Health Action Research Articles

Longterm efficacy of a patient focused intervention in patients with asplenia- a three year follow-up of the PrePPS trial.

This study aimed to reassess the long-term impact of a Health Action Process Approach (HAPA)-informed intervention on guideline adherence among asplenic patients and their physicians, three years post-intervention. This follow-up study was conducted within the framework of the interventional PrePSS (Prevention of Postsplenectomy Sepsis Score) study. Patients aged 18 or older with anatomical asplenia were in enrolled in a prospective controlled, two-armed historical control group design. The intervention group received tailored educational materials, medical alert cards, and a telephonic HAPA-based intervention. A telephonic follow-up assessment was conducted three years post-intervention, evaluating adherence to preventive measures using the PrePSS-score (range 0-10) and propensity-score based overlap weighting. Out of 106 patients who had received the intervention, 79 (75%) completed the three-year follow-up. The PrePSS-scores further increased compared to six months post-intervention (median of 8.08 points vs 7.60 points), with notable improvements in vaccination coverage and availability of emergency antibiotics. Only four participants reported severe infections requiring hospitalization, none of which were typical of post-splenectomy sepsis. 47/79 (59%) of participants contracted SARS-CoV2 but clinical courses were mild with only one patient needing hospital and ICU treatment. Patients who had received our novel telephonic intervention exhibited significant and sustained improvement in adherence to guideline-based preventive measures at three years post intervention. HAPA-based interventions may yield more sustained effects than traditional nudging strategies.

Factors Influencing Pregnant Women's Participation in Randomised Clinical Trials in India: A Qualitative Study.

To explore factors affecting participation of pregnant women in randomised clinical trials in Belagavi, Karnataka, India. A qualitative study using semi-structured in-depth interviews and focus group discussions as data collection methods. Primary, secondary and tertiary health facilities and their community catchment areas in Belagavi district. Thirty-three in-depth interviews with health workers and previous participants of a pregnancy-focused trial, and 12 focus group discussions with currently pregnant women who had not previously participated in a clinical trial, family and community members, and accredited social health activists. Inductive thematic analysis with a team-based approach to interpretation in the study context. Pregnant women were often unable to distinguish between maternal health programmes and trial interventions. Among previous trial participants, expectations of higher quality care were a key motivation for trial participation. Household gendered power relations and trust in the health workforce influenced decisional dynamics regarding participation. Health workers vouched for trial safety, once they assessed the intervention as acceptable. Trial Implementation by the health workforce required understanding and navigating pregnancy-related beliefs and practices in communities. Anticipated health benefits, improved healthcare access, and trust in health workers are facilitators of trial participation. Engaging primary decision-makers is essential due to household gender dynamics. Trials must integrate strategies that clarify the distinct goals of research versus clinical care.

A national framework for transition to precision medicine

Precision medicine (PM) is transforming healthcare by offering tailored interventions that address individual variability, transforming patient care and outcomes. PM is based on providing health-oriented services according to genetic characteristics, individual and family medical history, lifestyle, place of residence, and other personalized characteristics. This study aims to establish an appropriate framework for implementing PM in Iran. First, the global transition framework to PM was drawn by a systematic review, and then a framework for transition to PM in Iran was drawn by a case study through semi-structured interviews, an expert panel, and an analytic hierarchy process (AHP) questionnaire. The statistical sample of the study comprised PM specialists, researchers, and patients whose PM plays a significant role in their diagnosis and treatment. The sampling method was non-random with a combination of purposive and snowball techniques. The results from the systematic review show that for the transition to PM, we must first move from common medicine to stratified medicine and then PM. Moving toward PM requires strong economic, social, political, institutional, industrial, and, most importantly, technological infrastructures. These infrastructures will vary from country to country. In general, coexistence between the health system and PM technologies did not exist in the beginning, but it will emerge with its development. The resistance of the health system to accepting PM will gradually decrease. Furthermore, the government plays a key role in the early phases, while market and PM demand become more prominent during the development. New health actors will also develop PM, and out-of-date actors will be deleted or replaced. But moving toward PM is slightly different in Iran, particularly in the middle phases of transition.

