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Background: Preventive nutrition interventions (PNI) are usually implemented without understanding how multilevel factors affect uptake. Undernutrition is defined as inadequate intake of nutritious foods. Pastoral populations in conflict settings are seen to have low uptake. The study assessed the level and multiple factors influencing the uptake of PNI in caregivers of under 5 in Kapoeta South County of South Sudan. Methods: A quantitative approach was employed with an element of a qualitative in a socio-ecological framework. A total of 405 caretakers of CU5 were selected to respond to quantitative household interviews, while qualitative data was collected using KIIs. Primary data were collected through structured questionnaires, which were used to attain quantitative data. The data collected through the method of KII were of qualitative type. Using deductive thematic analysis approach, the quantitative data were coded into personal, interpersonal, and community-level factors, and the analysis was done using STATA software version 16. A technique for constructing the uptake level as low, medium, or high was factor analysis. With the result of the binary logistic regression to determine association. Furthermore, semi-structured KIIs were conducted and the qualitative information analyzed thematically to elaborate on the quantitative results. Result: The uptake level of the Preventive Nutrition Interventions (PNIs) was low at 51. 4%. In the socioecological system, facilitators and barriers related to this uptake differed across the benchmarks of that model. At the community level however, lack of a health facility within the community (OR = 1. 63, C. I. = 1. 02–2. 59) and the time taken before one can access a health facility (OR = 1. 70, C. I = 1. 30–2. 23) showed that accessibility could encourage uptake of PNIs. In the interpersonal dimension, joint decision makers at the family level (OR = 0. 31, C. I = 0. 19–0. 50) had higher uptake. Three factors at the individual level revealed that low uptake was inversely related to caregivers' knowledge of PNIs (OR = 0. 16, C. I. = 0. 10–0. 25), but positively related to having an undernourished child (OR = 2. 59, C. I. = 1. 73–3. 89), as well as number of children in the household (OR = 0. 40, C. I. = 0. 26). KIIs validate that undernutrition and practical issues were the main determinant of PNI uptake. Conclusion: This study found that caretakers of children under 5 years reported low knowledge of and uptake to preventive nutrition interventions (PNIs) among the pastoral population in South Sudan. Based on the proposed socioecological model, we recommend that PNI approaches need to target multiple levels. At the community level, the focus is on improving access to health facilities and reducing the travel time to these facilities. Another way to increase intervention uptake is to improve spousal-supported joint decisions at the interpersonal level. Enhancing the awareness of the target audience and providing them with relevant information can impact the utilization rates of PNIs at the individual level. Therefore, nutrition stakeholders should employ an approach that targets community, interpersonal, and individual levels with the purpose of increasing PNI uptake. [ABSTRACT FROM AUTHOR]

Hookahs have been rising in popularity in the United States (U.S.) especially among the youth yet not much research has been carried out to understand the various predictors of hookah use among youth. We have thus conducted a cross-sectional study with a mixed-methods triangulation design to identify the hookah use determinants at different levels of the Social Ecological Model among youth. Participants between the ages of 18–24 years were sampled purposively, between April to November 2023, following a snowballing technique from various communities in Virginia and California, United States. Data were collected via a survey, one-on-one interviews, and focus groups. The study had a total sample size of 20. We found that participants smoked for a median of 5 times in the past 30 days. The main determinants of hookah smoking included the limited knowledge of health effects and addiction, positive attitude, family and peer influence, use as a means to socially connect with others, culture, social acceptability, lack of education at school and work place, access to hookah bars and smoke shops, and lack of strict enforcement of laws to ban smoking of youth. Educational interventions should be implemented by public health authorities to target the youth, their social and communities to provide education on hookah harm and addictiveness and to restrict access to- and the production, distribution, marketing and sales of hookahs. [ABSTRACT FROM AUTHOR]

• Multi-dimensional factors (except for political factors) accounted for 10.10 % of the variation in adequate social participation among stroke survivors. • Anxiety and motivation were strong negative associated factors of perceived adequacy in social participation. Furthermore, healthcare service accessibility was highly associated with social participation. • Health condition (i.e., stroke sequelae) was one of significant determinants of perceiving adequacy in participation only for females. • Interpersonal and organizational factors were significant predictors of participation only for males and people living in rural. This cross-sectional study aimed to investigate the multi-dimensional factors associated with adequate social participation among stroke survivors based on the social ecological model, and to identify the gender and living place differences. A total of 470 stroke survivors were recruited through convenience sampling method in two northern tertiary hospitals in China. Stepwise multiple logistic regression models showed that multi-dimensional factors (except for political factors) accounted for 10.10 % of the variance in adequate social participation. Intrapersonal (i.e., anxiety, motivation) and physical environmental factors (i.e., healthcare service accessibility) were strong associated determinants. Health condition (i.e., stroke sequelae) was one of significant determinants of perceiving adequacy in participation only for females. Interpersonal (i.e., social support) and organizational factors (i.e., frequency of community activities) were significant predictors of participation only for males and people living in rural. Comprehensive interventions addressing negative emotions, improving social support and integrating community resources are necessary for full social participation among stroke survivors. [ABSTRACT FROM AUTHOR]

Background: Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity. Research Aim: To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black. Method: We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017–2020. Women who delivered a firstborn, singleton infant were included (N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited. Results: Breastfeeding initiation was 57.4% (n = 1988) for women delivering in accredited hospitals versus 55.4% (n = 2540) in non-accredited hospitals and multivariable model results were non-significant (OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, (OR = 1.55, 95% CI [1.16, 2.09]). Conclusion: Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed. [ABSTRACT FROM AUTHOR]

Simple Summary: Cervical cancer poses a major public health concern in Singapore, but it can be effectively prevented through cervical cancer screening. Unfortunately, many Singaporean women have never been screened. Our research examined factors influencing screening participation in cervical cancer screening. We analyzed data from 665 Singaporean women, examining how knowledge, beliefs, health practices, and interpersonal and healthcare system influences affected their screening participation. Our findings showed that Malay women, those aged 25–29 years, and unmarried individuals were less likely to undergo screening. Conversely, women were more likely to undergo screening if they had better cervical cancer screening knowledge, understood that primary care doctors could perform the screening, had prior experience seeking cancer information, or were open to self-sampling options. These results shed light on potential multifaceted approaches to increase cervical cancer screening uptake, ultimately improving women's health in Singapore. Background/Objectives: Cervical cancer screening uptake in Singapore remains suboptimal. This study employed the Social Ecological Model (SEM) to investigate factors influencing cervical cancer screening participation among Singaporean women. Methods: The study included 665 women, aged 25–69 years, who reported awareness of cancer screening and no personal cancer history. Data were collected through a previously described online survey. Hierarchical logistic regression analysis was conducted to identify significant factors influencing screening participation. Results: Only 30% of participants reported cervical cancer screening participation. Women aged 25–29 years (OR = 0.33; 95% CI = 0.12–0.77), Malay women (OR = 0.42; 95% CI = 0.20–0.83), and unmarried women (OR = 0.30; 95% CI = 0.18–0.48) were less likely to be screened. Positive associations with screening participation were observed with good cervical cancer screening knowledge (OR = 2.90; 95% CI = 1.96–4.32), awareness of primary care providers' role in delivering screening services (OR = 1.94; 95% CI = 1.24–3.10), cancer information seeking behavior (OR = 1.59; 95% CI = 1.07–2.39), and acceptance of self-sampling options (OR = 1.81; 95% CI = 1.22–2.70). Conclusions: Our study highlights the cumulative impact of factors at various SEM levels on screening participation and underscores the necessity for more targeted and multi-pronged strategies to improve cervical cancer screening uptake in Singapore. [ABSTRACT FROM AUTHOR]

