Greater Engagement Research Articles

Factors influencing engagement with adherence-enhancing mobile health app in sickle cell disease

BackgroundMobile health (mHealth) applications have been utilized in chronic diseases to improve medication adherence, though factors driving engagement remain understudied. We previously demonstrated the benefits of mHealth app utilization in increasing adherence to hydroxyurea. In the “Integration of mHealth into Sickle Cell Disease (SCD) Care to Increase Hydroxyurea Utilization” (meSH) study, greater engagement with the InCharge Health app increased the percentage of days covered (PDC) for hydroxyurea. However, factors influencing app engagement were not investigated. This study aimed to identify patient-level factors associated with mHealth engagement during and post-study among adolescents and adults with SCD.MethodsAll meSH participants were included. The InCharge Health app use was measured for 24 weeks (study period) and 12 weeks (post-study period). Baseline demographics and validated measures of self-efficacy, financial hardship, and pain severity, impact, and frequency were evaluated as predictors of app engagement during the study period and post-study using linear models.ResultsComplete app use data were obtained from 284 of 293 participants, including 150 (52.8%) females and 240 (84.8%) who were HbSS/HbSβ0-thalassemia with a median age of 27 years. During the study period, 232 (81.7%) used InCharge Health at least once (median use excluding zeros: 26 days; IQR: 7–72 days). During the post-study period, 132 (46.5%) participants used the app at least once (median use excluding zeros: 16 days; IQR: 3–44 days). During the study period, the HbSS genotype, age > 25 years, higher education, higher self-efficacy score, and lower pain severity were associated with greater app engagement. Only age (p = 0.0032) and financial hardship (p = 0.0125) were significant in a multivariable model after backward elimination. During the post-study period, older age (p = 0.035), lower pain severity (p = 0.021) and lower frequency of pain (p = 0.033) predicted mHealth engagement. All three remained significant in a multivariable model after backward elimination.ConclusionsOlder age, lower financial hardship, lower pain severity, and greater self-efficacy were associated with increased engagement with a mHealth intervention for improving medication adherence among people living with SCD. This research can shift future app development from focusing on factors that drive patient interaction with mHealth targeting modifiable factors influencing app engagement.Trial registrationThe trial was registered with ClinicalTrials.gov. Registration Identifier: NCT04080167. Registration date: November 11, 2019.

Positive Neuropsychological Factors Associated With Greater Engagement in Brain Health Behaviors in Older Adults.

Background: Research has examined the influence of positive psychological factors including purpose in life (PIL), need for cognition (NFC), and psychological flexibility on behaviors that support brain health (i.e., preserved cognitive functioning and brain structures). However, more research is needed to examine their predictive validity in relation to other important factors in this context including emotional distress and dementia worry. Objective: The current study included 348 older adults who completed self-report measures of PIL, NFC, psychological flexibility, emotional distress, dementia worry, and brain health behavior engagement via Qualtrics. Results: Greater PIL was associated with more engagement in all brain health behaviors while NFC was only associated with more cognitive activity, heart health monitoring, and stress management. Psychological flexibility mediated the association between PIL and engagement. Conclusion: Our findings add evidence to the incremental validity of positive neuropsychological factors on engagement in brain health behaviors. Implications for neuropsychological interventions are discussed.

Open Science at the generative AI turn: An exploratory analysis of challenges and opportunities

Abstract Technology influences Open Science (OS) practices, because conducting science in transparent, accessible, and participatory ways requires tools and platforms for collaboration and sharing results. Due to this relationship, the characteristics of the employed technologies directly impact OS objectives. Generative Artificial Intelligence (GenAI) is increasingly used by researchers for tasks such as text refining, code generation/editing, reviewing literature, and data curation/analysis. Nevertheless, concerns about openness, transparency, and bias suggest that GenAI may benefit from greater engagement with OS. GenAI promises substantial efficiency gains but is currently fraught with limitations that could negatively impact core OS values, such as fairness, transparency, and integrity, and may harm various social actors. In this paper, we explore the possible positive and negative impacts of GenAI on OS. We use the taxonomy within the UNESCO Recommendation on Open Science to systematically explore the intersection of GenAI and OS. We conclude that using GenAI could advance key OS objectives by broadening meaningful access to knowledge, enabling efficient use of infrastructure, improving engagement of societal actors, and enhancing dialogue among knowledge systems. However, due to GenAI’s limitations, it could also compromise the integrity, equity, reproducibility, and reliability of research. Hence, sufficient checks, validation, and critical assessments are essential when incorporating GenAI into research workflows.

