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Health promotion is conceived as a unifying concept for improving the health of populations. This means addressing the socio-cultural, economic and commercial causes of ill-health, which are necessarily informed by past policies and socio-cultural contexts. However, historical scholarship has rarely figured in health promotion practice or scholarship. This gap resides in the determinants of health, and notably in the analyses of tobacco control and skin cancer prevention, two long-running campaigns that have shaped modern health promotion in Australia. Both highlight a need for understanding the profound impact of history on the present and the value of learning from past successes and failures. Doing so requires integrating historical analyses into existing health promotion scholarship. To achieve this aim, we present a new 'public health humanities' methodology. This novel interdisciplinary framework is conceived as a spectrum in which historical studies integrate with existing health promotion disciplines to solve complex health problems. We draw on the many calls for more interdisciplinarity in health promotion and derive this methodology from proposals in the medical humanities and cognate fields that have wrestled with combining history and present-focused disciplines. Using tobacco control and skin cancer prevention as case studies, we demonstrate how public health humanities uses interdisciplinary teams and shared research questions to generate valuable new knowledge unavailable with traditional methods. Furthermore, we show how it creates evaluation criteria to consider the powerful impact of issues like colonialism on current inequities that hinder health promotion strategies, and from which lessons may be derived for the future. [ABSTRACT FROM AUTHOR]

Background: Despite global popularity, Community-based Health Intervention (CBHI) programmes have yet to be fully incorporated into Singapore's public healthcare systems, with most initiatives focusing on specific diseases. This qualitative study aimed to evaluate older adults' perceptions of the "Get Well, Live Well" multi-domain preventive health programme, explore the effectiveness of Community Health Workers (CHWs) in promoting health literacy and modifying health behaviours, and examine participants' experiences in the CHW-delivered CBHI programme., Methods: Purposeful sampling was used to recruit study subjects from participants in the "Get Well, Live Well" programme until data saturation was achieved. In-depth, semi-structured, one-to-one telephone interviews were conducted in English or Chinese with participants aged ≥ 40 years. Audio recordings were translated into English as needed and transcribed in full. The collected data were anonymised, and thematic analysis was performed by three trained evaluators using a structured process., Results: The final study sample included 19 subjects (median age of 64 years; 84% women; and 95% Chinese). Three key themes emerged regarding the programme's value, interactions with CHW, also known as Care Connectors, and their facilitation of health services/behaviours. Participants acknowledged that the "Get Well, Live Well" programme provided physical/emotional support, improved health literacy, and enhanced social interaction. The programme's effectiveness may depend on Care Connector's personal qualities, service quality beyond expectation, connection with participants, and their proactive and authoritative roles in facilitating health services/behaviours., Conclusion: The findings suggest that future Community-based Health Interventions could benefit from deploying CHWs with strong people skills to enhance the programme's success., (© 2024. The Author(s).)

Background: High levels of physical activity are key to improving health outcomes, yet many people fail to take action. Using pedometers to target steps per day and providing financial incentives is a simple and scalable approach to promoting public health. However, conventional pedometers do not account for "intensity" and "duration," making it challenging to efficiently increase people's moderate-to-vigorous physical activity (MVPA), which is expected to improve health outcomes. Based on these rationales, we developed a smartphone app that sets step cadence as a goal (defined as a daily challenge of walking more than 1500 steps in 15 minutes twice a day, which is a heuristic threshold for moderate physical activity) and provides financial incentive when the challenge is met., Objective: This study aimed to evaluate the feasibility of our novel app and explore whether its use can increase users' daily MVPA., Methods: A single-arm pre-post study evaluated the feasibility and efficacy of the app. A total of 15 participants used app 1 (an app without financial incentives) for the first period (4 weeks) and then switched to app 2 (an app with financial incentives) for the second period (4 weeks). The primary outcome was the difference between the first and second periods in the number of successful challenge attempts per week. Secondary outcomes were differences between the first and second periods in daily steps and distance walked. Exploratory outcomes included the difference between the first and second periods in daily "heart points" as measured by Google Fit, a publicly available app that measures users' daily MVPA., Results: The number of successful challenge attempts per week increased significantly compared to the first period (5.6 times per week vs 0.7 times per week; P<.001). Although not statistically significant, there was a trend toward an increase in the mean steps per day and distance walked per day (6586 steps per day vs 5950 steps per day; P=.19; and 4.69 km per day vs 3.85 km per day; P=.09, respectively). An exploratory end point examining daily MVPA by "heart points" collected from Google Fit also showed a significant increase compared to the first period (22.7 points per day vs 12.8 points per day; P=.02)., Conclusions: Our app using step cadence as a goal and providing financial incentives seemed feasible and could be an effective app to increase users' daily MVPA. Based on the results of this study, we are motivated to conduct a confirmatory study with a broader and larger number of participants., Trial Registration: UMIN 000050518; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr&#95;view.cgi?recptno=R000057420., (©Kosuke Hayashi, Hiromitsu Imai, Ichiro Oikawa, Yugo Ishihara, Hirokazu Wakuda, Iori Miura, Shingo Uenohara, Asuka Kuwae, Megumi Kai, Ken'ichi Furuya, Naoto Uemura. Originally published in JMIR Formative Research (https://formative.jmir.org), 24.10.2024.)

Background: Oral health is so important for the adolescent age group that the World Health Organization has listed oral health as a lifelong prerequisite for maintaining public health; Therefore, this research was carried out with the aim of the effect of educational intervention based on self-efficacy theory on the promotion of behaviors related to oral health of adolescents through mobile application., Methods: In this clinical trial, 80 adolescents aged 13-15 years from Shushtar city were selected using a random cluster sampling method and assigned to either the test or control group. The data collection tools included a standard questionnaire for measuring Oral health behavior (awareness, attitude, behavior) and a standard questionnaire for measuring self-efficacy (self-efficacy in brushing teeth, self-efficacy in using dental floss, and self-efficacy in visiting the dentist), as well as demographic characteristics. Training was provided to the test group via a mobile application for 3 weeks. During the intervention, the control group did not receive any training. Questionnaires were distributed in both groups immediately after the intervention, as well as one month and three months post-intervention, and data were collected. In accordance with research ethics, at the end of the study, the educational content was provided to the control group. Collected data were analyzed using SPSS 22 software and Mann-Whitney and Friedman non-parametric tests., Results: The findings showed that the educational intervention through the mobile application was effective in improving the average scores of awareness, attitude, self-efficacy in brushing teeth, flossing, visiting the dentist, and the behavior of adolescents regarding oral health behaviors, and this statistical difference was significant compared to before the educational intervention (P < 0.05), while no change was observed in the control group (p > 0.05)., Conclusion: Considering that adolescents aged 13-15 years are the age of starting behavioral habits, including oral health behaviors, and on the other hand, their interest in using technology and virtual spaces is high, it is suggested that part of the education of this age group should be designed and implemented in the platform of mobile application., Clinical Trial: Registration in Iran Clinical Trial Center with ID code (IRCT20200120046204N1) Date of., Registration: 2018-02-25., (© 2024. The Author(s).)

Purpose and Objectives: The Diabetes Prevention Program (DPP), an effective evidence-based strategy to reduce the incidence of type 2 diabetes, has been widely implemented in various locations, including workplaces. However, most people do not remain engaged in the program for the recommended full year. Limited qualitative research exists around participant engagement in the workplace DPP. Our study aimed to explore participant engagement in the DPP delivered through the employer-based clinic (EBC) at a large technology company., Intervention Approach: The DPP was implemented through the EBC at a large technology company in Southern California, beginning in September 2019 by using in-person and virtual synchronous group classes before and during the COVID-19 pandemic., Evaluation Methods: Virtual focus groups with DPP participants from 2 inaugural cohorts were conducted via Zoom from October 2020 to February 2021. Data were analyzed by using inductive thematic analysis., Results: Five focus groups with 2 to 3 participants in each (total n = 12) were conducted, 2 focus groups per cohort and 1 focus group with the group instructors. Barriers and facilitators to engagement in the DPP were grouped into thematic domains: Individual Drivers, Small Group Community, Workplace Setting, Integrated EBC, and the COVID-19 Pandemic. Results showed that prepandemic workplace demands (ie, meetings, travel) affected DPP participation, yet the group setting provided social support in the workplace to engage in and maintain healthy habits. With the move to a virtual synchronous offering during the pandemic, participants valued the group setting but expressed a preference for in-person meetings. Collectively, participant engagement was bolstered by shared buy-in and collaboration between the employer and the EBC., Implications for Public Health: Our findings suggest that engagement in a workplace DPP can be supported by addressing workplace-specific barriers and gaining buy-in from employers. Delivering the DPP, in person and virtually, through an EBC has the potential to engage employees who have prediabetes.

Background: Psychosocial work factors significantly influence both organisational and worker health. Poor management of these factors can create precarious working conditions, risking drivers' health. This review maps evidence on the health impact of these factors and health interventions targeting the working conditions and unhealthy habits of commercial drivers., Method: The search was conducted in four main databases (PubMed, Central, JSTOR and Dimensions Ai) and other sources like Google Scholar. In All, 28,039 articles were retrieved and through a rigorous screening process, 68 records were included in this scoping review., Results: This review found that drivers work in precarious conditions like long driving hours, low job resources and social support, low job control, poor remuneration, workplace abuse and sexual harassment, work-family conflict, lone driving hour, irregular shift work, lack or insufficient breaks during work hours and difficult access to social protection and sanitation facilities. These precarious working conditions may expose drivers to mental health issues, cardiovascular diseases, HIV/AIDs, stroke, chronic fatigue, kidney and bladder issues and musculoskeletal pains. Most health promotion interventions target behaviour at the individual level, such as the benefits of a healthy diet and exercise, with little effort to improving working conditions., Conclusion: Employers in the road transport sector need to implement health promotion interventions that focus on drivers' well-being. Additionally, improving working conditions and enforcing occupational health and safety standards in the road transport sector are essential for creating a safe and healthy workplace for all commercial drivers., (© 2024. The Author(s).)

