Contemplation Stage Research Articles

Predicting Smoking Cessation Stages: An Insight from the Transtheoretical Model Using a Cross-Sectional Approach Among Adults in Saudi Arabia

Background: Smoking is a detrimental health behavior that can be addressed by designing stage-matched interventions with evidence-based behavioral change models such as the transtheoretical model (TTM). This study applied the TTM to predict smoking cessation stages among adults in Saudi Arabia. Methods: This social media-based cross-sectional study in Saudi Arabia used a convenient sample of 491 adult smokers (men and women). A digital questionnaire containing basic and smoking-related data and smoking scales (stages of change, cessation readiness, decisional balance, and self-efficacy) was used for data collection. The data were collected from 1 July to 30 October 2023 and were investigated using an ordinal regression analysis. The results illustrate that among the studied smokers, cigarette smoking was the prevalent method of smoking, especially among men (71.7%) compared to women (27.8%). Regarding stages of smoking, the pre-contemplation (35.8%) and contemplation (30.1%) stages were the highest, where men were more represented in both stages (37.9% and 40.8%, respectively). In comparison, women represented a higher percentage in the action (23.9%) and maintenance (21.1%) stages. The ordinal regression showed that increasing age (adjusted odds ratio; AOR = 1.045, p = 0.044), high quitting readiness (AOR = 1.134, p < 0.001), self-efficacy (AOR = 1.965, p = 0.028), decisional balance (AOR = 1.870, p < 0.001), and absence of psychological problems (AOR = 2.047, p < 0.001) increased the likelihood of being at higher smoking cessation stages. However, increased smoking duration (AOR = 0.756, p = 0.010), male gender (AOR = 0.340, p < 0.001), not working (AOR = 0.364, p = 0.013), adequate income (AOR = 0.535, p = 0.032), no chronic diseases (AOR = 0.430, p < 0.001), regular smoking (AOR = 0.052, p < 0.001), high smoking dependency (AOR = 0.775, p = 0.038), and hookah smoking (AOR = 0.032, p < 0.001) decreased the likelihood of being at higher smoking cessation stages. Conclusion: Cigarette smoking is a prevalent problem among Saudi adults, especially men, with the highest percentage of these being at lower smoking cessation stages. Thus, this study recommends the development of stage-matched interventions to facilitate the move towards higher smoking cessation stages through efforts by, and collaboration between, community sectors to face this rising issue.

Evaluating Tobacco Cessation Readiness in OPMD Patients Using the Transtheoretical Model in a tertiary care setting in Northeast India

Background: Oropharyngeal cancers pose significant global health challenges and addressing public awareness, early symptoms, and risk factors, alongside promoting tobacco cessation among individuals with potentially malignant oral disorders, is crucial for reducing the disease burden.Objective: Evaluating the degree of public knowledge of oral malignancy & OPMD, initial signs & risk factors amongst patients going to a dental college in North East India, as well as readiness to quit tobacco amongst OPMD patient.Methods: This cross-sectional investigation was undertaken at the Department of Public Health Dentistry, Tertiary care Hospital in Guwahati. 200 participants aged 15-65 years who consented were surveyed using a self-administered questionnaire. Collected data underwent thorough checks for completeness and accuracy. To determine the odd's ratio (OR) and to summarise the data, descriptive & inferential statistics were used. To test the relationship, data were dichotomised. Oral lesions present or absent; behavioural phases were divided into two categories: (preparation + action) & (precontemplation + contemplation). P < 0.05 was used as the statistical significance threshold.Results: Most participants were in the contemplation stage regarding tobacco's risks, neglecting other risk factors like alcohol & inadequate dental hygiene for oral malignancy/OPMD development.Conclusions: The lack of knowledge of oral malignancy & potentially malignant disorders (OPMDs) amongst North Eastern Indian communities, underscores the immediate demand for targeted education and health promotion campaigns. Emphasizing early symptom recognition, risk factors, and prevention measures, tailored to diverse communication preferences, is crucial.

Determining the perceived risk of lung cancer and chronic obstructive pulmonary diseases (COPD) among hookah users in Iran.

