Health Behavior Change Research Articles

The wildland firefighter exposure and health effect (WFFEHE) study: cohort characteristics and health behavior changes in context.

Work is an under-recognized social determinant of health. There is limited research describing US wildland firefighter (WFF) workforce demographics or how to work associates with WFF health behaviors. In this study researchers characterized a WFF cohort and tested hypotheses that WFFs used tobacco, alcohol, and sugar-sweetened beverages (SSBs) differently over the course of the fire season and that different fire crews may exhibit different behavior patterns. Researchers collected data in the field with 6 WFF crews during 2 consecutive fire seasons (2018 and 2019). WFF crews completed questionnaires before and after each season. WFFs with an initial preseason questionnaire and at least 1 follow-up questionnaire were included (n = 138). Descriptive statistics summarized WFFs' baseline demographic, employment, and health characteristics. Linear mixed models were used to test for changes in WFFs' substance use over time and assess crew-level differences. A meta-analysis of WFF longitudinal studies' population characteristics was attempted to contextualize baseline findings. WFFs were predominately male, less than 35 yr of age, non-Hispanic White, and had healthy weight. Smokeless tobacco use and binge drinking were prevalent in this cohort (52% and 78%, respectively, among respondents). Longitudinal analyses revealed that during the fire season WFFs' use of tobacco and SSBs increased and the number of days they consumed alcohol decreased. Crew-level associations varied by substance. The meta-analysis was not completed due to cross-study heterogeneity and inconsistent reporting. WFF agencies can promote evidence-based substance use prevention and management programs and modify working conditions that may influence WFF stress or substance use.

The feasibility of motivational interviewing on adherence to care practices, emotional intelligence, and dispositional optimism among patients with permanent pacemakers.

Motivational interviewing (MI) has been recognized as highly effective for treating chronic diseases and various conditions, with encouraging results demonstrating its effectiveness in promoting health behaviour change. The current study was proposed to evaluate the feasibility of MI on adherence to care practices, emotional intelligence (EI), and dispositional optimism among patients with permanent pacemakers. This study was a parallel arm randomized controlled trial. Seventy clients with permanent pacemakers were randomly allocated to a six-session MI intervention (n = 35) or a waiting list control group (n = 35). A statistically significant improvement in the mean scores of adherence to care practices, EI, and dispositional optimism, along with a significant reduction in pessimism, was registered among the study group compared with the control group. Following the intervention for 1- and 2-month follow-up measurements, there were statistically significant improvements in self-care practice adherence. After 1 month of intervention, there were statistically significant gains in EI and dispositional optimism, but at the 2-month follow-up measurement, this improvement had somewhat lessened. The findings suggest that MI may be a feasible and practical approach for improving adherence to care practices, EI, and dispositional optimism in patients with permanent pacemakers. ClinicalTrials.gov: NCT05883514.

Biomedical Dogmas Still Influence the Delivery of Exercise Therapy in Chronic Low Back Pain Management: Mixed-Methods Study.

Non-specific, chronic low back pain (NSCLBP) is a leading cause of disability, prompting long-term rehabilitation. Positive patient beliefs and expectations towards lasting exercise engagement play a crucial role for a successful management of this condition. The aim was to investigate beliefs, unmet needs and expectations of NSCLBP patients for exercise-related health behaviour change in the context of rehabilitative care. In a mono-centric mixed-methods study, we conducted semi-structured interviews with NSCLBP patients and care providers. We recruited in a rehabilitation clinic which is specialized in orthopaedics and internal medicine. Interviews were analysed deductively by combining health behaviour change theories with Donabedian's quality model of care. In a patient survey, disability (RMDQ), exercise behaviours, fear avoidance beliefs (FABQ), self-efficacy in chronic disease management (SES6G), process- and outcome-expectations (OEE-2) were queried and analysed descriptively. Twenty-two interviews were conducted and 40 questionnaires completed. Qualitative results revealed that NSCLBP patients had persistent biomedical perspectives on their health condition, marked by strong preferences for biomedical diagnostics and beliefs in the superiority of specific exercise regimes. Based on met expectations and positive movement experiences, patients' motivation was successfully fostered in the motivational phase of health behavior change. In the volitional phase, the postulated desire to receive self-management strategies was largely unmet. Psychosocial aspects of care were not widely accepted. The survey study sample showed a disability score (RMDQ) of M = 6.8 (±4.6). Mean scores of validated scales reflecting on attitudes, beliefs and expectations of chronic NSCLBP management were at FABQ-pa M = 15.4 (±6.0), FABQ-w M = 24.0 (±12.1), SES6G M = 6.4 (±2.3), and OEE-2 M = 2.7 (±0.5). In this sample, patients' understanding of NSCLBP was still dominated by biomedical dogmas and perspectives. Inpatient rehabilitation predominantly addressed expectations towards the motivational phase of exercise-related health behaviour change.