Situational analysis of the quality of maternal, child, and adolescent health data in the health districts of Thiès, Mbour, Kédougou, and Saraya in Senegal

SummaryIntroductionIn Senegal, the Routine Health Information System (RHIS) captures the majority of data from the Ministry of Health and Social Action (MHSA) public structures and very little health data from the private sector and other ministerial departments. Quality data strengthens the validity and reliability of research results. Common areas of data quality include accuracy, completeness, consistency, credibility, and timeliness. The work aims to assess the quality of routine maternal, child, and adolescent health data in Senegal.Materials and methodsA mixed quantitative and qualitative design was chosen in four health districts, including Thiès, Mbour, Kédougou, and Saraya. The study included functional health structures that produce maternal, child, and adolescent health data. For the quantitative part, a descriptive and analytical study was carried out. Lot Quality Assurance Sampling (LQAS) was used as the sampling method. Data were collected using Performance of Routine Information Systems Management (PRISM) data collection tools and the ODK application and analyzed (univariate and bivariate) using R and Stata with an alpha risk of 5%. The following data quality indicators (accuracy, completeness, and promptness) were estimated. An exploratory case study and purposive sampling supported the qualitative part by implementing individual interviews.ResultsThe study showed an accuracy ratio of 1 in the intervention districts, a difference in the control districts, and a disparity in the transmission of guidelines between districts (inter- and intra-region). The average level of completeness was 0.64 (+/- 0.44) for all regions combined, with no significant difference between districts. The promptness rate for Kédougou, Saraya, Thiès, and Mbour districts was 81%, 75.9%, 72.2%, and 86.7%, respectively. Between 40% and 60% of facilities in each district carried out self-assessments. Data collection tools were considered to be numerous. A large number of tools were easy to use. The recording space was appreciated. On the other hand, the length of the forms was little or not appreciated by the providers. Few of the providers in the 4 districts had been trained to record data in DHIS2.ConclusionAssessment of data quality in the districts studied shows shortcomings in terms of completeness and timeliness. Many factors influence the SMEA data quality situation, including knowledge or application of RHIS policies, standards, and protocols, perception of the importance of RHIS, ease of use of data collection tools, training of providers, and diversity of data production sources.

Impact of nocturnal road traffic noise and annoyance on self-reported insomnia symptoms: policy intervention in noise-polluted environments.

Chronic exposure to traffic noise is associated with increased stress and sleep disruptions. Research on the health consequences of environmental noise, specifically traffic noise, has primarily been conducted in high-income countries (HICs), which have guided the development of noise regulations. The relevance of these findings to policy frameworks in low- and middle-income countries (LMICs) remains uncertain. To investigate the relationship between road traffic noise exposure and annoyance on insomnia symptoms, a questionnaire survey was administered to 5408 randomly selected participants residing in Srinagar, India. Sleep quality was assessed using a standardized sleep disturbance score, along with self-reported annoyance levels related to road traffic noise at the participants' residences. Nighttime road traffic noise was modeled using Sound PLAN 8.2 software to generate noise contour maps, enabling the spatial evaluation of noise levels along roadways near residential areas. A total of 79.3% of the 5408 respondents were exposed to noise levels exceeding 45 Lnight dB(A). Statistically significant associations were observed between traffic noise exposure and all insomnia symptoms, with difficulty falling asleep showing the strongest association (OR = 1.53; 95% CI = 1.12-2.09) within the study sample. Compared to males, females exhibited higher insomnia symptoms (OR = 1.68; 95% CI = 1.35-2.08). The results indicated that insomnia was strongly correlated with an increased odds of traffic noise annoyance (OR = 2.39; 95% CI = 1.73-3.76) (p = 0.029). Finally, this study advocates for a robust regulatory framework to incorporate noise pollution mitigation strategies into the public health action plans of developing nations.