Background: The Structured Days Hypothesis posits that structure protects children against obesogenic behaviors (e.g., physical inactivity, unhealthy dietary intake) and, ultimately, prevents the occurrence of excessive weight gain. The hours following school (i.e., 3-6 pm school days) and summer vacation are two "windows of vulnerability" when children may experience less structure. Programs that provide a healthy structured environment and may prevent BMI gain exist for both time periods (i.e., after-school programs and summer day camps). Unfortunately, these programs are cost prohibitive for children from low-income families to attend. This study will test the impact of providing vouchers to access existing, community-operated after-school and summer programs on BMI z-score, body composition, and obesogenic behaviors (i.e., physical activity, screen use, diet, and sleep) of children (5-12 years) from schools that primarily serve families with low income., Methods: The study will employ a 2x2 factorial design. Participants (N = 480) attending 4 elementary schools in one school district will be randomly assigned to a no treatment control, after-school program voucher only, summer day camp voucher only, or after-school and summer day camp vouchers. Vouchers will cover the full cost of attending a pre-existing community-based after-school or summer camp program. The primary outcome (BMI z-score) will be measured at baseline (before end of school year, ~ May), 3-month follow-up (after summer, ~ August), and 12-month follow-up (end the following school year, ~ May). Secondary outcomes include body composition (i.e., whole-body fat mass, fat free mass, and percent body fat) and obesogenic behaviors (i.e., physical activity, sedentary time, sleep, screen-time, and diet). The study will also employ a rigorous process evaluation which will consider after-school and summer camp program attendance and content. Analyses will examine differences between the four groups in BMI z-score, body composition, and obesogenic behaviors. Incremental cost effectiveness ratios will determine the cost effectiveness of the intervention., Discussion: The current study will provide critical information for researchers, practitioners, and policy makers seeking to combat the childhood obesity epidemic in children from families with low-income during the school year and summer., Trial Registration: NCT05880901 . Registered 27 May 2023., (© 2024. The Author(s).)

Objectives: Although early-life dental care is crucial for preventing early childhood caries and has numerous benefits, the utilization rate of such care remains remarkably low worldwide, especially in families of low socioeconomic status. The aim of this study was to systematically review the scientific evidence relating to the effectiveness of interventions on improving early-life dental care utilization of very young children., Method and Materials: Scientific evidence relating to these positive changes was reviewed, with seven randomized controlled trials after qualitative evaluation. Interventions assessed included prenatal oral health promotion, motivational interviewing, intra-oral camera use alongside social work consultations to aid in decreasing barriers to care, monetary incentives for tooth brushing, fluoride varnish applications, and probiotic usage., Results: The intervention was significantly effective in reducing the incidence of dental caries among children, especially in caries risk. Caries reduction was significant when oral health information was provided at frequent intervals prenatally. Caries increment was also reduced when probiotics were introduced when administered daily. Interventions that attempted to increase parental involvement in oral health care by increasing motivation and decreasing barriers had inconclusive results within the study groups., Conclusions: Considering high rates of early childhood caries, early establishment and preservation of a dental home should be a focus in public health measures. Continuous monitoring and parental involvement are key components to maintaining healthy oral conditions. Future studies could explore and test various innovative strategies that utilize technological platforms to engage with parents and promote early-life dental care utilization among the underserved population.

Objective: More than 95% of melanomas in Australia are caused by UV radiation from the sun. Young adults are particularly at risk, with 18-24-year-olds spending more time in the sun and protecting their skin less than older adults. A new mass media campaign was delivered in New South Wales, Australia, to motivate this hard-to-reach group to protect their skin from harmful UV radiation. This paper shares learnings from this campaign for public health educators working across diverse fields., Program: Guided by audience research and testing, the campaign combined fear-based and self-efficacy messaging. UV radiation was portrayed as arrows descending from the sky, transforming it into a visible and ever-present threat. High-reach channels such as cinema, outdoor advertising, online videos, audio apps and social media were used to reach the audience., Methods: The campaign was evaluated through an online tracking survey (n = 750, 18-24-year-olds) measuring prompted recognition, message take-out, key diagnostics, and self-reported sun protection intentions and behaviours., Results: The evaluation found that 57% of survey participants recognised the campaign when prompted. Among those that recognised the campaign, 76% said they had used sun protection when outdoors over the summer campaign period (vs 64% of non-recognisers, p < 0.05), and 45% said they had adopted at least three of the five sun protection behaviours (Slip, Slop, Slap, Seek and Slide) 'always' or 'often' (vs. 36% of non-recognisers, p < 0.05)., Lessons Learnt: A mass-media campaign that aimed to elicit emotional (fear) and cognitive (perceived efficacy) responses and which drew upon social and heuristic cues was associated with greater self-reported sun protection among the target audience. Delivering a combination of message strategies simultaneously within a campaign tailored to young adults may be more effective than adopting a more singular focus., Competing Interests: None declared.

Objectives and importance of study: Despite an increasing trend in digitally delivered health promotion programs, evidence of their effectiveness compared to face-to-face approaches is limited. Go4Fun is a 10-week, scaled-up healthy lifestyle program in New South Wales (NSW) for children 7-13 years who are above a healthy weight and their families, delivered either face-to-face or digitally. We compared the impact of Standard Go4Fun (face-to-face) and Go4Fun Online (digital) on children's weight and health behaviour outcomes and whether attendance levels influenced outcomes., Study Type: Pre-post study., Methods: We conducted a secondary analysis of Go4Fun cohort data from 1893 face-to-face and 1283 digital participants (January 2018 to May 2022). Outcomes of interest were body mass index z-score (zBMI), physical activity, sedentary behaviour, and fruit, vegetable, sugary drink and takeaway food consumption., Results: A higher proportion of Standard Go4Fun children lived in major cities, in areas of greatest disadvantage and spoke a language other than English at home than in Go4Fun Online. Children in both Standard Go4Fun and Go4Fun Online demonstrated improvements in all outcomes; however, children in Go4Fun Online showed significantly larger improvements. On average, digital participants had a reduction in zBMI of 0.11 more than the reduction seen in face-to-face participants (95% Confidence Interval [CI] -0.12, -0.09), increased the days/week of moderate-to-vigorous-physical-activity by 30% more (95% CI 24%, 36%), were more likely to eat ≥ 2 serves of fruit/day (compared to < 2, Odds Ratio [OR] 1.85; 95% CI: 1.36, 2.52) or eat ≥ 3 serves of vegetables/day (compared to < 3, OR 1.96; CI: 1.58, 2.42). Across both modes, with each additional session attended, the odds of eating ≥ 3 serves of vegetables/day increased by 10% (95% CI 1.02, 1.19). There were no significant differences for other health outcomes., Conclusions: Our evaluation demonstrated that both face-to-face and digital program delivery helped children above a healthy weight to improve their weight and health behaviour outcomes. Go4Fun Online achieved significantly greater improvements in outcomes, which is encouraging for the future of digital interventions. Participation in Standard Go4Fun by more children with obesity from disadvantaged areas and non-English speaking backgrounds suggests that ongoing delivery of both modes of Go4Fun could facilitate program reach among all children above a healthy weight., Competing Interests: None declared

Objective: The Australian Government Tackling Indigenous Smoking (TIS) program aims to reduce tobacco use among Aboriginal and Torres Strait Islander peoples, delivering locally tailored health promotion messages, including promoting the Quitline. We aimed to analyse data on use of the Quitline by Aboriginal and Torres Strait Islander peoples nationally, specifically in TIS and non-TIS areas., Methods: We analysed usage of the Quitline in seven jurisdictions across Australia in areas with and without TIS teams (TIS areas and non-TIS areas respectively) between 2016-2020. Demographic and usage characteristics were quantified. Clients and referrals as a proportion of the current smoking population were calculated for each year, 2016-2020., Results: From 2016-2020, 12 274 Aboriginal and Torres Strait Islander people were clients of the Quitline in included jurisdictions. Most (69%) clients were living in a TIS area. Two-thirds (66.4%) of referrals were from third‑party referrers rather than self-referrals. Overall, between 1.25% and 1.62% of Aboriginal and Torres Strait Islander peoples who currently smoked were clients of Quitline (between 1.15-1.57% in TIS areas and 0.82-0.97% in non-TIS areas)., Conclusions: The Quitline provided smoking cessation support to approximately 2500-3000 Aboriginal and Torres Strait Islander clients annually between 2016-2020. Referrals from third parties including Aboriginal and Torres Strait Islander services are an important pathway connecting community members to an evidenced-based cessation support service., Competing Interests: None declared.

Background: Effective recruitment and retention of participants are prerequisites for high quality physical activity intervention programs and evaluation trials, but this is underreported in the literature making it difficult to identify the most promising strategies. Incorporating stakeholder feedback in the design of program components and recruitment materials can optimise recruitment reach and the engagement of participants throughout programs and trials., Methods: The Active Women over 50 randomised controlled trial is testing a program designed to support women aged 50 + to be more physically active. To optimise program design and recruitment flyers, we conducted one focus group and 17 interviews with diverse purposively sampled women aged 50 + living in New South Wales, Australia. Women were asked to review recruitment flyers and the four proposed program components: (1) health coaching, (2) dedicated website with resources, (3) private Facebook group and (4) motivational email and SMS messages. Data analysis incorporated framework methods, deductive analysis using the Adapted Mobile App Rating Scale for evaluating websites and abductive analysis to critique the underlying program theory., Results: Five themes were identified in relation to recruitment: I want to see (women like) myself, Keep it real, Readability is for everyone, Why should I do it? and Find us where we live. The four program components were strongly supported as a package, but were valued differently for their relative importance. Results were used to refine the health coaching scheduling; website appearance and content; promotion and moderation of the Facebook group; and the structure, appearance and content of messages. Not all suggestions were actionable due to technological and time constraints, and the desire to keep program costs low enough for delivery at scale during the study and beyond. The program theory was expanded to encompass two emergent concepts., Conclusions: This consultation resulted in substantial refinements to recruitment flyers and strategies, and all four program components. We anticipate that these refinements will increase the reach and appeal of the trial and optimise future scale-up. Consultation feedback, while specific to this program, may have wider transferability for recruitment and the design of programs with similar components targeting women aged 50+., (© 2024. The Author(s).)