Social Awareness for Women’s Health: An Endline Study in Gazaria, Munshiganj, Bangladesh

Background: The “Social Awareness for Women’s Health: Gazaria Pilot” project aimed to address menstrual health awareness and distribute free sanitary napkins in the Gazaria region. This endline survey evaluates the project’s impact on menstrual health practices, knowledge, and socio-cultural barriers among women and girls. Objective: Baseline data highlighted critical challenges, including limited awareness about menstrual hygiene, widespread use of non-hygienic materials such as old cloths, and significant emotional distress associated with menstruation. Access to reliable menstrual health information was predominantly through informal channels, with cultural taboos further exacerbating the menstrual health crisis. Methodology: A mixed-methods approach was employed, combining quantitative surveys and qualitative interviews to gather data from community members participating in the Gazaria Pilot project. Surveys were conducted to assess changes in health behaviors and attitudes, while interviews provided insights into community perceptions and experiences with project interventions. Findings: Following the project’s implementation, there was a notable improvement in menstrual hygiene practices. The use of disposable sanitary napkins increased from 5.99% at baseline to 15.36% at endline, reflecting enhanced access and acceptance of sanitary products. Additionally, knowledge about the risks of unclean menstrual practices and the benefits of personal hygiene saw significant gains, with awareness rising from 55.5% to 72.66% and from 62.0% to 75.78%, respectively. Menstruation has decreased emotional reactions, promoting mental well-being, but challenges persist like reliance on old cloths, lack of medical advice, and socio-cultural taboos affecting health behaviors. Conclusion: The project emphasizes the need for community-based interventions and sustained engagement to improve menstrual health outcomes in Gazaria, highlighting the need for ongoing efforts.

Needs and Preferences for Remote-Delivered Mindfulness-Based Cognitive Therapy in Patients After Acute Coronary Syndrome: A Qualitative Study.

Following acute coronary syndrome (ACS), up to 40% of patients report elevated depressive symptoms which is associated with a two-fold increase in mortality risk due to behavioral and biological mechanisms. Mindfulness-Based Cognitive Therapy (MBCT) delivered via synchronous group videoconferencing could help reduce depressive symptoms. To guide MBCT adaptation for ACS patients for a future clinical trial, this qualitative study aimed to explore ACS patients' (1) symptoms after ACS, (2) needs for behavioral health treatment, (3) perspectives on mindfulness intervention and group videoconference delivery, and (4) willingness to self-collect dried blood spots in a research study. We compared ACS patients with and without depressive symptoms to highlight particularly relevant treatment topics for patients developing depression following ACS experience. From 2/2019-11/2019, we conducted semi-structured individual telephone interviews with N = 23 patients after ACS (N = 13 with and N = 10 without elevated depressive symptoms; 63.4 (SD = 8.5) years, 87% male, 96% non-Hispanic white, 7.1 (SD = 7.5) years since ACS). In qualitative content analyses, four independent coders coded each interview. Participants with depressive symptoms experienced emotional, physical, social, and health behavior problems, while those without depressive symptoms made positive health behavior changes and struggled with anxiety symptoms. Both groups were interested in a behavioral health treatment for emotional and social support. Most were willing to participate in a mindfulness group via videoconferencing; some preferred in-person, but accessibility and convenience outweighed these cons. Almost all were willing to self-collect dried blood spots and some were already familiar with this technique. ACS patients, especially those with depressive symptoms, need help managing a multitude of quality of life concerns that can be targeted with an adapted MBCT approach. A videoconference-delivered MBCT approach is of interest. Suggestions for adapting MBCT to target the needs of ACS patients are discussed.

