Chronic pain conditions such as migraine and endometriosis affect millions worldwide and predominantly people born female. This online survey examined their psychological impact by comparing selfesteem, disease causality orientation (CO), stigma, and impairment among migraine patients (n=127), endometriosis patients (n=82), and controls without either condition (n=88). Both patient groups reported significantly lower self-esteem than controls. Controls were more likely to attribute symptoms to chance or illness rather than personal weakness. In both conditions, internalized stigma exceeded experienced stigma, and leisure-time impairment exceeded work-related impairment. Findings underscore the importance of integrating psychological interventions into chronic pain management.

OBJECTIVES:Antimicrobial resistance (AMR) is an urgent public health threat. Antibiotic prescriptions in primary care, such as for uncomplicated urinary tract infections (UTIs) in females, contribute substantially to antibiotic overuse. We examined whether consequence-based risk communication emphasizing either individual (gut microbiome disruption) or societal (AMR) consequences can reduce expectations to receive antibiotics and improve decision-related outcomes. DESIGN AND METHODS:Across three online experiments (N = 3057), women in the United Kingdom were exposed to a hypothetical physician consultation for an uncomplicated UTI. Depending on the experimental condition, the physician explained individual consequences of antibiotic use, societal consequences or no such consequences. Outcomes included expectations to receive antibiotics, trust in the physician and decisional conflict. RESULTS:An internal meta-analysis showed that both societal and individual consequence messages significantly reduced patients' expectations to receive antibiotics. Neither message type undermined trust in the physician (in Studies 1 and 2), and both communication messages significantly reduced decisional conflict (in Study 3). CONCLUSIONS:These findings indicate that brief, targeted communication regarding consequences of antibiotic use can lower antibiotic expectations and support decision-making without eroding physician trust. Such messages represent a useful tool that can be adapted to different clinical contexts for patient-centred antibiotic stewardship in primary care.

: Background: Respiratory syncytial virus (RSV) can cause severe illness, especially in older adults. Since the European Medicines Agency approved two RSV vaccines in 2024, it is important to assess the public's knowledge of this virus. Aims: Exploring knowledge about RSV and identifying associations with vaccination antecedents and vaccination intention. Method: We collected data from 565 individuals over 60 years of age in Germany, assessing their awareness and knowledge about RSV using a novel, pre-tested RSV knowledge scale and RSV-specific 5C vaccination antecedents (confidence, constraints, collective responsibility, complacency, and calculation), as well as their RSV vaccination intentions. Results: Around 50% of the sampled individuals stated that they had never heard of RSV. The RSV-aware sample (n = 289) showed an intermediate level of knowledge concerning RSV, M (SD) = 0.58 (0.19). The 5C vaccination antecedents collective responsibility and complacency mediated the relationship between knowledge and intentions. Limitations: As the results are from a survey study, mediation analysis can only be interpreted as correlational evidence. Conclusion: Educational interventions on RSV and respective vaccines are needed, as awareness, particularly about its infectiousness in children and vaccine availability, is low in the target group.

Patients with haematological or oncological malignancies are at increased risk of severe infections. Vaccination is a key preventive strategy and is recommended by National Immunization Technical Advisory Groups (NITAGs). Yet, vaccination rates in this population remain improvable. This project aimed to evaluate and enhance vaccine uptake in cancer patients. We conducted a pre- and post-observational study at the University Hospital Cologne in Germany to assess vaccination status over a 1.5-year intervention. Relevant infections included COVID-19, influenza, herpes zoster, pneumococci and RSV. The campaign included patient education, staff training, on-site vaccination, and targeted promotional efforts. A total of 749 patients were included (n = 398 in 2023, n = 351 in 2025). Overall vaccination rates increased from 43 to 49

Endometriosis affects 5–14% of women and those presumed female at birth (PFAB), yet public understanding remains limited. In an online survey of 427 Australians, diagnosed individuals had better knowledge about endometriosis than those at risk but undiagnosed. In detail, at-risk individuals underestimated prevalence, consequences, and diagnostic pathways. Targeted education may improve symptom recognition and healthcare engagement, supporting earlier diagnosis and better care.

