Behavioral Determinants Of Health Research Articles

Family Support to Women During Pregnancy and Its Impact on Maternal and Fetal Outcomes.

Family support is one of the determinants of lifestyle habits and relevant health behavior for pregnancy outcomes. In India, the joint family system is still practiced. Due to education, urbanization, and industrialization, the family institution continues to play a central role in people's lives.Pregnancy is a crucial period in women's lives. Good care during pregnancy is important for the health of the mother and the newborn baby. During this period, hormonal changes are complex and involve multiple hormones working together to support the developing fetus and prepare the mother's body for labor, delivery, and breastfeeding. To avoid maternal and fetal complications, she needs support from her family throughout pregnancy and the postnatal period. This study aims to evaluate the influence of the level and quality of family support during pregnancy on maternal and fetal outcomes and to identify any association between the sociodemographic variables and the impact of the level and quality of family support during the first trimester. This study used a quantitative approach with a survey research design. Data were collected from four Primary Health Centers at Karad, Maharashtra, India, i.e., Rethare, Vadgaon, Kale, and Supane. A consecutive sampling technique was used to select the 344 subjects from the Rethare, Vadgaon, Kale, and Supane areas of Karad Taluka. Data were collected before the completion of the first three months of pregnancy, then during the second trimester and after delivery. Upon evaluation, the tool was validated by experts representing a range of specialties, including community health nursing, mental health nursing, obstetric gynecology, and pediatric care. A pilot study was conducted on 30 samples. The data collected were analyzed by using descriptive and inferential statistics. The findings of the study show a significant association between the psychosocial support received in the first trimester and the total gestational weeks completed at the time of delivery (p < 0.05). The study suggests the need for psychosocial support during the first trimester for better maternal and fetal outcomes. Psychosocial family support is needed by pregnant women during the first trimester to achieve maternal and fetal outcomes.

Use of systems thinking and adapted group model building methods to understand patterns of technology use among older adults with type 1 diabetes: a preliminary process evaluation

BackgroundA growing number of older adults (ages 65+) live with Type 1 diabetes. Simultaneously, technologies such as continuous glucose monitoring (CGM) have become standard of care. There is thus a need to understand better the complex dynamics that promote use of CGM (and other care innovations) over time in this age group. Our aim was to adapt methods from systems thinking, specifically a participatory approach to system dynamics modeling called group model building (GMB), to model the complex experiences that may underlie different trajectories of CGM use among this population. Herein, we report on the feasibility, strengths, and limitations of this methodology.MethodsWe conducted a series of GMB workshops and validation interviews to collect data in the form of questionnaires, diagrams, and recordings of group discussion. Data were integrated into a conceptual diagram of the “system” of factors associated with uptake and use of CGM over time. We evaluate the feasibility of each aspect of the study, including the teaching of systems thinking to older adult participants. We collected participant feedback on positive aspects of their experiences and areas for improvement.ResultsWe completed nine GMB workshops with older adults and their caregivers (N = 33). Each three-hour in-person workshop comprised: (1) questionnaires; (2) the GMB session, including both didactic components and structured activities; and (3) a brief focus group discussion. Within the GMB session, individual drawing activities proved to be the most challenging for participants, while group activities and discussion of relevant dynamics over time for illustrative (i.e., realistic but not real) patients yielded rich engagement and sufficient information for system diagramming. Study participants liked the opportunity to share experiences with peers, learning and enhancing their knowledge, peer support, age-specific discussions, the workshop pace and structure, and the systems thinking framework. Participants gave mixed feedback on the workshop duration.ConclusionsThe study demonstrates preliminary feasibility, acceptability, and the value of GMB for engaging older adults about key determinants of complex health behaviors over time. To our knowledge, few studies have extended participatory systems science methods to older adult stakeholders. Future studies may utilize this methodology to inform novel approaches for supporting health across the lifespan.

Social Determinants of Health and Psychological Capital Among Youth Experiencing Homelessness.

Social determinants of health affect health behaviors and outcomes. Youth experiencing homelessness suffer significant deprivation of resources such as inadequate housing, reduced education, poor health care, and decreased economic stability. Inner resources, such as psychological capital, may also be related to health behaviors and health outcomes. In this study, we sought to describe and explore associations among selected determinants of health and self-reported scores on indicators of psychological capital among youth experiencing homelessness. This cross-sectional secondary analysis was conducted with a randomized subsample of 148 youth. We calculated chi-square frequencies to describe the data, classical item analyses to evaluate responses, and correlation tests to examine significance of associations. Youth in this sample demonstrated that they possess inner resources associated with determinants of health. Education, health care, and social support were significantly associated with attributes of psychological capital (hope, efficacy, resilience, optimism). Sexual minority groups had high representation in this subsample (25.7%), indicating a need for more study and equitable services for this population. More research should be conducted to better understand the associations between determinants of health, psychological capital, and health behaviors among disadvantaged youth to advance health equity initiatives.

