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This special issue brings together five original research papers on chronic conditions in South Asian contexts with a view to rethink dominant discourses of risk, evidence and control surrounding the category of chronic conditions. Focusing on the multiple and contradictory (re)definitions of what counts as illness, specifically in the context of the rising burden of chronic illness, the papers in this issue deal with a range of health care practices from individual patients negotiating with 'healthy diet', to policy questions about the etiology of emerging disease burden and appropriateness of pharmaceutical interventions in 'traditional' sites of healing. While some of the chronic illnesses addressed in this special issue have received considerable attention from anthropologists (e.g. mental illness, diabetes), others, like leucorrhea have rarely been studied by anthropologists, despite the growing literature on 'chronic illnesses'. [ABSTRACT FROM AUTHOR]

Preventive health is a key, yet nascent, area in health marketing that deserves greater attention in order to fullfil its promise for improving public health. This paper aims to contribute toward this cause by developing and testing a framework for preventive health marketing. To do so, this paper employs the Health Belief Model (HBM) as a theoretical lens, health screening as a case of preventive health, and structural equation modelling on cross-sectional survey data from 326 consumers. In doing so, this paper finds that preventive health behavior (i.e., desire and intention to attend and recommend health screening) is predominantly influenced by consumers' efficacy (i.e., perceived benefits and barriers of health screening), social (i.e., subjective norm), and personal (i.e., perceived health importance), but not threat (e.g., perceived susceptibility and severity of health screening), beliefs of preventive health. This paper also finds that preventive health behavior may be significantly influenced by a number of preventive health externalities, such as affordability and cultural orientation. These findings, as a whole, contribute to a nuanced understanding of preventive health behavior for preventive health marketing. [ABSTRACT FROM AUTHOR]

Advances in technologies (e.g. smartphones, wearables) have resulted in the concept of 'self-tracking', and the use of self-tracking technologies in physical activity (i.e. fitness tracking) is on the rise. For example, many people track and monitor their fitness-related metrics (e.g. steps walked, distance ran, and calories burned) to change their behaviours or keep themselves active. Despite the widespread application of self-tracking in fitness, relatively little is known about its drivers and outcomes. To address this gap, the current paper provides an overview of the literature (empirical papers) on self-tracking with a focus on the drivers and outcomes of fitness tracking behaviour and offers four important contributions. First, it identifies 19 drivers of fitness tracking technology usage. Second, it discusses four main outcomes of fitness tracking behaviour. Third, by drawing on the existing studies conducted across various fitness tracking technologies (e.g. fitness trackers, apps) and user groups (e.g. patients, seniors, and females), it provides valuable insights that can be generalisable to other settings (e.g. other types of users and fitness tracking products). Finally, the current paper provides important practical implications and addresses avenues for future research. [ABSTRACT FROM AUTHOR]

Native residents are indispensable participants in developing and conserving the natural environment. Specifying the factors that lead to responsible behavior among the local people can help increase sustainability. This paper aims to investigate the pro-environmental behavior among the local residents of the Kashmir region defined by the components of Theory of Planned Behavior (TPB) and Value Belief Norm (VBN) Theory. To analyze the data, Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) has been used as research methods. The results reveal that the three components of TPB (general environmental attitude, subjective norms, perceived behavior control) have a positive and significant impact on the pro-environmental behavior of residents. Moreover, the findings also demonstrate that the factors of VBN (altruistic, egoistic and biospheric values) significantly influence the general environmental attitude which in turn impacts the pro-environmental behavior of local residents. The paper seeks to contribute to the existing literature by adding local community insights based on the explanations given by socio-psychological theories within the context of natural environment. The study will help policymakers to understand better the residents' intentions and pro-environmental behavior so that they can develop strategies to manage and combat the environmental problems. [ABSTRACT FROM AUTHOR]

The words used to refer to weight and individuals with large bodies can be used to reinforce weight stigma. Given that most previous research has examined preferred terminology within homogenous groups, this research sought to examine terminology preferences across populations. This paper reports on data gathered with the general public, family physicians, and obesity researchers/practitioners. Participants were asked about the words they commonly: (1) used to refer to people with large bodies (general public); (2) heard in their professional contexts (physicians and obesity specialists); and (3) perceived to be the most socially or professionally acceptable (all samples). Similarities and differences were evident between samples, especially related to weight-related clinical terms, the word fat, and behavioral stereotypes. The results provide some clarity into the differences between populations and highlight the need to incorporate use of strategies that may move beyond person-first language to humanize research and clinical practice with people with large bodies. [ABSTRACT FROM AUTHOR]

Increases in the numbers of older adults with mental health and substance use concerns compel us to identify best practices in training to address these issues. Senior Centers are an ideal location for behavioral health education programs as they are the go-to place for many older adults. This paper describes an online certificate program in Behavioral Health and Aging offered by the Center for Aging and Disability Education and Research at Boston University School of Social Work in collaboration with the National Council on Aging to increase senior center staff knowledge and skills. A total of 228 senior center staff in Illinois, Florida, and Wisconsin completed the online certificate program. There were statistically significant changes in key competencies for all courses based on pre-post assessment. We held key informant interviews to assess the impact of training and participants stated that their knowledge, skills, and behaviors were influenced by the program. [ABSTRACT FROM AUTHOR]

Systems designed with persuasive software features can influence users to adopt attitudes and/or behaviours that contribute to better health outcomes. Studies on Coronary Heart Disease (CHD) interventions have shown how they can be used to support lifestyle changes. Meta-analytic reviews of randomised controlled trials (RCTs) are needed to appraise, summarise, and show their effects on health. To this end, we investigated the effectiveness of digital health interventions (DHI) designed for CHD and examined the impact of persuasive features in the DHIs. We performed a systematic search using three academic databases for scientific papers on CHD and digital interventions from 2010 to 2020, yielding 1556 papers. The systematic review and meta-analysis included 12 RCTs after screening. Our findings show that digital health interventions had an impact on diastolic blood pressure, systolic blood pressure, low-density lipoprotein, high-density lipoprotein, total cholesterol, glycated haemoglobin, glucose, triglyceride, heart rate, and depression but not body mass index. We present effective interventions and insights into persuasive software features that were associated with effective DHIs. More research is needed to investigate the effectiveness of persuasive features in other contexts and other factors that can impact the effectiveness of DHIs. [ABSTRACT FROM AUTHOR]

