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Background: Systematic reviews consistently indicate that interventions to change healthcare professional (HCP) behaviour are haphazardly designed and poorly specified. Clarity about methods for designing and specifying interventions is needed. The objective of this review was to identify published methods for designing interventions to change HCP behaviour.Methods: A search of MEDLINE, Embase, and PsycINFO was conducted from 1996 to April 2015. Using inclusion/exclusion criteria, a broad screen of abstracts by one rater was followed by a strict screen of full text for all potentially relevant papers by three raters. An inductive approach was first applied to the included studies to identify commonalities and differences between the descriptions of methods across the papers. Based on this process and knowledge of related literatures, we developed a data extraction framework that included, e.g. level of change (e.g. individual versus organization); context of development; a brief description of the method; tasks included in the method (e.g. barrier identification, component selection, use of theory).Results: 3966 titles and abstracts and 64 full-text papers were screened to yield 15 papers included in the review, each outlining one design method. All of the papers reported methods developed within a specific context. Thirteen papers included barrier identification and 13 included linking barriers to intervention components; although not the same 13 papers. Thirteen papers targeted individual HCPs with only one paper targeting change across individual, organization, and system levels. The use of theory and user engagement were included in 13/15 and 13/15 papers, respectively.Conclusions: There is an agreement across methods of four tasks that need to be completed when designing individual-level interventions: identifying barriers, selecting intervention components, using theory, and engaging end-users. Methods also consist of further additional tasks. Examples of methods for designing the organisation and system-level interventions were limited. Further analysis of design tasks could facilitate the development of detailed guidelines for designing interventions. [ABSTRACT FROM AUTHOR]

Background: Knowing about predictors of attrition in a panel is important to initiate early measures against loss of participants. We investigated attrition in both early and late phase of an online panel with special focus on preferences regarding mode of participation.Methods: We used data from the HaBIDS panel that was designed to investigate knowledge, attitudes, and practice regarding infections in the German general population. HaBIDS was divided into two phases: an initial phase when some participants could choose their preferred mode of participation (paper-and-pencil or online) and an extended phase when participants were asked to become members of an online panel that was not limited regarding its duration (i.e. participants initially preferring paper questionnaires switched to online participation). Using competing risks regression, we investigated two types of attrition (formal withdrawal and discontinuation without withdrawal) among online participants, separately for both phases. As potential predictors of attrition, we considered sociodemographic characteristics, physical and mental health as well as auxiliary information describing the survey process, and, in the extended phase, initial mode preference.Results: In the initial phase, higher age and less frequent Internet usage predicted withdrawal, while younger age, higher stress levels, delay in returning the consent form, and need for receiving reminder emails predicted discontinuation. In the extended phase, only need for receiving reminder emails predicted discontinuation. Numbers of withdrawal in the extended phase were too small for analysis. Initial mode preference did not predict attrition in the extended phase. Besides age, there was no evidence of differential attrition by sociodemographic factors in any phase.Conclusions: Predictors of attrition were similar in both phases of the panel, but they differed by type of attrition (withdrawal vs. discontinuation). Sociodemographic characteristics only played a minor role for both types of attrition. Need for receiving a reminder was the strongest predictor of discontinuation in any phase, but no predictor of withdrawal. We found predictors of attrition, which can be identified already in the early phase of a panel so that countermeasures (e.g. special incentives) can be taken. [ABSTRACT FROM AUTHOR]

Background: Adolescent pregnancy remains a major global health issue, increasing the risk of complications during pregnancy and childbirth in mothers and babies. In Tanzania, adolescent pregnancy threatens girls' education and makes it difficult for them to obtain a proper job; hence, the majority fall into poverty. Previous studies have developed and conducted reproductive health education for adolescent students; however, they evaluated only the effect immediately after education. Therefore, this study investigated the effects of reproductive health education on attitudes and behaviors toward reproductive health among adolescent girls and boys one year after the intervention in rural Tanzania. Methods: A longitudinal quasi-experimental study was conducted with 3295 primary and secondary students (2123 in the intervention group, 1172 in the control group) from three purposefully selected wards in Korogwe District. In the intervention group, the students received reproductive health education. We used paper-based questionnaires to evaluate the effect of the adolescent education program on attitudes and behaviors toward reproductive health education. To analyze the association between the intervention and each outcome, mixed-effect multiple regression analyses was conducted. Results: The mean age, primary school proportion, and female proportion of the intervention and the control group was 13.05 (standard deviation (SD) 1.59), 14.14 (SD 1.7), 77.9% and 34.3%, and 54.2% and 52.6%, respectively. There was no statistically significant effect of reproductive health education on adolescent health attitudes and behaviors in the multiple regression analyses (coefficient: − 0.24 (95% confidence interval (CI): − 0.98 to 0.50), coefficient: 0.01 (95%CI: − 0.42 to 0.43)). Conclusion: A statistically significant effect of reproductive health education on adolescent health attitudes and behaviors was not found. An effective reproductive health education intervention to improve the attitude and behaviors of reproductive health among Tanzania adolescents in the long term remain to be determined, particularly in real-world settings. Trial registration The National Institute for Medical Research, Tanzania (NIMR/HQ/R.8a/Vol. IX988). Plain Language Summary: Adolescent pregnancy increases the risk of complications during pregnancy and childbirth, which could cause death among 15–19-year-old girls. In Tanzania, one in four adolescents aged 15–19 began childbearing. However, there is no officially recognized curriculum for reproductive health in schools. Additionally, cultural and traditional norms prevent parents from discussing sexuality with their children. A solution to this issue is for a third party, such as a non-profit organization, to provide adolescents with adequate reproductive health education in schools. Previous studies have developed and evaluated a reproductive health education program and found significant effects on improved knowledge and behavior among adolescent girls and boys immediately after the intervention. This study examined the effects of reproductive health education on adolescents' attitudes and behavior toward reproductive health one year after the intervention in rural Tanzania. We could not find a statistically significant effect of reproductive health education on adolescents' attitudes and behavior during a one-year period in the multiple regression analyses. These results could have been influenced by the location of the intervention, contents, period of evaluation, and other potentially unknown factors. [ABSTRACT FROM AUTHOR]

The authors provide invitation for practitioners and researchers to submit reports on the opportunities that behavioural and social sciences offer in achieving health for all. Topics mentioned include the challenge of factoring behavioural evidence into health policies and programmes, the need for global community of experts to offer easy access to evidence, tools, expertise, and examples of use, and a multidisciplinary technical advisory group for behavioural insights and sciences for health.

Background: Global culture influences health behaviors and attitudes and the way we communicate and solve problems; it can also significantly affect the efficiency of the multicultural and interprofessional healthcare team. This scoping review aims to understand and identify global cultural considerations that exist in interprofessional education (IPE) and that influence the development, implementation, and effectiveness of IPE. Methods and Findings: The search included peer-reviewed articles focused on both IPE and global culture, also referred to as national, ethnic, or racial culture. There was no limitation placed on levels of learners nor specific health professions. Articles were excluded if they did not explicitly discuss global cultural considerations in IPE. The authors screened 1094 records, and 155 full text articles were assessed for eligibility. No eligible papers were found for inclusion yielding an empty review. The most common reasons for exclusion were failure to address global culture and a focus on provider-patient cultural competency as opposed to cultural aspects of IPE. Conclusions: Despite the recognition of the importance of global culture in all interactions, it is not explicitly addressed within the interprofessional healthcare team or the development and implementation of IPE. Studies addressing culturally congruent teamwork and IPE, and the relationship to culturally inclusive patient care, are needed. [ABSTRACT FROM AUTHOR]

