Health Behavior Change Research Articles

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

IntroductionCOVID-19 has triggered significant disruptions globally, necessitating swift adaptations in individuals’ health behaviors.MethodsThis 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.ResultsFindings 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).ConclusionThe 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&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.

7.A. Skills building seminar: Is Behavioural Science Relevant for Public Health? A Quintuple Helix Lens

Abstract Background On 29 May 2023, the World Health Assembly adopted the first-ever global Behavioural Sciences for Better Health resolution (WHA76.7). This resolution requests the World Health Organization (WHO) to mainstream and support behavioural sciences in public health across the WHO and within Member States; including enhancing awareness, knowledge, and evidence and providing technical assistance, normative guidance, and capacity-building. But is behavioural science really relevant for public health? Why and how it can help us to improve people’s health? Rationale This workshop seeks to delve into the application of behavioural science in public health within the context of the quintuple helix framework - academia, industry, government, civil society, and the broader environment. Through collaborating across sectors, stakeholders can leverage behavioural science to design more effective strategies for promoting positive health behaviour change, preventing diseases, and addressing public health challenges. This workshop will feature discussions and case studies in various public health domains. Aim The main aim of this skills-building seminar is to explore the synergies between behavioural science and the quintuple helix, examining how these collaborations can drive innovation, enhance policy implementation, and foster sustainable health outcomes. By critically examining these intersections, we seek to stimulate dialogue, foster collaborations, and inspire innovative approaches for addressing complex health challenges in our society. Workshop structure This workshop will consist of three parts: - It will start with a short scene-setting presentation by Iveta Nagyova, EUPHA president, highlighting the innovation potential of behavioural science to improve people’s health (10 mins). - In the second part (30 mins), the panellists will discuss concrete examples of interconnections of behavioural science and public health within the quintuple helix framework. 1. Susan Michie will share her experience of interconnections between academia and government as a member of the UK SAGE - Scientific Advisory Group for Emergencies. 2. Simon Bacon will discuss the behavioural lens applied to the commercial determinant of health. 3. Tiina Likki will share WHO/Europe’s experience with developing and implementing the European regional action framework for behavioural and cultural insights for health, 2022-2027, 4. Kim Lavoie will speak about community involvement and social innovation within the context of more efficient healthcare systems. 5. Stefano Capalongo will show us examples of salutogenic design and architecture, applying neurobiobehavioural mechanisms. - The third part (20 mins) will be dedicated to a facilitated discussion with the audience to explore attendees’ opinions regarding the challenges and opportunities of applying behavioural sciences to improve people’s health and well-being, using the quintuple helix framework. Key messages • Integrating behavioural science within the quintuple helix framework cultivates partnerships advancing effective, inclusive and lasting public health initiatives. • Fostering cross-sector collaboration establishes an ecosystem driving innovative, equitable and sustainable solutions in public health. Speakers/Panelists Susan Michie University College London, London, UK Simon Bacon Concordia University, Montréal, Canada Kim Lavoie UQAM, Department of Psychology, Montreal, Canada Tiina Likki WHO/Europe, Hellerup, Denmark Stefano Capolongo Politecnico di Milano, Milan, Italy

Health coaching: the node of health literacy & health promotion

Abstract Introduction To achieve sustainable health behaviors and outcomes to move from a precarious health situation to good health, people need to be supported in health literacy in behavior change that ensure interventions’ success. As a non-clinical approach, health coaching aims to increase a person’s levels of self-efficacy, confidence and resilience, by promoting the sense of coherence. This communication aims to identify the benefits that health coaching as a salutogenic approach can trigger. Methods The work is structured in a narrative review of literature and the lived experience of the authors in health coaching. Results The published research on health coaching and the systematic professional experience of the authors highlight: (1) the anchoring of health coaching in the salutogenic model and in the person-centered approach focused on individual characteristics and needs in driving healthy behaviors; (2) health coaching as a collaborative relationship with chronically ill people and people at risk of developing illness; (3) the role of health coaching as a sense of coherence (SOC) promoter; (4) health coaching as a new profession in the healthcare ecosystem (e.g. NHS, UK), cooperating with multidisciplinary teams. Discussion From A.Antonovsky’s model approach to health, the SOC stands out and constitutes one of the basic theories in health coaching interventions, by strengthening the person’s capabilities of comprehensibility, manageability, and meaningfulness. As an emerging profession, with ethical and a growing research foundation, it is facilitated by trained professionals in managing and monitoring health behavior change. Conclusions Health coaching aims to bring relevance, meaning and strategy to a person’s behavioral change. Health coaching demonstrates positive effects on several health parameters by supporting the implementation of health literacy development and empowering people to trigger sustainable changes that lead to healthier lifestyles.

