Behavior Change Strategies Research Articles

Cogstim: A Shared Decision-making Model to Support Older Adults' Brain Health.

The lack of effective treatments for cognitive decline in older adults has led to an interest in the possibility that lifestyle interventions can help to prevent changes in mental functioning and reduce the risk for dementia. Multiple lifestyle factors have been related to risk for decline, and multicomponent intervention studies suggest that changing older adults' behaviors can have a positive impact on their cognition. How to translate these findings into a practical model for clinical use with older adults, however, is not clear. In this Commentary, we propose a shared decision-making model to support clinicians' efforts to promote brain health in older persons. The model organizes risk and protective factors into three broad groups based on their mechanism of action and provides older persons with basic information to allow them to make evidence- and preference-based choices in choosing goals for effective brain health programs. A final component includes basic instruction in behavior change strategies such as goal setting, self-monitoring, and problem-solving. The implementation of the model will support older persons' efforts to develop a personally relevant and effective brainhealthy lifestyle that may help to reduce their risk for cognitive decline.

Behavior Change Techniques Improve Adherence to Physical Activity Recommendations for Adults with Metabolic Syndrome: A Systematic Review.

Exercise and physical activity interventions improve short-term outcomes for people with metabolic syndrome, but long-term improvements are reliant on sustained adherence to lifestyle change for effective management of the syndrome. Effective ways of improving adherence to physical activity and exercise recommendations in this population are unknown. This systematic review aims to determine which interventions enhance adherence to physical activity and/or exercise recommendations for people with metabolic syndrome. Electronic databases MEDLINE, PubMed, CINAHL, SPORTdiscuss and ProQuest were searched to July 2022. Risk of bias was assessed using the Cochrane risk of bias tool and overall certainty of evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation approach. Four randomized controlled trials with 428 participants (mean age 49-61 years) were included. There was very low certainty evidence from two trials that goal setting interventions may improve adherence to physical activity recommendations over three to six months. There was low certainty evidence from two trials that self-monitoring and feedback interventions increased adherence to physical activity interventions over 12 months for people with metabolic syndrome. Clinicians and researchers may consider using behavior change strategies such as goal setting, monitoring and feedback in interventions for people with metabolic syndrome to increase adherence to physical activity and exercise recommendations over 3 to 12 months, but high-quality evidence is lacking.

Abstract P650: Addressing Cardiovascular Disease Inequities: Qualitative Process Evaluation From a Co-Investigation With Im/Migrants Exploring How to Sustain a Community-Driven, Social Network Intervention Using a Racism-Conscious Approach

Introduction: Health promotion programs focused on cardiovascular disease are underutilized with im/migrants. The one-time referral to group-based interventions model ignores (1) the complex sociocultural influences on behavior change and (2) the socio-historical context of migration, racialization of immigrants and refugees, and the roles these play in differential social integration of refugees. One solution may be to apply community-based participatory research (CBPR) and Public Health Critical Race Praxis (PHCRP) to social network interventions with opinion leaders. Yet, these interventions are challenging to scale. There is a critical need to understand how to scale community-driven social network interventions to effectively address cardiovascular disease inequities resulting from systemic racism experienced by im/migrant populations. Developed using CBPR and informed by PHCRP, this work builds upon Healthy Immigrant Community (HIC), a collaborative effort between Latinx and Somali im/migrant partners and Rochester Healthy Community Partnership. Our aim is to explore opinion leader recruitment, their characteristics, and expectations for HIC scale-up. Qualitative Hypothesis: Learning more about the opinion leaders’ background and experience in the Healthy Immigrant Community social network intervention will prepare us for a future efficacy study. Methods: We conducted a process evaluation by: (1) interviewing community partners who recruited opinion leaders (n=8) and (2) conducting three pre-intervention focus groups with opinion leaders (Latinx n=4; Somali women n=8; Somali men n=8). We used PHCRP to deductively form codes yet allowed for new ideas that arose from the data by inductively generating additional codes. Results: Interview participants described their decision-making process, qualities considered, recruitment strategies, and expectations for an implementation study. Focus group participants discussed their personal motivations for participation, how they hoped the study would help their community, and the barriers to health they experience because of structural determinism (macro-level forces that sustain inequities). Conclusions: This work will enhance our ability to translate HIC to other communities by expanding our knowledge of opinion leader characteristics that are important in a community-driven, social network intervention. Because social network interventions have been demonstrated to cause positive behavior change, further adapting these interventions in a community setting would be expected to provide a more effective approach compared to individually targeted behavior change strategies. Additionally, selecting OLs is neither time nor resource intensive and could enhance organizational strategies for implementing health promotion programming.

