Health Behavior Change Research Articles

Effectiveness of Health Behaviour Modification for Chronic Non-communicable Disease Patients with Health Coaches at Khiensa Hospital, Surat Thani Province

Background: Patients with chronic noncommunicable diseases often struggle to control their blood sugar and blood pressure levels, and they frequently experienced physical, mental, and self-care practice issues that needed to be addressed. However, they may not receive adequate guidance, or the guidance they receive may be mismatched to their needs, or they may be misunderstandings between providers and patients. Therefore, medical treatment alone is insufficient; lifestyle and behavioural changes are also required throughout treatment. Objectives: This quasi-experimental study aimed to investigate the effectiveness of health behaviour modification for chronic non-communicable disease patients through health coaching at Khiensa Hospital, Surat Thani Province. Methods: The study included 550 participants who underwent a three-month health behaviour change process for patients with chronic non-communicable diseases. Each group of ten participants was supervised by a single health coach. Health literacy, health behaviour modification, and blood sugar levels were assessed before and after participating in the process using structured questionnaires. The data were analyzed by using a paired t-test to compare the mean scores of the effectiveness of health behaviour modification for chronic non-communicable disease patients through health coaching using STATA. Result: The results showed that the average health literacy scores related to chronic noncommunicable diseases increased significantly from 162.0 to 170.2 after intervention. Similarly, the average health behaviour modification scores increased significantly from 51.4 to 55.1. Furthermore, average blood sugar levels decreased from 114.1 mg/dl to 109.2 mg/dl. Our statistical analysis revealed that the significant differences in the average scores of health literacy, health behaviour modification, and blood sugar levels before and after participating in the process (t=170.3, 151.6, and 95.0, respectively, p<0.001). Conclusion: The Ministry of Public Health should develop policies to support and prioritize holistic patient care and promote proactive health promotion services for patients through intensive health promotion program activities led by health coaches to enhance the effectiveness of care for chronic non-communicable disease patients.

Addressing emotional distress to improve outcomes in adults with type 1 diabetes: Protocol for ACT1VATE randomized controlled trial

BackgroundDiabetes distress (DD) is a prevalent concern among people with type 1 diabetes (T1D) and is linked to poor clinical outcomes. Instead of targeting the elimination of DD, we propose a novel approach that empowers individuals with strategies to manage their diabetes effectively in the context of DD: Acceptance and Commitment Therapy (ACT). The purpose of this in-progress trial is to compare an ACT group intervention (ACT1VATE) with usual care in improving HbA1c, DD, quality of life, and cost-effectiveness in adults with T1D. MethodsThis is a two-arm, parallel group, randomized controlled superiority trial enrolling N = 250 adults with T1D, elevated HbA1c, and significant DD in a real-world community-based health system. Participants are randomized to receive ACT1VATE (a five-week ACT group telehealth intervention) or diabetes self-management education and support (usual care as the first-line recommended intervention for DD). The trial will examine comparative effectiveness in improving HbA1c, DD, quality of life, and cost-effectiveness over 12 months. DiscussionWe predict that ACT1VATE will be superior given its (1) specific focus on DD, without any expectation that difficult diabetes-related thoughts and emotions must (or can) be completely eliminated; and (2) purposeful linkage of diabetes self-care behaviors to an individual’s deeply held values, thus eliciting intrinsic, patient-centric motivation for meaningful and lasting health behavior changes. This trial will provide a valuable test of real-world effectiveness, drive sustainability and scalability, and inform the future of chronic disease care.Trial registration: NCT04933851 (https://clinicaltrials.gov/ct2/show/NCT04933851).Clinical Trial: Clinicaltrials.govNCT04933851https://clinicaltrials.gov/study/NCT04933851

Exploring Demographic and Cognitive Predictors of Self-Management in Quasi-Randomized Fall Prevention Intervention for Older Adults With and Without Traumatic Brain Injury.