Health behavior has a substantial impact on health conditions. Illness prevention through good health behavior is the most economical and effective health protection strategy. From an institutional standpoint, while endowment insurance systems have been widely recognized as an important means of promoting individual's health and heightened by the current aging population situation, empirical analyses of whether and how endowment insurance affects health behavior are still limited. This paper uses China Family Panel Studies data from 2010 to 2020 to verify the relationship between the two. The results reveal that endowment insurance systems with different security levels have diametrically opposite effects on the behavior of the insured. Mediating effect analysis shows that the effect of basic endowment insurance is channeled by enhancing individuals' awareness of health risks, while the effect of supplementary endowment insurance is achieved by guiding residents to devote more time to work. In addition, the impact of the endowment insurance system is heterogenous over age, economic conditions and place of residence. This study uncovers the novel relationship between endowment insurance and health behavior and adds to the theoretical understanding of health behavior from the perspectives of policy feedback and behavioral public management. [ABSTRACT FROM AUTHOR]

The article presents the discussion on improving emotional well-being in older adults. Topics include seeking to understand mental health needs of veterans across mental health conditions; and examining innovative interventions using novel approaches such as mindfulness, meditation, nature, performance art, and visual art.

Background: Youth alcohol use and misuse lead to adverse outcomes. However, the literature has not always associated complete abstinence with better health. Since recent literature indicates an increased proportion of young abstainers, the aim of this paper is to review the studies investigating this upward trend and the factors associated with it, such as socio-demographics, school performance, social life, physical and mental health, and parental influence. Methods: Different databases were searched and appropriated terms were used. Given that the trend has only emerged in recent years, the review was limited to papers published since 2000. A total of 970 papers were returned and 10 were retained for the present review. Results: All papers covered by the review acknowledge the existence of a new significant trend resulting in more young people in developed countries who are choosing to abstain completely from drinking alcohol. They are in good physical and mental health and perform better at school than their drinking peers. The quality of their social life, albeit slightly more limited than that of their drinking peers, appeared to be good. Conclusion: Young alcohol abstainers represent a group situated at the beginning of a continuum of alcohol consumption, they do well and are not very different from light drinkers. Alcohol abstinence at young age does not seem to have any downsides and should therefore be generally advised. To further promote such behavior, measures to encourage parental monitoring and more generous public expenditure on health services and family benefits should be encouraged. [ABSTRACT FROM AUTHOR]

This review tested the use of psychological theories for predicting seasonal influenza vaccination behaviour among adults with a health condition (for which the vaccine is clinically indicated). Ovid (1946–August 2018), Embase (1974–August 2018), CINAHL (1958–August 2018) and PSYCInfo (1986–August 2018) databases were searched. Studies drawing upon a psychosocial or psychological theory to explain seasonal influenza vaccination behaviour among adults with a high-risk health condition were eligible for inclusion. Papers were systematically extracted by title, abstract and full text. Quantitative and qualitative studies were included, and all papers were quality assessed. A total of 4840 papers were identified after removal of duplicates. Twelve papers were retained in the narrative synthesis. Studies were conducted across a range of high-risk condition populations and most (83.3%) were cross-sectional. The Health Belief Model (HBM), the model of Psychological Flexibility, The Health Action Process Approach and House's Framework of Social Support were applied. Ten out of 12 papers (83.3%) drew on the HBM. There was evidence of an association between HBM perceived benefits, perceived barriers and vaccination behaviour, although there were inconsistencies across studies. This review highlighted the need for further research, particularly prospective studies of high methodological quality. [ABSTRACT FROM AUTHOR]

Inadequate sleep is an on-going risk to the health and mission readiness of U.S. Armed Forces, with estimates of sleep problems high above U.S. civilian populations. Intervening early in the career of active duty Air Force personnel (or "Airmen") with education and the establishment of healthy behaviors may prevent short and long term-detriments of sleep problems. This paper describes the results of a qualitative study seeking to understand the facilitators and barriers to achieving good sleep in a technical training school during the first year of entry into the United States Air Force. Using the social ecological framework and content analysis, three focus groups with Airmen were conducted to explore themes at the individual, social, environmental, and organizational/policy level. Overall, results indicated a cohort motivated to achieve good sleep, and also struggling with a number of barriers across each level. This paper highlights opportunities for population health interventions during technical training aimed at supporting Airmen in developing healthy sleep behaviors early in the course of their career. [ABSTRACT FROM AUTHOR]

The burden of malnutrition experienced globally, coupled with the increasing rate of micronutrient deficiencies, compromises the health and well-being of women during their reproductive years. Obesity places young South African women at particular risk during pregnancy, and increases obesity risk for their offspring. To address these risks, the Bukhali trial is being implemented in Soweto, South Africa with 18–28-year-old women, as part of the Healthy Lifestyle Trajectory Initiative. A dietitian is part of the Bukhali intervention team (community health workers) to provide nutritional support for overweight/obese trial participants, making use of the International Federation of Gynaecology and Obstetrics (FIGO) Nutrition Checklist. This paper reflects on the experiences and lessons learned by the Bukhali dietitian, including the use of the FIGO Nutrition Checklist and Healthy Conversation Skills to facilitate conversations about making healthy dietary behaviour changes. Identified challenges that influence nutrition and behaviour are discussed, including lack of food affordability, cultural and social influences on healthy food choices, unsupportive environments and food insecurity. Strategies to optimise this nutritional support are also mentioned. The Bukhali trial is showing that introducing additional nutrition support by a dietitian for at-risk participants has the potential to encourage young women to prioritise nutrition and health, even in the midst of contextual challenges to both nutrition and health. [ABSTRACT FROM AUTHOR]

Sustainable Development Goals (SDGs), 17 of which all nations of the world are targeting to achieve by 2030, are essential for a sustainable future. Two key aspects pertaining to good health and well-being, responsible production and consumption are integral to SDGs. Adoption of technologies like artificial intelligence and big data, presented by the fourth industrial revolution, can facilitate achieving these goals and also help establish a circular economy. In this paper, we study the concerns related to the security, privacy and confidentiality of personal information of patients in an Electronic Health Information Exchange (EHIE) System. This system helps achieve the two SDGs mentioned above and is linked to the adoption of green recovery efforts. The Antecedent, Privacy-Concern and Outcomes Micro Model (APCO) and the Theory of Planned Behaviour (TPB) are used in this study to develop testable hypotheses which have been corroborated through a survey. Aadhar Card based Medical Records EHIE, which the Government of India is planning to implement by 2030, has been taken as the case study. Adoption behaviour of the EHIE System is validated through this study. Three hundred fifty-seven responses across a wide range of demographic participants were received. The structural equation modelling technique (PL-SEM) was used to validate the hypotheses. This study has found that the EHIE System has a positive impact on the intention of citizens to use EHIE for exchange of health information. [ABSTRACT FROM AUTHOR]

