To examine associations between trust in influenza vaccine information sources, perceived message credibility, healthcare provider (HCP) influenza vaccine recommendations, and influenza vaccine hesitancy and uptake among adults living in rural Indiana. We surveyed adults from two rural northern Indiana clinics between May 2024 and March 2025. Influenza vaccine hesitancy was measured using a validated nine-item scale, and vaccine uptake was assessed by self-reported influenza vaccination within the past year. Multivariable linear and logistic regression analyses with multiple imputations examined associated factors. Among 213 participants, 78.9% trusted HCPs and 54.0% trusted professional organizations as influenza vaccine information sources. Trust in influenza vaccine information from HCPs (B = -1.09, 95% CI: -1.42, -0.76), professional organizations (B = -0.30, 95% CI: -0.58, -0.03), and receiving HCP vaccine recommendations (B = -0.79, 95% CI: -1.05, -0.52) were associated with lower influenza vaccine hesitancy. Greater perceived bias in vaccine information from mass media was associated with higher hesitancy (B = 0.13, 95% CI: 0.03, 0.22), while greater perceived bias in social media was associated with lower hesitancy (B = -0.10, 95% CI: -0.19, 0.00). Receiving HCP vaccine recommendations was strongly associated with vaccine uptake (aOR = 12.69, 95% CI: 4.04, 39.83), whereas trusted influenza vaccine information from family members (aOR = 0.22, 95% CI: 0.05, 0.93) and higher hesitancy (aOR = 0.16, 95% CI: 0.07, 0.35) were associated with lower uptake. Rural HCPs remain a trusted vaccine information source in this rural population. Strengthening vaccine-specific clinical communication strategies and addressing broader determinants of hesitancy may improve influenza vaccination uptake in rural populations.
PURPOSE Postpartum sleep loss and fatigue are common during the transition to parenthood, with important implications for parental health and wellbeing. Given their role in supporting families during this transition, health care stakeholders can provide valuable insight into the sleep-related challenges experienced by first-time parents. DESIGN This study employed a narrative inquiry approach to examine health care stakeholders' (e.g. midwives, psychologists, and doulas) perceptions, attitudes, and opinions regarding sleep and wellbeing among first-time parents during the postpartum period. METHODS Five semi-structured focus groups (N = 16) were conducted online with stakeholders. Data were analyzed using reflexive thematic analysis. FINDINGS Three primary themes were identified: 1) Transition to parenthood, 2) Barriers to parental sleep, and 3) Sleep and biopsychosocial functioning. Theme 1 captured how the unpredictability of sleep postnatally challenged parents' preconcieved expectations, revealing a discrepancy between anticipated and actual postpartum experiences. Theme 2 was concerned with the barriers that prevent first-time parents from securing sleep. Theme 3 described how sleep loss impacts parents' physical, mental, and social wellbeing. CONCLUSIONS Participants agreed that many first-time parents are largely underprepared for the impact that sleep loss can have on their wellbeing. This research has provided evidence for the need for specific perinatal interventions designed to support first-time parents who struggle with the effects of sleep loss. CLINICAL RELEVANCE The findings reported here highlight that postpartum sleep loss should be recognised as a significant clinical issue rather than an expected/unavoidable aspect of early parenting. Health care professionals should routinely assess parental sleep quality during perinatal care.
Purpose To examine associations between family characteristics, parenting behaviors, disease-related cognitive attitudes, and functional gastrointestinal disorder (FGID) status among family members.Design Cross-sectional survey.Methods From June to August 2024, adult guardians from community-based households in China with at least one child completed an online questionnaire. Household characteristics, parenting behaviors, and FGID-related attitudes were assessed. Multivariate logistic regression identified associated factors. Model performance was evaluated using receiver operating characteristic, calibration, and decision curve analyses.Findings Of 896 valid households, 242 (27.0%) reported at least one family member with an FGID. Lower odds were associated with more daily time spent with children (OR = 0.929, 95% CI: 0.879-0.981), ethnic minority status (OR = 0.425, 95% CI: 0.254-0.687), greater attention to children's health (OR = 0.489, 95% CI: 0.264-0.925), and lower disease concern (OR = 0.439, 95% CI: 0.270-0.691). Greater FGID understanding was associated with higher odds (OR = 2.404, 95% CI: 1.630-3.538). The model showed moderate discrimination (AUC = 0.674), acceptable agreement between predicted and observed probabilities on calibration analysis, and positive net benefit across threshold probabilities of 0.27-0.64 on DCA.Conclusions Family characteristics, parenting behaviors, and disease-related attitudes were associated with household FGID status.Clinical Relevance Family-centered assessment may support early identification and health education.
PURPOSE:To examine the effect of a nurse-led, 360-degree video-based virtual reality disaster risk reduction program (VR-b-DRRP) on disaster literacy, preparedness, and individual resilience among rural adults, who are often underprepared for disasters because of limited fixed infrastructure, distance from health services, and low health literacy. DESIGN:A randomized controlled trial with an intervention group and a control group (ClinicalTrials.gov: NCT06565962). METHODS:Sixty-four adults from a rural village were randomly allocated to either the intervention group (n = 32) or the control group (n = 32). Participants in the intervention group received the eight-week VR-based disaster risk reduction program (VR-b-DRRP), whereas those in the control group received a brochure-based disaster education program over the same eight-week period. Disaster literacy, the primary outcome, along with disaster preparedness and individual disaster resilience, was assessed at three time points: baseline, immediately following the intervention, and three months after its completion. All 64 randomized participants were included in the final analysis. FINDINGS:The two groups were similar before the program began (p > .05). After the program, the intervention group improved significantly more than the control group on all three measures, and these gains were still present three months later: disaster literacy (F = 46.53, p < .001, partial η2 = .600), disaster preparedness (F = 41.84, p < .001, partial η2 = .574), and individual disaster resilience (F = 38.26, p < .001, partial η2 = .552). Scores in the control group did not change significantly at any point. CONCLUSIONS:The nurse-led VR-b-DRRP significantly improved disaster literacy, preparedness, and resilience compared to a brochure-based program, and the improvements lasted for at least three months. CLINICAL RELEVANCE:Public health nurses can deliver portable VR disaster education to hard-to-reach rural communities, supporting efforts to reduce rural-urban preparedness inequalities.