Purpose: This paper's aim is to highlight the essential factors influencing the fluoride management programs' effectiveness and dentistry overall. This multisided, complex, and multifaceted issue requires a thorough understanding of several social, political, and cultural factors that can be altered or utilized to enhance fluoride management, a factor that would reduce caries significantly and raise the patient's overall level of dental health. Methods: The paper takes data conducting on health officials, in addition to administration staff at high-fluoride regions in China and Pakistan. Results: The results obtained clearly indicate that the relationship between social media representation, stakeholder pressure, public engagement, political support factor and the effectiveness of the fluoride management program is mediated through prior public knowledge and awareness levels. Additionally, the moderation and factors' moderating effects show that political support modulates the relationship between stakeholder pressure, public engagement, and public awareness. Conclusion: In conclusion, the results bring additional evidence as to the factors based on public awareness raising, support from politicians to the stakeholders and patient's pressure-inducing to a more successful and, therefore, the more effective result. For policymakers, public health practitioners, and community leaders, the finding calls for more evidence as to what can be done to achieve the optimal results of the fluoride-managing program. Future research should focus on similar issues as fluoride managing to see similar results. [ABSTRACT FROM AUTHOR]

Introduction: Like many diasporas, the Tibetan diaspora has also had cataclysmic events and migratory movements and wish to return to their exiled homeland one day. In their countries of settlement, they face various challenges as they try to cope with their loss and adapt to a new environment. Purpose: This study aims to attempt to explore the socio-political construction of the mental health issues and coping strategies of the members from different generations of the Tibetan diaspora in India using the social ecological model as the theoretical framework. This study further aimed to provide suggestions based on findings to inform culturally sensitive care. Design/methodology/approach: Using the snowball sampling method, 20 Tibetans residing in North India were interviewed about their socio-political experiences. The obtained narratives were analyzed using thematic content analysis framework by Braun and Clarke (2006). Findings: Findings suggest that several socio-political conditions shape the mental health issues of the Tibetans that are inclusive of the acculturative stress, distress, intergenerational trauma and negative affectivity. A range of coping strategies, including spiritual-religious coping, collective coping and nostalgic coping emerged from the analysis. Research limitations/implications: This study has few limitations that must be considered to accurately interpret the findings. First, the sample size is small and hence may not be an accurate representation of the entire Tibetan diaspora. Second, the study uses self-reported data that may be subject to personal biases. Third, having been conducted in a specific socio-political context, the findings of this study may not be generalizable to other settings or to the members of the Tibetan diaspora elsewhere. Practical implications: The findings of the study will help spread awareness about mental health issues within the Tibetan diasporic community. The study will also help the mental health professionals to recognize the need for culturally responsive approaches to care. It also highlights the need to use the benefits of traditional healing practices, spirituality and cultural identity. The findings also will be relevant to developing interventions that are effective at individual, interpersonal, community and societal levels. The tailored interventions should address political issues surrounding the Tibetans, emphasize on their education and support cultural activities that can be essential for identity affirmation of these individuals. Originality/value: Shifting focus: Instead of viewing mental health solely through a psychological lens, it recognizes the powerful influence of political and social forces on their well-being. Generational lens: It explores how different generations within the diaspora grapple with the complexities of exile and its impact on their mental health. Unveiling coping strategies: It goes beyond the diagnosis, showcasing the diverse coping mechanisms used by Tibetans, including spiritual practices, collective support and even nostalgia. [ABSTRACT FROM AUTHOR]

Abstract Background Preventive nutrition interventions (PNI) are usually implemented without understanding how multilevel factors affect uptake. Undernutrition is defined as inadequate intake of nutritious foods. Pastoral populations in conflict settings are seen to have low uptake. The study assessed the level and multiple factors influencing the uptake of PNI in caregivers of under 5 in Kapoeta South County of South Sudan. Methods A quantitative approach was employed with an element of a qualitative in a socio-ecological framework. A total of 405 caretakers of CU5 were selected to respond to quantitative household interviews, while qualitative data was collected using KIIs. Primary data were collected through structured questionnaires, which were used to attain quantitative data. The data collected through the method of KII were of qualitative type. Using deductive thematic analysis approach, the quantitative data were coded into personal, interpersonal, and community-level factors, and the analysis was done using STATA software version 16. A technique for constructing the uptake level as low, medium, or high was factor analysis. With the result of the binary logistic regression to determine association. Furthermore, semi-structured KIIs were conducted and the qualitative information analyzed thematically to elaborate on the quantitative results. Result The uptake level of the Preventive Nutrition Interventions (PNIs) was low at 51. 4%. In the socioecological system, facilitators and barriers related to this uptake differed across the benchmarks of that model. At the community level however, lack of a health facility within the community (OR = 1. 63, C. I. = 1. 02–2. 59) and the time taken before one can access a health facility (OR = 1. 70, C. I = 1. 30–2. 23) showed that accessibility could encourage uptake of PNIs. In the interpersonal dimension, joint decision makers at the family level (OR = 0. 31, C. I = 0. 19–0. 50) had higher uptake. Three factors at the individual level revealed that low uptake was inversely related to caregivers’ knowledge of PNIs (OR = 0. 16, C. I. = 0. 10–0. 25), but positively related to having an undernourished child (OR = 2. 59, C. I. = 1. 73–3. 89), as well as number of children in the household (OR = 0. 40, C. I. = 0. 26). KIIs validate that undernutrition and practical issues were the main determinant of PNI uptake. Conclusion This study found that caretakers of children under 5 years reported low knowledge of and uptake to preventive nutrition interventions (PNIs) among the pastoral population in South Sudan. Based on the proposed socioecological model, we recommend that PNI approaches need to target multiple levels. At the community level, the focus is on improving access to health facilities and reducing the travel time to these facilities. Another way to increase intervention uptake is to improve spousal-supported joint decisions at the interpersonal level. Enhancing the awareness of the target audience and providing them with relevant information can impact the utilization rates of PNIs at the individual level. Therefore, nutrition stakeholders should employ an approach that targets community, interpersonal, and individual levels with the purpose of increasing PNI uptake.

Abstract Background Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia. Methods Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19–30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels. Results Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information. Conclusions Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.