Untangling the Complex Relationships between Horse Welfare, Rider Safety, and Rider Satisfaction

ABSTRACT Securing the horse industry’s long-term future is becoming increasingly urgent due to community concerns for horse welfare; human behavior change may offer novel solutions to this challenging problem. Self-determination theory (SDT), a well-established theory in human behavior change, assumes humans are intrinsically motivated by three universal psychological needs: competence, autonomy, and relatedness. These align well with horse–human interaction. To explore the potential for human behavior change to improve horse welfare, this study investigated the relationship between horse welfare, rider safety, and rider satisfaction. An online survey asked equestrians about their horse-keeping and training practices, their riding accidents and injuries, and their level of satisfaction with their horse. Relative horse welfare and rider satisfaction were significantly related (r = 0.34, p < 0.001). Hyperreactive horse behavior (defined in this study as bucking, bolting, rearing, and spooking) and rider accidents and injuries were negatively related to rider satisfaction (r = −0.23, p < 0.001 and r = −0.16, p = 0.001, respectively). Further, goal achievement (r = 0.57, p < 0.001), rider control (r = 0.49, p < 0.001), and horse–human partnership (r = 0.62, p < 0.001) were all significantly related to rider satisfaction. A regression analysis testing the proposed SDT-based rider satisfaction model was significant (p < 0.001), with goal achievement, rider control, and horse–human partnership accounting for 63% of the variance of rider satisfaction scores. We found that horse welfare, rider safety, and rider satisfaction were related, with equestrian goal achievement (competence), horse control (autonomy), and horse-rider partnership (relatedness) all significantly contributing to rider satisfaction, suggesting that SDT may offer a useful framework for developing behavior change strategies. While more work is needed to develop and evaluate such strategies, a better understanding of intrinsic rider motivation represents an important first step.

The factors influencing inappropriate child feeding practices among families receiving nutrition allowance in the Himalayan region of Nepal

BackgroundChild feeding practices during the first two years of life are crucial to ensure good health and nutrition status. This study aimed to assess the factors influencing inappropriate child feeding practices in children aged 6 − 23 months in families receiving nutrition allowance in the remote Mugu district, Nepal.MethodsA community-based cross-sectional study was conducted among 318 mothers who had children aged 6 − 23 months of age in the seven randomly selected wards. Systematic random sampling technique was used to select the desired number of respondents. Data were collected using pre-tested semi-structured questionnaire. Bivariate and multivariable binary logistic regression was used to estimate crude odds ratio (cOR), and adjusted odds ratio (aOR), and 95% confidence intervals (CIs) to understand factor associated with child feeding practices.ResultsAlmost half of the children aged 6 − 23 months were not consuming a diverse diet (47.2%; 95% CI: 41.7%, 52.7%), did not meet the recommended minimum meal frequency (46.9%; 95% CI: 41.4%, 52.4%) and did not consume minimum acceptable diet (51.7%; 95% CI: 46.1%, 57.1%). Only 27.4% (95% CI: 22.7%, 32.5%) of children met the recommended complementary feeding practices. Multivariable analysis showed maternal characteristics such as mothers who gave birth at home (aOR = 4.70; 95% CI: 1.03, 21.31) and mothers in unpaid employment (aOR = 2.56; 95% CI: 1.06, 6.19) were associated with increased odds of inappropriate child feeding practices. Household economy (i.e. family with < 150 USD monthly income) was also associated with increased odds of inappropriate child feeding practices (aOR = 1.19; 95% CI: 1.05, 2.42).ConclusionDespite the receipt of nutritional allowances, child feeding practices among 6 − 23 months children were not optimal. Additional context-specific behavior change strategies on child nutrition targeting mothers may be required.

