Journal of Primary Care and Community Health最新文献

{"title":"Burden of Care, Depression, and Anxiety Among Family Caregivers of People With Dementia.","authors":"Doaa S Abdelhalim, Marwa M Ahmed, Hoda A Hussein, Ola O Khalaf, Mai D Sarhan","doi":"10.1177/21501319241288029","DOIUrl":"10.1177/21501319241288029","url":null,"abstract":"<p><strong>Background: </strong>There are many challenges that entail caring for an individual with dementia, affecting not only the individual with the condition but also their caregivers. This can lead to increased burden, frustration, and depression among those taking care of them. A research gap exists concerning the care of people with dementia in Egypt, particularly regarding the mental health of caregivers. Limited studies have been conducted in Egypt, particularly focusing on the mental health of caregivers. This lack highlights the need to understand the prevalence and impact of caregiver burden in this population.</p><p><strong>Objectives: </strong>The research aimed to evaluate the burden of dementia, levels of depression, and anxiety among family caregivers of individuals with dementia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at a geriatric unit clinic of a psychiatric hospital in Cairo University, Egypt. Caregiver burden, anxiety, and depression were assessed using questionnaires. These questionnaires included the Zarit Burden Interview (ZBI), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), together with demographic data on the patients and caregivers.</p><p><strong>Results: </strong>The majority of the 141 participants (73% (n = 103)) were female, mostly daughters, with an average age of 40 years. Approximately 50% (n = 71) of the subjects exhibited mild to moderate burden, whereas 30% (n = 43) showed moderate to severe burden. About 31% (n = 44) of the subjects exhibited symptoms of moderate depression, whereas 9% (n = 13) had symptoms of severe depression. Furthermore, almost 43% (n = 60) of caregivers exhibited a moderate level of anxiety. Furthermore, a significant association was seen between caregiver burden and the presence of anxiety and depression.</p><p><strong>Conclusion: </strong>This study showed a substantial burden in providing care, elevated levels of despair, and anxiety among caregivers of PWD. The findings highlight how important it is to develop targeted therapies and support systems in order to lessen the load on caregivers, advance their mental health, and improve overall care for both caregivers and their patients in Egypt. Policy-makers should prioritize investing in dementia-related support systems and services to empower caregivers and improve the quality of life for both caregivers and their patients.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241288029"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Family Structure on Adolescent Depression Outcomes in a Collaborative Care Program.","authors":"Brian A Lynch, Charles P Lewis, Jennifer L Vande Voort, Aiswarya L Nandakumar, RoxAnne M Brennan, Kristin C Cole, Sandra J Rackley, Chung-Ii Wi, Paul E Croarkin, Magdalena Romanowicz","doi":"10.1177/21501319241291790","DOIUrl":"10.1177/21501319241291790","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>We aimed to investigate the effect of family structure on depression program outcomes for adolescents enrolled in a depression-focused, primary care-based collaborative care program.</p><p><strong>Methods: </strong>This was a retrospective study of primary care patients ages 12 to 18 years seen at a Midwestern academic center with data obtained by medical record review. We used logistic regression models to assess the effect of family structure on program graduation and achievement of a single Patient Health Questionnaire 9-Modified for Adolescents (PHQ-9M) score <5 at any time while enrolled.</p><p><strong>Results: </strong>Adolescents were divided into 2 groups, Both Parents in Household (n = 179) and Parents Not Together (n = 161). The Both Parents in Household group had higher rates of graduation (38.0% vs 23.6%, <i>P</i> = .005) and achieving single PHQ-9M scores <5 (64.1% vs 46.2%, <i>P</i> = .002) than the Parents Not Together group.</p><p><strong>Discussion: </strong>Youth residing with both parents had higher rates of successful outcomes in a depression-focused collaborative care program.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241291790"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of the COVID-19 Vaccination Within a Convenience Sample of Sudanese Americans.","authors":"Jonathan Freese, Fatima Abuzaid, Harlan Sayles, Mujtaba Abdellatif, Nada Fadul","doi":"10.1177/21501319241234868","DOIUrl":"10.1177/21501319241234868","url":null,"abstract":"<p><strong>Introduction: </strong>Sudanese American and other immigrant and refugee communities are at greater risk for exposure to COVID-19. This survey sought to better characterize COVID-19 vaccination practices, motivators, and drivers for hesitancy among Sudanese Americans.</p><p><strong>Methods: </strong>We developed an online, cross-sectional survey in English and Arabic distributed by Sudanese American community leaders in April 2022 with data stored anonymously in REDCap. Inclusion criteria were self-reporting being born within Sudan and living in the US within the last 2 years. Descriptive analysis tested survey responses for possible associations between the primary outcome, self-reported vaccination status, and questions regarding vaccination history, perspectives on vaccination, and demographic characteristics using Fishers Exact and Chi Squared Tests.