Education Behavior Change Research Articles

Jumantik Education: Strategy Toward Malaria Elimination in the Resettlement Area of Osi Island, West Seram Regency

The Covid-19 pandemic, which has been global for 3 years, tends to have a domino effect in various aspects, such as individuals, groups, and countries. One of the causes of decreased immune system in the host is due to comorbid diseases suffered by the host (patients). Those at risk of Covid-19 may also be at risk of infectious diseases caused by viruses, parasites, and bacteria. In a pandemic situation like Covid-19, health behavior change education with a risk communication approach needs to be implemented in preventing, treating, and rehabilitating environmental stages of worm infection risk in the community of Osi Island hamlet. This education aims to increase public knowledge of potential health risks and threats. Thus, they can determine appropriate steps and actions to protect themselves from these issues. The method used is education with the project-based learning model, which combines lecture, discussion, and field practice methods. The target group is high school students of PGRI Pelita Jaya Seram Western Part. The achieved results are that the JUMANTIK cadres know about malaria-free health (cognitive), can collect trash (containers) from yards (psychomotor), do not allow stagnant water (affective), can drain water storage containers inside and around the house (psychomotor), can make simple mosquito traps using recycled materials, can sleep under mosquito nets (psychomotor), can observe larvae and pupae (psychomotor). Kyewords: Jumantik education, malaria elimination, Osi Island

Water, Sanitation, and Hygiene (WASH) in Schools: A Catalyst for Upholding Human Rights to Water and Sanitation in Anápolis, Brazil

Ensuring access to water, sanitation, and hygiene (WASH) facilities, along with behavior change education in schools, is essential for fostering a conducive learning environment and promoting principles of inclusion, dignity, and equality. This study focuses on 12 primary schools in Anápolis, Brazil, with a total of 4394 students and 248 teachers. WASH assessments were conducted using a questionnaire, observations of water and sanitation facilities, and microbiological analysis. Between 2018 and 2020, the proportion of schools with safely managed drinking water increased from 42% to 92%. However, sanitation conditions in the schools were categorized as basic, with hygiene services rated as limited in 92% of the schools due to the absence of soap. While this study shows that Anápolis schools generally meet WASH guidelines for basic/advanced drinking water services, there is a crucial need for improvements in both hardware and software facilities to address sanitation and hygiene challenges.

Feasibility of an exercise-nutrition-psychology integrated rehabilitation model based on mobile health and virtual reality for cancer patients: a single-center, single-arm, prospective phase II study

ObjectiveExplore the feasibility of a mobile health(mHealth) and virtual reality (VR) based nutrition-exercise-psychology integrated rehabilitation model in Chinese cancer patients.MethodsWe recruited cancer patients in the Oncology department of the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University from October 2022 to April 2023. The rehabilitation program was provided by a team of medical oncologists, dietitians, psychotherapists, and oncology specialist nurses. Participants received standard anti-cancer therapy and integrated intervention including hospitalized group-based exercise classes, at-home physical activity prescription, behavior change education, oral nutrition supplements, and psychological counseling. An effective intervention course includes two consecutive hospitalization and two periods of home-based rehabilitation (8 weeks). Access the feasibility as well as changes in aspects of physical, nutritional, and psychological status.ResultsAt the cutoff date of April 2023, the recruitment rate was 75% (123/165). 11.4%patients were lost to follow-up, and 3.25% withdrew halfway. Respectively, the completion rate of nutrition, exercise, and psychology were 85%,55%, and 63%. Nutrition interventions show the highest compliance. The parameters in nutrition, psychology, muscle mass, and quality of life after the rehabilitation showed significant improvements (P < .05). There was no significant statistical difference (P > .05) in handgrip strength and 6-minute walking speed.ConclusionIt is feasible to conduct mHealth and VR-based nutrition-exercise-psychology integrated rehabilitation model in Chinese cancer patients. A larger multi-center trial is warranted in the future.Trial registrationChiCTR2200065748 Registered 14 November 2022.