Health Behavior Change in Post-Traumatic Stress Disorder: Patient Perspectives

Health Behavior Change in Post-Traumatic Stress Disorder: Patient Perspectives

MHealth app features that facilitate adolescent use for lifestyle management, and are endorsed by caregivers and health care providers.

Mobile health (mHealth) apps are becoming a promising tool to motivate sustainable lifestyle and behavior changes, including modifications to diet and exercise. However, most current mHealth apps do not have meaningful, and sustained user acceptance, particularly, among adolescents. They perceive mHealth apps designed for adults to be tedious and visually unexciting, which discourage adolescent usage. Researchers and adolescent mHealth app developers would benefit from a foundational understanding of which functions and features adolescents feel would most motivate app use. Capturing caregivers' and health care providers' inputs are also important as both groups play an integral role in adolescent health care decision-making. The purpose of the study is to explore and analyze mHealth app features identified by adolescents, caregivers, and health care providers that have the potential to inspire continued use, thereby resulting in sustained health behavior changes in adolescents. We used inductive thematic analysis of qualitative data obtained from semi-structured focus groups conducted via Zoom©. Important features of mHealth apps that encourage adoption and continued use were explored with 25 participants, including adolescents, their caregivers, and health care providers. Common features facilitating continual usage of mHealth apps that were identified as significant by participating adolescents, their caregivers and health care providers were: look and feel of the app, customization, educational information/recommendations, and integration with electronic health record. Features such as gamification and social interaction that are usually lacking in current adolescent mHealth apps were well recognized as meaningful for motivational purposes. The findings suggest that adolescents and caregivers identify an app as valuable when it is user-friendly and intuitive and appreciate features that are motivating and can engage users in positive behaviors. Health care providers prefer mHealth apps that are user-friendly and can be effectively integrated into the cycle of care, thereby enabling delivery of efficient and value-based health care. Thus, mHealth app designs that are informed by health care providers' clinical experience and needs, in combination with app features that are desired and supported by both adolescents and their caregivers, have the potential to motivate widespread adoption and long-term use, which could result in improved health behaviors and outcomes among adolescents.

Examining the Building Blocks of Health Behavior Change in Rheumatology Rehabilitation: A Theory-Driven Qualitative Study.

To identify and describe behavior change techniques (BCTs) used in rehabilitation for patients with rheumatic and musculoskeletal diseases (RMDs), according to their own perceptions. Further, to examine patients' descriptions of their capability, opportunity, motivation, and readiness for health behavior change. Patients were adults in need of specialized, multidisciplinary rehabilitation services due to inflammatory rheumatic disease, systemic connective tissue disease, or fibromyalgia / chronic widespread pain. Semi-structured interviews of 21 patients were analyzed with deductive qualitative content analysis applying three theoretical frameworks: the Behavior Change Technique Taxonomy, the transtheoretical model and stages of change, and the capability, opportunity, and motivation model of behavior. Forty-six BCTs aggregated within 14 BCT groups were identified used by either patients, healthcare professionals (HPs), or both. Goals and planning, feedback and monitoring, social support, shaping knowledge, repetition and substitution were most frequently used to facilitate behavior change. Twenty patients had reached the action stage and made specific lifestyle changes concerning more than half of their goals. Concerning other goals, 6 of these patients reported to be contemplating behavior change and 15 to be preparing for it. The rehabilitation process appeared to strengthen capability, opportunity, motivation, and the desired behaviors. Patient-reported barriers to behavior change were connected with restrictions in physical capability resulting from an unpredictable and fluctuating disease course, weakened motivation, and contextual factors, such as lack of access to healthcare support and training facilities, and high domestic care burden. The rehabilitation process seemed to strengthen individual and contextual prerequisites for behavior change and facilitate the use of required techniques and engagement in the desired behaviors. However, patients with RMDs may need prolonged support from HPs to integrate healthy lifestyle changes into everyday life. The findings can be used to optimize rehabilitation interventions and patients' persistent engagement in healthy behaviors.