Enablers and barriers to COVID-19 vaccine uptake in an urban slum in Lagos, Nigeria: informing vaccine engagement strategies for the marginalized.

Vaccination against coronavirus disease 2019 (COVID-19) is a cost-effective mitigation strategy against the pandemic. As the COVID-19 vaccine becomes more available, low uptake is now a global threat and understanding the underpinnings in local contexts is a priority for intervention development. We aimed to evaluate behavioural determinants of COVID-19 vaccine acceptance that could inform engagement strategies to improve vaccine uptake in Makoko, an urban slum in Lagos, Nigeria. A population-based case-control study utilized the barrier analysis (BA) approach to evaluate the beliefs and behaviours of 45 'doers' and 45 'non-doers'. The standardized BA tabulation sheet was used to assess differences in the proportions between the two groups to identify significant factors that could be addressed through a behaviour change strategy. Perceived social norms (family, friend, healthcare workers) that approve the vaccine and expected vaccine protection against diseases among doers were determinants of behaviour. Perceived poor accessibility, safety concerns, lack of trust, low vaccine efficacy and low susceptibility to the infection were the most important determinants of behaviour among non-doers. Measures to improve COVID-19 vaccine acceptance in Makoko should include improvement in accessibility and exposing myths and misinformation through clear, concise and evidence-based community education delivered by trusted persons such as healthcare workers and religious leaders.

Improving Uptake of Cancer Genetic Risk Assessment in a Remote Tailored Risk Communication and Navigation Intervention: Large Effect Size but Room to Grow.

Cancer genetic risk assessment (CGRA) is recommended for women with ovarian cancer or high-risk breast cancer, yet fewer than 30% receive recommended genetic services, with the lowest rates among underserved populations. We hypothesized that compared with usual care (UC) and mailed targeted print (TP) education, CGRA uptake would be highest among women receiving a phone-based tailored risk counseling and navigation intervention (TCN). In this three-arm randomized trial, women with ovarian or high-risk breast cancer were recruited from statewide cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TP received a mailed educational brochure. Participants assigned to TCN received the mailed educational brochure, an initial phone-based psychoeducational session with a health coach, a follow-up letter, and a follow-up navigation phone call. Participants' average age was 61 years, 25.4% identified as Hispanic, 5.9% identified as non-Hispanic Black, and 17.5% lived in rural areas. At 6 months, more women in TCN received CGRA (18.7%) than those in TP (3%; odds ratio, 7.4; 95% CI, 3.0 to 18.3; P < .0001) or UC (2.5%; odds ratio, 8.9; 95% CI, 3.4 to 23.5; P < .0001). There were no significant differences in CGRA uptake between TP and UC. Commonly cited barriers to genetic counseling were lack of provider referral (33.7%) and cost (26.5%), whereas anticipated difficulty coping with test results (14.0%) and cost (41.2%) were barriers for genetic testing. TCN increased CGRA uptake in a group of geographically and ethnically diverse high-risk breast and ovarian cancer survivors. Remote personalized interventions that incorporate evidence-based health communication and behavior change strategies may increase CGRA among women recruited from statewide cancer registries.

Effectiveness of Behavioural Economics Informed Interventions for the Prevention, Screening, and Antiretroviral Treatment of HIV Infection: A Systematic Review of Randomized Controlled Trials.

Failure to meet international targets set for the human immunodeficiency virus HIV pandemic suggests that more effective public health strategies are needed. New strategies informed by behavioural economics are now increasingly being tested, with promising results. However, the evidence base is diverse and challenging for policymakers to interpret. This paper aims to synthesise existing evidence by reporting results from a systematic review of behavioural economics-based interventions for addressing HIV prevention, testing and treatment. The reported study was a systematic review of randomized controlled trials. The search was conducted in four electronic medical literature databases, six trial registries, four grey literature sources and was not restricted to any country or region. Bias was assessed using criteria outlined in the Cochrane Handbook for Systematic Reviews; quality of evidence was assessed using GRADE methodology. Fifteen full text articles were included in the final analysis. The synthesis of these studies revealed that strategies involving opt-out defaults, active-choice defaults, and lottery incentives can potentially increase uptake of HIV testing. Lottery incentives also showed signs of effectiveness in improving HIV prevention, ART adherence and initiation. Despite the promising findings, the overall evidence was judged to be of moderate to very low quality. Behavioural economics-based interventions are promising behavioural change strategies, although more well-designed studies are needed to strengthen the evidence base.