Changes in health behavior are key to maintaining health, safety, and independence of older adults. The purpose of this study was to explore factors impacting training in self-management and behavior change in older adults with and without traumatic brain injury (TBI), informing efforts to improve safety and independent function. Forty-one older adults, 19 with TBI, completed a self-regulation intervention (mental contrasting with implementation intentions; MCII) to promote fall prevention behavior change. Participant outcomes were related to single and recurring behavior changes; implementation outcomes were measured as modifications to treatment. Although participants with TBI performed more poorly on tests of neurocognitive function, there were no differences in behavior change rates following MCII, suggesting the treatment worked similarly for participants with and without TBI. Across both groups, those with higher executive function scores were more likely to complete recurring behavior changes. Participants with higher stress, higher Fall Risk Scores, or history of TBI were more likely to need modifications to treatment. This quasi-experimental pilot study describes cognitive and psychosocial predictors that may be critical for participation and success in health behavior change and self-management of fall prevention for older adults with and without TBI.

Effectiveness of an mHealth App That Uses Financial Incentives and Gamification to Promote Health Behavior Change in Adolescents and Caregivers: Protocol for a Clinic-Based Randomized Controlled Trial.

Adolescent and adult obesity continues to be a public health epidemic in the United States. Despite the popularity of mHealth apps with gamification among adolescents, there are insufficient studies to evaluate the efficacy of gamified mHealth apps and financial incentives to motivate sustained health behavior change in adolescents or their adult caregivers. This study aims to evaluate the effectiveness of gamification techniques and financial incentives used in the novel "CommitFit" mHealth app to motivate health behavior change and improve various mental and physical health metrics in adolescents and their caregivers. This study is a 3-month randomized controlled trial (RCT) with 30 adolescents (aged 13-15 years) and their adult caregivers (N=60). It evaluates "CommitFit," which uses gamification including points and leaderboards to motivate logging and achievement of self-selected health behavior goals (eg, more water, sleep, physical activity, fruits, or vegetables or fewer sugary beverages). The RCT had three arms, each with 10 dyads: (1) CommitFit-only users; (2) CommitFit$, where adolescents were paid US $0.05 for each point they earned; and (3) waitlist control. Intervention dyads used the app for 3 months and had the option to use it for the fourth month without prompts or extra financial incentives. User analytic software was used to evaluate the frequency of user logs and goal achievement. Monthly surveys evaluated self-reported change in the 5 CommitFit health behaviors. Changes in BMI and blood pressure were evaluated for all participants at 3 clinical visits. Mental health, gamification, and behavior economics surveys were completed during the clinical visits. Recruitment began in August 2023 and was completed in 10 weeks. The research team successfully recruited and enrolled 30 dyads. Researchers emailed and called 89 caregivers on a physician-approved adolescent patient list, a 33% recruitment rate. Data collection and analysis will be conducted in the spring and summer of 2024. The results of this study are anticipated to be published between late 2024 and early 2025. This RCT will expand knowledge of the effectiveness of gamification techniques, financial incentives, and mHealth apps to motivate sustained health behavior change among adolescents and caregivers. These results may offer new opportunities to caregivers, health insurers, health care systems, and clinicians to motivate health behavior change in adolescents and caregivers, with the ultimate goal of preventing or reducing obesity and obesity-related diseases. Additional gamification, mental health surveys, and app user analytics included in the study may provide further insight into the characteristics of adolescents or caregivers who would benefit the most from using a gamified mHealth app like CommitFit. DERR1-10.2196/63505.

