Health Behavior Change Research Articles

“They say it may cause cancer:” A Qualitative Exploration of Filipinos' Contraceptive Misconceptions and Primary Healthcare Interventions

Background and Objective. Contraceptives are widely acknowledged for preventing unwanted pregnancies. However, there is a prevalent lack of awareness regarding contraceptives, leading to unaddressed misconceptions. This study aimed to identify common contraceptive misconceptions among men and women of reproductive age and explore how primary health workers address them. Methods. A qualitative study was conducted in two phases within District 5, Manila City. Phase 1 comprised focused group discussions with men and women of reproductive age (n=60), while Phase 2 involved conducting in-depth interviews with primary healthcare providers (n=16). MAXQDA, a qualitative software, to organize and code the data, was utilized. Results. Women of reproductive age reported several misconceptions about contraceptives, including concerns about adverse health effects, emotional and behavioral changes, perceived ineffectiveness, and cosmetic or bodily changes. For instance, they believed that contraceptives could lead to serious health complications, such as cancer, genital injury, and even death. Primary healthcare providers addressed these misconceptions through open dialogue during service delivery, particularly during prenatal and postpartum check-ups and infant immunizations. They utilized patient education strategies, including the teach-back method, and conducted community outreach and workshops on contraceptives and family planning, especially during Women’s Month. Conclusion. Several misconceptions were identified among women of reproductive age regarding the proper use and safety of contraceptive methods, as well as misguided beliefs. In contrast, men did not exhibit any misconceptions about contraceptives, which warrants further investigation. Primary healthcare providers have taken a proactive approach to address this issue by offering comprehensive explanations and ensuring clear understanding between healthcare providers and women. Promoting contraceptive health literacy could help bridge the knowledge gap between men and women of reproductive age.

Cultivating partnerships to incorporate health promotion modules into primary school curricula: a case study in France

School-based health promotion (HP) emerged from the settings-based approach. Children from disadvantaged neighborhoods benefit from HP in their school. Teachers deliver HP modules but need additional resources. This case study aimed to form a transdisciplinary partnership in a socially disadvantaged area to co-develop and embed HP modules into existing curricula. A 3-stage framework was used in this study. Stage 1 cultivated partnerships, reviewed evidence and existing data. Stage 2 generated ideas and co-developed HP modules. Stage 3 trialed the modules within primary school classrooms. Stage 1 resulted in a partnership between city authorities, a primary school and a comprehensive cancer center all located in the same community in France. The reviewed data and evidence provided 18 examples of school-based HP programs and showed that the school is in a highly disadvantaged neighborhood with a large immigrant population. Stage 2 developed 3 HP modules: “Taste and Science Week,” “Nutrition Weeks,” and “Breakfast Week,” each embedded as add-ins into existing math and science lessons and workshops. Finally, stage 3 trialed the modules in 10 first to fifth grade classrooms impacting 214 total students. Transdisciplinary partnerships help co-create and support evidence-driven HP programs. This collaborative approach enabled primary school teachers to effectively embed the HP modules into pre-existing math and science curricula. Families and volunteers are an integral part of successful HP programs however, limited participation was a challenge. Further research is needed to evaluate indicators such as student academic success and health behavior change.

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

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

Jumantik Education: Strategy Toward Malaria Elimination in the Resettlement Area of Osi Island, West Seram Regency