Hookah consumption is harmful to human health and can cause various diseases. Developing lung cancer and other lung diseases are one of the health consequences of hookah consumption. Measuring the perceived risk for being diagnosed with these conditions among hookah users is necessary. Therefore, this study was conducted to determine the perceived risk of lung cancer and Chronic Obstructive Pulmonary Disease (COPD) in hookah users in Iran. This cross-sectional study was conducted with a descriptive-analytical approach on 340 hookah users between January-May 2023. These people were recruited through convenience sampling. The information on the perceived risk of participants was collected through a questionnaire on the perceived risk of lung cancer and COPD. Data were analyzed through descriptive tests and multiple linear regression tests. These analyses were performed using Stata statistical software version 17. The mean and standard deviation of the perceived risk for lung cancer was 8.41 ± 5.50 and for COPD was 8.51 ± 5.58 out of 20 possible scores. The results of multiple linear regression generally showed that the using other type of tobacco (β = 3.14, p < 0.0001), 2 or more use of hookah in past month (β=-3.41, p = 0.025), unskilled workers (β = 1.79, p = 0.017), married smokers (β=-1.31, p = 0.026), negative attitude toward hookah (β = 0.46, p < 0.0001) were the predictive variables regarding to lung cancer perceived risk. In line with COPD the using other type of tobacco (β = 3.47, p < 0.0001), once a month use of hookah in past month(β=-3.74, p = 0.041) and twice or more use of hookah in past month (β=-4.82, p = 0.008), smokers in contemplation stage (β = 3.91, p < 0.0001), female smokers (β = 3.08, p < 0.0001), unskilled workers (β = 2.42, p = 0.007), negative attitude toward hookah (β = 0.46, p < 0.0001) were the predictive variables to COPD perceived risk. In general, the perceived risk of developing lung cancer and COPD among hookah users was low. Therefore, it is necessary to provide widespread information about the potential harm of hookah in causing lung cancer and COPD, at the community level.

An approach to persons who are not willing to engage in behavioural change.

With its unique position, primary health care (PHC) can provide health promotion and prevention services, including lifestyle behavioural counselling. Unhealthy lifestyle behaviours are very prevalent among patients attending PHC, with many patients unwilling to change or in the precontemplation stage. While patients in the contemplation stage are better managed using the 5As approach of motivational interviewing counselling, those unwilling or not ready for change necessitate a different approach, such as the 5Rs of motivational interviewing (MI) counselling. The 5Rs MI approach holds promise in motivating unwilling individuals to consider embarking on the journey of behavioural change. The 5Rs approach is not a stand-alone checklist of tasks implemented in isolation but is best integrated within a theoretical behavioural change framework. Of the four health-related behavioural change theoretical frameworks that are frequently used, the transtheoretical stages of the change model are the most used. This continued professional development article provides a summary review of the literature on behavioural change theories as they apply to lifestyle health behaviour change and presents the 5Rs approach as a feasible and practical approach to manage patients who are unwilling to change or in the precontemplation stage. This offers a beacon of hope for improved patient outcomes in a PHC system saddled with high prevalence of modifiable unhealthy lifestyle behaviours.

Factors Influencing the Self-Management Stages of Older Patients With Chronic Pain: A Cross-Sectional Study

PurposeTo investigate the current status and related influencing factors of self-management stages in older patients with chronic pain. DesignA cross-sectional study. MethodsA total of 326 older patients with chronic pain were selected as the study subjects in five city districts from December 2022 to June 2023. We used a general information survey form, a numerical rating scale, a pain stages of change questionnaire, a health literacy assessment instrument for patients with chronic pain, and a psychological inflexibility in pain scale to collect relevant information from participants. Univariate analysis and multiple ordinal logistic regression analysis were conducted to identify the relevant influencing factors of the self-management stages. ResultsThe self-management stages of older patients with chronic pain were as follows: precontemplation stage (n = 52; 16.0%), contemplation stage (n = 103; 31.6%), action stage (n = 62; 19.0%), and maintenance stage (n = 109; 33.4%). Regression results showed that average monthly household income, smoking history, pain duration, health literacy, and psychological inflexibility were the influencing factors for the self-management stages of older patients with chronic pain. ConclusionsIn this study, the self-management stages of older patients with chronic pain still needed to be improved. Suitable personalized pain self-management strategies should be developed based on identified factors affecting patients to improve their self-management stages. Clinical ImplicationsNursing professionals can use research survey findings to identify patients at low levels of self-management stage and develop personalized intervention strategies based on various influencing factors. For example, nurses can provide practical smoking cessation guidance to assist older chronic pain patients in improving their lifestyle. Nurses can also seek support from family members to collectively offer better medical care and nursing services for the patient if financially feasible. Secondly, as our study has demonstrated, patients' health literacy and psychological flexibility were poor. Nurses can utilize available clinical resources to offer educational materials, such as portable handbooks and online videos, covering pain-related knowledge, managing pain medication, and coping strategies like massage and exercise. Combining this approach with mental health education, such as relaxation therapy, can help patients better understand their pain and actively participate in their self-management. In addition, nursing staff should pay more attention to the self-management stages of older chronic pain patients, and the assessment of self-management stages can be included in clinical pain management for patients. Regular assessment will help track more patients needing attention and make timely adjustments to their pain management plans.

