Health Choices Research Articles

Critical thinking about treatment effects in Eastern Africa: development and Rasch analysis of an assessment tool

Background: Every day we are faced with different treatment claims, in the news, in social media, and by our family and friends. Some of these claims are true, but many are unsubstantiated. Without being supported by reliable evidence such guidance can lead to waste and harmful health choices. The Informed Health Choices (IHC) Network facilitates development of interventions for teaching children and adults the ability to assess treatment claims (informedhealthchoices.org). Our objective was to develop and evaluate a new assessment tool developed from the item bank for use in an upcoming trial of lower secondary school resources in Uganda, Kenya, and Rwanda. Methods: A cross-sectional study evaluating a questionnaire including two item-sets was used. The first evaluated ability using multiple-choice questions (scored dichotomously) and the other evaluated intended behaviour and self-efficacy (measured using Likert scales). This study was conducted in Uganda, Kenya, and Rwanda in 2021. We recruited children (over 12 years old) and adults through schools and our networks. We entered 1,671 responses into our analysis. Summary and individual fit to the Rasch model (including Cronbach’s Alpha) were assessed using the RUMM2030 software. Results: Both item-sets were found to have good fit to the Rasch model and were acceptable to our target audience. The reliability was good (Cronbach’s alpha >0.7). Observations of the individual item and person fit provided us with guidance on how we could improve the design, scoring, and administration of the two item-sets. There was no local dependency in either of the item-sets, and both item-sets were found to have acceptable unidimensionality. Conclusion: To our knowledge, this is the first instrument validated for measuring ability to assess treatment claims in Uganda, Kenya and Rwanda. Overall, the two item-sets were found to have satisfactory measurement properties.

Exploring Factors Influencing Paternal Engagement in Prenatal Health Services within Hoima East Division, Hoima City: A Comprehensive Assessment

Socioeconomic, cultural, and gender dynamics continue to impede women's autonomy in healthcare decision-making. Men often wield control over financial resources, time allocation, and access to medical services, creating disparities in women's health choices. This study investigated male engagement in antenatal care among residents of Hoima East Division, Hoima City in Western Uganda. Employing a cross-sectional survey design and quantitative methods, data was meticulously coded, cleaned, and analyzed using Microsoft Excel Version 13 and STATA 14.0. The study encompassed 534 participants, with a predominant age range of 21-30 years (59.4%) and a majority being married (82.2%). Most participants had completed secondary education (53.8%), identified as Catholic (41.1%), and had 3-4 children (50.1%). Results indicated that 263 individuals (69.8%) exhibited low levels of male involvement in antenatal care, while 114 (30.2%) demonstrated high levels of engagement. Notably, 54.6% displayed inadequate knowledge, contrasting with the 45.4% who exhibited a strong grasp of antenatal care. The analysis revealed significant associations between male involvement and various factors including age, marital status, educational attainment, employment status, decision-making capacity, monthly income, perception of healthcare providers' attitudes, privacy provisions at antenatal clinics, and waiting times. Despite these findings, the level of male involvement and understanding of antenatal care remained suboptimal. In summary, this research highlights the multifaceted interplay of factors influencing male involvement in antenatal care. Factors such as age, marital status, education, employment, decision-making capacity, income, healthcare provider attitudes, and clinic conditions emerged as pivotal determinants. Addressing these variables can potentially enhance male participation and knowledge regarding antenatal care, ultimately empowering women in making informed health decisions. Keywords: Antenatal care and associated factors, Attitude of health care providers, Health facilities, Maternity care, Male partners.

COVID-19 Vaccine Framing: The Case of Astrazenca and Twitter Users

Framing of health messages on social media can impact health choices and behaviour such as vaccine uptake. The present study aimed to examine how AstraZeneca has been framed on social media, characterize Twitter users who have engaged in the distribution of health-related information about the AstraZeneca vaccine, and demonstrate the impact of various frames on user engagement. Tweets with a collective total of more than 159,000 words were gathered from tweets posted during the second and third week of March 2021 and analyzed using a cognitive linguistics approach, i.e., frame semantics. In addition, social media mining tools were employed to investigate user engagement. The findings indicate the presence of negative vaccination framing with three sub-systems: the vaccine (i.e., vaccination politics), the government’s response to (in)effectiveness, and citizens (the vaccinated), which are known through public reaction. All frames represented AstraZeneca in a negative light and have implications for health professionals, policies, and practices. Furthermore, Twitter user analysis revealed a link between the condensed nature of the retweets about the AstraZeneca vaccine and the potential spread of health misinformation. The findings inform future research by providing a snapshot of how the public has dealt with recent news of the reported side effects of the AstraZeneca vaccine on social media. The study concludes that the findings provide useful information in understanding the impact of health messages on social media in influencing people’s vaccine uptake.