Objective: The Samoan community has a disproportionately higher incidence of gestational diabetes mellitus (GDM). We explored consumer and healthcare providers' insight into perceptions of risk, attitudes to lifestyle behaviour change and experiences of GDM among Australian Samoan women in South Western Sydney. Methods: Semi-structured interviews and a focus group with Samoan women recruited through three churches, a diabetes and pregnancy clinic in South Western Sydney and via social media were conducted. Semi-structured interviews with healthcare providers' were also conducted. Main themes were thematically analysed to identify recurring patterns using Quirkos software. Identified themes were framed against the constructs of the Health Belief Model. Results: One focus group (n=4) and 12 one-to-one interviews were conducted among Samoan women. Eighteen semi-structured interviews with healthcare providers' were also conducted. There was a high concordance between Samoan women and healthcare providers' regarding perception of risk and barriers to maintaining a healthy lifestyle. However, Samoan women reported negative interactions with healthcare providers' that hindered their behaviour change, while healthcare providers' reported that normalisation of diabetes, confusion of GDM with type 2 diabetes and spiritual health beliefs were deterrents to behaviour change among Samoan women. Conclusion: Cross-cultural factors can influence the uptake of a healthy lifestyle. Future research should consider use of culturally tailored strategies when developing educational resources targeting Samoan women. Implications for research, policy and practice: The participants' viewpoints expressed in this study suggest a critical need for the development of culturally-tailored health promotion strategies for Samoan women and cultural training for healthcare providers', to improve GDM care and subsequent pregnancy outcomes. What is already known about the topic? * There is limited data and research on GDM particularly among the Australian-Samoan community though the available data highlight the significant morbidity and mortality due to diabetes in this population. * Samoan women are at an increased risk of gestational diabetes mellitus. What this paper adds: * This paper provides knowledge and understanding on ways to prevent and manage GDM by investigating the perception of risk and experiences of GDM among Australian Samoan women and healthcare professionals in Sydney. * It provides current evidence base for policy makers and researchers to develop health promotion strategies and interventions that are relevant to the Samoan and other culturally and linguistically diverse (CALD) communities in Australia. [ABSTRACT FROM AUTHOR]

Children who grow up in homes affected by domestic violence and abuse (DVA) are at risk of poor outcomes across the lifespan, yet there is limited evidence on the acceptability and effectiveness of interventions for them. A recent review of child‐focused interventions highlighted a gap in understanding the factors influencing the willingness of parents and children to engage with these programmes. We conducted a systematic review of qualitative evidence on the experiences of receiving and delivering interventions with the aim of identifying factors at different levels of the social–ecological context that may influence parent and child readiness to take up interventions. We searched literature till April 2016 and found 12 reports of eight programmes. Two authors independently screened papers for inclusion, extracted data and identified the first‐ and second‐order constructs. The third‐order constructs were derived and fitted to the ecological framework to inform a picture of readiness to engage with interventions. Three key findings emerged from this review: (a) parent and child readiness is influenced by a complex interplay of individual, relationship and organisational factors, highlighting that individual readiness to take up child‐focussed interventions must be viewed in an ecological context; (b) the specific process through which women become ready to engage in or facilitate child‐focussed interventions may differ from that related to uptake of safety‐promoting behaviours and requires parents to be aware of the impact of DVA on children and to focus on children's needs; (c) there are distinct but interlinked processes through which parents and children reach a point of readiness to engage in an interventions aimed at improving child outcomes. We discuss the implications of these findings for both practice and research. [ABSTRACT FROM AUTHOR]

Background and Objective: Decision making as a basis of management is like a nervous system of an organization and crisis is effective in decision making processes. This study aimed to analysing available researches about decision making in crisis in media organizations. Materials and Methods: This systematic review was implemented from March to June 2020.English language publications (2000-2019) were filtered in databases of Willey, Elsevier, ISI, Pubmed, SCOPUS and Google Scholar search engine by combination of following Keywords:"Decision making"AND"Media"AND"Crisis"in title, abstract and keywords. Results: After searching 6155 papers and removing repeated and unrelated ones, finally 14 papers were selected for deep analysis according to items identified. Results of this systematic review indicated that following factors are effective in descion making in crisis:"Attention to time of content production, Agile organizations, Decision-making models, Method of news coverage continuation,Effects of place on crisis management ","Creating the trust, Recording experiences before during and after the crisis, Shortage of human resources in crisis, Interactive nature of social medias,Attention to panoramic dimension of the crisis, Time of the crisis, using tools of social medias and attention to new media trends". Conclusion: In health crisis (Corona Pandemic) Convincing use of communicational message by media organizations with the goal of effecting in belief, attitude and health behaviors of society is necessary.Meanwhile designing a big and panoramic picture of all related dimentions of media and health and attention to “Media litracy” and “Health litracy” of media managers besides designing and implementing researches based on descion making methods development in crisis and also benefit of other countirs experiences will leads to effective descion making in health system. [ABSTRACT FROM AUTHOR]

Background: The prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally. This systematic review aimed to determine the complementary medicine products (CMPs) used in pregnancy and/or lactation for the benefit of the mother, the pregnancy, child and/or the breastfeeding process. Additionally, it aimed to explore the resources women used, and to examine the role of maternal health literacy in this process. Methods: Seven databases were comprehensively searched to identify studies published in peer-reviewed journals (1995–2017). Relevant data were extracted and thematic analysis undertaken to identify key themes related to the review objectives. Results: A total of 4574 articles were identified; 28 qualitative studies met the inclusion criteria. Quantitative studies were removed for a separate, concurrent review. Herbal medicines were the main CMPs identified ( n = 21 papers) in the qualitative studies, with a smaller number examining vitamin and mineral supplements together with herbal medicines ( n = 3), and micronutrient supplements ( n = 3). Shared cultural knowledge and traditions, followed by women elders and health care professionals were the information sources most accessed by women when choosing to use CMPs. Women used CMPs for perceived physical, mental-emotional, spiritual and cultural benefits for their pregnancies, their own health, the health of their unborn or breastfeeding babies, and/or the breastfeeding process. Two over-arching motives were identified: 1) to protect themselves or their babies from adverse events; 2) to facilitate the normal physiological processes of pregnancy, birth and lactation. Decisions to use CMPs were made within the context of their own cultures, reflected in the locus of control regarding decision-making in pregnancy and lactation, and in the health literacy environment. Medical pluralism was very common and women navigated through and between different health care services and systems throughout their pregnancies and breastfeeding journeys. Conclusions: Pregnant and breastfeeding women use herbal medicines and micronutrient supplements for a variety of perceived benefits to their babies' and their own holistic health. Women access a range of CMP-related information sources with shared cultural knowledge and women elders the most frequently accessed sources, followed by HCPs. Culture influences maternal health literacy and thus women's health care choices including CMP use. [ABSTRACT FROM AUTHOR]

Introduction: Regular physical activity (PA) can be beneficial to breast cancer survivors, although the majority do not devote sufficient time to the practice. The long-term side effects of cancer treatment represent barriers to adopting healthy lifestyle habits. Goal: Identify factors that influence the intention to practise regular PA among breast cancer survivors. Methodology: A correlational study was conducted among my Active Health (Ma Santé Active) program participants (N = 136), using a self-administered questionnaire based on the theory of planned behaviour. Findings: Multiple regression analysis shows that attitude, perceived control, behavioural beliefs and control beliefs are the determinants of intention. Discussion and conclusion: It is recommended to design interventions based on these determinants to strengthen the behavioural intention of breast cancer survivors. The paper will also inform healthcare professionals about the intervention targets to be utilized to motivate women with a breast cancer diagnosis to engage in regular PA. [ABSTRACT FROM AUTHOR]

Social networks influence health-related behavior, such as obesity and smoking. While researchers have studied social networks as a driver for diffusion of influences and behavior, it is less understood how the structure or topology of the network, in itself, impacts an individual's health behavior and wellness state. In this paper, we investigate whether the structure or topology of a social network offers additional insight and predictability on an individual's health and wellness. We develop a method called the Network-Driven health predictor (NetCARE) that leverages features representative of social network structure. Using a large longitudinal data set of students enrolled in the NetHealth study at the University of Notre Dame, we show that the NetCARE method improves the overall prediction performance over the baseline models—that use demographics and physical attributes—by 38%, 65%, 55%, and 54% for the wellness states—stress, happiness, positive attitude, and self-assessed health—considered in this paper. [ABSTRACT FROM AUTHOR]

Introduction. Recent experiences from global outbreaks have highlighted the severe disruptions in sexual and reproductive health services that expose women and girls to preventable health risks. Yet, to date, there is no review studying the possible impact of outbreaks on sexual and reproductive health (SRH). Methodology. Studies reporting outbreaks impacting sexual and reproductive health and pregnancy outcomes were identified using MEDLINE, Embase, and ISI-WoS. Reported impacts were reviewed at systems, community, and legislative levels. Results. The initial run listed 4423 studies; the 37 studies that met all inclusion criteria were mainly from Latin America and Africa. Studies on outbreaks of diseases like Zika and Ebola have documented declines in facility-based deliveries, contraceptive use, and antenatal and institutional care due to burdened healthcare system. Service usage was also impacted by a lack of trust in the healthcare system and system shocks, including workforce capacity and availability. At the community level, poverty and lack of awareness were critical contributors to poor access to SRH services. Assessing the target population's knowledge, attitude, beliefs, and behavior and using health literacy principles for communication were fundamental for designing service delivery. Online resources for SRH services were an acceptable medium of information among young adults. In outbreak situations, SRH and pregnancy outcomes were improved by implementing laboratory surveillance, free-of-cost contraceptive services, improved screening through professional training, and quality of care. In addition, mobile health clinics were reported to be effective in remote areas. Knowledge Contribution. In outbreaks, the interventions are categorized into preoutbreak, during, and postoutbreak periods. The proposed steps can help to improve and do course correction in emergencies. Though conducted before the COVID-19 crisis, the authors believe that lessons can be drawn from the paper to understand and mitigate the impact of the pandemic on sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

