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Importance: Public trust in health experts has been decreasing leading to decreased adherence to expert recommendations. Objective: To evaluate public perceptions of conflict and uncertainty among experts in healthcare recommendations and association with decreased trust in health entities for accurate health information. Methods: Analysis of the US nationally representative Health Information National Trends Survey (HINTS 6-2022). Adults aged 18 and older were respondents to the survey (unweighted n = 5,842, representing 241 million adults). The main outcome was trust in doctors, scientists and government health agencies for health information. Analyses examined trust in experts with public perceptions of conflict about recommendations and changing recommendations. Results: There was high trust in doctors for health information (95%) versus 84% in scientists and 70% in government health agencies. Only 18% have high trust in the health information on social media. Respondents who felt expert recommendations change often were less likely to have high trust (65%) in government agencies compared to those who felt that the recommendations did not often change (82%) (p < 0.01). In logistic regressions controlling for age, sex, race, education, income and trust in social media for health information perceptions of low conflict among expert health recommendations is associated with likelihood of high trust in government health agencies (OR 2.86; 95% CI 1.96-4.15). Conclusion: The public has low trust in government health agencies and perceptions of conflict among experts over recommendations is likely playing a role in the erosion of trust in health experts.

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Context: Adolescent suicides are a significant public health concern in India and understanding the intersecting perspectives becomes imperative for the prevention of various mental health concerns. Aim: Assessing perceptions of various key stakeholders, that is, mental health experts, school and college teachers, and District Mental Health Program staff about peer-led strength building programs for suicide prevention. Settings and Design: A cross-sectional qualitative design using two Focus Group Discussions (FGDs) with mental health experts and teachers and one FGD with DMHP staff was conducted. The sample comprised 45 participants from Bengaluru urban district. Materials and Methods: The data were analyzed manually by the method of direct content analysis, and themes were determined using existing literature. Results: The teachers and the DMHP highlighted the need for an intensive training program/module that is necessary to be developed in order to train the peer leaders first. The mental health experts opined that creating a network will help in easy identification of the cases and appropriate treatment could be provided without delays. Conclusions: This study indicated that suicide is a preventable public health emergency and inaccessibility to existing as well as proper support systems was perceived as a major concern. Therefore, peer-led programs are beneficial in steering and improving help seeking behavior in suicidal adolescents.

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The use of social media has increased during the COVID-19 pandemic because people are isolated and working from home. The use of social media enhances information exchange in society and may influence public protective behavior against the COVID-19 pandemic. The purpose of this study is to identify the factors affecting public protective behavior when relying on COVID-19 pandemic-related content shared on social media. A model based on Protection Motivation Theory (PMT) was proposed and validated using a quantitative survey approach. A questionnaire was distributed to random respondents, and 488 responses were received and analyzed using Smart-PLS software. The findings showed that perceived risk, e-health literacy, public awareness, and health experts' participation influence public protective behavior when using social media to share COVID-19-relevant content. The outcomes of this study can enhance government agencies' and public health care authorities' understanding of how to use social media to raise awareness and reduce panic among the public.

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Our study analyzes the intention of Chinese health experts (health professionals and medical students) to correct health misinformation in social media. In an experimental 2 × 2 × 2 between-subjects factorial design (n = 415), we manipulated the experts' perception of the threat that health misinformation poses for online users, their self-efficacy with respect to correcting misinformation, and their self-affirmation. To select the potential influence factors, we draw on self-affirmation theory and the extended parallel process model. Results of our experiment revealed that correction intention increases if experts perceive the threat for online users as severe, believe that they are capable of countering the impact of misinformation, and have a high motivation to maintain a positive self-image of caring for others. We discuss the consequences of our findings for motivating experts to help reduce the adverse effects of health misinformation in social media.