Randomised controlled trials of behavioural nudges delivered through text messages to increase influenza and COVID-19 vaccines among pregnant women (the EPIC study): study protocol

BackgroundInfluenza and COVID-19 infections during pregnancy may have serious adverse consequences for women as well as their infants. However, uptake of influenza and COVID-19 vaccines during pregnancy remains suboptimal. This study aims to assess the effectiveness of a multi-component nudge intervention to improve influenza and COVID-19 vaccine uptake among pregnant women.MethodsPregnant women who receive antenatal care at five tertiary hospitals in South Australia, Western Australia and Victoria will be recruited to two separate randomised controlled trials (RCTs). Women will be eligible for the COVID-19 RCT is they have received two or less doses of a COVID-19 vaccine. Women will be eligible for the influenza RCT if they have not received the 2023 seasonal influenza vaccine. Vaccination status at all stages of the trial will be confirmed by the Australian Immunisation Register (AIR). Participants will be randomised (1:1) to standard care or intervention group (n = 1038 for each RCT). The nudge intervention in each RCT will comprise three SMS text message reminders with links to short educational videos from obstetricians, pregnant women and midwives and vaccine safety information. The primary outcome is at least one dose of a COVID-19 or influenza vaccine during pregnancy, as applicable. Logistic regression will compare the proportion vaccinated between groups. The effect of treatment will be described using odds ratio with a 95% CI.DiscussionBehavioural nudges that facilitate individual choices within a complex context have been successfully used in other disciplines to stir preferred behaviour towards better health choices. If our text-based nudges prove to be successful in improving influenza and COVID-19 vaccine uptake among pregnant women, they can easily be implemented at a national level.Trial registrationClinicalTrials.gov Identifier NCT05613751. Registered on November 14, 2022.

Income inequalities beyond access to mental health care: a Dutch nationwide record-linkage cohort study of baseline disease severity, treatment intensity, and mental health outcomes

Existing literature shows low and unequal access to mental health treatment globally, resulting in policy efforts to promote access for vulnerable groups. Yet, there is little evidence about how inequalities develop once individuals start treatment. The greater use of mental health care among individuals with low income, such as in the Dutch system, might be driven by differences in need and might not necessarily lead to better treatment outcomes. In this study, we aimed to examine income inequalities in four stages of the mental health treatment pathway while adjusting for need. We constructed a nationwide retrospective cohort study, examining all patients aged older than 18 years with a first specialist mental health treatment record in the Netherlands between 2011 and 2016, excluding those who did not receive any treatment minutes. We linked patient-level data from treatment records to administrative data on income, demographics from municipal registries, and health insurance claims. We used multivariate models to estimate adjusted associations between household income quintile (standardised for household size) and outcomes characterising four stages of mental health treatment: severity at baseline assessment based on the Global Assessment of Functioning (GAF) score, treatment minutes received, functional improvement by the end of the initial record, and additional treatment in a subsequent record. Estimates were adjusted for patient need (97 categories of primary diagnosis and severity at baseline assessment measured by GAF) and demographic covariates. Our study population consisted of 951 530 adults with a first specialist mental health treatment record in the Netherlands between Jan 1, 2011, and Dec 31, 2016. Patients in our cohort were on average aged 45·0 years (range 19-107) and mostly female (529 859 [55·7%] women and 421 671 [44·3%] men; no ethnicity data were available). First, we found that patients with the lowest income had the greatest initial therapist-assessed disease severity (5·545 GAF points), which was 0·353 GAF points (95% CI 0·347-0·360) lower than those in the highest income quintile. Second, we found that the negative association between income and treatment minutes was reversed once we adjusted for diagnosis and severity at baseline, with patients with the lowest income receiving 1·8% fewer treatment minutes (95% CI 1·1-2·4) than those in the highest quintile. Third, those in the highest income quintile were 17·3 percentage points (95% CI 17·0-17·6) more likely to have functional improvements by the end of the initial record, compared with 25·8% of patients with an improvement in the lowest income quintile. Fourth, while 35·7% of patients in the lowest income quintile received additional treatment in a subsequent record, this was only 3·0 percentage points (95% CI 2·7-3·3) lower for those in the highest quintile. None of these patterns were explained by diagnosis, severity at baseline, or treatment minutes received. Disparities favourable to patients with a higher income persist through the different stages of mental health treatment. These differences highlight the limitations of solely focusing on improving access to care to reduce the mental health gap. Our findings call for a better understanding of the role of social environment and quality of care as complementary mechanisms explaining inequalities during mental health treatment. Erasmus Initiative Smarter Choices for Better Health (Erasmus University Rotterdam), European Union's Horizon 2020, and Nederlandse Organisatie voor Wetenschappelijk Onderzoek (Dutch Research Council). For the Dutch translation of the abstract see Supplementary Materials section.

