Evidence-based Health Education Research Articles

“My Back Exercise App”—mHealth for Low Back Pain: Development and Usability Testing

Abstract Effective management of chronic low back pain (LBP) often relies on maintaining a healthy lifestyle. Mobile health (mHealth) applications provide a unique opportunity to support LBP sufferers by integrating evidence-based health education into daily routines. However, many existing mHealth apps lack scientific rigour in their development, limiting their impact. This study reports on developing and usability testing My Back Exercise, an mHealth app designed to support individuals managing chronic LBP through a user-centred, theory-based approach. The development followed the Double Diamond framework and Software Development Life Cycle (SDLC) model, focusing on behaviour change theory to promote healthy lifestyle habits. Usability testing involved ten users and employed the System Usability Scale (SUS) and Mobile App Rating Scale (MARS) to assess engagement, functionality, aesthetics, and information quality. Additionally, a think-aloud approach captured real-time feedback and guided iterative improvements. Results showed that the app was well-received, achieving a SUS mean score of 79 (total score of 100) and a MARS mean score of 3.7 (out of 5.0). Key intervention components included exercises, sleep management, diet, and pain education, contributing to a holistic self-management tool. This study provides a transparent roadmap for the development of evidence-based digital health tools. The My Back Exercise app offers an innovative, holistic approach to help people self-manage chronic LBP using evidence-based methods.

Youth Mental Health First Aid (YMHFA): A Change Initiative in an Underresourced School.

Background: School-aged children with unidentified mental illnesses experience poor health outcomes; managing this issue requires a collaborative community approach. Objectives: The objective was to implement an evidence-based mental health education and sustainment program within an underresourced school setting for staff and parents/guardians supervising children to optimize adult mental health literacy (MHL). Methods: The intervention included Youth Mental Health First Aid (YMHFA) training; measurements of pre- and post-MHL were completed with the Mental Health Literacy Scale (MHLS). Sustainment was achieved by developing a school-centered mental health toolkit and integrating a school champion. Results: There was a significant MHL score change from pretest to posttest. The toolkit bolstered sustainability by increasing the utilization of community resources. Conclusions: This mental health awareness initiative proved effective and can be expanded across similar underresourced schools to fill voids.

Social Networks as a Tool for Evidence-Based Health Education: Umbrella Review.

The number of people who access social networking sites continues to increase at an exponential rate. The use of technology is an essential skill for nursing professionals and its development represents a challenge in improving health education, promotion and care. The objective of this systematic review is to analyse the use of social networking sites by healthcare professionals as an intervention tool for evidence-based public health education. The protocol of this umbrella review was registered in the International Prospective Register of Systematic Reviews (CRD42023407249). Searches were carried out in MEDLINE (PubMed), Web of Science, CINAHL, PsycINFO (EBSCOhost), and Cochrane Library of Systematic Reviews, in February 2023. A narrative synthesis of the results was conducted. 1896 articles were found, of which 15 reviews fulfilled the inclusion criteria. Social networks broadened the profession; they were YouTube, X (formerly Twitter), Facebook, and Instagram. The target population was mainly young professionals, and they came across different topic areas that addressed health education. It is important to have information backed by scientific evidence to make health decisions. Health professionals active on social networking sites have a unique opportunity to educate the public about health by sharing scientific evidence in an accessible and clear way, which helps to combat misinformation.

Empowerment-based Teddy Bear Clinic for Pre-school Children: A Student-led Educational Project.

Nurses are at the forefront of providing health education for the general public and are leaders in developing health education programs for all ages. Research has shown that the pediatric population often experience anxiety surrounding common medical procedures. However, evidence-based health education has been shown to enhance self-management, increase knowledge, and decrease anxiety in the pediatric population. One such successful evidence-based health education approach designed for the pediatric population is the Teddy Bear Clinic. The purpose of this article is to report on the efficacy of a nursing student-led Teddy Bear Clinic designed to increase the awareness of common medical equipment and procedures in the pre-school pediatric population. This quality improvement project used a program evaluation design to assess the children's knowledge of common medical procedures and equipment. Participants were a convenience sample of 16 children aged 3-5 years old, attending one daycare center in a large city in Atlantic Canada. Findings showed that after participation in the clinic, the pre-schoolers reported a high level of knowledge of common medical equipment and procedures. This project shows that a Teddy Bear Clinic run by senior nursing students can promote community partnerships and enhance health knowledge in pre-school children.

