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Karolin ME Nettelrodt,1 Ivonne Tomsic,1 Maike Stolz,2 Christian Krauth,2 Iris F Chaberny,3,4 Thomas von Lengerke1 1Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany; 2Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health, Hannover Medical School, Hannover, Germany; 3Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany; 4Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, GermanyCorrespondence: Thomas von Lengerke, Hannover Medical School, Center of Public Health, Department of Medical Psychology (OE 5430), Carl-Neuberg-Str. 1, Hannover, 30625, Germany, Tel +49 511 532 4445, Fax +49 511 532 4214, Email lengerke.thomas@mh-hannover.dePurpose: Psychosocial determinants influence healthcare workers’ compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance.Participants and Methods: N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression.Results: The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach’s α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (β = 0.301) and planning (β = 0.201) showed associations with compliance for nurses only.Conclusion: The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.Keywords: infection prevention and control, surgical site infections, compliance, nurses, physicians, capability-opportunity-motivation-behavior (COM-B) model, measurement equivalence

Tim Bartling,1,2 Carina Oedingen,1,2 Harald Schrem,2,3 Thomas Kohlmann,4 Christian Krauth1,2 1Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany; 2Center for Health Economics Research Hannover, Hannover, Germany; 3General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria; 4Department of Methods of Community Medicine, Institute for Community Medicine, University of Greifswald, Greifswald, GermanyCorrespondence: Tim Bartling, Medizinische Hochschule Hannover / Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str, 1, Hannover, Lower Saxony, 30625, Germany, Tel +49 511 532 9462, Fax +49 511 532 5376, Email bartling.tim@mh-hannover.dePurpose: Organ transplantation systems benefit from guidelines that are harmonious with the preferences of the people involved. Discrete choice experiments are useful tools for eliciting preferences.Patients and Methods: This study evaluated the preferences of patients and their relatives (n=285) to identify their priorities in organ allocation using a discrete choice experiment. In eight hypothetical allocation decisions, the participants were asked to select the candidate they considered the most suitable The candidates differed in years of life gained after transplantation, quality of life after transplantation, waiting time until transplantation, age, compliance and social support.Results: The most important aspects for setting priority in organ allocation were lack of compliance (β= − 2.5, p< 0.001) and good quality of life after transplantation (β = +1.4, p< 0.001). The lack of social support (ß = − 0.8, p< 0.05) and the more years of life gained after transplantation (β = +0.5, p< 0.001) had less but still a significant amount of influence on this decision, while the waiting list was not considered significantly important (β = 0.1, p> 0.05). The comparison of the different relations to transplantation showed that life years gained after transplantation was of high relevance to posttransplant patients (+10 years: β = +0.709, p< 0.001 / +15 years: β = +0.700, p< 0.001) and of no importance to waitlisted patients (+10 years: β = +0.345, p> 0.05 / + 15 years: β = +0.173, p> 0.05) and relatives (+ 10 years: β = +0.063, p> 0.05 / +15 years: β = +0.304, p> 0.05).Conclusion: This study provides useful insights into the unique perspective of patients and their relatives on priority-setting in the allocation of donor organs that should be reflected in improved donor organ allocation rules.Keywords: organ transplantation, health priorities, health resources, ethics, patient involvement, resource allocation, discrete choice experiment

Melanie Brinkmann, Isabell von Holt, Leonie Diedrich, Christian Krauth, Gabriele Seidel, Maren Dreier Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, GermanyCorrespondence: Melanie Brinkmann, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany, Email Brinkmann.Melanie2@mh-hannover.dePurpose: This qualitative study is part of the SIGMO study, which evaluates general populations’ preferences for colorectal cancer (CRC) screening in Germany using a discrete choice experiment. Attribute identification and selection are essential in the construction of choice tasks and should be evidence-based ensuring that attributes are relevant to potential beneficiaries and contribute to overall utility. Therefore, this qualitative study aims to identify relevant attributes characterizing CRC screening tests from the perspective of those eligible for screening in Germany.Patients and Methods: Individuals aged 50 to 60 were purposively selected. A questioning route was developed and piloted. Four focus groups (FG) (n=20) were conducted (November 2019) with two moderators and one observer each. FGs were audio recorded, transcribed, and analyzed using qualitative content analysis. Attributes were deductively assigned based on a priori identified attribute categories, and inductively derived.Results: Across FGs, 24 attributes (n=293 codes) were discussed, five of which (sedation, inability to work, transportation home, predictive values, waiting time for screening colonoscopy) were inductively derived (n=76 codes). Four attributes identified a priori were not addressed in any FG. The most frequently discussed attribute category was procedural characteristics, followed by measures of screening test validity, benefits, harms, and structural characteristics of health care. The most commonly addressed attributes were preprocedural bowel cleansing, kind of procedure, and predictive values.Conclusion: Newly identified attributes characterizing CRC screening tests from an individual’s perspective, and a priori identified attributes not addressed by any FG stress the added value of qualitative research and thereby the importance of applying a mix of methods in identifying and selecting attributes for the construction of choice tasks. This study meets the requirements for a transparent and detailed presentation of the qualitative methods used in this process, which has rarely been the case before.Keywords: focus groups, qualitative study, colorectal cancer screening, attribute identification, discrete choice experiment