Associations between app usage and behaviour change in a m-health intervention to improve physical activity and sleep health in adults: secondary analyses from two randomised controlled trials

BackgroundTo examine associations between user engagement and activity-sleep patterns in a 12-week m-health behavioural intervention targeting physical activity and sleep.MethodsThis secondary analysis used data pooled from two Randomised Control Trials (RCT, [Synergy and Refresh]) that aimed to improve physical activity and sleep (PAS) among physically inactive adults with poor sleep. Both RCTs include a PAS intervention group (n = 190 [Synergy n = 80; Refresh n = 110]) and a wait list Control (CON n = 135 [Synergy n = 80; Refresh n = 55]). The PAS groups received a pedometer and accessed a smartphone/tablet “app” with behaviour change strategies, and email/SMS support. Activity-sleep patterns were quantified using the activity-sleep behaviour index (ASI) based on self-report measures. Intervention usage was quantified as a composite score of the frequency, intensity and duration of app usage during intervention (range: 0–30). Assessments were conducted at baseline, 3 and 6 months. Relationships between usage and ASI were examined using generalised linear models. Differences in ASI between the control group and intervention usage groups (Low [0–10.0], Mid [10.1–20.0], High [20.1–30.0]) were examined using generalised linear mixed models adjusted for baseline values of the outcome. Trial Registration: ACTRN12617000376347; ACTRN12617000680369.ResultsDuring the 3-month intervention, the mean (± sd) usage score was 18.9 ± 9.5. At 3 months (regression coefficient [95%CI]: 0.45 [0.22, 0.68]) and 6 months (0.48 [0.22, 0.74]) there was a weak association between usage score and ASI in the intervention group. At 3 months, ASI scores in the Mid (Mean [95%CI] = 57.51 [53.99, 61.04]) and High (60.09 [57.52, 62.67]) usage groups were significantly higher (better) than the control group (51.91 [49.58, 54.24]), but not the Low usage group (47.49 [41.87, 53.12]). Only differences between the high usage and control group remained at 6 months.ConclusionThese findings suggests that while higher intervention usage is associated with improvements in behaviour, the weak magnitude of this association suggests that other factors are also likely to influence behaviour change in m-health interventions.Trial registration number: ACTRN12617000376347; ACTRN12617000680369.

The United Nations Sustainable Development Goals: Aspirational or obtainable?

The <scp>United Nations</scp> Sustainable Development Goals: Aspirational or obtainable?

Misconceptions About Female Cancers Contributing to Late Presentation to Health Facilities in Ethiopia: A Qualitative Study.

Morbidity and mortality from female cancers is a major public health problem in low- and middle-income countries, including Ethiopia. More than three quarters of women visiting health facilities are diagnosed with late-stage cervical and breast cancer. Evidence reveals that misconception affects timely health seeking behavior which could have averted expensive treatment and poor survival. This study aimed to explore misconceptions about female cancers that may have contributed to late presentation of the problem to health facilities in Sidama region, Ethiopia. A descriptive qualitative study was carried out in June 2021. Nine focus group discussions (six with women and three with men) and 14 key informants were conducted. Data were collected using interview guide until all information get saturated. Data were inductively coded and qualitative content analysis was applied. A total of 63 (24 men and 39 women) people participated in this study. Nearly all (12) key informant interviewees have awareness about cervical and breast cancer, yet reported that their community members clearly lack awareness and they are working to improve misconceptions regarding cervical and breast cancer. The focus group discussion participants (15 men and 36 women) reported lack of detailed information related to cervical and breast cancer. Women believe that cervical and breast cancer mainly resulted from poor hygiene, trauma, having multiple sexual partners, early marriage, breast exposure to heat, not breast feeding, birth complication, urinating in the sun, hereditary, devil's intrusion and God's punishment. There were misconceptions among the community on what cervical and breast cancer mean, how they could happen, what the symptoms are, why and when to screen, when to seek health care and how to use modern treatment options. Therefore, we recommended the design of social and behavioral change strategies to address the misconceptions among different population groups.