Feasibility and Preliminary Effects of a Social Media-Based Peer-Group Mobile Messaging Smoking Cessation Intervention Among Chinese Immigrants who Smoke: Pilot Randomized Controlled Trial.

Chinese immigrants experience significant disparities in tobacco use. Culturally adapted tobacco treatments targeting this population are sparse and the use is low. The low use of these treatment programs is attributed to their exclusive focus on individuals who are ready to quit and the wide range of barriers that Chinese immigrants face to access these programs. To support Chinese immigrant smokers at all levels of readiness to quit and address their access barriers, we developed the WeChat Quit Coach, a culturally and linguistically appropriate WeChat (Tencent Holdings Limited)-based peer group mobile messaging smoking cessation intervention. This study aims to assess the feasibility, acceptability, and preliminary effects of WeChat Quit Coach. We enrolled a total of 60 Chinese immigrant smokers in 2022 in New York City for a pilot randomized controlled trial (RCT) and a single-arm pilot test. The first 40 participants were randomized to either the intervention arm (WeChat Quit Coach) or the control arm (self-help print material) using 1:1 block randomization stratified by sex. WeChat Quit Coach lasted 6 weeks, featuring small peer groups moderated by a coach, daily text messages with text questions, and chat-based instant messaging support from the coach in response to peer questions. The next 20 participants were enrolled in the single-arm pilot test to further assess intervention feasibility and acceptability. All 60 participants were offered a 4-week supply of complimentary nicotine replacement therapy. Surveys were administered at baseline and 6 weeks, with participants in the pilot RCT completing an additional survey at 6 months and biochemical verification of abstinence at both follow-ups. Of 74 individuals screened, 68 (92%) were eligible and 60 (88%) were enrolled. The majority of participants, with a mean age of 42.5 (SD 13.8) years, were male (49/60, 82%) and not ready to quit, with 70% (42/60) in the precontemplation or contemplation stage at the time of enrollment. The pilot RCT had follow-up rates of 98% (39/40) at 6 weeks and 93% (37/40) at 6 months, while the single-arm test achieved 100% follow-up at 6 weeks. On average, participants responded to daily text questions for 25.1 days over the 42-day intervention period and 23% (9/40) used the chat-based instant messaging support. Most participants were satisfied with WeChat Quit Coach (36/39, 92%) and would recommend it to others (32/39, 82%). At 6 months, self-reported 7-day point prevalence abstinence rates were 25% (5/20) in the intervention arm and 15% (3/20) in the control arm, with biochemically verified abstinence rates of 25% (5/20) and 5% (1/20), respectively. WeChat Quit Coach was feasible and well-received by Chinese immigrants who smoke and produced promising effects on abstinence. Large trials are warranted to assess its efficacy in promoting abstinence in this underserved population. ClinicalTrials.gov NCT05130788; https://clinicaltrials.gov/study/NCT05130788.

A Mixed Methods Investigation Examining the PrEP Cascade Among 13-18-Year-Old Latino Adolescent Sexual Minority Men.

