Behavior Change Strategies Research Articles

Clarifying the Concepts of Personalization and Tailoring of eHealth Technologies: Multimethod Qualitative Study.

Although personalization and tailoring have been identified as alternatives to a "one-size-fits-all" approach for eHealth technologies, there is no common understanding of these two concepts and how they should be applied. This study aims to describe (1) how tailoring and personalization are defined in the literature and by eHealth experts, and what the differences and similarities are; (2) what type of variables can be used to segment eHealth users into more homogeneous groups or at the individual level; (3) what elements of eHealth technologies are adapted to these segments; and (4) how the segments are matched with eHealth adaptations. We used a multimethod qualitative study design. To gain insights into the definitions of personalization and tailoring, definitions were collected from the literature and through interviews with eHealth experts. In addition, the interviews included questions about how users can be segmented and how eHealth can be adapted accordingly, and responses to 3 vignettes of examples of eHealth technologies, varying in personalization and tailoring strategies to elicit responses about views from stakeholders on how the two components were applied and matched in different contexts. A total of 28 unique definitions of tailoring and 16 unique definitions of personalization were collected from the literature and interviews. The definitions of tailoring and personalization varied in their components, namely adaptation, individuals, user groups, preferences, symptoms, characteristics, context, behavior, content, identification, feedback, channel, design, computerization, and outcomes. During the interviews, participants mentioned 9 types of variables that can be used to segment eHealth users, namely demographics, preferences, health variables, psychological variables, behavioral variables, individual determinants, environmental information, intervention interaction, and technology variables. In total, 5 elements were mentioned that can be adapted to those segments, namely channeling, content, graphical, functionalities, and behavior change strategy. Participants mentioned substantiation methods and variable levels as two components for matching the segmentations with adaptations. Tailoring and personalization are multidimensional concepts, and variability and technology affordances seem to determine whether and how personalization and tailoring should be applied to eHealth technologies. On the basis of our findings, tailoring and personalization can be differentiated by the way that segmentations and adaptations are matched. Tailoring matches segmentations and adaptations based on general group characteristics using if-then algorithms, whereas personalization involves the direct insertion of user information (such as name) or adaptations based on individual-level inferences. We argue that future research should focus on how inferences can be made at the individual level to further develop the field of personalized eHealth.

Ragi Revolution: Enhancing Dietary Practices through Nutritional Education and Local Food Systems Implementation

Ragi (Eleusine coracana), commonly known as finger millet, is a nutrient-rich cereal that remains underutilized in modern diets despite its high calcium, iron, and dietary fiber content. This examines how ready-to-eat ragi-based supplementary foods, combined with effective nutrition education, can drive behavioral changes to incorporate ragi into daily diets and local food systems. The increasing availability of ready-to-eat ragi products offers an accessible solution for improving nutrition, but challenges remain in terms of consumer acceptance due to unfamiliarity and taste preferences. This paper focuses on the role of nutrition education in reshaping dietary behaviour, emphasizing case studies that demonstrate the effectiveness of targeted interventions in promoting ragi consumption. Additionally, it explores strategies for integrating ragi into public nutrition programs and sustainable food systems, highlighting the importance of community-driven efforts and public-private partnerships. The review also discusses the role of policy support and multi-stakeholder collaboration in fostering ragi’s cultivation and incorporation into local food systems. By examining behavioural change strategies such as social marketing and culturally sensitive approaches, this paper presents a roadmap for promoting ragi as a key component of sustainable diets and public health interventions.

Delivery of Supported Self-Management in Primary Care Asthma Reviews: Insights From the IMP2ART Programme.