My Body, My Choice: An Adapted Sexual Health Intervention for Youth with Histories of Commercial Sexual Exploitation

Youth with commercial sexual exploitation (CSE) histories experience high rates of unplanned pregnancies and sexually transmitted infections, with few interventions targeting their needs. We therefore piloted an evidence-based sexual health education intervention tailored for CSE-impacted youth, My Body, My Choice (MBMC). MBMC was implemented in two rounds between March and October 2021 with a total of 37 youth who completed a baseline questionnaire, engaged in a 13 to 16-hour online course over two to three weeks, and then assessed the course’s likability and feasibility via a post-course evaluation survey. To measure sexual health knowledge retention and attitudes, follow-up questionnaires were administered at baseline, 1-month, and 3-months post-course. Descriptive and bivariate analyses examined demographic characteristics and differences between timepoints. Most participants identified as female (92%), and Latinx (57%) or Black (27%). Overall, youth had an improved understanding of sexual health concepts over time, with significantly increased knowledge regarding birth control methods such as IUDs and condoms. Youth expressed high rates of satisfaction with MBMC, with 93% seeking continued course access. Findings underscore the utility and acceptability of MBMC and may inform future interventions to reduce health disparities and improve sexual health outcomes among youth with CSE histories.

Understanding Vaccine Hesitancy Dynamics: Insights from Northern Mindanao, Philippines

Background & Aim: Amidst the ongoing COVID-19 pandemic, vaccine hesitancy persists, especially within specific demographics. This study delved into vaccine hesitancy among Northern Mindanao, Philippines, residents aged 20 to 64, aiming to understand factors shaping vaccination decisions. Employing the Health Belief Model, the research sought to dispel misconceptions and bolster vaccine uptake through evidence-based public health education and improved communication strategies. By examining socio-demographic variables like age, gender, education, religion, and vaccination status, the study informed targeted interventions for enhancing vaccine acceptance and bolstering community health outcomes. Methods: This study employed a quantitative, descriptive-correlational design and analyzed vaccine hesitancy factors among Northern Mindanao, Philippines residents aged 20 to 64. Stratified sampling ensured representative inclusion across age groups, with a sample size of 372 respondents. Statistical analyses, including F-tests and ANOVA, assessed hesitancy differences, while stringent adherence to data privacy regulations safeguarded participant confidentiality. Results: Among respondents, those aged 51 to 69 exhibited the highest vaccine hesitancy levels, particularly regarding uncertainty and knowledge about COVID-19 vaccines. However, no significant relationship was found between hesitancy levels and age or gender. Conversely, significant disparities in hesitancy were observed concerning educational attainment, religion, and vaccination status. Conclusion: While age, gender, education, and religion are associated with varying levels of COVID-19 vaccine hesitancy, none singularly determine hesitancy. Enhanced education and knowledge about vaccines correlate with decreased hesitancy, emphasizing the necessity of targeted education initiatives. However, significant hesitancy disparities based on vaccination status underscore the ongoing challenge of addressing hesitancy despite reassurances about vaccine safety. Recommendation: Implementing tailored educational programs that address specific concerns related to demographic factors is recommended as a crucial strategy for reducing COVID-19 vaccine hesitancy

Survey of knowledge, practice, and associated factors toward home management of childhood fever among parents visiting Gondar health facilities in 2022.

Fever is a typical symptom of many sicknesses, but for children under the age of five, fever can have devastating consequences and represents a source of worry for parents. To the best of our knowledge, no research on home management of fever in children has been conducted in Ethiopia. We aimed to assess knowledge, practices, and associated factors towards home management of childhood fever among parents visiting Gondar Town health facilities in 2022. This multicenter institutional-based cross-sectional study was conducted in Gondar public health facilities from June 1st-June 30th, 2022. Participants were fathers and mothers of children aged 0-5 years. A stratified random sampling technique was used. Data were collected through face-to-face interviews using a pretested structured questionnaire. Approximately, 40.2% (95% CI: 35.5%, 45.2%) of parents had good knowledge and only 12.8% (95% CI: 9.7-15.8) of parents practiced home fever management. Being married [Adjusted odds ratio [(AOR) = 2.1 (1.2, 3.2)], having a primary or higher level of education [AOR = 2.4 (1.17, 4.9)] [AOR = 2.0 (1.02-4.6)], respectively, and number of children [AOR = 1.8 (1.63, 2.03)] were factors associated with parental knowledge. Likewise, being married [AOR = 3.05 (2.27.50-3.83)], receiving counseling from health care providers [AOR = 2.12 (1.53-3.32)], and being male [AOR = 2.03 (1.50-3.00)] were significant predictors of practice. Inadequate levels of knowledge and numerous irrational practices related to home fever management were predominant among parents, which needs to be addressed. Evidence-based health education is essential for parents to enhance their level of knowledge and practice to effectively treat fever at home.