Development of a Comprehensive Health Literacy Scale and Relationship between Health Literacy and Health-Related Behaviors among Japanese Workers

In this study, we aimed to develop a comprehensive health literacy (HL) scale for Japanese workers (CHLS-J) and to investigate the relationship between HL and health-related behaviors. We conducted a cross-sectional study by a questionnaire survey of Japanese workers aged 18 years and older (N=313). The HL scale we previously developed was slightly modified on the basis of the pre-examination and used for developing CHLS-J. Self-reported data on demographic variables, socioeconomic status, health-related behaviors, present illness, past illness, and HL were collected. To determine the factor structure of the HL scale, an exploratory factor analysis was conducted, and the internal consistency of the scale was assessed using Cronbach's coefficient alpha. The criterion-related validity was evaluated using the Pearson product-moment correlation coefficient. From the results of factor analysis, 30 HL items were extracted and the structure was based on three factors (the knowledge and competencies for collecting health information, decision-making and communication, and the motivation for utilizing health information). High CHLS-J scores were significantly associated with food purchasing behaviors based on food labeling and maintaining a well-balanced diet. Furthermore, patients with present or past illness were more likely to have high CHLS-J scores. The results show that CHLS-J is mostly a validated and reliable scale, and that the high-HL group had a healthy eating lifestyle. This study suggests that CHLS-J can be used to measure HL and educate Japanese workers on the necessity of health behavioral changes.

Predictors of performing preventive behaviors against affliction with COVID-19 based on vaccination: An application of the health belief model.

Nowadays, the COVID-19 pandemic has become one of the greatest global threats to human communities. Presently, the most important solution to deal with this pandemic is to fully comply with health protocols along with general vaccination. Given the increased vaccination rate in the community and the change in the thought of some people in the field of durable immunity and changing health behaviors, the present study determined the predictors of preventive behaviors against affliction with COVID-19 in two vaccinated and non-vaccinated groups based on the health belief model in the Iranian population aged 15-65 years. This descriptive-analytical study was conducted cross-sectionally in 2022. A sample size of 500 Yazdi citizens was selected using the convenience non-random sampling method using the contact numbers received from the SIB system of the Iranian health deputy. They were examined online in two vaccinated and unvaccinated groups. The instrument used was Delshad Noghabi et al.'s questionnaire which was based on the health belief model. Due to the adjustment of the questionnaire according to the target group, its validity and reliability were re-checked and confirmed. Data were analyzed with SPSS22 using descriptive and analytical statistics, t-test, and linear regression. Based on the findings of the study, a significant difference was observed between the three variables of income level (P = 0.019), smoking (P <0.001), and employment status (P = 0.025) in two vaccinated and unvaccinated groups at the level of preventive behaviors. Besides, the constructs of perceived sensitivity (P <0.001), perceived benefits (P <0.001), action guide (P <0.001), and self-efficacy (P = 0.018) significantly predict preventive behaviors, so that the predictive value of perceived benefits (β =3.67) was more than other variables. To prevent diseases, it is very important to increase people's awareness and information (self-efficacy) about the use of vaccination and pay attention to individual demographic characteristics in vaccination programs. Also, perceived sensitivity, perceived benefits, action guidelines, and perceived self-efficacy can be considered as important factors in determining people's willingness to be vaccinated. Therefore, education and information programs should be focused on these factors to increase people's willingness to be vaccinated.

Changes in sleep, physical activity, and health behaviors among Nigerian fasting adults in Ramadan during the COVID-19 pandemic.