A systematic review on the effect of identity-related interventions on physical activity and smoking

Abstract Background Identity (self-perceptions of ‘who I am’) is important for health behavior change. Hence, identity-related interventions, aiming to influence how people view themselves, show promise for health promotion. This systematic review describes the effect of identity-related interventions on physical activity (PA), a health-promoting behavior, and smoking, a health-compromising behavior, and PA- and smoking-related identities in adults. Methods A comprehensive search, updated in May 2023, identified 5801 publications across eleven databases. After screening, 19 quantitative and mixed-methods publications were selected, describing 20 different studies. Relevant data were systematically extracted and a quality assessment was conducted using the Mixed Methods Appraisal Tool. Results Identity-related interventions were more common for enhancing PA (n = 13) than for smoking cessation (n = 6). Only one study targeted PA- and smoking-related identities to change both behaviors simultaneously. Various identity-related interventions were used, e.g. possible (future) selves manipulations and avatar games. The target population was rarely involved in intervention development. The results are mixed; some studies showed (significant) positive effects of identity-related interventions on identities or behavior, and no significant negative effects were shown. Similar results were found for PA and smoking. The one study targeting both behaviors showed positive results. Conclusions Identity-related interventions hold promise in promoting PA and smoking cessation. Future research could investigate identity-related interventions targeting multiple health behaviors, e.g., PA-promotion and smoking cessation, leveraging the synergy between those identities and behaviors. Collaboratively developing these interventions with the target population (i.e., patient and public involvement) could optimize them for different populations, improving public health and reducing health disparities. Key messages • Identity-related interventions could improve public health. • Collaboratively developing identity-related interventions with the target population could optimize them for different populations.

The recent history and near future of digital health in the field of behavioral medicine: an update on progress from 2019 to 2024.

The field of behavioral medicine has a long and successful history of leveraging digital health tools to promote health behavior change. Our 2019 summary of the history and future of digital health in behavioral medicine (Arigo in J Behav Med 8: 67-83, 2019) was one of the most highly cited articles in the Journal of Behavioral Medicine from 2010 to 2020; here, we provide an update on the opportunities and challenges we identified in 2019. We address the impact of the COVID-19 pandemic on behavioral medicine research and practice and highlight some of the digital health advances it prompted. We also describe emerging challenges and opportunities in the evolving ecosystem of digital health in the field of behavioral medicine, including the emergence of new evidence, research methods, and tools to promote health and health behaviors. Specifically, we offer updates on advanced research methods, the science of digital engagement, dissemination and implementation science, and artificial intelligence technologies, including examples of uses in healthcare and behavioral medicine. We also provide recommendations for next steps in these areas with attention to ethics, training, and accessibility considerations. The field of behavioral medicine has made meaningful advances since 2019 and continues to evolve with impressive pace and innovation.

Positive psychological well-being and cardiovascular health

Positive psychological well-being (PPWB) is increasingly recognized as a critical factor in cardiovascular health of both healthy individuals and those with cardiovascular diseases (CVD). This mini-review synthesizes the current state of knowledge on the relationship between PPWB and cardiovascular health, examining relevant studies on PPWB in both populations. The conceptualization of PPWB encompasses hedonic and eudaimonic facets, with constructs such as optimism, purpose in life, and vitality playing crucial roles. Studies among healthy individuals show a significant association between PPWB and improved cardiovascular health indicators, while research among cardiac patients highlights the importance of PPWB in predicting outcomes such as mortality and rehospitalization. Mechanistic pathways linking PPWB and cardiovascular health include biological processes, health behavior changes, and additional psychological resources that mitigate stress. Despite the growing evidence, questions remain unanswered, necessitating further research to understand these relationships and develop effective interventions. Promoting psychological well-being alongside physical health can enhance cardiovascular disease prevention and management, offering a comprehensive approach to improving patient outcomes and overall well-being.