Drug use is one of the global public health issues, and its accompanying disorders have consequences on people's mental, physical, and environmental health. Nevertheless, the majority of people who use drugs have never been treated for drug dependence and other health conditions whilst others discontinue their treatment for drug use disorder. Using the health belief model, the study aimed at exploring facilitators and barriers to health-seeking among people who use drugs in the Sunyani Municipality of Ghana. A descriptive study design was used, employing a qualitative approach. In-depth interviews were conducted with a total of 22 participants, including two key informants (male and female). The first group of participants was recruited from the ghetto (an area in the municipality where people who use drugs are usually located). The other group of participants was recruited using hospital-based records. The interview data were transcribed, coded, and analysed for the generation of themes with the aid of Nvivo version 12 pro. The results showed that people who use drugs face health challenges such as drug dependence, malaria, lungs and breathing complications, cardiovascular complications, and skin complications. People who use drugs experienced poor perceived quality of life and low health status. Health-seeking behaviours of interviewees were influenced by the perceived benefit, perceived severity, cues to action, among others. Multiple sources of healthcare were used by the people who use drugs. Whereas ease of communication, perceived severity, benefit, among others were facilitators to their health-seeking behaviours, cost, dwindling social support, lack of knowledge of the condition, and fear of arrest by law enforcement agencies also served as barriers to seeking healthcare at the orthodox health facilities. This paper suggests a holistic approach to help improve the health and health-seeking behaviours of people who use drugs. The researchers wish to indicate that an earlier version of this manuscript has been presented at the University of Ghana as a thesis. [ABSTRACT FROM AUTHOR]

Background: This paper compares the relationship between theoretically-driven mechanisms of change and clinical outcomes across two different interventions to improve oral hygiene of older adults participating in a group randomized trial. Methods: Six low-income senior residences were paired and randomized into two groups. The first received a face to face counseling intervention (AMI) and the second, a peer-facilitated health campaign (three oral health fairs). Both were based on Fishbein's Integrated Model. 331 participants were recruited at baseline and 306 completed the post-assessment one month after intervention. Clinical outcomes were Gingival Index (GI) and Plaque score (PS), collected by calibrated dental hygienists. Surveys obtained data on patient background characteristics and ten mechanisms of change including oral health beliefs, attitudes, norms and behaviors. GLMM was used to assess the effects of time, intervention arm, participant characteristics, intervention mechanisms and differences between the two interventions over time in relation to outcomes. Results: At baseline, both groups had similar background characteristics. Both groups improved significantly in outcomes. Overall GI scores changed from baseline mean of 0.38 (SD =.032) to.26 (SD =.025) and PS scores changed from baseline mean of 71.4 (SD = 18%) to 59.1% (SD = 21%). T-tests showed that fears of oral disease, oral health intentionality, oral health norms, worries about self-management of oral health, flossing frequency and sugar control improved significantly in both interventions from baseline to post intervention. Oral health self-efficacy, perceived risk of oral health problems, oral health locus of control and brushing frequency improved significantly only in the counseling intervention. GLMM models showed that the significant predictors of GI improvement were intentionality to perform oral hygiene, locus of control, and improvement in frequency of brushing and flossing in association with the counseling intervention. Predictors of PS improvement were worries about oral hygiene self-management and fear of oral diseases, in association with the counseling intervention. In the reduced final models, only oral health locus of control (predicting GI) and fears of oral diseases (predicting PS) were significant in association with the counseling intervention. Locus of control, a key concept in oral hygiene interventions including the IM was the main contributing mechanism for GI improvement. Fear, an emotional response, drove improvement in PS, reinforcing the importance of cognitive/emotional mechanisms in oral hygiene interventions. Conclusions: Though both groups improved in outcomes, GI and PS outcomes improved more in response to the counseling intervention than the campaign. The counseling intervention had an impact on more mechanisms of change than the campaign. Improvements in intervention mechanisms across both interventions however, suggest a closer examination of the campaign intervention impact on outcomes over time. Trial Registration: Clinicaltrials.gov NCT02419144, first posted April 17, 2015. [ABSTRACT FROM AUTHOR]

Policy PointsPreventive measures such as the national lockdown in Italy have been effective in slowing the spread of COVID‐19. However, they also had psychological and economic impacts on people's lives, which should not be neglected as they may reduce citizens' trust and compliance with future health mandates.Engaging citizens in their own health management and in the collaboration with health care professionals and authorities via the adoption of a collaborative approach to health policy development is fundamental to fostering such measures' effectiveness.Psychosocial analysis of citizens' concerns and emotional reactions to preventive policies is important in order to plan personalized health communication campaigns. Context: Because of the COVID‐19 pandemic, between February 23 and March 8, 2020, some areas of Italy were declared "red zones," with citizens asked to stay home and avoid unnecessary interpersonal contacts. Such measures were then extended, between March 10 and May 4, 2020, to the whole country. However, compliance with such behaviors had an important impact on citizens' personal, psychological, and economic well‐being. This could result in reduced trust in authorities and lowered compliance. Keeping citizens engaged in their own health and in preventive behaviors is thus a key strategy for the success of such measures. This paper presents the results from a study conducted in Italy to monitor levels of people's health engagement, sentiment, trust in authorities, and perception of risk at two different time points. Methods: Two independent samples (n = 968 and n = 1,004), weighted to be representative of the adult Italian population, were recruited in two waves corresponding to crucial moments of the Italian COVID‐19 epidemic: between February 28 and March 4 (beginning of "phase 1," after the first regional lockdowns), and between May 12 and May 18 (beginning of "phase 2," after the national lockdown was partially dismissed). Respondents were asked to complete an online survey with a series of both validated measures and ad hoc items. A series of t‐tests, general linear models, and contingency tables were carried out to assess if and how our measures changed over time in different social groups. Findings: Although sense of self and social responsibility increased between the two waves, and trust toward authorities remained substantially the same, trust in science, consumer sentiment, and health engagement decreased. Our results showed that while both the level of general concern for the emergency and the perceived risk of infection increased between the two waves, in the second wave our participants reported being more concerned for the economic consequences of the pandemic than the health risk. Conclusions: The potentially disruptive psychological impact of lockdown may hamper citizens' compliance with, and hence the effectiveness of, behavioral preventive measures. This suggests that preventive measures should be accompanied by collaborative educational plans aimed at promoting people's health engagement by making citizens feel they are partners in the health preventive endeavor and involved in the development of health policies. [ABSTRACT FROM AUTHOR]

Context: Self-report questionnaires are an important method of evaluating lifespan health, exercise, and health-related quality of life (HRQL) outcomes among elite, competitive athletes. Few instruments, however, have undergone formal characterization of their psychometric properties within this population. Objective: To evaluate the validity and reliability of a novel health and exercise questionnaire, the Trojan Lifetime Champions (TLC) Health Survey. Design: Descriptive laboratory study. Setting: A large National Collegiate Athletic Association Division I university. Patients or Other Participants: A total of 63 university alumni (age range, 24 to 84 years), including former varsity collegiate athletes and a control group of nonathletes. Intervention(s): Participants completed the TLC Health Survey twice at a mean interval of 23 days with randomization to the paper or electronic version of the instrument. Main Outcome Measure(s): Content validity, feasibility of administration, test-retest reliability, parallel-form reliability between paper and electronic forms, and estimates of systematic and typical error versus differences of clinical interest were assessed across a broad range of health, exercise, and HRQL measures. Results: Correlation coefficients, including intraclass correlation coefficients (ICCs) for continuous variables and K agreement statistics for ordinal variables, for test-retest reliability averaged 0.86, 0.90, 0.80, and 0.74 for HRQL, lifetime health, recent health, and exercise variables, respectively. Correlation coefficients, again ICCs and K, for parallel-form reliability (ie, equivalence) between paper and electronic versions averaged 0.90, 0.85, 0.85, and 0.81 for HRQL, lifetime health, recent health, and exercise variables, respectively. Typical measurement error was less than the a priori thresholds of clinical interest, and we found minimal evidence of systematic testretest error. We found strong evidence of content validity, convergent construct validity with the Short-Form 12 Version 2 HRQL instrument, and feasibility of administration in an elite, competitive athletic population. Conclusions: These data suggest that the TLC Health Survey is a valid and reliable instrument for assessing lifetime and recent health, exercise, and HRQL, among elite competitive athletes. Generalizability of the instrument may be enhanced by additional, larger-scale studies in diverse populations. [ABSTRACT FROM AUTHOR]