Objective: Helping people to change their health behaviours is becoming a greater feature within the role of health professionals, including through whole system initiatives such as Making Every Contact Count. Health services provide an ideal setting to routinely promote health behaviours, including physical activity. Snacktivity is a novel approach that promotes small bouts of physical activity (activity snacks) throughout the day. This study explored health professionals' initial experiences of delivering a Snacktivity intervention to promote physical activity within routine health consultations. A further aim was to investigate health professionals' ability/fidelity in delivering the Snacktivity intervention to their patients., Design: Semistructured interviews (n=11) and audio recording of consultations (n=46)., Setting and Participants: Healthcare professionals from a variety of specialisms who delivered the Snacktivity intervention within patient consultations., Results: Analyses revealed two higher-level themes of interest: (1) health professionals' conceptualisation of Snacktivity (subthemes: observations/reflections about patients' understanding, engagement and enthusiasm for delivering the Snacktivity intervention) and (2) health professionals' understanding of Snacktivity and experience in delivering the intervention (subthemes: delivering Snacktivity; limitations, challenges and possible improvements). Consultation audio recordings demonstrated health professionals delivered the Snacktivity intervention with high levels of fidelity. Health professionals were proficient and supportive of delivering the Snacktivity intervention within consultations although practical barriers to implementation such as time constraints were raised, and confidence in doing so was mixed., Conclusions: Health professionals were proficient and supportive of delivering the Snacktivity intervention within consultations. The primary barrier to implementation was the time to deliver it, however, gaining greater experience in the intervention and improving behaviour change counselling skills may reduce this barrier., Trial Registration Number: ISRCTN64851242., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Older adults with lower socioeconomic status are less likely to be physically active than those with higher socioeconomic status. To inform future intervention development, this review explored: [i] how effective are physical activity interventions at increasing levels of physical activity amongst older adults with lower socioeconomic status?; [ii] what factors are associated with the acceptability of physical activity interventions amongst older adults with lower socioeconomic status?; [iii] what are the implications for developing physical activity interventions for older adults with lower socioeconomic status?, Methods: This mixed methods systematic review followed PRISMA guidelines. MEDLINE, CENTRAL, Embase, Scopus, Web of Science, PsycINFO, CINAHL, ASSIA and Sports Medicine and Education Index were searched up to May 2023, to identify quantitative, qualitative and mixed methods primary research studies measuring the effectiveness of and/or experiences of physical activity interventions for older adults (aged ≥ 65 years) with lower socioeconomic status. No limits on country were applied. Included studies were assessed for methodological quality using the Mixed Methods Appraisal Tool. Results were synthesised using a results-based convergent synthesis approach with narrative synthesis of quantitative findings and thematic synthesis of qualitative findings., Results: Thirty studies were included. Mixed effects were found for the effectiveness of physical activity interventions, with positive effects for increases in utilitarian walking (i.e. for transport) but not for leisure, mixed effects for objectively measured physical activity and no effects for self-reported total physical activity or muscle strengthening and flexibility activities. Engaging in physical activity interventions was perceived as offering many benefits, social familiarity was important to intervention acceptability and interventions were seen as more acceptable when they were compatible with the lifestyles of older adults with lower socioeconomic status., Conclusions: Future development of physical activity interventions for older adults with lower socioeconomic status should foster social connections, emphasise health benefits of physical activity, hold interventions in locations that are accessible and familiar to older adults with lower socioeconomic status, minimise costs to participants, employ individuals who share participant characteristics to lead interventions, and combine physical activity with other activities older adults with lower socioeconomic status already do to make more efficient use of time., Trial Registration: PROSPERO CRD42023417312; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=417312 ., (© 2024. The Author(s).)

Introduction: To minimise adverse health events among older adults, physical activity (PA) is considered one of the most fundamental and effective forms of lifestyle. Therefore, an urgent effort to promote a physically active lifestyle among our older adults is needed, in which walking could be a better choice, especially for mass promotion. Besides, the types of PA interventions were also shown to affect their effectiveness on older adults' psychosocial outcomes. Hence, the overall aim of the project is to examine the effectiveness of supervised group-based walking intervention by comparing it with unsupervised group-based walking and unsupervised individual-based walking interventions on improving physical, psychological and social outcomes among older adults in Hong Kong., Methods and Analysis: The research will conduct a four-group (supervised group-based, unsupervised group-based walking, unsupervised individual-based, control group), double-blind, randomised control trial, targeting 184 older adults in Hong Kong. The primary outcomes will be measured by participants' changes in resting heart rates, body compositions, resting blood pressures, walking performance, loneliness, perceived social support and PA enjoyment. The results will be analysed using repeated analysis of variance and one-way analysis of covariance, as well as by conducting in-depth interviews with selected participants. Also, the outcomes of the research will be used as references for designing an effective walking operation manual for promoting healthy ageing among older adults in the community., Ethics and Dissemination: The current study involves human participants, and the research protocol has been approved by the research ethics committee at Hong Kong Baptist University (Ref: R2022-2023-0013). All participants will be provided with written informed consent to participate. The outcomes of the intervention protocol will be disseminated through manuscript publications., Trial Registration Number: The trial is registered at the ClinicalTrials.gov PRS (Trial ID: NCT05907252; date of first posted: 16 June 2023)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Stroke survivors face many barriers to physical activity (PA). Solving physical inactivity after stroke requires a "systems-based" approach. We aimed to develop a complex intervention targeted at improving PA after stroke in Singapore using behaviour change theory and a co-design approach involving multiple stakeholders., Methods: We carried out the intervention development in three phases: i. preparation phase, ii. co-design phase, and iii. intervention refinement phase. During the preparation phase, we conducted surveys (n = 38 stroke survivors, 71 physiotherapists and 35 exercise professionals) and interviews (n = 19 stroke survivors) to understand the factors influencing PA after stroke. The co-design phase consisted of two-co-design workshops held in August 2022 and were attended by 13 stroke survivors and 4 caregivers. Relevant domains of the Theoretical Domains Framework (TDF) and items in the Template for Intervention Description and Replication (TIDieR) checklist guided the discussion topics in the first co-design workshop. Solution prototypes such as exercise videos, arm and leg straps and information resources were shown in the second co-design workshop to gather feedback. In the intervention refinement phase, eight healthcare professionals from various sectors participated in two virtual Zoom meetings in August 2023, and used the Acceptability, Practicability, Effectiveness, Affordability, Spillover effects and Equity (APEASE) grid to rate the active ingredients in the complex intervention by considering the current healthcare landscape in terms of resources and manpower., Results: Stroke survivors and caregivers want a personalised PA program, stroke-specific PA opportunities and information resources, medical clearance, advice and help from healthcare professionals skilled in stroke care, face-to-face sessions at preferred exercise spaces, and access to adaptive equipment. A complex intervention consisting of 21 behaviour change techniques, 6 intervention functions and 8 options was developed., Conclusions: Using behaviour change theory and a co-design approach involving multiple stakeholders, a complex intervention was developed to target physical inactivity after stroke. The intervention titled MOTIVATE is currently being tested in a type 1 hybrid effectiveness-implementation trial., (© 2024. The Author(s).)

Background: Strong Hearts, Healthy Communities 2.0 (SHHC-2.0) was a 24-week cardiovascular disease prevention program that was effective in improving physical activity and nutrition behaviors and clinical outcomes among women in 11 rural New York, USA towns. This study evaluated the delivery of SHHC-2.0 to prepare the intervention for further dissemination., Methods: This process evaluation was guided by the Medical Research Council recommendations and engaged program leaders and participants (i.e., women over age 40) using quantitative and qualitative methods. The quantitative evaluation included examination of enrollment and retention data, a participant survey, and a fidelity checklist completed after classes. Descriptive and comparative statistics were used to assess implementation measures: program reach, participant attendance, dose delivered, program length, perceived effectiveness, fidelity, and participant satisfaction. The qualitative evaluation included focus groups (n = 13) and interviews (n = 4) using semi-structured guides; audio was recorded and transcripts were deductively coded and analyzed using directed content analysis and iterative categorization approaches. Comparisons across towns and between intervention and waitlist control groups were explored., Results: Average reach within towns was 7.5% of the eligible population (range 0.7-15.7%). Average attendance was 59.8% of sessions (range 42.0-77.4%). Average dose delivered by leaders was 86.4% of curriculum components (range 73.5-95.2%). Average session length was 51.8 ± 4.8 min across 48 sessions. Leaders' perceived effectiveness rating averaged 4.1 ± 0.3 out of 5. Fidelity to curricular components was 81.8% (range 67.4-93.2%). Participants reported being "more than satisfied" with the overall program (88.8%) and the health benefits they obtained (72.9%). Qualitative analysis revealed that participants: (1) gained new knowledge and enjoyable experiences; (2) perceived improvements in their physical activity, nutrition, and/or health; (3) continued to face some barriers to physical activity and healthy eating, with those relating to social support being reduced; and (4) rated leaders and the group structure highly, with mixed opinions on the research elements., Conclusions: SHHC-2.0 had broad reach, was largely delivered as intended, and participants expressed high levels of satisfaction with the program and its health benefits. Our findings expand on best practices for implementing cardiovascular disease prevention programs in rural communities., Clinical Trials Registration: www., Clinicaltrials: gov #NCT03059472., (© 2024. The Author(s).)