A prospective phase II study of an exercise-nutrition-psychology integrated rehabilitation model based on mobile health and virtual reality for patients with cancer.

e13786 Background: The optimal rehabilitation model for patients with cancer is unclear. Nutritional and psychological interventions have proven to be beneficial for this population. Although mobile health (mHealth) and virtual reality (VR) advances have transformed many clinical areas including cardiovascular and psychiatric care, they are relatively nascent in cancer care. Due to the multidimensional rehabilitation needs of patients, here we explored the feasibility of an exercise-nutrition-psychology rehabilitation model in cancer patients, which based on VR and mHealth. Methods: A single-center, single-arm, prospective phase II study was conducted from November 2022 to April 2023. With the help of mHealth participants received standard cancer therapy and integrated interventions featuring in-person group-based exercise classes, at-home physical activity prescription, behavior change education, nutritional instruction, oral nutritional supplements (Ainst, China), music therapy (MT), VR treatment and psychological counselling. The rehabilitation was provided by a team of medical oncologists, dietitians, psychotherapists, and technicians. An effective intervention course includes two consecutive hospitalization and two periods of home-based rehabilitation (total 8 weeks). The primary endpoint was the feasibility. The paired T test was used to analyze and compare the differences. Results: At the cutoff date of April,10, 2023. 165 patients were screened, 123 were recruited, and the recruitment rate was 75% (123/165). 14 (11.4%) patients were lost to follow-up, and 4 (3.25%) withdrew halfway. Respectively, the completion rate of exercise, nutrition, and VR and mHealth based psychology were 55% (68 / 123), 85% (105 / 123), and 63% (78 / 123). The parameters in nutrition, psychology, and muscle mass after the rehabilitation showed significant improvements than before (P&lt;0.05). There was no significant statistical difference (P&gt; 0.05)in 6-minute walking speed and handgrip strength. All functional domains of life quality were significantly improved, except role optimization function (P&gt; 0.05). Conclusions: The mHealth and VR based exercise-nutrition-psychology integrated rehabilitation model is feasible for cancer patients and shows potential benefits. The mHealth application (app) we used is a rudimentary version and needs to be optimized in the future. This rehabilitation model warrants further investigation in a larger cohort trial. Clinical trial information: ChiCTR2200065748.

The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study.

Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children's hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193.

DELIVERING GROUP-BASED TELE-EXERCISE SESSIONS FOR PEOPLE WITH TYPE 2 DIABETES: RESULTS AND EXPERIENTIAL INSIGHTS OF A PILOT STUDY

INTRODUCTION &amp; AIMS Delivery of group-based tele-exercise is an emerging treatment option for people with type 2 diabetes (T2D), but best practice is not yet understood. We evaluated the results and experiential insights of a pilot study investigating this model of care. METHODS Sixteen people with T2D (age 58.7±12.6, 63% male, duration of T2D 10.0±8.4years) underwent an 8-week tele-exercise intervention. Participants were assessed at baseline (in-person and via telehealth; results compared using intra-class correlations coefficients) and post-intervention (in-person only). The program was delivered in groups of 3-5, by an Accredited Exercise Physiologist using Zoom. Sessions were held once weekly and incorporated whole-body aerobic and resistance exercise (45min) and health behaviour change education (15min), reflecting the structure of Medicare-subsidised group exercise physiology sessions. Semi-structured interviews were conducted to gain participant and clinician feedback. Adverse events were monitored throughout. RESULTS The intervention demonstrated efficacy, with improvements in HbA1c (mean change -0.3±0.5%), fasting glucose (-0.8±0.8mmol/L), systolic blood pressure (-6.4±8.4mmHg), waist circumference (-0.8±4.2cm), muscular strength (30sec sit-to-stand score 1.6±2.9; 30sec bicep curl score 5.6±3.0) and fitness (2min step test score 24.5±11.9). Clients could reliably self-assess outcomes such as waist circumference (ICC 0.98, 95%CI 0.95-0.99), 30sec sit-to-stand (0.94, 0.82-0.98), and 2min step test (0.96, 0.87-0.99) when supervised by the clinician via telehealth, negating the need for in-person consults. No serious adverse events were reported. Key experiential insights include 1) Technological issues were minimised by providing clients with a guide for using Zoom, and conducting individual Zoom familiarisation sessions, prior to program start. 2) Client confidentiality could be managed by using breakout rooms for private conversations. 3) Creative exercise selection (e.g., TheraBand anchor points, non-traditional equipment) allowed participants to envision exercising in their home, which assisted in self-management. CONCLUSION This study contributes practical insights to optimise the delivery of group-based tele-exercise interventions to people with T2

Effectiveness of engaging religious leaders in maternal health education for improving maternal health service utilization in Ethiopia: cluster randomized controlled trial.