Background While maternal adherence to a healthy lifestyle was shown to be associated with a lower risk of obesity in offspring, the potential role of overall parental lifestyles has not yet been explored. We aimed to address this gap by exploring whether parental adherence to an overall healthy lifestyle was associated with a lower risk of obesity in offspring. Methods We included 5881 children and adolescents aged 6-15 years at enrolment in the 2010, 2012, and 2014 waves of the China Family Panel Studies (CFPS) who were free of obesity and followed them until 2020. Parental healthy lifestyle score at study baseline was composed of five modifiable lifestyle factors (0-5; 1 for each): never smoking, non-habitual drinking, weekly exercise, modified dietary diversity score ≥5 points, and body mass index (BMI) of 18.5-23.9 kg/m2. We defined obesity according to the age- and gender-specific cutoffs by the BMI percentile curves for Chinese children aged 6-18 years. We used multivariable Cox proportional hazard models to examine the association between parental healthy lifestyle score (both as continuous and categorical variables) and risk of offspring obesity. Results Overall, 597 (10.2%) offspring developed obesity during a median follow-up of 6 years. Compared to the lowest tertile of parental healthy lifestyle score, participants in the highest tertile had a 42% (hazard ratio (HR) = 0.58; 95% confidence interval (CI) = 0.45-0.74) lower risk of obesity. Both maternal (HR = 0.75; 95% CI = 0.61-0.92) and paternal (HR = 0.73; 95% CI = 0.60-0.89) healthy lifestyle scores were associated with lower risks of obesity in offspring. For specific lifestyle factors, we observed beneficial associations for paternal diverse diet (HR = 0.73; 95% CI = 0.60-0.88) and healthy BMI (HR = 0.65; 95% CI = 0.55-0.78). Conclusions Adherence to an overall parental healthier lifestyle was associated with a lower risk of obesity in childhood and adolescence. This finding highlights the potential benefits of promoting a healthy lifestyle among parents for the primary prevention of offspring obesity. [ABSTRACT FROM AUTHOR]

Lay illness risk beliefs are commonly held philosophies about how risk works. These include beliefs that one's personal illness risk is unknowable and beliefs that thinking about one's risk can actually increase that risk. Beliefs about risk may impact risk behaviors and thereby subsequent health status. However, limited research examines the relation between lay risk beliefs and health behavior. This paper explores this possible relation. A nationally representative sample of adults (N = 1005) recruited from an internet panel were surveyed about lay risk beliefs and risk perceptions regarding diabetes and colorectal cancer, psychosocial factors (i.e., health literacy, need for cognition, locus of control), demographics, and current health behaviors (i.e., cigarette smoking, red meat intake, physical activity). In separate sets of regressions controlling for either demographics, psychosocial factors, or risk perceptions, lay risk beliefs remained significantly related to health behaviors. It may be important to consider how to address lay risk beliefs in intervention content and targeting in order to increase adaptive health behaviors and thereby prevent chronic disease. [ABSTRACT FROM AUTHOR]

This paper applies the limited capacity model of motivated mediated messages (LC4MP) to the problem of creating effective messages about cancer. A general description of the model is presented and then applied specifically to the task of creating effective cancer communication messages by asking the following questions about cancer communication: (a) What is the goal of the message? (b) Who is in the target market? (c) What medium will carry the message? and (d) What is the motivational and personal relevance of the main information in the message for the majority of people in the target market? The paper concludes that cancer is a motivationally relevant topic that will elicit aversive activation. Target markets for various types of cancer-related messages (e.g., smokers or people of a certain age) will process mediated messages in predictably different ways making certain design decisions better for certain target markets. Both structural and content elements of messages interact with the limited capacity information processing system to impact resource allocation, which in turn determines how well messages are encoded, stored, and retrieved at a decision point. Individual differences in peoples' motivational activation influence both their tendencies to engage in risky behaviors that increase the probabilities of getting cancer and their processing of health-related messages. Future research from this perspective should be done to optimize cancer messages for specific target audiences using specific media. [ABSTRACT FROM AUTHOR]

Background: Over the past few decades Egypt has attempted to limit and control female genital mutilation (FGM). However, these efforts have not succeeded in curbing the practice, which maintains wide popular support and is firmly embedded in local traditions and structures. An attitudinal change is therefore a prerequisite for any successful campaign against FGM. This paper charts the evolution of beliefs that the practice of FGM in Egypt should be stopped. Method: This paper examines trends in opposition to FGM among ever-married women in Egypt between 1995 and 2014, using six waves of the Egypt Demographic and Health Surveys. Results: The results show that the percentage of ever-married women who think the practice of FGM should be stopped rose from 13.9 % in 1995 to 31.3 % in 2014. The central question here is whether this trend exists because new cohorts of young married women are more modern and more opposed to the practice, or because opposition to FGM has spread through multiple segments of society. Our results show that back in 1995 opposition to FGM was concentrated in two groups: non-circumcised women, and wealthy, highly educated urban women. Between 1995 and 2014 opposition to FGM increased considerably among other groups of women. Conclusion: Our results show that the observed increases in opposition to FGM are not caused by younger cohorts of married women who oppose FGM, nor by the expansion of the groups most likely to oppose FGM. Rather, the results imply that the belief that FGM should be stopped spread to all walks of life, although poorly educated rural women remain least likely to oppose FGM. [ABSTRACT FROM AUTHOR]

Adolescence is a critical period of physical, cognitive, and social development that needs to be supported with healthy diets. Dietary behaviours of adolescents can be shaped by their nutrition‐literacy and their interaction with parents and peers as well as their school food environment. Therefore, the present study aimed to assess factors that influence dietary behaviours of adolescents in urban Ethiopia. Sex‐disaggregated, focused group discussions (n = 70) were conducted in 36 private and government schools (n = 12/city) among adolescents (n = 432) 15–19 years of age in Addis Ababa, Bahir Dar, and Dire Dawa. Photovoice was applied in a subgroup of participants (n = 216) to gain further insights into adolescents' perception of their school food environment. Key informant interviews were conducted among school principals (n = 36). Adolescents had a relatively good nutrition knowledge and recognised the importance of diverse diets, but misperceptions also existed. They identified fruit and vegetables as healthy foods, but their consumption was deterred by food safety concerns. The adolescents identified foods high in salt, fat, and sugar, including processed/packaged foods as unhealthy, but still consumed them frequently due to their taste, affordability, availability and accessibility in and around schools. Both undernutrition and overweight/obesity were linked to social exclusion and bullying in school. Effective behavioural change communication is required to address common misperceptions. School nutrition programs should integrate water, sanitation and hygiene programs to ensure food safety. Regulations promoting healthy eating while discouraging unhealthy dietary behaviours are vital. Interventions to make nutrient‐dense and healthy foods available, accessible, and affordable are urgently needed to improve the nutrition and health outcome of adolescents. Key messages: Adolescents had a relatively good nutrition knowledge, but misperceptions also existedFoods high in fat, sugar, and salt, but also processed/packaged foods were considered unhealthy, but were frequently consumedUnhealthy foods were widely available/accessible in the school food environmentComprehensive food safety and nutrition interventions are needed at schoolsRegulations for availability and advertising of unhealthy foods in and around schools are needed. [ABSTRACT FROM AUTHOR]