Background: Vaping among 18-24-year-old Australians has increased from 5.8% in 2019 to 21% in 2023. This protocol describes a trial to investigate the dissemination and engagement achieved by three anti-vaping messages on Facebook., Methods: This research employs a 3-arm randomised experimental design. Three distinct anti-vaping messages will be disseminated via Facebook using Meta Ads Manager. Each arm has a message that focuses on either health risks, environmental impact, or anti-vape industry sentiment. The campaign will run for three months. The primary outcome is the engagement rate as a measure of the effectiveness of anti-vaping message, and the secondary outcomes include network indicators: size, density, centralisation, and centrality to evaluate the extent to which the messages are disseminated. Participants will be randomly exposed to one of the three messages. Data on reach and engagement will be compared across the groups., Discussion: This study will provide insights into the dissemination of social media-based anti-vaping campaigns. By evaluating engagement rates and network indicators, the research aims to identify which message themes engage most with young Australians. The findings will contribute to the development of more effective public health strategies for vaping cessation and prevention among youth., Trial Registration: The study was registered on July 19th 2024 with the Australian New Zealand Clinical Trials Registry (ACTRN12624000885594)., (© 2024. The Author(s).)

Objective: Behaviour Change Communication (BCC) intervention programmes often lack documentation of successful processes. This manuscript aims to describe the development of Program Impact Pathway (PIP) using Theory of Change (ToC) approach for a mHealth BCC intervention titled 'Mobile Solutions Aiding Knowledge for Health Improvement (M-SAKHI)' aimed at reducing stunting in infants at 18 months of age., Design: The PIP was developed using ToC to design the intervention and plan its implementation. Literature review and data from previous pilots helped to identify health service gaps that needed to be addressed by the PIP of this intervention., Setting: M-SAKHI was implemented in 244 villages under governance of forty primary health centres of Nagpur and Bhandara districts of eastern Maharashtra in central India., Participants: The study investigators and the public health stakeholders participated in developing the PIP. M-SAKHI evaluation study recruited 2501 pregnant women who were followed up through delivery until their infants were 18 months old., Results: The PIP was developed, and it identified the following pathways for the final impact: (1) improving maternal and infant nutrition, (2) early recognition of maternal and infant danger signs, (3) improving access and utilisation to healthcare services, (4) improving hygiene, sanitation and immunisation practices, and (5) improving implementation and service delivery of community health workers through their training, monitoring and supervision in real time., Conclusion: This paper will illustrate the significance of development of PIP for M-SAKHI. It can aid other community-based programmes to design their PIP for nutrition-based BCC interventions.

Effective health promotion may benefit from understanding how persuasion emerges. While earlier research has identified brain regions implicated in persuasion, these studies often relied on event-related analyses and frequently simplified persuasive communications. The present study investigates the neural basis of valuation change induced by a persuasive healthy eating call, employing naturalistic stimuli. Fifty healthy participants performed two blocks of a bidding task, in which they had to bid on sugar-containing, sugar-free, and nonedible products during functional MRI. In between the two blocks, they listened to a persuasive healthy eating call that influenced their bidding behavior. Intriguingly, participants who resisted persuasion exhibited increased synchronization of brain activity during listening in several regions, including default mode network structures. Additionally, intersubject functional connectivity among these brain regions was found to be weaker in persuaded individuals. These results emphasize the individualized nature of processing persuasive messages, challenging conventional interpretations of synchronized neural activity. Our findings support the emerging practice of tailoring persuasive messages in health promotion campaigns., Competing Interests: Competing interests statement:The authors declare no competing interest.

Objective: To investigate if a combination of an online and onsite implementation strategy was superior to an online-only strategy in enhancing the use of an injury prevention exercise programme (IPEP) and in reducing the risk of shoulder, knee and ankle injuries in youth community handball players (age 11-17) over a handball season., Methods: In this 30-week hybrid effectiveness-implementation cluster randomised type 3 study, 20 youth handball clubs were randomly assigned 1:1 to either a combined online and onsite implementation strategy (coach workshop using the health action process approach behaviour change model and health service provider (HSP) support) or an online-only strategy (control group). The primary implementation outcome was coach-reported adherence, measured as the average IPEP exercise usage by the team over 30 weeks. The primary effectiveness outcome was player-reported handball playing time to any new handball-related shoulder, knee and ankle injuries, reported weekly using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems., Results: We enrolled 63 coaches (27% women) and 945 players (mean age 14.5 years, 55% girls). Intention-to-treat analyses showed no statistically significant difference between implementation strategies in adherence (between-group difference 1.4, 95% CI -0.5 to 3.4) or in cumulative injury risk (between-group difference 5.5% points, 95% CI -2.2 to 13.1)., Conclusion: Our findings demonstrate that in youth community handball, a combined online and onsite implementation strategy, including a coach workshop and HSP support, was not superior to an online-only strategy regarding adherence to an IPEP or in reducing shoulder, knee and ankle injury risk., Trial Registration Number: NCT05294237., Competing Interests: Competing interests: MM is associate editor for the British Journal of Sports Medicine., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Cardiovascular diseases (CVDs) and their risk factors are a major cause of illness and death worldwide, especially in low- and middle-income countries like Cameroon. Physiotherapist-led health promotion (PLHP) has proven effective in improving health and reducing CVD risks. Understanding patient perspectives is crucial for designing effective, context-specific PLHP interventions. This study explored patients' views, experiences, perceived usefulness, acceptability, and preferred methods of PLHP, through a sequential explanatory mixed-methods approach. The quantitative data highlights a significant burden of CVD conditions and risk factors among patients seen in physiotherapy services. Qualitatively, three themes were identified and included: (1) perspectives and experiences of people at risk or with CVDs (pwCVDs) on PLHP; (2) perceived usefulness and acceptability of PLHP; (3) preferred delivery methods of PLHP. Participants reported positive feedback on PLHP and physiotherapy services. Barriers to effective PLHP included high workloads for physiotherapists, limited service access in rural areas, and prohibitive costs. Despite these challenges, participants expressed strong confidence in physiotherapists' competence, though they also called for improved regulation and ongoing professional development. PLHP components, especially physical treatment and dietary advice, were deemed highly useful and acceptable. Patients suggested various delivery methods, including peer support groups, home visits, and mass media interventions. This study highlights the need to improve the scope of practice, competence of physiotherapists, and accessibility of physiotherapy services in Cameroon for pwCVDs. It is necessary to adopt multidisciplinary approaches to achieve better outcomes for risk factors like diabetes and hypertension in context.

Background: We aim to assess the effect of a smoke-free beaches (SFB) intervention in Barcelona on smoking during the 2021 bathing season., Methods: Quasi-experimental pre-post design (pre-intervention period: 15-28 May; post-intervention period: 29 May-12 September). Based on users' profiles and location, four beaches were assigned to the intervention group (IG) and five to the comparison group (CG). The intervention involved: a mayoral decree (29 May), a communication campaign and beach on-site information. We established two 3 m × 3 m transects per beach from the coastline to the promenade. Trained teams collected smoking-related information in the transects through observations and surveys to beach users. Outcomes are as follows: percentage of people reporting witnessing smoking behaviours the last fortnight and percentage of people observed smoking. We calculated and compared prevalence ratios (PRs) with adjusted Poisson regressions., Results: 3751 interviews (1721 IG; 2030 CG) and 1108 observations (498 IG, 610 CG) were carried out. SFB were associated with a significant reduction in the percentage of people reporting witnessing smoking (IG (pre: 87.2%; post: 49.7%); CG (pre: 86.2%; post: 74.1%); PR (95% CI): 0.7 (0.6 to 0.8)); and in the users observed smoking in the beach (IG (pre: 3.8%; post: 3.0%); CG (pre: 2.3%; post: 9.9%); PR (95% CI): 0.3 (0.3 to 0.4)). Satisfaction scores were 8.3 (IG) and 8.1 (CG) out of 10., Conclusion: An SFB intervention is an effective and well-accepted measure to reduce smoking and smokers' visibility. Smoke-free measures should be extended to beaches and other non-regulated outdoor areas., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

One person suffers from dementia every 3 seconds globally. Thirteen older adults aged 65 and older will have dementia, and 1 in 5 older adults over the age of 80 years will have dementia in Taiwan. Older adults should be equipped with demonstrated health beliefs regarding dementia prevention and health promotion about Ascertain Dementia 8-item Questionnaire (AD8), cues to action, health beliefs, self-efficacy, and behavioral intention in daily life. The purpose of this study was to survey older adults' demographic background, AD8, cues to action, health beliefs, self-efficacy, and behavioral intention for dementia prevention and health promotion. A cross-sectional survey design was used. Convenience sampling was performed. A total of 330 older adults participated in the study. The questionnaire used in this study included questions on older adults' demographic background, AD8, cues to action, health beliefs, self-efficacy, and behavioral intention. The researcher collected complete data by receiving the sampling on paper or by interview from October 8, 2021, to February 12, 2022. The SPSS 23.0 statistical package was employed for quantitative analysis. Data analysis included frequency, percentage, mean, standard deviation (SD), Spearman's rho correlation, and simple regression analysis. The findings showed that older adults had the following mean scores on health beliefs (perceived susceptibility 13.45 ± SD 2.34, perceived severity 13.54 ± SD 2.69, perceived benefits 16.57 ± SD 2.84, perceived barriers 8.20 ± SD 3.69), self-efficacy 16.96 ± SD3.52, and behavioral intention 19.56 ± SD 3.51. Older adults' demographic background, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy explained 56.1% of the variance in behavioral intention. The conclusions of the study indicated that older adults' demographic background, AD8, cues to action, health beliefs, self-efficacy, and behavioral intention constituted the main factors for effective dementia prevention and health promotion. In the future, the research team will continue to explore older adults' dementia prevention and develop many strategies on health promotion, as well as slowing the aging brain process., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Unfavourable changes occur in children's health behaviours and outcomes during the summer holidays. This systematic review aimed to determine the effectiveness of summer holiday programs in mitigating these changes., Methods: Six databases (MEDLINE, JBI, PsychINFO, Embase, ERIC and Scopus) were systematically searched for experimental controlled studies that investigated programs of at least 5 days' duration conducted exclusively during the summer holiday period on school-aged children (5-18 years). Primary outcomes were moderate-vigorous physical activity and energy intake. Secondary outcomes were sedentary behavior, diet quality, adiposity, and cardiorespiratory fitness. Risk of Bias was assessed using the PEDro tool. Effect sizes were calculated using random-effects meta-analysis with narrative synthesis of effects by student or program characteristics., Results: Ten studies (two randomised controlled trials, and eight non-randomised controlled trials) involving 1,446 participants were included. Summer programs had a significant moderate effect on reducing sedentary behaviour (g= -0.59, 95%CI= -1.16, -0.03) and significant small effects on improving moderate-to-vigorous physical activity (g = 0.35, 95%CI = 0.02, 0.67) and adiposity (g= -0.25, 95% CI = -0.39, -0.10). No significant change was detected for cardiorespiratory fitness (g = 0.43, 95%CI= -0.32, 1.17), energy intake (g= -0.06, 95% CI -2.33, 2.22), or diet quality (g = 0.20, 95%CI= -0.43, 0.83). Summer program effectiveness did not appear to differ by child sociodemographic or program characteristics. Concerns regarding bias and high heterogeneity impacted results., Conclusions: Summer programs show potential in promoting healthier movement behaviours in children and supporting healthy body weight during the summer months. Although evidence from the included studies has limitations, these programs produced small to moderate effect sizes and present promising health intervention opportunities for children. Future research with more rigorous study designs and comprehensive reporting is needed to confirm these findings and better understand the impact of summer programs on children's health., Prospero Registration: CRD42023409795., (© 2024. The Author(s).)