There is limited data on sleep, physical activity, and health-related behaviors among the general public during Ramadan, particularly during the COVID-19 pandemic. This study aimed to assess the factors associated with sleep and physical activity changes among Nigerian Muslims during Ramadan fasting. A nationwide web-based cross-sectional study was conducted among Nigerians aged ≥18 years who performed diurnal fasting during Ramadan. The target sample size was obtained using Fisher's formula, and snowball sampling was employed. Adapted versions of the International Physical Activity Questionnaire Short Form and Copenhagen Psychosocial Questionnaire II were used to evaluate sleep and physical activity. Correlates of change in physical activity and sleep quality were assessed using logistic regression analysis. Seven hundred and seventy individuals participated in the study. During Ramadan, 39.1% (95% confidence interval (CI): 35.6%-42.6%) reported decreased physical activity, and 56.6% (95% CI; 53.0%-60.2%) stated having self-reported good sleep. The independent correlates of physical activity were female sex (adjusted odds ratio (aOR):0.5, 95% CI: 0.4-0.8), having very good sleep (aOR: 0.4, 95% CI: 0.2-0.7), and obesity (aOR: 2.0, 95% CI: 1.1-3.7). In addition, factors associated with improved self-reported sleep quality were perceived good health state (aOR: 8.8, 95% CI: 1.1-72.4), sleeping 7-9 h per day (aOR: 5.5, 95% CI: 2.6-10.3), and sleeping for over 9 h per day (aOR: 4.6, 95% CI: 2.1-14.1). Although physical activity decreased by about a third, over half of the respondents lost weight and slept well during Ramadan. Strategies to include intermittent fasting in positive lifestyle changes could improve the health and well-being of the population.

User experiences of an AI application for predicting risk of sexually transmitted infections.

Awareness of one's individual risk of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is a necessary precursor to engagement with prevention strategies and sexual health care. Web-based sexual health applications may improve engagement in sexual health prevention and care by providing individualised and evidence-based sexual health information. The STARTOnline (Supporting Timely and Appropriate Review and Treatment Online) study sought the views of sexual health service users on three web-based sexual health applications to better understand their usefulness, acceptability and accessibility. This paper reports the views and experiences of users of one of the applications called MySTIRisk. MySTIRisk estimates the risk of three common STIs and HIV using data from attendees of a metropolitan sexual health service. This study used a bespoke qualitative design, informed by a developmental evaluation approach. Melbourne Sexual Health Centre clinic attendees' views were sought using semi-structured interviews conducted between October 2023 and January 2024 via videoconferencing, telephone and on site at the clinic. Data was analysed using qualitative data analysis methods. A diverse group of 14 participants described an ideal pathway to better sexual health outcomes that might be facilitated by use of the MySTIRisk application, particularly for individuals with limited sexual health knowledge, or affected by stigma and geographical barriers. This pathway was described as: 1) being concerned about my sexual health; 2) checking my STI risk easily and privately; 3) understanding and trusting the result; and 4) deciding how to look after my health. Factors that might influence this pathway were also described, including areas for improvement in accessibility and acceptability. These findings support the role of web-based sexual health applications in facilitating access to sexual health education and behavioural change and underscore the importance of codesign approaches in improving their uptake and impact.

The Influence of Traffic Lights Presentation of Dementia Risk Screening Information on Older Adults' Motivations for Risk Reduction in Primary Care Settings.

This study assessed older adults' preferences for how to communicate dementia risk information to maximize motivation for behavior change. Eighty-nine community-dwelling older adults (aged 61 to 92 years, M=72.93, SD=6.36, 76% women) received dementia risk factor information in 2 formats: "traffic lights" (green=risk absent, amber=risk emerging, and red=risk present) or red/risk-only. Participants reported motivation to change risk-related behaviors, motivation to maintain good health behaviors, liking of the formats, categorical preference for traffic lights versus risk-only formats, reasons for preferences (open-ended), total applicable risks, and Motivation to Change Lifestyle and Health Behaviour for Dementia Risk Reduction. Traffic lights presentation was more motivating ( Z =4.16, P <0.001), more liked ( Z =4.80, P <0.001), and preferred, N Traffic =71, N Red =14, χ 2 (1)=38.22, P <0.001, over risk-only. Self-efficacy and motivation to maintain good health behaviors were significant unique predictors of motivation to change risk-related behaviors following traffic lights presentation over age, sex, education, total applicable risks, perceived susceptibility, cues to action, and liking of the traffic lights presentation format. Themes indicated (1) traffic light presentation is informative and clear, and (2) green-light information increases self-efficacy. Traffic light presentation increases patient motivation to reduce dementia risk. Green-light information increases self-efficacy. Maximizing motivation through information presentation can decrease dementia prevalence.