Background: This study assessed knowledge, behaviors, and perceptions towards hypertension following community dissemination on cardiovascular disease (CVD) risk within the Navrongo Health and Demographic Surveillance Site in Northern Ghana. Methods: A cross-sectional mixed methods study was conducted among middle aged men and women following education on CVD and their risk factors. Knowledge and attitudes of participants regarding hypertension were measured in 310 participants using a survey tool and the resultant data was analyzed with descriptive statistics. Focus group discussions (FDG) were used to assess perceptions of 40 study participants on their lived experiences with hypertension. Recorded interviews were transcribed verbatim and coded into themes using Nvivo 12 software before thematic analysis. Results: Of the 310 surveyed participants, 54% were women and the mean age was 50 ± 6 years. The results showed that 84% of participants had heard about hypertension, 70% knew it was an increase in blood pressure and could be caused by excess salt intake, poor diet and physical inactivity. About 22.3% of participants were aware of the had hypertension. In terms of management, majority of the participants were aware that hypertension could be treated with antihypertensive medication and that untreated or uncontrolled hypertension could result in adverse health consequences. Few participants had ever had their blood pressure measured and did not access screening or healthcare care services and rather perceived the health system as inadequate to screen, and manage hypertension. Conclusion: Though, knowledge on hypertension was high, awareness of hypertension status and access to screening and healthcare services was low. Community beliefs and perceptions strongly influence treatment, and control of hypertension. Effective sustained community dissemination efforts addressing misperceptions could improve hypertension treatment and control. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) and exercise (EX) participation rates have not been increasing among older adults, with many not meeting recommended guidelines. This qualitative descriptive study examined factors influencing engagement in PA within and outside an older adult fitness club context, using self-determination theory (SDT). Methods: Thirty-seven community-dwelling adults 65 years and older participated in focus groups or telephone interviews. Two researchers independently coded and analyzed transcript data inductively and deductively using SDT. Results: Two broad themes, The Spectrum of Motivating Factors and Facilitators and Barriers, and nine sub-themes, Physical Activity and Exercise Brings Me Joy; Meaningful Personal Impetuses; I Get Active with a Little Help from my Spouse and Others; I See Changes and Improvements (Theme 1); I Can Do This; Connections and Sense of Belonging; I Cannot Do This; Setting, Environment, and People Supports; and Pragmatics (Theme 2), emerged from the data. All participants discussed several motivating factors: enjoyment, managing health conditions, being held 'to account' by others, opportunities for socialization, and seeing improvements in health and well-being. A lack of supportive environments, knowledgeable staff and suitable settings and programs were cited as barriers by participants who were not older adult fitness club members. Discussion: Factors along the extrinsic to intrinsic regulation continuum facilitated or hindered community-dwelling older adults to engage in and sustain PA within and outside an older adult fitness club context. The findings underscore the need for programs, settings, environments, and related components to be expressly older-adult-tailored to enhance motivation through competence, autonomy, and relatedness support for maximal engagement and participation in PA or EX. [ABSTRACT FROM AUTHOR]

Oral health is situated within the framework of the global health agenda, addressing facets pertaining to well-being and quality of life. The research is based on the need to address variables at the community level to improve schoolchildren's oral health and promote healthy behaviors and aims to carry out an in-depth analysis from the perspective of the factors that influence children's oral health. Step 1, designed by the World Health Organization, was utilized. An easy-to-use web interface was created for data collection. The statistical analysis consisted of using multinomial and binominal logistic regression models. The level of education of the adult has a high probability of influencing the consumption of unhealthy or healthy foods, it has a significant probability of exerting influence on social or medical problems and a correlation was found between the level of academic education and the pattern of dental visits. The development of health-promoting behaviors begins in childhood and involves parents, who have an essential role in the education of their children. Oral health promotion programs in schools need to target the child–adult–teacher–dentist relationships. Taking into consideration the aforementioned, a threefold viewpoint is necessary for the development of a national program aimed at promoting the oral health of schoolchildren in Romania. [ABSTRACT FROM AUTHOR]

Public health policy often involves implementing cost-efficient, large-scale interventions. When mandating or forbidding a specific behaviour is not permissible, public health professionals may draw on behaviour change interventions to achieve socially beneficial policy objectives. Interventions can have two main effects: (i) a direct effect on people initially targeted by the intervention; and (ii) an indirect effect mediated by social influence and by the observation of other people's behaviour. However, people's attitudes and beliefs can differ markedly throughout the population, with the result that these two effects can interact to produce unexpected, unhelpful and counterintuitive consequences. Public health professionals need to understand this interaction better. This paper illustrates the key principles of this interaction by examining two important areas of public health policy: tobacco smoking and vaccination. The example of antismoking campaigns shows when and how public health professionals can amplify the effects of a behaviour change intervention by taking advantage of the indirect pathway. The example of vaccination campaigns illustrates how underlying incentive structures, particularly anticoordination incentives, can interfere with the indirect effect of an intervention and stall efforts to scale up its implementation. Recommendations are presented on how public health professionals can maximize the total effect of behaviour change interventions in heterogeneous populations based on these concepts and examples. [ABSTRACT FROM AUTHOR]

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Introduction/Objectives: In 2022, 1 in 6 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and pediatric clinicians are encouraged to actively screen and intervene in clinical settings. This study aims to evaluate the feasibility and impact of a FI management protocol implemented in 2017 at a pediatric primary care health network serving patients who are Medicaid-eligible in Washington, DC. Methods: In 2019, an 18-item electronic survey was sent to a convenience sample of 42 pediatric clinicians within the health network to understand their knowledge, attitudes, and behaviors surrounding implementation. Both quantitative and qualitative responses were collected and analyzed. We report frequencies of the Likert-type responses, including perceived compliance with protocol components and intervention efficacy. We evaluated the relationship between FI knowledge level and rates of clinician documentation compliance by chi square and Cramer's V statistic for effect size. Open-ended responses were reviewed, and common themes were identified and used to provide context for quantitative results. Results and Conclusions: Out of 42 clinicians invited to complete the survey, 35 completed responses. All respondents reported universal screening for FI (100%) at routine examinations, 80% reported frequently electronically documenting FI in medical records, and 91% of clinicians reported frequently referring families who screened positive for FI to at least one FI resource, with 24% reporting that resources met families' needs. Open-ended responses revealed increased awareness of FI prevalence and of patient experiences in households experiencing FI, increased satisfaction with clinical management of FI, but also concerns around having limited clinical time to do the protocol and the usefulness and accessibility of referred resources. In conclusion, implementing this pilot FI protocol was feasible, but clinicians perceived limited impact of the protocol on alleviating FI and desired more robust intervention options. Further improvements include shifting the burden of performing the protocol away from the clinician, such as by streamlining the protocol or identifying a resource staff member, and establishing more accessible and effective FI interventions such as "Food as Medicine" offerings in partnership with community organizations. [ABSTRACT FROM AUTHOR]

Introduction. During the COVID-19 pandemic, there was a need to promote the most adequate behaviors. It is essential to know what aspects were implemented and what needs to be re-enforced. Objectives. (a) To identify the knowledge and behaviors related with preventive measures, lifestyle habits, sources of information, vaccination, and emotions generated and coping strategies and (b) to explore the personal experiences with respect to the knowledge, attitudes, and practices when facing COVID-19. Design. A convergent mixed method design. Setting and Participants. This study was conducted in the Segrià region (Catalonia, Spain) during the months of January and February 2022, with individuals 18 years old or older. Methods. Based on variables proposed by the WHO and a bibliographic review, an ad hoc electronic survey was utilized for the quantitative part, analyzed through frequency distribution or central tendency and dispersion measurements. For the qualitative part, two focus groups were analyzed through content analysis. Results. The participants (n QUAN = 1,559; n QUAL = 19) were aware about and applied the prevention measures, but when delving into it, deficiencies were detected especially when referring to hand-washing; lifestyles remained healthy; the population trusted the information from professionals (78.8%), but excess of information led to saturation; protection (75.3%) and herd immunity (47.2%) were recognized with vaccination; and the psychological impact (69.5%) was buffered with the activation of positive coping measures (99.1%), although it was maintained in more than half of them. Conclusions. This study showed that prevention measures must be re-enforced, especially hand-washing. Another revealing aspect was psychological impact, which, although coping measures were utilized, was maintained for another two years in most of them. This evidences the need for an intervention centered on this to guarantee the mental health of the population. Implications for Nursing Management. The detection of the current needs of the population provides the information necessary for the design of an adapted intervention and for promoting health education programs to address COVID-19 or other future health situations. [ABSTRACT FROM AUTHOR]