Expanding the primary care workforce by integrating genetic counselors in multidisciplinary care teams.

Collectively, rare diseases are common, affecting approximately 8% of the population in Canada and the USA. Therefore, the majority of primary care (PC) clinicians will care for patients who are affected or at risk for a genetic disease. Considering the increasing ways in which genetics is being implemented into all areas of healthcare, one way to address these needs and expand the capacity of the PC workforce is through the integration of genetic counselors (GCs) into PC multidisciplinary teams. GCs are Masters-educated allied health professionals with specialized training in molecular genetics, communication, and short-term psychotherapeutic counseling. The current models of GCs in PC mimic other multidisciplinary models. Complex tasks related to genetics, such as pre- and post-test counseling, genetic test selection, and results interpretation, are conducted by GCs, which, in turn, allows physicians, nurse practitioners, and other PC providers to work at the top of their scope of practice. Quality genetics services provided by GCs improve clinical outcomes for patients and their families; the simultaneous provision of genetic education and psychological support by a GC is associated with an increase in patient knowledge, perceived personal control, decrease in distress, and can lead to positive health behavior changes, all of which are aligned with the goals of primary healthcare. With their extensive training in clinical care, medical communication, and psychotherapeutic counseling, integrating GCs into PC care teams will improve the care patients receive and allow PC clinicians to ensure their patients are at the forefront of the personalized medicine revolution.

Effects of an Exercise and Lifestyle Education Program in Brazilians living with prediabetes or diabetes: study protocol for a multicenter randomized controlled trial.

Patient education is a crucial strategy for promoting prevention and diabetes self-management since glycemic control achievement involves taking medications, medical nutrition therapy, physical exercise, and behavior changes. However, patient education programs are still barely implemented in low- and middle-income countries. This trial aims to investigate whether a lifestyle education intervention added to physical exercising is superior to sole physical exercising regarding functional capacity, disease-related knowledge, health behaviors, cardiometabolic health parameters, quality of life, depression, and diet quality in individuals with prediabetes or diabetes. Multicenter double-blinded randomized controlled trial with two parallel arms involving 12-week intervention and 6-month follow-up. The eligible individuals (≥ 18years, living with prediabetes or diabetes, literate, no clinical decompensation and/or physical and/or mental limitations that contraindicate physical exercising, written physician permission for exercise, no cognitive impairment, no vision limitations for reading, no confirmed diagnosis of unstable coronary disease or heart failure, no pacemaker and/or implantable cardioverter-defibrillator, no complex ventricular arrhythmias, no intermittent claudication, no recent cardiovascular event or cardiac surgery, and no currently enrolled in a structured exercise program) were recruited from two Brazilian cities and randomized to either (1) an Exercise and Lifestyle Education Program (ExLE) or (2) an Exercise Program (Ex), which can be delivered on-site or remotely based on the participants' internet access and technology literacy. The primary outcomes will be changes in functional capacity and disease-related knowledge. The secondary outcomes will involve changes in health behaviors (health literacy, physical activity level, exercise self-efficacy, and medication adherence) and cardiometabolic health parameters (glycemic control, anthropometric measures, and cardiac autonomic control). Program adherence, satisfaction with the program, diabetes-related morbidity, and changes in quality of life, depression, and diet quality will be the tertiary outcomes. Assessments will occur at baseline, post-intervention, and after 6-month follow-up. If superior effectiveness of ExLE compared to Ex program to improve the outcomes measures is found, this program could be delivered broadly in the Brazilian health system, especially in the primary care facilities where most individuals living with prediabetes and diabetes in our country are assisted. ClinicalTrials.gov, NCT03914924 . Registered on April 16, 2019.

Perceptions of the 2D short animated videos for literacy against chronic diseases among adults with diabetes and/or hypertension: a qualitative study in primary care clinics.