High mortality rates for pregnant women and their new-borns are one of Africa's most intractable public health issues today, and Ethiopia is one of the countries most afflicted. Behavioral interventions are needed to increase maternal health service utilizations to improve outcomes. Hence, this trial aimed to evaluate effectiveness of trained religious leaders' engagement in maternal health education on maternal health service utilization. The study employed a cluster-randomized controlled community trial that included baseline and end-line measurements. Data on end points were gathered from 593 pregnant mothers, comprising 292 and 301 individuals in the intervention and control groups, respectively. In the intervention group, the trained religious leaders delivered the behavioral change education on maternal health based on intervention protocol. Unlike the other group, the control group only received regular maternal health information and no additional training from religious leaders. Binary generalized estimating equation regression analysis adjusted for baseline factors were used to test effects of the intervention on maternal health service utilization. Following the trial's implementation, the proportion of optimal antenatal care in the intervention arm increased by 21.4% from the baseline (50.90 vs. 72.3, p ≤ 0.001) and the proportion of institutional delivery in the intervention group increased by 20% from the baseline (46.1% vs. 66.1%, p ≤ 0.001). Pregnant mothers in the intervention group significantly showed an increase of proportion of PNC by 22.3% from baseline (26% vs. 48.3%, p ≤ 0.001). A statistically significant difference was observed between in ANC4 (AOR = 2.09, 95% CI: 1.69, 2.57), institutional delivery (AOR = 2.36, 95% CI: 1.94, 2.87) and postnatal care service utilization (AOR = 2.26, 95% CI: 1.79, 2.85) between the intervention and control groups. This research indicated that involving religious leaders who have received training in maternal health education led to positive outcomes in enhancing the utilization of maternal health services. Leveraging the influential position of these religious leaders could be an effective strategy for improving maternal health service utilization. Consequently, promoting maternal health education through religious leaders is advisable to enhance maternal health service utilization.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT05716178].

Effectiveness of Structured Teaching Programme on Konwlege regarding Prevention and Management of Oral Cancer

Oral cancer includes cancers of the lip, other parts of the mouth and the oropharynx and combined rank as the 13th most common cancer worldwide. In India, it is the third most common cancer overall but the most common cancer among males, and also ranks third among the various cancer types contributing to mortality in the country. While oral health literacy is defined as the degree to which individuals have the capacity to obtain process and understand basic oral health information and service needed to make appropriate health decision. It has been suggested that lower patient health literacy is a barrier to effective medical diagnosis and treatment. The present pre experimental one group pre-test and post-test design research study was conducted among nursing students to evaluate the effectiveness of structured teaching programme regarding oral cancer. The researcher selected 60 samples based on purposive sampling technique. The results shown that the level of knowledge was improved after ST, which indicates the STP was effective. The resercher concluded that, the teaching aids will be helpful in improving knowledge among students as well as public. The resercher recommended that, the community education programe and personal behaviour change education is required for cancer free nation.

Uptake of human papillomavirus vaccination and its associated factors among adolescents in Gambella town, Southwest, Ethiopia: a community-based cross-sectional study

ObjectiveTo assess the uptake of human papillomavirus (HPV) vaccination and its associated factors among adolescents in Gambella town, Southwest Ethiopia.DesignA community-based cross-sectional study.SettingGambella town, Southwest Ethiopia.ParticipantsA total of 882 adolescents...

Results of the MOVE MS Program: A Feasibility Study on Group Exercise for Individuals with Multiple Sclerosis.