This paper explores the effects of kin, social network and the neighbourhood on an individual's well-being. The material is drawn from a community-based qualitative study that explored the attitudes and experiences of African-Caribbean adolescents and their families in the north of England towards healthy lifestyles. A convenience sample of 10 African-Caribbean households units comprising 24 adolescents (12-18 years of age) and 18 adults (22-60 years of age) participated in the study with interviews conducted in their homes. The paper focuses on the adult participants' perception of the role of social support networks and neighbourhood effects on well-being. An in-depth interview schedule was used to explore participants' perceptions on barriers to health and healthy lifestyles; and factors facilitating and inhibiting good health and healthy lifestyles. Data were subjected to thematic analysis with the aid of a Qualitative Data Analysis software package. Emerging categories were discussed with participants by conducting post interview visits and at community events. Findings indicated that participants believed that being a member of a kin network enhanced one's well-being, with such networks described as capable of providing protective support for one's health and well-being. In addition, they preferred to live in neighbourhoods with a high concentration of people of the same ethnicity, despite the effects of neighbourhood deprivation such as poor housing and lack of services. However, participants believed that ethnic segregation leads to marginalisation and further deprivation. These findings suggest that there is a need to explore further the influence of social networks and neighbourhoods on the full spectrum of an individual's well-being. The study concludes by suggesting that in considering new paradigms for the promotion of well-being, health and social care practitioners need to incorporate ways to promote social support and consider relevant psychosocial and neighbourhood factors in designing models of community well-being. [ABSTRACT FROM AUTHOR]

This paper sets out to review the influence of social processes on the timing of the diagnosis of cancer and to explore the potential for promoting earlier diagnosis by addressing social factors that influence symptom recognition and the diagnostic process. Social processes refer to the means by which culture and social organisation may impact on timely cancer diagnosis. The paper calls for concerted action around an important and developing research agenda that may prove highly valuable in the quest to secure prompt diagnosis for cancer and through it improved outcomes for individuals. [ABSTRACT FROM AUTHOR]

In this paper, we discuss the Charles et al. approach to shared treatment decision-making (STDM) as applied to patients with chronic conditions and their clinicians. We perceive differences between the type of treatment decisions (e.g. end-of-life care, surgical treatment of cancer) that generated existing approaches of shared decision-making for acute care conditions (including the Charles et al. model) and the treatment decisions that patients with chronic conditions need to make and revisit on an ongoing basis. For instance, treatment decisions in the chronic care setting are more likely to require a more active patient role in carrying out the decision and to offer a longer window of opportunity to make decisions and to revisit and reverse them without important loss than acute care decisions. The latter may require minimal patient participation to realize, are often urgent, and may be irreversible. Given these differences, we explore the applicability of the Charles et al. model of STDM in the chronic care context, especially chronic care that relies heavily on patient self-management (e.g. diabetes). To apply the Charles et al. model in this clinical context, we suggest the need to emphasize the patient–clinician relationship as one of partners in making difficult treatment choices and to add a new component to the shared decision-making approach: the need for an ongoing partnership between the clinical team (not just the clinician) and the patient. In the last section of the paper, we explore potential healthcare system barriers to STDM in chronic care delivery. Throughout the discussion we identify areas for further research. [ABSTRACT FROM AUTHOR]

Obesity is classified as a chronic disease. Women and men seem to face different obstacles in their attempts to overcome one of the most challenging tasks in the treatment of this disease, namely, weight reduction maintenance. The Common-Sense-Model (CSM) is mainly used to improve the understanding of self-regulation and health behaviour in chronic diseases but has yet to be explored for obesity. This paper applies the CSM to obesity, focussing on the construct of illness representations, which is the basis of health behaviour according to the CSM. A sample of n = 356 women and n = 77 men with obesity was investigated to assess the extent that illness representations in obesity are shaped by experiences of weight-cycling and the extent that gender influences their quality. Our results show that the representations of timeline and consequences as well as the emotional representation are particularly influenced by weight-cycling, especially in men. On average, women showed more maladaptive illness representations than men. These findings not only contribute to a better applicability of the CSM in obesity, but also emphasize the importance of gender in obesity research and interventions. [ABSTRACT FROM AUTHOR]

INTRODUCTION Thirdhand smoke (THS) is the toxic residue of tobacco smoke that persists long after tobacco smoking on the clothing and hair of smokers and in the surrounding environment. This study aimed to assess parents' beliefs about THS in terms of harm and persistence in the environment and evaluate associations between parents' THS beliefs and home smoking rules. METHODS A sample of parents living in Kuwait were enrolled in a cross-sectional study. Parents reported home smoking rules (strict, partial, and no, home smoking ban) and completed the 9-item Beliefs About ThirdHand Smoke (BATHS) scale that assessed parents' overall, health, and persistence beliefs about THS. Associations between the quartiles of THS overall, health, and persistence beliefs scores and home smoking rules were evaluated using a modified Poisson regression, and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated. RESULTS In total, 536 parents (404 females) were enrolled in the study, with 42.0% (n=225) and 43.6% (n=234) reporting a strict or partial home smoking ban, respectively. The prevalence of a strict home smoking ban was higher among never smokers than among ever smokers (49.1% vs 25.2%, p<0.001). The majority of participants indicated that THS exposure harms the health of children (67.2%) and adults (60.6%) and THS residue could remain for days in the environment (58.9%). The prevalence of a strict home smoking ban increased as THS overall (APRQ4 vs Q1 = 1.48; 95% CI: 1.12-1.96), health (APRQ4 vs Q1 = 1.22; 1.02-1.45), and persistence (APRQ4 vs Q1 = 1.55; 1.17-2.05) beliefs scores increased. CONCLUSIONS Parents' harm and persistence beliefs about THS were associated with enforcing a strict home smoking ban, which provides a safer environment for children and non-smokers. Therefore, tobacco prevention programs need to incorporate educational messages about the harm of THS in an attempt to promote smoke-free homes. [ABSTRACT FROM AUTHOR]

Background: It is of significance to look into the intergenerational transmission of risk behaviour to explain the disparity of health. Our paper contributes to the literature by providing evidence in the context of China, focusing on smoking behaviour.Methods: This paper studies the intergenerational transmission of smoking in the context of China using a nationally representative dataset - the China Health and Nutrition Survey (CHNS). The two-part model, the Tobit model, and the fixed effects model are utilized for the empirical analysis, respectively.Results: We found a strong intergenerational persistence of health behaviour. That is, parents' smoking behaviour is positively correlated with their children's smoking initiation.Conclusions: Our study provides evidence of the intergenerational persistence of health behaviour in the case of smoking, in the world's most populous country. This has policy implications for the issue of intergenerational mobility and health education, as well as for tobacco control in China. [ABSTRACT FROM AUTHOR]

Background: Around a fifth of children starting school in England are now overweight/obese. There is a paucity of interventions with the aim of obesity prevention in preschool-age children in the UK. Previous research has demonstrated some positive results in changing specific health behaviours, however, positive trends in overall obesity rates are lacking. Preschool settings may provide valuable opportunities to access children and their families not only for promoting healthy lifestyles, but also to develop and evaluate behaviour-change interventions.Methods: This paper presents a cluster randomised feasibility study of a theory based behaviour-change preschool practitioner-led intervention tested in four preschool centres in the North East of England. The primary outcome measures were to test the acceptability and feasibility of the data collection measures and intervention. Secondary measures were collected and reported for extra information. At baseline and post intervention, children's anthropometric, dietary and physical activity measures as well as family 'active' time data were collected. The preschool practitioner-led intervention included family intervention tasks such as 'family goal-setting activities' and 'cooking challenges'. Preschool activities included increasing physical activity and providing activities with the potential to change behaviour with increased knowledge of and acceptance of healthy eating. The process evaluation was an on-going monthly process and was collected in multiple forms such as questionnaires, photographs and verbal feedback.Results: 'Gatekeeper' permission and lower-hierarchal adherence were initially a problem for recruitment and methods acceptance. However, at intervention end the preschool teachers and parents stated they found most intervention methods and activities acceptable, and some positive changes in family health behaviours were reported. However, the preschool centres appeared to have difficulties with enforcing everyday school healthy eating policies.Conclusions: The findings from the current study may have implications for nursery practitioners, nursery settings, Local Educational Authorities and policy makers, and contributes to the body of literature. However, further work with preschool practitioners is required to determine how personal attitudes and school policy application can be supported to implement successfully such an intervention.Trial Registration: ISRCTN12345678 (16/02/17) retrospectively registered. [ABSTRACT FROM AUTHOR]