“Do you want a period?” Launching and evaluating a brief contraceptive decision-making educational intervention

ObjectiveDo you want a period? empowers people who menstruate to better understand their reproductive health and contraceptive choices through informed patient-centered contraceptive decision-making. MethodsResearchers partnered with the WISE (Women in the South-East) Telehealth Network to design, implement and evaluate the Do you want a period? brief educational intervention. Participants completed a longitudinal research study, including a web-based survey at baseline and a mobile-optimized text-based survey up to 6 weeks following baseline. ResultsDo you want a period? was believable (93%, n = 79), informative (89%, n = 76), and helpful (85%, n = 72). Participants who reported that the intervention was helpful were significantly more likely to be satisfied with the usefulness of information provided (OR 5.61 [95% CI 1.65–19.12]), the overall quality of services (OR 3.39 [95% CI 1.04–11.08)], and obtaining necessary medical care (OR 2.40 [95% CI 1.08–5.33)]. At longitudinal follow-up, participants who received contraceptive services reported high acceptability of intervention (4.51 (±0.53) out of 5). ConclusionsDo you want a period? envisions a new dialogue between women and clinicians, family, and friends. This brief educational intervention supports people who menstruate to determine if a safe and effective tailored contraceptive regimen is right for them.

“It’s my favorite kind of cake. Gigantic.”: healthism, postfeminist disruptions, and rhetorical “Othering” in The Mindy Project

ABSTRACT This article examines the romantic situation comedy program The Mindy Project as a conventional site where popular discourse about healthism appears. Despite a woman of color as the lead actor in the postfeminist television series, the rhetorics of healthism in The Mindy Project nevertheless strengthen postfeminist thinking and disguise dominant logics of racism and sexism. The series moralizes health to “other” women of color using three rhetorical strategies: (1) the representation of model minority women vis-à-vis health, (2) the white savior narrative in an era of healthism, and (3) the gendered/raced nature of negative role modeling. Since healthist rhetorics uphold Dr. Mindy Lahiri as both a threat to and reinforcer of white supremacist and anti-Asian ideology, this analysis has important implications for how women of color perceive themselves in relation to their health choices. The essay also demonstrates how healthism in The Mindy Project invites new considerations of the model minority trope that is embodied by Asian and Asian American television characters acting in medical professional roles.

DECODING COMPLEXITIES IN DESIGNING HEALTH COMMUNICATION: LESSONS FROM FIELD CASE STUDIES

Health communication influences the health choices of populations, informs decision makers, and is recognized by the WHO as a “best buy.” The current age is often referred to as a digital age of healthcare and a post-COVID world has accentuated the benefits of digital health because of increased stakeholder awareness and involvement and limited physical access to health setups. This paper aims to understand and evaluate the complexities that arise in the field when designing and delivering mobile-based healthcare interventions by discussing case studies of three programs currently running in India: 1) TAMA/Maitra – an interactive voice response system for people living with HIV/AIDS; 2) mMitra – an automated voice call service for pre- and post-natal women; and 3) Saathealth – a mobile application for sending nutrition messages to families with young children. The paper critically evaluates these programs based on learnings from the field, examines issues that affect program efficacy such as sociodemographic and psychosocial factors, and focuses on the change in perspectives toward health communication in the context of COVID-19. The analysis suggests the importance of self-regulation and self-responsibility as significant contributors to health promotion strategies, indicating possible directions for building a social communication model based on health behavior frameworks.

US South Asian Youths' Perspectives on the Use of Complementary and Alternative Medicine (CAM).