Abstract Background Physical inactivity is a critical predictor of all-cause mortality and many non-communicable diseases (NCD) including coronary heart disease, diabetes, hypertension, dementia, and several cancers. The main objective of this study was to determine the main barriers to physical activity based on the STEPwise Surveillance in Iran in 2021, to guide policymakers in developing the most effective physical activity increasing strategies. Methods This cross-sectional study was conducted on 27,515 female and male individuals aged over 18 years from the STEPwise Surveillance 2021. The barriers to physical activity according to the modified version of barriers questionnaire and intrapersonal, interpersonal, economic, cultural, and environmental domains based on social-ecological models were determined. Association between barriers domain and physical activity level was assessed. Results Lack of time due to job commitments (31.4%) and family (19.3%) and inappropriate physical conditions including illness, pain, injury, disability, and fatigue (30.4%) were the most frequent barriers to physical activity. Interest in sedentary leisure time activities including virtual space, computer games and watching TV were the next frequent barriers to physical activity (10.01%). Intrapersonal domain had the highest frequency (62.9%) and cultural domain had the lowest frequency (2.3%). Intrapersonal and interpersonal barriers reduced the odds of engaging in physical activity (OR: 0.62, P value

You-Ran Liu,1,&ast; Yan Wang,2,&ast; Juan Chen,3 Shan Luo,2 Xiaomei Ji,1 Huadong Wang,4 Li Zhang1 1School of Nursing, Bengbu Medical University, Bengbu, People’s Republic of China; 2Department of Nursing, Tangshan Vocational & Technical College, Tangshan, People’s Republic of China; 3Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, People’s Republic of China; 4Department of Respiratory medicine, The First Affiliated Hospital of Bengbu Medical University, Bengbu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li Zhang, Email 390026566@qq.comPurpose: This study aimed to identify the risk predictors of non-adherence to inhaler therapy and construct a nomogram prediction model for use in Chinese elderly patients with chronic obstructive pulmonary disease (COPD).Patients and Methods: A cross-sectional study was conducted with 305 participants recruited from a tertiary care hospital in Anhui, China. Adherence was analyzed using the Test of Adherence to Inhalers. Potential predictive factors were incorporated based on the social ecological model, and data were collected through a questionnaire method. R version 4.3.3 was utilized to perform the least absolute shrinkage and selection operator regression model and multivariable logistic regression analysis to identify risk factors and establish a nomogram prediction model.Results: The results of the multivariable analysis revealed that medication beliefs, illness perception, the COPD Assessment Test score, smoking status, and education level were significant risk factors for non-adherence to inhaler therapy in elderly COPD patients (all P < 0.05). The nomogram prediction model for non-adherence to inhaler therapy in elderly COPD patients demonstrated a good discriminative ability, with an area under the receiver operating characteristic curve of 0.912. The C-index was 0.922 (95% CI: 0.879 to 0.965), and the Brier value was 0.070, indicating good consistency and calibration. Decision curve analysis indicated that the use of the nomogram would be more beneficial in clinical practice when the threshold probability of non-adherence exceeds 17%.Conclusion: This study identified predictive factors regarding non-adherence among elderly patients with COPD and constructed a predictive nomogram. By utilizing the nomogram model healthcare professionals could swiftly calculate and comprehend the non-compliance level of COPD patients, thus guiding the development of personalized interventions in clinical practice.Keywords: chronic obstructive pulmonary disease, inhaler therapy, nomogram, non-adherence, social ecological model

Abstract Background Globally, the majority of kindergarten-aged children face obesity issues and insufficient physical activity (PA) engagement. Regular PA participation can provide various health benefits, including obesity reduction, for kindergarten-aged children. However, limited studies have investigated the factors influencing kindergarten-aged children’s PA engagement from the perspective of their teachers. This qualitative study aimed to identify factors that could help promote PA among kindergarten-aged children from teachers’ perspectives, including facilitators, barriers, and teachers’ recommendations. Methods Fifteen kindergarten teachers (age range: 28–50 years; mean age: 38.53 years) with teaching experience ranging from 2 to 31 years (mean: 16.27 years) were recruited from Shanghai municipality, Henan, and Jiangsu provinces in China. One-on-one semi-structured interviews were conducted via face-to-face (n = 7) or telephone (n = 8) to gather insights into factors influencing PA promotion among kindergarten-aged children. The interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach based on grounded theory, which involved open, axial, and selective coding processes. Results The study revealed mutual theoretical support between themes and the social-ecological model (SEM), as factors identified in the study are distributed at various levels of the SEM. Twelve factors were identified at four levels of the SEM: (1) intrapersonal level (children’s personality and skills), (2) interpersonal level (family, peers, and teachers influence), (3) organizational level (school environment and resources, opportunities for kindergarten teachers’ training and children’s PA, design and organization of PA, and PA that children need), (4) community level (family-school partnerships). Conclusion Various factors at different levels can influence kindergarten-aged children’s PA. The study’s findings revealed that these factors are distributed across the first four levels of SEM, with the majority being at the organizational level. These multilevel findings are expected to assist in developing and implementing more effective PA interventions for kindergarten-aged children. Future research is warranted to identify strategies for promoting PA among kindergarten-aged children at the policy level of the SEM.

Abstract Background Worldwide, the culturally and linguistically diverse (CALD) population is increasing, and is predicted to reach 405 million by 2050. The delivery of emergency care for the CALD population can be complex due to cultural, social, and language factors. The extent to which cultural, social, and contextual factors influence care delivery to patients from CALD backgrounds throughout their emergency care journey is unclear. Using a systematic approach, this review aims to map the existing evidence regarding emergency healthcare delivery for patients from CALD backgrounds and uses a social ecological framework to provide a broader perspective on cultural, social, and contextual influence on emergency care delivery. Methods The Joanna Briggs Institute (JBI) scoping review methodology will be used to guide this review. The population is patients from CALD backgrounds who received care and emergency care clinicians who provided direct care. The concept is healthcare delivery to patients from CALD backgrounds. The context is emergency care. This review will include quantitative, qualitative, and mixed-methods studies published in English from January 1, 2012, onwards. Searches will be conducted in the databases of CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), SocINDEX (EBSCO), Scopus (Elsevier), and a web search of Google Scholar. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram will be used to present the search decision process. All included articles will be appraised using the Mixed Methods Appraisal Tool (MMAT). Data will be presented in tabular form and accompanied by a narrative synthesis of the literature. Discussion Despite the increased use of emergency care service by patients from CALD backgrounds, there has been no comprehensive review of healthcare delivery to patients from CALD backgrounds in the emergency care context (ED and prehospital settings) that includes consideration of cultural, social, and contextual influences. The results of this scoping review may be used to inform future research and strategies that aim to enhance care delivery and experiences for people from CALD backgrounds who require emergency care. Systematic review registration This scoping review has been registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/HTMKQ

Background: Physical inactivity is a critical predictor of all-cause mortality and many non-communicable diseases (NCD) including coronary heart disease, diabetes, hypertension, dementia, and several cancers. The main objective of this study was to determine the main barriers to physical activity based on the STEPwise Surveillance in Iran in 2021, to guide policymakers in developing the most effective physical activity increasing strategies. Methods: This cross-sectional study was conducted on 27,515 female and male individuals aged over 18 years from the STEPwise Surveillance 2021. The barriers to physical activity according to the modified version of barriers questionnaire and intrapersonal, interpersonal, economic, cultural, and environmental domains based on social-ecological models were determined. Association between barriers domain and physical activity level was assessed. Results: Lack of time due to job commitments (31.4%) and family (19.3%) and inappropriate physical conditions including illness, pain, injury, disability, and fatigue (30.4%) were the most frequent barriers to physical activity. Interest in sedentary leisure time activities including virtual space, computer games and watching TV were the next frequent barriers to physical activity (10.01%). Intrapersonal domain had the highest frequency (62.9%) and cultural domain had the lowest frequency (2.3%). Intrapersonal and interpersonal barriers reduced the odds of engaging in physical activity (OR: 0.62, P value < 0.001, OR: 0.76, P value < 0.001). Conclusion: Intra- and inter-personal domain barriers might reduce the odds of being active. Developing action plans addressing these factors is suggested to increase physical activity levels. [ABSTRACT FROM AUTHOR]