The physical health of individuals with severe mental illness (SMI) is generally far worse than the general population. Emerging electronic and mobile health (e-& mHealth) technology may provide new ways to offer interventions in order to reduce modifiable lifestyle risk factors in this vulnerable population. This scoping review aimed to assess the state of knowledge about the use of e-& mHealth technology-based interventions to address modifiable lifestyle risk factors amongst individuals with SMI. EMBASE, Medline (Ovid) and PsycINFO were searched to identify papers published up to July 2021. Extended PRISMA guidelines for scoping reviews were followed to report the results. A total of 85 papers were identified, of which 10 met the inclusion criteria. These interventions were effective in bringing about positive and clinically significant impacts in weight loss, diet, smoking cessation, and physical activity for some participants. However, many participants did not experience these benefits. Overall, participants indicated that they were satisfied with, and receptive to e-& mHealth interventions. The evidence base for the use of technology-based interventions to improve modifiable lifestyle risk factors for people with SMI is very limited. More rigorous research on the use of technological tools is needed to determine how more users could benefit from them. Further research and intervention development should be undertaken in collaboration with people with SMI to ensure that unique requirements and preferences are included. What is already known about this topic: The rates of mortality for individuals with SMI are several times those of the general population. Reducing the major modifiable lifestyle risk factors for noncommunicable diseases (NCDs) among those with SMI is crucial. The use of emerging e-& mHealth technologies could expand the reach of services to improve modifiable lifestyle risk factors among this population. What this paper adds: More studies are currently required to build on the current evidence base regarding the feasibility and effectiveness of e-& mHealth technology to improve the modifiable lifestyle risk factors of those with SMI. Emerging research on the use of e-& mHealth technology to improve modifiable lifestyle risk factors of those with SMI looks promising. Findings from research can inform the design of future health interventions targeting this vulnerable patient population. [ABSTRACT FROM AUTHOR]

Unhealthy lifestyle behaviors such as spending too many hours sitting and inadequate physical activity (PA) can contribute to different chronic diseases. Research has revealed the capabilities of digital technology interventions such as persuasive technologies (PTs) for providing health support and encouraging healthy behavior changes to assist people in preventing chronic diseases and having healthier lifestyles. Thus, the use of mobile technology to deliver PT interventions has dramatically increased, especially for promoting PA and reducing sedentary behavior (SB) by employing various persuasive strategies (PSs). This paper provides a systematic review of 16 years of research from 2006 to 2021. The review aims to (1) explore the various ways each strategy is implemented on mobile-based PTs for PA and SB, (2) evaluate the effectiveness of different ways of implementing the PSs on mobile-based PT interventions for PA and SB, (3) provide a comparison of the different ways of implementing each PS, (4) show the weaknesses and strengths of the interventions based on the strategies and implementations, (5) highlight the limitations and pitfalls of the existing research, and (6) give recommendations and directions for future research. [ABSTRACT FROM AUTHOR]

Patient engagement is currently considered the cornerstone of a revolution in healthcare for its positive impact on health outcomes, health behaviors and healthcare costs. Patient engagement is focused on personalized care to consumers through providing knowledge, skills and confidence. Mobile health (mHealth) applications are an innovative means to facilitate patient engagement. Nevertheless, the extent to which the current mHealth applications are designed to engage patients in managing their chronic diseases is unclear. This paper aims to identify the Persuasive System Design (PSD) features present in current mHealth applications that increased the engagement of patients with chronic diseases. This review also aims to identify patient engagement-related outcomes of these features. This paper conducted a systematic literature review and meta-analysis to find relevant studies published from all years up to 2020 through six databases: PubMed, Scopus, Web of Science, Cinahl plus with full text, MEDLINE with full text, and Cochrane Library (Central register of controlled trials). The database search returned 4939 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 13. A qualitative content analysis was performed to identify PSD model features and their patient engagement-related outcomes. The quality assessment has been done through the Cochrane Risk of Bias tool for RCTs. The systematic literature review and meta-analysis identified eleven PSD features that can increase patient engagement through using mHealth applications. The identified PSD features have been shown to have various patient engagement-related outcomes. Behavior Change Techniques (BCTs) were combined with the identified PSD features. This paper identified persuasive features of mHealth application design that influence the engagement of patients with chronic diseases toward changing their behavior. The impact of these features is also analyzed in this review. The results show that an mHealth technology-mediated patient engagement model is needed. [ABSTRACT FROM AUTHOR]

Breastfeeding has many known benefits, but rates vary globally. We propose two main reasons why psychological theory and interventions have not been successful to date in explaining breastfeeding behaviours. Specifically, prior research underestimates the importance of (1) specific emotions and (2) wider injunctive influences (i.e., societal and moral norms about what women feel they ought to be doing) in the breastfeeding experience. Therefore, we conducted a systematic review of quantitative, qualitative, and mixed-methods studies that explored whether injunctive norms and/ or specific emotions are associated with breastfeeding behaviours (i.e., intentions, initiation and duration). Seventy-two papers were included in this review; data were extracted and quality appraisals conducted for all included studies. A meta-analysis of effect sizes was performed with the quantitative data. A convergent qualitative synthesis of the data was conducted, resulting in the following line of argument: Breastfeeding is a social behaviour and not a personal/individual behaviour. From this line of argument, three themes with associated sub-themes were developed, highlighting the importance of both specific emotions and injunctive norms on breastfeeding behaviours. These influences are discussed in relation to both theoretical and practical implications, as well as future research. [ABSTRACT FROM AUTHOR]