Uncovering the Potential Link Between Polychlorinated Biphenyls and Cardiovascular Diseases: A Comprehensive Analysis

Background: A family of persistent organic pollutants, known as polychlorinated biphenyls (PCBs), are extensively found in the environment and may be harmful to the cardiovascular system. Systematic reviews and meta-analyses are required to thoroughly evaluate the association between PCB exposure and cardiovascular disease (CVDs), despite the fact that studies on the subject have produced inconsistent results. Objective: The purpose of this study was to investigate the relationship between PCBs exposure and cardiovascular disease risk in order to provide more conclusive data to promote public health actions. Methods: The studies that met the inclusion criteria were screened out using the databases PubMed, Web of Science, ScienceDirect, and Cochrane Library. The comprehensive effect size (OR) was calculated using the random-effects model; the study’s heterogeneity was analyzed using I2 statistics; the major reasons of heterogeneity were identified using subgroup analysis; and publication bias graphically was measured using the Egger’s test. Results: A meta-analysis of 11 studies revealed that total PCBs (OR = 1.56, 95% CI: 1.20–1.75), non-dioxin-like PCBs (NDL-PCBs) (OR = 1.33, 95% CI: 1.15–1.53), and dioxin-like PCBs (DL-PCBs) (OR = 1.31, 95% CI: 1.10–1.57) were all found to be positively associated with the risk of cardiovascular disease. Subgroup analysis revealed that study type, biomaterials, and literature quality were the most significant drivers of variation. Furthermore, certain PCB homologues, such as non-dioxin-like (NDL)-PCB153 and dioxin-like (DL)-PCB118, are highly related with cardiovascular disease. Conclusions: According to this meta-analysis, exposure to PCBs may increase the risk of cardiovascular disease. Notwithstanding major drawbacks, our results emphasize the significance of lowering exposure to PCBs and offering a solid theoretical basis for public health initiatives.

Cohort profile: the BangladEsh Longitudinal Investigation of Emerging Vascular and nonvascular Events (BELIEVE) cohort study

PurposeBangladesh has experienced a rapid epidemiological transition from communicable to non-communicable diseases (NCDs) in recent decades. There is, however, limited evidence about multidimensional determinants of NCDs in this population. The...

Heterogeneous zonal impacts of climate change on a wide hyperendemic area of human and animal fascioliasis assessed within a One Health action for prevention and control.

The Northern Bolivian Altiplano is the fascioliasis endemic area where the highest prevalences and intensities in humans have been recorded. In this hyperendemic area of human fascioliasis, the disease is caused only by Fasciola hepatica and transmitted by Galba truncatula, the sole lymnaeid species present in the area. When analysing the link between global warning and the recently reported geographical spread of lymnaeid populations to out-border localities, a marked heterogeneous climatic change was found throughout the endemic area. The aim of the present study is to analyse the physiographical heterogeneity of the fascioliasis hyperendemic area in the Northern Bolivian Altiplano, in order to assess its repercussions in the implementation of a One Health action. We applied multivariate linear mixed models to analyse the influence of a number of physiographical features on the long-term variation of climate and of the risk of transmission. Despite its apparent physiographic homogeneity, the findings of this study revealed markedly heterogeneous climate characteristics throughout the endemic area. This irregular pattern is influenced by physiographical features such as altitude, inner hills, closeness to Lake Titicaca, and El Niño-Southern Oscillation. This is the broadest study ever performed in a human fascioliasis endemic area about the influence of physiography on climate. It highlights the importance of considering physiographical features, an aspect usually not considered in studies dealing with the influences of climate and climate change on human and animal fascioliasis. Moreover, it shows that an endemic area may climatically evolve differently in its various inner zones and emphasizes the need for continuous monitoring to assess whether control measures should be modified accordingly.