A nurse coaching intervention to improve support to individuals living with ALS

Objective Health coaching may supplement the multidisciplinary ALS clinic model to facilitate patient-centered health behavior change. The aim of this study was to determine the effects of nurse health coaching (NHC) on the quality of life and self-efficacy of individuals living with ALS. Methods Twenty-nine participants were randomized at 1:1 to the standard of care and coaching arms. All participants attended multidisciplinary ALS clinic visits quarterly, at which times they completed assessments of quality of life and self-efficacy. Those in the coaching arm participated in monthly coaching with a nurse coach over 12 months. The coaching sessions utilized motivational interviewing to identify personal goals along with barriers and solutions to achieve them. Linear mixed-effect models were used to quantify the effect of coaching on quality of life and self-efficacy outcomes. Thematic analysis was performed to summarize the participants’ experiences with coaching. Results Adherence to the coaching intervention was good. No effects of coaching were observed on the primary outcomes of quality of life and self-efficacy, although debriefed participants reported that they would recommend it to others. Patients and caregivers reflected on the impacts of coaching that extended beyond the pre-defined study outcomes and measures put in place to gauge effectiveness. Conclusions The elicited qualitative themes illustrating patient experience of coaching demonstrate the utility of nurse coaching as an important adjunct support to complement the multidisciplinary ALS clinic model.

Maternal Health During the COVID-19 Pandemic in the United States: An Interrupted Time-series Analysis.

The COVID-19 pandemic, and subsequent policy responses aimed at curbing disease spread and reducing economic fallout, had far-reaching consequences for maternal health. There has been little research to our knowledge on enduring disruptions to maternal health trends beyond the early pandemic and limited understanding of how these impacted pre-existing disparities in maternal health. We leveraged rigorous interrupted time-series methods and US National Center for Health Statistics Vital Statistics Birth Data Files of all live births for 2015-2021 (N = 24,653,848). We estimated whether changes in maternal health trends after the onset of the COVID-19 pandemic (March 2020) differed from predictions based on pre-existing temporal trends. Outcomes included gestational diabetes, hypertensive disorders of pregnancy, gestational weight gain, and adequacy of prenatal care. We found an increased incidence of gestational diabetes (December 2020 peak: 1.7 percentage points (pp); 95% confidence interval [CI]: 1.3, 2.1), hypertensive disorders of pregnancy (January 2021 peak: 1.3 pp; 95% CI: 0.4, 2.1), and gestational weight gain (March 2021 peak: 0.1 standard deviation; 95% CI: 0.03, 0.1) and declines in inadequate prenatal care (January 2021 nadir: -0.4 pp; 95% CI: -0.7, -0.1). Key differences by subgroups included greater and more sustained increases in gestational diabetes among Black, Hispanic, and less educated individuals. These patterns in maternal health likely reflect not only effects of COVID-19 infection but also changes in healthcare access, health behaviors, remote work, economic security, and maternal stress. Further research about causal pathways and longer-term trends will inform public health and clinical interventions to address maternal disease burden and disparities.

Oral health literacy, knowledge, attitude, and oral health practices among college students at Jenderal Soedirman University

Background: Oral health literacy (OHL) has an important role as a medium for health promotion and efforts to prevent oral diseases through oral health behavior changes. Purpose: This study aims to determine OHL and its correlation with oral health knowledge, attitude, and oral health practice among college students. Methods: This cross-sectional study was conducted on 583 students of Jenderal Soedirman University in 2020, as the students come from different provinces in Indonesia. The Indonesian Oral Health Literacy Questionnaire was used to assess OHL. A self-designed questionnaire was used to assess oral health knowledge, attitude, and oral health practice. Results: Most students had good OHL, knowledge, and attitude toward oral health (90.7%, 84.6%, and 90.5% respectively). A Pearson correlation test showed a correlation between OHL and oral health knowledge (p = 0.044) and attitude (p = < 0.001). The Fisher exact tests showed a correlation between OHL and snacking frequency, tooth-brushing frequency, tooth-brushing time, and toothbrush changing time. The better the OHL, the better the knowledge and attitude. There was no correlation between OHL and sweet food eating frequency, the use of cleansing aids, dentist visit frequency, and the first action taken when experiencing toothache. Conclusion: OHL has a correlation with oral health knowledge and attitude. However, OHL is only related to some oral health practice indicators. The results of this study are expected to be taken into consideration when formulating strategies to improve oral health within the university.