Latino adolescent sexual minority men (ASMM) are at high risk of HIV. Limited research has explored the impact of parent-adolescent communication and beliefs on PrEP adoption among Latino ASMM. Our objective was to examine how parental support and beliefs influence decisions regarding PrEP use. We analyzed PrEP-related attitudes and behaviors within a national cohort of 524 Latino ASMM aged 13-18. Out of the participants, 60.5% were suitable for PrEP. Among them, 59.7% were in the precontemplation stage (stage 1), indicating a lack of willingness or belief of unsuitability. However, 86.4% moved to reach the contemplation stage (stage 2), demonstrating willingness and suitability for PrEP. Only 16.8% moved on to the PrEParation stage (stage 3), indicating their intention to start using PrEP. Furthermore, 4.3% progressed to the PrEP action stage and initiation (stage 4), signifying they had received a prescription, and all reported high adherence (stage 5). Factors associated with reaching later stages included older age, parental support of sexual orientation, and previous HIV/STI testing. The qualitative findings revealed diverse attitudes towards parental involvement in PrEP care among Latino ASMM, including positive, negative, and ambivalent perspectives. Notably, Spanish-speaking participants expressed specific barriers to PrEP communication between ASMM and their parents. Given that parental support and attitudes emerged as significant factors in both our quantitative and qualitative findings, it is evident that public health approaches aiming to disseminate education and awareness about PrEP to parents and families could alleviate the burden on adolescents to educate their parents and enhance support.

The Perceived Benefits and Self-Efficacy of an Exercise Intervention on Tobacco Withdrawal Symptoms: A Qualitative Study Based on the Health Belief Model.

This study examined the effectiveness of an exercise programme as an adjunct to smoking cessation treatments. The effects of exercise on smoking habits and tobacco withdrawal symptoms (TWS) were evaluated among smokers who were in the pre-contemplation and contemplation stages. This was a case study with convenience sampling techniques. This study lasted approximately 2 years, beginning in February 2016. This study was divided into two phases: an intervention phase followed by an interview. The participants were invited to undergo the 8-week supervised moderate aerobic exercise programme. This qualitative study involved 14 participants selected from the intervention phase. They were interviewed about their experiences using a semi-structured questionnaire guided by the health belief model. This study involved 14 participants who were aged between 26 years old and 40 years old and smoked from 11 to 20 cigarettes per day. Most participants perceived benefits and self-efficacy regarding smoking habits and tobacco withdrawal symptoms (TWS) following the exercise intervention. This study demonstrated that moderate exercise might be helpful in increasing self-efficacy in smoking cessation and the findings encourage further research on exercise programmes as an adjunct to smoking cessation treatments in Malaysia.

Consumption status of functional drinks based on the theory of planned behavior and the stages of change model in female employees

This study aimed to determine the consumption status of functional drinks based on the theory of planned behavior and the Stages of Change Model. This study was conducted on 536 female employees of Birjand offices in 2022. The data was collected by using the functional food questionnaire and was analyzed using SPSS with significance level of P < 0.05. The largest number of people consume probiotic drinks (buttermilk, kefir, etc.) were in the maintenance stages (31.2%) and who consume milk fortified with vitamin D were in the contemplation stage (37.3%). The mean score of the participants in the subscales of attitude, behavioral control, and subjective norm was 17.69 ± 3.05, 16.83 ± 2.88, 21.73 ± 4.33, respectively. The mean score of the attitude and subjective norm regarding the consumption of all drinks had a significant relation with the stages of change model (p < 0.05). The results of this study showed that the most drinks that female employees consumed regularly were probiotic drinks, while they did not intend to use functional juices (pre-contemplation stage). Therefore, it seems that this theory can be used as a framework in designing educational programs in order to increase the consumption of functional foods and improve women's health.

Readiness for return to work and its influencing factors among head and neck cancer patients: a cross-sectional study.

This study aims to investigate the Readiness for Return-to-Work (RRTW) of patients with head and neck tumours and to analyse the relationships among self-efficacy, disease uncertainty, psychosocial adaptation, and RRTW in head and neck cancer (HNC) patients. A cross-sectional study was conducted with 259 HNC patients with a discharge length of ≥1 month at a tertiary hospital in Liaoning Province. The research tools included a self-designed general information questionnaire, the Readiness for Return-to-Work (RRTW) Scale, the General Self-Efficacy Scale (GSES), the Mishel Uncertainty in Illness Scale (MUIS), and the Self-Reporting Psychosocial Adjustment to Illness Scale (PAIS-SR). Descriptive statistical analysis, the rank sum test, Spearman correlation analysis, and ordered multiple and dichotomous logistic regression analyses were used. The overall RRTW among HNC patients was low (41.9%). HNC patients who did not return to work were mainly in the precontemplation stage (38.1%) and contemplation stage (29.9%). HNC patients who returned to work were mainly in the active maintenance stage (64.2%). Children's status (OR = 0.218, 95% CI 0.068-0.703), self-efficacy (OR = 1.213, 95% CI 1.012-1.454), unpredictability (OR = 0.845, 95% CI 0.720-0.990), occupational environment (OR = 0.787, 95% CI 0.625-0.990), and family environment (OR = 0.798, 95% CI 0.643-0.990) influence the RRTW of HNC patients who have not returned to work. Educational level (OR = 62.196, 95% CI 63.307-68.567), children's status (OR = 0.058, 95% CI 1.004-2.547), self-efficacy (OR = 1.544, 95% CI 3.010-8.715), unpredictability (OR = 0.445, 95% CI 1.271-2.280), and psychological status (OR = 0.340, 95% CI 1.141-2.401) influence the RRTW of HNC patients who have returned to work. Children's status, education level, self-efficacy, illness uncertainty, and psychosocial adjustment are crucial to RRTW. This study provides a theoretical basis for formulating intervention measures aimed at improving the RRTW of patients.