Loneliness and Crowded Living Predicted Poor Health in a Sample of Cancer Patients During COVID-19 Pandemic.

We investigated the influence of social determinants of health (SDOH), healthcare services, and health behaviors on mental and physical health outcomes of cancer patients between the first winter and the following post-vaccine summer of the COVID-19 pandemic. A three-wave online survey of individuals diagnosed with incident cancer between January 2019 and January 2020 was conducted between November of 2020 and August of 2021 in northeast Ohio. Descriptive analysis and mixed-effect regression analyses were performed. A total of 322 newly diagnosed cancer patients, with 40 African Americans and 282 Whites (215 from metropolitan areas and 67 nonmetropolitan) responded to the survey questions. In Wave 3 ending in August 2021, the survey respondents reported significantly reduced depression (p = .019) on the Hamilton Depression Rating Scale and improved global health (p = .036) on PROMIS. With age, comorbidity, and other demographic and medical variables controlled in the analyses, the feeling of loneliness (p < .001) and crowded living space (p = .001, p = .015) were the two most prominent factors associated with depression, irritability, and poor global health at baseline, with the lowest p values and persistent effect. Self-efficacy of taking preventive measures was associated with reduced depression (p = .001) and improved global health (p = .029). Increasing access to medicine (p < .01) and satisfaction with telehealth appointments (p < .01) were significantly associated with better global health and reduced irritability. Respondents who had private health insurance reported better health than those that had Medicare coverage only (p < .05). This longitudinal, observational study demonstrated the impact of SDOH on health outcomes of cancer patients. Substandard living conditions resulting in loneliness and crowdedness, quality of medical care (e.g., quality telehealth and access to medicine), and personal behaviors (e.g., self-efficacy) were significantly associated with health outcomes in newly diagnosed cancer patients during the pandemic and should be given adequate consideration for the purpose of improving clinical care.

Demographic and Socioeconomic Predictors of Prehypertension and Hypertension in the Adult Population: Serbian National Health Survey

Background and Objectives: Prehypertension and hypertension are the most common cardiovascular disorders worldwide and are increasingly considered one of the most serious public health problems, particularly in developing countries. The objective of this study was to determine the frequency and demographic and socioeconomic predictors of prehypertension and hypertension in the adults in Serbia, and to examine the relationship between prehypertension and hypertension and health behavior determinants (smoking, alcohol use, physical activity) and individual aspects of health (a health self-assessment, multimorbidity, BMI, depressive symptoms). Materials and Methods: The research is part of the fourth National Population Health Survey conducted in 2019, which was conducted by the Republic Institute of Statistics, in cooperation with the Institute of Public Health of Serbia and the Ministry of Health of the Republic of Serbia. As a research instrument, questionnaires were used in accordance with the methodology of the European Health Survey. For the purposes of this research, data on the adult population aged 20 and over were used. Results: Women are at a reduced risk for both prehypertension (OR = 0.328) and hypertension (OR = 0.349) by nearly 70%. Similarly, those aged below 60 years have a lower risk for prehypertension and those younger than 40 years have a lower risk for hypertension (OR = 0.995), whereas people with a lower education have a 4.3 times higher risk of prehypertension (OR = 4.323) and a 1.6 times higher risk of hypertension (OR = 1.614). The poor have a 1.4 times higher risk of prehypertension (OR = 1.413) and a 1 times higher risk of hypertension (OR = 1.035). People with multimorbidity have a 1.2 times higher risk of both prehypertension (OR = 1.218) and a 4.8 times higher risk of hypertension (OR = 4.867). Conclusions: Male gender, lower education, poverty, age and the presence of multimorbidity are significant predictors of prehypertension and hypertension in the Serbian adult population, so preventive strategies should be aimed at these sensitive population groups.