Place leadership through local planning: integrating urban design and economic development

ABSTRACT Amid growing interest in how place leadership supports local and regional development, this paper explores the place leadership contribution of UK local authority planning functions. It does this through case study evidence from West Dunbartonshire in Scotland, where place leadership capacity has been developed to implement a long-term urban design policy agenda. The paper argues that local authority planners play a crucial role in navigating powerful political economic processes to deliver a long-term vision for place, and that scholarship on place leadership could be informatively developed through greater engagement with how the built environment shapes place.

Performance Authenticity in the 2016 Liturgies at the Notre Dame Cathedral of Paris

This sociological study describes the exceptional qualities of the 2016 Notre Dame liturgies. My criterion of evaluation is authenticity, defined as faithfulness to a transcendent purpose in liturgical performances. The four areas of prayer, singing, participation, and visualization at Notre Dame are first compared to those of Papal Masses, a Protestant celebration, Sunday masses during the pandemic, and the daily 30-min Masses on American television networks. At Notre Dame, all the aspects of the liturgy were choreographed by the rector-master of ceremonies and visualized through theological concepts. The entrance procession was different each week, ranging from only two acolytes and the celebrating bishop to about fifty priests and several bishops. The performance of the choir was adapted to the needs of the weekly liturgies. The participation of the congregation was encouraged by professional singing leaders, and visualization through vertical and horizon images conveyed a sense of pilgrimage toward eternity. Is this a model for the universal Church, or specific to the French Church? The election of a pope from the Global South suggests that Catholicism has moved away from European models toward greater engagement in the world.

Rapid Assessment Amid an Injection Drug Use-Driven HIV Outbreak in Massachusetts' Merrimack Valley: Highlights from a Case Study.

Illicitly manufactured fentanyl within the drug supply has substantially increased opioid-related overdose deaths and driven infectious disease outbreaks among people who use drugs (PWUD). Local jurisdictions often lack the data and tools necessary to detect and translate such moments into actionable and effective responses. Informed by a risk environment framework, this case study adopted a mixed-methods design spanning two rapid assessment studies with PWUD in Lowell (n = 90) and Lawrence (n = 40), Massachusetts, during an HIV outbreak (2017, Study 1) and following the outbreak (2019, Study 2). Survey responses (n = 130) were summarized by computing descriptive statistics, ethnographic field notes were reviewed, and qualitative interviews (n = 34) were thematically analyzed to contextualize quantitative findings. Study 1 participants reported constrained syringe access, high injecting frequency, syringe reuse, and unsafe syringe disposal practices, and uncovered entrenched social and structural factors exacerbating existing substance use and HIV risks: housing instability, limited harm reduction supplies and services (e.g., MOUD access), and tensions between law enforcement and PWUD. Following the outbreak and substantial local investments in harm reduction and treatment infrastructures, Study 2 participants indicated lower injection risk reporting fewer syringe reuse episodes, improved syringe disposal practices, high frequency of naloxone administration at recent overdoses, frequent testing for HIV and HCV, and greater engagement with syringe services programs. A rapid assessment approach to fentanyl's emergence and a concomitant HIV outbreak provided time-sensitive, critical insights and identified needed and local response strategies. However, unless social and structural risk factors are also addressed, community vulnerability to future HIV outbreaks remains.

Gender Differences in Self-Advocacy Among Cancer Survivors: How Women and Men Vary in How They Learn to Engage in Decision-Making and Social Support.