The Medicine Wheel as a public health approach to lifestyle management interventions for indigenous populations in North America.

This analytic essay intends to elevate Medicine Wheel, or generally "four directions" teachings, to encourage a more comprehensive alignment of lifestyle intervention components with traditional ecological knowledge systems of Indigenous cultures in North America. North American Medicine Wheels provided people with a way to orient themselves both within their traditional belief systems and to the seasonal changes in their areas, improving survivability. The wheel or circle is a sacred symbol, indicating the continuity and perpetuity of all of life. The four directions are iconized in many Indigenous cultures across North America with different directions representing different aspects of our world and of ourselves, different seasons of the year and of our lives, different beings of the earth and tribes of humans with a balance among those necessary for health and wellbeing. In the context of public health, teachings of the four directions warn that a lack of balance limits our ability to achieve optimal health. While there is much public health success in lifestyle interventions, existing practice is limited by a siloed and one size fits all approach. Medicine Wheel teachings lay out a path toward more holistic and Indigenous-based lifestyle intervention that is modifiable depending on tribal teachings and needs, may appeal to a variety of Indigenous communities and is in alignment with health behavior change theory. It is a public health imperative that lifestyle management interventions are fully optimized to rigorously determine what can be achieved when interventions are implemented in a holistic and Indigenous-based manner, and in alignment with an Indigenous model of health. This more complete alignment would allow for a stronger foundation to further explore and develop social determinants (i.e., housing, employment, etc.) and structural intervention enhancements to inform public health practice and promote health equity.

The Relationship Between Negative Coping Styles, Psychological Resilience, and Positive Coping Styles in Military Personnel: A Cross-Lagged Analysis.

Military personnel experience prolonged exposure to high-stress environments. Positive coping styles can assist in maintaining their mental and behavioral well-being, whereas negative coping styles cannot. Health behavior change theory specifies that an individual can transition from a negative to a positive coping style. The psychological resilience concept may prove vital in this transition. In a longitudinal study design, two questionnaires were administered to 233 military personnel twice, the first at T1 in April 2023 and the second at T2 in July 2023. The questionnaire measured individual negative coping style, positive coping style and psychological resilience. The data showed that the negative coping style at T1 negatively predicted the level of psychological resilience at T2 (γ= - 0.26, p < 0.001) and the positive coping style at T2 (γ= - 0.16, p < 0.001). The level of psychological resilience at T1 positively predicted the positive coping style at T2 (γ= 0.22, p < 0.01). Psychological resilience played a mediating role between negative coping style and positive coping style. In addition, there was an interaction between psychological resilience and positive coping style in military personnel at the two time points. The negative coping styles that presently exist among military personnel have the potential to diminish their future positive coping styles by lowering their psychological resilience. This highlights the need to focus on the development and training of psychological resilience for military personnel, as it can effectively counteract negative coping styles and promote positive coping styles.

Exercise for People with Parkinson's Disease: Updates and Future Considerations.