Background: Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia. Methods: Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19–30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels. Results: Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information. Conclusions: Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks. [ABSTRACT FROM AUTHOR]

Background: Women with learning disabilities are less likely to access cervical and breast cancer screening when compared to the general population. The Social Ecological Model (SEM) was used to examine the inequalities faced by women with learning disabilities in accessing cervical and breast cancer screening in England, UK. Methods: The findings from a qualitative systematic review and a Q methodology study were triangulated. Framework analysis, in line with the SEM, was used to develop an integrated set of findings. Findings: Women with learning disabilities may lack knowledge of cancer symptoms, and cancer screening, as well as being scared about the process and getting the results. The attitudes of family and paid carers towards screening may influence women with learning disabilities' decisions as to whether screening is seen as favourable; support and training may ensure unbiased perspectives. Barriers were also associated with how cancer screening programmes are designed, such as postal invitations which assumes an ability to read. In addition, screening staff need to be aware of the general needs of people with learning disabilities, such as the benefits of easy‐to‐read documents. Lastly, multidisciplinary working is required so reasonable adjustments can be embedded into cancer screening pathways. Conclusion: This article highlights multiple methods to reduce the inequalities faced by women with learning disabilities, which can be achieved through reasonable adjustments. Embedding reasonable adjustments can support women with learning disabilities in making an informed decision and accessing screening if they choose to. This may result in women with learning disabilities getting a timely cancer diagnosis. Accessible Summary: Women with learning disabilities should be invited for checks to find out if they have cancer. Sometimes women with learning disabilities do not go for these checks, and we wanted to find out why.We found that women might not know about these checks or know what they will be asked to do in them. We found that women are also scared about going for the checks.Our results found there are a lot of things that can help women. Carers, nurses, and doctors can help women in knowing about the checks, and writing should have pictures to help women understand. Information can be given to women but these may not be routinely used.We found that women should be asked what can help them to go for the check. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONAssistive technology (AT) can increase or maintain the quality of life and overall well-being of people with disabilities. Nevertheless, access to AT is limited among Hispanics with disabilities in the United States (U.S.). AT research representing the experiences of Hispanics is limited, potentially leading to disparities in AT use. Moreover, poor inclusion of Hispanics neglects the needs of this population, resulting in discrepancies in research, practice, and policy related to AT. To address these limitations, this study aimed to identify and explore multilevel environmental barriers to AT use among a sample of Hispanics in the U.S.This was a descriptive qualitative research design study guided by the Social Ecological Model framework using in-depth interviews to collect data. Nine Hispanic individuals with disabilities and their caregivers who received AT services at the University of Illinois at Chicago Assistive Technology Unit outpatient clinic were interviewed. Data was analyzed using a qualitative thematic analysis approach.Barriers to AT use were found to exist in all levels of the Social Ecological Model. The most common barriers to AT use were identified in the community domain, which was related to the lack of AT information, and in the societal domain, which was related to sociocultural norms and the availability of AT funding, policies, and regulations.The participants’ lived experiences and perspectives underscored that environmental barriers to AT use are not isolated occurrences; rather, systemic attitudes permeate across all levels of the Social Ecological Model.Limited availability of assistive technology information and services in Spanish is a challenge that can impact assistive technology usage.Bridging language and cultural gaps is crucial to ensuring equitable access to assistive technology and rehabilitation services.Multilevel environmental barriers impact assistive technology use, adversely impacting the quality of life and overall well-being of Hispanics with disabilities.Limited availability of assistive technology information and services in Spanish is a challenge that can impact assistive technology usage.Bridging language and cultural gaps is crucial to ensuring equitable access to assistive technology and rehabilitation services.Multilevel environmental barriers impact assistive technology use, adversely impacting the quality of life and overall well-being of Hispanics with disabilities. [ABSTRACT FROM AUTHOR]

Background: Globally, the majority of kindergarten-aged children face obesity issues and insufficient physical activity (PA) engagement. Regular PA participation can provide various health benefits, including obesity reduction, for kindergarten-aged children. However, limited studies have investigated the factors influencing kindergarten-aged children's PA engagement from the perspective of their teachers. This qualitative study aimed to identify factors that could help promote PA among kindergarten-aged children from teachers' perspectives, including facilitators, barriers, and teachers' recommendations. Methods: Fifteen kindergarten teachers (age range: 28–50 years; mean age: 38.53 years) with teaching experience ranging from 2 to 31 years (mean: 16.27 years) were recruited from Shanghai municipality, Henan, and Jiangsu provinces in China. One-on-one semi-structured interviews were conducted via face-to-face (n = 7) or telephone (n = 8) to gather insights into factors influencing PA promotion among kindergarten-aged children. The interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach based on grounded theory, which involved open, axial, and selective coding processes. Results: The study revealed mutual theoretical support between themes and the social-ecological model (SEM), as factors identified in the study are distributed at various levels of the SEM. Twelve factors were identified at four levels of the SEM: (1) intrapersonal level (children's personality and skills), (2) interpersonal level (family, peers, and teachers influence), (3) organizational level (school environment and resources, opportunities for kindergarten teachers' training and children's PA, design and organization of PA, and PA that children need), (4) community level (family-school partnerships). Conclusion: Various factors at different levels can influence kindergarten-aged children's PA. The study's findings revealed that these factors are distributed across the first four levels of SEM, with the majority being at the organizational level. These multilevel findings are expected to assist in developing and implementing more effective PA interventions for kindergarten-aged children. Future research is warranted to identify strategies for promoting PA among kindergarten-aged children at the policy level of the SEM. [ABSTRACT FROM AUTHOR]

More than 3.6 M home healthcare aides are key parts of the U.S. healthcare workforce, serving older adults and individuals with disabilities living in the community. This study used a social ecological framework (SEM) to identify facilitators and barriers to Covid-19 vaccination among home healthcare aides and administrators in N.J. Key informant interviews with a purposive sample of home healthcare aides along with federal and state policy review were used to develop a survey of home healthcare administrators (HHA), which was sent to all home healthcare agencies in N.J. Results show that completed vaccination series rates among HHA were the same or higher than statewide and national rates, but there was skepticism about the utility of a booster among both aides and HHA. While organizational policy and information support around Covid-19 from the agencies to the staff was inconsistent, overall agencies acted as a driver for higher vaccination rates. At the intrapersonal level, individual self-assessment of risk was not consistent with actual risk, impeding vaccination. When all levels of the SEM are working in concert it can increase completed vaccinations. Key areas to target addressing the call for yearly boosters include organizational policy and intrapersonal factors aligning perceived and actual risk. [ABSTRACT FROM AUTHOR]

