as those not currently enrolled in school for the academic year, have not completed their schooling, and are between 13 and 20 years old. This paper examines the relationship between reasons for leaving school and past month cigarette smoking, taking into account gender differences., Methods: Multiple logistic regression was used to analyse survey data (n = 4185). Geographical location was also incorporated into the analysis as effect moderators., Results: Although no significant main effects between reasons for leaving school and tobacco use were found, results showed that those who leave school early smoke more. When examining interaction effects with gender, leaving school due to 'not being able to pay for school fees' was significantly associated with smoking, but only among girls residing in urban areas (OR = 0.327, p = .023)., Conclusions: More research is needed to understand why learners leave school and their subsequent tobacco use. This knowledge will help researchers identify and target those students that are at risk for dropping out of school and using tobacco.

Background: It is hard to convince people to participate in chlamydia screening programs outside the clinical setting. In two earlier studies (BMC Public Health. 2013;13:1091; J Med Internet Res. 2014;16(1):e24), we identified explicit and implicit determinants of chlamydia screening behavior and attempted, unsuccessfully, to improve participation rates by optimizing the recruitment letter. In the present study, we examined the links between a number of social-cognitive determinants (e.g., stereotypical beliefs about a person with chlamydia, intentions, changes in partner status), and self-reported chlamydia testing behavior six months after the initial study., Methods: The present study is a follow-up to our first study (T0). We assessed self-reported testing behavior 6 months after the first measure by means of an online questionnaire (T1; N = 269). Furthermore, at T1, we measured the social-cognitive determinants in more detail, and explored the influence of stereotypical beliefs and any changes in partner status during this six month period., Results: In total, 25 (9.1 %) of the participants tested for chlamydia at some point during the six months between baseline (T0) and follow up (T1). Testing behavior was influenced by testing intentions in combination with changes in risk behavior. The higher the participants' own numbers of partners ever, the higher they estimated the number of partners of the stereotypical person with chlamydia. Testing intentions were most strongly predicted by perceived norms and susceptibility, and having had multiple partners in the last 6 months (R(2) = .41)., Conclusion: The most relevant determinants for testing intentions and behavior were susceptibility, subjective norms and changes in partner status. We found a systematic tendency for individuals to underestimate their own risk, especially the risk of inconsistent condom use. Future research should focus on more promising alternatives to population-based interventions, such as online interventions, screening in primary care, the rescreening of positives, and clinic-based interventions. This future research should also focus on making testing easier and reducing barriers to testing, as well as using social and sexual networks in order to reach more people.