Supported self-management (SSM) for asthma reduces the risk of asthma attacks and improves asthma control and quality of life. SSM optimally includes patient-centred communication and behaviour change support, however, the extent to which this occurs in routine primary care is unclear. This project was nested within the IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme; a UK-wide trial evaluating an implementation strategy (including healthcare professional (HCP) training on behaviour change strategies and patient-centred care) to improve support for asthma self-management. To provide an understanding of how healthcare professionals deliver SSM in UK clinical practice; through assessing time spent on SSM strategies, how and to what extent patient-centred care and behaviour change discussions are delivered, and to explore whether factors such as mode of review or implementation support influence delivery. We conducted an observational study using video-recordings of 12 HCPs delivering routine face-to-face and telephone asthma reviews (n = 64) in a sample of general practices participating in the IMP2ART trial (implementation n = 4; control n = 6). Analytical methods included: ALFA Toolkit Multi-Channel Video Observation (to code and quantify tasks undertaken); the Patient-Centred Observation Form; and The Behaviour Change Counselling Index (to assess patient-centeredness and behaviour change counselling used by HCPs). HCPs mostly spent time during routine asthma reviews discussing: an individual's asthma condition and management (average of 27.8% of consultation time); collaboratively reviewing and completing a personalised asthma action plan (6.3%) and training for practical self-management activities (5.4%). Areas of patient-centred care delivery and behavioural discussions included: creating and maintaining relationships, discussing asthma action plans and medication reconciliation. Professionals in IMP2ART implementation group practices delivered more SSM strategies. Comparison of face-to-face and remote consultations found no significant differences in HCP delivery of SSM. HCPs in UK primary care spent half the time in both face-to-face and remote asthma reviews delivering components of SSM suggesting that either mode of delivery may be acceptable. Reviews carried out in IMP2ART implementation group practices demonstrated more behaviour change and collaborative SSM strategies compared to those in the control group. Asthma UK Centre for Applied Research (AUKCAR) PPI members were involved throughout, including project conception, providing feedback on participant-facing documents, and discussing implications of study findings.

Protocol for a co-design study for the development of a chronotherapeutic mobile health behaviour change intervention targeting light exposure among older adults

Through its wide-ranging effects on human physiology and behaviour, daily light exposure is an important environmental modulator of healthy ageing. Integrating mobile health (mHealth) technology with behaviour change strategies offers a promising approach to optimise light exposure and positively impact sleep, rest-wake cycles, cognitive function, and mood at scale. This study aims to develop the LightSPAN mHealth behaviour change intervention to optimise light exposure across the lifespan. Employing a co-design methodology, the study comprises two distinct workstreams. The first focuses on conceptualising the theoretical framework and implementation strategies through a comprehensive review of light exposure interventions, behaviour change theories, mHealth user personas, and recommendations for designing mHealth interventions for older adults. The second workstream centres on co-designing the intervention, involving consultation with community service providers and engagement with older adults at ageing community centres (≥60 years of age). Community service providers will be consulted through open-ended discussions (target n=5). Older adult participants (n=20) will engage in telephone interviews, focus group discussions and prototyping workshops to explore older adult participants’ characteristics, needs, preferences, and mHealth intervention design elements and co-design the LightSPAN mHealth behaviour change intervention. The insights generated in these co-design components will ensure that the intervention addresses the needs of its future users.

Evaluating Various Methods Used by Direct-to-Consumer Products Promising Personalized Nutrition

The increasing availability of direct-to-consumer personalized nutrition products has raised questions about their scope of personalization and added value compared to general dietary guidelines. This study evaluated eleven personalized nutrition products across six distinct methodologies, including DNA analysis, blood marker analysis, microbiome testing, blood glucose monitoring, questionnaire-based personalization, and consultation with a dietitian, comparatively evaluating their consistency and added value compared to general dietary guidelines. A 24-year-old obese male with no pre-existing illnesses was chosen as the case participant to represent a typical individual seeking personalized nutrition advice for weight loss. Significant variability and inconsistency were observed across and within the different methodologies, particularly in recommendations for energy intake and macronutrient distribution. Most advice was generic and aligned closely with existing dietary guidelines, with a notable lack of behavioral change strategies. This study underscores the challenges in personalized nutrition, highlighting the problem that current practices often fall short of delivering truly tailored recommendations. There is a critical need for clearer definitions, evidence-based guidelines, and more comprehensive approaches to fully realize the potential of personalized nutrition in improving individual health.

Diabetes prevention after gestational diabetes: challenges and opportunities.