Effectiveness of NSW health get healthy telephone coaching in adults screened from general practices

BackgroundThe effectiveness of the NSW Health “Get Healthy Information and Coaching Service®”(Get Healthy) to facilitate weight loss on a population scale has been documented, but this was based on self-reported measures. Our study aims to test the effectiveness of the Get Healthy Service on objectively measured weight, BMI, waist circumference, and changes in other health behaviours, including nutrition, physical activity and alcohol intake.MethodsMen and women aged 40–70 years (n = 154) with pre-diabetes (5.7% < HbA1c < 6.5%) were referred from GP Practices to the Get Healthy Service, NSW Health. A subset (n = 98) participated in the “Zinc In Preventing the Progression of pre-Diabetes” (ZIPPeD) trial (ACTRN12618001120268).ResultsThe self-reported outcomes showed a statistically significant improvement from baseline to 12 months in weight (mean 2.7 kg loss, p < 0.001), BMI (mean 1 unit reduction, p < 0.001), and waist circumference (mean 4.3 cm reduction, p < 0.001). However, in the objectively measured outcomes from ZIPPeD, the differences were more modest, with point estimates of 0.8 kg mean weight loss (p = 0.1), 0.4 unit reduction in BMI (p = 0.03), and 1.8 cm reduction in waist circumference (p = 0.04). Bland-Altman plots indicated that discrepancies were due to a small number of participants who dramatically underestimated their weight or BMI. There were minimal changes in nutrition, physical activity, and alcohol.ConclusionsThe potential benefits of Get Healthy should be interpreted with caution as we have shown significant differences between self-reported and objectively measured values. More valid and objective evidence is needed to determine the program’s effectiveness and cost-effectiveness.

Household Latrine Utilization Behavioral Model as an Effort to Improve Open Defecation-Free Program

Background: Healthy latrine-using behavior indicates healthy behavior. However, many people still practice open defecation, which can cause illness and increase death risk. Self-efficacy is a dominant predictor of health behavior change. Aims: The study aims to develop a household latrine utilization behavior model based on self-efficacy to improve an open defecation-free (ODF) program. Method: The study was a descriptive-analytic with a cross-sectional design. The sample size was 138 respondents with cluster random sampling. The study variables were endogenous (household latrine utilization), exogenous (predisposing, enabling, and reinforcing factors), and intervening variables (self-efficacy). Data were collected by questionnaire and analyzed using SEM-PLS. Result: The household latrine utilization behavior-based self-efficacy model is fit (SRMR=0.098; NFI= 0.910; Q2=0.334). Valid and reliable indicators were education (predisposing), clean water availability and latrine maintenance (enabling), and health worker and family support (reinforcing). Path analysis showed exogenous factors, directly and indirectly, influence latrine utilization behavior through self-efficacy. Predisposing and reinforcing factors had a direct and significant effect (p = 0.025; p = 0.001) while enabling factors were insignificant (p = 0.438). Enabling and reinforcing factors indirectly and significantly affected latrine utilization behavior through self-efficacy (p = 0.033; p = 0.004), while predisposing factors were insignificant (p = 0.141). Self-efficacy significantly influenced latrine-using behavior (p = 0.023). Conclusion: The household latrine utilization behavior-based self-efficacy model is a fit model with good predictive relevance in predicting household latrine use behavior. Health workers can use the model to enhance household latrine utilization behavior and improve the ODF program and public health status.