To examine the effects of an Arabic smartphone application on adherence to home exercise programs (HEPs) and the effectiveness of mobile-based HEPs on pain, physical function, and lower-limb muscle strength among older women with knee osteoarthritis (OA). This randomised control trial (ClinicalTrials.gov: (NCT04159883) enrolled 40 women aged ≥50 years with knee OA who were randomised into the app group (experimental; n = 20) receiving HEPs using an Arabic smartphone application called "My Dear Knee", whereas the paper group (control; n = 20) receiving HEPs as hand-outs. Both groups had the same exercise program. Outcome measures were self-reported adherence, changes in the Arabic Numeric Pain Rating Scale, the Arabic version of the reduced Western Ontario, McMaster Universities Osteoarthritis Index-Physical Function subscale, and Five-Times Sit-To-Stand Test scores. All participants were assessed at baseline, at week 3 and week 6. Using completer-only analyses, the repeated measures ANOVA was used to compare the means of the outcome measures between the two groups. At the end of week 6, the app group reported greater adherence to HEPs (p =.002) and significant reduction in pain (p =.015). A smartphone application with motivational and attractive features could enhance adherence to HEPs in this patient cohort. Older adults with knee OA may face many obstacles that prevent or limit their adherence to the prescribed HEP. Smart device apps supported with attractive and motivational features could be an effective strategy to enhance adherence to HEPs among older adults with knee OA. Using such remote technology appears to overcome the barriers that may limit the ability of older women to receive supervised physical therapy in a clinical setting. [ABSTRACT FROM AUTHOR]

This paper sets out the Collaborative Service Design Playbook, to guide planning, design, and implementation of co-created health services. Successful health service development and implementation is best guided by theoretically informed approaches; however, organisations often lack design and implementation know-how and have difficulty applying it. This study seeks to improve health service design and potential for scale-up by proposing a tool to guide an end-to-end process, drawing together service design, co-design, and implementation science; and exploring the tool's feasibility to establish a sustainable service solution developed with participants and experts that is scalable and sustainable. The Collaborative Service Design Playbook phases include, (1) Define the opportunity and initiatives, (2) Design the concept and prototype, (3) Deliver to scale and evaluate; and (4) Optimise to transform and sustain. This paper has implications for health marketing through providing an end-to-end approach with phased guidance for health service development, implementation, and scale up. [ABSTRACT FROM AUTHOR]

This paper explores racial differences in maternal risk factors associated with adverse pregnancy outcomes across urban and rural geographies using 2019 data from the Behavioral Risk Factor Surveillance System. Bivariate chi-square tests and logistic regression were performed which showed statistically significant geographical differences among Non-Hispanic (NH) Black pregnant women across income levels (p =.016) and perceived health status (p =.003). Regression analyses indicated an increased racial gap between NH White pregnant women and other racial/ethnic groups. The findings support that there are statistically significant racial differences in maternal risk factors across urban and rural geographies for NH Black and Hispanic pregnant women. [ABSTRACT FROM AUTHOR]

Physical activity is the most important lifestyle factor to contribute to a healthy early life. International recommendations are that children should be vigorously physically active for at least 1 h per day, and in Greenland, authorities have claimed a goal of being the world's most active population. Since 1994, the Health Behaviour in School-aged Children (HBSC) has measured physical activity among school-children in Greenland by questionnaire data, but the measurement properties of self-reported data in comparison to more objectively measured accelerometer data are unknown. The present paper describes the first study using clinical measures of physical activity among Greenlandic youth. Seventy-two school-children (56% girls) with a mean age of 12 years (range 25%; 75% was 11.5; 12.25) wore accelerometers for seven consecutive days, and data produced significant and informative findings for both practice and future research. Fifty-two per cent of the school-children met the international recommendations of being physically active >1 h per day, when measured by accelerometers, but self-reported data reported a prevalence of 10% meeting the recommendations. A majority of this sample of Greenlandic school-children lives up to international recommendations, which indicates that the goal of being the world's most active population is within reach. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic and resultant lockdown and containment measures have instigated substantial changes in our daily lives and have affected many people's mental health. This paper reports two studies exploring gender-based differences with regard to the impact of COVID-related confinement on individuals' self-efficacy to regulate negative emotions (RESE-NE) and anxiety. Methods: Study 1 (cross-sectional; 269 participants; 52% women) explored the evolution of RESE-NE and anxiety. To this end, participants assessed their status at two time points: a retrospective assessment of the period before confinement in Spain, and a current assessment during confinement. Study 2 (longitudinal; 114 participants; 72.2% women) explored the evolution of the variables by adding a post-confinement time point and analyzed the mediating role of RESE-NE in the positivity–anxiety and resilience–anxiety relationships. Results: The results confirmed that: (a) RESE-NE decreased and anxiety increased more among women than among men during confinement (Study 1); (b) women recovered their pre-pandemic levels of mental health more slowly than did men following confinement; and (c) the mediating role of RESE-NE could be observed in the two relationships under analysis. Conclusion: In practical terms, the research highlights the need to pay special attention to women undergoing mental health interventions related to the COVID-19 pandemic, as well as to the differential burden that the pandemic may entail for men and women and to the contrasting social roles traditionally attributed to them. From the gender differences identified, it is possible to infer how stereotypes and social roles influence the behavior and mental health of men and women, leading them to cope differently with stressful situations such as confinement. [ABSTRACT FROM AUTHOR]

To systematically identify, evaluate, and synthesise the qualitative literature on the self-care behaviours, skills, and strategies performed by individuals with spinal cord injury (SCI). The Joanna Briggs Institute (JBI) meta-aggregation method was followed. The search was conducted on five databases and limited to papers published from January 2000 to March 2020. Two independent reviewers screened, extracted the data from, and assessed the methodological quality of selected papers using the JBI qualitative assessment and critical appraisal instrument. Eleven qualitative papers were included. Three synthesised findings with a moderate level of confidence emerged from 90 findings: people with SCI perform self-directed or directed-by-other behaviours focused on their physical condition (i); and on their social life (ii); people with SCI perform self-directed behaviours focused on their emotional well-being (iii). Individuals with SCI are aware of their condition and incorporate self-care behaviours into their routine to maintain health and prevent complications. This meta-synthesis provides evidence on the self-care behaviours performed by people with SCI to prevent, control, and manage the physical, emotional, and social effects of their condition. These findings may help healthcare providers to understand the self-care process in SCI survivors and tailor educational programmes to their experiences. SCI survivors are directly responsible for their health and must reach their maximum level of independence by acquiring self-care behaviours and adjusting them over time. Self-care behaviours must be incorporated into SCI survivors' daily routine to maintain their condition, promote their social participation, and prevent complications. Caregiver contributions to self-care should be given more value, as these are fundamental to maintain SCI survivors' well-being and social participation. [ABSTRACT FROM AUTHOR]