Complementary and alternative medicine (CAM) includes varied medical and healthcare systems, healing practices, and products that are outside of allopathy/biomedicine. The aim of this study was to examine US South Asian youths' beliefs, practices, decision-making, and experiences of using CAM. Ten focus group discussions with 36 participants were conducted. Data were coded deductively and inductively by four coders, working in pairs. Thematic analysis was performed. Disagreements were resolved through consensus. The results showed that CAM was appealing because of its often low cost, ease of access, family traditions to use CAM, and the perception that it was safe to use. Participants exercised pluralistic health choices. Some responses suggested a hierarchy wherein allopathy was used for serious, acute issues, and CAM for much of the remaining issues. The high use of and trust in CAM among young US South Asians raises important issues (e.g., provider support and integration to prevent potential interactions and avoid delaying allopathic treatment). More exploration is needed about the decision-making processes of US South Asian youth, including the perceived benefits/limitations of allopathy and CAM. US healthcare practitioners should familiarize themselves with South Asian social and cultural beliefs about healing to provide culturally-appropriate services and enhance patient care.

Changes in health-related lifestyle choices of university students before and during the COVID-19 pandemic: Associations between food choices, physical activity and health.

The COVID-19 pandemic has had a profound effect on our lives and society, influencing both individuals' lifestyles and habits. Recent research shows that anxiety and loneliness have continued to rise, along with changes in food and lifestyle choices. The aim of the study was to investigate whether the pandemic influenced food choices and consumption of energy drinks, alcohol, fruits, and vegetables among first-year university students. Additionally, assessing the relationship between mental and physical health, physical activity, and food choices. A total of 128 male and 128 female first-year students at the University of Iceland were invited to answer an electronic questionnaire in January and early February 2021. A total of 118 students (54% men) participated in the study and valid answers were 115 (46% participation rate). Almost half of the students (44%) experienced that their food choices had worsened, while 14% reported an improvement, compared to before the pandemic. Consumption of caffeinated beverages increased for 26% of students, while 19% experienced a decrease. Just over half of the students reported not drinking alcohol (13%) or reduced consumption (41%). Participants who reported that their mental health had deteriorated or remained the same tended to spend less time on physical activity and experienced worsened food choices (p<0.05). Similarly, those who spent less or the same time on physical activity estimated that their food choices had deteriorated (p<0.05). The COVID-19 pandemic has had a significant impact on the lifestyles of university students and this study has revealed how lifestyle choices and mental health seem to be highly affected by one another. Additionally, the potentially harmful effects of excessive intake of energy drinks need to be enhanced. Interestingly, about 40% of the respondents in the current study drank less alcohol during the pandemic than prior to the pandemic, indicating a strong relationship between alcohol drinking and social gatherings. This study reveals the importance of educating young people on healthy lifestyle choices and the importance of mental health needs to be emphasised.

553-P: Perspectives on Culture, Health Beliefs, and Diabetes Risk among Asian Indians in Atlanta—A Qualitative Study

Background and Purpose: South Asians are a fast-growing ethnic minority in the Atlanta metro area and are at high risk for developing diabetes. In order to create culturally competent practices and interventions, it is critical to understand the nuances in health beliefs, attitudes towards diabetes, and cultural and religious practices. Methods: Design: Key informant interviews were conducted with participants as part of a mixed-methods study. After 5 interviews, a codebook was created with themes through inductive analysis, and interview questions were adjusted for clarity. Analyses were done using MAXQDA. Transcripts were reviewed and coded; any discrepancies in coding were discussed and resolved in weekly meetings. Semi-structured 60 minute interviews (n=8) were conducted online or in-person and recorded. Results: Of 2,460 participants enrolled in the parent study, 71 were selected for interviews based on age (18-79), gender, and religious backgrounds. Stratifying by generational cohort and nativity revealed differences in beliefs about healthy behavior (including physical activity and nutritional preferences) and interactions with various healthcare systems. Participants’ beliefs on mindfulness, meditation, and cultural foods affected their health and lifestyle choices. Most immigrants had different perceptions of western medicine and experiences with the U.S. healthcare system compared to ayurvedic medicine. Common areas of confusion included prescriptions and obtaining medications, insurance status, and distrust in medical practitioners. Conversely, first generation participants reported greater health knowledge and engagement in healthy practices to prevent diabetes. Discussion: Health beliefs and practices among South Asians vary by nativity, education, age, generational cohort, and sociocultural customs. Future studies should address how nativity and age might affect engagement in lifestyle change for South Asians. Disclosure D.Arora: None. I.Rajwani: None. M.K.Shah: None.

