Chiara Gasteiger, P.h.D. is a SPARQ Postdoctoral Scholar in the Mind & Body Lab, led by Associate Professor Alia Crum. Chiara's doctoral thesis explored how the transition to biosimilars can be improved, with a focus on optimising patient-practitioner communication and the involvement of companions (support people).
Chiara’s research aims to understand how the social environment influences the development of mindsets and how psycho-social forces can be harnessed to optimise people's mindsets about illness and improve health outcomes. She is also interested in understanding how changes in subjective mindsets can alter physiological mechanisms. Her other academic interests include patient-practitioner communication, patient expectations, funding and resource allocation in health and understanding how patients utilise social networks to cope with, manage and make sense of their illness.
Doctor of Philosophy, University of Auckland (2023)
Master of Health Psychology, University of Auckland (2019)
Alia Crum, Postdoctoral Faculty Sponsor
Rheumatology Patients' Experiences of a Mandatory Nationwide Transition to an Adalimumab Biosimilar.
ACR open rheumatology
Transitions to biosimilars are common to reduce the cost burden of biologics. While brand changes can be daunting for patients, few studies have explored patients' experiences with the transitioning process. This study examined rheumatology patients' experiences with a mandatory nationwide brand change to an adalimumab biosimilar.People with rheumatic diseases involved in the adalimumab transition in Aotearoa New Zealand completed a nationwide online survey. Participants (n = 117, 48% with rheumatoid arthritis) reported their satisfaction with the biosimilar, logistics and supply, information and communication, and availability of support. They also reported what did and did not go well during the transition and provided recommendations for future transitions.The mean [SD] satisfaction score with the transition was 6.2 [3.2] on a 0-10 scale, with 10 indicating high satisfaction. Participants were the least satisfied with the support and information from patient support organizations, and training for the device during the transition. Participants were most satisfied with the biosimilar supply, support from pharmacists, and how early they were informed before the transition occurred. After the transition, participants were less satisfied with the device quality, patient support program, biosimilar safety and efficacy, and the provision of alcohol wipes and sharps bins (p < 0.05 for all). Satisfaction with training for the biosimilar device (B = .25, p = .036) predicted overall satisfaction. Participants appreciated less injection pain and the ease of the biosimilar device. The lack of alcohol wipes and loss of the bio-originator support program were viewed negatively.Future biosimilar transitions should ensure the availability of alcohol wipes, sharps bins, and a comparable patient support program. Patient support organizations could be involved in providing information to patients about the change.
View details for DOI 10.1002/acr2.11634
View details for PubMedID 37994689
Community-based support to improve mental health and wellbeing in older sexually and gender diverse people: a scoping review.
Aging & mental health
This scoping review seeks to identify what community-based support is used by older sexually and gender diverse (SGD) people, that aims to improve mental health/wellbeing.A scoping review was conducted using the Arksey and O'Malley framework. APA PsycInfo, Embase, MEDLINE, PubMed, and Scopus were searched. Key information was extracted and entered into a structured coding sheet before being summarized.Seventeen studies were included (41% observational qualitative and 35% observational quantitative). The most commonly used community-based support was lesbian, gay, bisexual and transgender (LGBT) social groups. A range of practices were reported in five studies, including in SGD affirming religious congregations and mind-body practices. Two studies reported the use of formal programmes, with one based on a group initiative. Positive outcomes included feeling connected, improved social support and mental health, and coping with illness. Five studies reported null or negative findings, including a lack of acceptance. Most studies used categories for sex and gender inaccurately, and lacked detail when describing community-based support.The use of community-based support by older SGD people is underexplored. More interventions designed for and by this community are needed, along with experimental research to draw conclusions on effectiveness to improve mental health or wellbeing.
View details for DOI 10.1080/13607863.2023.2269097
View details for PubMedID 37855436
Health Care Providers' Experiences of a Mandatory Nationwide Transition to an Adalimumab Biosimilar.