Aim: The National Bowel Screening Programme (NBSP) fails to deliver screening equitably to Pacific New Zealanders. This research explored Tongan New Zealanders' experiences of participating in the NBSP and their views on ensuring the programme works well for the Tongan community., Method: In 2021, we conducted two talanoa focus groups with Tongan New Zealanders who had participated in the NBSP (n=26), recruited through a Pacific provider in Auckland. Participants were aged 60 or more and were Tongan born. Interviews with four Pacific experts working in the NBSP were also undertaken. Their views on the NBSP were explored and analysed using thematic analysis., Results: While the research participants valued the opportunity to participate in the NBSP, they had many valuable insights about strengthening it, as did the Pacific experts. Key was a by Tongan, for Tongan service run by Tongan providers, one based on Tongan models of health and health promotion, Tongan values and ways of working, and using the Tongan language, which empowers Tongans to take control of their health., Conclusions: This research demonstrates critical elements of an effective, culturally appropriate and empowering NBSP for Tongans led by Tongan providers. If these findings are enacted, more effective delivery of bowel screening to Tongans will likely be enabled, reducing inequity in participation between Tongans and other New Zealanders. What is required is courage and political will to shift power and resources to ensure equitable outcomes in the NBSP, not only for Tongans but for all Pacific peoples., Competing Interests: None to declare. This research was independently funded by the Cancer Society of New Zealand. This research does not necessarily represent the views of the funder., (© PMA.)

Objective: To evaluate the impact of a counselling programme to strengthen the health and nutrition behaviours of caregivers of children under 2 and the sustainability of that impact through reduced intervention intensity one year later., Design: The programme trained community- and facility-based health staff to provide nutrition counselling. We conducted an impact evaluation with a modified stepped-wedge design using difference-in-differences analysis to compare indicator changes in an intervention group to a comparison group (midterm survey) and then a full intervention group to a light intervention group (final survey)., Setting: Batken and Jalal-Abad oblasts, the Kyrgyz Republic, 2020-2023., Participants: Caregivers of children under 2 provided 6253 responses in three telephone surveys., Results: We observed statistically significant differences between the intervention and comparison groups at midterm for the percentage of children consuming vitamin A-rich foods; an increase in the intervention group (58-62 %) and a decrease in the comparison group (61-57 %). We observed similar results with exclusive breastfeeding (51-55 % in the intervention group and 48-40 % in the comparison group). There were also positive differences in other health and nutrition indicators. With the final survey results, in general, we observed statistically significant differences indicating a bigger change in full intervention areas compared to light intervention areas. We observed small negative changes in many indicators in light intervention areas., Conclusions: This evaluation highlights the importance of continued support for local interventions, particularly counselling programmes, to foster optimal nutrition behaviours.

Background: Despite the known benefits of physical activity (PA), rates of engagement in PA remain low globally. Low engagement in PA among young women can impact their health. Technology-supported PA may increase PA and physical literacy (PL; skills that can support PA) among young women., Objective: This systematic review aims to investigate the (1) associations between technology-supported PA and PA levels, (2) associations between technology-supported PA and PL levels, and (3) types of technology-supported PA that are associated with higher levels of PA engagement among young women aged 13 to 24 years. This age range was chosen as it includes two transitional periods characterized by decreases in PA., Methods: We searched 6 databases: Applied Science and Technology Source, Education Source, Embase, MEDLINE Complete, Global Health, and SPORTDiscus. Eligible studies were original research published in English between January 1, 2010, and April 24, 2024; focused on young women; and involving either technology-supported PA interventions or research exploring the correlation between technology and PA and PL. The findings of the review were presented descriptively. Study quality was assessed using the JBI Critical Appraisal tools. There were no deviations from the registered protocol., Results: In total, 23 (0.1%) studies (10,233 participants) from 23,609 records were included: randomized controlled trials (n=9, 39%), nonrandomized or retrospective observational studies (n=9, 39%), and cross-sectional studies (n=5, 22%). Of the 23 studies, 12 (52%) focused on young adults (aged ≥19 y), 9 (39%) involved adolescents (aged <19 y), and 2 (9%) focused on both groups. Nine studies (39%) were theory based. Common types of technology-supported PA were interactive websites or social media platforms (10/23, 43%), wearable fitness trackers (4/23, 17%), and mobile apps (4/23, 17%). PA or PL were predominantly self-reported (18/23, 78%). A total of 53 PA outcomes were measured: 36% (19/53) reported a positive impact on PA from mobile apps (9/15; 60% of analyses), interactive websites or social media platforms (8/27; 30% of analyses) and wearable fitness trackers (2/11; 18% of analyses). The impact on PL was weak (2/7; 29% of analyses). Eight studies (35%) were rated high, 7 (30%) medium, and 8 (35%) low in quality., Conclusions: There was limited evidence that technology-supported PA improved young women's PA or PL. The evidence was limited by poor study quality and a lack of theoretical frameworks. In addition, little information was provided on the designs of the technology used. Future interventions seeking to improve young women's PA and PL should focus on the development of mobile apps underpinned by behavior change theory and addressing whole domains of PL rather than specific elements. Given that technology continues to rapidly advance, further studies are needed to demonstrate the impact of technology-supported PA in improving PA and PL among young women., (©Kimberley Watson-Mackie, Lauren Arundell, Natalie Lander, Fiona H McKay, Alethea Jerebine, Fotini Venetsanou, Lisa M Barnett. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 18.10.2024.)

Background: Previous community-wide physical activity trials have been criticized for methodological limitations, lack of population-level changes, and insufficient reach among underserved communities. Social marketing is an effective technique for community-wide behavior change and can coincide with principles of community-based participatory research (CBPR)., Purpose: A systematic scoping review of community-wide interventions (system-level) targeting physical activity and/or weight loss was conducted to (i) describe and critically discuss how social marketing strategies are implemented; (ii) identify which populations have been targeted, including underserved communities; (iii) evaluate the use of CBPR frameworks; (iv) assess retention rates; and (v) identify gaps in the literature and formulate future recommendations., Methods: Eligible studies included those that: aimed to improve physical activity and/or weight loss on a community-wide level, used social marketing strategies, and were published between 2007 and 2022., Results: Approximately 56% of the studies reported a positive impact on physical activity. All studies described social marketing details in alignment with the five principles of social marketing (product, promotion, place, price, and people). Only two studies explicitly identified CBPR as a guiding framework, but most studies used one (k = 8, 32%) or two (k = 12, 48%) community engagement strategies. Few studies included at least 50% representation of African American (k = 2) or Hispanic (k = 3) participants., Conclusions: This review highlights key gaps in the literature (e.g., lack of fully-developed CBPR frameworks, reach among underserved communities, randomized designs, use of theory), highlights examples of successful interventions, and opportunities for refining community-wide interventions using social marketing strategies., (© Society of Behavioral Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The current study explored teacher and principal familiarity with school wellness polices in primary schools, including who serves on school wellness committees, and who should implement and enforce wellness policies in the school. An electronic survey guided by the Health Promoting Schools framework was administered from February to May 2020 to teachers and principals from one urban and one suburban school district in the Midwestern United States. There were 450 participants; response rates were 28% (urban), 33% (suburban), and 51% (school principals). Only 41.7% of the aggregate participant pool were familiar with their wellness policy. Participants were more familiar in the suburban compared to the urban district (χ 2 = 68.2, p -value ≤ 0.001). Teachers/health teachers, nurses, and principals were most likely to be on wellness committees, and the most preferred wellness champions were teachers, nurses, and food service staff. Teachers and nurses are integral to school wellness and health education as part of multiple systems that can promote school health. The Health Promoting Schools framework is useful for guiding examinations to improve understanding of school wellness within school communities.

