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Background: Enabling, supporting and promoting positive health-related behaviours is critical in addressing the major public health challenges of our time, and the multifaceted nature of behaviours requires an evidence-based approach. This statement seeks to suggest how a much-needed enhanced use of behavioural and cultural science and insights for health could be advanced. Study design and methods: and methods: Public health authorities of Europe and Central Asia and international partner organizations in September 2023 met in Copenhagen, Denmark, to discuss the way forward. Drawing on 1) country reporting to WHO, 2) interview study with public health authorities and 3) the meeting deliberations, this meeting statement was developed. Results: The meeting statement presents a joint call for step-change accelerated use of evidence-based approaches for health behaviours. Actionable next steps for public health authorities and international and regional development partners in health are presented. Conclusions: The way forward involves increased resource allocation, integration of behavioural insights into health strategies, advocacy through case and cost-effectiveness examples and capacity building.

Abstract Background Regulation of private health care providers (PHPs) in middle-income countries can be challenging. Mandatory safety and quality standards for PHPs have been in place in the Republic of Srpska since 2012, but not all PHPs have adopted them yet. Adoption rates have differed among different types of providers. We studied three predominant types of PHPs to determine why the rate of adoption of the standards varies among them. Methods This study used a mixed methods approach, which allowed the integration of both quantitative and qualitative data, to develop an explanatory case study. The case study covered three types of private PHPs: pharmacies, dental practices and specialist practices. Primary data were collected through face-to-face semi-structured in-depth interviews and a self-administered postal survey of private health care providers. Our study’s theoretical framework was based on the diffusion of innovation theory. Results The rate of adoption of mandatory standards varied among different types of PHP mainly due to four factors: (1) level of concern about negative financial consequences, such as the risk of fines or of losing contracts with the Health Insurance Fund of the Republic of Srpska; (2) availability of information on the standards and implementation process; (3) level of the relevant professional association’s support for the introduction of standards; and (4) provider’s perceptions of the relevant health chamber’s attitude toward the standards. Opinions conveyed to PHPs by peers slightly negatively influenced adoption of the standards at the attitude-forming stage. Perceived gains in professional status did not have a major influence on the decision to adopt standards. All three types of PHPs perceived the same disadvantages of the introduction of safety and quality standards: associated expense, increased administrative burden and disruption of service provision. Conclusions When introducing mandatory quality and safety standards for PHPs, national health authorities need to: ensure adequate availability of information on the relative advantages of adhering to standards; support the introduction of standards with relevant incentives and penalties; and work in partnership with relevant professional associations and health chambers to get their buy-in for regulation of quality and safety of health services.

Introduction. Anemia is an important public health problem recognized worldwide either as an isolated problem or associated with other forms of malnutrition. In 2016, the prevalence of anemia in women of reproductive age was 32.0%, that is 613 milions of women, aged 15-49 years. The aim of the present study was to determine the prevalence of anemia among women of reproductive age (>15≤49 years) in the Republic of Srpska as well as to determine the correlation between dietary habits and prevalence of anemia. Methods. The study was conducted as a cross-sectional study. The sample was designed as a two-stage stratified random sample, with census circles selected during the first stage and households in the second stage. The study included 1539 women, aged 15-49 years. For the assessment of dietary habits and basic socio-demographic characteristics of the sample, two specially created questionnaires were used. Photometer, HemoCue Hb 301/SET was used to determine the hemoglobin level from a capillary sample. Results. The prevalence of anemia among women in reproductive age in the Republic of Srpska was 11.8%, classifying the Republic of Srpska into countries with low prevalence. There was a statistically significant difference in prevalence of anemia among women (p< 0.001), aged 36-49 years, and within Doboj and East Sarajevo Region (p = 0.002). Analyzing dietary habits, with special emphasis on intake of heme and non-heme iron foods, a statistically significant difference was found in intake of heme iron foods (p=0.009) among the women without anemia. There was a weak but statistically significant correlation between intake of iron supplement and absence of anemia (r = -0.064, p = 0.013). Conclusion. The Republic of Srpska falls into the category of countries with low anemia prevalence but it is necessary to continue with the activities the aim of which should be dietary habit improvement among all population groups, with the special emphasis on intake of heme iron foods.

Introduction. Mental health is related to risky driving behavior and traffic accidents. The aim of this study is to investigate both social and demographic characteristics of drivers, as well as the connection between mental health and risky driving behavior among drivers in the Republic of Srpska, Bosnia and Herzegovina. Methods. The study was part of the population health survey conducted in the Republic of Srpska in 2010. The survey included 1866 households and a total of 4178 adults were interviewed (1688 drivers and 2490 non-drivers). The Chi-square test and independent samples t-test were used for data analysis. Results. Among 4178 respondents, 59.6% were non-drivers and 40.4% were drivers. There were significantly higher percentage of male drivers (73.3%), adults aged 25-54 years (66.1%), who lived in rural areas (55.3%) and were in employment (50.1%). Significantly higher percentage of drivers (58.2%) were present in the category with score values 58 to 78 on the mental distress scale, while most non-drivers were found in the category with mental distress score values 58 and lower (43.2%), p < 0.001. Also, a significantly higher percentage of non-drivers (91.5%) were found in the category with the lowest level of mental vitality (≥ 62.5), while the percentage of drivers increased in categories with higher scores on the mental vitality scale (p < 0.001). Persons driving under the influence of alcohol had lower values on the mental distress scale (p < 0.05, eta square = 0.005), while those who tended to use mobile phones while driving achieved higher scores on the mental vitality scale (p < 0.001, eta square = 0.15). Conclusion. Study results have revealed significant differences in the level of mental health between drivers and non-drivers. People who drive under the influence of alcohol have a lower level of mental health, taking into account the results on the mental distress scale, while those who use mobile phones while driving have a higher level of mental vitality. In subsequent research, it is necessary to thoroughly examine the influence of mental health on tendency towards risky driving behavior.

Introduction. Smoking prevalence among healthcare professionals is high in European countries and the surveys conducted in the past decade have confirmed the existence of this public health problem in the Republic of Srpska (RS) as well. The aim of this study is to investigate smoking habits, as well as the readiness for smoking cessation in family medicine services in RS. Methods. The study was conducted on randomly selected two-stage stratified sample in seven health centers in RS. Results. In family medicine services belonging to seven healthcare centers of RS, there were 22.7% of daily and 8% of occasional smokers. There were significantly higher percentage of smokers among nurses, compared to medical doctors. There were 10.5% of former smokers, mostly found among medical doctors. Approximately a quarter of smokers (25.3%) lit their first cigarette half an hour after waking up. The highest percent of health professionals (61.5%) intended to quit smoking, while more than a quarter (27.1%) were ready to quit smoking in the following 30 days, without any significant difference according to the healthcare professional profile. A small percentage of respondents used professional assistance (3.11%), as well as pharmacotherapeutic approach to the smoking cessation process (3.9%). Approximately one quarter of healthcare professionals (24.6%) were willing to participate in smoking cessation programs, but more than two-thirds of respondents needed additional motivation for it. Conclusion. This study has shown that more than a fifth of healthcare professionals in family medicine are daily smokers, and every one in ten individuals is a former smoker. Although half of healthcare professionals intend to quit smoking, it is a source of concern that the majority of respondents are reluctant to start the process of smoking cessation.