Will event inspiration and leveraging improve sport participation among the games makers? An examination on volunteers of the Beijing 2022 Winter Olympic games

ABSTRACT This longitudinal intervention study tracks sport participation changes among volunteers of the Beijing 2022 Winter Olympics, following their exposure to event inspiration and a post-event leveraging intervention. Specifically, the study investigates whether event inspiration increases sport participation among previously inactive volunteers and if a Transtheoretical Model-based intervention, incorporating event visuals to sustain inspiration, enhances this effect. The study included 408 university student volunteers, with 244 retained after attrition, who were either in the contemplation or preparation stages of sport participation before the Games. Findings revealed significant increases in sport participation both 3 months (T1) and 9 months (T2) after the Games commenced, irrespective of the intervention. However, a notable decline was observed from T1 to T2, with females exhibiting a greater decrease compared to males. Moreover, the intervention was effective in improving attitude towards sport participation among the contemplation group. In terms of originality, while confirming the presence of an inspirational effect under certain conditions within an Asian context, this study demonstrates the untapped potential of a specific event stakeholder group – event volunteers – whose engagement in sport can be significantly enhanced by event inspiration and leveraging initiatives. Further, this study underscores the importance of customising leveraging initiatives to align with the target group’s stages of sport participation, and providing ongoing support for continuing participation post-event, particularly for women. Finally, it illustrates how (winter) sports events can catalyse regular exercise, suggesting future organisers can enhance physical activity and public health by promoting both event-specific and general sports.

Factors Influencing Engagement Across the Motivational PrEP Cascade Among Latino SMM: A Mixed-Methods Analysis from the Perspectives of Community Providers and Latino SMM.

Latino sexual minority men (SMM) are a highly vulnerable population to HIV, and while pre-exposure prophylaxis (PrEP) has emerged as a promising biomedical tool for HIV prevention among them, its utilization remains disproportionately low in this community despite its potential. Understanding the barriers along the PrEP continuum of care, known as the "PrEP cascade," is crucial for effectively implementing PrEP interventions. Therefore, the objective of our study was twofold: first, to explore the stage of Latino SMM in the PrEP cascade by examining disparities in demographics, social factors, and healthcare aspects; second, to gain insights from healthcare providers who have direct clinical experience with our population regarding the challenges faced by Latino SMM in accessing and adhering to PrEP. Based on the study findings, the majority of participants (n = 74; 49%) were in the contemplation stage, and only one in ten Latino SMM (10.6%) were currently adherent to PrEP. Compared to those who were at least second-generation, first-generation status had a positive association (B = 0.699, SE = 0.208, β = 0.351, p < .001) with engagement along the PrEP Contemplation Ladder. Conversely, having at least one parent who did not have legal residency, relative to those whose parents were both U.S. citizens or held legal residency documentation, was found to have a negative association (B = - 0.689, SE = 0.245, β = 0.245, p = .006) with engagement along the PrEP Contemplation Ladder. Additionally, discussing PrEP with a healthcare provider had a positive association (B = 0.374, SE = 0.179, β = 0.185, p = .038) with engagement along the PrEP Contemplation Ladder. Qualitative results from our study suggest that some Latinos who initially agreed to start using PrEP ended up getting lost in the care pipeline and failed to attend their scheduled appointments. Providers also noted that many patients lacked access to a pharmacy where they felt comfortable obtaining their PrEP prescription, leading them to discontinue use after only a few months. These findings emphasize the importance of considering the unique needs, culture, and background of Latinos, including care delivery and provider attitudes that can facilitate progress through the PrEP cascade.