Exercise improves a wide range of symptoms experienced by those living with multiple sclerosis (MS) and may foster community and a positive sense of disability identity. However, exercise rates remain low. Sustained exercise participation has the greatest likelihood of improving symptoms and requires a theory-based approach accounting for the barriers faced by people with MS that impede exercise participation long-term. MOVE MS is a once weekly group exercise program based on Social Cognitive Theory supporting long-term exercise participation through peer instruction, behavior change education, multiple exercise modalities, and seated instruction. This feasibility study evaluated MOVE MS with a 7-month trial. The primary scientific outcome was exercise participation and the secondary outcomes were MS symptoms/impact, self-efficacy, depression, anxiety, disability identity, and quality of life, among others. We further conducted semi-structured formative interviews post-intervention. Thirty-three participants began the program. The onset of COVID-19 necessitated a shift toward online delivery. Seventeen participants completed the program. There were non-significant improvements in exercise participation (Godin Leisure-Time Exercise Questionnaire, baseline mean = 14.2 (SD = 11.8), post-intervention mean = 16.6 (SD = 11.2), F-value = 0.53 (Partial Eta2 = 0.08), and several secondary outcomes (including the MS Impact Scale, MS Walking Scale, and the Leeds MS Quality of Life Scale). Sixteen participants were interviewed, and analysis yielded five themes on program components and feedback. MOVE MS-delivered in-person or online-may be a feasible option for long-term exercise programming for people with MS.

Nutritional status of school children in the South Tongu District, Ghana.

BackgroundMalnutrition is a major public health problem because of the devastating consequences it has on children, their families, and society at large. Our study, therefore, sought to determine the prevalence of undernutrition and overweight/obesity and its associated factors among children aged 6–12 in the South Tongu District, Ghana.MethodsA school-based cross-sectional study was conducted among 423 school children aged 6–12 years in the South Tongu District of Ghana. A multistage sampling method was employed to recruit the school children for the study. A semi-structured questionnaire was used to collect data from the respondents. We used a dual-purpose (height and weight) measuring scale to obtain the anthropometric data. The World Health Organization’s AnthroPlus software was used to generate the z-scores for determining the nutritional status. Percentages were used to present the results of the prevalence of undernutrition and overweight/obesity among school children. Bivariate and multivariable binary logistic regression were used to examine the factors associated with undernutrition and overweight/obesity among school children. The results were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), with their 95% confidence interval (CI). Statistical significance was set at p<0.05. Stata 16.0 was used to perform the analyses.ResultsThe overall prevalence of undernutrition and overweight/obesity were 21.5% (CI = 17.7, 25.7) and 24.8% (CI = 20.8, 29.2), respectively. Specifically, the prevalence of stunting, thinness, underweight, overweight, and obesity were 10.4%, 12.1%, 3.8%, 11.1%, and 13.7%, respectively. School children whose household used water from non-portable sources were more likely to be undernourished [AOR = 2.03, 95% CI = 1.13, 3.63]. The odds of overweight/obesity was higher among school children whose mothers had attained formal education [AOR = 2.10, 95% CI = 1.09, 4.06], those who consumed beverages between meals per day [AOR = 1.87, CI = 1.08, 3.24], and those who had adequate dietary diversity score [AOR = 1.65, 95% CI = 1.02, 2.67]. School children aged 10–12 were less likely to be overweight/obese [AOR = 0.58, 95% CI = 0.35, 0.94] compared to those aged 6–9.ConclusionThe study showed a relatively high prevalence of undernutrition and overweight/obesity among school children in the South Tongu District. The identified risk factor(s) for undernutrition was the usage of water from non-potable sources whilst those of overweight/obesity were age (10–12 years), maternal formal education, beverage consumption between meals per day, and adequate dietary diversity. The findings reaffirm that malnutrition is still prevalent among school children. Hence, there is a need for the Ministry of Health, Ghana Education Service, and other Non-Governmental Organizations to pay critical attention to these factors to achieve the Sustainable Development Goal 2, target 2.2. Nutritional behavioural change education should be carried out among parents and school children. School health service activities should be intensified with a special focus on nutritional screening.

Human papillomavirus vaccination uptake and its associated factors among adolescent school girls in Ambo town, Oromia region, Ethiopia, 2020.

