Health Behavior Change Research Articles

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.

Adapting Gamification Strategies According to Targeted Health Behavior Change: Findings from a Focus Group.

In healthcare, improving lifestyle behaviors like medication adherence remains challenging, with an impact on treatment success and patient outcomes. Mobile health (mHealth) applications offer promising solutions by leveraging smartphone ubiquity and digital accessibility. However, sustaining user engagement and behavior change presents obstacles. This study explores the specificities of gamification-integrating game-like elements into non-game contexts-to improve mHealth applications for 3 health behaviors. During a focus group, 15 participants discussed the potential of 17 gamification strategies to improve medication adherence, physical activity, and diet within mHealth applications. Individual choices varied widely, with preferences influenced by targeted behaviors. Physical activity focused on self-monitoring and challenges, while dieting emphasized cooperation. Simulation models were particularly intriguing, projecting long-term benefits of behavior changes. Future research should explore personalized design options and consider individual characteristics. Iterative design cycles with end-users are crucial for refining concepts and sustaining user engagement. Overall, gamification presents an innovative avenue for empowering patients and transforming healthcare delivery.

Characterizing the Adoption and Experiences of Users of Artificial Intelligence-Generated Health Information in the United States: Cross-Sectional Questionnaire Study.

OpenAI's ChatGPT is a source of advanced online health information (OHI) that may be integrated into individuals' health information-seeking routines. However, concerns have been raised about its factual accuracy and impact on health outcomes. To forecast implications for medical practice and public health, more information is needed on who uses the tool, how often, and for what. This study aims to characterize the reasons for and types of ChatGPT OHI use and describe the users most likely to engage with the platform. In this cross-sectional survey, patients received invitations to participate via the ResearchMatch platform, a nonprofit affiliate of the National Institutes of Health. A web-based survey measured demographic characteristics, use of ChatGPT and other sources of OHI, experience characterization, and resultant health behaviors. Descriptive statistics were used to summarize the data. Both 2-tailed t tests and Pearson chi-square tests were used to compare users of ChatGPT OHI to nonusers. Of 2406 respondents, 21.5% (n=517) respondents reported using ChatGPT for OHI. ChatGPT users were younger than nonusers (32.8 vs 39.1 years, P<.001) with lower advanced degree attainment (BA or higher; 49.9% vs 67%, P<.001) and greater use of transient health care (ED and urgent care; P<.001). ChatGPT users were more avid consumers of general non-ChatGPT OHI (percentage of weekly or greater OHI seeking frequency in past 6 months, 28.2% vs 22.8%, P<.001). Around 39.3% (n=206) respondents endorsed using the platform for OHI 2-3 times weekly or more, and most sought the tool to determine if a consultation was required (47.4%, n=245) or to explore alternative treatment (46.2%, n=239). Use characterization was favorable as many believed ChatGPT to be just as or more useful than other OHIs (87.7%, n=429) and their doctor (81%, n=407). About one-third of respondents requested a referral (35.6%, n=184) or changed medications (31%, n=160) based on the information received from ChatGPT. As many users reported skepticism regarding the ChatGPT output (67.9%, n=336), most turned to their physicians (67.5%, n=349). This study underscores the significant role of AI-generated OHI in shaping health-seeking behaviors and the potential evolution of patient-provider interactions. Given the proclivity of these users to enact health behavior changes based on AI-generated content, there is an opportunity for physicians to guide ChatGPT OHI users on an informed and examined use of the technology.

Moderating effects of socioeconomic status and geographical location on the Health4Life school-based intervention

ObjectiveThis study evaluated the moderating effects of socioeconomic status (SES) and geographical location on the efficacy of an eHealth school-based multiple health behaviour change intervention – Health4Life – in targeting alcohol and tobacco use, dietary intake, knowledge, behavioural intentions, and psychological distress over 24-months. MethodsData from the Health4Life cluster-randomised controlled trial conducted from 2019 to 2021 in 71 Australian secondary schools were analysed (N=6639; baseline age 11-14yrs). Schools were from metropolitan (89%) and regional (11%) areas, and participants’ SES was classified as low (15%), mid (37%), and high (48%) relative to the study population. Primary outcomes included alcohol and tobacco use, and a composite indicator of poor diet. Secondary outcomes were knowledge, behavioural intentions, and psychological distress. Latent growth models assessed moderating effects of SES and geographical location on between-group change over 24-months. ResultsGeographical location moderated the intervention’s effect on odds of reporting a poor diet (OR = 1.79, 95% CI = 1.32–2.43, p < 0.001) and diet-related behavioural intentions (OR = 0.71, 95% CI = 0.56–0.89, p = 0.024) over time. Subset analyses indicated that intervention participants in regional areas had higher odds of reporting a poor diet (OR = 1.61, 95% CI = 1.13–2.29, p = 0.008), while those in metropolitan areas had higher odds of improving diet-related behavioural intentions (OR = 1.13, 95% CI = 1.01–1.27, p = 0.041), compared to the control group. No other significant moderation effects were observed. ConclusionsWhile significant disparities were generally not observed, the geographical differences in intervention effects on diet and diet-related intentions suggest that co-designed and tailored approaches may benefit disadvantaged adolescents to address the disproportionately high rates of lifestyle risk behaviours among these priority populations.