Smoking behaviour in post-acute myocardial infarction patients: cross-sectional study.

Heart disease remains the leading cause of death in developed countries, and cigarette smoking contributes to a significant proportion of cardiovascular-related deaths. Abstaining from tobacco use is associated with a significant reduction in the risk of recurrent myocardial infarctions. In this cross-sectional study, 384 participants post-acute myocardial infarction (MI) were recruited through random sampling to explore the associations between smoking status and intention to quit smoking. Data collection took place over a 6-month period at a tertiary care hospital, Islamabad, Pakistan. The majority of participants were male (59.9%) and fell into the age category of 46-50 years (37.5%). Heavy daily smokers comprised the largest smoking group (41.6%), and non-ST-elevated MI was the most common subtype (40.1%). Intention to quit smoking varied among participants, with the pre-contemplation stage having the highest representation (19.3%), followed by contemplation (25.8%). Notably, a significant proportion of participants expressed no intention to quit smoking (35.4%). Multinomial logistic regression analysis identified current smoking as a significant predictor of intention to quit in the preparation and contemplation stages. Overall, this study underscores the importance of considering smoking behaviour when evaluating the intention to quit smoking post-MI and highlights the need for tailored interventions and support strategies to address smoking cessation in this population. These findings offer valuable insights for the development of effective strategies aimed at reducing persistent smoking following MI and improving patient outcomes.

Adaptive Mechanism for Water and Wastewater Construction Companies in Coping with the Disruption of Projects Due to Crisis

The water and wastewater construction company (WWCC) plays an important role maintaining water sustainability for human. It is a very intricate industry vulnerable to disruptions, delays, and disputes in times of crisis or pandemic. It is a system that has internal interactions on its 5Ms of management such as Man, Material, Machine, Method, and Money that are sensitive to change affected by external environment which in turn affected their current projects. One of the external factors that affected WWCC in the year 2020 is the occurrence of coronavirus covid19. During the pandemic, the global construction industry including WWCC have experienced drastically altered risk environment applied to funding, labor shortages, material delays, suspension, and termination of contracts (Barriere 2020). The pandemic has affected WWCC’s 5Ms of management that ranges that eventually affected the triple constraints of projects such as scope, time, and cost. The study has determined the level of severity of the effect before and during covid19 to WWCC’s 5Ms of management that eventually affected the three interdependent constraints of projects. The data gathered before and during covid19 were compared and ultimately utilized in formulating the adaptive mechanism for WWCC in coping with the disruption of projects during crisis. The adaptive mechanism comprises of the precontemplation and contemplation phases. During pandemic, WWCC has to determine if there is a need for change in their organization. They have to adapt through precontemplation through internal and external scanning and situational analysis in order for them to comprehend and adapt to the change. WWCC upon realizing of the needed change, has to continue with the contemplation stage by utilizing the stop, start and continue (SSC) principle. To be more precise with the implementation of change, WWCC has to exercise pause, focus and identify prior to executing the SSC principle, followed by implementation, action, and maintenance.

Effect of Educational Intervention on Reducing Mobile Phone Addiction: Application of Transtheoretical Model

Background: Mobile phone addiction (MPA) among students leads to significant psychological changes. Therefore, modifying mobile phone usage (MPU) patterns using behavioral change theories and models can be beneficial. The transtheoretical model (TTM) is commonly employed in the field of addictive behaviors. Objectives: This study aimed to assess the effect of an intervention based on TTM on MPA in female primary school students. Methods: This experimental study included 72 students (36 participants in each group) randomly selected from girls' primary schools in Bushehr. The data collection tool comprised a questionnaire covering demographic factors, stage of changes, decisional balance (DC), self-efficacy (SE), excessive mobile phone use, and an MPA questionnaire. The training was conducted through motivational interview sessions: Two for participants in the preparation stage and three for those in the pre-contemplation and contemplation stages, utilizing the constructs of the TTM. After 3 months, the collected data were analyzed using SPSS software with a significance level of less than 0.05. Results: The findings indicated similarities between the two groups before the study. Following the intervention, the training led to a significant increase in the mean score of SE and DC distribution count of excessive MPU (P = 0.013) and stage of change (P &lt; 0.001) over time between the two groups. Mobile phone addiction significantly decreased in the intervention group three months after training (P &lt; 0.001). Conclusions: Education based on TTM can effectively reduce MPA in students.