Understanding gender variations in self-advocacy can help oncology clinicians support the educational needs of cancer survivors. This study aims to examine the role of gender along with additional other sociodemographic variables in how cancer survivors self-advocate including their engagement in decision-making, communication with healthcare providers, and use of social support. Data from two cross-sectional descriptive studies were combined for analyses. Each study used convenience sampling methods to recruit adults (≥ 18 years old) with a history of invasive cancer who had English literacy from cancer clinics and community advocacy groups. The first study recruited women (n = 317), and the second study recruited men (n = 179). In both studies, participants completed two assessments of self-advocacy: Self-Advocacy in Cancer Survivorship (SACS) Scale and the Patient Self-Advocacy Scale. We built a linear regression model to test the association between gender and self-advocacy total and subscale scores controlling for covariates. N = 496 participants completed study procedures between 2014 and 2022. On both self-advocacy scales, women reported higher self-advocacy scores compared to men, with women's higher scores on the SACS subscales of connected strength and informed decision-making driving the gender difference in cancer-specific self-advocacy. Self-advocacy behaviors are associated with gender, most notably by way of individuals' ability to derive strength through social connection. Women tend to have greater engagement in care with larger and more meaningful social networks, while men report less engagement. Educational materials for cancer survivors should leverage gender-associated self-advocacy skills and bolster skills that require support.

Pilot study protocol evaluating the impact of telerobotics interactions with autistic children during a Denver intervention on communication skills using single-case experimental design

IntroductionFor several years, studies have been conducted on the contribution of social robots as an intervention tool for children with autism spectrum disorder (ASD). One of the early intervention models...

Development of School Tour Video with Wall Tracking Technique (Planar Tracker) as a Promotional Media for The Introduction of Kak Seto School Facilities

This study aims to assess the quality improvement of the newly developed video (School Tour Sekolah Kak Seto) compared to the old video (Fasilitas Sekolah Kak Seto) and to understand user responses to the school tour video. This research was carried out because Kak Seto School faces challenges in utilizing digital media as the primary tool in its strategy to promote the school's facilities. Previously, Kak Seto School had a video titled “Fasilitas Sekolah Kak Seto” on its YouTube Channel, focusing on introducing all the facilities available at the school. However, the video has yet to implement visual effects, the text used in the video is still fundamental, the color grading remains dark and inconsistent, and the camera/footage techniques have not met current industry standards. Therefore, developing a new School Tour video for Kak Seto School is necessary, incorporating innovations such as wall-tracking visual effects to convey the school’s facilities better. This study uses the ADDIE development method by Robert Maribe Branch, consisting of analyzing, designing, Developing, Implementing, and Evaluating. The results demonstrate that the school tour video is of higher quality than the previous video, as it has greater engagement. User responses from media and content experts rated the video as "Very Good," while respondent assessments rated it as "Good" as a promotional medium for introducing school facilities.

Getting by with a little help from my antiracist White friends: Can White antiracism counteract the demobilizing effect of positive contact?

Recent research indicates that positive intergroup contact with advantaged groups (e.g., White Americans) may decrease ingroup collective action amongst marginalized groups (e.g., Black, Hispanic/Latinx Americans). However, we hypothesized that seeing White Americans—and specifically one’s friends—as antiracists who actively oppose racial inequality could boost collective action in marginalized groups, counteracting this effect. Four studies and an internal meta-analysis revealed that positive contact was associated with less collective action, but perceiving one’s White friends as antiracist was associated with greater engagement. This effect was specific to White friends; perceiving White people as antiracist was not mobilizing. Further, anger about inequality and movement identification (social identity model of collective action [SIMCA]) mediated these associations. This research reveals that although positive contact can be demobilizing for marginalized racial groups, Whites’ vocal allyship within intergroup friendships can enhance social change behaviors.