Gestational diabetes (GDM) poses significant health concerns for women and their offspring, with implications that extend beyond pregnancy. While GDM often resolves postpartum, a diagnosis of GDM confers a greater risk of future type 2 diabetes (T2D) and other chronic illnesses. Furthermore, the intergenerational impact of GDM predisposes offspring to increased chronic disease risk. Despite the awareness of the short- and long-term consequences of GDM, translating this knowledge into prevention strategies remains challenging. Challenges arise from a lack of clarity among health professionals regarding roles and responsibilities in chronic disease prevention and women's lack of awareness of the magnitude of associated health risks. These challenges are compounded by changes in the circumstances of new mothers as they adjust to balance the demands of infant and family care with their own needs. Insights into behaviour change strategies, coupled with advances in technology and digital healthcare delivery options, have presented new opportunities for diabetes prevention among women with a history of GDM. Additionally, there is growing recognition of the benefits of adopting an implementation science approach to intervention delivery, which seeks to enhance the effectiveness and scalability of interventions. Effective prevention of T2D following GDM requires a comprehensive person-centred approach that leverages technology, targeted interventions, and implementation science methodologies to address the complex needs of this population. Through a multifaceted approach, it is possible to improve the long-term health outcomes of women with prior GDM.

A behaviour change strategy to reduce greenhouse gas emissions from international scientific conferences and meetings

We estimated the environmental impact and financial cost of two exemplar in-person academic events organised by the European academic society, the European Academy of Nursing Science, identified the main sources of these emissions, and then mapped them against the COM-B behaviour change framework of capability, opportunity, motivation to identify strategies that could be applied by organisers and participants to reduce this impact. These events contributed 41 tonnes and 99 tonnes of CO2e emissions per event, a per-participant mean of either 0.324 (SD 0.173) or 0.724, (SD 0.263) tonnes, representing 2 to 5.5 times the daily per-person European average. Distance from home was the largest contributor to emissions. Costs were similar for both events. Our multi-component behavioural change programme includes environmental change, enablement, education, incentivisation and persuasion, by which organisers provide participants with the opportunity for less-polluting behaviour, and enhance participants capabilities and motivation to act on the opportunities provided.

Restoring trust in vaccination through collective engagement with key populations in Eastern Europe

Abstract Issue/problem COVID-19 vaccination rates remained below 50% in Moldova, North Macedonia, and Serbia, especially among vulnerable populations like pregnant women and those with chronic diseases. This was strengthened by a lack of targeted communication and training for healthcare workers, and COVID-19 fatigue. Strategies to increase vaccine demand and confidence are a global priority, especially among vulnerable populations. Description of the solution From May 2022 to April 2024, the USAID MOMENTUM Routine Immunization Transformation and Equity project employed behavior integration to design a social and behavior change strategy, centering on vaccination as a part of a healthy lifestyle. It was implemented through continuing medical education (CME) and community engagement (CE) workshops with vulnerable populations, supplemented by cross-country learning exchanges. The outcomes provide a framework for public health initiatives aimed at boosting vaccine uptake through innovative, behavior-based methods. Results 1,618 healthcare professionals, able to reach 2.5 to 4.8 million patients, received training in immunization, COVID-19 vaccines, and quality health service, and 99% indicated confidence in applying the knowledge. 265 CE workshops, engaging 4,079 patients, increased awareness and addressed concerns related to vaccination. Of 3,223 patients who were followed up, 47% reported setting an appointment with their doctor regarding vaccination, 27% discussed vaccination with their partners, and 7% proceeded to receive the COVID-19 vaccine. Lessons Behavior Integration helped address key barriers to vaccination and informed the design of strategies (i.e. situating COVID-19 vaccination as part of a healthy lifestyle). Establishing trust with healthcare providers and patients through collective engagement improved health behaviors. Focusing on health as a wider priority helped re-establish the significance of vaccination as part of a healthy lifestyle. Key messages • Behavior science and behavior integration helped identify and address barriers, as well as design tailored interventions to improve vaccination demand and confidence. • Collective engagement, focused on integration of COVID-19 vaccination as part of a healthy lifestyle, achieved results through addressing vaccine hesitance from both sides of the equation.

Kendra's journey: an intrinsic case study of a deaf autistic child.

This study used an intrinsic case study to investigate how interventions from applied behavior analysis impacted language development, academic progress, and the reduction of severe challenging behaviors for an 8-year-old child who is Deaf and autistic. 3 main themes were identified: language acquisition, behavioral change strategies, and academic performance. Additionally, 2 common threads wove in and out of each and connected all 3 themes: language access and qualified providers, including Deaf professionals. This study expands the literature about using behavioral strategies with children who are Deaf and autistic and discusses implications for clinical and educational practice.