BackgroundThe Human Papillomavirus (HPV) vaccine has offered a great promise to reduce the cervical cancer burden; its utilization (uptake) however has been lagging. However, the levels and factors associated with the uptake of the vaccine have not been well investigated, especially in the local context.ObjectiveTo assess the uptake of human papillomavirus vaccination and its associated factors among adolescent school girls in ambo town, Oromia, Ethiopia, 2020.MethodsAn institution-based cross-sectional quantitative study design supplemented with the qualitative inquiry was employed to assess Human Papillomavirus vaccination uptake and its associated factors among 422 adolescent school girls in Ambo town, central Ethiopia from December 1–30, 2020. The collected data were coded, entered, and cleaned by using Epi info 7.2.3 and exported to SPSS version 25 for analysis. Descriptive statistics were used to compute summary statistics and proportions. Both bivariate and multivariable logistic regression was employed to identify factors associated with HPV vaccine uptake. Adjusted odds ratio and 95% confidence interval were used for the strength and directions of association. A P-value of < 0.05 was used to declare statistical significance. Qualitative findings have been analyzed with manual thematic analysis.ResultThe proportion of HPV vaccination uptake among school girls in this study was 44.4%. Hearing about HPV vaccine [AOR = 2.50, 95%CI: (1.045–5.959)], availability of awareness creation [AOR = 2.53, 95%CI: (1.507–4.258)], and favorable attitude [AOR = 2.049, 95%CI: (1.153–3.64)] were the key identified factors associated with vaccination uptake. In addition, poor perception, fear of side effects, and misunderstanding were among the major factors identified by qualitative findings.ConclusionThere was low uptake of HPV vaccination among the school Adolescents in the study area. Availability of awareness creation programs, favorable attitude towards HPV vaccine, and hearing about HPV vaccine was significantly associated with the uptake of the HPV vaccination. Therefore, awareness creation and behavior change education are mandatory to scale up the vaccination.

A pilot and feasibility study of a randomized clinical trial testing a self-compassion intervention aimed to increase physical activity behaviour among people with prediabetes

BackgroundSeventy-five per cent of individuals with prediabetes will eventually be diagnosed with type 2 diabetes. Physical activity is a cornerstone in reducing type 2 diabetes risk but can be a challenging behaviour to adopt for those living with prediabetes. Individuals with prediabetes experience difficult emotions associated with being at risk for a chronic disease, which can undermine self-regulation. Self-compassion enhances self-regulation because it mitigates difficult emotions and promotes adaptive coping. We performed a pilot randomized controlled trial to determine the feasibility and acceptability of a self-compassion informed intervention to increase physical activity for persons with prediabetes.MethodsThis explanatory mixed methods study tested the feasibility and acceptability of a two-arm, randomized, single-blind, actively controlled, 6-week online intervention. Using a 1:1 allocation ratio, participants (identified as people with prediabetes, low physical activity, and low self-compassion) were randomized to a self-compassion (Mage = 60.22 years) or control condition (Mage = 56.13 years). All participants received behaviour change education (e.g. SMART goals, action-coping planning) and either other health knowledge (control condition: e.g. sleep, benefits of water) or self-compassion training (intervention condition: practising mindfulness, writing a letter to themselves offering the same support that they would offer to a friend). The primary outcome was to determine the feasibility and acceptability of the trial. To be considered feasible, our outcomes needed to meet or surpass our pre-determined criteria (e.g. time for group formation: 14–20 participants per month). Feasibility was assessed by examining the recruitment rates, retention, adherence, fidelity, and capacity. Semi-structured interviews were conducted with participants to determine trial acceptability. As a secondary purpose, we examined the means on key study variables (secondary and exploratory variables; see Table 1) at all planned time points (baseline, intervention-end, 6- and 12-week follow-up) to identify if they are suitable to include in the efficacy trial (see Additional Table 3).ResultsEighteen participants were screened and randomized to one of two conditions. Retention, instructor fidelity, safety, capacity, adherence to most of the study aspects, and acceptability by participants and facilitators all met the criteria for feasibility. Recruitment rate, process time, and adherence to home practice were below our criteria, and we offer ways to address these shortcomings for the efficacy trial.ConclusionThe results from this study suggest that it should be feasible to deliver our intervention while highlighting the alterations to components that may be altered when delivering the efficacy trial. We outline our changes which should improve and enhance the feasibility and acceptability of our planned intervention. Funding for this study was from the Canadian Institutes of Health Research (CIHR).Trial registrationClinicalTrials.gov, NCT04402710. Registered on 09 April 2020.