OBJECTIVE:Endometriosis is a chronic gynecological condition often characterized by severe menstrual pain. It takes 7 years on average to diagnose endometriosis, with menstrual stigma being an estimated factor for this delay. METHOD:In this preregistered study, both the Theory of Planned Behavior and Stigma Theory are included in an online survey to understand conversation intentions about menstrual symptoms and the impact of menstrual stigma in daily life. With a partial least squares structural equation model including 776 participants, the research investigates the facilitators and barriers influencing participants' intentions to seek advice for severe menstrual discomfort across different social contexts, including conversations with friends, medical experts, and coworkers. RESULTS:The results highlight that the perceived public stigma surrounding menstruation is associated with higher self-stigmatization, decreased attitudes, and decreased perceived behavioral control, which in turn significantly decreases conversation intentions. CONCLUSIONS:The study's results inform targeted interventions to promote open dialogue about menstrual health and reduce stigma. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

During a pandemic, knowledge, risk perceptions, trust in institutions and attitudes towards public health measures influence protective behaviours and mental health. The COVID-19 Snapshot Monitoring (COSMO) project collected psychosocial data on pandemic-related attitudes, feelings and behaviours from representative samples in Germany. In sixty-nine cross-sectional online surveys conducted between 03.03.2020 and 29.11.2022, N = 69,013 individuals were assessed. Our 332 variables show how COVID-19 was perceived (e.g., symptoms, risk perceptions), which behaviours were exhibited (e.g., mask wearing, keeping distance, being vaccinated, meeting other people), what attitudes and beliefs people held (e.g., towards vaccination, conspiracy beliefs, pandemic fatigue), which information sources they used and trusted, how their mental health was affected (e.g., worries, wellbeing, resilience) and what consequences the pandemic had for people (e.g., financial losses, alcohol consumption). Variables are available for at least five waves (i.e., roughly 5,000 participants), some variables are available for all waves. The data allow tracing population-level changes in pandemic perceptions and actions, assess the relationships between determinants and behaviours, and help prepare for future crises.

BACKGROUND:We examine patients' informational needs regarding novel vaccination decisions, focusing on what information they expect to receive in doctor-patient communication after having lived through a pandemic. METHOD:In Study 1, n = 842 German participants received information on a fictional disease and vaccination (called dysomeria), including symptoms, disease impact, vaccine efficacy, and potential side effects. They were asked what questions they would ask their doctor in a consultation. In Study 2, we included n = 1127 people over the age of 60. The participants received information about the novel Respiratory Syncytial Virus (RSV) vaccine and then, they were asked the same open-ended question as in Study 1. RESULTS:An inductively developed categorization system from Study 1 proved effective for coding responses in both studies. Participants frequently raised concerns about vaccine safety, side effects, and contraindications-especially in the context of preexisting medical conditions. Questions also focused on efficacy, booster timing, immunization schedules, vaccine types, and disease incidence. Trust in physicians was important, with participants seeking clarity on both medical recommendations and official guidelines. CONCLUSIONS:Healthcare providers should adapt communication strategies, focusing on shared decision-making and personalized vaccination decisions including novel and well-known determinants of vaccination decisions.

In central Europe, tick-borne encephalitis (TBE) virus poses a growing health risk, amplified by climate-related changes in tick distribution. However, the TBE vaccination rate in Germany remains low. This study uses the Protection Motivation Theory (PMT) to investigate factors influencing TBE vaccination intention in Germany and the effect of tailored information on TBE risk areas. Participants (N = 309) aged between 18 and 61 living in Germany were included in an online survey with an additional experimental variation of tailored TBE risk messages. Three experimental groups were provided with (a) no tailored risk information, (b) semi-tailored information about risk areas on federal level or (c) full-tailored information on risk areas on county levels. The PMT concepts showed that perceived susceptibility, severity, and response efficacy were positively related to the intention to be vaccinated against TBE. In exploratory analyses, perceived self-efficacy was a positive predictor of vaccination status. Permanent residence in risk areas was also associated with vaccination status, whereas planned or previous vacations in such areas were not. The effect of tailored information on vaccination intentions could not be confirmed. TBE vaccination intentions and uptake appear to be shaped by PMT factors and residence in risk areas. Public health interventions should therefore focus on communicating TBE risk, enhancing self-efficacy, and presenting clear evidence of vaccine efficacy to strengthen preventive measures against tick-borne diseases. Factors such as travel planning should also be considered in evidence-based health campaigns.