The Covid-19 pandemic, which has been global for 3 years, tends to have a domino effect in various aspects, such as individuals, groups, and countries. One of the causes of decreased immune system in the host is due to comorbid diseases suffered by the host (patients). Those at risk of Covid-19 may also be at risk of infectious diseases caused by viruses, parasites, and bacteria. In a pandemic situation like Covid-19, health behavior change education with a risk communication approach needs to be implemented in preventing, treating, and rehabilitating environmental stages of worm infection risk in the community of Osi Island hamlet. This education aims to increase public knowledge of potential health risks and threats. Thus, they can determine appropriate steps and actions to protect themselves from these issues. The method used is education with the project-based learning model, which combines lecture, discussion, and field practice methods. The target group is high school students of PGRI Pelita Jaya Seram Western Part. The achieved results are that the JUMANTIK cadres know about malaria-free health (cognitive), can collect trash (containers) from yards (psychomotor), do not allow stagnant water (affective), can drain water storage containers inside and around the house (psychomotor), can make simple mosquito traps using recycled materials, can sleep under mosquito nets (psychomotor), can observe larvae and pupae (psychomotor). Kyewords: Jumantik education, malaria elimination, Osi Island

Interventions to improve students’ feedback literacy

Feedback literacy has been identified as a key capability to promote in higher education, such that individuals can make the most of the imperfect feedback situations they find themselves in, both within their studies and the world beyond – work and life inclusive, and increasingly digital. Recent attention has turned to interventions that can improve student feedback literacy. These have largely been context-specific and focused on particular feedback opportunities that have been created within a unit or module of study. However, the enacted components of feedback literacy as established by Dawson et al (2024) are relatively generic, and so it may be possible to support the development of students’ feedback literacy more generally. This symposium will welcome debate on the level of tailoring of feedback literacy interventions, and offer insights into interventions which may improve students’ feedback literacy regardless of context, building on psychological theories of health behaviour change.

Pragmatic online obesity treatment in primary care: a hybrid randomized clinical trial of implementation strategies

Online behavioral weight loss (BWL) in primary care is effective and disseminable. This trial compared two implementation approaches on program uptake, use, and weight loss via a pragmatic hybrid type 2 implementation-effectiveness design to evaluate online BWL implementation (Rx Weight Loss [RxWL]) and effectiveness. This manuscript presents the implementation results. RxWL was implemented across a state-wide network of primary care clinics using lower- and higher-intensity implementation strategies (Basic [base program] and Enhanced [base plus enhanced training and dashboard], respectively) between 2018 and 2022. Nurse care managers (NCMs; N = 23) were recruited and block-randomized to implementation condition. Adult primary care patients (body mass index [BMI] > 25 kg/m2, internet-connected device access) were referred and enrolled by their NCMs. Outcomes were the proportion of eligible patients who enrolled in and completed RxWL by NCM condition, initial weight loss and regain over 12 and 24 months by NCM condition, and clinician acceptability and feasibility. NCMs (N = 12 Enhanced, N = 11 Basic) in Enhanced enrolled more patients (N = 490) than in Basic (N = 164). Although the proportion of patients who completed RxWL and mean weight loss did not differ by condition, different enrollment rates resulted in the Enhanced condition engaging more patients. NCMs rated RxWL as acceptable and feasible with no difference by condition. Findings support connecting primary care patients with technology-based health behavior change programs. Clinical trial registration number: ClinicalTrials.Gov identifier NCT03488212: https://clinicaltrials.gov/ct2/show/NCT03488212. Trial registration: clinicaltrials.gov Identifier: https://clinicaltrials.gov/study/NCT03488212.

Impact of Genetic Risk Information for Cardiovascular Disease on Behavioural, Psychological Responses, and Risk Factor Modification: A Systematic Review.

Cardiovascular disease (CVD) remains a significant public health concern, influenced by both genetic susceptibility and lifestyle factors. Integrating genetic risk information into clinical practice shows promise but has yielded mixed results regarding its impact on CVD prevention and management. This systematic review aimed to assess the impact of providing genetic CVD risk information on health behaviours, psychological outcomes, and risk factors. Following JBI methodology and PRISMA 2020 guidelines, four electronic databases and two trial registries were searched for randomised controlled trials evaluating the impact of genetic risk information on the CVD risk profile. Data was synthesised using a narrative synthesis approach. Of the 3,596 articles retrieved, 11 studies were eligible. Genetic risk information showed modest improvements in dietary behaviour but had inconclusive effects on physical activity and medication adherence. Minimal changes in psychological outcomes were noted, including a slight decrease in depression. The impact on traditional risk factors, such as systolic blood pressure and total cholesterol was also limited. Bias across all studies was noted. Genetic CVD risk information has limited effects on clinical outcomes and psychological factors, despite its potential to encourage some health behaviour changes. These findings suggest that genetic risk information alone may not be sufficient to significantly reduce cardiovascular risk, highlighting the need for further research to better understand its long-term effects.