Comprehensive Approach of Hospital Role in Managing Non-Comunicable Disease

Health problems classified as non-communicable diseases (NCDs) are those that cannot be spread from one person to another directly. With 41 million fatalities annually, or 71 percent of all deaths globally, these illnesses rank as the leading cause of death and disability worldwide. 15 million individuals between the ages of 30 and 69 die from non-communicable diseases (NCDs). The most common cause of NCD fatalities is cardiovascular disease, which is followed by cancer, respiratory conditions, and diabetes. Hospitals are crucial to the management of non-communicable diseases (NCDs) in a number of ways, including palliative care, treatment, screening, and detection. The purpose of this study is to examine hospitals' involvement in NCD management. The scoping review technique, a methodical approach and selection procedure, is employed in this study. The last ten years' worth of publications from national and international databases, including PubMed, Scopus, and Ebsco/Springer, are searched for literature sources. According to the study's findings, hospitals, as health service institutions, play a part in global health diplomacy (GHD), or a negotiated process of collective action for global health. This includes three types of diplomacy: informal diplomacy, which takes the form of interactions between international public health actors and their partners, such as officials from the host country, non-governmental organizations, private businesses, and the community, and core diplomacy, which takes the form of formal negotiations between countries. Multi-stakeholder diplomacy is defined as talks between countries and other actors that don't always result in agreement.

A mobile-based multidomain lifestyle intervention using Cognitive Evergreenland for older adults with subjective cognitive decline: a feasibility study

BackgroundDementia is a growing public health issue. Non-drug interventions targeting individuals before the onset of overt cognitive decline may be effective. Subjective cognitive decline (SCD) is present in > 50% of older adults and associated with progression to dementia. Here, we tested the compliance and effectiveness of a Multidomain Lifestyle Intervention Program using the mini-program, Cognitive Evergreenland, (MLIP-CE), based on the Health Action Process Approach model to support home-based intervention in older adults with SCD.MethodsCognitive Evergreenland was designed to improve cognitive reserve and maintain brain function in people at high risk of dementia and included: cognitive stimulation, cognitive training, health education, vascular risk monitoring, social support, and functional assessment, among other features. This was an exploratory trial designed to examine participant compliance with the mobile lifestyle intervention and its effectiveness, as well as changes in health-related indicators and cognitive function of older adults with SCD from baseline to 12 and 24 weeks post-intervention.ResultsThe retention rate for MLIP-CE was 90.2% (37/41). Mean participant age was 70.93 ± 6.91 years, 73.2% of participants were female, and mean Montreal Cognitive Assessment score was 24.51 ± 2.87. Throughout the 24 weeks of the prescribed intervention, app usage remained consistently high, with over 92% of participants using the mini-program at least once a week and successfully completing corresponding health management tasks. In terms of average usage, cognitive training emerged as the most frequently used functional module (95.73%), closely followed by health education (95.02%). The health behavior levels of older adults with SCD, measured in terms of ability, opportunity, and motivation, were significantly increased relative to baseline (p < 0.001). Regarding cognitive function, Mini-Mental State Examination scores were significantly improved post-intervention, with a moderate effect size (Hedges’ g = 0.60).ConclusionsThese findings suggest that MLIP-CE, which was designed based on a theoretical framework, has potential for implementation, and support ongoing research into use of MLIP-CE for individuals at high risk of SCD or other dementia conditions.Trial registrationThe trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR2200058665 on 13 April 2022.