Does stress compromise fruit and vegetable intake? A randomized controlled trial testing a model with planning as a mediator and stress as a moderator

ObjectiveIndividuals experiencing higher stress levels tend to consume fewer fruits and vegetables compared to their less stressed counterparts. Thus, to promote fruit and vegetable (FV) consumption, action planning has been proven effective in translating behavioral intentions into actual dietary behaviors. This study aims to evaluate a 7-day intervention designed to improve FV planning and intake, while also examining the role of stress. MethodsThe trial employed a 3 (time: pretest, post-test, and follow-up) * 2 (group: intervention vs. control) between-participant factorial design. A total of 99 young Chinese adults (age = 23.84 years ± 4.63, 26 men) who had formed an explicit intention to consume more fruit and vegetables, participated in a 7-day online randomized controlled trial. ResultsThe intervention successfully enhanced FV planning as well as FV intake. Furthermore, a moderated mediation model revealed that FV planning mediated the relationship between experimental conditions and FV intake, with stress moderating this mediation. Specifically, planning facilitated FV intake for individuals with low stress levels, while this effect was not observed for those with high stress levels. ConclusionThese findings confirm the positive impact of the planning intervention on improving FV intake, particularly for individuals with low stress levels, and highlight stress as a barrier to health behavior change that warrants further attention in future studies.

Analysis of health behavior changes among residents in depopulation areas in Korea: a cross-sectional study based on Community Health Survey data from 2010 to 2019

Objectives: The total population of Korea began to decline in 2019; in particular, the population in rural areas has been rapidly decreasing and is aging. Therefore, the government has designated depopulation areas and is seeking ways to support them. To assess whether health disparities exist between areas with population decline and those without, this study used community health survey data to observe temporal changes in health behaviors between the two types of areas. Methods: The analysis used Community Health Survey data from 2010 to 2019, and regional classification was divided by depopulation areas designated by the Ministry of the Interior and Safety. Trends in health behavior and chronic disease prevalence between depopulation and non-depopulation areas were analyzed. All analyses were conducted using complex sample analysis procedures in SAS 9.4 software. Results: The smoking rate steadily decreased in both depopulation and non-depopulation areas, whereas the high-risk drinking rate increased slightly. The walking practice rate did not improve in depopulation areas compared to non-depopulation areas. Furthermore, nutritional labeling usage rate was consistently lower in depopulation areas than in non-depopulation areas, with the gap being the largest. The prevalence of obesity, diabetes, and hypertension showed that the gap between depopulation and non-depopulation areas is continuously increasing. Conclusions: Health behaviors in depopulation areas have not improved, and the prevalence of chronic diseases is increasing rapidly. Therefore, the demand for health care services that support healthy lifestyle practices and chronic disease management in these areas is expected to increase.

Does the Association between Changes in Health Behaviors and Weight Gain Differ by Race and Ethnicity During the (COVID)-19 Pandemic? Findings from a Population-based Study

Objectives: We examined racial and ethnic differences in the association between changes in lifestyle behaviors and weight gain during COVID-19. Methods: We obtained data from a 2020 national survey involving 2,709 adult Americans. The outcome of interest was self-reported weight change status; behavioral measures included changes in exercise time, screen time, fast food meals consumed, and alcohol and tobacco use. We performed weighted multivariable logistic regression analyses to examine the association. Results: Non-Hispanic (NH) black adjusted odds ratio (AOR) (AOR = 1.59, 95% CI: 1.21-2.10) and Hispanic respondents (AOR = 1.89; 95% CI: 1.48-2.42) were more likely to experience weight gain, relative to the NH white respondents. Among NH Whites, changes in exercise time (AOR = 0.93), screen time (AOR = 1.16), fast-food meals consumptions (AOR = 1.14), and being drinkers (AOR = 1.35) and smokers (AOR = 0.53) were associated with weight gain; while among Hispanics, only changes in exercise time (AOR = 0.92) and screen time (AOR = 1.14) were associated with weight gain. Changes in exercise time (AOR = 0.94) among NH Blacks and changes in screen time (AOR = 1.16) among NH Asians were associated with weight gain. Conclusions: Risk factors of weight gain differ across racial and ethnic groups during the COVID-19 pandemic. Tailored intervention strategies are warranted to address specific risk behaviors within each racial and ethnic group.