Pedagogical approaches to health-related physical education (PE) in the context of digitalisation – a scoping review

ABSTRACT Introduction There are varied consequences of digital transformation processes within the fitness and health-related living environments of adolescents (e.g. increased physical activity through wearables, body dissatisfaction through social media) which could potentially provide fruitful health-related learning experiences within different pedagogical approaches to health in PE (e.g. biomedical vs. alternative, Mong and Standal, 2019, “Didactics of Health in Physical Education – a Review of Literature.” Physical Education and Sport Pedagogy 24 (5): 506–518. https://doi.org/10.1080/17408989.2019.1631270). However, concerns have been raised that the integration of digital media into health-related PE could reinforce biomedical approaches to health and lead, for example, to a focus on increasing fitness through technology. This one-sided focus would not be in line with the demands for a comprehensive health education. This paper aims to map the current trend of pedagogical approaches to health-related PE in the context of digitalisation and to identify typical learning goals against this background. Methods We conducted a scoping review based on the framework of Tricco et al. (2018, “PRISMA Extension for Scoping Reviews: Checklist and Explanation.” Annals of Internal Medicine 169 (7): 467–473. https://doi.org/10.7326/M18-0850). We searched nine databases using a search term covering three topic areas: digitalisation, health, and physical education. Considering the publication years from 2013 to 2023, we selected papers in a three-step process (title-, abstract-, and full-text-screening). In total, we included 103 empirical and theoretical papers in the analysis using qualitative content analysis (Kuckartz, 2019, “Qualitative Text Analysis: A Systematic Approach.” In Compendium for Early Career Researchers in Mathematics Education, edited by G. Kaiser and N. Presmeg, 181–197. Cham: Springer). To map the pedagogical approach to health, we applied the following main deductive categories: conceptualisation of health, paradigmatic approach to health and envisaged learning goals. To analyse learning goals with regard to digitalisation, we used the distinction between learning with and about digital media as a focus of analysis. Results The scoping review shows that most of the papers discussed a broad conceptualisation of health for PE by addressing biopsychosocial aspects of health. Many of the implications for health- and digitalisation-associated learning goals related to pre-reflective and functional-reflective learning goals in the area of learning with digital media. They mainly focused, from a pathogenic viewpoint, on how digital media can increase health-enhancing physical activity, affective determinants of health behaviour and health-related knowledge. Parts of these learning goals have already been empirically investigated. Only a few papers proposed critical-reflective learning goals in the area of learning about digital media, aiming at a socio-emancipatory engagement with digital media, health and society. No empirical study within the scoping review investigated the effectiveness of such critical health- and digitalisation-related PE. Discussion and conclusion In light of the results, it is important that future genuine pedagogical research about health- and digitalisation-related PE increasingly focuses on the development and empirical evaluation of theoretically sound concepts for PE that are in line with the educational demands of comprehensive – thus also critical and salutogenic – health and digital education.

Path modeling of socioeconomic, behavioral, and environmental attributes of the Ebola epidemic in West Africa

The 2014 Ebola outbreak stands as one of the most severe outbreaks of the virus, resulting in approximately 15,227 confirmed cases and 11,310 deaths. Despite substantial research conducted on the biological and epidemiological features of the virus, limited attention has been given to how an individual&amp;rsquo;s health behavior contributes to its spread. This study aimed to identify socioeconomic, behavioral, and environmental factors associated with Ebola infection. Guided by the Socioecological Model of Health, a correlational analysis was conducted using data from three English-speaking West African countries with the highest Ebola caseloads and fatalities: Liberia, Nigeria, and Sierra Leone. Each country&amp;rsquo;s Ministry of Health compiled daily reports on Ebola infections, including confirmed cases and deaths within each district. Possible health behavior determinants were gathered from surveys conducted by each country with the assistance of credible international agencies. Path analysis was then conducted to identify the size and direction of direct and indirect effects associated with an Ebola infection. The results revealed that female unemployment men with some secondary education, availability of hand washing soap, female literacy, and total health expenditure significantly predict initial confirmed cases with an R2 of 0.41. Along with the predictors of initial confirmed cases, the main source of drinking water accounted for 59% (R2) of the variance in the latest confirmed deaths. Officials in high-prevalence countries are suggested to address the availability of soap for hand washing, male secondary education proportion, female literacy and unemployment, health expenditure, and main sources of drinking water to reduce the transmission of the Ebola virus.