Parkinson's disease (PD) is now the world's fastest-growing neurological disorder with rapidly rising prevalence and increasing demand for effective health services. Recent research has focused on the importance of early diagnosis and proactive management of physical function. Accumulating evidence indicates that reduced physical activity levels and mild pre-clinical disability are present in many people prior to a clinical diagnosis, perhaps developing over years. Early referral to a physiotherapist at the time of diagnosis is now recommended in global guidelines. Multiple forms of exercise have been found to have benefits in early and mid-stage disease across a range of motor and non-motor symptoms. Evidence from longitudinal studies confirms that disability is delayed when regular exercise is sustained over long periods. Exercise is now recognized as an essential component of treatment, in combination with medical therapies. Contemporary physiotherapy interventions now combine health behavior change techniques with physical exercise to promote the development of long-term exercise adherence. Advances in technology and digital health have progressed quickly and now offer opportunities for remote assessment and monitoring, remote exercise supervision, and support adherence through feedback and motivational strategies. Recent biomedical discoveries forecast improved earlier and more accurate diagnosis of PD, allowing opportunities for earlier interventions. Current research in progress will provide important insights into the dose and intensity of aerobic exercise in PD. Physiotherapists have important roles in advocacy and education in conjunction with care delivery to support access to evidence-based care for all people with PD.

Positive cardiovascular health: longitudinal investigation of sustained health behavior in a cross-lagged model.

Our study focuses on the role of psychological states in the development of cardiovascular disease (CVD) and explores the potential of positive psychological factors in reducing CVD risk. While existing research has predominantly examined negative mental states and risk behavior, this longitudinal study takes a novel approach by investigating positive psychological wellbeing and its impact on sustained health behavior. The research involved participants (n = 502) with medium to high cardiovascular risk who underwent a comprehensive risk assessment in 2012, followed by written risk communication. Health behavior and psychological variables were measured in 2012 and 2019. A cross-lagged panel was employed to repeat measures of a cardiovascular health index with latent factors. Results indicated an excellent fit for the model (RMSEA = 0.0644, CFI = 0.936, TLI = 0.921, SRMR = 0.050), with significant associations between the observed variables (p < 0.05) and created latent factors. Furthermore, the model implied significant bivariate correlations (p < 0.05) between latent constructs of sustained health behavior and positive psychological states in 2012 and 2019. A significant regression relationship between Health Awareness Index 2012 and 2019, between Psychological wellbeing in 2012 and 2019 (B = 1.103 p = 0.038), latent factors could be identified (B = 1.103 p = 0.038) using cross-lagged panel model. Results highlighted the importance of cardiovascular health awareness, subjective risk perception, and self-directed efforts in facilitating health behavior change. Relationships between psychological wellbeing and health awareness emphasize that positive experiences and reinforcement are crucial in sustaining optimal health behavior. Our findings offer a new perspective on cardiovascular risk screening and preventive interventions. Extending cardiovascular risk screening with psychological measures may broaden prevention opportunities by including psychological elements reinforcing positive psychological states. The findings suggest that an effective prevention program must consider stabilizing and maintaining positive psychological states to achieve lasting improvements in cardiovascular health.

A qualitative study of barriers and facilitators for health behavior change in low-income men with prostate cancer.

Low-income prostate cancer survivors, who typically have worse outcomes and greater all-cause mortality, often have poor health-promoting behaviors. Our objective was to assess perceived facilitators of and barriers to healthy behavior change by interviewing low-income men with prostate cancer who received no-cost treatment through a state-funded program. Between September 2021 and April 2022, we conducted semi-structured interviews with 19 men (ages 60-75). Purposive sampling was utilized from participants of a cohort of men with prostate cancer from low-income backgrounds. Interviews were recorded, transcribed, and then coded by the authors to generate salient themes via thematic analysis. We found internal characteristics and structural characteristics that functioned independently and in concert to promote and/or hinder healthy behavior change. Internal characteristics such as motivations (prostate cancer diagnosis, self-perceptions, support system, and preferences) and determination, defined as level of motivation, drove behavior actualization. Structural characteristics that influenced behavior change included resources (access to food and opportunities for exercise) and social support. These outcomes suggest that motivation and determination can serve as protective facilitators encouraging healthy behaviors despite structural barriers low-income prostate cancer survivors may face. However, motivations challenged by financial constraints were not sufficient to guide healthy behavior change. With this in mind, we recommend that interventions promoting healthy behavior change among this population should focus on identifying and strengthening internal assets such as motivations, self-perceptions, preferences, and support systems.