Kidnapping-Induced Trauma and secondary stress in armed conflicts: a comparative study among women in hostage families, volunteers, and the General Population

BackgroundExposure to armed conflict negatively impacts health. However, there is limited data on secondary stress from ambiguous loss contexts, such as kidnapping. In this study we aimed to quantify changes in modifiable health behaviors and well-being among women in hostage families and hostage crisis volunteers versus the general female population within the first two months of the 2023 Israel-Hamas war.MethodsA cross-sectional online survey was conducted on 318 Hebrew-speaking women aged 18–75 in Israel comparing: (1) a general population sample (n = 245); (2) hostage crisis volunteers (n = 40); and (3) hostage family members (n = 33). Participants provided demographic information, details on chronic illnesses, and responded to Likert-scale questions covering self-rated health, mental health, and lifestyle habits before the conflict and in current state.ResultsHostage family members reported the most severe health impacts, followed by volunteers. Fair/poor physical health status increased significantly in all groups during the war, with hostages’ families reporting the highest rate (61.6%). Mental health deterioration was more pronounced among hostages’ families, with 84% expressing a need for mental health support. Hostages’ families also reported the highest rates of sleep problems, reduced adherence to a healthy lifestyle, and weight loss. Mental and physical health declined significantly across the exposed groups, as measured by multiple assessments, with hostage families experienced the most pronounced impairments across various domains of well-being.ConclusionsThis period of conflict severely harmed the well-being of all women in the study population. Women from all three groups - hostage families, volunteers, and those from the general population - experienced health deterioration due to varying levels of stress and exposure to conflict-related factors. Hostage families faced the greatest impact with nearly all members of this group showing significant health damage. Long-term support is needed to help restore post-conflict health for all affected women. Further research may be needed to determine the most effective interventions for addressing these impacts across the different groups.

Perspectives of Australian healthcare professionals towards gamification in practice.

Gamification may be an effective tool in motivating sustained behaviour change. This study aimed to explore perspectives of Australian-based healthcare professionals, including dietitians, towards gamification in their practice when assisting patients/clients to achieve health-related goals. Semi-structured online interviews were conducted with healthcare professionals. Data was audio-recorded, transcribed verbatim, de-identified and thematically analysed to identify key themes and inform the creation of personas. Six dietitians, two psychologists, two exercise physiologists, one medical specialist, with 1-24 years of work experience, participated. Most participants (n = 7, 64%) were unable to articulate a definition of gamification, however, when offered more context, they could identify examples. Overall, participants were positive towards gamification, regardless of prior experience/exposure. Three themes emerged; (1) Variable familiarity with gamification, (2) Context matters, (3) Barriers hinder engagement/adoption. Stage of career rather than profession influenced participants' views of gamification, as reflected in three characterising personas; 'Joel: Early-Career, Progressive', 'Bella: Mid-Career, Stable' and 'Sam: Advanced-Career, Expert'. Findings suggest that gamification is not widely used in health practice in Australia. Concerns about participation costs and data privacy are adoption barriers. Promotion of the effectiveness of gamification as a valuable adjunct tool to encourage behaviour change needs support from peak bodies. Embedding gamification in university curricula could better prepare graduates to engage with gamification in future practice. Further research capturing more diverse healthcare professionals' perspectives is required to fully understand the potential of gamification to change health behaviours, and to design feasible gamified solutions.

Decoding the Influence of eHealth on Autonomy, Competence, and Relatedness in Older Adults: Qualitative Analysis of Self-Determination Through the Motivational Technology Model.

Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied ElderTree, an online system for older adults that provides on-demand videos of healthy living content, self-monitoring, and weekly researcher-hosted video meetings. We aimed to understand the theoretical crossover between the motivational technology model and self-determination theory using features of ElderTree to understand the usability of the technology and how it may support older adults' autonomy, competence, and relatedness. Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronic conditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis. Older adults did find that features within ElderTree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants' experiences with the smart displays. Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization.

Self-efficacy and social support enable women to protect their pelvic floor health: A nonrandomized controlled trial in rural Nepal.

Carrying heavy loads increases the risk of pelvic organ disorders, particularly in low-income countries. Low self-efficacy hampers adoption of pelvic-floor-protective behaviors. The enabling hypothesis suggests that social support may strengthen women's behavioral self-efficacy. A three-arm parallel non-randomized controlled trial with 300 women and their social partners experimentally examined whether self-efficacy and social support can enable women's pelvic-floor-protective behaviors in rural Nepal. Three villages received (1) self-efficacy (2) self-efficacy and social support promotion, or (3) information only control. The co-primary outcomes were reduced weight carried and using protective lifting techniques at 2-month follow-up. Self-efficacy promotion increased the use of protective lifting techniques 9% more than information only (d = 0.28). Weight was reduced by 3 kg more when additionally promoting social support compared to self-efficacy alone (d = 0.39). Self-efficacy and social support promotion enable women to better protect their pelvic floor health and may complement educational approaches to health behavior change in low-resource populations.

Young Adults Journey with Digital Fitness Tools-A Qualitative Study on Use of Fitness Tracking Device.

Physical activity trackers possess the potential to encourage increased physical activity. However, users often exhibit poor long-term adherence to these devices, which may stem from a lack of understanding of the factors influencing their use, as well as changes in health behavior. This study aims to provide new insights into the types of health-related apps and devices that young people discover, select, and utilize, along with the underlying reasons for their choices. Young adults aged between 18-25 years reporting the use and nonuse of health apps and wearables were recruited and participated in focus group discussions about app choice, features, their perceptions towards the physical activity trackers, and reasons for continued use and for not using one. A total of Nine FGDS were conducted among users, nonusers, and former users of physical activity tracker usage. Data was recorded, transcribed, and analyzed for themes in an iterative approach. The physical activity tracker users group stated that they had a sense of achievement, validation, and other motivational feedback, which helped with adherence. All three groups (user, non-user, and former user) had similar concerns about cost, reliability, accuracy, and dependency. Former users also reported that the idea of accomplishing the goals would create anxiety and, in turn, harm the body. Former users and nonusers expressed their concerns regarding lack of time and loss of motivation to track their physical activity. Nonusers had issues with the functionality of the device (ease of use, battery, notifications, apps hang) and were also aware of all the health benefits of using wearables. Physical activity users group, former users group, and nonusers group shared concerns about accuracy, cost, and battery.

Changes in overweight and overweight-related health behavior in higher education students in Finland