ACR open rheumatology
Transitioning patients to biosimilars has become common to reduce costs and improve access. However, it is unclear how the transition process impacts health care providers at the frontline of the brand change. This study explores health care providers' experiences of a mandatory brand change to an adalimumab biosimilar.A cross-sectional study was conducted in Aotearoa New Zealand with 164 providers involved in the nationwide adalimumab brand change. Rheumatologists (n = 39), rheumatology nurses (n = 16), and pharmacists (n = 109) completed a survey that assessed their satisfaction with logistics and supply, information and education, support, and administrative workload and reported what did and did not go well during the transition.The mean satisfaction score (0-10) with the transition was 5.7 (SD = 2.6). Providers were the least satisfied with training for the biosimilar device, information from government agencies, and administrative workload during the transition. Satisfaction with adalimumab safety, efficacy and device quality, and the availability of sharps bins, alcohol wipes, and patient support was lower following the transition. Satisfaction with administrative workload (B = 0.37, P < 0.001) and training for the device (B = 0.20, P = 0.020) predicted overall satisfaction. Providers reported that a poorly implemented initial authorization process, loss of a patient support program, and insufficient communication between providers complicated the transition. The citrate-free preservative and longer authorization duration after the transition were viewed positively.Providers experienced an increased workload and reported less satisfaction with the biosimilar following the transition. Experiences may be improved by ensuring training for the device, a high-quality patient support program, and functioning authorization processes throughout the transition.
View details for DOI 10.1002/acr2.11617
View details for PubMedID 37779361
The mode of delivery and content of communication strategies used in mandatory and non-mandatory biosimilar transitions: a systematic review with meta-analysis.
Health psychology review
2023; 17 (1): 148-168
Effective patient-provider communication is crucial to promote shared decision-making. However, it is unclear how to explain treatment changes to ensure patient acceptance, such as when transitioning from a bio-originator to a biosimilar. This review investigates communication strategies used to educate patients on transitioning to biosimilars and explores whether the willingness to transition and treatment persistence differs for the delivery (verbal or written) and the amount of information provided. MEDLINE, Embase, Scopus, and relevant conference databases were systematically searched. Communication strategies from 33 studies (88% observational cohort studies) published from 2012 to 2020 were synthesized and willingness to transition, persistence, and subjective adverse events explored. Patients only received information verbally in 11 studies. The remaining 22 studies also provided written information. Cost-saving was the main reason provided for the transition. Patients were most willing to transition when receiving written and verbal information (χ2 = 5.83, p = .02) or written information that only addressed a few (3-5) concerns (χ2 = 16.08, p < .001). There was no significant difference for persistence or subjective adverse events (p's > .05). Few randomized controlled trials have been conducted. Available data shows more willingness to transition when patients received written and verbal information. Initial documents should contain basic information and consultations or telephone calls used to address concerns.
View details for DOI 10.1080/17437199.2021.1970610
View details for PubMedID 34409923
Using family-centered communication to optimize patient-provider-companion encounters about changing to biosimilars: A randomized controlled trial.
Patient education and counseling
2023; 106: 142-150
To explore whether family-centered communication impacts decisions and optimizes patient-companion-provider consultations.A parallel, two-arm randomized controlled trial was conducted with 108 participants acting as patients with inflammatory arthritis or companions. Pairs attended a mock consultation where a physician explained the change from a bio-originator to a biosimilar using family-centered or patient-only communication. Participants reported their willingness to transition, risk perceptions, understanding and social support, and completed various scales including the Patient Perception Scale. Interviews helped understand perceptions towards the consultation.Family-centered communication did not impact willingness to change or cognitive risk perceptions compared to patient-only communication. However, it improved emotional risk perceptions (p = 0.047, Cohen's d=.55) and satisfaction with communication (p = 0.015, Cohen's d=.71). Feeling the explanation was reassuring was associated with less worry (p = 0.004). Receiving emotional support (p = 0.014) and companions asking fewer questions (p = 0.046) were associated with higher recall. The intervention improved companion involvement (p < 0.001, Cohen's d= 1.23) and support (p = 0.002, Cohen's d=.86). Interviews showed that encouraging questions, inclusive body language, and acknowledging companions facilitated involvement.Family-centered communication augments patient-companion-provider encounters but does not influence willingness to change treatment.Practitioners can use family-centered communication when discussing biosimilars but should provide reassurance, encourage emotional support, and summarize key points to improve understanding.