Understanding resilience: Lifestyle-based behavioral predictors of mental health and well-being in community-dwelling older adults during the COVID-19 pandemic

BackgroundChanges in sleep, physical activity and mental health were observed in older adults during early stages of the COVID-19 pandemic. Here we describe effects of the COVID-19 pandemic on older adult mental health, wellbeing, and lifestyle behaviors and explore predictors of better mid-pandemic mental health and wellbeing.MethodsParticipants in the Adult Changes in Thought study completed measures of lifestyle behaviors (e.g., sleep, physical activity) and mental health and wellbeing both pre-pandemic during regular study visits and mid-pandemic via a one-time survey. We used paired t-tests to compare differences in these measures pre- vs. mid-pandemic. Using multivariate linear regression, we further explored demographic, health, and lifestyle predictors of pandemic depressive symptoms, social support, and fatigue. We additionally qualitatively coded free text data from the mid-pandemic survey for related comments.ResultsParticipants (N = 896) reported significant changes in mental health and lifestyle behaviors at pre-pandemic vs. mid-pandemic measurements (p < 0.0001). Qualitative findings supported these behavioral and wellbeing changes. Being male, never smoking, and lower pre-pandemic computer time and sleep disturbance were significantly associated with lower pandemic depressive symptoms. Being partnered, female, never smoking, and lower pre-pandemic sleep disturbance were associated with higher pandemic social support. Pre-pandemic employment, more walking, less computer time, and less sleep disturbance were associated with less pandemic fatigue. Participant comments supported these quantitative findings, highlighting gender differences in pandemic mental health, changes in computer usage and physical activity during the pandemic, the value of spousal social support, and links between sleep disturbance and mental health and wellbeing. Qualitative findings also revealed additional factors, such as stresses from personal and family health situations and the country’s concurrent political environment, that impacted mental health and wellbeing.ConclusionsSeveral demographic, health, and lifestyle behaviors appeared to buffer the effects of the COVID-19 pandemic and may be key sources of resilience. Interventions and public health measures targeting men and unpartnered individuals could promote social support resilience, and intervening on modifiable behaviors like sleep quality, physical activity and sedentary activities like computer time may promote resilience to fatigue and depressive symptoms during future community stressor events. Further research into these relationships is warranted.

Investigation of community knowledge, attitudes and stigma towards leprosy in Nigeria: a mixed-methods study.

Little is known about community knowledge and stigma towards leprosy in endemic settings. The aim of this study was to evaluate community knowledge, attitudes and stigma towards leprosy in Nigeria. This was a mixed-methods study consisting of a quantitative cross-sectional survey of community members and qualitative focus group discussions with community members and people affected by leprosy as well as key informant interviews with healthcare workers and community leaders. Of the 811 survey participants, 401 (49.4%) had a poor knowledge of leprosy that was driven by cultural beliefs, fear of its contagiousness and poor knowledge of its means of transmission. The participants reported high stigma levels with a mean score of 18.96±7.73 on the Explanatory Model Interview Catalogue Community Stigma Scale and 9.39±7.03 on the Social Distance Scale. Stigma levels were influenced by age, residence, education and knowledge of leprosy. Qualitative data suggested that community members were scared of leprosy infectiousness, and local illness concepts and misconceptions informed attitudes and behaviour towards leprosy in the community. Community members have a poor knowledge of, and high stigma levels towards leprosy. Culture-specific health education and behavioural change interventions are needed to address the identified gaps.

Developing a Theory-Based Instrument for Pre-Exposure Prophylaxis (PrEP) Uptake in People of Color Using a Qualitative Approach.

There is a large disparity in Pre-exposure Prophylaxis (PrEP) utilization among communities of color compared to White Americans. There is also a lack of theory-based survey instruments to measure the underlying reasons for the disparity among communities of color. The purpose of this study was to create an instrument based on a qualitative approach involving community interviews. Semi-structured interviews guided by the Multi-theory Model (MTM) of health behavior change were performed in a sample of 12 members from communities of color. The analysis entailed a directed content analysis along the themes of MTM constructs to develop a survey instrument. The barriers to PrEP that emerged included the cost of PrEP, lack of protection from other sexually transmitted diseases, reduced trust between partners, and the stigma associated with PrEP. The perceived disadvantages included the potential cost of PrEP, partner mistrust when taking PrEP, discussion of sexual behaviors with a provider, and unclear process of acquiring the PrEP prescription. The results guided the development of a survey tool to further investigate aspects of cost, partner relations, stigma, reassurance of safety, and other factors. The tool can be used for future studies as part of guided interventions to increase PrEP uptake.

Changes in Daily life due to the COVID-19 Pandemic and Mental Health Status in Korean Adolescents.

This study assessed the relationship between daily life changes and mental health in Korean adolescents during the COVID-19 pandemic. Data from middle and high school students who responded to the relevant survey items the 2021 Korea Youth Risk Behavior Survey were analyzed (n = 53,868). The survey assessed changes in economic status, physical activity, skipping breakfast, drinking, smoking, and mental health, including stress, depression, generalized anxiety disorder, and suicidal ideation, due to the COVID-19 pandemic. The overall prevalence of perceived stress, depression, generalized anxiety disorder, and suicidal ideation was 38.6%, 26.4%, 12.2%, and 12.4%. Adolescents whose economic status worsened due to COVID-19 had a higher risk of perceived stress, depression, generalized anxiety disorder, and suicidal ideation. Changes in physical activity and breakfast consumption due to the COVID-19 pandemic were significantly associated with increases in perceived stress, depression, generalized anxiety disorder, and suicidal ideation. Adolescents who increased their alcohol consumption had the highest risk of perceived stress, depression, generalized anxiety disorder, and suicidal ideation. Changes in economic status and health behaviors caused by the COVID-19 pandemic had a negative effect on the mental health of Korean adolescents. These results can be used to identify adolescents at high risk of developing mental health problems.