Introduction: The majority of children fails to have a healthy diet. Providing a healthy lunch at school is a way to target all children, regardless of ethnic and socioeconomic background. This study aims to investigate the effectivity and feasibility of a co-created healthy school lunch in disadvantaged neighbourhoods of the city of Rotterdam, the Netherlands., Methods and Analysis: This is a cluster randomised cross-over trial with five participating primary schools. Schools will be randomised to have an 18 week healthy school lunch the first or second half of the academic year. The other half of the academic year, children will bring their own lunch from home. A tailored lunch concept for each school will be co-created with school staff, parents, children and key-stakeholders.Primary outcome is the dietary content of children's lunches, assessed by observations for all children. Secondary outcomes include healthy lunch-related parameters, like general dietary behaviour, perceived health, taste preferences, concentration in class, and some feasibility outcomes, like satisfaction, implementation at school and affordability for parents. Secondary outcomes will be assessed by questionnaires for children (grades 5-8), parents and teachers. The observations and questionnaires for children and parents will be completed at baseline (September 2023), half way the academic year (January-February 2024) and at the end of the academic year (June-July 2024). Teachers will complete a monthly questionnaire starting in September 2023., Ethics and Dissemination: This study obtained ethical approval from the Institutional research Review Board Erasmus MC of Rotterdam, the Netherlands. Informed consent will be collected from all participants (parents, teachers and children 12 years or older) and/or their parents (for children under the age of 16). The findings will be disseminated by conference presentations and publications in scientific peer-reviewed journals., Trial Registration Number: NCT06058325., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Promoting the use of insecticide-treated mosquito nets (ITNs) is one of the main strategies for reducing malaria-related morbidity. An innovative activity-based contracting (ABC) approach has been implemented in Kwilu Province, Democratic Republic of Congo to optimize ITN mass distribution campaigns, with payments based on contractually defined programmatic outcomes for key campaign activities following independent verification of results., Methods: This internal evaluation was carried out using a mixed methods approach combining qualitative and quantitative document and content analysis from a series of three workshops: validation workshops for campaign results at provincial level for the 2021 and 2022 campaigns; internal evaluation workshop for the Kwilu campaign as part of the ABC approach organized by "Santé pour tous en milieu rural" (SANRU) with its sub-contractors; and national campaign evaluation workshop organized by the National Malaria Control Program., Results: The pilot campaign with the ABC approach in Kwilu has demonstrated better results than campaigns conducted using the standard, non-ABC, approach: better household coverage (99.9% vs. 97.3%) and improved compliance with ITN allocation to households based on the household size (98. 9% vs. 84.7%); lower loss of ITNs (0.3% vs. 0.5%) with immediate penalties for lost ITNs in the province under the ABC approach; shorter campaign lead times (14 vs. 28 weeks from the start of training to the launch of distribution). This last point is crucial, as it is likely to generate efficiencies and contribute to ensuring timely ITN replacement campaigns., Conclusion: The challenges encountered and the lessons learned in the implementation of the pilot ABC approach in Kwilu could guide future distribution campaigns in the DRC and other African countries that would like to engage in distribution campaigns based on performance-based incentive contracts., (© 2024. The Author(s).)

Introduction: Globally, it is estimated that dietary habits contribute to 22% of adult deaths and 15% of disability-adjusted life years, highlighting the critical role of dietary behaviour in public health. Despite the known benefits of healthy eating, many individuals find it challenging to change their diet for disease prevention. eHealth and mHealth interventions using behaviour change techniques (BCTs) have emerged as promising strategies to address this issue. However, the specific BCTs that are most effective in promoting dietary behaviour are not well established. This systematic review and component network meta-analysis (CNMA) aims to estimate the effect size of each BCT on fostering healthy eating., Methods and Analysis: We will include randomised controlled trials that assess the effects of eHealth and mHealth interventions on promoting changes in dietary behaviours among healthy adults. Studies with a minimum follow-up period of 3 weeks will be considered. Searches will be conducted in MEDLINE [PubMed], Embase [Dialogue], Cochrane Central Register of Controlled Trials, PsycInfo [Dialogue], ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and the University Hospital Medical Information Network Clinical Trials Registry on 27 January 2024. Two independent reviewers will conduct title and abstract screening followed by a full-text review. Disagreements will be resolved through discussion or consultation with a third reviewer. The primary outcome is dietary behaviour, as measured by changes in the diet quality score and the intake of a specific food. Our data synthesis will apply a frequentist random-effects model for pairwise meta-analysis, network meta-analysis and an additive CNMA model to compute the effect size of each BCT. This methodological approach will reveal the positive and negative effects of each BCT and provide a ranking of these techniques, considering both direct and indirect evidence., Ethics and Dissemination: Ethical approval is not required for this systematic review because it uses existing published data. These results will be submitted for publication in a peer-reviewed journal. The current protocol was submitted to PROSPERO on 16 January 2024 (CRD 42024502217)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study aims to assess the levels of social support, fear of disease progression (FOP) and health promotion behaviors in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and to examine the associations between FOP, social support, and health promotion behaviors in OSAHS patients, with a focus on exploring the mediating role of social support. The findings aim to provide insights for enhancing health promotion behaviors among OSAHS patients in China and to offer a theoretical foundation for healthcare professionals in devising intervention strategies to promote health behaviors in individuals with OSAHS., Methods: This cross-sectional study included 307 patients diagnosed with OSAHS in Jinzhou City, Liaoning province. The survey instruments utilized included the Demographic Characteristics Questionnaire, Social Support Rating Scale (SSRS), Fear of Disease Progression Scale (Fop-Q-SF), and Health-Promoting Lifestyle Scale (HPLP II). Pearson correlation analysis was employed to assess correlations, while multiple linear regression and structural equation modeling were utilized to explore potential mediation effects., Results: In the OSAHS patient population, FOP (r=-0.55, p<0.001) and social support (r = 0.60, p<0.001) were found to be significantly correlated with health promotion behaviors. In the mediated effects model, social support was identified as a partial mediator in the association between FOP and health promotion behaviors among OSAHS patients, accounting for 59.00% of the total effect., Conclusion: FOP demonstrates a direct relationship with health promotion behaviors in patients with OSAHS, with social support playing a mediating role in this connection. Healthcare professionals are advised to underscore the significance of social support in promoting the health of OSAHS patients to mitigate FOP and consequently improve health promotion behaviors., (© 2024. The Author(s).)

Objective: The aims of this article are (1) to evaluate the association between oral health-related quality of life (OHRQoL) and self-perceived job readiness and (2) to investigate changes in self-perceived job readiness following an oral health promotion intervention., Materials and Methods: The first aim was elucidated in a cross-sectional design, and the second through a prospective intervention study. A survey was administered among 273 unemployed vulnerable people in Copenhagen, Denmark. Participants were randomised to either control or intervention in 2018, and follow-up was conducted 7-15 months later. The intervention entailed support for dental care. OHRQoL was measured by the Oral Health Impact Profile (OHIP-14), and self-perceived job readiness was measured using the Employability Indicator Project (BIP) questionnaire., Results: The sample reported a high mean OHIP-14 score at baseline (26.9, SD 15.6) and poor OHRQoL was significantly associated with low self-perceived job readiness (rs = -0.15, p = 0.02). The control group reported better job readiness at follow-up compared to the intervention group. However, the effect sizes were small in both groups and no clear pattern was observed., Conclusions: The results indicate that OHRQoL is linked to self-perceived job readiness. However, the oral health promotion applied in this study did not lead to better self-perceived job readiness. Further research is needed on the effect of oral health promotion interventions on job readiness within socially vulnerable groups.

Background: The benefits of healthy eating are well known, yet adolescent diet is often poor. School based interventions offer a promising option to promote healthy eating, however, evidence is unclear., Aim: This umbrella review synthesised the current evidence on school-based interventions for healthy eating in adolescents (10-19 years old)., Methods: Using Joanna Briggs Institute (JBI) umbrella review guidelines, a systematic search was conducted on 11 electronic databases (PubMed, CINHAL, EMBASE, Science Direct, PsycINFO, MEDLINE, Scopus, ERIC, Web of Science, Cochrane Register of Systemic Review and JBI Evidence Synthesis) to identify reviews published between January 2000 and December 2023. Methodological quality was assessed using JBI critical appraisal tool. A narrative synthesis was conducted informed by the World Health Organisation's Health Promoting School (HPS) framework that categorises school-based interventions into three components i.e., health education, school environment changes, and family and community involvement., Results: Seventeen reviews were identified (including 347 unique primary studies) that were published between 2008 and 2023. 87% of the reviews were based on interventions in high- income countries, limiting applicability to low- and middle-income countries. Fourteen reviews were rated as high, two as moderate, and one was rated as low methodological quality. Evidence from 71% of the reviews (n = 14 reviews, 13 = high methodological quality) found that multi-component interventions (i.e., interventions incorporating more than two components of the HPS framework) improved adolescents' knowledge and behaviour concerning healthy eating. At the individual level, tech-driven healthy eating curricula effectively improved eating behaviours of adolescents. These individual-level interventions proved to be more effective and sustainable when supported by system-level changes, such as modifying school environments including increased availability of healthy foods and involving parents to promote healthy eating for adolescents. However, limited evidence from only three reviews suggests mixed feasibility for technology-based interventions and lower feasibility for multi-component interventions. The lack of information on stakeholder involvement in intervention design is another critical evidence gap., Conclusion: School-based multi-component healthy eating interventions that combine individual-level interventions with system-level changes are effective in promoting healthy eating behaviours among adolescents. Future reviews should assess the effectiveness of participatory approaches in intervention design, feasibility and scale-up studies, and analysing evidence from low- and middle-income countries., (© 2024. The Author(s).)