Maximising Abilities, Negotiating and Generating Exercise options (MANAGE) in people with multiple sclerosis: A feasibility randomised controlled trial

Objective To investigate the feasibility and preliminary efficacy of a group self-management exercise and education program in people with multiple sclerosis. Design Feasibility randomised controlled trial. Setting Outpatient rehabilitation facility. Subjects Twenty-three adults (age 48.6 (11.7) years) recruited from a Multiple Sclerosis Clinic register. Interventions The intervention group undertook a 12-week group program incorporating behaviour change education, exercise and community integration. This was compared with a waitlist control group. Main measures Feasibility was measured by recruitment, adherence and safety. Efficacy outcomes included measures of physical function (6-metre and 6-min walk, Functional Reach) and self-report questionnaires (fatigue, quality of life, exercise benefits and barriers) at baseline, 6, 12 and 24 weeks. Results Of 74 individuals identified through the register, 48 (65%) were contacted and deemed eligible, and 23 (48%) agreed to participate. There was high adherence for attendance at education (57 of 72, 79%) and exercise (135 of 174, 78%) sessions. No adverse safety events occurred within the intervention sessions. Missed attendances at assessment sessions was high (5 to 8 participants missed at each time point) predominately due to health issues. The intervention group demonstrated positive changes in walking endurance, Functional Reach and fatigue, whereas the control had some reductions in walking speed and more perceived exercise barriers. Conclusions The MANAGE program appears feasible and safe for people with mild-to-moderate multiple sclerosis, with high adherence to exercise and education sessions. Future trials should consider strategies such as flexible scheduling or alternative methods of data collection to improve follow-up assessment attendance.

Classifying Features Persuading the Use of Long Lasting Insecticide Treated Nets (LLINs) and Its Implications in Exterminating the Incidence of Malaria-Death in Ghana

This is a cross-sectional quantitative study purported to identify features deemed to persuade the usage of LLINs in exterminating incidences of malaria-death in Ghana. The population consisted of mothers and caregivers of children under five in Asamankese a district in the Eastern region of Ghana. Questionnaires were developed based on the profile and the set of study objectives, it sought information on socio-economic variables, knowledge level on LLINs, and influence of climatic and environmental factors on LLINs usage. Data were coded and keyed into SPSS version 20. Frequencies, percentages, means, standard deviations, graphs and tables were used to explore the data. Chi-square test was used to do further investigation. It was revealed that LLINs usage was influenced by a group of features including: background characteristics of household; socio-economic variables, environmental variables and knowledge on importance of LLINs. There was an association between LLINs usage and monthly income of caregivers (p&lt;0.05). Furthermore, there was a significant relationship (p&lt;0.05) between environmental features and LLINs usage. There was a relationship (p&lt;0.05) between one’s knowledge and use of LLINs. In addition, there was a relationship between usage and the number of times per month visits were made to the hospitals for health care. Environmental factors permitted the use of LLINs, Eighty-six (86%) of the respondents who used LLINs did use it because the weather aided them. It is recommended that behavior change education be intensified in the region so that more people can accept and adopt a lifestyle that will protect them from the deadly malaria diseases. Efforts must be made by the major players in the health sector to make the net readily available in the communities at low prices to enable the ordinary Ghanaian to purchase it.

Men's Weight Loss Outcomes, Behaviors, and Perceptions in a Self-Directed Commercial Mobile Program: Retrospective Analysis.