Effects of school nurse-led health education to reduce malnutrition among primary school children in Bangladesh: Cluster nonrandomized controlled trial.

Malnutrition is a major health concern among children especially in low and middle-income countries. However, there are limited studies on school health in Bangladesh. This study aimed to reduce malnutrition among primary school children in Bangladesh by increasing awareness and knowledge through school nurse-led health education. A prospective, open-label, parallel-group (1:1), cluster nonrandomized controlled trial on primary school children conducted in rural Bangladesh. The study lasted 13 months between September 2021 and September 2022. Four schools were selected and assigned to the intervention and control groups (CGs). Next, school nurses provided evidence-based health education to the children in the intervention group (IG) for 9 months to improve awareness and knowledge of malnutrition. Data were collected at baseline, midline, and endline. Overall, 604 children were enrolled at the baseline; among them, 455 (CG, n = 220; IG, n = 235) completed the study. Changes in the malnutrition rate-the primary outcome-were not significant (P = 0.225). However, after adjusting the endline data with baseline and sociodemographic data, the children's body mass index improved significantly in the IG than in the CG (P < 0.05). Changes in eating behavior, and awareness and knowledge of malnutrition-the secondary outcomes-significantly differed between the groups (P < 0.001). The school nurse-led health education program significantly improved primary school children's awareness and knowledge of malnutrition. This study revealed the effectiveness of school nurses in reducing malnutrition among children, which may decrease future morbidity and mortality rates in children.

Implementing Public Health Modules as an Approach to Improve Knowledge and Attitudes of Medical Students: A Student-Led, Multiyear Study.

Public health is a necessary focus of modern medical education. However, while numerous studies demonstrate benefits of public health education during medical school among self-selected students (i.e., those interested in public health), there are few educational models shown to be effective across the general medical student population. This study examined the effect of a multiyear, case-based, longitudinal online public health curriculum required for all medical students at an urban, research-focused U.S. medical school. The authors created 11 short public health modules to supplement a year-long, organ-based preclerkship course at Columbia University Vagelos College of Physicians and Surgeons. Beginning in 2020, all students were required to complete these modules, with repeated surveys to assess changes in attitudes and knowledge of public health over time. The authors compared responses for these domains before and after each module, across multiple time points throughout the year, and cross-sectionally to a 2019 cohort of students who were not provided the modules. Across 3 cohorts, 405 of 420 (96.4%) students provided responses and were included in subsequent analyses. After completing the modules, students reported perceiving a greater importance of public health to nearly every medical specialty ( P < .001), more positive attitudes toward public health broadly ( P < .001), and increased knowledge of public health content ( P < .001). These findings were consistent across longitudinal analysis of students throughout the year-long course and when compared to the cohort who did not complete the modules. Case-based, interactive, and longitudinal public health content can be effectively integrated into the required undergraduate medical education curriculum to improve all medical students' knowledge and perceptions of public health. Incorporating evidence-based public health education into medical training may help future physicians to better address the needs of the communities and populations in which they practice.