Examining The Dual Impact of Comprehensive Psychological Intervention and Ideological and Political Education on College Students' Health Behaviour

Background: College students face unique challenges including lifestyle transitions and increased academic demands, highlighting the need for interventions that address both behavioral and psychological health. Recent insights into ideological education and mental health suggest they significantly influence students' health-related choices. Objective: This study aimed to evaluate the effects of an Integrated Physical Education (IPE) curriculum coupled with a psychosocial intervention on the health-related behaviors of college students. Methods: We employed a pre-test/post-test design to assess changes in self-reported health behaviors, physical activity levels, stress management, and sleep quality following the intervention. Results: The intervention led to noticeable improvements across several areas. Participants experienced reduced stress levels and enhanced sleep quality, attributed to the intervention's focus on relaxation techniques, potentially improving overall energy levels. Additionally, there was a positive shift in physical activity patterns, with an increase in moderate-intensity exercises and a decrease in lower-intensity activities. However, the study also identified barriers to sustaining these healthy behaviors, such as time constraints and elevated stress during examinations, which hindered consistent participation in fitness regimes and healthy eating. Lack of social support also emerged as a challenge in maintaining these lifestyle changes. Conclusions: The findings suggest that integrating comprehensive psychological therapies with political and ideological education can effectively promote positive changes in health-related behaviors among college students. The study recommends incorporating practical advice on integrating healthy routines into daily schedules to address time management challenges, thereby enhancing the sustainability of health-promoting behaviors. Recommendations: Future interventions should focus on strategies for overcoming time barriers and enhancing social support to facilitate long-term adherence to healthy behaviors among college students.

Multilevel Interventions Targeting Obesity: State of the Science and Future Directions.

A seminal report, released in 2001 by the Institute of Medicine, spurred research on the design, implementation, and evaluation of multilevel interventions targeting obesity and related behaviors. By addressing social and environmental factors that support positive health behavior change, interventions that include multiple levels of influence (e.g., individual, social, structural) aim to bolster effectiveness and, ultimately, public health impact. With more than 20 years of multilevel obesity intervention research to draw from, this review was informed by published reviews (n = 51) and identified intervention trials (n = 103), inclusive of all ages and countries, to elucidate key learnings about the state of the science. This review provides a critical appraisal of the scientific literature related to multilevel obesity interventions and includes a description of their effectiveness on adiposity outcomes and prominent characteristics (e.g., population, setting, levels). Key objectives for future research are recommended to advance innovations to improve population health and reduce obesity.

An approach to persons who are not willing to engage in behavioural change.

With its unique position, primary health care (PHC) can provide health promotion and prevention services, including lifestyle behavioural counselling. Unhealthy lifestyle behaviours are very prevalent among patients attending PHC, with many patients unwilling to change or in the precontemplation stage. While patients in the contemplation stage are better managed using the 5As approach of motivational interviewing counselling, those unwilling or not ready for change necessitate a different approach, such as the 5Rs of motivational interviewing (MI) counselling. The 5Rs MI approach holds promise in motivating unwilling individuals to consider embarking on the journey of behavioural change. The 5Rs approach is not a stand-alone checklist of tasks implemented in isolation but is best integrated within a theoretical behavioural change framework. Of the four health-related behavioural change theoretical frameworks that are frequently used, the transtheoretical stages of the change model are the most used. This continued professional development article provides a summary review of the literature on behavioural change theories as they apply to lifestyle health behaviour change and presents the 5Rs approach as a feasible and practical approach to manage patients who are unwilling to change or in the precontemplation stage. This offers a beacon of hope for improved patient outcomes in a PHC system saddled with high prevalence of modifiable unhealthy lifestyle behaviours.