Background and aimPublic health and social measures (PHSM) are critical aspects of limiting the spread of infections in pandemics. Compliance with PHSM depends on a wide range of factors, including behavioral determinants such as emotional response, trust in institutions or risk perceptions. This study examines self-reported compliance with PHSM during the COVID-19 pandemic in the Federation of Bosnia and Herzegovina (FBIH).Materials and methodsWe analyze the association between compliance and behavioral determinants, using data from five cross-sectional surveys that were conducted between June 2020 and August 2021 in FBIH. Quota-based sampling ensured that the 1000 people per wave were population representative regarding age, sex, and education level based on the data from the latest census in Bosnia and Herzegovina. One-way analysis of variance (ANOVA) was used to identify significant changes between studies on determinants and PHSM measures. Regression was used to find relations between behavioral determinants and PHSM.ResultsParticipants reported strong emotional responses to the rapid spread of the virus and its proximity to them. Risk perception was spiking in December 2020 when rates of infection and death were particularly high. Trends in policy acceptance were divergent; participants did not rate PHSM as exaggerated, but perceived fairness was low. Trust in institutions was low across all waves and declined for specific institutions such as the health ministry. In five wave-specific regression analyses, emotional response (βmin/max = .11*/.21*), risk perception (βmin/max = .06/.18*), policy acceptance (βmin/max = .09/.20*), and trust in institutions (βmin/max = .06/.21*) emerged as significant predictors of PHSM.ConclusionsThis study contributes to the body of research on factors influencing compliance with PHSM. It emphasizes the importance of behavioral monitoring through repeated surveys to understand and improve compliance. The study also affirms the impact of public trust on compliance, the risk of eroding compliance over time, and the need for health literacy support to help reinforce protective behaviors.

The reasons for low influenza and pneumococcal vaccine acceptance in the elderly population are largely unknown – despite the great need of vaccines in this risk group. While many studies examine the relationship between factors influencing vaccination, such as sociodemographic characteristics and influenza and pneumococcal vaccination intentions and behavior, psychological factors, such as vaccine-specific attitudes, are underutilized in research on vaccination behaviors and intervention strategies. This article assesses the psychological antecedents of influenza and pneumococcal vaccination in the elderly and assesses the predictive power of psychological vs. sociodemographic and other factors surrounding vaccination, on vaccination behavior. A cross-sectional telephone survey, representative of age, gender and rural/urban residence, was conducted with N = 701 German participants > 60 years of age, during the influenza season of 2016–17. Multiple logistic regressions were conducted to identify the relevant determinants of vaccination behavior. Results show unique patterns in the psychological antecedents: while confidence, the belief in the effectiveness of vaccination and calculation, the need for information, complacency, the lack of risk perception and constraints, and perceived practical barriers to vaccination predicted influenza vaccination behavior, only complacency predicted pneumococcal vaccination behavior. The amount of explained variance in influenza vaccination behavior nearly doubles when psychological antecedents of vaccination are taken into account, beyond other factors surrounding vaccination. However, the effect was smaller for pneumococcal vaccination behavior. The results are compared to a subnational sample. Understanding the psychological drivers of vaccination can help to plan interventions effectively. Deutsches Register Klinische Studien (German Clinical Trials Register) DRKS00012653. Registered 24.11.2017. Retrospectively registered.

Background: Dietary habits play a central role in the transition toward a more sustainable food system. However, many consumers lack an understanding of the principles of sustainable eating. Objective: This study examined whether a gamified quiz could enhance knowledge about the environmental impact of food. Additionally, it explored the role of prior knowledge and readiness for change, based on the Transtheoretical Model (TTM), in the learning process. Methods: A quasi-experimental, cross-sectional study with a pre-post design was conducted with 338 participants. Knowledge about sustainable eating was measured using a newly developed and piloted scale, and readiness for change was assessed using an adapted version of the TTM measures. The data were analyzed using t-tests, regression analyses, and variance analyses. Results: The quiz led to a significant increase in knowledge, particularly among participants with low prior knowledge. Contrary to expectations, no significant differences in knowledge gain were observed based on readiness to change, as defined by the Transtheoretical Model. Conclusion: Gamification has the potential to enhance knowledge about sustainable eating. Further research with more diverse samples and comprehensive measurement tools is needed to better understand the long-term effects on knowledge and to promote sustainable nutrition education in practice.

