Health Behaviors Research Articles

Health-promoting school. Mediation effects on health behaviors and the socio-economic level of pupils

Abstract Pupils health indicators and behaviors are marked by social and territorial inequalities which develop early (DREES, 2015, 2019). In order to combat these inequalities and improve the health behaviors and well-being of pupils, the “health-promoting school” approach is recognized as convincing. It is endorsed by the World Health Organization (Langford, 2015; WHO, 2021). The health policy currently implemented in French schools is convergent (MEN, 2018, 2021). In order to disseminate this policy, since 2019, the Alliance project has been implemented in 101 French schools (9 - 12 years old) and 97 municipalities in the AURA region. Each school and community are trained and supported to promote the development of professional practices and a health promotion project to improve the health behaviors of pupils. The question arises as to the extent to which the development of health-promoting teaching projects and practices participating in the strengthening of health protective factors - life skills and health literacy - of pupils would have a mediating effect from the point of view of socio-economic level and health behaviors of pupils? Each year, data are collected from pupils by questionnaire, mesuring their well-being, health habits, psychosocial competencies and their families’ socio-economic level. 11500 questionnaires collected during 3 years have been analyzed. Descriptive and bivariate analysis indicate sevreral improvements between years in their health habits like for example daily physical activities (6% for T0 and 16% for T2) or daily consumption of sweets (17% for T0 and 13% for T2). They confirm negative influence of risk factors as low socio-economic level on health habits. But mediation analysis show that psychosocial competencies, especially emotionnal and social competencies, mediate significatively this influence (mediation effect range from 5% to 21%). Key messages • The health indicators and behaviors of young people are marked very early on by social and territorial health inequalities. • Health-promoting school approach and particularly – life skills and health literacy – would have a mediation effect on health behaviors and the socio-economic level of students.

Association of lifes essential 8 and mortality among adults with and without CVD

Abstract Background Differences in the American Heart Association’s Life’s Essential 8 (LE8) score and its association with mortality based on the presence of clinically prevalent cardiovascular disease (CVD) has not been assessed previously. Methods Data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018 was utilized to calculate LE8 scores among adult patients, stratified by the presence of existing CVD. Health metrics were further divided into health behaviors and health factors. Scores were also evaluated based on sex, age, race/ethnicity, and socioeconomic status. Cox proportional hazard models were used to evaluate the association between the levels of cardiovascular health (CVH) and risk of all-cause and cardiovascular mortality. Results 25,359 patients were included in the analysis, of which 10.2% had known CVD. Individuals with known CVD had lower overall CVH (55.9 vs. 65.8, p <0.001), health behaviors (60.6 vs. 67.9, p <0.001), and health factors (51.3 vs. 63.8, p <0.001) scores. The lower CVH scores in those with prior CVD persisted after stratification by sex, age, race/ethnicity, and socioeconomic status. When assessing the association of CVH metrics with mortality, for every 10-point increase in LE8 score, there was a significant reduction (17%-27%) in all-cause and CV mortality in those with and without CVD. Conclusions Individuals with known CVD have lower CVH metric scores. Overall, the LE8 score is able to predict future CV outcomes in both individuals with and without CVD and highlights the importance of effective implementation strategies that target health factors and behaviors in primary and secondary prevention populations.