Dating relationships during adolescence is a complex interaction that involves multiple systems however, the systemic factors promoting the development of healthy dating relationships in adolescence are not well understood. The current study aims to address this gap by reviewing studies that assessed factors contributing to healthy adolescent dating relationship skills, competencies, and capacities. Through a social ecological perspective, healthy dating relationship factors were identified across five levels of adolescents' environments (e.g., individual, peer, family, school, and online) to inform intervention strategies for the promotion of healthy dating relationships. After an iterative screening process, 51 peer-reviewed empirical articles were identified across a search strategy from 2008 to 2018. Amongst the 51 articles, 76 key healthy dating relationship factors were identified across the five social ecological levels: individual (n = 34), family (n = 16), peer (n = 13), school (n = 9), and online (n = 4). While several healthy dating relationship factors identified in school-based relationship education interventions (school level) overlapped with individual and peer level factors (e.g., communication, listening), the review highlighted two social ecological levels of family and online that can further benefit the efficacy and comprehensiveness of school-based relationship education interventions. [ABSTRACT FROM AUTHOR]

Background: Worldwide, the culturally and linguistically diverse (CALD) population is increasing, and is predicted to reach 405 million by 2050. The delivery of emergency care for the CALD population can be complex due to cultural, social, and language factors. The extent to which cultural, social, and contextual factors influence care delivery to patients from CALD backgrounds throughout their emergency care journey is unclear. Using a systematic approach, this review aims to map the existing evidence regarding emergency healthcare delivery for patients from CALD backgrounds and uses a social ecological framework to provide a broader perspective on cultural, social, and contextual influence on emergency care delivery. Methods: The Joanna Briggs Institute (JBI) scoping review methodology will be used to guide this review. The population is patients from CALD backgrounds who received care and emergency care clinicians who provided direct care. The concept is healthcare delivery to patients from CALD backgrounds. The context is emergency care. This review will include quantitative, qualitative, and mixed-methods studies published in English from January 1, 2012, onwards. Searches will be conducted in the databases of CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), SocINDEX (EBSCO), Scopus (Elsevier), and a web search of Google Scholar. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram will be used to present the search decision process. All included articles will be appraised using the Mixed Methods Appraisal Tool (MMAT). Data will be presented in tabular form and accompanied by a narrative synthesis of the literature. Discussion: Despite the increased use of emergency care service by patients from CALD backgrounds, there has been no comprehensive review of healthcare delivery to patients from CALD backgrounds in the emergency care context (ED and prehospital settings) that includes consideration of cultural, social, and contextual influences. The results of this scoping review may be used to inform future research and strategies that aim to enhance care delivery and experiences for people from CALD backgrounds who require emergency care. Systematic review registration: This scoping review has been registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/HTMKQ [ABSTRACT FROM AUTHOR]

Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice. [ABSTRACT FROM AUTHOR]

Grounded in the socio-ecological model of health, this study aims to understand the broader impact of adult attention deficit hyperactivity disorder (ADHD) on the family system. With a notable gap in knowledge concerning the impact of adult ADHD on spouses' well-being, this research explores the lived experiences of women in relationships with partners diagnosed with ADHD. Using a descriptive qualitative phenomenological approach, we conducted semi-structured interviews with thirteen women without ADHD, to gain insights into their experiences. Three main themes were identified- ADHD in Everyday Life, Burden Experience, and Women's Coping Strategies for managing ADHD within relationships. The findings suggest that partners' ADHD symptoms involve a burden on women. In response, women developed coping strategies such as learning about ADHD, setting limits, and cultivating partnership by creating bridges to compensate for ADHD-related barriers. This study highlights the substantial burden experienced by women in a relationship with partners diagnosed with ADHD, suggesting they should be recognized as caregivers and a potentially vulnerable group at risk. However, the homogeneous nature of our sample, focusing on white, heterosexual women, underlines the need for further research to better understand the impact of adult ADHD on diverse partners' functioning and health, as well as pathways to support them. Women partners of adults with attention deficit hyperactivity disorder (ADHD) often fulfill a caregiving role that can create a substantial burden. Healthcare providers working with adults diagnosed with ADHD are encouraged to recognize the broader social context of their patients and validate the burden experienced by both partners living with the implications of this health condition. Healthcare providers can offer supportive measures for both partners, such as education and counseling to facilitate a deeper understanding of the unique challenges posed by ADHD, and to provide guidance on effective coping strategies. Interventions are needed to support women in relationships with adults with ADHD. Future interventions might include peer support groups, individual counseling, or couples therapy that specifically addresses the unique challenges of living with ADHD in a relationship. [ABSTRACT FROM AUTHOR]

In order to understand how the COVID-19 pandemic influenced older adults' grocery shopping behaviors, semi-structured individual interviews were conducted with 23 older adults using the Social-Ecological Model (SEM) as a framework. Interviews were audiotaped and transcribed verbatim. Data were analyzed using deductive content analysis. Results revealed that the pandemic affected grocery shopping behaviors of community-dwelling older adults in response to factors at the organizational level of the SEM. Findings from this study provide useful information for nutrition educators as they help older adults establish shopping behaviors for safe and less stressful store environments, virtual shopping environments, and home environments. [ABSTRACT FROM AUTHOR]

Living with family and friends is a common strategy used to prevent or exit homelessness, but little is known about structural barriers that impede family and friends' ability to provide temporary or permanent housing for older homeless adults. We conducted semi-structured interviews with 46 homeless participants from the HOPE HOME study, a cohort of 350 community-recruited homeless adults age 50 or older in Oakland, CA, who reported having stayed with housed family/friends for 1 or more nights in the prior 6 months. We conducted semi-structured interviews with 19 hosts of homeless participants and 11 stakeholders in housing and homelessness. We found that homeless older adults and hosts perceived staying with family or friends as a form of temporary housing rather than as a permanent exit to homelessness. Structural barriers to family and friends providing housing for temporary stays or permanent exits from homelessness included housing regulations restricting visitors and changing rent obligations; decreased eligibility and priority for shelter and permanent housing; geographic and transportation challenges; and environments inconducive to older adults. We suggest four areas for policy reform: providing subsidies to hosts and homeless individuals, removing disincentives for homeless older adults to stay with family, changing lease regulations, and expanding the supply of affordable housing.

IntroductionThe satisfaction of the public with the healthcare system of Ethiopia is a crucial but unanswered question. This is an essential issue since recent trends indicate that the demographic and epidemiological makeup of the population is changing. Therefore, the aim of this study was to assess the overall satisfaction of the public with the Ethiopian healthcare system in Addis Ababa, Ethiopia, in 2022.MethodsA community-based convergent parallel mixed methods study was conducted. Bivariable and multivariable logistic regression analyses were used to determine the factors associated with public satisfaction. A 95% confidence interval along with a p