This paper uncovers the complexity of the term "Jian kang/health 健康" and "Fu/wellbeing (福)" by analysing their etymological origins and cultural connotations in the context of China. The paper introduces a Taoist philosophy of tradition to understand health and wellbeing. This paper argues that in Chinese cultural connotations, "Jian kang" (health) and "Fu" (wellbeing) entail the integration of human beings' physical and mental status and beyond. Notwithstanding the contextual and culturally specific philosophy and traditions of understanding health and wellbeing, this paper initiates intercultural epistemological dialogue, engages with contemporary psychotherapy, and argues that health and wellbeing is regarded and understood as a concept across cultural boundaries, while emphasising its pivotal features of being holistic, comprised of multifaceted and interrelated components of body, mind, and spirit, focusing on lifestyle behaviours, and recognising the interweaving relationship between human and the environment. [ABSTRACT FROM AUTHOR]

Access to clean and functional toilet is quintessential in meeting children's physiological and psychosocial needs in a learning environment. However, little is known on experiences of children's access to quality toilets while in preschool institutions within urban settings of sub-Saharan Africa countries. This paper draws from a study that explored experiences of vulnerable children in early childhood development education (ECDE) institutions in underserved and informal urban settings of Kenya and South Africa. 11 urban ECDE centres were purposively selected and 17 teachers were recruited as key informants. Data was collected using an adapted infrastructural checklist, observation and conversational interviews. Findings indicated that a majority of toilets in ECDE centres were inadequate, inappropriate, poorly maintained, or had structural weaknesses which affected children's experiences of access and use of the facilities. Scheduled toilet visits as a control measure and toilet avoidance potentially exposed them to psychosocial and health risks. Insights into children's toilet facilities, managing their access in institutions located within informal and low resourced areas, and investment policies that target preschool children' sanitary facilities are given. Suggestions are made for interventions for children's positive toilet experiences in poor urban areas. [ABSTRACT FROM AUTHOR]

In some countries, far-reaching 'lockdown' measures to contain the spread of coronavirus were implemented early in 2020. In Austria, these early measures were met with a high degree of compliance among the country's population. In this paper, we draw upon qualitative interviews, and ask how people made sense of the restrictions imposed during the first lockdown in April 2020 and what shaped their compliance. Empirical research has so far tried to explain compliance by means of people's disposition and motivations as well as demographic and social characteristics. Instead of focussing on who is compliant, we aim to understand how people practice compliance. We do this by approaching compliance through the concepts of values and practice. First, our findings indicate that people assess whether measures are suitable and legitimate in relation to the values of science, the law, and morality. Second, people assign additional personal value to compliance by stressing its positive implications on their own lives. By adopting a nuanced perspective on compliance as inextricably linked to peoples' values and practices, our paper critically contributes to the political and scholarly discussion of pandemic public health measures. Understanding compliance through the lens of values shows how people make sense of the measures in the context of their everyday lives, helping us to move away from a binary understanding of (non-)compliance that has become morally charged. [ABSTRACT FROM AUTHOR]

Risk perceptions are key constructs in some theories of health behavior. A tripartite model of risk perception, the TRIRISK model, was developed to assess deliberative, affective, and experiential components of risk perception. The current paper attempts to replicate the factor structure of the TRIRISK measure for cancer and extend the structure to respiratory illness. Participants 18 or older were recruited using an address-based sample in New York State to participate in a Web-based survey. We employed the TRIRISK questionnaire with respect to cancer and respiratory illness. Confirmatory Factor Analyses were conducted in Mplus to validate the TRIRISK model in our sample. TRIRISK model fit across demographic and behavioral groups was tested using multiple-group models. Of the 704 people included in the analysis, the mean age of participants was 46.9, the majority reported being female (58.5%), and most were White (81.7%). For cancer and respiratory illness, items loaded on the respective constructs as expected. Overall, the TRIRISK model framework fits well across differing subgroups, suggesting that this is a valid model of risk perception to use in a general population sample. These results provide further evidence that the TRIRISK model is a good model to use for risk perceptions in tobacco control research. The TRIRISK model can be used to communicate risk to encourage positive health behaviors among most sociodemographic groups. [ABSTRACT FROM AUTHOR]

Health care providers have highlighted the need for tools and resources that support promotion of exercise behavior within comprehensive multiple sclerosis (MS) care. This study involved a final quality improvement evaluation of exercise promotion models and materials for inclusion within this setting. Our research team distributed a paper-based survey containing Likert scales, open answer questions, and copies of the models for editing. We distributed this survey among health care providers across the United States. We conducted a novel mixed-methods analysis evaluating quantitative, qualitative, and creative data. We received completed surveys from 13 health care providers who strongly rated the clarity and applicability of the models and materials, and reported that no major improvements were necessary. The minor improvements were specific per comprehensive MS care center. The feedback indicated that the "Exercise in Medicine" models and materials are guides such that the processes should be integrated into real world practice by amending roles and responsibilities with the team members and structure per comprehensive MS care center. This paper presents finalized models and materials for exercise promotion within comprehensive MS care that are ready to be tested for feasibility and efficacy in a clinical trial. Health care providers require support to promote exercise within the context of comprehensive MS care. The practice models in this article provide guides regarding how to promote exercise in this context. Implementing these exercise promotion guides can reduce the burden of neurologists, and ensure patients receive exercise support from appropriate providers. These guides should be implemented within the context of each individual care center, and not as an explicit step by step guide as each care center is unique. [ABSTRACT FROM AUTHOR]