Changes in Health Behaviour Factors in Response to COVID-19

The coronavirus pandemic caused profound changes in many aspects of people's lives, especially in the area of health behaviour. The restrictions caused by the pandemic have had negative effects on both the physical and mental health of society, while also transforming the way individuals exercise. The aim of our research was to analyse the changes in health behaviour of Hungarian adults, including their sporting habits as well as their mental health, caused by the COVID-19 pandemic. We also focused on comparing the experiences of a population that regularly participates in sport and a population that rarely or never participates in sport. Results of the survey showed that individuals who regularly participate in sport activities rated their general physical health significantly better than those living a more sedentary life. More than half of the sample stated that they did not experience any particular change in their physical health, but the second highest percentage of respondents reported that their health had been affected negatively by the pandemic period. Results also showed that almost half of respondents said that their sporting habits had not changed as a result of the pandemic, while many reported that their sporting frequency had decreased. Finally, we also analysed the changes in sporting habits with regard to the place of residence, finding that those individuals living in an apartment complex building were most likely to choose a different type of exercise from the one they had previously practised, while a higher proportion of individuals living in a suburban area, or with access to garden reported that they had started to doing sports.Our research provided partial confirmation that the pandemic had a negative effect on people's health behaviour, but given the high levels of exercise in the target group,it is not surprising that many did not experience any change in sporting habits or physical health. JEL Code: I12

Technology-Enabled Collaborative Care for Diabetes and Mental Health (TECC-D): Feasibility and Satisfaction of a Co-Re-Designed Integrated Virtual Care Model

Objective: For individuals living with Type-2 Diabetes (T2D), mental health issues such as distress, anxiety, and depression are common. However, current models of care require those living with T2D and mental health issues to navigate a fragmented healthcare system to receive physical and mental health services. This is especially true in rural areas where there are additional barriers at the individual and provider level. To address these gaps, we co-re-designed a person-centred Technology-Enabled Collaborative Care for Diabetes and Mental Health (TECC-D) model through iterative input. &#x0D; Co-Re-Design: To meet the complex needs of those living with T2D and mental health issues, a co-re-design process was utilized. This involved building on existing assets, including a previously co-designed collaborative care model that was re-designed for this population with input from three people with lived experience of diabetes, diabetes and mental health care providers, and community stakeholders. This team supported the design and implementation of the model throughout the study duration.&#x0D; Methods: In this explanatory sequential feasibility trial, the TECC-D model leveraged existing assets including widely available technology (telephone, web-conferencing) to integrate T2D and mental health support through weekly, virtual health coaching sessions with a Certified Diabetes Educator, supported by a multidisciplinary virtual care team for 8 weeks. Primary outcomes included the feasibility and acceptability of the TECC-D model with exploratory outcomes including changes in mental health, substance use, and physical health behaviours collected at baseline, 4, 8, and 12 weeks. Provider and partner experience and satisfaction were also explored through a qualitative descriptive study.&#x0D; Results: 31 participants were recruited and completed the program between June 2021 and June 2022. Study findings demonstrate that the TECC-D model is a feasible and scalable care solution that empowers individuals living with T2D and mental health issues to take an active role in improving their physical and mental health. Participants and providers described program components (e.g., health coaching, virtual care team) and program delivery (e.g., frequency and duration of the program) positively. This included: 1) seeing virtual care as practical and effective for managing routine care needs; 2) feeling that having an expert care coach supported by a virtual care team was “over and above” the care that participants had previously experienced; 3) building expertise and capacity within the care team specific to diabetes and mental health; and 4) recognizing that integrated care is “missing from diabetes care” and that in offering clinical integration, participants felt “much more than just the sum of my parts”. &#x0D; Conclusions: Utilizing widely available technology in the current health system and engaging existing primary and community-based care assets, this model of care was found to be both feasible and acceptable by participants, providers, and patient partners and may improve the lives of individuals living with T2D and mental health issues.