DESIGN AND IMPLEMENTATION OF THE ACHIEVE SUCCESSFUL AGING HEALTH EDUCATION CONTROL INTERVENTION

Abstract Choice of comparison group was essential for participant recruitment and retention for the ACHIEVE Study and necessary to control for key components of the hearing intervention. The Successful Aging (SA) Health Education control intervention followed the protocol and materials developed for the 10 Keys to Healthy Aging (10Keys™), an evidence-based interactive health education program for older adults on topics relevant to chronic disease and disability prevention, previously implemented in other trials. The 10Keys contained up-to-date prevention guidelines based on the current recommendations from leading groups (e.g., United States Preventive Services Task Force, Centers for Disease Control and Prevention). To control for general levels of staff and participant time and attention, participants randomized to the SA control met individually with a 10Keys certified health educator who administered the program every 1-3 weeks, totaling four visits over ∼2-3 months. To match the contact schedule with the hearing intervention and promote retention, participants returned for booster sessions semi-annually. During COVID-19 restrictions, we delivered booster sessions by phone. Individually tailored session content included a standardized didactic education component (a 10Keys module) as well as activities, goal-setting, and optional extracurricular enrichment. To further enhance retention and perceived benefit, each session also included a 5- to 10-minute upper body extremity stretching program. We offered the SA control participants the hearing intervention and vice versa at the trial conclusion. Monthly committee calls ensured fidelity and allowed for troubleshooting any participant-related issues. Audio recordings of sessions delivered by health educators were reviewed monthly for quality control.

Implementing High-Intensity, Trauma-Informed Sexual Risk Reduction in Women Involved in the Criminal Legal System.

Although research supports using brief or extended behavioral interventions to increase prevention of sexually transmitted infections (STIs), there is a shortage of current information about the specific effects on women in a short-stay carceral environment. This evidence-based practice implementation project aimed to employ the Safer Sex Efficacy (SSE) Workshop in a jail setting. A repeated measures design was used to compare STI knowledge acquisition and reports of condom use self-efficacy in a group of incarcerated women before, immediately after, and 3 weeks after participation in a high-intensity behavioral counseling intervention. Twenty-one females between the ages of 20 and 45 years participated in the program. STI knowledge acquisition and reports of condom use self-efficacy were measured using the Sexually Transmitted Disease Knowledge Questionnaire and the Condom Use Self-Efficacy Scale. Findings support the feasibility of implementing evidence-based sexual health education programming incorporating information about sexual risk behaviors, STI knowledge, and behavioral skills practice in a short-stay correctional setting and further investigation with a larger sample.

Influences Impacting the Acceptance of Voluntary Medical Male Circumcision among Medical Students Pursuing Bachelor’s Degrees at Kampala International University Teaching Hospital

The primary objective of this investigation was to identify the determinants influencing the adoption of voluntary medical male circumcision services among bachelor’s male medical students at Kampala International University Teaching Hospital (KIU-TH). The study employed a cross-sectional descriptive design over a three-month period within Bushenyi District-Uganda, specifically at KIU-TH situated in Ishaka town. This hospital, a private institution, serves as a prominent teaching center for various medical programs. A sample of 372 bachelor’s male medical students participated in the study, responding to simple pretested semi-structured questionnaires. Analyzing the collected data via SPSS version 20 revealed a mean age of 28±5.504 years, ranging from 19 to 50 years. Predominantly, participants were in their 4th year of study (47.1%), unmarried (76.1%), identified as Christians (78.2%), and held Ugandan nationality (79.6%). Notably, 38.7% of students reported being circumcised, with 68.1% undergoing voluntary medical male circumcision (VMMC). However, among uncircumcised individuals, only 25.0% expressed willingness to undergo VMMC. All participants demonstrated awareness and comprehension of VMMC, with 96.5% acknowledging its role in HIV prevention and 77.2% recognizing potential complications associated with VMMC. Regarding attitudes, 68.5% held positive views on VMMC, highlighting that pain during the procedure is manageable (40.6%) and recovery is relatively swift (72.8%). Despite this, the uptake of Voluntary Medical Male Circumcision remained below national targets. While a majority exhibited favorable attitudes toward VMMC, a smaller fraction displayed willingness to engage in this procedure. The findings underscore the necessity for evidence-based health education initiatives and structured VMMC campaigns, specifically targeting medical students, to enhance the uptake of VMMC services. Keywords: Male circumcision, Healthcare providers, Male medical students, HIV, Health education.

Outcomes of a Comprehensive Sexual Health Education Intervention among Sexual and Gender Minority Youth Living in a Socially Conservative U.S. State

The purpose of this secondary analysis was to examine sexual health beliefs, self-efficacy, and knowledge of resources among sexual and gender minority youth (SGMY) participants. Sexual health education policy is inconsistent throughout the United States, especially in socially conservative regions of the U.S. Reach One Teach One North Dakota (ROTO-ND) was developed as an evidence-based and community implemented sexual health education program. Our results demonstrated improvement across the outcomes of interest among SGMY following the educational intervention. Multivariate analysis offers context of predictor variables post-education. Our findings underscore the importance of inclusive education for SGMY.

