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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).)

In the transitioning era towards the COVID-19 endemic, there is still a sizable population that has never been vaccinated against COVID-19 in the Netherlands. This study employs Bayesian spatio-temporal modelling to assess the relative chances of COVID-19 vaccination uptake - first, second, and booster doses - both at the municipal and regional (public health services) levels. Incorporating ecological regression modelling to consider socio-demographic factors, our study unveils a diverse spatio-temporal distribution of vaccination uptake. Notably, the areas located in or around the Dutch main urban area (Randstad) and regions that are more religiously conservative exhibit a below-average likelihood of vaccination. Analysis at the municipal level within public health service regions indicates internal heterogeneity. Additionally, areas with a higher proportion of non-Western migrants consistently show lower chances of vaccination across vaccination dose scenarios. These findings highlight the need for tailored national and local vaccination strategies. Particularly, more regional efforts are essential to address vaccination disparities, especially in regions with elevated proportions of marginalized populations. This insight informs ongoing COVID-19 campaigns, emphasizing the importance of targeted interventions for optimizing health outcomes during the second booster phase, especially in regions with a relatively higher proportion of marginalized populations.

Adolescents' sexual and reproductive health challenges are of global public health concern and good quality sexual and reproductive health (SRH) education has an important role to play in addressing these negative sexual health outcomes. Yet in most Sub-Saharan African countries including Ghana, there is limited implementation of SRH education. Several environmental factors hinder the implementation of SRH education with the attitudes expressed by religious leaders having a major impact. We conducted semi-structured interviews with 15 Christian leaders in Bolgatanga, Ghana, to explore the factors influencing their decision to adopt and implement SRH education. Findings show that although Christian leaders were aware of (unsafe) sexual practices among adolescents, they held a conservative position on SRH education. While leaders were open to educating adolescents about sexual health, most held the opinion that SRH education for adolescents should be limited to abstinence-only and not acknowledge sexual activity or promote contraceptive use. Beliefs related to sexual morality, the perceived cause(s) of teenage pregnancy, and perceived responsibility for SRH education influenced Christian leaders' thinking about SRH education. Implementing SRH education programmes to address young people's sexual behaviour will require intervention programmes to change Christian leaders' beliefs and attitudes towards SRH education.

Background: Social networks, our social relationships, influence the spread of infectious diseases and preventive behaviors such as vaccination. Here, we aimed to assess which individual, interpersonal (social network characteristics), community and societal factors are associated with coronavirus disease 2019 (COVID-19) vaccination intention during the second wave of the COVID-19 pandemic in 2020, prior to vaccine availability., Methods: This cross-sectional study collected primary data from 5,001 community-dwelling adults aged 40 years and older in the Netherlands, using an online questionnaire from August and November 2020. COVID-19 vaccination intention was measured by assessing whether respondents were willing to receive a COVID-19 vaccination if the vaccines became available. Associations between individual (sociodemographic variables, health, health concerns), interpersonal (social network characteristics including structure, function, and quality), community (social and labor participation) and societal factors (degree of urbanization), and the outcome variables COVID-19 vaccination intention (yes vs no, yes vs unsure, unsure vs no) were assessed in stepwise multivariable logistic regression analyses. p -values < 0.05 indicated statistical significance., Results: Among participants (N = 3,396), 59 % reported a positive intention to vaccinate, 35 % were unsure, and 6 % had no intention. Men, individuals of older age, those with a college or university degree, those concerned about their personal and family health, and knowledge about protecting oneself from the virus were more likely to have the intention to vaccinate (versus no intention). Interpersonal factors associated included having a larger network size (social network structure) and a larger proportion of informational supporters (social network function). Living outside of urban areas, a societal factor, was associated with vaccination intention (versus no intention)., Conclusion: This study identified key factors influencing COVID-19 vaccination intention. Health promotion efforts should address not only individual factors but also incorporate the social environment. Our findings highlight the importance of organizing social networks to mobilize social support for pandemic preparedness., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