Abstract Introduction Covid-19 pandemic may have had negative effects on overweight and overweight-related health behavior in young adults. The aim was to examine the changes in overweight, physical activity, sedentary behavior and daytime tiredness in higher education students during and after the pandemic. Methods Two cross-sectional student representative surveys (aged 18-34 y) were conducted in 2021 (n = 6258, response rate 53 %) and 2024 (n = 3638, response rate 31 %). Overweight (BMI ≥25 kg/m2) was based on self-reported height and weight. Physical activity was dichotomized into those meeting physical activity recommendations and others. Sedentary behavior was dichotomized into sitting in front of TV, computer or smart device over three hours a day during leisure time and others. Daytime tiredness was dichotomized into those feeling tired 6-7 days a week and others. Results The preliminary results indicate that overweight in women increased from 34 % to 39 % whereas no increase was observed among men (47 % vs. 46 %) between 2021 and 2024. Meeting the physical activity recommendation increased from 46 % to 55 %, the change being similar for both sexes. Sitting over three hours in leisure time in front of TV, computer or smart device decreased from 54 % to 50 %. In men, the prevalence of sitting decreased (62% vs. 57 %) whereas in women no statistically significant change was observed (47% vs 45 %). No statistically significant change was observed in feeling tired almost every day (26 % vs 24 %). Conclusions Among higher education students, an increase in prevalence of overweight in women was observed for three years period. Favourable changes were observed in physical activity in both men and women, and sedentary behavior in men. Surveillance of the long-term health consequences of the pandemic in young adults is important for planning and targeting preventive activities. Key messages • Overweight increased among female higher education students after COVID-19 pandemic. • Factors supporting favourable changes in health behaviour of young adults after pandemic should be examined in longitudinal setting.

Discussing health behavior change during pregnancy: co-creation of a training and conversation tool

Abstract Background Health risk behaviors during pregnancy are major risk factors for adverse health outcomes for mother and child, and they are more prevalent among vulnerable pregnant women. However, interventions often do not sufficiently meet the needs of disadvantaged groups. Changing behavior is more likely when people feel autonomous and when a behavior aligns with our identity (how we see ourselves). Despite the clear importance of identity in health behavior change, very few identity- based interventions exist for pregnant women, let alone for vulnerable pregnant women. Through co-creation, this study aims to develop an identity- and autonomy- based training program and conversation tool tailored to the needs and preferences of healthcare professionals and vulnerable pregnant women. Methods Four co-creation sessions were conducted with five professionals from medical and social domains, and five (expectant) parents in vulnerable situations. The Participatory Learning and Action research methodology was applied to ensure an equal and democratic process in designing the training and conversation tool. Results The training for professionals will focus on enhancing knowledge about the importance of identity and autonomy in behavior change, and on improving their self-efficacy through practicing the conversation tool. Example of the conversation tool, which can be integrated into daily practice, is a comic strip illustrating the conflict of being a smoker and a mother. Conclusions During intervention development, it is important to consider the needs and preferences of end-users, particularly for whom few appropriate interventions exist. Involving end-users yields valuable insights for feasible (e.g. one-consultation time frame) and accessible (e.g. easy-to-understand language) interventions. This study aligns with public health efforts toward early intervention and health promotion among vulnerable groups. Key messages • During intervention development, it is important to consider the needs and preferences of end-users. • This study aligns with public health efforts toward early intervention and health promotion among vulnerable groups.

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

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

A cross-sectional study on health behavior changes during COVID-19 among adults in Malaysia.

COVID-19 has triggered significant disruptions globally, necessitating swift adaptations in individuals' health behaviors. This cross-sectional study was conducted during Phase Four of Malaysia's National Recovery Plan and examines how the pandemic has affected health behaviors among adult Malaysians. The study gathered data online using convenience sampling with 1,004 respondents aged 18 and above. The research focused on diverse health domains, including eating habits, physical activity, smoking, alcohol consumption, and sleep patterns. The Wilcoxon Signed Rank test and descriptive statistics were employed to compare health behaviors before and after COVID-19. Findings indicate noteworthy shifts in eating behaviors, with increased water and fruit consumption (p < .001). The frequency of home-cooked meals stayed relatively stable despite declining dinner preference and increasing daily snacks. Physical activity declined, marked by increased sedentary behavior and screen time (p < .001). There were differences in the patterns of smoking and alcohol consumption; some had started these behaviors during the pandemic. Notably, intentions to quit smoking among respondents were more prominent than attempts to stop drinking. Respondents' sleep patterns also changed, with more sleeping fewer than seven hours daily (p < .001). The study emphasizes the need for focused interventions to address new challenges by highlighting the impact on health behaviors. As Malaysia navigates the post-pandemic landscape, understanding and mitigating the persisting effects on health behaviors are crucial for promoting overall well-being.