Using Health Education to Address Student Physical Activity and Nutrition: Evidence and Implications to Advance Practice.

School-based health education can provide students with learning experiences that improve knowledge, attitudes, and perceptions (KAP) and behaviors regarding physical activity and nutrition. We conducted a 2-phase systematic review. Phase 1 was a review of reviews (ie, systematic reviews or meta-analyses) that were published 2010-2018. Phase 2 was a search for individual articles published 2010-2020 addressing topics relevant to our review; we searched for articles that had not been part of a sufficiently relevant or recent review or that had been part of a review that concluded that too few articles were available to assert sufficient evidence. Forty-three studies were assessed: 20 randomized controlled trials and 23 quasi-experimental designs. Collectively, interventions had a favorable impact on students' PA and nutrition KAP, but behavioral and secondary outcome results (eg, body mass index) were mixed. Using the evidence-based health education strategies identified in this review can help contribute to improvements in students' KAP and behaviors.

Increasing the Productivity of Public Health Awareness Through Quality Education

The purpose of this article is to understand the importance of improving health awareness through education to achieve a quality and productive society. This article presents a synthesis of various scientific studies examining the impact of health education on increasing health awareness and its implications for society. The research methods used included a descriptive qualitative approach, a literature review, and a document analysis. The results show that health education has a positive impact on behavior change towards a healthy lifestyle, decreased disease burden and health care costs, and improved quality of life and productivity. Challenges in implementing health education in schools were also discussed, along with effective strategies to overcome these challenges. The implications of the findings include the need for educational policies and practices that prioritize health education, integrate it into the curriculum, and provide adequate resources and support for teachers. In addition, the article recommends further research and action, including the evaluation of specific health education interventions, exploration of cultural and contextual factors, and collaboration between stakeholders, to support evidence-based health education initiatives. Overall, improving health awareness through education plays an important role in building a quality and productive society.

Testing a Proof of Concept of an Online Simulator-Based Training for Facilitators of Evidence-Based Sexual Health Education Interventions: A Small Randomized Trial Involving Making Proud Choices

Well-trained facilitators are critical for prevention programs. However, in-person facilitator training can be expensive and inconvenient. To make facilitator training affordable and accessible, we tested a prototype of online simulator-based training for Making Proud Choices! (MPC) facilitators using a mixed-method approach of survey assessments and observations of teaching. MPC is a leading evidence-based human immunodeficiency virus (HIV), sexually transmitted infection (STI), and teen pregnancy risk-reduction program. A convenience sample of 53 adults was randomly assigned to receive facilitator training on one MPC activity either via an online simulation or via in-person. Participants completed pre–post-surveys and role-played the activity to demonstrate both fidelity and quality of instruction post-training. Pre–post-survey findings demonstrated that the online simulation group was no different compared to the in-person group for improvement in creating a safe and inclusive environment and for engagement of students. This was not the case for knowledge of the curriculum and steps of proper condom use, self-efficacy, and self-reported handling of some sensitive questions and student whispering. However, we did find comparable pre–post-change between the two groups on these measures. Role-play observation results showed that the online simulation group was no different, and in many cases better, than the in-person group on fidelity and quality indicators. Participants reported high levels of acceptability, likability, and applicability to teach youth about sexual health and safety using the prototype. Findings suggest online simulation training can replicate the learning experience from in-person methods, which, in turn, increases access to effective educator training.