Abstract Background The prevalence of burnout, depression, and anxiety among Chinese nurses was 34%, 55.5%, and 41.8% respectively. Mental health problems have significant impacts on their personal well-being, work performance, patient care quality, and the overall healthcare system. Mental health is influenced by factors at multiple levels and their interactions. Methods This was a descriptive qualitative study using phenomenological approach. We recruited a total of 48 nurses from a tertiary hospital in Changsha, Hunan Province, China. Data were collected through focus group interviews. Audio-recorded data were transcribed and inductively analysed. Results Four major themes with 13 subthemes were identified according to the social ecological model: (1) individual-level factors, including personality traits, sleep quality, workplace adaptability, and years of work experience; (2) interpersonal-level factors, encompassing interpersonal support and role conflict; (3) organization-level factors, such as organizational climate, organizational support, career plateau, and job control; and (4) social-level factors, which included compensation packages, social status, and legislative provision and policy. Conclusions Our study provides a nuanced understanding of the multifaceted factors influencing nurses’ mental health. Recognizing the interconnectedness of individual, interpersonal, organizational, and social elements is essential for developing targeted interventions and comprehensive strategies to promote and safeguard the mental well-being of nurses in clinical settings. Trial and protocol registration The larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676 . Reporting method This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Abstract Background Effective mentorship is an important contributor to academic success. Given the critical role of leadership in fostering mentorship, this study sought to explore the perspectives of departmental leadership regarding 1) current departmental mentorship processes; and 2) crucial components of a mentorship program that would enhance the effectiveness of mentorship. Methods Department Division Directors (DDDs), Vice-Chairs, and Mentorship Facilitators from the Department of Medicine at the University of Toronto Temerty Faculty of Medicine were interviewed between April and December 2021 using a semi-structured guide. Interviews were audio-recorded and transcribed verbatim, then coded. Analysis occurred in 2 steps: 1) codes were organized to identify emergent themes; then 2) the Social Ecological Model (SEM) was applied to interpret the findings. Results Nineteen interviews (14 DDDs, 3 Vice-Chairs, and 2 Mentorship Facilitator) were completed. Analysis revealed three themes: (1) a culture of mentorship permeated the department as evidenced by rigorous mentorship processes, divisional mentorship innovations, and faculty that were keen to mentor; (2) barriers to the establishment of effective mentoring relationships existed at 3 levels: departmental, interpersonal (mentee-mentor relationships), and mentee; and (3) strengthening the culture of mentorship could entail scaling up pre-existing mentorship processes and promoting faculty engagement. Application of SEM highlighted critical program features and determined that two components of interventions (creating tools to measure mentorship outcomes and systems for mentor recognition) were potential enablers of success. Conclusions Establishing ‘mentorship outcome measures’ can incentivize and maintain relationships. By tangibly delineating departmental expectations for mentorship and creating systems that recognize mentors, these measures can contribute to a culture of mentorship.

Abstract Background Research evidence suggests that a lack of engagement with palliative care and advance care planning could be attributed to a lack of knowledge, presence of misconceptions and stigma within the general public. However, the importance of how death, dying and bereavement are viewed and experienced has been highlighted as an important aspect in enabling public health approaches to palliative care. Therefore, research which explores the public views on strategies to facilitate engagement with palliative care and advance care planning is required. Methods Exploratory, qualitative design, utilising purposive random sampling from a database of participants involved in a larger mixed methods study. Online semi-structured interviews were conducted (n = 28) and analysed using reflexive thematic analysis. Thematic findings were mapped to the social-ecological model framework to provide a holistic understanding of public behaviours in relation to palliative care and advance care planning engagement. Results Three themes were generated from the data: “Visibility and relatability”; “Embedding opportunities for engagement into everyday life”; “Societal and cultural barriers to open discussion”. Evidence of interaction across all five social ecological model levels was identified across the themes, suggesting a multi-level public health approach incorporating individual, social, structural and cultural aspects is required for effective public engagement. Conclusions Public views around potential strategies for effective engagement in palliative care and advance care planning services were found to be multifaceted. Participants suggested an increase in visibility within the public domain to be a significant area of consideration. Additionally, enhancing opportunities for the public to engage in palliative care and advance care planning within everyday life, such as education within schools, is suggested to improve death literacy and reduce stigma. For effective communication, socio-cultural aspects need to be explored when developing strategies for engagement with all members of society.

Young people with diabetes in Korea face a healthcare transition from adolescence to adulthood, involving various management tasks. Imagine a patient who is struggling to stay on track with their glycemic control at a time in their life when they are also struggling to fulfill their life cycle tasks, we must consider disease management from the perspective of the individual. There are many factors that result in health inequality being regarded as an individual problem, and they may be difficult for individuals to overcome. However, most hospitals have limited approaches to account for individual factors of diabetics. Known limitations in socio-ecological approaches to diabetes care are based on such factors as limited personnel, limitations in community resource collection, differences in accessibility, and personnel work load. We performed this review of an approach that considers personal characteristics to help young diabetics secure a healthy life expectancy in cooperation with government policies. [ABSTRACT FROM AUTHOR]

Despite the noted risks of sport specialization, it is evident that parents, athletes, and coaches are engaging in and promoting early sport specialization. To develop more effective intervention strategies, researchers and other stakeholders should consider evaluating this behavior through a multilevel theoretical perspective and comprehensively evaluating the levels of influence. In response to recent calls for ecological assessments and a need for more theory-based research, we have created an ecological framework for youth sport based on the information synthesized in this literature review. To this end, the use of a social ecological perspective may help to better inform youth sport specialization research. The literature supports the multi-factorial determinants of behavior and the interplay between each of the levels of influence is important. [ABSTRACT FROM AUTHOR]

A revised way of thinking is essential for promoting harm reduction strategies and reducing the negative implications of injection drug use (IDU). Despite the growth of harm reduction approaches in the United States, there is limited guidance for designing and implementing multi-sector efforts that address the external determinants that promote and facilitate IDU. Current frameworks fail to acknowledge the individual's role and influence in multi-sector change. To address the multifaceted nature of IDU, we must address the complex relationship between people who inject drugs (PWID) and their external environment. As part of a community–academic partnership, a framework was developed to address the gaps in current theoretical models and community practice. Our Harm Reduction Collaboration Framework (HRCF) accepts PWID as key stakeholders and presents a practical framework in which PWID and community organizations partner in decision making to influence policy, systems, and environmental change. We provide examples of two organizations that have made substantive changes in implementing harm reduction strategies in their communities by utilizing the HRCF. [ABSTRACT FROM AUTHOR]

The availability, promotion, and price of healthy foods within the university food environment may impact students' dietary choices. This systematic review summarizes the tools and methods used to assess the healthfulness of university food environments where many students spend a significant portion of their emerging adulthood. Thirty-six global studies published between 2012 and 2022 were sourced from PubMed (NNLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycInfo (EBSCO), CINHAL Complete (EBSCO), ProQuest Nursing, and Allied Health, following PRISMA 2020 guidelines. Of the included studies, 58% were institutional-level audits, 17% examined individual-level perceptions, and 25% combined both. Most institutional-level audits focused on one aspect of the food environment (e.g., eateries, vending machines). For studies examining multiple spaces within the campus environment (38%), comprehensive assessments were limited, and most studies had to employ a combination of assessment tools. Surveys were most often used to gather individual perceptions about the food environment. The Nutrition Environment Measures Survey (NEMS) was the most commonly used tool across all studies. This review highlights the need for a standardized tool, method, or a "healthy" benchmark for specific use at universities to improve methodological rigor and comparability of findings across institutions. [ABSTRACT FROM AUTHOR]