Animation has promise for teaching complex health content through smartphone applications. However, smartphones have had limited use in Thailand for health literacy improvement among adults with chronic diseases. This study aims to explore the perceptions of adults with diabetes and/or hypertension resulting from 2D short animated videos for literacy against chronic disease that are available via smartphones. Four animated videos were initially developed based on clinical practice guidelines and nursing experience. Physicians, an expert in health education, and an animation team developed and revised scripts and storyboards of the animated videos. Lastly, videos were validated by physicians and health educators for content breadth and depth and by media experts for motion graphics and illustration. Each video presents a different situation in diabetes, hypertension, missing appointments, and obesity, ranging from 2.18 to 4.14min in duration. The inclusion criteria were adults 35-70 years old with diabetes or hypertension who received care from primary care units. Thematic analysis was performed on the extracted data. Twenty participants with a mean age of 58.4 years (SD 6.7; ranged 41-68) were focus-group interviewed. Three animation elements were assessed, including presentation, impacts, and suggestions. Participants had positive responses regarding the presentation (suitability of images and smooth motion graphics, short length of videos, simple language, understandable content, and clear sound) and impacts (recalling information, enhancing engagement, and motivating health awareness and behavior change). Suggested improvements were for a bigger font size for subtitles and considering the use of spoken text instead of on-screen text for recommendations at the end of the animations. Animated videos are acceptable for delivering health information. Pilot testing animated videos for promoting literacy against chronic diseases in adults with diabetes and hypertension is needed for optimal utility.

Preventing cardiovascular disease in at-risk patients: Results of a pilot behavioural health programme in general practice

Background The ‘High-Risk Prevention Programme’ (HRPP) involved a six-week health behaviour change programme based in general practices and aimed to address cardiovascular disease (CVD) risk in disadvantaged Irish communities. Objectives This pilot study aimed to establish the HRPP’s likely effectiveness and acceptability to inform the development of a future definitive trial. Methods The HRPP was conducted at six general practices in disadvantaged areas in the Ireland East region. Patients with high CVD risk were recruited by participating practices and were allocated to either a General Practice Nurse (GPN) or Health Promotion Professional (HPP) led programme focusing on positive health behavioural change. Baseline and 12-month follow-up data were collected to capture the HRPP’s likely effectiveness in promoting health outcomes and health behavioural change. Results The HRPP programme was completed by 270 patients. Out of these 270 patients, 245 (90.74%) completed baseline assessments, and 176 (65.19%) completed follow-up assessments at 12 months. Baseline data indicated a high level of CVD risk among patients and follow-up demonstrated positive change in several areas, especially weight (−1.95 kg, p < 0.001), BMI (−0.72, p < 0.001), exercise during the last week ( p <0.001), and consumption of healthy fats in the HPP group (+60%, p < 0.001). Conclusion The HRPP was a much-needed pilot intervention, and positive results were seen in both GPN and HPP arms, especially with regards to weight loss, exercise, and dietary improvements. Future definitive trials of the HRPP are likely to be effective and acceptable in terms of combatting these issues among high-risk patients.

General hospital patients’ attitude towards systematic health risk behavior screening and intervention

BackgroundSystematic counseling on behavioral health risk factors (HRFs) may be suitable to promote health among general hospital patients. This study aimed to investigate the openness of patients towards systematic screening and intervention of HRFs, its relation to actual participation in a multi-behavioral intervention, and whether socio-economic characteristics, HRFs and health indicators are related to approval.MethodsAll 18- to 64-year-old patients hospitalized in five medical departments at the University Medicine Hospital Greifswald in Germany were asked between May and July 2022 to participate in a survey and in a subsequent pre-post intervention study. Among all eligible patients, 225 (78.9%) participated in the survey. Patients’ approval of systematic screening and intervention of HRFs was assessed using five statements with a total sum score of 0–20 (i.e., scores of 0–6, 7–13, 14–20 referring to low, medium and high approval). Associations with intervention participation, socio-economic, behavioral and health-related patient characteristics were analyzed using logistic and multivariable linear regression analyses.ResultsThe mean total approval of screening and intervention was 13.8 (SD = 4.8). Of the 125/ 73/ 16 patients with high/ medium/ low approval, 88.0%/ 78.1%/ 50.0% participated in the subsequent intervention, respectively. Approval was independent of socio-demographic and -economic characteristics and self-rated general health. Current tobacco smoking was the only HRF negatively (p = 0.02) and diabetes mellitus was the only disease positively (p = 0.01) associated with approval.ConclusionHigh approval of HRF screening, which was rather independent of socio-economic characteristics and worse self-rated general health, speaks in favor of proactively approaching and motivating all general hospital patients to participate in health behavior change intervention. Tobacco smokers might need higher efforts to motivate participation than non-smokers.Trial registrationClinicalTrials.gov Identifier NCT05365269 on May 9, 2022.