In the United Kingdom, people with non-white ethnicities are more likely to report being in worse health conditions and have poorer experiences of healthcare services than white counterparts. The voices of those of Black ethnicities are often merged in literature among other non-white ethnicities. This literature review aims to analyse studies that investigate Black participant experiences of primary care in the UK. We conducted a systematic literature review searching Medline, Web of Science, EMBASE, SCOPUS, Social Policy and Practice, CINAHL plus, Psych INFO and Global Health with specific search terms for appropriate studies. No publish date limit was applied. 40 papers (39 articles and 1 thesis) were deemed eligible for inclusion in the review. A number of major themes emerged. Patient expectations of healthcare and the health seeking behaviour impacted their interactions with health systems in the UK. Both language and finances emerged as barriers through which some Black participants interacted with primary care services. (Mis)trust of clinicians and the health system was a common theme that often negatively impacted views of UK primary care services. The social context of the primary care service and instances of a cultural disconnect also impacted views of primary care services. Some papers detail patients recognising differential treatment based on ethnicity. The review included the voices of primary care professionals where descriptions of Black patients were overwhelmingly negative. Views and experiences of Black groups may be radically different to other ethnic minorities and thus, should be teased out of broader umbrella terms like Black and Asian Minority Ethnic (BAME) and Black Minority Ethnic (BME). To address ethnicity-based health inequalities, culturally sensitive interventions that engage with the impacted community including co-designed interventions should be considered while acknowledging the implications of being racialised as Black in the UK. [ABSTRACT FROM AUTHOR]

In the past decade, Non-Communicable Diseases (NCDs) have become a highly visible public health issue in Senegal. In the absence of adequate and affordable care, people diagnosed with NCDs seek to manage their symptoms through the adoption of healthy diet. However, in households built on collective eating, dietary change is extremely challenging. Drawing on participant observation, biographical interviews, and focus groups with women in six households in the Dakar suburb of Pikine, this paper presents a relational analysis of the reception and translation of dietary advice within low-income households. Women diagnosed with chronic disease strategically 'bracketed' advice that was not possible to enact, prioritised collective transformation over individual change, and valued consumption that demonstrated 'respect' and solidarity over 'healthy eating'. I show that relational approaches open up new intervention and health promotion strategies for the prevention and management of Non-Communicable Diseases outside of the global North. [ABSTRACT FROM AUTHOR]

Office well-being aims to explore and support a healthy, balanced and active work style in office environments. Recent work on tangible user interfaces has started to explore the role of physical, tangible interfaces as active interventions to explore how to tackle problems such as inactive work and lifestyles, and increasingly sedentary behaviours. We identify a fragmented research landscape on tangible Office well-being interventions, missing the relationship between interventions, data, design strategies, and outcomes, and behaviour change techniques. Based on the analysis of 40 papers, we identify 7 classifications in tangible Office well-being interventions and analyse the intervention based on their role and foundation in behaviour change. Based on the analysis, we present design considerations for the development of future tangible Office well-being design interventions and present an overview of the current field and future research into tangible Office well-being interventions to design for a healthier and active office environment. [ABSTRACT FROM AUTHOR]

This paper focuses on an innovative approach to preparing children and young people, with Spina Bifida, to move from child-centered to adult-oriented healthcare systems. Reflecting on our role in delivering a national nurse led service, we set to identify and critique international transition tools in use for this population. Specifically, we aimed to identify the core capabilities and indicators of progression to successful transition, so that holistic interventions could be planned to match the needs of individuals and their carers. There were two phases to the study, initially focusing on a systematic literature review on transition tools and the specific items that these tools captured, including skills, abilities and behaviors. Phase two culminated in the articulation of a segmented and incremental "road map", aligned with facets deemed essential for a successful healthcare transition. The reporting of the literature review (phase one) followed the PRISMA guidelines and shaped the qualitative element of the study (phase two) through the use of semi-structured interviews and thematic analysis. The search strategy yielded 11 studies, which were then manually searched for other relevant literature, adding a further 14 articles. The review analyzed 7 specific tools for spina bifida and 8 generic tools, which were deemed appropriate for this group of patients. A comprehensive list of core capabilities was then articulated and framed to fit a progression timeline. Specific interventions were formulated to explore ways to co-produce resources that could enhance and support a planned transition to adult-focused services. Our proposed mapping of capabilities and progression could shape other transition programs, where nurses work collaboratively with young people, carers and other members of a team. More work is needed to further explore and embed the framework that, as we did, could be digitized and shared with all stakeholders involved in the transition process. [ABSTRACT FROM AUTHOR]

There is strong evidence of the impact of opinion leaders in health promotion programs. Early work by Burke-Garcia suggests that social media influencers are the opinion leaders of the digital age as they come from the communities they influence, have built trust with them, and may be useful in combating misinformation by disseminating credible and timely health information and prompting consideration of health behaviors. AI has contributed to the spread of misinformation, but it can also be a vital part of the solution, informing and educating in real time and at scale. Personalized, empathetic messaging is crucial, though, and research supports that individuals are drawn to empathetic AI responses and prefer them to human responses in some digital environments. This mimics what we know about influencers and how they approach communicating with their followers. Blending what we know about social media influencers as opinion leaders with the power and scale of AI can enable us to address the spread of misinformation. This paper reviews the knowledge base and proposes the development of something we term "Health Communication AI" – perhaps the newest form of opinion leader – to fight health misinformation. [ABSTRACT FROM AUTHOR]

There is a growing focus on developing person-adaptive strategies to support sustained exercise behaviour, necessitating conceptual models to guide future research and applications. This paper introduces Flexible nonlinear periodisation (FNLP) – a proposed, but underdeveloped person-adaptive model originating in sport-specific conditioning – that, pending empirical refinement and evaluation, may be applied in health promotion and disease prevention settings. To initiate such efforts, the procedures of FNLP (i.e., acutely and dynamically matching exercise demand to individual assessments of mental and physical readiness) are integrated with contemporary health behaviour evidence and theory to propose a modified FNLP model and to show hypothesised pathways by which FNLP may support exercise adherence (e.g., flexible goal setting, management of affective responses, and provision of autonomy/variety-support). Considerations for future research are also provided to guide iterative, evidence-based efforts for further development, acceptability, implementation, and evaluation. [ABSTRACT FROM AUTHOR]