We piloted a Motivational Interviewing (MI) training program for lay counsellors in South Africa (SA) to assess its impact on retention and viral suppression among newly diagnosed individuals living with HIV (PLHIV) at 12 months post-diagnosis. We randomized eight primary healthcare clinics (PHC) in Johannesburg to either the intervention clinics (n=4) where all lay counsellors were supported for 12 months before the PLHIV enrolment or the standard of care (n=4 clinics). Overall, 548 adults (≥ 18 years) PLHIV were recruited after HIV diagnosis from March 2020 to August 2021 (n=291 intervention, n=257 control). We conducted Poisson regression modelling to assess the intervention effect on patient attendance status (out of care - being ≥28 days late for the last appointment) and viral suppression (<50 copies/ml) at 12 months, reporting risk ratios (RR) with 95% confidence intervals (CIs). Of the 548 eligible participants enrolled, 56.3% were ≥28 days late (52.9% intervention vs 60.9% controls, RR 0.9, 95% CI: 0.7-1.0). Retention at 12 months positively correlated with baseline counselor MI skill levels (Cultivating change talk, RR 1.6, 95%CI: 1.1-2.5; Softening sustain talk, RR 1.5, 95%CI: 0.8-2.9; Empathy, RR 1.4, 95%CI: 1.0-1.8; Partnership RR 1.5, 95%CI: 1.2-1.9). Among those retained at 12 months, 65.3% of intervention participants were virally suppressed compared to 49.3% controls (RR 1.3, 95%CI: 1.0-1.7). Compared to control participants, the intervention group reported more positive counseling experiences, fewer concerns about HIV disclosure (RR 0.8 for high vs low-medium concerns, 95% CI: 0.7-1.0) and ART (RR 0.8, 95% CI: 0.7-1.0), and were more likely to express high confidence to take treatment in public (47.4% vs 28.8%, RR 1.4, 95% CI: 1.0-1.8) after counselling., Competing Interests: Declaration of interests The authors confirm that the research was performed in accordance with the Declaration of Helsinki. The study was approved by the Human Research Ethics Committee (Medical) of the University of the Witwatersrand (Wits HREC M170579). All participants provided written informed consent to participate in the study. Informed consent was administered in the participant’s preferred language (English, Sotho or Zulu). All personal identifiers, including participants’ and facility names, were removed from the final analytic dataset.

We developed a motivational interviewing (MI) counselling training and support program for lay counsellors in South Africa-branded "Thusa-Thuso-helping you help", commonly referred to as Thusa-Thuso. We present the results of a pilot study to determine the program's impact on MI technical skills and qualitatively assess the feasibility of a training-of-trainers (TOT) scale-up strategy among counselling staff of non-governmental (NGO) support partners of the human immunodeficiency virus (HIV) treatment program in South Africa. We enrolled adult (≥ 18 years) lay counsellors from ten primary healthcare clinics in Johannesburg (South Africa) selected to participate in the Thusa-Thuso training and support program. Counsellors attended the ten-day baseline and quarterly refresher training over 12 months (October 2018-October 2019). Each counsellor submitted two audio recordings of mock counselling sessions held during the ten-day baseline training and two additional recordings of sessions with consenting patients after each quarterly contact session. We reviewed the recordings using the MI treatment integrity (MITI) coding system to determine MI technical (cultivating change talk and softening sustain talk) and relational (empathy and partnership) competency scores before and after training. After 12 months of support with pilot site counsellors, we were asked to scale up the training to NGO partner team trainers in a once-off five-day Training of trainers (TOT) format (n = 127 trainees from November 2020 to January 2021). We report TOT training experiences from focus group discussions (n = 42) conducted six months after the TOT sessions. Of the 25 enrolled lay counsellors from participating facilities, 10 completed the 12-month Thusa-Thuso program. Attrition over the 12 months was caused by death (n = 3), site exclusion/resignations (n = 10), and absence (n = 2). MI competencies improved as follows: the technical skills score increased from a mean of 2.5 (standard deviation (SD): 0.8) to 3.1 (SD: 0.5), with a mean difference of 0.6 (95% confidence interval (CI): 0.04, 0.9). The MI relational skills score improved from a mean of 3.20 (SD: 0.7) to 3.5 (SD: 0.6), with a mean difference of 0.3 (95% CI: -0.3, 8.5). End-point qualitative data from the counsellors highlighted the value of identifying and addressing specific skill deficiencies and the importance of counsellors being able to self-monitor skill development using the MITI review process. Participants appreciated the ongoing support to clarify practical MI applications. The TOT program tools were valuable for ongoing on-the-job development and monitoring of quality counselling skills. However, the MITI review process was perceived to be too involved for large-scale application and was adapted into a scoring form to document sit-in mentoring sessions. The Thusa-Thuso MI intervention can improve counsellor motivation and skills over time. In addition, the program can be scaled up using an adapted TOT process supplemented with fidelity assessment tools, which are valuable for skills development and ongoing maintenance. However, further studies are needed to determine the effect of the Thusa-Thuso program on patient ART adherence and retention in care. Trial registration: Pan African Clinical Trials Registry No: PACTR202212796722256 (12 December 2022)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mokhele et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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).)