</p><p><strong>Results: </strong>Of 111 survey responses received, 107 met inclusion criteria. 93% of respondents reported COVID-19 vaccine uptake with the primary motivation to protect oneself from disease. The most cited reason for vaccine hesitancy was belief it had not been studied enough. The group that reported vaccination had higher levels of education (.032) and were more likely to perceive that COVID-19 vaccinations were able to reduce spread (.001), decrease severe outcomes (.004), and benefits outweighing their risks (.004).</p><p><strong>Discussion and conclusions: </strong>This survey population of Sudanese Americans demonstrated high levels of vaccine uptake (93%), far greater than either the corresponding US (78%) or Sudanese population (15%). It is likely that high levels of educational attainment moderated vaccine uptake, though our survey may not have had the power to fully evaluate vaccine hesitancy.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241234868"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Member Adherence to a Health Insurer-Sponsored Gap Closure Program Using Multi-Target Stool DNA Test for Colorectal Cancer Screening.","authors":"Mallik Greene, Timo Pew, Quang Le, Alisdair Philp, William K Johnson, A Burak Ozbay, John Kisiel, Michael Dore, Derek Ebner, A Mark Fendrick, Paul Limburg","doi":"10.1177/21501319241305958","DOIUrl":"10.1177/21501319241305958","url":null,"abstract":"<p><strong>Objectives: </strong>To describe member adherence to a mail-based, health insurer-sponsored gap closure program for colorectal cancer (CRC) screening using multi-target stool DNA (mt-sDNA; Cologuard^®) tests.</p><p><strong>Methods: </strong>Combined patient data from Exact Sciences Laboratories LLC and data from mass-mailed mt-sDNA orders placed by a large Medicare Advantage Insurance Plan were analyzed (03/01/2023-06/30/2023). Adherence and time to test return were the primary and secondary outcomes, respectively. Their association with patient characteristics was evaluated using multivariable regression.</p><p><strong>Results: </strong>Among the 3201 member-patients included (86.6% aged 65-75 years; 58.7% female), adherence rate was 49.4%, and mean time to test return was 25.5 days. After multivariable adjustment, the odds of test return were significantly higher among 65- to 75-year-olds (odds ratio [OR] = 1.59 relative to 45- to 64-year-olds), those living in small towns (OR = 1.43 relative to metropolitan-located individuals), and with digital outreach via both SMS and email (OR = 4.31 relative to no digital outreach). Time to test return was shorter in 65- to 75-year-olds than in 45- to 64-year-olds and was not associated with other patient characteristics.</p><p><strong>Conclusions: </strong>Mass-mailed mt-sDNA tests for CRC screening were associated with an overall adherence rate of about 50% in this Medicare Advantage population, with higher likelihood of test return among patients receiving digital outreach.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241305958"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving Cancer Equity by Improving Health Insurance Access for All Latinos.","authors":"Nathalie Huguet, Heather Holderness, Cirila Estela Vasquez Guzman, Miguel Marino, John Heintzman","doi":"10.1177/21501319241278874","DOIUrl":"10.1177/21501319241278874","url":null,"abstract":"<p><p>Cancer is the top leading cause of death among Latino people. Lack of health insurance is a significant contributor to inadequate cancer detection and treatment. Despite healthcare policy expansions such as the Affordable Care Act, Latino people persistently maintain the highest uninsured rate among any ethnic and racial group in the US, especially among Latino individuals who are immigrants or part of a mixed immigration status household. Recognizing that immigration status is a critical factor in the ability of Latino community members to seek health insurance and access healthcare services, a few US states and the District of Columbia have implemented policies that have expanded coverage to children and adults regardless of immigration status. Expansion of Medicaid eligibility regardless of immigration status may significantly benefit Latino communities, however the facilitators and barriers to enrolling in these programs need to be evaluated to ensure reach and achieve health equity across the cancer control continuum for all Latinos.