External Factors Influencing the Implementation of Policy, System, and Environmental Change Strategies Within Cooperative Extension.

Introduction. Multilevel approaches are important to promote the adoption of healthier practices at the individual and community levels. Cooperative Extension pairs policy, systems, and environmental (PSE) change approaches with direct education programs focused on individual and community health. This study sought to understand Family and Consumer Sciences (FCS) Extension agents' perceptions of PSE change supports, benefits for their communities, and resources and partnerships important for implementation. Method. The Consolidated Framework for Implementation Research was used to develop a survey to assess outer setting domains related to PSE work. In addition to close-ended questions, the survey included several open-ended, qualitative questions exploring the benefits, resources, and relationships required to implement PSE changes. The surveys were collected online from FCS agents in two states. Descriptive statistics were calculated, open responses were coded, and key themes were established. Results. FCS agents (n=116) indicated high levels of agreement about having necessary support from state-level specialists (71%) and the overall Extension organization (64%). The largest gaps in support were reported as grant or external funding sources, time, and county programming funds. Half of the sample agreed that PSE training was adequate, but only 38.5% reported previously participating in PSE-specific training. Open-ended question responses revealed diverse relationships and numerous benefits of PSE work, including more sustainable health behavior changes and greater local Extension visibility. Discussion. Our findings corroborate previous work and identify potential gaps that future interventions can address to better support Extension and public health professionals when implementing PSE work at the community level.

Effects of a mobile health intervention based on a multitheoretical model of health behavior change on anxiety and depression, fear of cancer progression, and quality of life in patients with differentiated thyroid cancer: A randomized controlled trial

BackgroundDespite the high cure rate of differentiated thyroid cancer (DTC), patients endure side effects from treatment and psychological distress, impacting their quality of life. The potential of mobile health (mHealth) interventions to address these issues remains unexplored. The purpose of this study is to develop an mHealth intervention based on the Multi-Theoretical Model of Health Behavior Change (MTM) and evaluate its impact on reducing anxiety, depression, fear of cancer progression, and enhancing quality of life in DTC patients.MethodsA single-blind, single-center, prospective, randomized controlled trial was conducted. One hundred and eleven consecutive DTC patients from Harbin Medical University’s Fourth Hospital were enrolled from March 2023 to March 2024. Participants were randomized into a control group and an intervention group that received a 3-month mHealth intervention based on MTM theory. Outcomes were assessed using web-based questionnaires at baseline and conclusion.ResultsOne hundred four patients with DTC completed the study, with 7 lost to follow-up (6.3%). The intervention group experienced a significant drop in PHQ-4 scores post-MTM-mHealth intervention (P < .026), with no change in the control group, demonstrating a significant difference. The intervention group also had significantly lower anxiety (P < .015) and depression (P < .032) scores compared to controls. All PHQ-4 scores improved in the intervention group except for “Little interest or pleasure in doing things.” Anxiety levels were significantly lower in the intervention group (P < .026) but remained unchanged in controls. The control group exhibited a significant increase in FCR-4 scores at follow-up, differing from the intervention group (P < 0.001). Quality of life scores did not differ at baseline but saw a significant improvement in the intervention group, while the control group experienced no significant change. The intervention group had higher VAS scores (P < .030) and greater health education satisfaction across all dimensions (P < .019).ConclusionsThe MTM-based mHealth intervention significantly benefits DTC patients by reducing anxiety, fear of cancer recurrence, and improving quality of life, though its effect on depression requires further investigation.Trial registrationChina Clinical Trial Registry ChiCTR2200064321.