The impact of the COVID-19 pandemic on physical activity among primary school children in Ireland

Abstract Background The containment measures implemented during COVID-19 to curb the virus’s spread disrupted family life globally and profoundly impacted children’s daily behaviours. A decrease in children’s physical activity during COVID-19 is one such health behaviour change that was observed in many European countries. This study aimed to understand the pandemic’s impact on primary school children’s physical activity in Ireland which is important given the epidemic of childhood obesity and chronic diseases in the long term. Methods All Childhood Obesity Surveillance Initiative (COSI) participating countries (n = 45) could voluntarily implement the COVID study as part of their COSI Round 6 (R6) data collection or separately. The parents of First and Second-class primary school children (n = 2,784) who consented to participate in COSI-Ireland R6 were invited to complete the family survey which included the standardised COVID study. The COVID module assessed children’s lifestyles and health behaviours before and during the pandemic through 12 questions. Consenting parents supplied their email or postal address and completed the survey in hardcopy or electronically using LimeSurvey. Descriptive statistics were then calculated on the cleaned pseudonymised dataset (n = 1,060) using IBM SPSS Statistics 27. Results The time spent playing actively outside school hours remained the same for some children on both weekdays and weekends (24.2% and 37.1%, respectively). An increase rather than a decrease in the time spent in active play was also observed among almost twice as many children across Ireland on both weekdays (47.3% and 24.2% respectively), and weekends (40.10% and 21.80% respectively). Conclusions The positive findings show that the public health messaging from the Irish Government which emphasized the importance of staying active during COVID-19 may have been effective. Further research to assess children’s physical activity during COVID-19 is warranted to inform future pandemics. Key messages • In Ireland, unlike in many European countries, a substantial number of primary school children increased their time spent playing actively during the COVID-19 pandemic. • A unique trend in Irish children’s physical activity levels compared to their European counterparts.

Fidelity of the Face-it health promotion intervention for women with recent gestational diabetes

Abstract Introduction According to the 2021 British Medical Research Council 2021 framework, a feasibility study aims to assess intervention-specific progression criteria. Fidelity is a critical criterion because it concerns how an intervention is implemented as intended. Fidelity conceptualisation has expanded beyond intervention adherence to encompass participant engagement, i.e., how well they receive and enact the intervention, but these latter aspects achieve little attention. We aimed to assess the fidelity of the Face-it intervention, a health promotion intervention for women with a history of gestational diabetes mellitus and their families. The intervention consisted of three home visits and health technology delivered by health visitors/coaches. Our fidelity assessment included: i) training of the health visitors/coaches ii) the delivery, iii) receipt, and iv) enactment of the intervention. Methods The National Institutes for Behaviour Change Consortium’s (NIHBCC) framework for fidelity was used to assess four elements of fidelity. Data were collected from 150 women using intervention checklists, health technology logs and the virtual climate care questionnaire, which measured autonomy supportiveness from the intervention. Results The health visitors/coaches received four training days before the implementation and 16 hours throughout the intervention delivery. 73.3% of women completed three home visits, and 91.3% of women registered as health technology users. The participants perceived the intervention to be autonomy supportive, encourage health behaviour change and provide effective possibilities for health behaviour change, even though the delivery of the health technology varied greatly. Conclusions The Face-it intervention was largely implemented as intended. Using the NIHBCC framework, we expanded our fidelity conceptualisation and gained important insight into the feasibility of the intervention and interplay between delivery, receipt, and enactment.