The contribution of women to the achievement of global public health targets cannot be underestimated. It is well evidenced that within families, women are a key influence on the health and well-being of their children and partners. However, geographical differences in women's health inequalities persist and research focusing specifically on women's perceptions of locality factors influencing their own health and well-being is scarce. This paper presents an interpretive, qualitative research study undertaken in 2011 with a group of women living in one locality in the North East of England in the United Kingdom which aimed to better understand their health and well-being perceptions and locality influences on it. Fifteen women participated in two focus groups and six individual, semi-structured interviews. Thematic analysis yielded four key themes: health and well-being perceptions; mental resilience; low income and choice; and influence of place. The influence of women's geographical location in relation to amenities and services and loneliness were recurring factors in the discussion, each influencing lifestyle. It was evident that women in their local context were themselves assets through which their own physical and mental health could be improved. However, women's perceptions of protective factors and their influences on health and well-being varied. Connecting with women in the context of their immediate living circumstances and understanding their perceptions as individuals are important first steps in the process of gaining consensus and mobilising their assets to collectively build healthy local communities. [ABSTRACT FROM AUTHOR]

INTRODUCTION A growing body of research has evaluated the effect of university tobacco-free policies on faculty and staff, however, none of these studies has been carried out in the Eastern Mediterranean Region. This study evaluates changes in faculty and staff attitudes, perceptions and smoking behavior, at 1 year post adoption of a tobacco-free policy in a medium-sized university in Lebanon and the region. METHODS Two cross-sectional surveys were conducted in 2017 and 2018: baseline and at 1 year post policy implementation. A random sample of 625 and 624 participants took part in the 2017 and 2018 studies, respectively. RESULTS Faculty and staff had a positive attitude towards the policy at the two time points. The belief that there should be exceptions to the policy significantly decreased from 79% to 59% (p=0.002) among all smokers, particularly those with lower educational attainment (81% to 57%, p=0.007). Perception of compliance among peer smokers increased from 73% to 87% (p=0.009). The proportion of smokers did not significantly change at 1 year post policy implementation, however, 44% of smokers with lower educational attainment, compared to only 7% of those with higher educational attainment (p<0.001), reported a decrease in their smoking behavior outside campus. CONCLUSIONS The policy had a positive effect on the attitude, behavior and perception of policy benefits among smokers with lower educational attainment, who constitute the majority of smokers. Findings from this study inform and support future efforts to develop university and workplace tobacco-free policies. [ABSTRACT FROM AUTHOR]

Objectives: Oral health is one of the greatest unmet health needs of migrant farmworkers and many migrant workers lack basic oral health knowledge. This paper presents evaluation results for an oral health education program designed to both increase knowledge concerning oral health practices and to gain a better understanding of the knowledge, attitudes and behaviors regarding oral health among migrant workers. Methods: We used a pre-post uncontrolled design to assess the impact of the education program on participant knowledge about oral health practices. Changes in knowledge were assessed using a paper and pencil survey given to participants before the session began (pre) and at the end of the session (post). The pre-post survey was supplemented by qualitative information in the form of participant self-reported barriers and facilitators, and figure drawings illustrating their feelings about the state of their own oral health. Results: There were 311 participants in 12 workshops held in 2017 throughout Washington State. There were statistically significant increases in knowledge for all of the pre/post survey questions. Questions with particularly large improvements included: the results of having a mouth infection, factors causing oral health problems, and whether children in low-income families experience more tooth decay. Conclusions: An interactive, lay-led oral health education program can be an effective way to increase oral health knowledge in migrant populations. Recommendations for similar programs include using interactive approaches to engage participants, being open to learning and changing your own thinking, and using lay leaders for the education sessions. [ABSTRACT FROM AUTHOR]

INTRODUCTION There are few reports on the beliefs about thirdhand smoke in Chinese families with primary school children. This study aims to understand the beliefs about thirdhand smoke among parents or grandparents of primary school children in Shanghai and to provide an evidence base to incorporate thirdhand smoke preventative action into tobacco control interventions. METHODS We performed a cross-sectional survey among parents and grandparents of children aged 6-13 years in the Changjiang Road Primary School and recruited 843 participants to make assessments on the 'beliefs about thirdhand smoke' (BATHS) scale. Sociodemographic details including age, gender, marital status, education level, personal income and type of home ownership (new house, secondhand house with or without redecoration) and health status of children (whether they suffered from respiratory diseases or not) were investigated. Scale assessment, univariate and multivariate analyses to explore the factors influencing the BATHS scale and subscale scores, were performed using SPSS version 22.0. RESULTS Participants who were aged >65 years were more likely to get lower scores on the BATHS scale (OR=0.476; 95% CI: 0.311-0.728, p=0.001). Undergraduates (OR=1.190; 95% CI: 1.020-1.388, p=0.027) and graduates (OR=1.4490; 95% CI: 1.102-1.906, p=0.008) obtained higher scores. Moreover, the scores of residents living in a secondhand house with redecoration (OR=0.882; 95% CI: 0.782-0.995, p=0.041) and without redecoration (OR=0.801; 95% CI: 0.698-0.919, p=0.002) were lower compared with those of new-house owners. The scores for participants whose children suffered from respiratory diseases in the past six months (OR=1.104; 95% CI: 1.003-1.216, p=0.043) were higher than those whose children had no respiratory diseases. CONCLUSIONS This study shows that younger people, females, those with higher incomes, and higher education levels, were more likely to believe the thirdhand smoke impacts on health and its persistence in the environment. Our findings can guide targeted actions for smoke-free home interventions. [ABSTRACT FROM AUTHOR]

The study used the American Time Use Survey data from 2010 to 2019 to compare the daily moderate-to-vigorous activity of Native Hawaiians and Pacific Islanders (NHPI) and seven Asian ethnic subgroups. Adults aged 24 years and older were included. The study analyzed activities from sports and recreation, household activities, and all activities carried out during the day. Outcomes were determined by the completion of 30 min or more of moderate-to-vigorous activity and the type of activity carried out in the day. Significant ethnic differences were observed for sports and recreation but not for household activities and not for all activities carried out during the day. Of the ethnic populations, NHPI were the least active, and Asian Indians and Chinese were the most active. A majority achieved 30 min or more of moderate-to-vigorous activity during the day from all their activities. Physical activity from household activities exceeded physical activity from sports and recreation. The most physically active group was adults over the age of 65 years, perhaps reflecting more time to exercise or greater concerns about their health. For sports and recreation, exercising with someone doubled the minutes of moderate-to-vigorous activity. The results emphasize the importance of activities performed around the household in addition to sports and recreation and the benefit of exercising with someone. Ethnic populations may be receptive to interventions that emphasize activities they are performing in their daily lives. [ABSTRACT FROM AUTHOR]

The article reviews the impact of cognitive factors on the formation of consumer attitudes towards health behaviour. Following a short overview of the cognitive component (level) of attitude formation and its factors, as well as a theoretical model of the formation of attitudes towards health behaviour, the results of the empirical study are presented to measure the impact of the consumer's level of education on the formation of consumer attitudes towards health behaviour. The evaluation of the results provides some insights, conclusions and directions for future research. [ABSTRACT FROM AUTHOR]

Background. The link between health beliefs and health behaviours, which includes changing diet, exercise, regular selfmedication, self-monitoring of blood glucose, investigation and examination programmes, helps in raising the level of social health awareness, as well as focuses on the individual's role in being responsible for his health. Objectives. To evaluate self-care activities among patients with type 2 diabetes mellitus in the Wasit and Dhi-Qar provinces. Material and methods. This analytic cross-sectional study was directed at patients with type 2 diabetic mellitus. The sample was collected from patients who visited Diabetes and Endocrinology centres in the Wasit and Dhi-Qar provinces. Data was collected via a questionnaire based on the "Arabic Summary of Diabetes Self-Care Activities" (A-SDSCA), which consisted of questions related to self-management. Results. The results were based on the analysis of 404 samples of patients previously diagnosed with type 2 diabetes mellitus. Only 75 (18.6%) had controlled blood glucose. The best self-care practice was diet, with a mean score ± SD (3.17 ± 2.43), followed by testing blood sugar (2.83 ± 2.19). The most frequent advice received from health givers was to follow a meal plan with low-fat contents, which was mentioned by 90.6% of the patients. The participants with the lowest educational level were less likely to undertake appropriate self-management for diabetes (p = 0.026). Conclusions. The educational level was the significant predictor of self-care behaviours among patients with type 2 diabetes mellitus. It is necessary to increase health education to manage diabetes and change lifestyle through healthcare organisations, as well as through the use of social media [ABSTRACT FROM AUTHOR]