The Determinants of Adherence to Public Health and Social Measures Against COVID-19 Among the General Population in South Korea: National Survey Study.

The COVID-19 pandemic has created devastating health, social, economic, and political effects that will have long-lasting impacts. Public health efforts to reduce the spread of COVID-19 are the priority of national policies for responding to the pandemic globally. Public health and social measures (PHSMs) have been shown to be effective when used alone or in combination with other measures, reducing the risk of spreading COVID-19. However, there is insufficient evidence on the status of compliance with PHSMs in the general population for the prevention of COVID-19 in public areas, including Korea. The aim of this study was to assess levels of compliance with the recommended PHSMs against SARS-CoV-2 infection and their predictors among the general population by using national data. This study was a secondary data analysis of the National Survey of Infectious Disease Preventive Behaviors in Community, which was conducted by the Korea Centers for Disease Control and Prevention Agency (KDCA) between October 12 and October 30, 2020. The primary study was cross-sectional, using stratified sampling via an adjusted proportional allocation method to select representative samples and ensure the stability of samples. The data were collected through phone interviews conducted by trained enumerators using a structured questionnaire. PHSM adherence was measured using a 10-item comprehensive infectious disease prevention behavior (CIDPB) scale, and each sociocognitive factor, including perceived susceptibility to SARS-CoV-2 infection, perceived severity of SARS-CoV-2 infection, perceived confidence in performing preventive behaviors related to COVID-19, information comprehension ability, and trust in information from the KDCA, was measured. A total of 4003 participants were included in the final analysis. Tobit regression and a decision tree analysis were performed to identify the predictors of preventive measures and the target groups for intervention. We discovered that women scored 1.34 points higher on the CIDPB scale than men (P<.001). Compared to the group aged 19 to 29 years, those aged 50 to 59 years and those older than 60 years scored 1.89 and 2.48 points higher on the CIDPB scale (P<.001), respectively. The perceived severity of infection, confidence in preventive behaviors, information comprehension ability, and trust in information from the KDCA were significant positive determinants of CIDPBs (P<.001). The perceived susceptibility to infection showed a significant negative relationship with CIDPBs (P<.001). Female sex, older age, lower income, and sociocognitive factors were found to be significant determinants of adhering to PHSMs. The findings suggest the need for tailored interventions for target groups; specifically, the age group that was the most active at work indicated the highest potential to spread infection. Adequate public health education and health communication for promoting adherence to PHSMs should be emphasized, and behavior change strategies for those with low perceived confidence in performing PHSMs should be prioritized.

Barriers to Optimal Child Sleep among Families with Low Income: A Mixed-Methods Study to Inform Intervention Development

This study gathered formative data on barriers to optimal child sleep to inform the development of a sleep intervention for parents of preschool-aged children in low-income households. Parents (n = 15, age: 34 ± 8 years, household income: $30,000 ± 17,845/year) reporting difficulties with their child's sleep participated in this study. Mixed methods included an online survey and semi-structured phone interview. Items assessed barriers/facilitators to optimal child sleep and intervention preferences. Interview transcripts were coded using inductive analyses and constant-comparison methods to generate themes. Derived themes were then mapped onto the Theoretical Domains Framework to contextualize barriers and inform future intervention strategies. Themes that emerged included: stimulating bedtime activities, child behavior challenges, variability in children's structure, parent work responsibilities, sleep-hindering environment, and parent's emotional capacity. Parent's intervention preferences included virtual delivery (preferred by 60% of parents) to reduce barriers and provide flexibility. Mixed preferences were observed for the group (47%) vs. individual (53%) intervention sessions. Parents felt motivated to try new intervention strategies given current frustrations, the potential for tangible results, and knowing others were in a similar situation. Future work will map perceived barriers to behavior change strategies using the Behavior Change Wheel framework to develop a parenting sleep intervention.