10.Y.2. Unlocking innovation: trustworthy co-creation for tackling complex public health challenges

Abstract Background Public health interventions often have limited effects, with few achieving large-scale implementation. Moreover, these interventions frequently fail to replicate their effects in real-world settings, possibly due to an overemphasis on generating universal knowledge through theory building and testing in controlled conditions. An alternative approach involves developing interventions within specific contexts, fostering collaborative knowledge generation, and establishing equitable partnerships. Co-creation offers a transformative strategy for addressing complex public health issues by generating real-world solutions. However, utilizing co-creation in public health presents challenges, including a lack of guidance on implementation and evaluation in public health settings. This underscores the need to integrate real-world co-creation with rigorous research to establish a reliable methodology grounded in both scientific evidence and participatory principles. Workshop This Pecha Kucha-style workshop will explore the essence of an evidence-based co-creation methodology developed through rigorous research by the European-funded H2020 Marie Sklodowska-Curie Innovative Training Network, Health CASCADE, and its partners. Emphasizing the significance of fostering innovative solutions to public health challenges, the workshop will provide key considerations for designing co-creation projects. It will also examine the role of enabling technologies in optimizing hybrid intelligence for effective co-creation, highlighting their contribution to collaboration enhancement. Perspectives from co-creators will be presented to offer unique insights into their experience of the co-creation process. Additionally, the workshop will elucidate the adaptation of co-creation processes within the Danish context, exploring collaborative efforts across sectors and shedding light on cross-sectoral cooperation intricacies. A moderated panel discussion will conclude the workshop, facilitating deeper engagement with the presented topics. Delegates will gain insight into applying co-creation in health promotion and behaviour change research, navigating prevalent challenges through Health CASCADE’s systematic approach, and discovering strategies for fostering effective and inclusive co-creation. They will also acquire strategies and resources to overcome potential obstacles, fostering more effective and inclusive approaches to complex public health challenges. Key messages • Co-creation presents a powerful approach to addressing complex public health challenges by fostering collaboration, creativity, and inclusivity across diverse stakeholders and communities. • Effective and trustworthy implementation of co-creation requires an understanding of its principles and methods, enabling technologies, and strong partnerships across sectors and institutions.

9.B. Scientific session: Promoting health in the digital age: a room to improve health literacy and digital health literacy?

Abstract The workshop aims to explore innovative approaches to promoting health literacy and digital health literacy and their impact on individual and community health outcomes at different stages of life. This initiative is driven by the recognition that digital platforms and tools offer unprecedented opportunities to improve population health through health education and behavior change. The workshop will feature a dynamic and interactive format starting from plenary sessions in which speakers will provide insights into digital health promotion best practices and their outcomes, offering diverse perspectives. The added value of organizing this workshop lies in its comprehensive approach to integrating digital tools into health prevention strategies, particularly for addressing childhood smoking. By examining innovative digital interventions, the workshop provides a platform for sharing insights and strategies that leverage technology to promote healthier lifestyles among youth. This is increasingly pertinent as digital platforms become central in the daily interactions of young people. The coherence between the presentations revolves around the theme of enhancing digital health literacy as a preventive measure against health issues. The first presentation sets the stage by exploring digital tools that educate and engage young people about the dangers of smoking. The subsequent session builds on this by assessing the current state of digital health education and literacy, emphasizing the need for curriculum integration and better training for educators to support these initiatives effectively. Finally, the meta-analysis presentation ties everything together by evaluating the effectiveness of these digital interventions across various demographics, offering evidence-based recommendations for tailoring health literacy programs to diverse needs. Together, these presentations form a cohesive narrative on the critical role of digital literacy in health prevention, illustrating a clear pathway from educational content to educational infrastructure, and culminating in broad-based intervention strategies that can be adapted to different settings and populations. This coherence enhances the workshop’s impact, providing attendees with a well-rounded understanding of how digital tools can be harnessed to foster long-term health improvements from an early age. Live Q&amp;A sessions will encourage dialogue between speakers and attendees, enhancing the learning experience. By combining expert knowledge with interactive discussions, the workshop aims to share insights needed to implement effective digital health promotion strategies. Key messages • The role of health literacy and digital health literacy in improving health outcomes demands that the efficacy of the most effective strategies be evaluated. • Digital tools offer opportunities for innovative health promotion approaches and tools.