Randomized Controlled Trial of the Behavioral Intervention for Increasing Physical Activity in Multiple Sclerosis Project: Fidelity Monitoring and Outcomes

Treatment fidelity is a key component for assessing the reliability and validity of clinical trials in behavioral medicine. This manuscript reports on the outcomes of a pre-planned fidelity monitoring protocol for a Phase-III clinical trial, project Behavioral Intervention for Physical Activity in Multiple Sclerosis (BIPAMS). The fidelity monitoring protocol included the five areas of the National Institutes of Health Behavior Change Consortium with primary data sources including: coaching call checklists, coaching logs, auditing of coaching calls by experts, behavioral resource bank within the treatment group, review of participant website log-ins, review of participant self-monitoring, and team meetings for discussing participant progress and protocol adherence. The fidelity monitoring protocol was implemented across six waves of participants, and a final sample of 269 participants (i.e., n = 135 in BIPAMS intervention and n = 134 in WellMS control) completed the 24-week study. Ten coaches were comprehensively trained to implement the study protocol, which included an orientation call and one-on-one behavioral coaching calls. Among BIPAMS participants, an average of 11.81/13 scheduled calls were completed, and 96 (62% of planned) were audited by an expert. Among WellMS participants, an average of 8.19/9 calls were completed, and 54 (55% of planned) audits were completed. Unplanned protocol deviations included inability to complete live call audits during the COVID-19 pandemic lockdown and changes in coaching criteria to accommodate unanticipated medical conditions and graduations. This manuscript provides an example and insights for demystifying treatment fidelity monitoring to help facilitate wide-spread use of standard protocols.

Goal Setting Moderates Behavior Change Outcomes in College Students After an Online Health Coaching Intervention

ABSTRACT Background Health coaching sessions that incorporate goal setting may help improve college students' health behaviors. Purpose This study examined whether specific goal-setting practices moderated changes in health behaviors during an online wellness intervention in college students. Methods Participants were 90 college students recruited from one US university. The intervention was a one-hour virtual one-on-one health coaching session where participants set two goals for either physical activity (Metabolic Equivalent Task (MET)-minutes or MET-minutes), nutrition, sleep, or stress management. Self-reported baseline behaviors were collected, and follow-up surveys were completed at 6- and 12-weeks. Mixed effects models examined behavior change outcomes across the follow-up timepoints while testing the moderating effect of goal setting using interactions. Results The Goal×Time interaction was significant for moderate MET-minutes at 1st follow-up (b = 443, p = .003), and for total MET-minutes at the 2nd follow-up (b = 717, p = .047). The Goal×Time interaction was also significant for stress management at 1st follow-up (Odds Ratio = 7.3, p = .042). Discussion Participants who set physical activity and stress management goals had significantly higher physical activity and utilized more stress management techniques. Translation to Health Education Practice The use of specific goal-setting strategies for physical activity and stress management is recommended during online health coaching sessions. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars.

The Asymmetric Spillover Effects of Retirement on Disability: Evidence From China.

Recent research has explored the spillover effects of retirement on spousal well-being, yet limited attention has been given to the short-term impact on spousal disability. This study explored the asymmetric spillover impact of retirement on spouses' disability severity among a national cohort of urban residents in China. Utilizing 4 waves of data (2011-2018) from the China Health and Retirement Longitudinal Survey, we employ a nonparametric regression discontinuity design to estimate the short-term effect of retirement on spousal disability severity. Disability is assessed based on their ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Furthermore, we conduct heterogeneity analysis stratified by factors such as the husband's retirement status, health conditions, lifestyle behaviors, and the wife's educational level. Additionally, we explore potential mechanisms including changes in health behaviors, emotions, and disease diagnoses. Our findings indicate that wives' retirement has a significant favorable short-term effect on husbands' ADL scores, with a magnitude of -0.644 points (-9.78% relative to baseline). A significant beneficial effect of wives' retirement on the prevalence of husbands' difficulty in dressing, bathing, and eating was observed with substantial magnitudes of 0.075, 0.201, and 0.051 points, respectively. Various heterogeneity analyses and sensitivity tests confirmed the robustness of our results. The positive spillover effect of wives' retirement likely results from reduced negative emotions in husbands. In contrast, husbands' retirement does not affect the prevalence of ADL/IADL disability in their wives. Underscoring the gender asymmetry in the effects of spousal retirement on disability, this study emphasizes the need for tailored policies considering men's and women's distinct disability experiences.