Background: Effective mentorship is an important contributor to academic success. Given the critical role of leadership in fostering mentorship, this study sought to explore the perspectives of departmental leadership regarding 1) current departmental mentorship processes; and 2) crucial components of a mentorship program that would enhance the effectiveness of mentorship. Methods: Department Division Directors (DDDs), Vice-Chairs, and Mentorship Facilitators from the Department of Medicine at the University of Toronto Temerty Faculty of Medicine were interviewed between April and December 2021 using a semi-structured guide. Interviews were audio-recorded and transcribed verbatim, then coded. Analysis occurred in 2 steps: 1) codes were organized to identify emergent themes; then 2) the Social Ecological Model (SEM) was applied to interpret the findings. Results: Nineteen interviews (14 DDDs, 3 Vice-Chairs, and 2 Mentorship Facilitator) were completed. Analysis revealed three themes: (1) a culture of mentorship permeated the department as evidenced by rigorous mentorship processes, divisional mentorship innovations, and faculty that were keen to mentor; (2) barriers to the establishment of effective mentoring relationships existed at 3 levels: departmental, interpersonal (mentee-mentor relationships), and mentee; and (3) strengthening the culture of mentorship could entail scaling up pre-existing mentorship processes and promoting faculty engagement. Application of SEM highlighted critical program features and determined that two components of interventions (creating tools to measure mentorship outcomes and systems for mentor recognition) were potential enablers of success. Conclusions: Establishing 'mentorship outcome measures' can incentivize and maintain relationships. By tangibly delineating departmental expectations for mentorship and creating systems that recognize mentors, these measures can contribute to a culture of mentorship. [ABSTRACT FROM AUTHOR]

The tradition of Swedish ice hockey as a masculine-dominated territory that encourages characteristics like roughness, aggressiveness, and to some extent violence has been hotly debated. Using historical articles from the Swedish Hockey magazine, and with a perspective combining hegemony with the social-ecological model of violence prevention, this study develops an interpretation of how masculinity traits and violence in Swedish ice hockey interconnect. The historical case provides findings for this interconnection, with meanings of masculinity and a competitive commitment as permeating threads. Triggered by individuals, but also connected to coaches' encouragements, organizations' endeavours, societal, and financial forces, the negotiations around playing styles and allowance levels have been permeated by ideals of masculinity; ideals that enforce the current hegemonic gender order. Ultimately, the article contributes to a more comprehensive understanding of sport violence as an issue that not only impacts or can be utilized by sport organizations and players/practitioners but also its broader societal implications. [ABSTRACT FROM AUTHOR]

Purpose: Intimate Partner Violence and Abuse (IPVA) is as a major health concern globally. The prevalence of IPVA perpetration and victimisation has been found to be higher in military compared to civilian populations. Of concern, help-seeking for other psychosocial difficulties among military communities has been shown to be both limited and challenging, and military personnel could face additional or amplified barriers to help-seeking for IPVA than their civilian counterparts. This study aimed to use qualitative methods to explore the experiences of, and barriers to, help-seeking for IPVA victimisation and perpetration among UK military personnel. Methods: Thematic analysis was conducted on 40 one-to-one semi-structured interviews with military personnel (29 male, 11 female). Results: Four superordinate themes were derived, thematically organised according to different levels of the social ecological model: Military cultural factors; Support service factors; Interpersonal factors; and Individual factors. At a military cultural level, participants described difficulties in help-seeking for IPVA resulting from widespread stigma and hypermasculine attitudes in military communities, minimisation of violence, perceived pressure from chain of command, and fear of consequences of reporting. At a support-service level, participants' negative views or experiences and lack of awareness of services were also significant in deterring help-seeking. At an interpersonal level, participants recounted how relationships with military colleagues, their partner and their family could be both instrumental or a hindrance to help-seeking for IPVA. At an individual level, lack of insight into IPVA and different forms of abuse were suggested through minimisation of violence and described to contribute to delay in help-seeking. Shame, compounded by multi-layered stigma present at each social ecological model level, was a key reason for delaying or avoiding help-seeking. Conclusions: The findings indicate the added challenges in help-seeking for IPVA experienced by military personnel and highlight a need for a whole systems approach to improve the provision of support for IPVA in the military serving and ex-serving community to instil meaningful change. [ABSTRACT FROM AUTHOR]

Women coaches have remained underrepresented within sports coaching at all levels. Thus, the purpose of this paper was to describe the factors surrounding the development, progression, and retention of women coaches within the United Kingdom. The study involved semistructured interviews with 15 women coaches who were coaching female athletes in team sports. Content analysis of the qualitative data identified barriers and enablers at individual, interpersonal, organisational, and sociocultural levels. Results indicated that women coaches face several barriers because of their gender, which their men counterparts do not often encounter. Practically, individuals and organisations can both take action to reduce damaging stereotypical ideologies that produce challenging predicaments for women within the coaching landscape. [ABSTRACT FROM AUTHOR]

Research indicates that health interventions are most effective when they address multiple social determinants of health to support positive behavior. Schools as Hubs of Health, a comprehensive model of nutrition and physical activity education, was developed to support wellness within school communities defined as low-income by the national Supplemental Nutrition Assistance Program Education (SNAP-Ed). Components of the model include the following: classroom education; garden education; youth engagement; staff training; parent and community engagement; and policies, systems, and environments. Findings over the last decade indicate positive outcomes in nutrition and physical activity behaviors, youth leadership and engagement, and systems and environmental changes that support health and wellness. [ABSTRACT FROM AUTHOR]

Background: Research evidence suggests that a lack of engagement with palliative care and advance care planning could be attributed to a lack of knowledge, presence of misconceptions and stigma within the general public. However, the importance of how death, dying and bereavement are viewed and experienced has been highlighted as an important aspect in enabling public health approaches to palliative care. Therefore, research which explores the public views on strategies to facilitate engagement with palliative care and advance care planning is required. Methods: Exploratory, qualitative design, utilising purposive random sampling from a database of participants involved in a larger mixed methods study. Online semi-structured interviews were conducted (n = 28) and analysed using reflexive thematic analysis. Thematic findings were mapped to the social-ecological model framework to provide a holistic understanding of public behaviours in relation to palliative care and advance care planning engagement. Results: Three themes were generated from the data: "Visibility and relatability"; "Embedding opportunities for engagement into everyday life"; "Societal and cultural barriers to open discussion". Evidence of interaction across all five social ecological model levels was identified across the themes, suggesting a multi-level public health approach incorporating individual, social, structural and cultural aspects is required for effective public engagement. Conclusions: Public views around potential strategies for effective engagement in palliative care and advance care planning services were found to be multifaceted. Participants suggested an increase in visibility within the public domain to be a significant area of consideration. Additionally, enhancing opportunities for the public to engage in palliative care and advance care planning within everyday life, such as education within schools, is suggested to improve death literacy and reduce stigma. For effective communication, socio-cultural aspects need to be explored when developing strategies for engagement with all members of society. [ABSTRACT FROM AUTHOR]

Using hypothesized structural equation modeling, we investigated contributions to physical activity (PA) from psychological, social, and environmental variables. Participants were 768 adults aged 30 years or older (men = 353, women = 415; M age = 42.51, SD = 10.21 years) living in Jungrang-gu, Seoul. To assess psychological, social, and environmental variables, respondents completed scales measuring self-efficacy, decisional balance, social support, physical environment, and leisure time exercise. We found that psychological, social, and environmental variables had a statistically significant effect on PA, with psychological variables mediating the effects of social and physical environmental variables on PA. These findings lend support to the assumed internal and external validity of the social ecological model (SEM) as an explanation for PA. [ABSTRACT FROM AUTHOR]