Background: Universal community engagement interventions can address childhood obesity., Objectives: This review aimed to evaluate the effectiveness of these interventions in improving body mass index (BMI) (primary outcome) as well as dietary choices and activity levels (secondary outcomes) among children and adolescents., Methods: Eight electronic databases were searched from inception dates to January 2024. A meta-analysis was conducted using the random-effect model, when appropriate; otherwise, the findings were narratively synthesized. Heterogeneity was determined by the I 2 statistics and Cochran's Q chi-squared test. The Cochrane ROB tool and the GRADE approach were used to assess the quality appraisal at the study and outcome levels, respectively., Results: Twenty-two studies were included in this review. The results showed that these interventions had a limited effect in improving children's standardized BMI (BMI-z) scores post-intervention. A meta-analysis on BMI-z scores showed that the intervention group had a statistically non-significantly lower BMI-z score than the control group (MD = -0.02, 95%CI = [-0.07, 0.03], Z = 0.83, p = 0.40) at immediate post-intervention. It was also reported that universal community engagement interventions had a limited effect in improving children's dietary choices and activity levels. Only the meta-analysis on children's daily sugar-sweetened beverage intake measured using continuous data reported a statistically significant small effect favoring the intervention group (SMD = -0.25, 95%CI = [-0.38, -0.13], Z = 3.98, p < 0.0001) at immediate post-intervention., Conclusions: Universal community engagement interventions have the potential to address childhood obesity. Children and adolescents could benefit more from interventions that focus on implementing both environmental and behavioral changes, and interventions that include parental involvement.

Background: The ageing population, coupled with the desire to age-in-place, highlight the need for programs that target health promotion as a means of maintaining functional ability, autonomy, and independence among community-dwelling older adults. This paper describes the development of the VIeSA intervention, which aimed to model a healthy ageing trajectory, including the identification of the necessary tools and methods, that would allow people older people, in partnership with health and social care professionals, to define personal health-related goals and the actions to achieve them. A key element of the intervention development was the creation of a support tool intended to assist this process., Methods: The UK Medical Research Council (MRC) guidance on developing and evaluating complex interventions was applied in the development of the intervention and of the support tool. A participatory approach was selected, with stakeholders engaged on different occasions to allow the refinement of the intervention and of the support tool. Following the steps and suggested actions in the MRC development phase, the development process was conducted by identifying (1) the evidence base and (2) the theoretical framework and (3) by modelling the process and outcomes of the intervention., Results: Following a literature review on effective interventions for functional ability, draft 1 of the support tool was designed. Focus groups with stakeholders provided feedback on this draft allowing for its refinement in terms of content, language use, and structure (draft 2). A review of the approaches for health promotion delivery led to further additions to the tool (draft 3) and informed the content of the training of health and social care professionals. After their training, professionals provided feedback on the acceptability, appropriateness, and feasibility of different elements of the intervention. Results suggested that no further major refinement to the intervention or support tool was necessary., Conclusions: The design and development of the VIeSA intervention using the MRC guidance allowed for a clarity of direction, an optimised content in terms of usefulness and accessibility for all concerned stakeholders, and greater opportunities for its implementation and uptake., (© 2024. The Author(s).)

Background: The University of California's Diabetes Prevention Program (UC DPP) Initiative was implemented systemwide to address diabetes and obesity risk on all 10 campuses. As little is known about implementing lifestyle change programs in university settings, we examined implementation partners' (i.e., UC DPP leaders and campus leads) perceptions of factors influencing program success on UC campuses., Methods: We conducted qualitative interviews with UC DPP leaders and campus leads to examine challenges and opportunities with university-based DPP delivery models. Interviews were recorded, professionally transcribed, and reviewed in detail by the research team. Transcripts were analyzed using rapid qualitative analysis (RQA). The study was approved by the UCLA Institutional Review Board. All implementation partners provided verbal informed consent., Results: Twenty-six implementation partners (8 UC DPP leaders and 18 campus leads) completed interviews in 2021. Seven themes were identified as critical for implementation, including (1) marketing and recruitment (i.e., market and recruit broadly through established channels as well as target at-risk populations); (2) enrollment (i.e., offer the program during convenient times and let participants know what to expect); (3) use an adaptable, evidence-based program; (4) secure funding for the program, participants, lifestyle coaches, and space; (5) hire experienced and dedicated staff and lifestyle coaches; (6) ensure leadership support; and (7) utilize campus linkages and resources. Perceptions of challenges faced with respect to these themes are also described., Conclusions: This is one of the first studies to examine the challenges and opportunities of delivering an intensive lifestyle change program across 10 university sites. Understanding factors that enhance success of university-based diabetes prevention programs can facilitate UC DPP efforts and help inform delivery strategies of health and wellness programs across other university settings more broadly., (© 2024. The Author(s).)

Background: Strategies to promote workplace mental health can target system, organization, team, and individual levels exclusively or in concert with each other. Creating toolkits that include these different levels is an emerging innovative strategy to support employees working in various sectors. Our paper describes the development, implementation, and refinement of two different online toolkits: the Healthy Professional Worker Toolkit for Education Workers and the Health Worker Burnout Toolkit., Methods: The Knowledge to Action Framework guided the team during the development and early interventions phases of toolkit development. Stakeholder engagement regarding the intended use of the toolkit of promising practices for workplace interventions was integrated throughout with different forms of feedback in a research capacity between 2022 and 2024., Results: Reflecting on the different phases of the KTA Framework, we describe first the engagement involved in building the toolkits and then on their utilization. Our toolkits were built to include different resources aimed at empowering workers, teams, and employers offering innovative ideas to address the mental health-leaves of absence and return to work cycle in one case and the different forms and consequences of burnout in the other. Criteria for inclusion were informed by ongoing research with a range of stakeholders and other intended toolkit users including managers, supervisors, executives, human resource specialists, staff, and others in healthcare and educational organizations and settings. In the implementation phase, the volume of resources available in each toolkit considered a strength by some was overwhelming for some partners and individual workers to navigate. Capacity, engagement, time, and readiness for change, are themes that heavily influenced if and when organizations interacted with each toolkit, and how much time they spent exploring the resources provided., Conclusion: It is critical to ground toolkits in the experiential evidence of workplace mental health as is linking these to evidence-informed interventions that correspond to workplace concerns. Organizational readiness to adopt and adapt resources and implement changes is a key consideration. Ultimately, user engagement is what brought these toolkits to life., (© 2024. The Author(s).)

Background: Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (eg, timing of intervention prompts) is an evidence gap in the optimization of digital physical activity interventions., Objective: The study examined the feasibility and acceptability, as well as the technical and functional reliability, of and participant engagement with a digital intervention that aligned its decision points to occur during times when adolescents typically exercise. This study also explored the impact of the intervention on adolescents' moderate to vigorous physical activity (MVPA) levels. Consistent with the Obesity-Related Behavioral Interventions Trials (ORBIT) model, the primary goal of the study was to identify opportunities to refine the intervention for preparation for future trials., Methods: Ten adolescents completed a 7-day baseline monitoring period and Temporally Augmented Goal Setting (TAGS), a 20-day digital physical activity intervention that included a midday self-monitoring message that occurred when adolescents typically start to exercise (3 PM). Participants wore an accelerometer to measure their MVPA during the intervention. Participants completed questionnaires about the acceptability of the platform. Rates of recruitment and attrition (feasibility), user and technological errors (reliability), and engagement (average number of text message responses to the midday self-monitoring message) were calculated. The investigation team performed multilevel models to explore the effect of TAGS on MVPA levels from preintervention to intervention. In addition, as exploratory analyses, participants were matched to adolescents who previously completed a similar intervention, Network Underwritten Dynamic Goals Engine (NUDGE), without the midday self-monitoring message, to explore differences in MVPA between interventions., Results: The TAGS intervention was mostly feasible, acceptable, and technically and functionally reliable. Adolescents showed adequate levels of engagement. Preintervention to intervention changes in MVPA were small (approximately a 2-minute change). Exploratory analyses revealed no greater benefit of TAGS on MVPA compared with NUDGE., Conclusions: TAGS shows promise for future trials with additional refinements given its feasibility, acceptability, technical and functional reliability, participants' rates of engagement, and the relative MVPA improvements. Opportunities to strengthen TAGS include reducing the burden of wearing devices and incorporating of other strategies at the 3 PM decision point. Further optimization of TAGS will inform the design of a Just-in-Time Adaptive Intervention for adolescent physical activity and prepare the intervention for more rigorous testing., (©Adrian Ortega, Christopher C Cushing. Originally published in JMIR Formative Research (https://formative.jmir.org), 10.10.2024.)

Background: The transition period from adolescence to early adulthood is critical for developing new nutritional behaviors, making higher education students an important target group for public health nutrition interventions. Given the complexity of nutrition-related behaviors and their various determinants, involving the student population (the future beneficiaries of interventions) and the partners engaged in their implementation when designing campus nutrition interventions is essential. Citizens' assemblies are deliberative processes which are more and more frequently organized to co-create solutions to complex problems. This study aims 1) to design and implement a student citizens' assembly using participatory research methods, 2) to describe its process and evaluate its transferability, 3) to evaluate changes in dietary habits, knowledge and citizen practices among students participating in this assembly., Methods: This study will take place at a French university (University Sorbonne Paris Nord, USPN) located in socio-economically disadvantaged suburbs of Paris. The student citizens' assembly will gather a mini-public of 30 students enrolled at the time of the study and a co-creation team of academic and non-academic partners involved in student life, nutrition, physical activity, or public policies. The aim of the assembly is to co-create a set of concrete proposals that would enhance USPN students' access to sustainable diets and physical activity. The protocol is based on a continuous process evaluation and a pre-post design among the mini-public. A mixed-method framework combining quantitative and qualitative approaches will be developed. This study will make use of (i) field observations of the intervention process and transferability, (ii) data collected by questionnaires on pre- and post- dietary habits, knowledge and citizen practices of the mini-public, and (iii) pre-post interviews with a subsample of the same mini-public., Discussion: Relying on participatory research methods, this study will provide new insights into involving higher education students and diverse partners in co-creating campus nutrition interventions. Through the collaborative work of researchers, higher education students, university representatives, public institutions, and local and community actors, this study will provide evidence-based guidance for designing innovative and contextually-relevant nutrition interventions in the higher education setting., Trial Registration: This research was registered at the ClinicalTrial.gov (NCT06580795; registration date: 2024-08-30; https://www., Clinicaltrials: gov/study/NCT06580795 )., (© 2024. The Author(s).)