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241278874"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Family Medicine in Addressing the Maternal Health Crisis in the United States.","authors":"Saskia Spiess, Robert Owens, Elizabeth Charron, Mario DeMarco, Mirela Feurdean, Karen Gold, Kathryn Murray, Nicholas Schenk, Kirsten Stoesser, Pauline Thomas, Emmanuel Adediran, Elena Gardner, Katherine Fortenberry, Thomas Carl Whittaker, Dominik Ose","doi":"10.1177/21501319241274308","DOIUrl":"10.1177/21501319241274308","url":null,"abstract":"<p><p>The United States (US) is experiencing a maternal health crisis, with high rates of maternal morbidity and mortality. The US has the highest rates of pregnancy-related mortality among industrialized nations. Maternal mortality has more than quadrupled over the last decades. Rural areas and minoritized populations are disproportionately affected. Increased pregnancy-care workforce with greater participation from family medicine, greater collaborative care, and adequate postpartum care could prevent many maternal deaths. However, more than 40% of birthing people in the US receive no postpartum care. No singular solutions can address the complex contributors to the current situation, and efforts to address the crisis must address workforce shortages and improve care during and after pregnancy. This essay explores the role family medicine (FM) can play in addressing the crisis. We discuss pregnancy care training in FM residencies as well as the threats posed by financial and medico-legal climates to the maternal health workforce. We explore how collaborative care models and comprehensive postpartum care may impact the maternal health workforce. Efforts and resources devoted to high impact solutions for which FM has considerable autonomy, including collaborative and postpartum care, are likely to have greatest impact.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241274308"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11382238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fear of Crime During Years of Street Violence Is Associated With Worsening Cardiovascular Health Status.","authors":"Oscar H Del Brutto, Robertino M Mera, Victor J Del Brutto, Denisse A Rumbea, Emilio E Arias, Mark J Sedler","doi":"10.1177/21501319241305951","DOIUrl":"10.1177/21501319241305951","url":null,"abstract":"<p><strong>Background: </strong>Street violence has detrimental effects on cardiovascular health (CVH). However, the significance of these consequences have not been systematically evaluated. In this study, we aimed to assess the impact of fear of crime on CVH status among community-dwellers aged ≥40 years living in a rural village stricken by violence.</p><p><strong>Methods: </strong>Participants were selected from individuals enrolled in the Atahualpa Project Cohort, a population-based longitudinal study that aims to reduce the burden of cardiovascular risk factors and diseases in rural Ecuador. Fear of crime was evaluated using a structured scale. The Life's Simple 7 construct of the American Heart Association was employed to assess CVH before the escalation of violence and crime in the village (2019) and at the end of the study (2024). Multivariate logistic regression models were fitted to examine the association between the exposure and outcomes.</p><p><strong>Results: </strong>A total of 648 individuals (mean age = 57.4 ± 11.7 years; 56% women) were included. At the end of the follow-up, significant association between fear of crime levels and worsening CVH status was noted. Participants allocated to the second and third tertiles of fear of crime were 3.27 (95% CI = 2.07-5.19) and 5.46 (95% CI = 3.14-9.48) times more likely to have worsening CVH status at follow-up compared to baseline determinations, respectively.</p><p><strong>Conclusion: </strong>This study shows an aggravating impact of fear of crime on the CVH status and identifies interventional targets that may help to reduce the risk of CVH status worsening in community-dwellers living in rural settings afflicted by violence.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241305951"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Acceptability of a Mobile-Assisted Screening and Brief Intervention for Multiple Health Behaviors in Medical Settings.","authors":"Camille Forcier, Aymery Constant, Florine Grisard, Elise Clair, David Val-Laillet, Ronan Thibault, Romain Moirand","doi":"10.1177/21501319241303604","DOIUrl":"10.1177/21501319241303604","url":null,"abstract":"<p><strong>Introduction: </strong>Leveraging every interaction between patients and healthcare professionals constitutes an opportunity to foster behavior change. We developed a mobile Screening and Brief Intervention (mSBI) designed to screen for and intervene with multiple health behaviors, based on a personalized feedback. The objectives of the present study were to assess its feasibility during consultations for chronic conditions, collect users' opinions, and to investigate patients' behaviors and intention to change.</p><p><strong>Methods: </strong>Research counselors provided the mSBI to patients from 2 departments at University Hospital. Socio-demographic, behavioral, and acceptability data were collected from patients together with feasibility data from counselors' reporting.</p><p><strong>Results: </strong>A total of 259 participants were analyzed, aged 51 ± 17 years, with a majority of women (53%). The m-SBI averaged 20 min and most patients (92%) could complete the screening with minimal assistance. Medical doctors' involvement facilitated referral to and uptake of the m-SBI, and limited adverse events. On average, patients adhered to 11 of the 18 guidelines screened. A majority of patients rated the personalized feedback as comprehensible and useful. Nearly half of them intended to change behavior.