Diabetes and the social, biologic, and behavioral determinants of endometrial cancer in the United States

BackgroundEndometrial cancer is one of the most common types of cancer that affects women’s reproductive system. The risk of endometrial cancer is associated with biologic, behavioral and social determinants of health (SDOH). The focus of the work is to investigate the cumulative effect of this cluster of covariates on the odds of endometrial cancer that heretofore have only been considered individually.MethodsWe conducted a quantitative study using the Behavioral Risk Factor Surveillance System (BRFSS) national data collected in 2020. Data analysis using weighted Chi-square test and weighted logistic regression were carried out on 84,118 female study participants from the United States.ResultsWomen with diabetes mellitus were approximately twice as likely to have endometrial cancer compared to women without diabetes (OR 1.54; 95%CI: 1.01–2.34). Biologic factors that included obesity (OR 3.10; 95% CI: 1.96–4.90) and older age (with ORs ranging from 2.75 to 7.21) had a significant increase in the odds of endometrial cancer compared to women of normal weight and younger age group of 18 to 44. Among the SDOH, attending college (OR 1.83; 95% CI: 1.12-3.00) was associated with increased odds of endometrial cancer, while renting a home (OR 0.50; 95% CI: 0.28–0.88), having other arrangements (OR 0.05; 95% CI: 0.02–0.16), being divorced (OR 0.55; 95% CI: 0.30–0.99), and having higher incomes ranging from $35,000 to $50,000 (OR 0.35; 95% CI: 0.16–0.78), and above $50,000 (OR 0.29; 95% CI: 0.14–0.62), were all associated with decreased odds of endometrial cancer. As for race, Black women (OR 0.24; 95% CI: 0.07–0.84) and women of other races (OR 0.37; 95% CI: 0.15–0.88) were shown to have lower odds of endometrial cancer compared to White women.ConclusionOur results revealed the importance of adopting a comprehensive approach to the study of the associated factors of endometrial cancer by including social, biologic, and behavioral determinants of health. The observed social inequity in endometrial cancer among women needs to be addressed through effective policies and changes in social structures to advocate for a standardized healthcare system that ensures equitable access to preventive measures and quality of care.

Personal Resources and Expectations and Health Behaviors Among Solid Organ Transplant Recipients—A Multicenter Study

BackgroundThe long-term success of organ transplantation (Tx) depends on the transplant recipient's ability to self-manage symptoms, treatment, lifestyle changes, and psychosocial consequences. Health behavior (HB) determinants include personality traits such as optimism, self-efficacy, and health locus of control. PurposeAssessing the relationship between personal resources and expectations and health behaviors of organ transplant recipients. Material and methodsThe study was conducted between 01/04/2018 and 30/10/2019 at 3 transplant centers in Poland. The study group consisted of 243 Tx recipients of kidney, heart, liver, and lung. The Health Behavior Inventory, Multidimensional Health Locus of Control Scale (MHLC), General Self-Efficacy Scale, Dispositional Optimism Scale, and Hospital Anxiety and Depression Scale were used to collect data. FindingsThe study group had medium levels of dispositional optimism (mean 15) and high levels of self-efficacy (mean 30.18). The MHLC scale was dominated by a belief in the influence of others and an internal locus of control over one's health. The respondents presented a high level of HB (mean 92.09). A positive relationship was found between personal resources (self-efficacy and optimism), MHLC and HB. The presence of depression and anxiety negatively affected personal resources and internal locus of health control and HB in terms of a positive mental attitude. Type of Tx differentiated internal locus of health control and HB. Predictors of HB were dispositional optimism, self-efficacy, influence of others with health locus of control, symptoms of depression, age and time since transplantation-explaining between 6.1% and 14.5% of health behavior categories. ConclusionsTo improve health practices among organ recipients, strengthening their personal resources is recommended. It is necessary to form an internal locus of control for adherence to positive HB.

WiN-Reha-effectiveness and durability of effects of orthopedic rehabilitation programs and the study of psychological determinants of aftercare behaviors: a study protocol.

Rehabilitation programs have been shown to have a positive impact on patients' health and work ability. However, the durability of these effects and the extent to which patients alter their health behaviors remain underexplored. This study is divided into two parts; the first assesses the effectivity of rehabilitation programs for orthopedic patients and the durability of effects. The second part examines psychological determinants of aftercare health behaviors. Study Part 1 employs a longitudinal study design with up to nine measurement occasions encompassing a three-year follow-up period. Treatment is provided as per orthopedic indications through rehabilitation centers. Measures include subjective health, work ability, body weight, and physical activity behavior. Study Part 2 incorporates a mixed-methods design, involving both quantitative and qualitative assessments. The quantitative component aims to recruit a subsample from Study Part 1 to assess psychological determinants of aftercare health behaviors over 12 to 24 weeks using Ambulatory Assessment. The qualitative component aims to explore the reasons for maintenance and discontinuation of health behaviors and involves a reflexive thematic analysis of interviews with at least 16 individuals, analyzing the differences between those who adopt and those who discontinue their aftercare health behavior. This comprehensive research project may offer insights into the long-term effectivity of rehabilitation programs. Furthermore, it may foster a more profound understanding of the successful incorporation of health-promoting aftercare behaviors, such as physical activity, into everyday life. Therefore, this study may contribute significantly to the evolving field of patient-centered rehabilitation. The trial has been registered at the German Register of Clinical Studies (DRKS) with the registration number: DRKS00032257.