THE ROLE OF THE EXERCISE PROFESSIONAL IN THE SUPERVISED VERSUS TELEREHABILITATION EXERCISE PROGRAMS FOR MULTIPLE SCLEROSIS (STEP FOR MS) TRIAL

https://youtu.be/itqMuZmn70Q BACKGROUND The STEP for MS trial was designed and delivered by a team of medical and rehabilitation professionals with a key player being the exercise professional (EP). Our purpose is to showcase the role of the EP and methods for standardized, safe and effective exercise and behavior change intervention. DESIGN Site principal investigators who designed the intervention and implementation plan were physical medicine and rehabilitation doctors, physical therapists and kinesiologists with expertise in MS and exercise programming. The interventional EP were site staff members with varied backgrounds in delivering exercise programming to people with MS. Professional titles include personal trainer, exercise specialist, clinical exercise physiologist, graduate teaching assistant, research associate, clinical integration and research coordinator. Interventionalists had little to no prior experience using the theory-based behavior change strategies employed in the trial. METHODS To accommodate differences in EP backgrounds and expertise, standardized training on behavior change principles and exercise prescription was required. Weekly booster meetings were held via Zoom to discuss participant progress, challenges and identify solutions and modifications to the intervention while maintaining trial fidelity. Supporting materials like exercise training manuals, scripts, newsletters, logbooks and calendars were used by EPs to deliver the intervention. EPs deployed their unique skills and training to provide guidance on exercise program progression, exercise technique modification and behavior change strategies to participants. EPs and participants mutually decided on the trajectory of exercise progression based on experiences during the first 2 standardized weeks. The trajectories differed in the rate of progression with all participants meeting the exercise guidelines of 30 minutes of aerobic exercise and 5–10 strength exercises consisting of 1–2 sets, 10–15 repetitions targeting lower body, upper body, and core musculature 2 days a week, by week 10 of the program. Outcome measures were transcribed by EPs in a research database. CONCLUSION There was a varied skillset among principal investigators and interventionalists in the STEP for MS trial which provided a well-rounded intervention to people with MS. Standardized training, trial-issued supporting materials and weekly booster meetings enabled successful and standardized program implementation across 8 sites.

Chances and Challenges of Mobile Health in Public Health Dentistry

The future of healthcare delivery keeps evolving and mobile phone technology may have a huge role to play. Mobile health (mHealth) is a facet of Electronic Health (eHealth) that involves the use of mobile phones and other wireless devices in medical practice. The effectiveness of mHealth has been proven in different studies as well as in different aspects of medicine and dentistry. Text messaging has made significant progress in delivering health education for maintaining oral hygiene, especially for orthodontic patients as well as tobacco cessation counseling. Mobile phone applications incorporate various features like gaming, audio, and video messages to engage smokers in several behavioural change strategies. Mobile health technology has made an immense contribution to contact tracing, screening, and tele-consultation during the Novel Coronavirus Disease-19 (COVID-19) pandaemic. Given that mHealth is a low cost, easily accessible, and widely available means of communication, it has the potential to play a significant role in public health dentistry.

Risk Negotiation With People With Dementia: From Co-designed Paper Version to Implementation Preparation of an Electronic Conversation Tool.

The home care workforce provides essential support for older people with dementia to live a life of fulfillment. "Enabling Choices," an evidence-informed conversation tool, aims to negotiate risk around everyday activities between home care workers, people with dementia and their informal carers. This paper describes tool conversion into electronic format and preparation for implementation throughout a large Australian health and aged care service provider, utilizing the Implementation Framework for Aged Care (IFAC). Using codesign principles, the tool was converted from paper-based to electronic format involving frontline, operational and Information Management Services staff, and people with dementia/carers. Focus groups and interviews identified tool acceptability, feasibility, and appropriateness. For implementation preparation, the wider socio-cultural-political context was mapped, and key questions of the IFAC addressed. Environment, workflow, and training requirements were determined, and strategies for behavior change ascertained. Numerous opportunities and challenges exist for the widespread upscale of an evidence-informed tool into practice.

Time and risk preferences and the perceived effectiveness of incentives to comply with diabetic retinopathy screening among older adults with type 2 diabetes.