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Although declines in intent to vaccinate had been identified in international surveys conducted between June and October 2020, including in the United States, some individuals in the United States who previously expressed reluctance said, in spring 2021, that they were willing to vaccinate. That change raised the following questions: What factors predicted an increased willingness to inoculate against COVID-19? And, to what extent was the change driven by COVID-specific factors, such as personal worry about the disease and COVID-specific misinformation, and to what extent by background (non-COVID-specific) factors, such as trust in medical authorities, accurate/inaccurate information about vaccination, vaccination history, and patterns of media reliance? This panel study of more than 8,000 individuals found that trust in health authorities anchored acceptance of vaccination and that knowledge about vaccination, flu vaccination history, and patterns of media reliance played a more prominent role in shifting individuals from vaccination hesitance to acceptance than COVID-specific factors. COVID-specific conspiracy beliefs did play a role, although a lesser one. These findings underscore the need to reinforce trust in health experts, facilitate community engagement with them, and preemptively communicate the benefits and safety record of authorized vaccines. The findings suggest, as well, the need to identify and deploy messaging able to undercut health-related conspiracy beliefs when they begin circulating.

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BACKGROUND: This study aimed to explore which measures and risk factors for a COVID - 19 infection are considered most important in the general population, health experts and policymakers and to assess the level of agreement across the groups from Austria and Germany. METHODS: A two-phased survey was conducted, participants were matched according to age and gender. Three different groups were asked which measures they considered most relevant in reducing a COVID-19 transmission, to determine which factors contribute most to the risk of disease, and to evaluate the level of agreement in the assessment of risk factor relevance for (a) the transmission of the disease and (b) the risk of a severe course of COVID-19. RESULTS: Risk factors for an infection that were selected from all three groups were immunosuppression/deficiency, cancer, chronic lung disease, smoking, age and working as a health care professional. Interrater agreement per population was only poor to slight and results were highly heterogeneous. CONCLUSIONS: Our survey shows a broad spectrum of opinions and the associated general uncertainty about the risk factors for infection and a severe course of disease across the groups. Profound knowledge of politicians and experts is of high relevance to provide the public with valid information to ensure cooperation fighting the pandemic. TRIAL REGISTRATION: https://apps.who.int/trialsearch/ (ID: DRKS00022166). Registered 15 June 2020.

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Recommendations by health experts to deal with public health emergencies are primarily guided by the principle of "saving more lives". It is unclear whether people perceive this principle as ethically more legitimate than some other principle such as "saving more life-years". Understanding the answer to this question is particularly relevant to the allocation of scarce medical resources during public health emergencies. Different principles typically lead to different allocations, and consequently have dramatically different implications as to who survives and who dies. We fielded an online randomized controlled survey experiment in the context of scarce ventilator allocation with a demographically representative sample of US adults (n = 700) from October 22 to October 30, 2020. Participants faced hypothetical situations where they had to allocate few available ventilators among several needy patients. The experiment was designed such that the allocation decision made by a participant can be used to infer the principle in line with their personal ethical values. We interpret this inferred principle as the one that the participant perceives to be most legitimate. The treatment group, but not the control group, was provided balanced information that described the ethical dilemmas faced by experts in developing ventilator allocation guidelines. Nearly half of the participants in the control group perceive saving more lives the most legitimate principle. Despite the balanced nature of the information, the perceived legitimacy of saving more lives was 7·6 percentage points higher in the treatment group. The magnitude of this impact was particularly strong among republican-leaning participants, a subgroup that has less trust in experts according to previous research. Our findings suggest that enhancing public awareness of ethical dilemmas faced by health experts can increase the perceived legitimacy of their proposed guidelines even among those with lower trust in experts.