Developing a questionnaire to evaluate the health information literacy in China.

Health information literacy is critical for individuals to obtain, understand, screen, and apply health information. However, there is currently no specific tool available to evaluate all four dimensions of health information literacy in China. Public health emergencies can present an opportunity to evaluate and monitor the health information literacy level of residents. Therefore, this study aimed to develop a questionnaire to evaluate the level of health information literacy and to measure the reliability and validity. The development process of the questionnaire consisted of the determination of questionnaire items, expert consultation, and validation. Based on the National Residents Health Literacy Monitoring Questionnaire (2020) and the 2019 Informed Health Choices key concepts, the researchers drafted the questionnaire, including all four dimensions of health information literacy. Experts in relevant fields were invited to evaluate the draft questionnaire, and revisions were made accordingly. Finally, the reliability and validity of the finalized version were examined in Gansu Province, China. The research team preliminarily formulated 14 items encompassing the four dimensions of health information literacy. After consulting with 28 experts, modifications were made. A convenience sample of 185 Chinese residents was invited to participate. Cronbach's alpha coefficient was 0.715 and McDonald's omega was 0.739 for internal consistency, and the test-retest intra-class correlation coefficient after 4 weeks was 0.906, indicating that the questionnaire content and measurement structure was relatively stable. This questionnaire is the first evidence-based assessment tool developed for monitoring health information literacy in China, and it has shown good reliability and validity. It can help to monitor the health information literacy levels of Chinese residents, promote evidence-based decision-making, and guide interventions to improve health information literacy.

Pulse-Based Nutrition Education Intervention Among High School Students to Enhance Knowledge, Attitudes, and Practices: Pilot for a Formative Survey Study.

Promoting pulse consumption in schools could improve students' healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food. This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan. Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis. In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use. Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students.

The Influence of the Heath Literacy on Tourist Health and Wellbeing Choices

Currently, there is a growing tendency for tourists to look for new experiences during their leisure or vacation trips. Increasingly, these experiences are echoed in pleasant places of relaxation. However, a classic tourist activity continues to be in high demand – hydrotherapy – which no longer offers only the usual and traditional treatments with water, but also other alternatives, bringing together a complex of proposals for all tastes and all budgets. Travel, stay, gastronomy, enjoy the landscapes and historical and cultural sites are today added to places where health and well-being complement tourists who seek it in a very rewarding way. However, choosing where to sleep, what to eat and what to visit is different from deciding which health and wellness treatments you can and should get and which ones will be beneficial and not harmful to your needs. The research question is, therefore, to understand if the health and wellness tourist influences his choices of health and wellbeing. By carrying out an empirical study, based on a questionnaire survey, some answers were obtained to the questions raised by the work and the conclusion shows that some results in terms of Health Literacy, differ slightly from previous studies.

"It's just not easy to understand": A mixed methods study of health insurance literacy and insurance plan decision-making in cancer survivors.

Understanding cancer survivors' health insurance decision-making is needed to improve insurance choice, potentially resulting in reduced financial hardship. This explanatory mixed methods study assessed health insurance decision-making in cancer survivors. Health Insurance Literacy Measure (HILM) captured HIL. Quantitative eye-tracking data collected from two simulated health insurance plan choice sets gauged dwell time (seconds), or interest, in benefits. Dwell time differences by HIL were estimated using adjusted linear models. Qualitative interviews explored survivors' insurance decision-making choices. Cancer survivors (N = 80; 38% breast cancer) had a median age of 43 at diagnosis (IQR 34-52). When comparing traditional and high-deductible health plans, survivors were most interested in drug costs (median dwell time 58 s, IQR 34-109). When comparing health maintenance organization and preferred provider organization plans, survivors were most interested in test/imaging costs (40s, IQR 14-67). Survivors with low versus high HIL had more interest in deductible (β = 19 s, 95% CI 2-38) and hospitalization costs (β = 14 s, 95% CI 1-27) in adjusted models. Survivors with low versus high HIL more often ranked out-of-pocket (OOP) maximums and coinsurance as the most important and confusing benefits, respectively. Interviews (n = 20) revealed survivors felt alone "to do their own research" about insurance choices. OOP maximums were cited as the deciding factor since it is "how much money is going to be taken out of my pocket." Coinsurance was considered "rather than a benefit, it's a hindrance." Interventions to aid in health insurance understanding and choice are needed to optimize plan choice and potentially reduce cancer-related financial hardship.