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

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

Determinants of health prevention behaviors in Portugal

Abstract Background One of the main causes of death in developed societies are chronic non-communicable diseases, often originated by risky behaviors as tobacco consumption, poor diet, excessive alcohol consumption and lack of physical activity. Changing lifestyles can thus lead to a reduction in chronic diseases and in their economic costs. The objective of this study is to understand what the main factors associated with health behaviors are. Methods We used the data collected through the Portuguese National Health Surveys from 2014 and 2019. The sample analyzed was composed of individuals aged 15 or more years old living in the national territory at the time the surveys were conducted. Data on demographics, socio-economic variables and health related variables was used. A maximum likelihood estimation was performed using a multivariate probit model, by using health behaviors (weekly exercise, healthy diet, non-smoking, and prudent alcohol consumption) as the outcomes of the analysis. Results The results point to a strong association between social class and health behaviors, particularly between higher income and healthy diet. It is important to highlight that having an appointment with a General Practitioner is positively associated with all healthy behaviors. For all behaviors but healthy diet, the coefficients are statistically significant at a 5% significance level and non-smoking displays the highest one (0.135). Conclusions This study presents the first step to understand the determinants of health prevention behaviors, which is important to design policies targeting lifestyles. One of its main conclusions indicates that social class (income and education) and GP appointments are associated with health behaviors. Further research would be needed to study the underlying mechanisms through which some of these factors impact behaviors. This presentation was supported by National Funds through FCT, I.P., within CINTESIS, R&amp;D Unit (reference UIDB/4255/2020). Key messages • This study is an important step in the formulation of policies targeting lifestyles since it allows us to understand which factors are associated with health behaviors. • From this study one can conclude that social class characteristics, particularly income, and access to GP appointments are associated positively with health behaviors.

Inequities in child health in Luxembourg

Abstract Background In Luxembourg, despite its economic prosperity, 28.6 % of children are estimated to be at the risk of poverty. Research has shown that growing up with socioeconomic disadvantage is associated with worse physical and mental health in childhood. We explore the association of socioeconomic status with health, health behaviours and access to healthcare in Luxembourg for children up to age twelve. Methods We used data from 2014 to 2022 for 11-12 year old children from the Health Behaviour in School-aged Children (HBSC) survey as well as social security data from Luxembourg for a similar time period and children 0 to 12 years old. To assess socioeconomic status, we used information on self-perceived household wealth for the HBSC results and stratified health and health behaviours by well-off, average, or less well-off households. For the social security data, we stratified access to care indicators by equivalized household income quintiles. Results We found that physical activity levels, nutritional quality and daily routines such as eating breakfast and brushing teeth are significantly lower in children from less affluent families. For example, 61% of 11-12-year-old children from well-off families reported eating breakfast every day, but only 41% of children from less well-off families. Only 23% of 11-12 year olds from less affluent families rated their health as excellent, compared to 52% of children from affluent families. There were similarly large differences for multiple health complaints, with 63% of children from less affluent families reporting this indicator for psychosomatic problems, compared to 34% of children from affluent families. We did not find differences in the use of pre- and postnatal care visits. Conclusions Socioeconomic differences in child health, mental health and health behaviours are large, with children from poorer households being in worse physical and mental health and less likely to report positive health behaviours. Key messages • Many children in Luxembourg face socioeconomic challenges that are adversely associated with health and health behaviours. The underlying reasons require further attention to improve child health. • Children from poorer backgrounds are in significantly worse mental health than children from better off families in Luxembourg.

Digital health literacy and health behaviour of schoolchildren: A representative study in Germany

Abstract Background Health information is increasingly available and plays a crucial role in making health decisions and developing healthy behaviours. Digital health literacy (DHL) enables one to distinguish between true and false health information online. Studies have found higher health literacy to be associated with healthier behaviour. However, there is no research on child DHL and health behaviour. This study aims to investigate the relationship between DHL and selected health behaviour of schoolchildren in Germany. Methods This cross-sectional study is based on a representative sample of (N = 1448) secondary schoolchildren (aged 9-18 years) in Germany across all 16 federal states and school forms. DHL was assessed using the child and adolescent version of the Digital Health Literacy Instrument developed and pretested in this study. Selected health behaviours (eating, teeth brushing, smoking, and alcohol consumption) were measured using self-report scales. Chi-square tests were conducted to measure differences between DHL and health behaviour. Results Associations were found between DHL and all eating behaviours (fruits; vegetables and salad; whole-grain products; other animal-based products; chocolate or other sweets; sugary drinks; fast food), except for eating meat and sausages. Schoolchildren with higher levels of DHL reported more often about regular consumption of fruits and vegetables (X2 (2)=17.06, p = &amp;lt;.001). salads (X2 (2)=56.54 p = &amp;lt;.001) and whole-grain-products (X2 (2)=98.81 p = &amp;lt;.001). While DHL was associated with teeth brushing (X2 (2)=44.46, p = &amp;lt;.001), no differences were observed for smoking (X2 (2)=1.93, p=.381) and drinking alcohol within the last 30 days (X2 (2)=2.62, p=.270). Conclusions These findings indicate that most health behaviours of schoolchildren may benefit from enhancing DHL in schools. Programs should build around these topics. However, more research is needed to investigate associations between DHL and health behaviours comprehensively.