The potential and limitations of large language models in identification of the states of motivations for facilitating health behavior change.

The study highlights the potential and limitations of the Large Language Models (LLMs) in recognizing different states of motivation to provide appropriate information for behavior change. Following the Transtheoretical Model (TTM), we identified the major gap of LLMs in responding to certain states of motivation through validated scenario studies, suggesting future directions of LLMs research for health promotion. The LLMs-based generative conversational agents (GAs) have shown success in identifying user intents semantically. Little is known about its capabilities to identify motivation states and provide appropriate information to facilitate behavior change progression. We evaluated 3 GAs, ChatGPT, Google Bard, and Llama 2 in identifying motivation states following the TTM stages of change. GAs were evaluated using 25 validated scenarios with 5 health topics across 5 TTM stages. The relevance and completeness of the responses to cover the TTM processes to proceed to the next stage of change were assessed. 3 GAs identified the motivation states in the preparation stage providing sufficient information to proceed to the action stage. The responses to the motivation states in the action and maintenance stages were good enough covering partial processes for individuals to initiate and maintain their changes in behavior. However, the GAs were not able to identify users' motivation states in the precontemplation and contemplation stages providing irrelevant information, covering about 20%-30% of the processes. GAs are able to identify users' motivation states and provide relevant information when individuals have established goals and commitments to take and maintain an action. However, individuals who are hesitant or ambivalent about behavior change are unlikely to receive sufficient and relevant guidance to proceed to the next stage of change. The current GAs effectively identify motivation states of individuals with established goals but may lack support for those ambivalent towards behavior change.

Abstract P203: Healthy Diet Perception, Cardiovascular Disease, and Risk Factors in Americans

Introduction: Healthy diet perception may influence cardiovascular (CV) outcomes. Misperceptions on the healthfulness of one’s diet can interfere with the precontemplative and contemplative stages of behavioral change if individuals overestimate their diet quality. Using a nationally-representative sample, we explored the prevalence of healthy diet misperception in the general population and in those with CV diseases, as well as whether misperceptions are associated with clinical CV risk factors. Methods: We included adults≥20 years old from the National Health and Nutrition Examination Survey 2017-2020. Using survey data on participants’ perception of their own diet and diet recall data to calculate Healthy Eating Index-2015 (HEI), we divided participants into dietary quantiles. We categorized healthy diet perception (HDP) as overestimated (perceived&gt;HEI quantile), accurate (perceived=HEI quantile), or underestimated (perceived&lt;HEI quantile). We categorized those who self-reported hypertension, coronary heart disease, myocardial infarction, congestive heart failure, and stroke as having CV disease. Clinical CV risk factor measures were body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin A1c, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). We used multiple logistic regression to measure the association between CV disease and HDP and multiple linear regression for HDP and CV risk factors, stratified by presence of CV disease. Results: Of 7,710 adults, 4,470 (57.5 weighted %) overestimated HDP; 1,924 (25.6 weighted %) underestimated HDP; and 1,316 (16.9 weighted %) correctly estimated HDP. After adjusting for age, sex, and education level, having CV disease was not associated with incorrectly estimating HDP (adjusted OR 1.08; 95% CI 0.93, 1.26) or overestimating HDP (adjusted OR 1.21; 95% CI 1.00, 1.48), compared to correctly estimating HDP. Among those with CV disease, overestimating HDP was associated with higher BMI (adjusted difference 1.9 m/kg 2 ; 95% CI 0.8, 2.9) and lower HDL (adjusted difference -2.8 mg/dL; 95% CI -5.1, -0.5). Among those without CV disease, overestimating HDP was only associated with higher BMI (adjusted difference 1.9; 95% CI 0.8, 2.9) Conclusions: More than half of Americans overestimate their diet quality, and adults with CV disease do not estimate diet quality more accuracy than those without CV disease. Among adults with CV disease, misperceptions in diet quality were associated with worse CV risk factor profiles, highlighting the need to assess and educate patients with CV disease on personal diet quality as part of healthy lifestyle promotion. Among those without CV disease, dietary misperceptions were associated with higher BMI, suggesting that increasing awareness of one's diet is also important in CV disease prevention.

Predictor of smoking cessation among school-going adolescents in Indonesia: a secondary analysis based on the transtheoretical model of behavioral change.