Road through a broken place: the BRI in post-coup Myanmar

In the wake of the 2021 coup, Myanmar experienced a renewed civil war that has fragmented the country along a myriad of old and new conflict lines. Despite the high-intensity violence across many regions of the country, China is still pursuing an ambitious connectivity project under its Belt and Road Initiative (BRI): The China-Myanmar Economic Corridor (CMEC) is meant to connect Myanmar to the Chinese market and boost Myanmar’s industrial development. However, the challenging post-coup environment has required significant changes in China’s approach to local infrastructure development and empowered a new set of subnational actors on both sides of the border. This article analyzes how CMEC has fared since the coup, and how the fragmentation of Myanmar has gone hand in hand with that of Chinese agency in the country. Contrary to prevailing descriptions of the BRI as a coherent, strategic, and top-down project, we argue that the case of Myanmar exposes the degree to which it is shaped by local interests and circumstances, and the limits of centralized BRI implementation. Finally, it is likely that adjustments in Chinese policy triggered by the situation in Myanmar will have more long-term consequences for the future of the BRI, specifically a more direct involvement in local security efforts and greater engagement with local authorities beyond the central government.

Effects of personal cancer history and genomic risk information on mothers' psychological adaptation to inherited breast/ovarian cancer syndrome.

This study aimed to understand long-term coping responses of mothers (N = 287) receiving genetic counseling and testing (GCT) for hereditary breast/ovarian cancer (HBOC) syndrome. Psychological characteristics, including cancer-specific distress (Impact of Events Scale-Revised, α = .85) and coping (Brief COPE, α = .93) were assessed via structured personal communication, along with epidemiologic items assessing personal and family history of cancer. Genetic risk was determined by BRCA1/2 carriage. A principal component analysis was conducted on the coping measure to reduce its summary score to active coping (α = .91) with nine approach-oriented strategies responsive to stress. A multivariable regression model examined the main and interacting effects of clinical and psychological characteristics on maternal coping. Personal cancer history (F = 4.99, df = 1, p = .026), BRCA test result (F = 22.20, df = 1, p < .001), and cancer-specific distress (F = 17.80, df = 1, p < .001) were associated with greater engagement in active coping strategies. When controlling for cancer-specific distress, the interaction between personal cancer history and genetic test results was significant, such that women previously unaffected by cancer who received positive BRCA results reported the greatest levels of active coping (F = 7.92, p < .001). These findings indicate that previous cancer history, genetic risk, and psychological distress independently and jointly impact how women adapt to the threat of cancer over time.

Advancing flourishing as the north star of medical education: A call for personal and professional development as key to becoming physicians

Over the past 15 years, multiple calls to transform medical education, and by extension, health sciences education, have addressed issues pertaining to learners’ subjective experiences as well as the learning environment. By and large, these calls to transform share many of the same themes: greater engagement with the humanities, enhanced professional identity formation, leadership development, as well as systemic changes to enhance meaning, purpose, and belonging. However, the many initiatives and reforms underway in medical education have yet to fully reach their desired outcomes – particularly those focused on enhancing meaning, purpose, and belonging. We suggest that calls to transform medical education can be unified and guided by focusing on the promotion of human flourishing. Briefly, we define human flourishing as an aspirational objective enabling one to reach a state of ‘wholeness—of being and doing, of realizing one’s potential and helping others do the same.’ We share our implications of a flourishing guided medical education journey for medical students, residents, and faculty.

Mind-Body Dualism, Health, and Well-being in University Students

Abstract Mind-body dualism conceptualizes mind and body as distinct, but there are different ways that dualism may be instantiated. In this study, we examined how Hierarchical Dualism (the belief that mind and body are distinct, and the mind is superior) and Mutual-Influence Dualism (the belief that mind and body are separate but interrelate) related to health behaviors and mental health in three student samples: exclusively queer, exclusively straight, and a mixed university subject pool (N = 535). Participants in each sample endorsed Mutual-Influence Dualism at a higher rate than Hierarchical Dualism. Mutual-Influence dualism was consistently associated with greater engagement in health-promoting behaviors and greater well-being, whereas Hierarchical Dualism differed by sample. These results suggest that dualist beliefs do not uniformly shape the lives of those who hold them: rather, the relation between dualist beliefs and health differs as a function of the type of dualism and the identities we hold.

The Role of Grandparents in Facilitating Children's Physical Activity.