THE CONTRIBUTION OF STANDARDS AND STANDARDIZATION IN ACHIEVING ACOUSTIC COMFORT

Acoustic comfort in the context of the harmful effect of noise on human health in the living space of a residential building can be viewed based on the definition of the World Health Organization (WHO), according to which health is "a state of complete physical, spiritual and social comfort". According to this definition, health action includes both increased subjective comfort and physical health damage, which over time may result in physical health damage. This paper offers one point of view in an attempt to improve the process of establishing evidence of exposure to noise in the living space of a residential building and to support a more impartial presentation of data regarding the negative effects of disrupting acoustic comfort with contents that violate privacy and human health. The growing influx of complaints about the phenomenon of noise in the environment, as well as its impact on mental and physical health, requires a higher level of professional attitude towards a complex-multidimensional problem and a layered analysis of the spectrum of negative effects that imply sleep disturbance, auditory and extra auditory disturbances. Achieving acoustic comfort is a complex, multi-functional problem, which includes numerous external and architectural factors such as: the purpose of living space, the nature of noise in the environment, and acoustic values of building structures and materials. Unfortunately, numerous examples of "bad practice" are known, where the owners-buyers noticed all construction defects hidden under the luxurious surface only after moving in, and the largest number of customer complaints is related to acoustic comfort.

“I was angry that I fell” all the way to “if I fall, I fall”: a qualitative study of the spectrum of behavioral fall risk factors for veterans with dysvascular lower-limb amputation

Purpose To explore behavioral risk factors contributing to fall and near-fall scenarios for Veterans with dysvascular lower-limb amputation. Materials and methods Participants were a convenience sample of Veterans with unilateral dysvascular lower-limb amputation, receiving care at a single Veterans Administration Regional Amputation Center, who participated in an interview (12/2021–04/2023). We used phenomenological research and directed content analysis to explore participant perspectives on fall scenarios. Two frameworks informed a priori codes (The Health Action Process Approach, and the Falls-Type Classification Framework); however, analysis was also inductive, with additional codes emerging. Following an independent and iterative coding process, codes were categorized, and patterns identified to create final themes. Results Twenty-one veterans completed interviews. Five themes were identified that were salient across a behavioral fall risk factor spectrum from low to high: self-efficacy, trust in the prosthesis, dual-task awareness, participation, and emotional regulation, and one theme pertaining to context surrounding the index fall. Conclusion Different levels of behavioral fall risk factors exist for Veterans with dysvascular lower-limb amputation. Understanding individuals’ perceptions of these behavioral risk factors is important as a first step in developing comprehensive fall-risk management rehabilitation interventions for Veterans with amputation.

Gambling advertising regulation in Ghana: what do we know and where to next?

In Ghana and many other sub-Saharan African countries gambling advertising has become pervasive due to weak regulations that allow gambling operators to zealously promote their products as a risk-free way to make money. In this commentary, we provide a public health perspective based on document analysis of the Ghana Gaming Commission's guidelines on advertisements, and recommendations for strengthening Ghana's gambling regulatory environment. With the industry intensifying its focus on new markets to grow and sustain profits, and new global players entering Ghana's market, the competition for market share will most likely intensify with an associated and aggressive increase in gambling advertising. Accordingly, a strengthened gambling advertising regulation underpinned by public health principles is required to restrict advertising across all forms of media and regulate advertising content. The next step for public health action should focus on advocating for new gambling advertising regulations and a review of the Gaming (gambling) Act.

Characterising Carbon Monoxide Household Exposure and Health Impacts in High- and Middle-Income Countries-A Rapid Literature Review, 2010-2024.

Carbon monoxide (CO) is a toxic gas, and faulty gas appliances or solid fuel burning with incomplete combustion are possible CO sources in households. Evaluating household CO exposure models and measurement studies is key to understanding where CO exposures may result in adverse health outcomes. This assists the assessment of the burden of disease in high- and middle-income countries and informs public health interventions in higher-risk environments. We conducted a literature review to identify themes that characterise CO exposure in household dwellings. A keyword-structured search using literature databases was conducted to find studies published in the period of 1 January 2010-5 June 2024. We focused on studies from high- and middle-income countries, excluding animal and biomass studies, and narratively synthesised themes. We identified 5294 papers in the literature search and included 22 papers from thirteen countries in the review. Most measured CO levels were below the WHO or country guidance levels, with sporadic peaks of measured CO linked to fuel-burning activities. To understand CO exposure in households, we identified sixteen themes grouped into five main categories: dwelling characteristics, source characteristics, temporal variation, environmental characteristics, and socioeconomic status of occupants. Seasonal variation (temporal variation), size of room and ventilation (dwelling characteristics), and cooking and outdoor CO levels (source characteristics) had the most evidence. These themes characterising CO exposure in household dwellings are important to aid the development of indoor exposure models and for understanding where CO exposures result in adverse health outcomes. These themes should be validated by household CO monitoring studies, which will enable the identification of higher-risk household dwellings and inform public health actions.