Dyadic concordance and other considerations for matching pairs for peer support diabetes prevention interventions: A mixed methods assessment

ObjectivesDyadic peer support helps patients make health behavior changes for improved outcomes, yet the impact of matching dyads on demographic characteristics such as race or gender is unknown. Therefore, we investigated associations of concordant characteristics with peer outcomes in a diabetes prevention intervention and qualitatively examined participant perspectives on matching. MethodsBinary variables for peer-supporter concordance on 6 demographic characteristics were created for 177 peers and 69 supporters. Regression models compared changes in weight, HbA1c, perceived social support, patient activation, and formal diabetes prevention/education program participation for concordant and non-concordant dyads. Semi-structured qualitative interviews were conducted with 39 peers and 34 supporters. ResultsConcordance on demographic characteristics was not significantly associated with outcomes. Qualitatively, peers and supporters emphasized that more important than shared demographic characteristics was a supporter's empathic, non-judgmental communication style. ConclusionsDemographic characteristics for matching supporters with adults with prediabetes are less important than ensuring high-quality coach training in goal setting and communication style, supporting prior research on the necessity of autonomy supportive communication for effective behavioral change interventions. Practice implicationsExisting peer support programs should incorporate fidelity assessments into practice to ensure peer supporter skill in motivational interviewing-based, autonomy supportive communication and brief goal setting.

A cross-sectional study on domestic use of biomass fuel and the prevalence of respiratory illnesses in a rural community in Thaba-Tseka district of Lesotho

The domestic utilization of biomass fuel for purposes such as cooking, space heating, and water heating has been linked to a number of respiratory ailments, particularly when burned inefficiently. However, there is an existing knowledge gap on the impact of this practice on the health of Basotho. This study aims to explore the impact of biomass fuels use on the prevalence of respiratory illnesses among residents of two rural communities in Thaba-Tseka. A quantitative, cross-sectional design was adopted, using a structured questionnaire, to assess the correlation between biomass fuel use and the prevalence of respiratory symptoms and diseases. Data were collected from 326 randomly selected individuals aged 18 and above. The major source of fuel energy used was firewood (39.6 %), followed by paraffin (29.1 %) and animal dung (15.6 %). The most prevalent respiratory symptom reported was cough, among 27.6 % of participants (n = 326), followed by sneezing (n = 326, 23.0 %), and fever (n = 326, 17.5 %). The lowest prevalent respiratory disease was pneumonia (0.9 %) while lung cancer was not reported. The reporting of respiratory symptoms and diseases was most prevalent in January. A greater prevalence of cough was reported by participants with a higher level of education (r (5) = 1.746, p = 0.008). More male participants reported to have tuberculosis (7.8 %) compared to females (3 %) (r (1) = 3.809, p = 0.051). Asthma was noted to be more prevalent among high income earners (r (3) = 8.169, p = 0.043) and those reported to have an employment (r (1) = 4.277, p = 0.039). Surprisingly, there was no association between respiratory diseases and symptoms, and the type of domestic fuel used. In the rural communities of Thaba-Tseka, about 4 in 10 Basotho rural communities, relied on firewood for cooking, space heating and water heating. Respiratory symptoms and diseases were observed mostly in the month of January. Several factors, including education level, marital status, gender, and income level, were significantly associated with specific respiratory symptoms and diseases. Targeted public health interventions are urgently needed to mitigate respiratory symptoms and diseases in the rural communities of Lesotho. More focus should be directed to health behavioral change and provision of improved stoves for exposure reduction of biomass emissions.