Research suggests there is considerable opportunity to improve children's movement behaviors while they are being cared for by their grandparents. An understanding of the extent to which grandparent practices facilitate children's engagement in physical activity is critical to the development of health interventions targeting grandparent caregivers. This study examined the activity-related beliefs and practices of grandparents and their association with grandchildren's engagement in various movement behaviors while in grandparental care. Australian grandparents (N = 1190; 60% women) who provided regular care to a grandchild aged 3-14years were recruited via a web panel provider to complete an online survey. The survey assessed grandparents' physical activity-related beliefs (eg,perceived importance) and practices (eg,support and social control) and their grandchildren's engagement in physical activity (unstructured, structured, and outdoor play) and screen-based activities while in grandparental care. The importance of grandchildren's physical activity was rated highly by grandparents. Grandparents' support for their grandchildren's physical activity was positively associated with their grandchildren's engagement in structured physical activity, unstructured physical activity, and outdoor play. Negative social control was associated with greater engagement in screen-based activities. Other correlates of grandchildren's physical activity and screen-based activities included grandparents' own engagement in these activities. Findings highlight the importance of reinforcing the beliefs and practices that positively influence children's movement behaviors and addressing those that have unintended consequences. Encouraging grandparents to support their grandchildren's physical activity and discouraging forms of negative social control are likely to be important in efforts to promote physical activity in children.

Attitudes and engagement about cascade genetic testing among women diagnosed with cancer.

313 Background: Cascade testing in families with hereditary cancer syndromes is challenging because patients are responsible for engaging their relatives about test results and clinical support is limited. There are concerns that patient engagement with family members may not be well tailored to the clinical relevance of their test results, with particular concern about variants of uncertain significance (VUS). Methods: We selected patients from the Georgia California Genetic Linkage Initiative, which identified all patients diagnosed with cancer 2013-19 in the 2 states who linked to a germline genetic test. We surveyed 2100 women diagnosed with breast, ovarian or uterine cancer in 2018-19 in Georgia and California who reported a pathogenic variant (PV) that increases the risk of cancer on testing about 4 years after diagnosis and a comparable sample of 1250 women who reported a VUS-only result. The expected response rate from the cohorts is 55% (N=1900). We present preliminary results on patient attitudes about engagement with family and clinicians and behaviors related to their test results. Results: The 2 cohorts were comparable in age (mean 54 vs 58 for VUS, p&lt;.001) and education (college graduate or more 52% vs 53% for VUS p=.235). The Table shows that for patients who reported a PV, belief in the utility of testing in family members was high. A substantial proportion reported that a genetic counselor encouraged them to talk to relatives and talked directly with relatives about testing. PV carriers informed most first-degree relatives about their test results. Patients who reported VUS only were less likely to endorse the utility of testing in relatives; less likely to report that a genetic counselor encouraged family engagement or engaged family directly about testing; and were less likely to have informed relatives about their test results. PV carriers with breast cancer were more likely than VUS-only carriers to receive bilateral mastectomy after diagnosis: PV high risk 88%, PV lower risk 55%, PV other 48%, VUS only 45% p&lt;.001. Conclusions: Compared to patients with VUS-only test results, women with PVs on germline genetic testing after diagnosis of cancer had more positive attitudes about the utility of testing of family members, greater engagement with clinicians and family members about test results and greater uptake of prevention procedures. These findings suggest that engagement with family about genetic testing after cancer diagnosis matches the clinical relevance of the results. Patient attitudes and report of engagement about genetic test results. % Item PV N=596 VUS only N=166 Genetic test results are useful to my family 90 64 Wanted family members to get tested 84 46 Genetic counselor encouraged me to talk about results with family 73 46 Genetic counselor talked directly with family members about testing 56 38 % of first-degree relatives who were informed of patient test results, mean 88 65 p&lt;.001 for all comparisons.