There is little understanding of men's weight loss outcomes and behaviors in self-directed contexts, such as digital commercial mobile weight management programs. This is an especially pressing question given that men often express disinterest in weight management programs and it is unknown how that manifests in self-directed environments. Aims. Two studies fill this gap by retrospectively observing how men lose weight and engage in weight loss behaviors (Study 1) and their perceptions of improvements and gained knowledge (Study 2) when participating in the full length of a commercial mobile behavior change program called Noom. In Study 1, repeated-measures linear mixed modeling was used to examine whether weight loss was statistically significant from baseline to 16 weeks and how engagement behaviors predicted weight in a sample of 7,495 male Noom users. In Study 2, 971 male Noom users completed an exploratory survey on the impact of the behavior change education in the program. In Study 1, men who remained in the full length of the program lost statistically significant weight from baseline to 16 weeks. 63% achieved clinically meaningful (5% or more) weight loss. Engagement in weight loss behaviors on the program predicted the amount of weight lost. In Study 2, men reported learning most about practical application and psychological aspects relating to food and psychology. This is the first study to observe men's weight loss outcomes, behaviors, and perceptions of what they learned in a self-directed behavior change program. Our findings have important implications for more effective health promotion for the many men who choose to self-direct their weight loss.

"Context, content, and system" supporting digital health hub (DHH)-enabled models of care (MoCs) for fragility hip fractures: perspectives of diverse multidisciplinary stakeholders in South Australia from qualitative in-depth interviews.

SummaryCombining thematic analysis and a human–computer persuasive systems framework suggests that hip fracture recovery among older people can be enhanced through person-centered digital health hub models of care focused on behavior change education and integrated care. The findings intend to guide settings involving comorbid conditions and low- and middle-income countries in developing innovative digital health solutions.PurposeThe purpose of this study was to understand stakeholders’ perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model.MethodsQualitative in-depth interviews were conducted with stakeholders from various clinical disciplines, allied health, and computer science. A hybrid process involving thematic analysis of the raw data using inductive coding was the first step. In the second step, the tenets of a theoretical framework (health behavior change supporting systems) were deductively applied to the thematic constructs generated as part of the first step of the analysis.ResultsIn total, 24 in-depth interviews were conducted with stakeholders. We identified 18 thematic constructs presented under the categories of context, content, and system. Context covered patient characteristics such as frailty, digital literacy, and patient or carer participation, whereas healthcare delivery aspects included the structure and culture of existing practice and the need for innovative holistic models of care. Content outlines the active ingredients and approach in developing a digital health hub, and it highlights the importance of targeted education and behavior change. The system is a complicated matrix crossing different aspects of healthcare and offering a value proposition design through personalization across modes of content delivery. This must foster trust, ensure adequate financing, and support ownership and privacy by establishing appropriate mechanisms for embedding change.ConclusionThe findings from this study provide insights around potential factors related to patients, community support, and healthcare delivery influencing the design and next-stage implementation of a digital health hub model of care for fragility hip fractures.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11657-021-01031-3.

The Role of Targeted Nutrition Education of Preschoolers and Caregivers on Sustained Consumption of Biofortified Orange-Fleshed Sweetpotato in Kenya.

ABSTRACTBackgroundPersistent prevalence of high malnutrition in poor households in developing countries calls for enhancement of cost-effective nutrition interventions among the vulnerable groups. One responsive way is to promote regular consumption of home-grown biofortified foods, particularly in the micronutrient-deficient groups. Previous nutrition interventions have targeted adults with behavior change education, but have rarely explored the potential of nutrition education of preschoolers as change agents.ObjectivesThis study sought to assess the effect of nutrition education targeting preschool children and their caregivers on their consumption of vitamin A–biofortified orange-fleshed sweetpotato (OFSP) in rural farm households in Homa Bay County, Kenya.MethodsA total of 431 preschooler-caregiver pairs from 15 village-level clusters were recruited into a randomized controlled trial. The sample was randomized into 1 control (3 villages) and 3 treatment groups (4 villages each). Treatments involved channeling nutrition education to preschoolers through their learning materials (preschooler treatment); the caregivers through their mobile phones (caregiver treatment); and to both preschoolers and their caregivers simultaneously (integrated treatment). Baseline and follow-up household-level surveys were conducted with the caregivers, and consumption data were collected from the preschoolers using a child dietary diversity register. Class teachers sought 24-h consumption recalls of the preschoolers for 19 consecutive schooldays.ResultsThe results of a zero-inflated Poisson regression showed that the phone-mediated and multichanneled nutrition education approaches significantly increased the number of days of OFSP consumption. The integrated nutrition education approach significantly increased the preschoolers’ likelihood to consume OFSP, number of OFSP consumption days, and likelihood to consume it more than once per week by 11%, 77%, and 20%, respectively.ConclusionsNutrition education through OFSP-branded preschoolers' learning materials and phone-mediated messages provides effective nudges to the caregivers to feed their preschoolers regularly with OFSP. This could have implications for realizing sustainable nutrition programs in biofortified crop-growing areas.

Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer

BackgroundAdvanced lung cancer patients face significant physical and psychological burden leading to reduced physical function and quality of life. Separately, physical activity, nutrition, and palliative symptom management interventions have been shown to improve functioning in this population, however no study has combined all three in a multimodal intervention. Therefore, we assessed the feasibility of a multimodal physical activity, nutrition, and palliative symptom management intervention in advanced lung cancer.MethodsParticipants received an individually tailored 12-week intervention featuring in-person group-based exercise classes, at-home physical activity prescription, behaviour change education, and nutrition and palliative care consultations. Patients reported symptom burden, energy, and fatigue before and after each class. At baseline and post-intervention, symptom burden, quality of life, fatigue, physical activity, dietary intake, and physical function were assessed. Post-intervention interviews examined participant perspectives.ResultsThe multimodal program was feasible, with 44% (10/23) recruitment, 75% (75/100) class attendance, 89% (8/9) nutrition and palliative consult attendance, and 85% (17/20) assessment completion. Of ten participants, 70% (7/10) completed the post-intervention follow-up. Participants perceived the intervention as feasible and valuable. Physical activity, symptom burden, and quality of life were maintained, while tiredness decreased significantly. Exercise classes prompted acute clinically meaningful reductions in fatigue, tiredness, depression, pain, and increases in energy and well-being.ConclusionA multimodal physical activity, nutrition, and palliative symptom management intervention is feasible and shows potential benefits on quality of life that warrant further investigation in a larger cohort trial.Trial registrationNCT04575831, Registered 05 October 2020 – Retrospectively registered.

Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: results from the WASH HELPS cluster-randomized trial.

BackgroundWater, sanitation, and hygiene (WASH) in schools is promoted by development agencies as a modality to improve school attendance by reducing illness. Despite biological plausibility, the few rigorous studies that have assessed the effect of WASH in schools (WinS) interventions on pupil health and school attendance have reported mixed impacts. We evaluated the impact of the Laos Basic Education, Water, Sanitation and Hygiene Programme – a comprehensive WinS project implemented by UNICEF Lao People’s Democratic Republic (Lao PDR) in 492 primary schools nationwide between 2013 and 2017 – on pupil education and health.MethodsFrom 2014-2017, we conducted a cluster-randomized trial among 100 randomly selected primary schools lacking functional WASH facilities in Saravane Province, Lao PDR. Schools were randomly assigned to either the intervention (n = 50) or comparison (n = 50) arm. Intervention schools received a school water supply, sanitation facilities, handwashing facilities, drinking water filters, and behavior change education and promotion. Comparison schools received the intervention after research activities ended. At unannounced visits every six to eight weeks, enumerators recorded pupils’ roll-call absence, enrollment, attrition, progression to the next grade, and reported illness (diarrhea, respiratory infection, conjunctivitis), and conducted structured observations to measure intervention fidelity and adherence. Stool samples were collected annually prior to de-worming and analyzed for soil-transmitted helminth (STH) infection. In addition to our primary intention-to-treat analysis, we conducted secondary analyses to quantify the role of intervention fidelity and adherence on project impacts.ResultsWe found no impact of the WinS intervention on any primary (pupil absence) or secondary (enrollment, dropout, grade progression, diarrhea, respiratory infection, conjunctivitis, STH infection) impacts. Even among schools with the highest levels of fidelity and adherence, impact of the intervention on absence and health was minimal.ConclusionsWhile WinS may create an important enabling environment, WinS interventions alone and as currently delivered may not be sufficient to independently impact pupil education and health. Our results are consistent with other recent evaluations of WinS projects showing limited or mixed effects of WinS.