Objective: To evaluate nudge strategies that increase the consumption of plant-based foods, defined as vegetarian or vegan food items, compared with meat-based options in post-secondary dining hall settings., Design: A pilot study., Setting: This study took place in the University of British Columbia Vancouver Campus's Gather Dining Hall (GDH) over a 6-week intervention period and two control periods. The intervention incorporated several nudges (proportion increases, item placement, taste-focused labelling, Chef's featured special verbal prompts, social media and promotional posters) into the menu and dining hall area with the goal of increasing the purchases of plant-based items. Sales data from meals that were purchased during the intervention period were compared with sales data from the two control periods., Participants: Students and staff who purchased meals in the GDH., Results: The proportion of plant-based items sold significantly increased during the intervention period (56·7 %; P < 0·01) compared with the last 6 weeks of term one (53·6 %) and the first 6 weeks of term two (53·4 %). The proportion of plant-based 'main' menu items was significantly higher in the intervention period (46·4; P < 0·01) when compared with the last 6 weeks of term one (40·9 %) and the first 6 weeks of term two (41·7 %)., Conclusions: The combination of nudges was effective at significantly increasing the selection of plant-based options over meat-based options in a post-secondary dining hall setting.

The One Health concept underscores the interconnectedness of human, animal, and environmental health, necessitating an integrated, transdisciplinary approach to tackle contemporary health challenges. This perspective paper explores the pivotal role of genomics and bioinformatics in advancing One Health initiatives. By leveraging genomic technologies and bioinformatics tools, researchers can decode complex biological data, enabling comprehensive insights into pathogen evolution, transmission dynamics, and host-pathogen interactions across species and environments (or ecosystems). These insights are crucial for predicting and mitigating zoonotic disease outbreaks, understanding antimicrobial resistance patterns, and developing targeted interventions for health promotion and disease prevention. Furthermore, integrating genomic data with environmental and epidemiological information enhances the precision of public health responses. Here we discuss case studies demonstrating successful applications of genomics and bioinformatics in One Health contexts, such as including data integration, standardization, and ethical considerations in genomic research. By fostering collaboration among geneticists, bioinformaticians, epidemiologists, zoologists, and data scientists, the One Health approach can harness the full potential of genomics and bioinformatics to safeguard global health. This perspective underscores the necessity of continued investment in interdisciplinary education, research infrastructure, and policy frameworks to effectively employ these technologies in the service of a healthier planet.

Background: Investing in the capabilities of adolescents is essential to achieving the United Nations Sustainable Development Goals, which focus on realising adolescent girls and young women's (AGYW) rights to education, health, bodily autonomy and integrity, sexual and reproductive health (SRH) and well-being. Despite significant scientific and programmatic progress in understanding and responding to their unique and intersecting vulnerabilities, AGYW continue to face disproportionate risk of STIs, HIV and early pregnancy. Health promotion and preventative interventions stand to be improved by early and meaningful engagement of AGYW in intervention design and delivery., Methods: This study employed Youth Participatory Action Research (YPAR) to co-generate lessons for future school-based SRH programming. The 5-step YPAR process included: (1) youth investigator recruitment; (2) youth investigator training and co-design of YPAR methods; (3) youth investigator-led data collection; (4) collaborative analysis and interpretation; and (5) dissemination., Results: Collaborative analysis revealed improvements in self-concept and bodily autonomy, understanding and formation of healthy relationships and demand for girl-centred health services and information at school. Additionally, the study highlights YPAR's positive influence on both the collaborative process and outputs of research. Further, it provides further insight into the quantitative biomedical and socio-behavioural findings of a larger experimental impact evaluation, in which it was nested., Conclusion: Results from YPAR methods point to high programme acceptability and practical lessons to inform future school-based SRH programming. The inclusion of adolescent girls in the design, delivery and evaluation of intervention research that affects their lives is an important strategy for improving acceptability, and also has demonstrated value in building their health and social assets. Future recommendations include parental involvement, and employing quantitative measures for better evaluation of youth engagement, leadership and partnerships in the research process., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Coakley, Lee, Pike, Myers, Hartmann, Oduro, Ntlapo, Bekker and Youth Investigators of the Goals for Girls study.)

Background: There is an escalating concern for the mental health of university students being recognized as a high-risk group for psychological distress. Despite research emphasizing the need to integrate mental well-being into higher education, existing interventions primarily focus on challenges and support services, leaving a gap in practical insights for promoting mental well-being at the university as a whole., Objectives: This paper aims to cover the theoretical and methodological foundations for the design and development of a complex multi-level intervention called the ABCs of mental health at the university (ABC-uni)., Methods: Following the MRC framework for complex interventions, the design and development of a novel complex intervention is described (Phase I). Using the socio-ecological model and incorporating principles from health promotion charters, capacity building, organizational change models, and the principles of the ABCs of mental health a program theory for mental health promotion at the university is proposed. Following this theoretical foundation a logic model outlines the ABC-uni intervention components at structural, community, and individual levels. The components include staff training, campaign materials, a photovoice project, integration of mental well-being literacy into introductory programs, a credit-bearing course, and an online module. Preferably, most of these components are developed and carried out collaboratively with students at the university. As proposed in the logic model expected outcomes encompass heightened awareness, supportive environments, commitment, and accountability, aiming to enhance mental well-being across the entire university. The design and development of the intervention components occur at a Danish public university., Discussion: This section addresses the strengths and limitations of the design of the ABC-uni intervention. Future research will cover the feasibility phase of each components of the ABC-uni intervention (phase II). The conceptual framework and program theory outlining mental health promotion at the university, along with the detailed description of the intervention components, provides valuable insights for fostering mental well-being in the university community., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Nielsen, Bermejo-Martins, Nelausen, Madsen, Riva, Koushede and Meilstrup.)

Apples are consumed lavishly worldwide, while demand is increasing for the management of the huge apple-waste amounts that lead to significant disposal costs and ecological issues. Additionally, apples represent fruits with several bioactive constituents, which are key factors in a healthy, balanced diet. In the present study, an extensive review is presented regarding the bioactive compounds of an apple processing by-product, namely apple pomace, mentioning their significance as viable ingredients/substances in foods and cosmetics aiming at chronic disease prevention and health promotion. Apple pomace contains several constituents, such as polar lipids, phenolics, vitamins and dietary fibers, with potential antioxidant, anti-inflammatory, anti-thrombotic, anti-aging and skin-protecting properties, and thus, they may contribute to minimizing the risk of various health conditions. Additionally, the mechanisms of action of such functional bioactives from apple pomace exert health benefits that will be examined, while the potential synergistic effects will also be investigated. Moreover, we will present the methods and techniques needed for the utilization of apple pomace in the appropriate form, such as powder, extracts, essential oil and so on, and their several applications in the food and cosmeceutical industry sectors, which summarize that apple pomace represents an ideal alternative to synthetic bioactive compounds.

Background: Breastfeeding is a powerful public health intervention that produces long-term health benefits. However, in high-income countries such as Denmark, breastfeeding rates are suboptimal and unequally distributed across socio-economic positions. The 'Breastfeeding - a good start together' intervention, to promote longer duration of exclusive breastfeeding and reduce social inequity, was implemented in a cluster-randomised trial during 2022-2023 across 21 municipalities in two Danish regions. A process evaluation was conducted to assess the implementation, mechanisms of impact, and possible contextual factors affecting the intervention., Methods: The study was guided by the Medical Research Council's guidance for conducting process evaluations and employed a mixed-methods approach in a convergence design. Quantitative data: contextual mapping survey (n = 20), health visitor survey (n = 284), health visitor records from 20 clusters and intervention website statistics. Qualitative data: dialogue meetings (n = 7), focus groups (n = 3) and interviews (n = 8)., Results: Overall, the intervention was delivered as planned to intended recipients, with few exceptions. Health visitors responded positively to the intervention, noting that it fitted well within their usual practice and enhanced families' chances of breastfeeding. Mothers expressed having received the intervention with few exceptions, and reacted positively to the intervention. Although health visitors were concerned about the potential stigmatisation of mothers receiving the intensified intervention, none of the interviewed mothers felt stigmatised. Contextual factors impacting the intervention implementation and mechanisms included staff and management turnover, project infrastructure and mothers' context, such as resources, social networks and previous experiences. The overall fidelity of the intervention delivery was high., Conclusions: Health visitors and families responded well to the intervention. Interventions aimed at enabling health care providers to deliver simplified and structured breastfeeding support, in alignment with support provided in other sectors of the health care system, may increase breastfeeding rates and reduce social inequity in breastfeeding, even in international contexts., Trial Registration: Clinical Trials: NCT05311631. First posted April 5, 2022., (© 2024. The Author(s).)

Objective: To assess changes in caregiver practices for young children after integrating the Responsive Care and Early Learning (RCEL) Addendum package into nutrition services after 10 months of implementation., Design: We measured changes in RCEL practices through a pre- and post-intervention assessment comprising a household survey and observations. To implement the intervention, we trained health service staff and community volunteers to deliver RCEL counselling to caregivers of children 0-23 months of age through existing community and facility-level platforms., Setting: Jalal-Abad and Batken regions in the Kyrgyz Republic., Participants: Caregivers of children aged 0-23 months at baseline., Results: We found statistically significant increases in RCEL practices, availability of early learning opportunities in the home, decreases in parenting stress and improvements in complementary feeding practices after the intervention implementation period., Conclusions: Findings show that delivery of RCEL counselling using the RCEL Addendum was associated with improved responsive care practices and early learning opportunities. We also found that integration of RCEL with infant and young child feeding counselling did not disrupt nutrition service delivery or negatively affect complementary feeding outcomes, but rather suggest synergistic benefits. Given the importance of providing holistic care to support optimal early childhood development, these findings provide new evidence on how to strengthen the delivery of nurturing care services in the Kyrgyz Republic.