Delayed engagement with health services is a key contributor to poorer health outcomes experienced by men. Patterns of health service usage which reduce the opportunity for disease prevention and health promotion appear to be especially prominent amongst young men. To identify the multiple and intersecting determinants of young men's help-seeking practices and health services usage, this review uses the social ecological model (SEM) to guide a critical synthesis of the literature on barriers and facilitators experienced by young men in accessing health services. A systematic review was conducted across five databases (MEDLINE, Embase, PsychINFO, CINAHL and Scopus). Included studies presented primary data regarding young men's (12–24 years) barriers and/or facilitators to seeking and accessing health care. Thirty-one studies (24 qualitative and 7 quantitative) underwent data extraction, quality appraisal and thematic analysis under the guiding framework of the SEM. Seven key themes were constructed, encapsulating the perceived barriers and facilitators to help-seeking and accessing health care experienced by young men, including masculine attitudes, health literacy, social pressure, service accessibility, economic factors, service characteristics and cultural attitudes. These findings highlight the complex interplay between the individual, interpersonal, organizational and societal factors impacting young men's healthcare engagement. They also illuminate avenues for multifaceted, context-specific interventions to enhance healthcare accessibility for this group, including addressing health literacy gaps, providing culturally sensitive care and reducing cost barriers. [ABSTRACT FROM AUTHOR]

The significance of mental health inequities globally is illustrated by higher rates of anxiety and depression amongst racial and ethnic minority populations as well as individuals of lower socioeconomic status. The COVID-19 pandemic has further exacerbated these pre-existing mental health inequities. With rising mental health concerns, arts engagement offers an accessible, equitable opportunity to combat mental health inequities and impact upstream determinants of health. As the field of public health continues to shift its focus toward social ecological strategies, the social ecological model of health offers an approach that prioritizes social and structural determinants of health. To capture the impacts of arts engagement, this paper creates an applied social ecological model of health while aiming to advocate that engaging in the arts is a protective and rehabilitative behavior for mental health. [ABSTRACT FROM AUTHOR]

PURPOSE This study aimed to analyze factors associated with physical activity (PA) in older adults based on social ecological theory. METHODS Secondary analysis was conducted using raw data from the 2021 Community Health Survey. after excluding 129 non-responses in the PA domain, a total of 74,363 individuals were included in the final analysis. A total of eight factors, including personal (level of depression, history of falls), relational (relationships with neighbors, living alone), community (satisfaction with the local community system, safety), and environmental factors (living environment, natural environment), were selected in accordance with the key points of social ecological theory. To analyze social ecological factors related to the PA of older adults, we conducted a decision tree analysis using Chi-square automatic interaction detection (CHAID). RESULTS The average PA level among older adults was approximately 136 minutes, but the mode and median were both 0 minutes. A total of 20.2% of older adults met the physical activity recommendations, while 79.8% did not. According to the first split of the decision tree, living alone was the most relevant factor associated with the PA of older adults, followed by depression and falls. Older adults living alone, with a depression score of 10 or higher, and who had experienced a fall within the past year, were least likely to meet the PA recommendations. CONCLUSIONS This study urgently suggests that PA programs should target older adults living alone, experiencing depression, and falls.

Social interaction and physical activity are critical components in supporting health among older adults, yet rates of activity are low in rural communities. There is significant merit in exploring the relationship between these interrelated concepts. A scoping review was conducted to synthesize existing literature. Search results identified 26 studies meeting inclusion criteria. Findings indicated that social interaction and physical activity were important for many older adults to maintain health; however, not all older adults preferred the social aspect of group-based exercise. Opportunities for physical activity and social interaction were limited based on geographical location and other socioeconomic factors. This was evident in rural communities where populations were lower and education and income levels varied. Differences on the defining role and meaning of physical activity also emerged. Increasing physical activity and social interaction must account for negative associations to address the lower rates of participation among rural older adults. [ABSTRACT FROM AUTHOR]

The refugee crisis is global in scope and the number of migrants is expected to rise for the foreseeable future. While politicians around the world engage in military action, diplomacy, and rhetoric to shape outcomes to respond to this crisis, local school and community leaders are on the frontlines of migrant-student and family integration and inclusion. In addition, dominant discourse in the U.S. has grown increasingly hostile towards immigrant and refugee populations. With this in mind, our research explores ways school district leaders act as advocates by shaping the practices, policies, and discourse related to refugee integration. We conducted a two-year, qualitative case study in the U.S. state of Vermont between 2018 and 2019. Data collection included in-depth interviews and observations of public meetings with the superintendents of two districts; email communication with the director of a refugee-serving non-profit organisation; and document analyses of publicly available materials related to refugee resettlement. Our study locates strategies contributing to what we call an "architecture of care", engaged in by school leaders and community members. We highlight the power of small communities to serve as "thin places of resistance", where community members work together to build welcoming places for newly arrived refugee children and families. [ABSTRACT FROM AUTHOR]

Background and Purpose Our study examined individual-, interpersonal-, community-, and policy-level associations with nicotine/tobacco use among gender-varying and gender-stable U.S. individuals. Methods Data from Waves 2–4 (2014/15–2016/18) of the Population Assessment of Tobacco and Health (n = 33,197 U.S. adolescents and adults aged ≥14 years) and state-level gender minority policy data were used. Using multivariable logistic regression, the odds of past-30-day nicotine/tobacco use at W4 were estimated as a function of gender stability/variability, psychological distress, number of tobacco products used by family/friends, anti-tobacco marketing exposure, and change in gender minority-related policies from 2015 to 2017. Results Gender-varying individuals had higher odds of nicotine/tobacco use compared with gender-stable individuals (AOR range = 1.7–2.3, p <.01). In the overall sample, positive change in gender minority policy protections (tallied from medium to high) was associated with lower odds of any nicotine/tobacco, other tobacco, and poly-tobacco use (AOR = 0.8, p <.05) compared to states with no change in their negative policies. Anti-tobacco marketing exposure was associated with lower odds of any tobacco, cigarette, e-cigarette, and poly-tobacco use compared with those who had no anti-tobacco marketing exposure (AOR = 0.9, p <.05). Higher psychological distress (AOR range = 1.7–2.4, p <.001) and an increasing number of tobacco products used by family/friends (AOR range = 1.1–1.3, p <.001) were associated with increased odds of nicotine/tobacco use. Conclusions Multilevel prevention and intervention strategies are needed to reduce the risk of nicotine/tobacco use among gender-varying and gender-stable individuals. [ABSTRACT FROM AUTHOR]

Loneliness is increasingly understood as a public health crisis, and older adults are experiencing particularly severe impacts. Social distancing efforts during the COVID-19 pandemic may have increased loneliness among older adults. Guided by the Social Ecological Model, this study uses two cross-sectional waves of the National Survey of Older Americans Act Participants (NSOAAP) from 2019 and 2021 to expand understanding and identify possible points of intervention to increase social support for vulnerable older adults. Results reveal that while home-delivered meal participants have higher levels of loneliness than congregate meal participants, levels of loneliness did not increase during the COVID-19 pandemic and their loneliness levels did not differ significantly by age, geographic location, or living arrangement. Congregate meal participants’ loneliness increased during the first year of the pandemic, particularly for participants aged 65–74, those living in suburban or rural areas, and those living alone. These findings suggest opportunities for policymakers and aging services providers who seek to increase social engagement among older adults who participate in Older Americans Act (OAA) nutrition programs. The evidence suggests a need for increased social engagement initiatives through OAA programs that prioritize social support for groups who are disproportionately burdened by loneliness.