Neighborhood-level social determinants of health and cardioprotective behaviors among church members in New Orleans, Louisiana

BackgroundFavorable neighborhood-level social determinants of health (SDoH) are associated with lower cardiovascular disease risk. Less is known about their influence on cardioprotective behaviors. We evaluated the associations between neighborhood-level SDoH and cardioprotective behaviors among church members in Louisiana. MethodsParticipants were surveyed between November 2021 to February 2022, and were asked about health behaviors, aspects of their neighborhood, and home address (to link to census tract and corresponding social deprivation index [SDI] data). Logistic regression models were used to assess the relation of neighborhood factors with the likelihood of engaging in cardioprotective behaviors: 1) a composite of healthy lifestyle behaviors [fruit and vegetable consumption, physical activity, and a tobacco/nicotine-free lifestyle], 2) medication adherence, and 3) receipt of routine medical care within the past year. ResultsParticipants (n = 302, mean age: 63 years, 77% female, 99% Black) were recruited from 12 churches in New Orleans. After adjusting for demographic and clinical factors, perceived neighborhood walkability or conduciveness to exercise (odds ratio [OR]=1.25; 95% CI: 1.03, 1.53), availability of fruits and vegetables (OR=1.23; 95% CI: 1.07, 1.42), and social cohesion (OR=1.55; 95% CI: 1.22, 1.97) were positively associated with the composite of healthy lifestyle behaviors. After multivariable adjustment, SDI was in the direction of association with all three cardioprotective behavior outcomes, but associations were not statistically significant. ConclusionsIn this predominantly Black, church-based population, neighborhood-level SDoH including the availability of fruits and vegetables, walkability or conduciveness to exercise, and social cohesion were associated with cardioprotective behaviors. Findings reiterate the need to address adverse neighborhood-level SDoH in the design and implementation of health interventions.

Perceived Determinants of Health-Related Behaviors Among Patients with Coronary Heart Disease After Percutaneous Coronary Intervention: A Longitudinal Qualitative Study.

Studies had reported some influencing factors of health behavior among patients with coronary heart disease(CHD) after percutaneous coronary intervention(PCI). However, considering that human perceptions are complex, unrestricted and dynamically changing. A longitudinal qualitative study was conducted to explore the determinants of health-related behaviors of patients after PCI and dynamic changes of these determinants at the 1st, 3rd, and 6th months. Using purposive sampling, 18 patients undergoing PCI were interviewed. The conventional content analysis method was used to identify categories and subcategories. Semi-structured, face-to-face or telephone in-depth interviews were conducted at the cardiology unit of a tertiary referral hospital in Yunnan Province, China from March 2022 to January 2023. Seven categories with some subcategories were constructed from the data, categorized into three domains. Firstly, individual factors include (i) Personal coping with healthy lifestyle requirements (tried but failed; I can do it), (ii) individual perception and feeling toward disease (knowing about the disease; belief of cure; fearsofrelapse), and (iii) personal benefits (improved health; meaning of life). Secondly, social factors include (i) social facilitators (family resources; healthcare support), (ii) social barriers (inconvenient medical care service; conflicting information). Finally, cultural factors include (i) way of living (dietary habits; key roles of yan (cigarette) and jiu (alcohol) in Chinese society), (ii) way of thinking (fatalism and Confucian familism). The determinants of health-related behaviors of patients after PCI are multifaceted and dynamic. Different interventions should be formulated to promote patients' adherence to health behaviors. Moreover, priority should be given to the impact of traditional Chinese philosophy on the health behaviors of patients after PCI, and the health promotion program for these patients should be culturally sensitive. In addition, future research should further explore the determinants of health behaviors among diverse ethnic minorities after PCI, which has not been fully inquired in this study.