View details for DOI 10.1016/j.pec.2022.11.006
View details for PubMedID 36400636
Pharmacists' confidence in explaining biosimilars to patients before a nationwide medicine change: A cross-sectional study.
Exploratory research in clinical and social pharmacy
2022; 8: 100199
Biosimilars can improve patient access to biological medicines. Although biosimilars have been shown to be equally effective and safe, some patients remain reluctant to transition to biosimilars. Pharmacists may support patients changing to biosimilars and are often at the frontline for dealing with queries and concerns, but their confidence and readiness for this role are unclear.This study examines pharmacists' confidence in explaining biosimilars to patients and explores the information they would provide in response to common queries.Practicing community, hospital, and primary care pharmacists (N = 142) in New Zealand completed an Internet-based survey on their experience and familiarity with bio-originators and biosimilars, attitudes and concerns towards biosimilars, confidence in explaining key concepts, and responses to common queries. A hierarchical linear regression was conducted to examine possible factors associated with confidence in explaining biosimilars, and a content synthesis was conducted to examine responses to common patient queries.Pharmacists were most confident in explaining how biosimilars are administered, their efficacy, and cost-saving, and least confident in describing manufacturing and testing. Respondents who had more positive attitudes (B = 1.64, p < .001) and more familiarity with biosimilars (B = 27.15, p < .001) were more confident in educating patients. Pharmacists' main concerns about biosimilars included reduced efficacy, safety, and a lack of knowledge and acceptance. Responses to common queries were diverse but further highlighted several gaps in knowledge. Gaps included being unable to define biosimilars, provide information on side effects, and believing that biosimilars undergo the same testing process as bio-originators. Pharmacists wanted resources (written and Internet-based) to improve their knowledge and ability to educate patients.Pharmacists reported a lack of knowledge and confidence in explaining manufacturing processes and testing of biosimilars. Additional resources are needed to support their practice and may help improve patient and companion acceptance of biosimilars.
View details for DOI 10.1016/j.rcsop.2022.100199
View details for PubMedID 36386274
View details for PubMedCentralID PMC9649382
A bio-what? Medical companions' perceptions towards biosimilars and information needs in rheumatology.
2022; 42 (11): 1993-2002
Patient perceptions influence biosimilar uptake in non-mandatory transitions. Companions (support people) are often actively involved in the patient's medical journey and are likely to have unique perceptions of biosimilars, which may shape patient attitudes. This study explores the congruence between patient and companion perceptions towards biosimilars and their information needs. Patients taking bio-originators for rheumatic diseases (59% for rheumatoid arthritis) and their companions received an explanation about biosimilars. Participants (N = 78) completed questionnaires assessing their familiarity with biosimilars, perceptions, concerns, and benefits of being accompanied. Contingency tables and paired sample t-tests were used to explore differences in familiarity, confidence in knowledge, and perceptions. Intra-class correlation coefficients were calculated to assess the degree of congruence for perceptions towards biosimilars. Companions were significantly less familiar with biosimilars (p = 0.014, Cramer's V = 0.28) and reported lower confidence in their knowledge (p = 0.006, Cohen's d = 0.47) than patients. Companions and patients had moderate to good congruency for perceptions toward confidence in biosimilar use and safety, efficacy, and side-effect expectations (intra-class correlation coefficients ranging from 0.75 to 0.81). Companions and patients were most concerned about safety and effectiveness. Companions also reported concerns about cost savings driving the transition, while patients had concerns about uncertainty and testing. Patients reported the ability for discussion, improved understanding, and validation as benefits of being accompanied. Companions and patients have similar levels of perceptions and expectations towards biosimilars but report some unique information needs. Future educational interventions should involve companions and address their concerns to help improve biosimilar acceptance.