Empirically exploring the association of health literacy with schoolchildren’s health behaviours

Abstract Background Health literacy (HL) is a modifiable factor contributing to the promotion and maintenance of health and well-being throughout an individual’s life. Identified as a priority in Wales, UK in 2010, progress has since stalled despite health and education as national policy priorities and international policy growth. There is a gap in understanding of children in Wales’ HL needs, particularly below adolescent age ( &amp;lt; =11 years). Methods This study aimed to scope a measure of children’s HL to be integrated into the existing HAPPEN Cohort Study survey, which collects self-reported health behaviours of children aged 8-11. A review identified the Health Literacy of School-Aged Children (HLSAC) tool which conceptualises health literacy as a learning outcome. A convenience sample of n = 15 primary schools were recruited in April 2023 through HAPPEN and n = 669 school children n = 669 completed the online survey between May-June 2023. Results Preliminary data using sum HLSAC scores show a proportion of children with low (20.5%), moderate (52.8%) and high HL (26.8%). Independent samples t-tests comparing mean HLSAC scores with binary self-reported health behaviours show higher HL scores for weekly behaviours (p &amp;lt; 0.05); feeling less tired (0-4 days: 15.1+-4.1, &amp;gt; =5 days 14.5+-3.4), can concentrate (0-4 days: 14.3+-3.6, &amp;gt; =5 days: 15.5+-4.0) and consume less fizzy drinks (0-4 days: 15.0+-3.9, &amp;gt; =5 days: 14.0+-3.8). Further, for can ride a bike (no: 14.3+-4.0, yes: 15.0+-3.9), can swim 25m (no: 14.6+-3.7, yes: 15.1+-4.0), someone active in the household (no: 14.3+-3.8, yes: 15.2+-4.0) and higher health well-being (&amp;lt;7/10: 13.9+-3.5, &amp;gt; =7/10: 15.3+-3.9). This preliminary data will be strengthened with further analyses including regression. Conclusions Associations appear between various important health behaviours spanning physical activity, nutrition, cognition and wellbeing. Capturing children’s HL and health behaviour needs enables targeted health promotion and education activities.

Asking to thrive: structures supporting young men’s behavioural health in Belfast, Northern Ireland

Abstract Background Men in Northern Ireland are three times more likely to die by suicide and psychiatric morbidity is significantly higher than for the United Kingdom overall, in part due to the Troubles, a 30-year conflict during which there were 34,000 shootings, 14,000 bombings, and 3,500 deaths. Prior studies suggest strong friendships and high collective efficacy in communities are protective against suicide and self-harm in adolescents and that inquiring about supportive people and structures directly-rather than through parental intermediaries-yields more accurate responses. Methods Semi-structured interviews were conducted with 30 adolescent males aged 16-19 from working-class communities across Belfast. Participants were recruited via trusted community partners and often had experiences with sectarianism and restorative justice. A deductive thematic analysis was conducted of interview transcripts, supplemented by responses to the Self-Harm Inventory and a modified Collective Efficacy Scale. Analyses were completed in NVivo and RStudio. Results In addition to male peer friendships in which they could share confidences, participants strongly endorsed the value of youth work organisations as keystones in supporting not only their own behavioural health through positive modelling but also the reduction of antisocial and sectarian behaviours in their communities. Participants named specific aspects of these structures they found most useful, including demonstrating “masculine success” though community engagement and family life, providing a safe venue for socialising, and delivering restorative justice programming. Conclusions Findings from this study suggest that youth work programming is an important component of both adolescent behavioural health promotion and community safety through the reduction of sectarian and other antisocial behaviours. Participants expressed dismay at the reduction of these services and endorsed both their personal and wider community importance. Key messages • Youth workers may provide valuable positive modelling and behavioural health support to the young men. • Youth work programmes may function both for behavioural health promotion and community violence reduction in Belfast, Northern Ireland.