Tim Bartling,1,2 Carina Oedingen,1,2 Thomas Kohlmann,3 Harald Schrem,2,4,5 Christian Krauth1,2 1Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany; 2Center for Health Economics Research Hannover (CHERH), Hannover, Germany; 3Department for Methods of Community Medicine, Institute for Community Medicine, University of Greifswald, Greifswald, Germany; 4Transplant Center Graz, Medical University Graz, Graz, Austria; 5General, Visceral and Transplant Surgery, Medical University Graz, Graz, AustriaCorrespondence: Tim Bartling, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany, Tel +49 511 532 9462, Fax +49 511 532 5376, Email bartling.tim@mh-hannover.dePurpose: The gap between the supply and demand for deceased donor organs is increasing worldwide, while patients on waiting lists for organ transplantation die. This situation requires ethical donor organ allocation rules. The patients’ perspective on donor organ allocation rules offers a highly relevant and unique perspective that may differ from the perspectives of physicians and the general public.Patients and Methods: Semi-structured telephone interviews were conducted with the regional group coordinators of the federal self-help organization for organ transplanted patients and their relatives in Germany in early 2021. Twelve interviews were conducted with patients and relatives of transplantation patients who received transplants for the affected organs including the lungs, heart, kidney, and liver. Transcripts were analyzed using the deductive framework method which was based on an earlier study. All criteria were reported following the COREQ statement.Results: Participants emphasized aspects of “medical urgency” and “effectiveness/benefit” of transplantation and associated trade-offs as well as the recipient’s responsibility for organ failure (“own fault”), the appreciation for the gifted graft and the patient’s capability of taking care of it (“appreciation/responsibility”). Patients acknowledged that urgent patients should be prioritized and they showed a clear preference toward allocation rules that strive to maximize both the life years and quality of life gained by transplantation.Conclusion: The patients’ perspective is unique in that patients agree on certain rules for allocation and share many preferences, but also have a hard time finding clear cutoff points when considering selecting a participant for allocation. Patient representatives should therefore be consulted in the debate on donor organ allocation rules.Keywords: organ transplantation, organ allocation, scarce medical resources, distributive justice, qualitative research

Background: The public generally has a positive view of colorectal cancer screening, but there is still room for improvement in participation rates. The aim of this study was to identify factors that are associated with intended and actual participation. Methods: We conducted a prospective cohort study of a random sample of insurees of the AOK (a statutory health insurance carrier) in the German federal state of Lower Saxony. 50-year-old men and 55-year-old women who were eligible for their first screening colonoscopy received a written questionnaire in June 2020, three weeks after being invited to undergo colorectal cancer screening. For those who intended to do so, we used multivariable logistic regression analysis to determine any statistical associations between sociodemographic and medical characteristics and participation rates within 30 months. Results: 82.7% of the respondents (239/298) intended to participate, and 43.3% (129/298) actually did so within 30 months. The participation rates among persons who had already decided to have a stool test or a colonoscopy were 50.7% (36/71) and 55.2% (58/105), respectively; the participation rate among undecided persons was 33.3% (19/57). The strongest association in the regression model was with an already made appointment (OR = 11.1, 95% confidence interval: [3.9; 31.8]). After exclusion of the existing-appointment variable from the regression model, living in a smaller town (OR = 2.41 [1.08; 5.35]) and a stated preference for colonoscopy (OR = 2.52; [1.20; 5.27]) were positively associated with participation. Insurees with a parent affected by colorectal cancer participated less frequently, even after adjustment for prior colonoscopies (OR = 0.31 [0.12; 0.80]). Conclusion: The wide gap between intended and actual participation implies that there is potential for improvement in the prevention of colorectal cancer, and that certain groups of people could benefit from targeted support in making their intention to undergo screening a reality. Because of the methodological limitations of this initial investigation, its findings need to be confirmed by further studies. [ABSTRACT FROM AUTHOR]