View details for DOI 10.1007/s00296-021-05037-5
View details for PubMedID 34705051
View details for PubMedCentralID 8421278
Moving forward: Implementing health psychology research to improve patient acceptance of biosimilars.
Research in social & administrative pharmacy : RSAP
2022; 18 (10): 3860-3863
As more biosimilars enter the pharmaceutical market, patient acceptance remains a significant barrier to their uptake. Psychological factors, such as negative expectations, are important causes of patient hesitancy. As a result, patients can develop nocebo responses following a transition, discontinue biosimilar treatment early, or have poor adherence. These negative outcomes may offset some of the cost-saving potential of biosimilars. Key healthcare professionals such as pharmacists, physicians, and nurses already play a noteworthy role in educating and transitioning patients. However, given the psychological aspect of biosimilar acceptance, it is logical for healthcare professionals and researchers to draw on research and theory from health psychology. This commentary outlines how a multidisciplinary approach can add to the understanding of the mechanisms behind patient resistance to biosimilars and help engage patients in the transitioning process. It also explores how health psychology strategies that have been successful in similar areas can be translated to help conduct more effective transitions. Future directions in research are discussed.
View details for DOI 10.1016/j.sapharm.2022.03.009
View details for PubMedID 35339394
Characteristics associated with the willingness to receive a COVID-19 vaccine and an exploration of the general public's perceptions: A mixed-methods approach.
2022; 40 (25): 3461-3465
Demographics and media discourse impact vaccine hesitancy. We explored the New Zealand public's perceptions of COVID-19 vaccines and associated media portrayal, and determined predictive factors associated with willingness to receive vaccines. A community cohort (N = 340) completed online surveys. A logistic regression explored whether characteristics predict willingness to receive the vaccine. Textual data were analysed thematically. Willingness to receive the vaccine was high (90%). Having a postgraduate degree (p =.026), trying to receive an influenza vaccine (p <.001) and fewer concerns (p <.001) predicted willingness. Health keyworkers (p <.001) were less willing. Participants wanted the vaccine for protection and returning to normality. Reasons against receiving vaccines regarded safety, efficacy, and an unclear roll-out plan. The media was reported to generally provide good/positive coverage, but also engage in unbalanced reporting and spreading misinformation. Education strategies should include collaborations between media and scientists and focus on distributing easy-to-access information. Health keyworkers should be reassured of testing/safety.
View details for DOI 10.1016/j.vaccine.2022.04.092
View details for PubMedID 35562194
View details for PubMedCentralID PMC9068660
Is Three a Crowd? The Influence of Companions on a Patient's Decision to Transition to a Biosimilar.
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine
2022; 56 (5): 512-522
Involving patients in treatment decisions is commonplace in healthcare, and patients are frequently accompanied by a companion (support person). Companions are often actively involved in medical consultations, yet their impact on decisions to change medications is unknown.This study examines the influence of companions on a patient's decision to transition from their bio-originator therapy to a biosimilar.A parallel, two-arm randomized controlled trial was conducted with 79 patients taking a bio-originator for rheumatic diseases who regularly attend clinic with a companion. Patients were randomized to receive an explanation about a hypothetical transition to a biosimilar alone or with their companion. Patients reported willingness to transition, risk perceptions, difficulty understanding, social support, and completed the Decisional Conflict Scale and Satisfaction with Decision Scale.Companions did not influence decisions to transition to biosimilars or cognitive and affective risk perceptions. Accompanied patients reported more difficulty understanding the explanation (p = .006, Cohen's d = .64) but thought it was more important to receive information with companions (p = .023, Cohen's d = -.52). Companions did not impact decision satisfaction or decisional conflict. Receiving emotional, but not practical support, was associated with less decisional conflict in accompanied patients (p = .038, r2 = 0.20).The presence of companions does not seem to influence risk perceptions or decisions about transitioning to biosimilars. Companions, however, impact the patient's reporting of their ability to understand treatment explanations. Providers should check understanding in all patients but may need to provide additional time or educational resources to accompanied patients and companions.Australian New Zealand Clinical Trial Registry: ACTRN12619001435178.