Linking health-related behaviours to quality of life in older adults: A latent class analysis

Abstract Background Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population. Methods Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions. Results In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics. Conclusions To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class. Key messages • This study explores the relationship between health behaviour and QoL in older Austrians. • Findings support the development of differentiated interventions targeting different types of behaviour.

Health disparities among in multicultural and non-multicultural families in South Korea

Abstract South Korea has experienced significant immigrant growth, with international marriages playing a key role in this demographic change. In 2019, international marriages accounted for 10.3% of all marriages, increasing the number of multicultural households. Multicultural families in Korea faced controversies over accepting new members in a society traditionally considered racially and ethnically homogenous. In rural areas, where patriarchal and conservative values prevail, there is greater discrimination and negative perception towards foreigners compared to urban areas, impacting access to healthcare. This potentially adversely affects the health of married immigrants. However, research on this issue is limited. This study aims to examine the differences in health behaviors, access to care, and health status between multicultural and non-multicultural families in rural and urban areas. Using a cross-sectional study design based on the 2023 Community Health Survey, the sample included 228,216 adults from non-multicultural families and 3,373 adults from multicultural families. Adjusted differences in outcome were estimated using regression models, including linear probability and logistic models. Overall, there were minimal or no differences in health behaviors and health status between adults from multicultural and non-multicultural families. However, significant differences were observed in access to care, such as annual health check-ups (0.72 [0.64, 0.81]) and vaccinations (0.84 [0.76, 0.94]). Non-multicultural families showed regional differences in all outcomes, whereas multicultural families exhibited minimal or no regional differences. These findings suggest that multicultural families may face barriers beyond regional environments, limiting their access to care and potentially leading to long-term negative health outcomes. Targeted policy development for multicultural families in Korea is necessary to address this issue. Key messages • Access to health care may vary for individual and local factors, especially for people with different ethnicities or cultures. • Multicultural families may encounter greater barriers than individual and regional characteristics, requiring the development of tailored policies for immigrants and multicultural families.

Health behaviour and well-being in the Faroe Islands prior to and during the first COVID-19 lockdown

Abstract Detrimental effects on health and well-being were reported during the COVID-19-induced lockdown periods in several countries, but these associations have not been studied in small-scale island societies. This study aimed to examine the lockdown period’s impact on health behaviour, social media use and measures of well-being in the Faroe Islands. We used cross-sectional data from two extensive population-based surveys of public health conducted in November 2019, the pre-COVID survey (n = 2906), and 4-6 weeks into the first national lockdown, the lockdown survey (n = 1204). A larger proportion of participants in the lockdown vs. pre-COVID survey people reported high physical activity levels (42.1 vs 30.7% p &amp;lt; 0.001), while nutritional habits were rated worse and social media usage increased. Furthermore, the proportion displaying excellent/very good self-rated health was larger in the lockdown vs. pre-COVID survey (68.1 vs 62.0% p &amp;lt; 0.001), and the same pattern was observed for reporting good quality of life (85.7 vs 82.7% p &amp;lt; 0.05). These associations remained statistically significant in a logistic regression model after adjusting for characteristics for which varying impact of the pandemic has been shown. Indicators of health behaviour showed that larger proportions of participants kept active during the lockdown vs pre-COVID survey, and these differences were statistically significant for physical, mental, and spiritual activities (p &amp;lt; 0.001). On the other hand, similar stress levels in the pre-COVID/lockdown periods were observed, but stratified analysis showed that participants with a high-stress level displayed better self-rated health in the lockdown period compared to the pre-COVID period (p = 0.001). Conclusions Findings indicate that self-reported health and quality of life improved during the early phase of the COVID lockdown, and individuals reported higher activity levels associated with good mental health during the COVID-19-induced lockdown period. Key messages • Physical activity improved, but dietary habits worsened during initial COVID-19 lockdown in the Faroe Islands. • Measures of wellbeing and quality of life improved during initial COVID-19 lockdown in the Faroe Islands, while there was no overall difference regarding stress levels.