Reduction of screen induced myopia by parental interventions

Abstract Background Excessive use of digital devices, including smartphones and tablets, has been shown to increase the risk of myopia in children. Gaps persist in understanding parental attitudes towards handheld screen use and effective interventions guiding eye health policies. This study examined the associations between parental behavior related to myopia and children’s handheld screen use. Methods Data obtained from 395 parents of pre-adolescents (Mean age 10.63; SD 1.09) were used, collected from an online community panel. Parents reported on various behavioral determinants related to myopia and their child’s screen time: knowledge, attitude, risk perception and self-efficacy. They reported on their child’s frequency and amount of screen use. Logistic regression analysis was used to assess associations between variables, using parental efforts to reduce screens as outcome measure. Results Of the 395 participating 9-12 year-olds, 73.4% of the children spent up to two hours a day on recreational handheld screens, 26% more than two hours. Of the parents surveyed, 28.1% perceived the risk of screen-induced myopia as significant, prompting 62.6% of them to take active measures to minimize screen time. The more knowledge parents had on child myopia the more they attempted to reduce screen time (OR = 2.57; 95% CI [1.57-4.19], p = <.001). Moreover, a more negative attitude towards screens was significantly related to attempting to reduce screen time (OR = 1.26; 95% CI[1.17-1.35],p = <.001). Key messages • These findings emphasize a need to address parental knowledge and attitude towards myopia and screen time reduction. • We recommend increasing knowledge, influencing attitude and searching for alternatives as a part of behavioral change strategies.

A mixed-methods evaluation of a virtual coach for smoking cessation and physical activity in adults

Abstract Background Mobile health (mHealth) interventions with virtual coaches (i.e. AI conversational agents) offer scalable and cost-effective solutions for health behavior change. We developed Perfect Fit, an mHealth intervention with a virtual coach providing personalized feedback to promote smoking cessation and physical activity simultaneously. Through innovative techniques (e.g. sensor technology) and iterative development involving end-users, we aim to overcome challenges faced by mHealth interventions, like insufficient personalization. This study examines Perfect Fit’s feasibility and acceptability. Methods A single-arm, mixed-method, real-world evaluation study was conducted with 100 adult smokers in the Netherlands. The intervention lasted approximately 16 weeks. Data were collected at baseline and post-intervention. Quantitative data included usage data and self-report questionnaires on feasibility, acceptability and participant characteristics (e.g. eHealth literacy). Qualitative data included semi-structured post-intervention interviews with a subsample of 12 participants. Descriptive analyses (quantitative) and the Framework Approach (qualitative) were used for data analysis, and quantitative and qualitative data were integrated during interpretation. Preliminary results Participants adapted the use of Perfect Fit to their preferences. Many participants were satisfied with the content but missed variations in conversations with the virtual coach. The coach offered anonymity, positively experienced by some (e.g. non-judgemental), but negatively by others (e.g. lower accountability). Many participants liked the combination of smoking cessation and physical activity enhancement. Conclusions Findings show the potential of interventions like Perfect Fit as a multiple health behavior change strategy in promoting public health and preventing chronic disease. Findings can inform intervention development and identify methods to foster feasibility and acceptability. Key messages • mHealth interventions with virtual coaches, like Perfect Fit, could promote public health. • Targeting multiple behaviors, like low physical activity and smoking, simultaneously seems beneficial.

Feasibility and Acceptability of a Self-Guided Digital Family Skills Management Intervention for Children Newly Diagnosed With Type 1 Diabetes: Pilot Randomized Controlled Trial.