View details for DOI 10.1093/abm/kaab082
View details for PubMedID 34453530
The more the merrier! Barriers and facilitators to the general public's use of a COVID-19 contact tracing app in New Zealand.
Informatics for health & social care
2022; 47 (2): 132-143
Contact tracing for infectious diseases can be partially automated using mobile applications. However, the success of these tools is dependent on significant uptake and frequent use by the public. This study explored the barriers and facilitators to the New Zealand (NZ) general public's use of the COVID-19 contact NZ COVID Tracer app. Adults (≥18 years, N = 373) in NZ. Qualitative and quantitative data were gathered from a nation-wide online survey. App use and frequency of use were presented as descriptive statistics. Qualitative data were analyzed thematically. 31% reported using the app frequently, 24% used it sometimes, 21% had installed but not used it, and 24% had not installed it. Barriers to use include technical issues, privacy and security concerns, forgetfulness and a lack of support from businesses. The perceived risk of contracting COVID-19, government recommendations and communications, and the importance of contact tracing facilitated use. Technical, user, business, and government factors influenced the public's use of a COVID-19 contact tracing app. The development of apps requiring minimal user effort and initial user testing may improve uptake. Enabling environments and better risk communication may improve uptake of similar community-driven contact tracing apps during future pandemics.
View details for DOI 10.1080/17538157.2021.1951274
View details for PubMedID 34260338
Predictors of parental stress from admission to discharge in the neonatal special care unit.
Child: care, health and development
2021; 47 (2): 243-251
Exacerbated parental stress during a stay in the neonatal intensive care unit can negatively impact the development of the hospitalized infant, strain the dyadic relationship and put parents at risk for poor mental health. It is therefore important to identify risk factors of stress throughout the duration of a hospitalization. This longitudinal study aimed to investigate sources of stress for mothers and fathers who had a baby in the neonatal special care unit.Parents of 57 singletons and 11 twins (68 infants) admitted to a neonatal special care unit (46% for prematurity) were recruited. Sixty-four mothers and 20 fathers were assessed at admission, and 60 mothers and 16 fathers at discharge. Participants reported their satisfaction with hospital information and completed the Perceived Stress Scale, the Brief Illness Perception Questionnaire and the Dyadic Adjustment Scale.Parents demonstrated similar stress trajectories, with stress on average declining over time. Higher maternal stress at admission was associated with a belief that the baby's illness would have a longer timeline, lower perceptions of treatment efficacy and lower satisfaction with the information received from medical staff. Younger age and lower levels of education predicted higher maternal stress at discharge. Fathers had higher stress at discharge when they were older, had a baby born at younger gestation and felt they had less control. At admission, information satisfaction was positively associated with parental beliefs about treatment efficacy and understanding the infant's condition. At discharge, information satisfaction was negatively associated with beliefs about illness severity and the likely time frame of the illness.The findings highlight that parents' perceptions of their baby's illness and treatment at admission and discharge have a significant association with stress. Clinical staff can use these factors to identify parents who are at risk of exhibiting a greater level of stress over the hospitalization period.
View details for DOI 10.1111/cch.12829
View details for PubMedID 33171525
Patients' beliefs and behaviours are associated with perceptions of safety and concerns in a hypothetical biosimilar switch.
2021; 41 (1): 163-171
Although patient acceptance is important for biosimilar adoption and reducing healthcare costs, many patients perceive biosimilars to be unsafe and have concerns about switching. Studies show that patients' characteristics influence negative perceptions toward generic drugs, but little research has explored biosimilar acceptance. This study examines which demographic and psychological characteristics are associated with patients' safety perceptions and concerns about switching to biosimilars. Ninety-six patients taking bio-originators for rheumatic conditions (65% for rheumatoid arthritis) completed the Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire and Perceived Sensitivity to Medicines Scale. Demographic factors, information seeking, concerns about switching and safety perceptions were also assessed. Pearson's correlations and hierarchical linear regressions were conducted to explore whether patient characteristics are associated with perceptions of biosimilars. Negative safety perceptions were associated with being female, short-term bio-originator use, illness beliefs, seeking health information online, high perceived sensitivity to medicines and negative beliefs about medicines. Only being female (β = 0.24, P = 0.02) was independently associated. More concerns about switching were associated with being female, illness beliefs, high perceived sensitivity to medicines, information-seeking behaviours and preferring innovator drugs. Seeking health information online (β = 0.20, P = 0.04), preferring innovator drugs (β = 0.29, P = 0.004) and stronger emotional responses (β = 0.26, P = 0.01) were independently associated. Perceived bio-originator effectiveness was inversely associated with preferring biosimilars (rs= - 0.33, P < 0.001). Patients who have stronger emotional responses to their condition, are females, seek health information online and prefer innovator drugs that have more negative perceptions about biosimilars. Experiences with bio-originators influence attitudes towards switching.