Eco-anxiety: an additional burden for university students?

Abstract Background Eco-anxiety encompasses climate change anxiety, including global warming, as well as anxiety about a multiplicity of environmental disasters, which not be directly caused by climate change The objective is to assess eco-anxiety in healthcare and non healthcare students and investigate a relationship with health behaviour, mental health, and environmental opinion. Methods A cross-sectional study was conducted among voluntary university students in the Rouen University in Normandy, France. Volunteer healthcare students aged 18 years and older were included. Eco-anxiety was assessed with the Hogg Eco-Anxiety Scale (HEAS-13). Socio-demographics, health behavior, mental health and healthcare data were also collected. Results A total of 1,887 students were included with 74.3% of women and a mean age of 21.1 years (SD = 6.8). The HEAS-13 mean was 13.2 (SD = 2.6): affective symptoms 4.1 (SD = 2.7), eco-rumination 3.7 (SD = 2.4), behaviour 1.0 (SD = 1.5), and anxiety about one’s personal impact on the planet 4.4 (SD = 2.5). Respectively, 59.6% and 31.4% of students are moderately and very much involved in pro environmental-behaviour. 84.6% of students will consider environmental issues in their career choices. Eco-anxiety was associated with being a woman, being in curricula other than health, accommodation with roommates or in couple, use of cannabis, eating disorders, insomnia, emotional exhaustion, cynicism, depression, quality of life, and visiting a general practitioner for stress. Conclusions An high eco-anxiety was associated with impaired mental health and could be an additional burden for university students. Intervention options for those that do experience eco-anxiety and suffering can be as prescribing environmental action, mental health skills, and climate change resolution without imposing the burden of change solely on young people Key messages • A high eco-anxiety is prevalent among university. • The eco-anxiety impaired mental health that could be an additional burden for university students.

1.K. Scientific session: Health literacy of children and adolescents across Europe

Abstract Health literacy is developed throughout the life course. Enhancing health literacy at an early age is especially important since it may impact both current and future health skills and outcomes. Low health literacy in child and adolescent populations has been linked to worse health outcomes and health disparities in Europe, making health literacy of children and adolescents an important public health topic. Developing and delivering targeted interventions and services for these age groups requires insight and data on the development and state of health literacy in early age. However, child and adolescent health literacy is still an under-researched topic. This is partly due to a lack of appropriate measurement instruments and methods to involve children in research. In the past years, new studies on child and adolescent health literacy have emerged in several European countries. In this workshop, innovative studies from Germany, the Netherlands and the UK on HL in childhood and adolescence are introduced and discussed. Both methodological findings as well as empirical data will be presented. In Germany, an instrument to measure child health literacy was developed and validated for primary school children. This instrument, the HLS-Child-Q15, has been used both in Germany and in the Netherlands to study the relationship between children’s health literacy and their health behaviors and outcomes. In the UK, methods of involving primary school children in health literacy research were studied. Experiences with a Children’s Advisory Group will be shared. Another study in the Netherland focuses on the health literacy profiles and needs of adolescent patients with rheumatic diseases. The format of this workshop will be 4x10-minute presentations (including questions) followed by a 20-minute interactive discussion, reflecting on the relevance of these results to further research, health promotion and health services. which will be followed by Q&amp;A and an open discussion with the audiences. This workshop offers a forum for researchers, health educators, practitioners and policy-makers interested in health literacy measurement and research in children and adolescents. Key messages • Child and adolescent health literacy is an important, yet under-researched public health topic. • Child health literacy is an important predictor of their health behavior and outcomes.