Factor model of the health of the Russian population in the border areas

The subject of the study included significant conditions and factors for maintaining health in the context of ensuring the demographic security of Russian society. The object of the study was the national health of Russians and its regional specifics. Methodological approaches included a civilizational approach to the analysis of global and regional social, economic, behavioral determinants of health and population motivation for health-saving technologies. A secondary analysis of the phenomenon of national health in the context of modern humanitarian research is presented. The novelty of the study is based on the analysis of regional practices of the population in relation to their health, the structure of morbidity, factors and reasons motivating the population to take care of their health and lead a healthy lifestyle. Behavioral models of the population's attitude towards health and a healthy lifestyle are described; the structure of diseases in the population of border areas was analyzed. The specifics of motivation to preserve health through employer investments are described. It was concluded that there are regional specificities that determine the quality of public health and, in some cases, provoke specific “medical” interregional and external migration (for example, the opportunity to change place of residence to improve medical care). The health of employees of an enterprise of any form of ownership is a decisive reproductive component of human capital. In the conditions of the modern world, the permanent experience of the socio-economic and financial crisis, the transformation of values, the population is expected to significantly adapt to the changed conditions of society. All of this requires optimal levels of health and vitality. In this context, health is essential for the full and effective implementation of educational or professional activities.

Determinants of Health Behavior for Effective Treatment and Prevention of Chronic Obstructive Pulmonary Disease: Empirical Advances

Objective: The prime objective of this research is to investigate the impact of health behavior, quitting smoking, access to healthcare, and patients' adherence to healthcare on chronic obstructive pulmonary disease treatment. Methods: A 7-point Likert scale questionnaire was administered to collect the data. A sample size of 471 respondents was used for the determination of results with a structural equation modeling approach. Smart PLS 4 was used for testing the results of the measurement model assessment and structural model assessment. Results: The findings of the current study showed that health behavior, quitting smoking, access to healthcare, and patients' adherence to healthcare are significant antecedents of chronic obstructive pulmonary disease effective treatment. Conclusion: This research reported that the emphasis and support for health behavior improvement, quitting smoking support, access to better healthcare, and patient adherence to healthcare are opportunities useful for chronic obstructive pulmonary disease effective treatment all over the world. The research has reliable theoretical as well as practical implications that are critical to improving the body of knowledge and practices for the improvements in the treatment of chronic obstructive pulmonary disease.

Applying a multi-faceted infection control strategy to improve hospital environmental cleaning quality

BackgroundAlong with existing infection control policies, repeated education and training of environmental service workers (ESWs) improves their compliance and ultimately reduces hospital-associated infection (HAI) rates. However, only limited studies have explored the health behavioral determinants of ESWs regarding their cleaning performance after implementing an educational intervention with multi-faceted infection control strategy. ObjectiveTo determine whether an educational intervention with multi-faceted infection control strategy improves the health behavioral determinants associated with ESWs’ cleaning performance. MethodsTwenty-eight ESWs who received an educational intervention with multi-faceted hospital infection control strategy were included. ESWs’ knowledge, perceived benefits and barriers, self-efficacy, health literacy, and cleaning performance were evaluated at pre-intervention, post-intervention, and 3-month follow-up. ResultsHAI-related adenosine triphosphate (ATP) levels decreased significantly at post-intervention and 3-month follow-up compared with pre-intervention levels (all p < 0.05). All post-intervention ATP levels met the standard criterion after the 2nd environmental cleaning, with a median score of 267 (range, 71–386). High baseline ATP levels (odds ratio [OR] = 4.195, 95%CI 2.500–7.042, p < 0.05) were positively associated with qualified post-intervention ATP levels, while high education (OR = 0.480, 95%CI 0.276–0.833, p < 0.05) and high baseline knowledge scores (OR = 0.481, 95%CI 0.257–0.903, p = 0.023) were negatively associated with qualified post-intervention ATP levels. ConclusionEducational intervention using a multi-faceted infection control strategy improves health behavioral determinants (baseline education, knowledge scores and ATP levels) associated with ESWs’ hospital cleaning performance. Receiving an educational intervention may increase HAI knowledge of environmental cleaning among ESWs with high education or low baseline HAI knowledge.

Social Determinants of Health and 30-Day Readmissions in an Urban Community Hospital in Northwest Indiana