Objective: Older adults may fail to demand vaccinations because they lack knowledge about the benefits of vaccination or underestimate disease risks. This study evaluated an extended knowledge intervention that provided information on lesser-known risks of influenza—including pneumococcal disease and sepsis—and the benefits of vaccination. Methods: The intervention was implemented in a model region in Germany during two influenza seasons. Two quota-sampled telephone surveys targeting adults 60+ were conducted to assess the impact of the intervention (N = 700 each). Quasi-experimental groups (intervention-exposed vs. non-exposed) were defined based on self-reported intervention exposure. Primary outcomes included knowledge (influenza, pneumococci, sepsis), the 5C antecedents of vaccination, and vaccination intention and behavior. Results: Intervention exposure had small positive effects on knowledge about influenza (η² = .009), pneumococci (η² = .012), and sepsis (η² = .004). It was also associated with higher risk–benefit calculation regarding influenza vaccination (η² = .003) and increased confidence in the safety of pneumococcal vaccination (η² = .020). Vaccination intentions for both diseases did not differ between groups. Although the intervention did not directly influence behavior, vaccination uptake increased over time due to external factors (influenza: OR = 1.880; pneumococci: OR = 2.080). Conclusions: Information alone can enable informed decisions and can help to change underestimated risks, but does not shift behavior. Embedding knowledge gains within multi-component strategies (e.g., provider endorsement, reminders, easy access) is the most plausible path to increased coverage. Targeting other factors is also important.

Abstract Background The 5C psychological antecedents of vaccination (Confidence, Complacency, Constraints, Calculation, and Collective Responsibility) facilitate understanding vaccination decisions in specific target groups as well as the general public’s informational needs. This study aims to explain pre-pandemic vaccination behaviour (a) in general, (b) for specific vaccines such as influenza, and (c) for certain target groups (e.g. people over the age of 59 years, parents, healthcare workers), using the 5C model and sociodemographic variables. The intention to get an influenza vaccination was also analysed for target groups. Methods The 5C, self-reported vaccination behaviour and the intention to vaccinate were collected in two representative telephone surveys in Germany – one in 2016 (n1 = 5,012) and another in 2018 (n2 = 5,054). Parents, people over the age of 59 years, chronically ill people, people with a migratory background, pregnant women and healthcare workers were target groups. Results Overall, the 5C model had higher explanatory power than sociodemographic variables. The pattern of vaccine hesitancy slightly differed between vaccinations and target groups. Confidence in safety and effectiveness was always a significant predictor. Complacency (the underestimation of disease risks) and Constraints were significant predictors as well. Calculation (of risks and benefits) was important for influenza vaccination intentions. Conclusions This work builds an important benchmark for understanding potential changes in vaccine acceptance due to the pandemic. The benchmark can be used in research on potential effects of the pandemic on vaccination behaviours. Intervention designers can also use the results to understand specific audiences and their vaccination decisions.