Family dynamics play an important role in determining the glycemic outcomes of type 1 diabetes (T1D) in children. The time interval immediately following T1D diagnosis is particularly stressful for families, and interventions to support families in adjusting their family practices to support adjustment to and management of T1D in the months following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for interventions to support caregivers in learning evidence-based family management skills for adjustment to and management of T1D. We hypothesized that a self-guided, web-based, family skills management program (addressing caregiver social support as well as family problem-solving, communication, and supportive behavior change strategies) initiated at the time of T1D diagnosis would improve glycemic outcomes in children with T1D. In this study, we report on the feasibility and acceptability of this program. We prospectively evaluated a sample of 37 children newly diagnosed with T1D recruited from a pediatric endocrinology clinic. Parent participants were asked to complete web-based modules addressing social support, family problem-solving, communication, and supportive behavior change strategies. Module completion was analyzed for percentage completion, patterns of completion, and differences in completion rates by coparenting status. Qualitative open-ended feedback was collected at the completion of each module. A total of 31 (84%) of the 37 participants initiated the web-based program. Of those 31 participants, 25 (81%) completed some content and 15 (48%) completed all 5 modules. Completion rates were higher when coparenting partners engaged in the intervention together (P=.04). Of the 18 participants given a choice about the spacing of content delivery, 15 (83%) chose to have all sessions delivered at once and 3 (17%) chose to space sessions out at 2-week intervals. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D. In this study, we found that a self-guided digital family support intervention initiated at the time of a child's T1D diagnosis was largely feasible and acceptable. Overall, rates of participation and module completion were similar to or higher than other self-guided digital prevention interventions for mental and physical health outcomes. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management and can decrease cost, increase access, and add flexibility compared to traditional interventions. ClinicalTrials.gov NCT03720912; https://clinicaltrials.gov/study/NCT03720912.

Young Flexitarians: An Insight into Barriers and Facilitators Related to Capability, Opportunity, and Motivation for Meat Reduction

In recent decades, meat consumption has faced growing scrutiny from an environmental, health, and animal welfare perspective. As a result, reducing meat consumption has emerged as an important strategy to mitigate its negative effects. Flexitarians, a growing group of meat reducers, have attracted attention for potentially shaping future dietary trends. This study uses a qualitative approach and draws on 15 in-depth interviews with young flexitarians in Slovenia (YFS) to identify the main facilitators and barriers to meat reduction by exploring their motivations, capabilities, and opportunities as described in the COM-B behavioral model. This study fills the gap in studies on flexitarians using the COM-B model by looking at capabilities and opportunities, not solely motives. In addition, it fills the gap in qualitative in-depth studies on all three COM-B categories, as well as a gap in studies conducted outside northwest Europe and other primarily western geographical contexts. This study highlights important findings for the central and eastern European context that industry and governments should consider when developing behavior change strategies for healthy, sustainable diets. This study shows that strong rural family ties and limited access to meat alternatives are the major barriers to meat reduction in Slovenia. The YFS preferred whole, unprocessed foods (legumes, vegetables, grains) over processed meat alternatives and reduced their meat consumption primarily for health and environmental reasons, relying on social support from peers and information from popular documentaries and social media influencers.

Barriers and facilitators to healthy eating during post-partum among non-Hispanic Black mothers.

Maternal diet is a key predictor of child diet, yet an in-depth inquiry into the barriers and facilitators for the adoption of healthy eating behaviours during the post-partum period is lacking, specifically for non-Hispanic Black mothers. This study used qualitative research methods to investigate healthy eating practices among a sample of non-Hispanic Black mothers participating in a family-based obesity prevention intervention. In-depth interviews were conducted with 22 mothers who participated in the Mothers and Others: Family-based Obesity Prevention for Infants and Toddlers intervention trial. Interviews were audio-recorded and transcribed verbatim. A deductive and inductive process was used to develop a consensus codebook; once the data were coded, matrices were developed to explore the data and identify similarities and differences between respondents. Relevant themes were identified, and salient quotes were used to illustrate each theme. Mothers believed that time and taste were significant barriers to eating healthy. Social influence and social support had both positive and negative influences on mothers' ability to adopt healthy eating behaviours. Despite their children often being a facilitator to healthy eating, many mothers struggled with finding the time, energy and desire to focus on themselves when it came to healthy eating. Many mothers were intent on preparing healthy meals and snacks for their children but did not prepare them for themselves. Future interventions should focus on the importance of role-modelling healthy eating behaviours for their children and include behaviour change strategies that incorporate skill-building activities emphasizing time-saving methods for planning and preparing healthy meals and snacks for the whole family to eat.