Background: Hospital readmission within 30 days of discharge is a quality of care indicator with implications for healthcare systems, payers, and patients. The Hospital Readmission Reduction Program enacted in 2012 aimed to reduce preventable readmissions. Yet in 2018, there were 3.8 million adult 30-day readmissions with an average rate of 14% and estimated cost of $15,200 per readmission. This study examined the influence of social determinants of health (SDOH), demographics, and health behaviors on 30-day readmissions at an urban hospital in Northwest Indiana. This is part of a Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to address SDOH.&#x0D; Methods: This retrospective study analyzed a limited dataset generated by SMMC in EPIC™ with SDOH, demographics, health behaviors, and health outcomes measures from inpatient admissions between January 2021 to March 2023. Data analysis consisted of descriptive, bivariate (Chi-Square; p&lt;0.05), and multivariate (binary logistic regression; p&lt;0.05) analyses in SPSS 29.0. This study was exempted by the Indiana University Human Research Protection Program (IRB #14040).&#x0D; Results: The sample consisted of 7445 patients, majority 65 years and above (56.5%), white (77.47%), and publicly insured (76.83%). 30-day readmissions represented 10.5% of admissions. The bivariate analysis revealed statistically significant associations between 30-dayreadmissions and age (p&lt;0.001), language (p=0.008), insurance type (p&lt;0.001), veteran status (p=0.017), and smoking (p&lt;0.001). The multivariate analysis found that age (OR=1.008; p=0.004), being a non-English speaker (OR=1.866; p=0.009), public insurance (OR=2.096; p&lt;0.001), and former smoking (OR=1.243; p=0.011) remained significantly associated with 30-day readmission.&#x0D; Conclusions: Social and behavioral factors were associated with 30-day readmissions in an urban community hospital. Incorporating SDOH and behavioral interventions into hospital readmission reduction programs may reinforce these programs. The upcoming CBPR phase will conduct advanced analysis on these findings to uncover new relationships relevant to SMMC’s objectives.

Neurovascular Conditions and Associated Socio-Demographic and Behavioral Factors in an Urban Hospital in Northwest Indiana

Background: Brain health equity remains an underexplored research area despite high prevalence of neurovascular conditions and related health impacts. This study examined the associations between socio-demographic, behavioral factors, and hospital admissions for neurovascular-related morbidity in an urban underserved community. It is part of a multi-phased Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to examine the prevalence, distribution, and relationships between social determinants of health (SDOH), demographics, health behaviors, and health outcomes in Northwest Indiana.&#x0D; Methods: This retrospective study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral and health outcomes data for adult inpatient visits from January 2021 to March 2023. Neurovascular admission was determined by ICD-10 Codes I67-69. Data analysis was conducted in SPSS 29.0 using descriptive statistics (i.e., frequencies and central tendency), bivariate analysis (Chi-square; p&lt;0.05), and multivariate analysis (binary logistic regression; p&lt;0.05). This study received exemption from Indiana University Human Research Protection Program (IRB #14040).&#x0D; Results: There were 1,489 participants included in this study. The majority were white (77.7%), older adults (67 ± 21.5) and publicly insured (77.8%). The bivariate analysis demonstrated significant relationships between admission for neurovascular conditions and age group (p&lt;0.001), veteran status (p&lt;0.001), insurance type (p&lt;0.037), and physical activity (p&lt;0.001). After adjusting for these factors in multivariate analysis, age group (p&lt; 0.003) and physical inactivity (p&lt;0.008) were significantly associated with admission for neurovascular conditions.&#x0D; Conclusion: Understanding how SDOH and behavioral factors influence neurovascular admissions and inequities in urban settings will enhance collaborative efforts to develop, implement, and evaluate evidence-based interventions. The subsequent CBPR phases will utilize these findings to explore how socioeconomic status affects these patients’ ability to seek emergent and/or surgical care. This will enable implementation of strategies that better account for SDOH in patient care.

Identifying Socio-Demographic and Behavioral Predictors of Prolonged Hospital Stay in an Urban Hospital in Northwest Indiana

Background: Hospital length of stay (LOS) is a crucial metric that impacts patient outcomes, healthcare resource utilization, and financial burden. In 2019 the CDC reported the average LOS in community hospitals was 5.4 days. Prolonged LOS is associated with an increased risk of hospital-acquired infections, decreased hospital bed availability limiting patient access to care, and cognitive impairment, particularly among the elderly. This indicates the importance of addressing LOS as a healthcare priority. This study examined the relationship between LOS and social determinants of health (SDOH), patient demographics, health behaviors, and health outcomes as part of a long-term Community Based Participatory Research partnership between IUSM-NW and St. Mary Medical Center (SMMC).&#x0D; Methods: This retrospective study analyzed EPIC™-generated data for adult inpatient visits at an urban hospital in Northwest Indiana from January 2021 to March 2023. Data analysis was performed using SPSS 28.0, consisting of descriptive statistics, bivariate analysis (One-way ANOVA, Independent T-tests, Kruskal Wallis H; p&lt;0.05), and Simple Linear Regression. This study was granted an exemption by the Indiana University Human Research Protection Program (IRB #14040).&#x0D; Results: The sample comprised of 10,916 predominantly white (77.7%) patients with a median age of 65 (IQR=22) and a median LOS of 4 days (IQR= 5). Bivariate analysis revealed LOS was significantly associated with age (p&lt;0.001), race (p&lt;0.033), sex (p&lt;0.012), insurance type (p&lt;0.001), physical inactivity (p&lt;0.001), and smoking tobacco (p&lt;0.001). After controlling for all factors in the multivariate analysis, age (p&lt;0.020), physical inactivity (p&lt;0.013), and insurance type (p&lt;0.013) retained their significance.&#x0D; Conclusions: These findings highlight the significance of demographic, behavioral, and social factors in relation to hospital LOS. Understanding these factors holds immense potential to guide the development of targeted interventions and healthcare strategies to optimize patient care and reduce LOS.