Introduction Climate change is a paramount global health threat with multifaceted implications. Societal change is required to mitigate the negative effects of climate change, as well as help people adapt to the associated health risks. This requires situation-specific, large-scale data to help scientists and policymakers understand public perceptions and behaviours and identify the levers to increase public readiness to act against climate change and protect health. The Planetary Health Action Survey (PACE) assesses this readiness to act as a regular monitoring of representative samples in Germany. The ongoing monitoring seeks to develop and refine an integrated conceptual model of the trait-like readiness to act, comprising policy acceptance, political participation and individual behaviours as indicators of the trait. It also proposes as set of determinants to explain different levels of readiness to act. This study protocol provides newly developed valid measurement instruments and the methodological details of the monitoring.Method and analysis PACE assesses indicators of the readiness to act and a set of sociocognitive factors predicting the readiness to act in continuous cross-sectional data collections. The latter comprise climate change knowledge, trust in institutions, perceived health risks, self-efficacy, social norms and perceived effectiveness of policy measures. The online questionnaire is updated regularly. Data collection involves non-probabilistic quota samples from Germany (n≈1000 at each collection).Ethics and dissemination The project adheres to the ethical guidelines of the University of Erfurt and the German Research Foundation. Ethical clearance was granted by the University’s Institutional Review Board (No #20220525/No #2024-01). Participants are guaranteed confidentiality and anonymity, and informed consent is obtained before participation. Results will be published in peer-reviewed journals. Additionally, we aim to inform and empower the public and support stakeholders (media, policymakers, climate protection organisations) in preparing climate communication and assisting policymakers through the project website including an interactive tool, detailed reports and short summaries for practitioners.

: Background: Following the protection motivation theory (PMT), a lack of risk perception is one of the reasons for differences in vaccine uptake (Rogers, 1975). When the risk for diseases like seasonal influenza is underestimated, protective measures such as vaccination are used less. Aims: In this paper, we propose that the sequelae approach, which involves providing information about the severe complications of diseases, can influence people's risk perceptions and their intention to vaccinate. This is in comparison to providing merely information about the disease itself. Method: Three preregistered online experiments (2017-2019) were conducted to examine whether risk perceptions and vaccination intentions increase when (1) information about sequelae is presented as statistical texts or narratives (vs. not presented at all), (2) known or unknown sequelae (myocardial infarction vs. sepsis), and (3) different target populations (e.g., health literacy) are considered. Results: An internal meta-analysis showed that the sequelae approach increases intentions (SMD = .39[.20;.59]) but not risk perception (SMD = .09[-.10;.27]). Unknown and known sequelae had an equal impact on vaccination intentions. None of the strategies (narratives vs. statistical texts, sequelae type) produced adverse reactions in people with low health literacy. In addition, no evidence was found for boomerang effects. Limitations: Even though our research was based on PMT, we cannot add evidence on self-efficacy or response efficacy as influential factors. Conclusion: Although increased risk perception is not the primary mechanism behind the sequelae approach, the results support the use of this strategy in educational interventions that target vaccine hesitancy.

The coronavirus disease 2019 (COVID-19) pandemic emphasized the importance of vaccinations for the prevention of life-threatening diseases and for avoiding the overburdening of the healthcare system. Despite the clear advantage of vaccinations, increasing vaccine hesitancy has been observed worldwide, especially among young people who are potential future parents. Vaccine hesitancy describes the delayed or lack of willingness to utilize recommended vaccinations and represents a substantial challenge for public health. This article analyzes the causes of vaccine hesitancy in the postpandemic period and discusses factors that could make communication successful. The role of artificial intelligence and structured evidence-based discussion techniques, such as the empathetic refutation interview, are emphasized. The aim is to provide practice-oriented recommendations to be able to provide physicians with tools that can help in the education counselling with insecure patients and can promote the acceptance of vaccinations.

Context: Long COVID can appear as a severe late consequence (sequela) of a COVID-19 infection, leading to the inability to work or participate in social life for an unknown amount of time. To see friends or family struggling with long COVID might influence people’s risk perceptions, vaccine efficacy expectations, and self-efficacy perceptions to prevent COVID-19 and its consequences. Methods: In an online survey in August 2022, n = 989 German-speaking participants indicated whether they knew someone who suffered from long COVID illness. Four dimensions of protection motivation theory (PMT) were assessed afterwards, as well as vaccination intentions. Results: Multiple mediation analysis with participants who knew vs. didn't know someone with long COVID (n = 767) showed that knowing someone with long COVID was associated with higher perceived affective and cognitive risk of long COVID-19 as well as higher perceived vaccine efficacy. Self-efficacy, i.e., the ease to protect oneself against long COVID, was lower in participants who knew long-COVID patients. Indirect positive effects for response efficacy and affective risk suggest that vicarious experience with long COVID is associated with increased intentions to get a COVID-19 vaccine. Conclusion: The protection from long COVID through vaccination are relevant aspects for individual decisions and health communication.