Health literacy of pregnant women in Hungary

Abstract Health literacy determines our state of health and through this our quality of life. The health behavior of women of reproductive age should be treated with priority, since the lifestyle of pregnant women shows a correlation with the occurrence of premature birth and intrauterine development, and also between fetal development and the occurrence of chronic diseases in adulthood. The aim of our research is to explore the factors influencing the health behavior of pregnant women, to analyze regional differences, and to identify the causes of regional differences and inequalities. During a prospective, cross-sectional study, the health behavior of pregnant women living in Hungary was assessed using a questionnaire. In the course of our research, we examined health literacy using two measuring instruments, the Chew questionnaire and The Newest Vital Sign test. A total of 2,000 questionnaires were distributed of which 1,655 evaluable questionnaires were returned, the willingness to answer was 75%. The most people considered their own health to be good or very good (59.7%). 59.5% of the respondents changed their health behavior because of their pregnancy, mainly for the sake of the health of the fetus. 18.1% of pregnant women most likely have insufficient, 15.0% probably limited and 48.1% most likely have adequate functional health literacy. Age, education, place of residence and financial situation of pregnant women show a significant correlation with health literacy. Our results confirmed that sociodemographic factors, especially age and education, significantly influence the health literacy, perceived health status and health behavior of pregnant women. The two health literacy questionnaires we use can be combined well with each other and complement each other. The results greatly contribute to the development of health literacy, and thus to the development of individual and community-level strategies for improving health behavior in the field of pregnant women’s care. Key messages • Health literacy of pregnant women in Hungary. • Health literacy in health promotion.

Community Health Worker Service: addressing the needs of Gypsy/Travellers in Scotland

Abstract Background Members of the Gypsy/Traveller community in the United Kingdom face significant health inequalities compared to the general population, including lower life expectancy, higher rates of morbidity and suicide and poorer infant and child outcomes. This study evaluated the implementation of community-based lay workers in Scotland - the Gypsy/Traveller Community Health Worker (CHW) service. Methods This multi-method qualitative study (December 2021 to August 2023) included 16 individual interviews, five focus groups, one workshop, two informal discussions, and one site visit. Participants were stakeholders, CHWs, and members of the Gypsy/Traveller community. Additionally, 116 documents were analysed. The framework method, Proctor’s implementation outcomes and thematic analysis were used for data analysis. Results CHWs reached approximately 1,000 individuals across six National Health Services (NHS) Boards. The implementation outcomes showed that the intervention was accepted and feasible. A third-sector organization (Black and Minority Ethnic Carers of People Project - MECOPP), played a crucial role in successfully delivering the CHW service. This innovative intervention employed members of the Gypsy/Traveller community as lay healthcare workers to break down barriers to accessing healthcare and other services (e.g., uptake of cervical screening, vaccination, housing, and sanitation). The CHWs were trusted, ensured healthcare information was culturally appropriate and successfully addressed discriminatory behaviours in health and social care. Limited resources pose challenges to the sustainability of the service. Conclusions The Gypsy/Traveller CHW service enhanced prevention, acted as a bridge between communities and health systems and addressed the wider determinants of health. The Gypsy/Traveller community still faces discriminatory, racist, and stigmatising behaviours, which further impede the quality, delivery, and accessibility of care. Key messages • The Community Health Worker service was acceptable and feasible in the Gypsy/Traveller community, acting as a bridge between community and health systems and increasing access to services. • Community Health Worker Service is an important strategy for delivering healthcare support through their sector organizations to address historical discrimination against minority ethnic groups.