</p><p><strong>Conclusions: </strong>The m-SBI seems well-accepted and useful, but doctor referral, adapting the screening tool to patients with low health literacy, and app's ability to send the feedback to patients/doctors are essential for feasibility.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241303604"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11663265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Scope of Services and Monetary Impact of Charity Medical Clinics in North Texas.","authors":"Logan G Mills, Barbara Newsom, Abigail Lewis, Alexandra Pottorff, Ashley Wallace Wu, Erika Castro, Kelsi Morgan, Lawrence Wu, Bau P Tran, Katherine Lake, Mina Guirguis, James M Wagner, Nora Gimpel, Tiffany B Kindratt","doi":"10.1177/21501319241304143","DOIUrl":"10.1177/21501319241304143","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>The cost of medical services is a major barrier to healthcare accessibility for underserved populations in the United States. Community charity medical clinics help address this disparity by providing free or reduced-cost care for the medically underinsured; however, their economic and public health contributions are unknown. The objective of this study was to evaluate the scope of services and monetary impact of 4 community charity medical clinics in North Texas, with one of the largest medically underinsured populations in the United States.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using electronic health records from 4 clinics serving adults and children in North Texas. Encounters from June 1 to December 31, 2018 completed by with sufficient documentation to assign a level of service were reviewed. There were 3942 encounters identified and 2148 (54.5%) audited. Centers for Medicare and Medicaid Services Evaluation and Management Standards were used to identify level of service provided for each encounter, and their subsequent value was determined based on CMS fee-for-service schedules at the time service was provided. Common conditions managed during these encounters were identified using ICD-10 codes documented with each encounter.</p><p><strong>Results: </strong>The most prevalent diagnoses encountered were hypertension, diabetes, hyperlipidemia, and major depressive disorder. We estimate the total value of services and medications provided for 1 year is between $840 278.30 to $845 737.41.</p><p><strong>Conclusions: </strong>The charity clinics in North Texas provide a significant economic impact through a high level of charity care and a broad scope of services for a vulnerable patient population. The results may be used in the development and implementation of future services to meet the needs of the medically underinsured.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241304143"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccine Hesitancy Affecting Pneumococcal Vaccine Refusal in Older Adults with Morbidities.","authors":"Woothikrai Chitaree, Nida Buawangpong, Thanachat Yotruangsri, Wichuda Jiraporncharoen, Kanokporn Pinyopornpanish","doi":"10.1177/21501319241303568","DOIUrl":"10.1177/21501319241303568","url":null,"abstract":"<p><strong>Introduction: </strong>Pneumonia is a leading cause of mortality worldwide, with Streptococcus pneumoniae being the most common cause. Older adults are particularly at risk. However, vaccination rates in Thailand remain low.</p><p><strong>Objective: </strong>This study aims to examine the prevalence of vaccine refusal and its association with factors outlined in the 5C model (Confidence, Complacency, Constraints, Calculation, and Collective Responsibility) among older patients with morbidities.</p><p><strong>Setting: </strong>Study was conducted at outpatient clinic of the Department of Family Medicine, Chiang Mai University.</p><p><strong>Methods: </strong>An observational cross-sectional study. The data was collected via a self-administered questionnaire including demographic data, questionnaire in 5C model, and intention to received pneumococcal vaccine. Comparison of characteristic between vaccine refuser and non-refuser was performed by using Chi-square or a <i>T</i>-test. To explore the association between factors in 5C model and vaccine refusal, multiple logistic regression was performed with an adjustment for confounders.</p><p><strong>Results: </strong>From a total of 150 participants, the mean age was 69.8 ± 5.6 years old. Most of the patients were female (60.7%). The study found that 18% of the participants refused the pneumococcal vaccine. After adjusted for the confounders, the lower collective responsibility and confidence were significantly associated with vaccine refusal (Odds ratio 0.22 (95% confidence interval [CI] 0.06-0.74, <i>P</i> = .015) and Odds ratio 0.43 (95% CI 0.20-0.89, <i>P</i> = .024), respectively.</p><p><strong>Conclusion: </strong>Strategies to enhance confidence and address complacency about vaccines are essential for improving pneumococcal vaccination coverage. This insight can be used as a guideline and policies can be formulated which are aimed at reducing pneumococcal vaccine refusal in the older adults by enhancing communication about the benefits, efficacy, and risks of vaccines.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241303568"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}