Background: Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy‐relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms. Objectives: This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps. Search Methods: We comprehensively searched for eligible English‐language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020. Selection Criteria: The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population‐level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer‐term consequences (health, safety, and socioeconomic outcomes) of these laws. Data Collection and Analysis: Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2. Main Results: The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws—including CBDLs, IHLs, and DCLs—are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid‐related harms (3), and alcohol‐related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality. Authors' Conclusions: More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer‐term—and arguably more salient—health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions. [ABSTRACT FROM AUTHOR]

Purpose: It can be challenging to research aspects of people's health behaviour, attitudes, and emotions due to the sensitive nature of these topics. We aimed to develop a novel methodology for discussing sensitive health topics, and explore the effectiveness in focus groups using prostate cancer and screening as an example. Method: We developed a fictitious case and employed it as a projective technique in focus groups on prostate cancer and screening. The participants were men and their partners who lived in Denmark. Results: The technique encouraged emotional and cognitive openness in focus group discussions about the risk of prostate cancer, the benefits and harms of screening, and decision-making about screening. It appeared that using the fictitious case allowed the participants to personally distance themselves from the topic, project emotions onto the case, and thereby openly talk about their emotions. Conclusion: This article presents a methodological contribution to communication about sensitive topics in focus groups, using prostate cancer screening as an example. Further refinement of the methodology is needed to enable participants to transfer improvements in knowledge to their own decision about screening. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Despite the availability of multiple screening options, CRC screening is underutilized. We conducted a survey of patients (n = 2973) who were prescribed the multi-target stool DNA (mt-sDNA) screening test (commercialized as Cologuard® and manufactured by Exact Sciences Corporation) to understand attitudes and experiences that influence test completion and likelihood of future test completion. Using exploratory factor analyses, we developed three scales: Perceived Effectiveness, Perceived Ease of Use, and Perceived Comfort. [ABSTRACT FROM AUTHOR]

Background: The provision of health and wellness care is undergoing an enormous transformation. A key element of this revolution consists in prioritizing prevention and proactivity based on the analysis of people's conducts and the empowerment of individuals in their self-management. Digital technologies are unquestionably destined to be the main engine of this change, with an increasing number of domain-specific applications and devices commercialized every year; however, there is an apparent lack of frameworks capable of orchestrating and intelligently leveraging, all the data, information and knowledge generated through these systems.Methods: This work presents Mining Minds, a novel framework that builds on the core ideas of the digital health and wellness paradigms to enable the provision of personalized support. Mining Minds embraces some of the most prominent digital technologies, ranging from Big Data and Cloud Computing to Wearables and Internet of Things, as well as modern concepts and methods, such as context-awareness, knowledge bases or analytics, to holistically and continuously investigate on people's lifestyles and provide a variety of smart coaching and support services.Results: This paper comprehensively describes the efficient and rational combination and interoperation of these technologies and methods through Mining Minds, while meeting the essential requirements posed by a framework for personalized health and wellness support. Moreover, this work presents a realization of the key architectural components of Mining Minds, as well as various exemplary user applications and expert tools to illustrate some of the potential services supported by the proposed framework.Conclusions: Mining Minds constitutes an innovative holistic means to inspect human behavior and provide personalized health and wellness support. The principles behind this framework uncover new research ideas and may serve as a reference for similar initiatives. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in Australia. Australian Aboriginal and Torres Strait Islander (Indigenous) people have higher levels of CVD compared with non-Indigenous people. Cardiac Rehabilitation (CR) is an evidence-based intervention that can assist with reducing subsequent cardiovascular events and rehospitalisation. Unfortunately, attendance rates at traditional CR programs, both globally and in Australia, are estimated to be as low as 10-30 % and Indigenous people are known to be particularly under-represented. An in-depth assessment was undertaken to investigate the provision of CR and secondary preveniton services in Western Australia (WA) with a focus on rural, remote and Indigenous populations. This paper reports on the findings for Indigenous people.Methods: Cardiac rehabilitation and Aboriginal Medical Services (n = 38) were identified for interview through the Heart Foundation Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Semi-structured interviews with CR coordinators were conducted and included questions specific to Indigenous people.Results: Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) were conducted. Identification of Indigenous status was reported by 65 % of coordinators; referral and attendance rates of Indigenous patients differed greatly across WA. Efforts to meet the cultural needs of Indigenous patients varied and included case management (32 %), specific educational materials (35 %), use of a buddy or mentoring system (27 %), and access to an Aboriginal Health Worker (71 %). Staff cultural awareness training was available for 97 % and CR guidelines were utilised by 77 % of services.Conclusion: The under-representation of Indigenous Australians participating in CR, as reported in the literature and more specifically in this study, mandates a concerted effort to improve services to better meet the needs of Indigenous patients with CVD as part of closing the gap in life expectancy. Improving access to culturally appropriate CR and secondary prevention in WA must be an important component of this effort given the high rates of premature cardiovascular disease affecting Indigenous people. Our findings also highlight the importance of good systematic data collection across services. Health pathways that ensure continuity of care and alternative methods of CR delivery with dedicated resources are needed. [ABSTRACT FROM AUTHOR]

Background: Randomised controlled trials (RCTs) are recommended as the 'gold standard' in evaluating health care interventions. The conduct of RCTs is often impacted by difficulties surrounding recruitment and retention of participants in both adult and child populations. Factors influencing recruitment and retention of children to RCTs can be more complex than in adults. There is little synthesised evidence of what influences participation in research involving parents and children.Aim: To identify predictors of recruitment and retention in RCTs involving children.Methods: A systematic review of RCTs was conducted to synthesise the available evidence. An electronic search strategy was applied to four databases and restricted to English language publications. Quantitative studies reporting participant predictors of recruitment and retention in RCTs involving children aged 0-12 were identified. Data was extracted and synthesised narratively. Quality assessment of articles was conducted using a structured tool developed from two existing quality evaluation checklists.Results: Twenty-eight studies were included in the review. Of the 154 participant factors reported, 66 were found to be significant predictors of recruitment and retention in at least one study. These were classified as parent, child, family and neighbourhood characteristics. Parent characteristics (e.g. ethnicity, age, education, socioeconomic status (SES)) were the most commonly reported predictors of participation for both recruitment and retention. Being young, less educated, of an ethnic minority and having low SES appear to be barriers to participation in RCTs although there was little agreement between studies. When analysed according to setting and severity of the child's illness there appeared to be little variation between groups. The quality of the studies varied. Articles adhered well to reporting guidelines around provision of a scientific rationale for the study and background information as well as displaying good internal consistency of results. However, few studies discussed the external validity of the results or provided recommendations for future research.Conclusion: Parent characteristics may predict participation of children and their families to RCTs; however, there was a lack of consensus. Whilst sociodemographic variables may be useful in identifying which groups are least likely to participate they do not provide insight into the processes and barriers to participation for children and families. Further studies that explore variables that can be influenced are warranted. Reporting of studies in this field need greater clarity as well as agreed definitions of what is meant by retention. [ABSTRACT FROM AUTHOR]

Background: Addressing the increasing prevalence, and associated disease burden, of diabetes is a priority of health services internationally. Interventions to support patients to effectively self-manage their condition have the potential to reduce the risk of costly and debilitating complications. The utilisation of mobile phones to deliver self-management support allows for patient-centred care at the frequency and intensity that patients desire from outside the clinic environment. Self-Management Support for Blood Glucose (SMS4BG) is a novel text message-based intervention for supporting people with diabetes to improve self-management behaviours and achieve better glycaemic control and is tailored to individual patient preferences, demographics, clinical characteristics, and culture. This study aims to assess whether SMS4BG can improve glycaemic control in adults with poorly controlled diabetes. This paper outlines the rationale and methods of the trial.Methods/design: A two-arm, parallel, randomised controlled trial will be conducted across New Zealand health districts. One thousand participants will be randomised at a 1:1 ratio to receive SMS4BG, a theoretically based and individually tailored automated text message-based diabetes self-management support programme (intervention) in addition to usual care, or usual care alone (control). The primary outcome is change in glycaemic control (HbA1c) at 9 months. Secondary outcomes include glycaemic control at 3 and 6 months, self-efficacy, self-care behaviours, diabetes distress, health-related quality of life, perceived social support, and illness perceptions. Cost information and healthcare utilisation will also be collected as well as intervention satisfaction and interaction.Discussion: This study will provide information on the effectiveness of a text message-based self-management support tool for people with diabetes. If found to be effective it has the potential to provide individualised support to people with diabetes across New Zealand (and internationally), thus extending care outside the clinic environment.Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12614001232628 . [ABSTRACT FROM AUTHOR]