Introduction: Maintaining and enhancing vaccine confidence continues to be a challenge. Making an informed decision not only helps to avoid potential future regret but also reduces susceptibility to misinformation. There is an urgent need for interventions that facilitate informed decision-making about vaccines. This paper describes the systematic development of two interventions designed to promote informed decision making and indirectly, acceptance of maternal pertussis vaccination (MPV) in the Netherlands., Materials and Methods: The 6-step Intervention Mapping (IM) protocol was used for the development of an online tailored decision aid and Centering Pregnancy-based Group Antenatal Care (CP) intervention. A needs assessment was done using empirical literature and conducting a survey and focus groups (1), intervention objectives were formulated at the behavior and determinants levels (2), theoretical methods of behavior change were selected and translated into practical applications (3), which were further developed into the two interventions using user-centered design (4). Finally, plans were developed for implementation (5), and evaluation (6) of the interventions., Results: The needs assessment showed that pregnant women often based their decision about MPV on information sourced online and conversations with their partners, obstetric care providers, and peers. Responding to these findings, we systematically developed two interactive, theory-based interventions. We created an online tailored decision aid, subjecting it to four iterations of testing among pregnant women, including those with low literacy levels. Participants evaluated prototypes of the intervention positively on relevance and usability. In addition, a CP intervention was developed with midwives., Conclusion: Using IM resulted in the creation of an online decision aid and CP intervention to promote informed decision making regarding MPV. This description of the systematic development of the interventions not only serves to illustrate design rationales, it will also aid the interpretation of the evaluation of the interventions, the development of future interventions promoting informed decision and acceptance of vaccines, and comparisons with other interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Anraad, van Empelen, Ruiter, Rijnders, van Groessen and van Keulen.)

Problem: Effective interventions are needed to promote informed decision making about vaccination., Background: We developed a group-antenatal care (CP; Centering Pregnancy) intervention, i.e., a session about MPV within existing group-care settings, to promote informed decision making about Maternal Pertussis Vaccination in the Netherlands., Aim: This study aimed to assess (1) to what extent the intervention was implemented as intended, (2) to what extent the intervention met the needs and wishes of pregnant individuals and midwives facilitating CP., Methods: We conducted exploratory interviews with 6 CP facilitators and 10 CP participants to assess the implementation of the intervention, and how the intervention and its different components were perceived. Interviews were analysed using thematic analysis. In addition, we conducted a pre- and post-intervention survey amongst 35 participants, measuring knowledge about MPV, and MPV attitude and intention., Results: The CP intervention was implemented as intended in 6 out of 7 groups. Participants were positive about the interactive CP-methods used to discuss MPV. Participants and facilitators evaluated the intervention as positive and relevant, although the intervention was time-consuming, and some participants had already made the de decision about MPV. Those who had not yet decided indicated that the session was helpful for their decision., Discussion and Conclusion: Discussing MPV in CP care settings is a feasible strategy to support decision making about MPV during pregnancy. The intervention could be improved by discussing the MPV sooner than 16-18 weeks of pregnancy. A larger-scale study is needed to assess effects on MPV uptake and informed decision making., Competing Interests: Declaration of Competing Interest The authors declare that they do not have competing interests., (Copyright © 2023. Published by Elsevier Ltd.)