This study elucidates the complex journey of adolescents toward smoking cessation, investigating the association of relevant demographic factors, advertising, promotion, anti-cigarette messages, and individual knowledge and attitudes with being in different smoking cessation stages. Utilizing data from the 2019 Indonesia Global Youth Tobacco Survey, this secondary analysis included adolescents who reported ever smoking. The Transtheoretical Model (TTM) guided the categorization of the outcome variable into three smoking cessation stages based on the responses to two questions related to the intention and timing of the smoking cessation. This included contemplation, action, and maintenance stages. Multinomial logistic regression analyzed the associations between each independent variable and being in each stage of smoking cessation. The study comprised 3596 Indonesian adolescents from grades 7-12, of which 2484 responded to two questions related to intention and timing of smoking cessation and were included in regression analysis. Findings indicate that males and those aged ≥16 were predominantly in contemplation phase. Early smoking initiation, usage of other tobacco products, and exposure to various forms of smoke increased the likelihood of being in contemplation and action phases. Parental smoking, school smoking exposure, and second-hand smoke were significant contemplation phase predictors. Exposure to tobacco advertising was linked to an increased likelihood of being in contemplation and action phases, whereas anti-cigarette messages showed no significant impact. Awareness of cigarette and second-hand smoke harms reduced the odds of being in the contemplation phase, while enjoying smoking and willingness to accept cigarettes from friends increased the odds of being in contemplation and action phases rather than in maintenance phase. Addressing age, gender, cultural influences, environmental factors, and attitudes towards smoking through tailored interventions is vital for aiding smoking cessation in Indonesian adolescents. Strengthened tobacco control in schools and public places is recommended to bolster these efforts. Longitudinal studies are required to explore the evolving patterns of smoking cessation behaviors over time, enhancing our understanding of the factors influencing sustained cessation.

An integrated theory based-educational intervention to change intention to have a child: study protocol of a cluster randomized controlled trial

BackgroundIn high- and low-income countries, declining birth rates have become a global concern. Couples do not have enough information about the complications of delaying and reducing childbearing and this leads them to make inappropriate decisions. Therefore, this study aims to evaluate whether an educational program based on integrating the Theory of Planned Behavior (TPB) and the Trans-Theoretical Model (TTM) affects child-free couples’ intention to have children and minimizes the consequences of this decline.MethodsThirty couples (intervention, n = 15; control, n = 15) will be enrolled in this cluster randomized controlled trial. After collecting baseline data and separating participants in the pre-contemplation and contemplation stages based on the TTM, the samples were randomly assigned to the intervention and control groups. The intervention group will receive 60-min training based on TPB components for 4 weeks. The first follow-up assessment was performed immediately after the intervention and the final assessment 6 months later. For all 3 time assessments, three questionnaires will be used: The knowledge questionnaire, the TTM, and the TPB questionnaire. The most important consequences are changes in knowledge, attitudes, subjective norms, perceived behavioral control, and stages of intentions to have children.DiscussionDecision-makers will use the results of this study as a basis to design appropriate, transparent, and useful policies and interventions to improve or stop the decline of the fertility rate at the national level. Also, this study will help young couples who wish to have a child in their lifetime by providing relevant information so that they do not miss this opportunity and face the consequences of delaying having a child.Trial registration This study was approved by the Iranian Registry of Clinical Trials (IRCT), Number: IRCT20220618055210N2, Date of registration: 2023-10-03

Deriving Mathematical Equations for Measuring the Holes of the Nay (Arabic Flute)

Developing and discovering things requires the process of collecting relevant data and information, which is then analyzed to draw conclusions that enable us to move from the contemplation stage to the innovation stage. It is evident that many musical instruments have undergone evolution over the decades, and this development continues to the present day. Before the commencement of the development and innovation phase, it is preceded by a stage of data and information collection and analysis, laying the foundation for a scientific basis relying on academic methods. The researcher believes that presenting an innovation or development process in a specific instrument should be followed by a mathematical analysis of the sound holes. The research aims to analyze the dimensions of the Nay instrument mathematically and derive mathematical equations for measuring its holes. The significance of the research lies in analyzing the holes of all sound degrees of the Nay instrument and deriving mathematical equations to measure the dimensions of the instrument, contributing to the overall development and elevation of research in Arab musical instruments, especially the Nay. The results were as follows: The ratio between the holes is equal, and equations were determined to calculate the positions of the Nay&amp;apos;s holes.