Media representation of recovery colleges in Australia: a content analysis

ABSTRACT Background: Recovery Colleges (RCs) are educational hubs that offer a distinct approach to mental health and wellbeing, fostering inclusive learning opportunities. This study aimed to investigate Australian media representations of RCs and discusses how these representations may influence overall community awareness and acceptance of RCs. Methods: Australian online and print news articles on RCs were identified using key words and extracted from two databases: (i) Google News and (ii) Factiva. Content analysis was used to summarise key characteristics of media articles and framing theory informed the identification of news frames. Results: Twenty–three news articles were included. Most were published in local or regional news outlets. Mental health was mentioned in most articles (n = 22), with the majority contextualising RCs as an alternative approach to mental health and recovery through education and participation. The sentiment in the articles was positive, however deficit language was still evident. Human interest and responsibility framing was common. Conclusion: Media coverage highlighted a role for RCs in promoting mental wellbeing through education and participation. However, key elements of their functioning, such as co–production or the role of people with lived experience were less visible. Greater engagement with media outlets to increase awareness and understanding of the individual and community benefits of RCs are needed.

Designing audio processing strategies to enhance cochlear implant users' music enjoyment

Cochlear implants (CIs) provide hundreds of thousands of users with increased access to sound, particularly speech, but experiences of music are more varied. Can greater engagement by CI users in the music mixing process mutually benefit them as well as audio engineers? This paper presents an exploratory mixed-methods study that leverages insights from CI users and professional audio engineers (AEs) in the investigation of techniques to enhance CI user music enjoyment and promote empathetic practices in AEs. Analysis of data collected over a multi-step process of surveys, interviews, and iterative cycles of sound mixing and feedback revealed two mixing strategies—namely essentializing and exaggeration of musical elements—common among mixes preferred by CI users. Participant responses also highlighted systemic ableism and audism in the music industry—an industry from which CI users report feeling excluded. Specifically, AEs felt inadequately trained around aural diversity considerations and experienced anxiety around their own aural diversity. In sum, this work contributes to insights into CI user music listening preferences; how AEs approach mixing for an aurally diverse audience; and discussion around the efficacy of CI simulation, user feedback, and AE peer feedback on mix enjoyment by CI users. Based on these findings, we offer several design insights that emphasize the need for customizable music listening tools centered around user agency and enjoyment.

“Poor and Dirty”: Unintended consequences in a hygiene material Distribution in Burkina Faso

The practical interrelationships between the African environment and hygiene practices during a pandemic period is a topic of significant importance. Specifically, this research explores the intersection of cultural dynamics and hygiene practices in Burkina Faso, focusing on a recent example of distribution of hygiene materials. It highlights the negative reactions to these foreign interventions, perceived as patronizing and stigmatizing, which underscores the complexities of implementing health initiatives in diverse socio-cultural landscapes. These findings stress the importance of culturally sensitive approaches and greater engagement in public health initiatives like the latrine usage with specific designs for communities.

Building narrative identity in a context of audience failures: Stories of resistance among young adults formerly in foster care

BackgroundChild maltreatment survivors with extensive foster care involvement are tasked with building identities that allow them to make sense of difficult pasts in ways that help them build adult lives. ObjectiveTo use narrative identity theory to explore identities and identity-building challenges of young adults formerly in foster care. Participants and settingTwelve young adults who aged out of the foster care system in Illinois. MethodsParticipants were interviewed three times with semi-structured protocols that focused on their life stories and the meanings derived from them. Data were analyzed using an adapted grounded theory approach. ResultsMany participants forged resistance identities around a fierce sense of agency, motivated to not be another foster care statistic or like their parents. Challenges to identity construction included the scarcity of trusted audiences willing to listen fully to their life stories, missing information about key events, and the senselessness of maltreatment experiences. College and work opportunities provided normative contexts and new audiences where identities shifted, but often at the cost of not revealing their histories, limiting social relations. Temporal coherence was evident in most life stories. Causal and global coherence was more difficult to achieve. ConclusionsIntervention efforts designed to provide willing and helpful audiences for narrative formation work may help young people from foster care find meaning in their pasts that help them forge identities that promote satisfying and successful adult lives. Narrative identity theory may benefit from greater engagement with theories of oppression and marginalization.