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BACKGROUND: The attitudes towards obesity may have an important role on healthier behavior. The goal of the present study was to explore the attitudes towards obesity and to investigate how these attitudes were associated with lifestyle-changing behavior among the patients attending primary care centers, health care professionals and public health experts. METHODS: This cross-sectional survey study was performed in 10 primary care offices in different regions in Lithuania and in 2 public health institutions. Nine hundred thirty-four patients, 97 nurses, 65 physicians and 30 public health experts have filled the questionnaire about attitudes towards obesity and presented data about lifestyle-changing activities during last 12 months. The attitudes were compared between different respondent groups and factors associated with healthier behaviors were analyzed among overweight/obese individuals in our study population. RESULTS: Participants failed to visually recognize correct figure corresponding to male and female with obesity. Majority of respondents' perceived obesity as a risk factor for heart diseases and diabetes but had less knowledge about other diseases associated with weight. About one third of respondents changed their lifestyle during last 12 months. Overweight individuals with age < 45 years (OR 1.64, 1.06-2.55; p = 0.025) were more likely and those who overestimated current weight (OR 0.44, 0.20-0.96; p = 0.036) less likely to change their lifestyle. Disappointment with their current weight (OR 2.57, 1.36-4.84; p = 0.003) was associated with healthier behavior among participants with obesity. CONCLUSION: Participants had similar body size perception and knowledge about obesity. Younger age had significant association with lifestyle changing behavior among overweight individuals and disappointment with current weight among obese participants.

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BACKGROUND: There is a growing international and regional interest in Health Research Systems (HRSs) in light of a global strategy for HRS stakeholders' (HRSSHs) active involvement. HRSSHs in Palestine have rarely been investigated with regard to uncertainties. AIMS: This study aimed to analyse perceptions of HRSSHs in order to understand their roles and involvement, identify gaps, and offer policy solutions for stakeholders' engagement in the Palestinian HRS. METHODS: This qualitative study targeted three local Palestinian health sectors, government, academia, and local and international agencies. Data were collected through 52 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) and then analysed using MAXQDA 12 software. Participants and institutions were selected purposively based on a set of criteria and peer review. RESULTS: The overall HRS stakeholders' roles were unsatisfactory, with low involvement from society, the private sector, local and international sectors. The role of academia and the Ministry of Health is vital but observed moderate in health research while that of international agencies is weak due to conflicting agendas and lack of a guiding body. Most universities have poor representation in public decision-making and scarcity in health research potential and capacity. Interest-power imbalance among stakeholders is reported where political, organizational, and technical shortfalls were indicative of weak roles and low involvement, along with a lack of health research culture, structure, resources, defined roles, and network. CONCLUSIONS: Tackling the inadequate roles, interests' disparity, and poor involvement of HRSSHs is imperative for HRS strengthening. Redefining HRSSHs' roles and involving all stakeholders is key through strategic dialogue, consolidated leadership, and resource mobilization.

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BACKGROUND: In 2011, the WHO Eastern Mediterranean Region committee launched a strategy for scaling up research in the region to address the countries' health needs through formulating and analysing the National Health Research System (HRS). Stewardship comprises three functions, namely governance, policy and priorities, and is a central pillar of this system to ensure a well-organised and functioning HRS. This study aims to examine the perceptions of the HRS performers to understand these functions and to generate insights for system strengthening. METHODS: The study was carried out in Palestine, targetting three sectors in the health field, including relevant governmental health institutions, schools of public health, and major local and international health agencies. The data were collected through 52 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) with policy-makers, academics, directors, and experts. Participants and institutions were selected purposively based on a set of criteria and peer review. RESULTS: A total of 104 experts participated in the IDIs (52 participants) and FGDs (52 participants in 6 FGDs), highlighting that stewardship functions remain problematic and insufficiently performed, mainly due to a missing health research structural and regulatory framework and dispersed health research work. Despite the limited good practices, the majority of the participants described the Ethical Review and Clearance as weak due to the lack of an agreed-upon national committee and procedural quality and ethics guidelines for non-compliance. A policy or strategy dedicated to health research is lacking. The exercises of research priority-setting appear to be evolving despite the lack of consensus and the low levels of knowledge and experience in research prioritisation. Common gaps, such as weak political will and capacity support, the absence of a national unified regulating body, and the indirect effects of political conditions on strengthening the HRS as well as other sectors, also emerged. CONCLUSIONS: The stewardship functions of the Palestinian HRS remain weak along with substantial political, structural, and resources and capacity gaps. The study emphasises the imperative need to initiate strategic efforts led by the MOH and the Palestinian National Institute of Public Health alongside with other players to strengthen a national HRS through improving the stewardship functions. To achieve this, attention and support of decision-makers, involvement, mobilisation and strategic dialogue are indispensable, in order to embark on building a well-regulated and coordinated structure, operational research policy, and prioritisation of essential research.