Using Behavior Integration to Identify Barriers and Motivators for COVID-19 Vaccination and Build a Vaccine Demand and Confidence Strategy in Southeastern Europe

Introduction. The COVID-19 pandemic has significantly impacted global health, with Eastern Europe experiencing notable excess morbidity and mortality and vaccine hesitancy. This study utilized the Behavior Integration (BI) framework to identify barriers and motivators for COVID-19 vaccination and develop strategies to increase vaccine demand and confidence in Moldova, North Macedonia, and Serbia. Methods. A mixed-methods approach was employed, including qualitative interviews and quantitative surveys. The BI framework was used to integrate human behaviors with technical and operational considerations throughout the project. Results. A total of 2742 online surveys were collected in Moldova and Serbia, revealing significant barriers such as vaccine safety concerns (OR = 1.839, 95% CI: 1.328–2.547 in urban Moldova; OR = 1.990, 95% CI: 1.351–2.931 in urban Serbia), logistical challenges, and lack of institutional trust. Conversely, motivators included personal health concerns, recommendations from health care providers, and the desire to travel. The proposed social and behavior change strategy included a continuing medical education course that trained 2403 medical providers, with post-test results showing a 99% improvement in knowledge and confidence in applying the information, and collective engagement workshops for 3260 chronic disease patients and 842 pregnant women, of which 7% were vaccinated against COVID-19. Conclusions. The BI approach effectively identified and addressed vaccination barriers and motivators, leading to tailored strategies that increased vaccine uptake. Continuous stakeholder engagement, adaptive learning processes, and local organizations are crucial for refining program implementation, ensuring sustainability, and promoting public health.

Establishing consensus on lifestyle recommendations and behaviour change strategies to promote brain health-focussed care for multiple sclerosis: A modified e-Delphi study

IntroductionBrain health is a global priority for multiple sclerosis (MS) care. This study aimed to establish consensus on internationally applicable lifestyle recommendations and behaviour change strategies to promote lifelong brain health for people living with MS. MethodsA three-round, modified, e-Delphi survey was conducted. Lifestyle recommendations and behaviour change strategies were generated based on a review of the published literature, qualitative interviews, and expert feedback, respectively. ResultsSixty-nine experts participated, with a final response rate of 75 %. Experts were predominantly female (n = 50, 72 %), 30 to 59 years of age (n = 54, 78 %) and worked in an academic institution (n = 21, 50 %). A majority (n = 16, 80 %) of experts with lived experience had a relapsing-remitting phenotype. Starting with 15 lifestyle recommendations, we iteratively identified new recommendations and combined existing ones, achieving consensus on 17 lifestyle recommendations among experts from healthcare, academia, research and advocacy; 16 among experts with lived experience, and 14 behaviour change strategies, presented as separate frameworks. ConclusionsAn e-Delphi process has established lifestyle recommendations and identified behaviour change strategies to promote brain health-focussed care for MS. Reliance on these frameworks with detailed management recommendations may help to establish consistency in lifestyle behaviour management of MS, between and within healthcare systems.

Factors associated with Finnish, German and UK consumers' intentions to test, buy and recommend reusable fast-moving consumer goods packaging

This study investigates factors connected with consumers' intentions to test, buy and recommend reusable packaging for Fast-Moving Consumer Goods (FMCGs) by extending the Theory of Planned Behavior model with positive and negative emotions as facilitators of intentions and all behavioral determinants (i.e. attitude, subjective norm, perceived behavioral control). In addition, the connection of five perceived value dimensions (functional, emotional, social, price, environmental sustainability) and attitudes is explored. A conceptual model and relevant hypotheses were tested with consumers from Finland, Germany, and the UK (total N = 2400) through Partial Least Squares - Structural Equation Modeling (PLS-SEM). Main results show that positive emotions have a key role in consumers' assessment of reusable FMCG packaging: They have a direct and strong influence on intentions and also influence perceived behavioral control and subjective norms. Additionally, none of the examined perceived values had a significant connection with consumers' attitudes. Consumers' adoption of reusable FMCG packaging solutions can be encouraged through positive emotional experiences related to packaging reuse. Behavioral change and marketing strategies can support consumers' experiences by considering affect (e.g., positive emotions), cognition (e.g., perceived behavioral control), and social expectations (e.g., subjective norms) as influential factors.

The Physical Activity and Cancer Control (PACC) framework: update on the evidence, guidelines, and future research priorities.