Behavioral economics has the potential to inform the design of incentives to improve disease screening programs by accounting for various behavioral biases. We investigate the association between multiple behavioral economics concepts and the perceived effectiveness of incentive strategies for behavioral change among older patients with a chronic disease. This association is examined by focusing on diabetic retinopathy screening, which is recommended but very variably followed by persons living with diabetes. Five time and risk preference concepts (i.e., utility curvature, probability weighting, loss aversion, discount rate, and present-bias) are estimated simultaneously in a structural econometric framework, based on a series of deliberately-designed economic experiments offering real money. We find that higher discount rates and loss aversion and lower probability weighting are significantly associated with lower perceived effectiveness of intervention strategies whereas present-bias and utility curvature have an insignificant association with it. Finally, we also observe strong urban vs. rural heterogeneity in the association between our behavioral economic concepts and the perceived effectiveness of intervention strategies.

Promoting adherence to stroke secondary prevention behaviours by imparting behaviour change skills: protocol for a single-arm pilot trial of Living Well After Stroke

IntroductionSurvivors of stroke have an elevated risk of recurrent stroke. Prompt intervention to support healthy lifestyle modification following an initial stroke is crucial for effective secondary prevention of stroke. However,...

Knowledge, Attitudes, and Practices of Hypertensive Patients Towards Stroke Prevention Among Rural Population in Saudi Arabia: A Cross-Sectional Study.

Stroke is a significant health problem and is considered one of the leading causes of mortality and permanent disability worldwide. Hypertension is a primary risk factor for stroke. Thus, hypertensive patients' knowledge, attitudes, and practices (KAP) are essential in preventing stroke. To examine hypertensive patients' KAP towards stroke prevention among rural population in Saudi Arabia. The study utilized a cross-sectional design. The data were collected using a convenience sampling technique from hypertensive patients in the northwestern rural areas of Riyadh Province. A self-administered questionnaire was adapted from the Stroke Recognition Questionnaire (SRQ) and utilized to assess KAP towards stroke prevention among rural hypertensive patients. The STrengthening of the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to report the study. A total of 196 hypertensive patients participated in the study. The total mean scores categorization into three quartiles showed that most respondents had poor levels of KAP towards stroke prevention. Weak positive correlations were found between KAP of patients. There were statistically significant differences between respondents' attitudes and practices with their age, education, marital status, and occupational status. This study denoted poor levels of KAP towards stroke prevention among hypertensive patients living in rural areas. This study showed the importance of further considering rural population by which improving their health and quality of life. Extending health educational programs and behavior-changing strategies to rural areas is essential to increase hypertensive patients and general public awareness about their stroke prevention and other health-related concerns.

The role of social value orientation in modulating vaccine uptake in the COVID-19 pandemic: A cross-sectional study

COVID-19 vaccination is the only pharmaceutical measure available to control the pandemic and move past the current crisis. As such, the Maldives, a small island country, invested heavily on securing and vaccinating the eligible population through an intensive risk communication campaign to create awareness on vaccination benefits. This paper reports on the vaccine coverage after a year of COVID-19 vaccine being introduced into the country, based on data obtained from the Values in Crisis Survey – Wave Two among Maldivian adults (n = 497). The findings show a vaccine coverage of 94%, with only 2.2% of the respondents indicating they will not get vaccinated. No significant differences were observed by age, gender, income earning, educational status or residential area. No significant relationship was observed in vaccine behaviour and confidence in government, health sector and experts. Social value orientations, particularly conservation and self-transcendence value orientations determined positive vaccine behaviour (rs = 0.180, p < 0.01 and 0.136 p < 0.01 respectively), yet conservation was the only predictor that contributed significantly to the regression model (B = 0.158, p < 0.01). The findings indicate that, despite the uncertainties around COVID-19 vaccinations, the prosocial value orientations were instrumental in achieving a high COVID-19 vaccine coverage. Further theoretical and conceptual exploration of vaccine behaviour in crisis situations is needed to inform future pandemic situations. The vaccination rollout and behaviour change strategies also need an examination of social value orientations in order to achieve a high coverage and sustain pro-vaccine behaviour post-pandemic.