Many psychological inclinations, such as maladaptive beliefs, can diminish the capacity of individuals to manage their weight effectively and sustainably. Yet, interventions that purportedly address these psychological inclinations and improve weight management are not always beneficial. To be effective, these interventions should offer participants several choices, should be devoid of features that have not been validated in isolation, and should arrange the various activities in an efficient and effective sequence. Few if any programs fulfill these criteria. The aim of this paper was to construct an intervention that assimilates all the validated features of interventions that overcome the psychological impediments to weight loss. To achieve this goal, we blended a technique called intervention component analysis with thematic analysis. Specifically, we extracted refereed journal articles about weight loss from PsycInfo, distilled the practical recommendations from these articles, excluded recommendations that had not been validated in isolation of other features, integrated overlapping recommendations, and applied several principles to arrange these recommendations into the most effective sequence. This procedure generated an intervention that could comprise up to 43 features and activities, including self-affirmation to foster openness to change, anecdotes about dramatic improvements, ambitious rather than modest targets, an emphasis on strategies rather than targets, rewards for attempts, implementation intentions with partners, self-hypnosis, cognitive reframing, and distancing. If these features are unsuccessful, practices that demand more resources—such as group disclosure, virtual environments, motivational interviewing, and customized programs—were also recommended. [ABSTRACT FROM AUTHOR]

Existing studies that explore the effects of education on health primarily focused on developed countries, and the extent to which education impacts health is still highly debated. This paper studies the causal effects of education on health in the largest developing country-China. We use 1977 Resuming College Entrance Exam Policy as an IV and find that education has little impact on health in general, while our findings suggest that people with higher education are more likely to be diagnosed with hypertension. We also test some possible mechanisms through which education might affect health, including smoking, drinking, exercise, and cognition. Majorities of these estimations provide no evidence that education would impact health behaviors or cognitive abilities. However, we find that higher-educated men are more likely to drink more and exercise less. [ABSTRACT FROM AUTHOR]

Sun protection behavior can reduce skin cancer risk. This paper provides an overview of skin cancer risk and the complex behavioral options for sun protection, along with a narrative review of research on determinants of, and interventions to promote, sun protection. Gaps and opportunities for future research are also outlined. Evidence supports the effectiveness of sunscreen use, ultraviolet (UV) protection clothing, and shade seeking. However, these behaviors are complex and are often performed in ways that are inadequate for sun protection. Most research examining and targeting determinants of sun protection behavior has focused on sunscreen use, to the exclusion of other strategies, and has largely ignored the complexity of even sunscreen use. Most research and interventions are theory- driven, drawing on social cognitive constructs, but also considering self and social identity and emotion. Multilevel perspectives considering context, environment, policies, and other structural contexts have also been applied to sun protection behavior, but there is a need to combine psychological constructs with factors at other levels to optimize predictive models and intervention effectiveness. Effective sun protection effectively involves complex behaviors and perceived and actual tradeoffs that should be considered, in combination with multilevel determinants, in research predicting and promoting sun safety. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the author discusses articles within the issue on topics including self-disgust in adolescence, health behaviors and health benefits in individuals with social, emotion and mental health difficulties, and experience of young people of isolation rooms/booths in mainstream secondary schools in the United Kingdom (UK).

Objectives: This paper seeks to: provide an overview of the impacts of and responses to the spread of COVID-19 in Ireland; assess the vulnerability of the population living in rural areas to COVID-19; compare the health status of male farmers to underlying medical conditions frequently associated with those experiencing the worst impacts of the illness; and assess the implications of COVID-19 for farmers living alone and farm households with children. Methods: We present an overview of the impact and response to COVID-19 through the use of public health statistics and reference to policy documents. We subsequently draw on the results of ongoing geographic and health research to present an overview of the impacts and potential implications of COVID-19. Results: The population of many rural areas and farmers in particular are highly vulnerable to adverse outcomes to COVID-19 infection. Single person farm households are at particular risk of isolation, whilst those families with children are at increased risk of stress. Conclusions: There is an urgent need to address both COVID-19 challenges and the health and wellbeing issues confronting farmers and farm families arising out of the current pandemic by supporting these populations adopt and sustain health behaviour changes, improve their wellbeing and develop the resources that support resilience. [ABSTRACT FROM AUTHOR]

Conceptually anchored on lived religion, this paper explores the meanings and experiences of health, illness, and healing among Filipino migrant women in Japan as they intersect with their religion. Likewise, it explores the functions and limitations of religion as migrant women face physical and mental health problems caused by work, marital status, and/or dislocation. Using biographical interviews and ethnography, this paper suggests that religion serves as a material and symbolic resource for making sense of health, illness and healing. As a material resource, it offered tangible, informational, and emotional support. It can however become limiting when personalised meanings and practices of religion frame illness based on morality, promote health misinformation, and delay healing and other health-seeking behaviours. Nonetheless, healing as perceived and experienced by Filipino migrant women involves lived religion in their complex meaning making and negotiated in terms of its physiological, spiritual and emotional effects. [ABSTRACT FROM AUTHOR]

Background: The network approach has recently been introduced to clinical psychology and provides a powerful framework for analyzing variables in a system. Since then, its applications have rapidly spread to various fields of social sciences. Unlike in the case of clinical psychology, the peculiarities of the phenomena under study in social sciences have not received sufficient attention. In this paper, along with practical illustrations, we discuss what a system of psychological variables represents and what the interrelationships between the variables mean in the context of health behavior research. Additionally, we explore the structural analysis of the system which has not been the focus of the recent applications of network analysis in health psychology. Discussion: In this paper, we illustrate two approaches of incorporating observable behavioral variables in a system and strategies for investigating structural components of the system. We illustrate these two approaches with an analysis of cross-sectional data on adolescents' beliefs and behavior with respect to registering their choice regarding organ donation in the Netherlands. Furthermore, with this paper, we wish to facilitate a larger discussion on conceptualizing networks of psychological variables, which will guide the analysis and the interpretation of node level interactions as well as network level structures. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to update and enhance the 1989 Association for Health Education (AAHE) Scholar presentation, Reflections on Directions in Health Education: Implications for Policy and Practice, at the American Association for Health Education (AAHE) National Convention in Boston. It describes and complements the notion of shifting health from one based on disease and a medical model by advancing our understanding that many premature deaths are preventable and by noting the importance of risk factors with behavioral influences as an important component. However, while recognizing the importance of individual responsibility and personal behavior, it labels the shift to focusing on individual health behaviors as "micro myopia" and highlights several negative implications. It also suggests using a macro approach on a population level that may be equal or more effective and efficient. Recognizing the value and need to incorporate both micro and macro approaches, this article suggests the use of a social ecological model for health promotion that takes into consideration public policy, community, institutional, interpersonal and intrapersonal factors. Health educators should consider utilizing an ecological approach in both practice and professional preparation. As in the 1989 paper, the goal is to stimulate thought and discussion. [ABSTRACT FROM AUTHOR]