Implementation of RedCap data systems in Kenyan psychiatric rehabilitation: a community case study.

Data collection systems are vital in implementation of interventions within patient care as they allow us to better understand and improve the care given. This is equally true in the field of psychiatric rehabilitation, which has been steadily growing in the medical world for the past 20 years. It has recently been a focus of psychiatric medicine in Kenya with the Kenya Mental Health Action Plan 2021-2025 calling for improvement of care in the field. With psychiatric rehabilitation growing in low- and middle-income countries in recent years studies have come out showing the effects of newly employed programs and stressing the need for data collection practices that can be used to encourage best practices in local communities. This paper describes the implementation of data systems for the Moi Teaching and Referral Hospital Nawiri Skills and Recovery Centre (Nawiri) in Eldoret, Kenya. The goals of the data systems were 1) To collect and organize information for continuous quality improvement of services at Nawiri, 2) To collect information for reporting to MTRH leadership, Ministry of Health as well as private funders, 3) To provide data to assess outcomes of people who receive services at Nawiri to create evidence for effective interventions to help create policy to make psychiatric rehabilitation more available to people living with Severe mental illness in Kenya. Lessons learned from data systems implementation included insights into ease of data collection, adaptability of data instruments to fit facility needs, and ability to reproduce RedCap data collection in other settings.

VISÍVEL E INVISÍVEL DA HIPERTENSÃO ARTERIAL SISTÊMICA ENTRE PROFISSIONAIS DE ENFERMAGEM

Descriptive, qualitative approach aims to understand the perception of nursing professionals about the risks for hypertension from the various demands of their daily work. Its relevance is legitimized both the clinical point of view, social, and management of people in the professional world of nursing, for reflections about the possible prevention of this disease and / or complications there of. The same was done in a coronary care unit (CCU) of Cuiabá-MT, which data collection occurred through semi-structured interviews conducted with fourteen (14) nurses, and data analysis was performed based on the method thematic analysis. We believe that the SAH has visible aspects, however, the invisible predominate when considering the perception and attitude of each professional despite the risks they may face the face of this potential possibility of becoming hypertensive. The invisibility of things becomes visible when we allow ourselves to go beyond appearance, and plunged in the meanings that permeate our existence, as part of this dynamic world we build from our perceptions and meanings attributed to it. The invisibility of hypertension is evident from the meaning that gives the same hypertensive, hence changing the attitudes and lifestyles, the health professional should seek to understand and realize this invisibility when implementing care within the primary, secondary and tertiary health actions.

Meat consumption and racial/ethnic disparities in population-based study in the city Campinas, Brazil

The aim of the present study was to investigate meat consumption among adults residing in a city in the countryside of São Paulo, Campinas, according to ethnicity/skin color in two periods: 2008/2009 and 2014/2015, given the scarce literature on the subject. Thus, we sought to evaluate the association between race/color and consumption of meat, a food of great cultural value, based on the hypothesis that this demographic marker is relevant to explain food choices. A cross-sectional population-based study evaluating participants from the Health Survey of the City of Campinas (ISACAMP) was conducted in 2008/2009 and 2014/2015, with 2,354 and 1,606 individuals respectively, aged 20y or older. Food consumption data were collected using the 24-hour food recall method and meats were classified according to animal origin and type of processing. Linear regression models were run to assess the association between meat consumption and sociodemographic variables with a significance level of 5%. Lower total consumption of meat, red meat, beef and fish was found among individuals with self-declared black skin color compared to those with self-declared white skin color. Red meat consumption varied from 109.4g to 157.9g in 2008/2009 and from 102.1g to 125.1g in 2014/2015 between the groups, remaining above the recommendation in both periods. The World Cancer Research Fund recommends consuming between 50 and 71.4 g/day of red meat; thus, these findings reinforce the importance of studies that investigate the impact of ethnicity on food consumption, since racial disparities may be in the origin of the insufficient or excessive consumption of certain types of meat, and understanding the factors associated with the consumption of types of meat is relevant for the adoption of health actions aimed at adequate food intake.