We proposed the Physical Activity and Cancer Control (PACC) framework in 2007 to help organise, focus, and stimulate research on physical activity in eight cancer control categories: prevention, detection, treatment preparation/coping, treatment coping/effectiveness, recovery/rehabilitation, disease prevention/health promotion, palliation, and survival. This perspective paper provides a high-level overview of the scientific advances in physical activity research across cancer control categories, summarises current guidelines, updates the PACC framework, identifies remaining and emerging knowledge gaps, and provides future research directions. Many scientific advances have been made that are reflected in updated physical activity guidelines for six of the cancer control categories apart from detection and palliation. Nevertheless, the minimal and optimal type, dose, and timing of physical activity across cancer control categories remain unknown, especially for the understudied population subgroups defined by cancer type, age, race/ethnicity, and resource level of regions/countries. To achieve the full benefit of physical activity in cancer control, future research should use innovative study designs that include diverse at-risk populations and understudied cancer sites. Additionally, effective behaviour change strategies are needed to increase physical activity levels across populations that use implementation science to accelerate the translation from evidence generation into practical, real-world interventions.

Tracking Well-Being: A Comprehensive Analysis of Physical Activity and Mental Health in College Students Across COVID-19 Phases Using Ecological Momentary Assessment.

Physical activity (PA) is a critical factor in maintaining mental health, particularly among college students who are vulnerable to stress, anxiety, and mood disturbances. The COVID-19 pandemic introduced unprecedented disruptions to daily routines. The purpose of this cohort study was to examine the longitudinal PA behaviors before and during COVID-19 using device-based assessment in a sample of college students. The participants were a convenience sample of 1-year college students from the University of Vermont Wellness Environment study. A daily survey was distributed to the participants every night on a study app measured three mental health outcomes of mood, anxiety, and stress for 16 weeks. Participants wore Apple Watches to monitor PA. A total of 167 participants completed at least 50% of daily surveys and had 20 days of valid Apple Watch data, which resulted in 11 387 participant-days' of observations. Changes in average daily moderate-to-vigorous physical activity (MVPA) and step counts were examined week-over-week from an 8-week period before COVID to an 8-week period during COVID using cluster-robust piecewise regression (16-weeks total). Linear mixed models examined the association between PA and mental health outcomes, while also examining the moderating influence of COVID phase. Significantly lower MVPA was observed from the end of pre-COVID to start of COVID by -18.2 min/day (p < 0.001) and significantly fewer steps/day was observed from end of pre-COVID to start of COVID by -3277 steps/day (p < 0.001). An MVPA "catch-up" effect was observed as there were small but positive week-over-week improvements during COVID for MVPA (b = 1.32 min/day, p < 0.001). The influence of COVID-19 phases had a notable impact on the relationships between PA/exercise and mental health outcomes. A discernible trend emerged, indicating stronger connections during the COVID period for anxiety and stress compared to the pre-COVID era. Interestingly, the moderating effect of COVID was opposite for mood and exercise. The COVID-19 pandemic led to a dramatic decline in PA among college students, coinciding with a period of heightened stress and anxiety. Despite a slight recovery in PA levels during the pandemic, the strengthened association between exercise and anxiety/stress during this time underscores the vital role of PA in promoting mental health. These findings highlight the importance of implementing behavior change strategies to maintain and promote student wellbeing.

Community service initiative: Empowering Mothers in Wongsorejo, Banyuwangi, East Java to Prevent Stunting Through Education and Complementary Feeding Circle Demonstrations

The challenge of stunting in Indonesia remains critical, with the National Basic Health Research of 2018 indicating a high prevalence rate of 30.8%. Addressing stunting effectively requires targeted interventions and behavior change strategies. This community service project aimed to tackle stunting in Wongsorejo, Banyuwangi, East Java, through a comprehensive approach focused on nutrition and complementary feeding practices. The initiative was structured around three main activities: a seminar on stunting, counseling on complementary feeding, and a cooking demonstration. The seminar aimed to enhance understanding of stunting, including its causes, consequences, and preventive measures, with a specific focus on the role of mothers. The counseling sessions were designed to educate mothers about the implementation of complementary feeding circles to ensure their infants receive adequate nutrition. The cooking demonstration provided practical guidance on preparing nutritious complementary foods using local ingredients. This community service project targeted mothers in the Wongsorejo area, along with representatives from local health centers and community leaders. The objective was to improve knowledge and practices related to stunting prevention, nutrition, and healthy feeding habits. Methods included educational seminars, interactive counseling, and practical demonstrations. Overall, this project seeks to empower mothers with the necessary knowledge and skills to combat stunting, thereby contributing to improved child health and nutrition in the Wongsorejo community. The effectiveness of these activities was evaluated through pre- and post-intervention assessments.