Use of online food delivery services among young adults in Depok City: Factors affecting the frequency of online food ordering and consumption of high-risk food

Purpose: The increasing desire of the community towards fulfilling the practical needs of life is currently accommodated by the rapid development of communication technology in the last five years in Indonesia. One example is the emergence of various food delivery applications. This will affect the pattern of daily food consumption in the community. Therefore, this study determined the personal and socio-environmental factors that influence the frequency of online food ordering (OFO) behavior and also high-risk food consumption through online food delivery services (OFDS) among young adults in Depok City. Theoritical Framework: This study adopts the social cognitive theory, developed by Bandura, as its framework. This theory is one of the most widely applied theories to discusses the determinants of health behavior. It is built on an understanding of the interactions that occur between individuals and environment. Methods: This research was a cross-sectional study conducted with 686 participants of young adults aged 20–39 years that lived in Depok City, West Java Province, Indonesia, for minimal the last six months. They were administered a questionnaire through Alchemer, formerly SurveyGizmo. Descriptive statistics were employed for all variables measured. A T-test and a Chi-square test were conducted to determine the factors influencing the OFO frequency and high-risk food consumption through OFDS. Predictor variables were generated using multi-logistic regression models. Results: The personal and socio-environmental factors related to the frequency of OFO behavior were attitudes toward risk, benefit, barriers, features of OFDS, satisfaction with OFDS, socio-environmental influence, perception about OFDS, and online food preference. Furthermore, the factors associated with high-risk food consumption through OFDS were attitudes toward benefit, features, satisfaction with OFDS, socio-environmental influence, perception about OFDS, online food preference, and knowledge of OFDS. The predictor for the frequency of OFO behavior was satisfaction toward OFDS (ß = 3.3; CI: 2.4–4.7; p-value &lt;0.001), while those for high-risk food consumption were personal and socio-environmental factors (ß = 1.8; CI: 1.3–2.5; p-value = 0.001 and ß = 1.7; CI: 1.2–2.4; p-value = 0.001, respectively). Conclusions: Satisfaction, social environment, and food preference play essential roles in OFDS. The findings demonstrated the urgency of conducting further studies to elaborate on the association of OFDS with non-communicable diseases.

Healthy Behaviors Among Non-Hispanic Black and Hispanic People Affected by Cancer During the Posttreatment Survivorship

Background There are disparities in health behaviors across racial and ethnic groups. However, limited studies focus on cancer survivors’ experiences developing and maintaining healthy behaviors, particularly in non-Hispanic Black (NHB) and Hispanic people. Objective This study aimed to understand the experiences of NHB and Hispanic people affected by cancer in developing and maintaining positive health behaviors beyond a cancer diagnosis. Methods The data were collected in a mixed-method study through semistructured interviews with 29 NHB and Hispanic cancer survivors between June and October 2022. Conventional content analysis was used. Results The lived experiences of cancer survivors were narrated in 3 themes: impact of a cancer diagnosis on oneself, facilitators and barriers to health and health behaviors, and utilization of available sources for health. Facilitators and barriers to health and health behaviors were further explored as biological (eg, symptoms, comorbidities), behavioral (eg, help-seeking behavior, sleep pattern), physical/built (eg, available sources, neighborhood), and sociocultural environment (eg, income, transportation, knowledge, culture, upbringing, household and community composition, social and family network), and healthcare system–related factors (eg, insurance coverage, personal preferences, perceived discrimination, and stigma). Conclusion Non-Hispanic Black and Hispanic people, specifically those living in disadvantaged neighborhoods with limited sources or where they feel discriminated and stereotyped, those with limited income and transportation, and those with physical, social, or mental health problems, seemed to have challenges prioritizing health behaviors and maintaining healthy living. Implications for Practice Biological, behavioral, and psychosocial determinants of health behaviors should be addressed through multilevel collaborations among different levels of partners.