Knowledge of Accredited Social Health Activists in India: a systematic review and meta analysis of evidence drawn from primary studies published between 2005 and 2022

BackgroundSince the inception of the ASHAs in the year 2005, their work horizons have increased from Reproductive, Maternal, Newborn, Child, and Adolescent health (RMNCH + A), Communicable and Non-Communicable Diseases (CD & NCD) to oral health, ophthalmologic care, and other supportive community level healthcare services. The present literature lacks comprehensive understanding and synthesis of domain-wise knowledge of ASHAs and the factors affecting their knowledge. Therefore, this study aimed to synthesize and collate the relevant evidence to understand the overall knowledge of ASHAs.MethodsThis systematic review and meta-analysis sourced literature from Google Scholar, PubMed, and Web of Science. Of the 1062 articles identified, 37 articles were selected for narrative synthesis and meta-analysis which focused on knowledge of ASHAs. In meta-analysis, pooled prevalence was estimated using the random effect model. Meta-analysis was performed using the statistical software R version. 3.6.1 for Microsoft Windows.ResultsThe overall pooled prevalence of knowledge regarding maternal, neonatal/child health, communicable, and non-communicable diseases among ASHAs was 62%, 69%, 62%, and 73%, respectively. The level of education, years of experience, inadequate supervision, and training were the factors affecting their knowledge and subsequently its translation into practices within the community. The review also evidenced variation of knowledge among ASHAs across domains and geographical regions of India.ConclusionThe systematic review and meta-analysis highlight that ASHAs have proven to be indispensable assets to India’s healthcare system with their strengths lying in maternal and child health programs. To further enhance their impact, it is imperative to invest in areas where they lack knowledge such as disease surveillance, and preventive healthcare. Empowering ASHAs with necessary resources, and training will not only enhance their capabilities but also contribute to the overall improvement of the healthcare system in India.

Facilitators and Barriers of Health Behaviors in Patients With Type 2 Diabetes: A Qualitative Study.

The purpose of the study was to explore the facilitators and barriers of health behaviors in patients with type 2 diabetes (T2D), providing a reference for the development of health behavior interventions programs. A qualitative descriptive research design was adopted, and interviews were conducted with 25 patients with T2D. The interview guide was developed based on the health action process approach theory. The interviews were audio-recorded and transcribed verbatim. Data analysis was performed using thematic analysis. Through the analysis of interview data, 2 main themes were identified: facilitators and barriers of health behaviors, comprising 18 subthemes. The facilitators included self-efficacy, outcome expectations, risk perception, intention, action planning, coping planning, emotional regulation, proactive and sustained sense of responsibility, and multidimensional social support. The barriers included insufficient disease awareness, insufficient self-control, impact of social activities, low self-efficacy, accessibility of personal conditions, lack of problem-solving skills, lack of disease management knowledge, lack of social support, and cognitive decline. When designing health behavior intervention programs for patients with T2D, it is crucial to consider both facilitators and barriers to enhance the effectiveness of the interventions to encourage patients to adopt healthy lifestyles, improve their quality of life, and reduce the occurrence of complications.

Shifting the Conversation on Wildland Fire Smoke Exposures: More Smoke within and across Years Requires a New Approach to Inform Public Health Action

Shifting the Conversation on Wildland Fire Smoke Exposures: More Smoke within and across Years Requires a New Approach to Inform Public Health Action