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BACKGROUND: There is a growing demand within international health agencies to ensure health research systems (HRSs) are strengthened and well-functioning to support healthcare systems (HCSs). Understanding HRS performance through system actors is an indispensable move in analysing this system. This study aims to examine policy-makers', academics' and experts' satisfaction with overall HRS performance, while also investigating their perceptions about political will and attention towards health research. Ultimately, we want to identify gaps related to performance and generate insights on how to move forward for HRS performance strengthening. METHODS: This study was carried out in Palestine, targeting three sectors, namely government institutions, public health universities, and major local and international health non-governmental organisations (NGOs). Semi-structured, in-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with participants. The institutions from the three sectors were selected based on stated criteria and peer reviews. Data were translated from Arabic into English, transcribed, content checked by the principal investigator, imported to a software programme (MAXQDA 12), and then coded. Thematic content analysis was used. RESULTS: A total of 104 experts participated in 52 IDIs and 52 experts participated in 6 FGDs. Findings revealed three principal domains. First, the HRS in Palestine is remarkably underperforming, and the majority of experts were unsatisfied. Participants perceived the system as ineffective and inefficient, poorly managed and lacking systematic assessment. Second, the factors behind system underperformance were (1) an unstructured system and the lack of a research culture as well as of a governing body or policies; (2) health research was seen as individualistic, non-development driven and unutilised in policy decisions; and (3) considerably deficient coordination and essential resources. The third finding showed inadequate political support and engagement, which then also related to system underperformance. CONCLUSIONS: The Palestinian HRS is perceived as underperforming by health experts at different levels, where research is not on the leadership agendas. Potential actions should be taken to actively engage the state health decision-makers and inform them of the importance, uses and impacts of performance assessment. Findings urge policy-makers and legislators to build an inclusive and national body of governance with agreed strategies including fundamentally hybrid and aligned performance assessment mechanisms, such as a research observatory platform. In addition, it is recommended to establish a strategic plan to expand professionals' research awareness and abilities, as well as empower the institution's research monitoring and evaluation capacities.

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BACKGROUND: The importance of a health research system (HRS), namely an instrument for developing and enabling health systems, is increasing, particularly in developing countries. Assessing the perceptions of system performers is a necessary part of system analysis, which seeks to recognize a system's strengths and limitations aiming towards improvement. This study assesses the perceptions of policy-makers, academicians and experts regarding the HRS concept and its importance to generate insights for system strengthening. In Palestine, HRS is just emerging, helping to address the many public health-related challenges faced by the country. METHODS: The study was implemented from January until July 2016, targeting three sectors, namely relevant government institutions, schools of public health, and major local and international health agencies. Data was collected through 52 in-depth interviews and six focus group discussions (FGDs) with policy-makers, academics, directors and experts. Participants and institutions were selected based on stated criteria and peer review. Data were translated, transcribed, checked and then imported to a software program (MAXQDA 12) for thematic and content analysis. RESULTS: A total of 104 experts participated, wherein 52 were interviewed and 52 participated in the six FGDs. The HRS concept, as defined by WHO, was conceptualized differently among participants with unclear delineations between various components. Inconsistencies appeared when participants attempted to conceptualize HRS in broader contexts, though HRS goals and functions were sufficiently delineated. The majority of participants agreed that HRS correlates with notions of 'improvement' and recognized HRS 'as a significant gain'. Neglect of HRS was perceived as a big loss. CONCLUSIONS: The study revealed that the level of understanding of HRS among health experts in Palestine is inadequate and not sufficiently conceptualized for its application. Findings also underlined the need to establish a central governance coordination body that promotes HRS understanding, awareness and culture as an enabler for HRS strengthening.

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