Background: This paper draws on a longitudinal study exploring the outcomes of an arts referral programme in General Practice in the South West of England since 2009. It focuses on the qualitative responses of the patient cohort Methods: Using qualitative methods and thematic analysis, this paper explores and considers the responses from n = 1297 participants who provided feedback from an open-ended questionnaire on self-reported benefits of the arts referral programme. Results: Participant reactions demonstrate that the programme provided a range of personal and social benefits rarely considered or explored in comparative studies. The analysis suggests participants were able to self-manage aspects of their health-related conditions, and were able to make progress towards a better physical and/or mental health. Conclusions: The evidence suggests that arts-based referral programmes, have a range of benefits for participants that may not have been fully appreciated. The consequences on self-management requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Congenital heart disease is the most common birth defect in the world. Medical advancements in pediatric cardiac surgery have led to an increased number of adults with congenital heart disease (ACHD). PA was discouraged for ACHD patients in the past however, today it is strongly encouraged for this population to remain active. Unfortunately, ACHD patients tend to be sedentary, which can be detrimental to their health, even more so than healthy adults. Purpose: This paper explains that ACHD patients may experience different types of factors that prevent PA behavior and may vary in their ability and desire to engage in regular PA. This paper also discusses how integrating the Social Ecological Model and Transtheoretical Stage of Change Model can be applied as a framework to better understand ACHD patients' PA behavior. Translation to Health Education Practice: The integration of these two models can help us gain a better understanding of the various factors that influence PA behavior at different levels of motivation. This paper is important for Health Education professionals as it could facilitate the development of targeted interventions designed to increase PA behavior for ACHD patients. [ABSTRACT FROM AUTHOR]

Persuasive gamified systems are effective tools for motivating behaviour change using various persuasive strategies. In line with the reinforcement theory, some persuasive gamified systems employ reward and punishment in their design to achieve the intended behavioural outcome. Research has argued both in favour and against using these strategies in behaviour change applications due to mixed results with respect to their effectiveness. However, there is a lack knowledge about how interventions using these strategies could motivate or demotivate behaviours. Therefore, this paper explores the mechanism through which Reward and Punishment motivate or demotivate behaviours with respect to their strengths and weaknesses. The results of large-scale exploratory studies (N = 1768) uncover important strengths and weaknesses that could facilitate or hinder the effectiveness of Reward and Punishment at motivating behaviour change. These include their ability to engage users and make behaviour fun, reinforce commitments to goals, and reveal some consequences of bad behaviour. We also compared the perceived effectiveness of reward and punishment quantitatively. [ABSTRACT FROM AUTHOR]

In Vanuatu, the use of the terms such as ʻmen who have sex with menʼ (MSM) and ʻtransgenderʼ has increased over the past decade. This paper draws on twenty months ethnographic research in Port Vila, the country's capital, to analyse what happens on the ground when MSM and transgender categories are taken up to identify people or to narrate the self. The focus is on who uses these terms, in what ways they are experienced, and what is rendered visible (or not) by their use. This research departs from approaches framing ʻnon-heteronormativeʼ categories as related solely to gender and sexuality. It argues that MSM and transgender categories are used in various ways to refer not only to sexual practices and/or gender identity, but also to health risk behaviours, transactional sex and LGBT rights advocacy. The analysis offered suggests we view MSM and transgender categories as technologies that, depending on the interactional context, contribute to bureaucratic tasks or to maintaining or, on the contrary, changing established socio-political relations. [ABSTRACT FROM AUTHOR]

Entertainment-education has been touted as a potent delivery channel for health education campaigns. Yet, there is little evidence of its causal effects. This paper aims to fill the gap in the literature by using a field experiment in India to study two questions on the efficacy of health entertainment-education. First, can health entertainment-education, particularly through films that show role models and draw on emotions, lead to lasting, positive change in health knowledge and behavior? Second, can financial incentives for ex-post health literacy boost the effectiveness of health entertainment-education? The results show that health entertainment-education successfully increased health knowledge (e.g. knowledge about cleanliness and hygiene) by 16 percent. These gains persist almost one year later, although there were no observed impacts on health behaviors. Further, financial incentives do not appear to have any effects. These insights contribute to our knowledge of what works for health education in low-income settings, so that future education campaigns can be crafted with more meaningful impact. [ABSTRACT FROM AUTHOR]

There are conflicting theories about the best ways to support behaviour in schools. This paper captures the perspectives of UK primary school staff regarding the advantages and disadvantages of different behaviour support approaches, in addition to exploring the facilitators and barriers to adopting relational-based approaches. Virtual semi-structured interviews were conducted with 15 school staff across three mainstream primary schools. A reflexive thematic analysis identified nine themes. Participants commented on the approaches' flexibility, familiarity, positive long-term behaviour change and emotional wellbeing and relationships. Key facilitators to adopting relational-based approaches included: whole-school training and understanding; quality and type of training; and working together and feeling supported. Key barriers included: changing perspectives; ease of implementation and familiarity; scarcity of resources; and persevering in the face of difficulties. Themes are discussed in light of psychological research and implications for educational practitioners and future research are considered. [ABSTRACT FROM AUTHOR]

For people with disordered eating, support groups can play an important role in treatment and recovery journeys. Such resources became crucial during COVID-19, as people with disordered eating reported increased isolation, symptomology, and decreased treatment access. This study examines participants' experiences of nine, rolling, clinician-led, free, virtual support groups for disordered eating. Participants (207 attenders and 70 nonattenders (individuals who signed up for groups and never attended)) completed an online survey. Codebook thematic analysis of open response items generated topics and themes including: reasons for signing up ("community connection and seeking support," "filling a treatment gap," "behavior and support changes due to COVID-19"), barriers to participation ("interpersonal dynamics," "accessibility factors," "group structure"), and benefits of attending group ("feeling less alone," "identifying new treatment needs," "coping skills and reduction of symptoms"). Participants discussed lack of accessible, identity-aware treatment options outside of these groups, particularly for those with minoritized identities. This paper highlights the role of groups in participants' eating disorder recoveries and explores how virtual clinician-led support groups fit into the constellation of eating disorder care that increasingly includes virtual resources. Group psychotherapy specialists could consider bringing skills to facilitate spaces for community-based healing to complement conventional treatment approaches. [ABSTRACT FROM AUTHOR]