An update on the concept and importance of health literacy in young people

Abstract The burden of non-communicable diseases is a growing public health crisis that requires immediate action. As health literacy (HL) has been strongly linked with health behaviours and health outcomes, it has many potential implications for health care and health education. Although recent research has emphasised the importance of developing HL early in life, much of the research has focused on understanding and improving HL in adult populations. As young people socialise in different contexts and are exposed to different health-related situations, they require different HL competencies. As part of a wider project, this study aims to gather the perceptions of international academics and community-based practitioners on the concept and importance of HL in and for young people. Specifically, the study aims to (i) explore current understandings of the concept of HL in young people; (ii) examine the importance of HL for young people; (iii) identify those at risk of having low levels of HL; and (iv) determine the specific health behaviours that young people are currently struggling with. A stakeholder mapping exercise was used to recruit academic and community-based practitioners to take part in a one-to-one interview (n = 29). Reflexive thematic analysis was used to analyse the data. The preliminary findings suggest that HL is a very broad yet individualised concept that is critical to develop at an early age given the difficulty young people face in adopting healthy behaviours in their social and physical environment. Furthermore, the participants highlighted that minority groups, such as members of the travelling community and refugees, and those from low socioeconomic populations, are at greatest risk of low HL. Finally, the health issues that appeared to be of most concern in young people were vaping, social media use and poor mental health. These findings can be used to inform appropriate interventions and policies to target the HL of young people. Key messages • Health literacy is a very, yet individualised, concept that is critical to develop given the difficulty young people face in adopting healthy behaviours in their social and physical environment. • Minority groups, such as members of the travelling community, refugees, and those from low socioeconomic populations are at greatest risk of low levels of health literacy.

First insights in children’s health literacy in the Netherlands–results in a sample of 8-11 year olds

Abstract Background There are few valid, age-appropriate tools to assess children’s HL. The German-language European Health Literacy Survey Questionnaire Adapted for Children (HLS-Child-Q15-DE) is a self-report questionnaire adapted from the adult European Health Literacy Survey Questionnaire. In 2021, this instrument was translated and validated in the Netherlands. In this presentation, we will describe the distribution of Health literacy in a sample of Dutch children, and relate their Health literacy level to certain aspects of their health behaviour such as food intake and physical activity. Methods The HLS-Child-Q15-DE was translated following WHO guidelines and administered digitally to 209 Dutch schoolchildren (eight-to-eleven-year-olds). Its psychometric properties were assessed and the sample’s HL distribution was explored by demographic characteristics. Associations with food intake and physical activity were computed. Results Of the sample, 17.2% had a low health literacy score (first quintile), 61.1% medium (second to fourth quintile) and 21.7% high (fifth quintile). Higher HL scores were observed for ten-to-eleven-year-olds (compared with eight-to-nine-year-olds; p = 0.021) and fourth-grade students (compared with third-grade; p = 0.019). A positive association between children’s HL and their vegetable consumption and PA behaviour was observed. Conclusions Children’s health literacy can have an impact on some aspects of their lifestyle. This supports the idea that health literacy evolves throughout life and stresses the importance of both parents and schools in this process.

A repositioning nudge to encourage healthier snack purchases at a supermarket in a deprived area

Abstract Background Diet quality positively correlates with socio-economic position (SEP). While nudges are often proposed as promising policy tools for promoting health behavior among lower SEP groups, research addressing their impact within lower SEP groups is limited. This study aimed to 1) examine the efficacy of a checkout repositioning nudge in a supermarket in a deprived area in encouraging purchases of healthier snacks, and 2) describe customers’ preferences and needs regarding grocery shopping and healthy eating. Methods Daily sales data were collected over four-week control and intervention periods. During the intervention, unhealthy snacks at the checkout were replaced by healthier snacks. Additionally, questionnaires were administered among customers (N = 90). Results The intervention led to a significant increase in daily sales of healthier snacks (M = 3.14, SD = 2.45) compared to the control period (M = 0.54, SD = 0.96), t(27) = 5.62, p &amp;lt; .001. Despite a statistically significant nudge-effect, the absolute daily sales of healthier snacks remains extremely low. No difference in daily sales of unhealthy snacks was observed between both periods. Questionnaire data showed that customers report to seldomly purchase snacks at the checkout, find it important to eat healthily, think well about what they buy in a supermarket, and long for a healthier and more affordable food offer within the supermarket. Conclusions Interventions that are effective among higher SEP groups, such as repositioning nudges, may not be suitable for the circumstances and needs of lower SEP groups. To combat existing health inequalities, interventions must be tailored to lower SEP groups. More system-level interventions that target the healthiness and affordability of the offer may be needed. Key messages • Although nudging is often proposed as a promising policy approach for improving health behavior among lower SEP groups, repositioning nudges may not suit their circumstances and needs. • To combat health inequalities, interventions must be tailored to lower SEP groups and integrated with system-level policies (e.g., targeting the healthiness and price of the offer in supermarkets).