View details for DOI 10.1007/s00296-020-04576-7
View details for PubMedID 32300866
View details for PubMedCentralID 4918734
Effects of Message Framing on Patients' Perceptions and Willingness to Change to a Biosimilar in a Hypothetical Drug Switch.
Arthritis care & research
2020; 72 (9): 1323-1330
Patients often hold negative perceptions toward biosimilars that can create barriers to their uptake. Physicians also report uncertainty in how best to explain biosimilars. The aim of this study was to measure the effect of differently framed explanations on patients' perceptions of and willingness to change to a biosimilar in a hypothetical drug switch.Ninety-six patients with rheumatic diseases taking an originator biologic were randomized to receive 1 of 4 biosimilar explanations: positive framing with and without an analogy, and negative framing with and without an analogy. Willingness to switch to a biosimilar, perceptions about biosimilars, and the effectiveness of the explanation were measured after the information delivery.Positive framing led to more participants being willing to switch (67%) than negative framing (46%). Framing significantly predicted willingness to switch to a biosimilar, with participants in the positive framing group being 2.36 times more willing to switch (P = 0.041). The positive framing group also reported significantly greater perceived efficacy of biosimilars (P = 0.046) and thought the explanation was more convincing (P = 0.030). The analogy did not enhance willingness to switch or increase understanding (P > 0.05).Positive framing can improve perceptions of and willingness to switch to a biosimilar in patients currently taking biologic treatments.
View details for DOI 10.1002/acr.24012
View details for PubMedID 31233269
Predicting patient reassurance after colonoscopy: The role of illness beliefs.
Journal of psychosomatic research
2018; 114: 58-61
Failure to effectively reassure patients can lead to patients becoming distressed and seeking further medical care. Whilst existing studies have identified that patients' psychological and demographic characteristics can impact patient reassurance, little research has explored specific predictors of patient reassurance following a colonoscopy. This study investigates demographic and psychological predictors of patient reassurance after receiving normal test results following a colonoscopy.Eighty-five participants receiving colonoscopies due to gastrointestinal symptoms were recruited from two endoscopy clinics. Patients provided demographic information and completed questionnaires assessing illness perceptions, health-related anxiety, hypochondriasis, somatisation and state and trait anxiety prior to the colonoscopy, as well as reassurance the day after the colonoscopy. Seventy-three participants provided complete data and were included in the analyses. Pearson's correlations and hierarchical linear regression were conducted to examine the associations between the baseline variables and patient reassurance after the colonoscopy.Health-related anxiety, hypochondriasis and four items from the Brief Illness Perceptions Questionnaire (consequence, identity, concern, and emotional response beliefs) were negatively correlated with reassurance (r's ranged from -0.28 to -0.54, P < .05). The hierarchical linear regression demonstrated that in the fully adjusted model, only consequence beliefs (i.e. negative beliefs regarding the impact of gastrointestinal symptoms) remained a robust predictor of reassurance (β = -0.56, P = .005).This study extends existing research on patient reassurance and is the first study to demonstrate that illness beliefs predicted reassurance following a colonoscopy. These findings suggest that targeting consequence beliefs may be a useful intervention for improving patient reassurance following clinical investigations.
View details for DOI 10.1016/j.jpsychores.2018.09.009
View details for PubMedID 30314580