Expectancies that Predict Cannabis Initiation in Response to Legalization

Background: Recent and prospective changes to nonmedical/recreational cannabis laws in the United States and abroad raise questions about how legalization may influence cannabis use behaviors. Objectives: In the current study, we examined links between legalization, context-specific likelihood of using cannabis, and cannabis expectancies using cross-sectional survey data from 121 college students who had never used or were abstaining from cannabis in a U.S. state where laws prohibit nonmedical cannabis. Results: We found that across scenarios, 61% of students reported they would be more likely to use cannabis if it were legal. Social/sexual facilitation expectancies predicted a higher likelihood of using cannabis after legalization in a social context. Relaxation/tension reduction expectancies predicted a higher likelihood of using in an anxiety relief context. Perceptual/cognitive enhancement expectancies predicted a higher likelihood of using in a pain relief context. Cognitive/behavioral impairment expectancies predicted a lower likelihood of using in social, pain relief, relaxation, and concert contexts. Global negative effects expectancies predicted a lower likelihood of using in relaxation and concert contexts. Conclusions: Our findings suggest that among college students who do not use cannabis, expectancies are linked to cannabis use likelihood in certain contexts if cannabis were legal. This work highlights cannabis expectancies and contexts as possible targets for evidence-based public health education and clinical prevention initiatives related to the potential increase in cannabis use associated with cannabis policy implementation. College students may benefit from initiatives that address cannabis expectancies and enhance harm reduction skills to help them effectively navigate contexts in which cannabis is available to them.

Assessment of Knowledge and Attitude towards Coronavirus Disease 2019 Vaccines among Students in Zambia - A Case Study of the University of Zambia

Equitable access to safe and efficacious vaccines is essential to the fight against Covid-19. Low vaccine acceptance poses a challenge to controlling the Covid-19 pandemic. Young people are key in the fight against Covid-19, as they are a majority in most African populations. A cross-sectional study was used to assess the knowledge and attitude toward Covid-19 vaccines among university students in Zambia. This study comprised a total of 160 respondents with an average age of 21.0 + 3.6 years, ranging from 18 to 46 years. The study was done between January and February 2022. Random sampling was used for participant enrollment, and an interviewer-administered questionnaire was used for data collection. Spearman’s Rank Correlation test and Binary Logistic Regression were performed to establish relationships among the study variables. The study revealed a knowledge score of 61.3%, and a Covid-19 vaccine acceptance score of 28.0%. Knowledge was also found to be associated with Covid-19 vaccine acceptance (p&lt;0.05). Covid-19 vaccine acceptance showed an association with history of having a relative or close friend who had Covid-19 infection (OR=2.041, C.I. 95%, 1.010-4.127; p&lt;0.05), as well as knowledge (OR=1.275, C.I. 95%, 1.045-1.556; p&lt;0.05). The results showed good knowledge of Covid-19 vaccines among students. The attitude was however found to be negative, as indicated by a vaccine acceptance score of 28.0%. Evidence-based health education on the importance of Covid-19 vaccination is needed to counter myths and conspiracy beliefs about the disease to improve vaccine uptake. Keywords: Vaccines; Covid-19; Acceptance; Attitude; Knowledge; Zambia.

Supporting Faith-Based Communities Through and Beyond the Pandemic.

The COVID-19 pandemic brought widespread and notable effects to the physical and mental health of communities across New York City with disproportionate suffering Black/African American and Hispanic/Latino communities alongside additional stressors such as racism and economic hardship. This report describes the adaptation of a previously successful evidence-based community engagement health education program for the deployment of resilience promoting workshop program in faith-based organizations in BIPOC communities in New York City. From June 2021 to June 2022, nine faith-based organizations implemented 58 workshops to 1,101 non-unique workshop participants. Most of the workshops were delivered online with more women (N = 803) than men (N = 298) participating. All organizations completed the full curriculum; the workshop focused on self-care and physical fitness was repeated most frequently (N = 13). Participants in the workshops ranged from 4 to 73 per meeting and were largely female. The Building Community Resilience Project is an easy and effective way to modify an existing, evidence-based community health education program to address new and relevant health needs such as resilience and stress amidst the COVID-19 pandemic among faith communities serving BIPOC populations. More research is needed regarding the impact of the workshops as well as adaptability for other faith traditions.

Research Progress on the Application of Intervention Mapping in Tertiary Prevention of Cancer

Intervention mapping (IM) is a framework for formulating theory-and evidence-based health education projects with participatory approaches from ecological perspectives.The intervention program designed via IM plays a role in reducing the exposure of cancer risk factors,increasing cancer prevention behaviors,and promoting early cancer screening and rehabilitation of cancer patients.This study summarizes the characteristics,implementation steps,and application status of IM in tertiary prevention of cancer,aiming to provide reference for the application of IM in the health education projects for cancer in China.