Immigrants and nurses’ perspectives on the barriers in using health promotion services in Finland

Abstract Background The incidence of chronic diseases and health disparities is high among immigrants. Lack of access to health promotion services targeting the needs of the immigrant population was reported. This study aimed to explore the perspectives of immigrants and nurses on the barriers to using health promotion services in Finland. Methods A qualitative study with 12 focus group interviews was conducted in various cities across Finland. A total of 69 participants, including 46 adult immigrants and 23 registered nurses, were selected through purposive sampling. A semi-structured interview was used. Interviews were transcribed verbatim and analyzed using content analysis. Results The analysis generated four themes: insufficient individual factors (i.e., knowledge, skills), restraining cultural norms (i.e., unhealthy cultural habits, gender disparities), inadequate health promotion services (i.e., lack of resources, structural limitations), and negative environmental impacts on health behavior (i.e., sweet foods and beverages, cold weather). Conclusions The findings suggest reinforcing health promotion services to prevent chronic diseases among the immigrant community. Providing health education resources that are culturally tailored helps improve immigrants’ knowledge to make healthier decisions in their own lives after migration. Moreover, it is recommended to introduce the health care system of the host country and healthy habits during the integration process, along with language training. Key messages • Improving equity in using health promotion services for immigrants requires reforms. • More strategies are needed to prevent chronic diseases among immigrants in Finland.

Determinants and strategies for successful scale-up of health interventions in the Netherlands

Abstract Background Although many evidence-based health interventions are proven effective, the process of scaling up is often complex and challenging. Yet, some interventions have managed to achieve successful scale-up. This provides a window of opportunity to learn from those experiences to inform future scale up processes. Objectives This mixed-methods study aimed to assess determinants and scale-up strategies contributing to successful scale-up of health promotion interventions in the Netherlands. Methods Semi-structured interviews were conducted with intervention owners (i.e. the individual or team taking the responsible for several aspects related to implementation and scale-up) (N = 25) of successfully scaled interventions (implemented across various health behaviours and different settings), and other relevant stakeholders (N = 10) involved in scaling up. Additionally, a survey was distributed among interventions (N = 306) registered in a national intervention database to assess scale-up experiences. Results Scale-up is often the result of a combination of determinants, such as persistent commitment of intervention owners and stakeholders, new funding opportunities, and accreditation by institutions. Several scale-up strategies were identified related to funding (e.g. reducing costs by setting up collaborations), organizational processes (e.g. infrastructure to support implementation), monitoring and evaluation, and dissemination and advocacy. Conclusions Achieving successful scale-up does not happen automatically and continuous effort of the intervention owner is crucial. There is no such thing as one successful scaling strategy which succeeds across all contexts. The intervention owner typically takes the lead in diverse scaling pathways, where sufficient time, funding, the right moment and added value form the critical ingredients for success. Funding: This study was funded by ZonMw. Key messages • Crucial elements of achieving scale-up are the continuous effort of the intervention owner, sufficient time, funding, the right moment and added value of the intervention. • Funding should not me allocated for new initiatives but also for continuous development of interventions, ongoing evaluation and covering overhead costs.