Demography and disorders of English Cocker Spaniels under primary veterinary care in the UK

BackgroundThe English Cocker Spaniel (ECS) is a common family dog in the UK. This study aimed to describe demography, morbidity, and mortality in ECS under primary veterinary care in the UK during 2016 using data from the VetCompass™ Programme. This study hypothesised that the prevalence of aggression is higher in male than female ECS, and higher in solid-coloured than bi-coloured ECS.ResultsEnglish Cocker Spaniels comprised 10,313/336,865 (3.06%) of dogs under primary veterinary care during 2016. The median age was 4.57 years (inter-quartile range (IQR) 2.25–8.01) and the median adult bodyweight was 15.05 kg (IQR 13.12–17.35). The annual proportional birth rate was relatively stable between 2.97–3.51% from 2005–2016. The most common specific diagnoses were periodontal disease (n = 486, prevalence 20.97%, 95% confidence interval (CI): 19.31–22.62), otitis externa (n = 234, 10.09%, 95% CI: 8.87–11.32), obesity (n = 229, 9.88%, 95% CI: 8.66–11.09), anal sac impaction (n = 187, 8.07%, 95% CI: 6.96–9.18), diarrhoea (n = 113, 4.87%, 95% CI: 4.00–5.75), and aggression (n = 93, 4.01%, 95% CI: 3.21–4.81). The prevalence of aggression was higher in males (4.95%) than in females (2.87%) (P = 0.015) and in solid-coloured (7.00%) than in bi-coloured dogs (3.66%) (P = 0.010). The median age at death was 11.44 years (IQR 9.46–13.47) and the most common grouped causes of death were neoplasia (n = 10, 9.26%, 95% CI: 3.79–14.73), mass-associated disorders (n = 9, 8.33%, 95% CI: 4.45–15.08), and collapse (n = 8, 7.41%, 95% CI: 3.80–13.94).ConclusionsPeriodontal disease, otitis externa, and obesity are identified as the most common health issues for ECS, and neoplasia and mass-associated disorders as the most common reasons for death. The prevalence of aggression was higher in males and solid-coloured dogs. The results can aid veterinarians in giving evidence-based health and breed choice information to dog owners and highlights the importance of thorough oral examination and body condition score evaluation during routine veterinary examination of ECS.

Teaching critical thinking about health information and choices in secondary schools: human-centred design of digital resources

Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centered design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

Development and Evaluation of a Serious Game Application to Engage University Students in Critical Thinking About Health Claims: Mixed Methods Study.

Misleading health claims are widespread in the media, and making choices based on such claims can negatively affect health. Thus, developing effective learning resources to enable people to think critically about health claims is of great value. Serious games can become an effective learning resource in this respect, as they can affect motivation and learning. This study aims to document how user insights and input can inform the concept and development of a serious game application in critical thinking about health claims in addition to gathering user experiences with the game application. This was a mixed methods study in 4 successive phases with both qualitative and quantitative data collected in the period from 2020-2022. Qualitative data on design and development were obtained from 4 unrecorded discussions, and qualitative evaluation data were obtained from 1 recorded focus group interview and 3 open-ended questions in the game application. The quantitative data originate from user statistics. The qualitative data were analyzed thematically, and user data were analyzed using nonparametric tests. The first unrecorded discussion revealed that the students' (3 participants') assessment of whether a claim was reliable or not was limited to performing Google searches when faced with an ad for a health intervention. On the basis of the acquired knowledge of the target group, the game's prerequisites, and the technical possibilities, a pilot of the game was created and reviewed question by question in 3 unrecorded discussions (6 participants). After adjustments, the game was advertised at the Oslo Metropolitan University, and 193 students tested the game. A correlation (r=0.77; P<.001) was found between the number of replays and total points achieved in the game. There was no demonstrable difference (P=.07) between the total scores of students from different faculties. Overall, 36.3% (70/193) of the students answered the evaluation questions in the game. They used words such as "fun" and "educational" about the experiences with the game, and words such as "motivating" and "engaging" related to the learning experience. The design was described as "varied" and "user-friendly." Suggested improvements include adding references, more games and modules, more difficult questions, and an introductory text explaining the game. The results from the focus group interview (4 participants) corresponded to a large extent with the results of the open-ended questions in the game. We found that user insights and inputs can be successfully used in the concept and development of a serious game that aims to engage students to think critically about health claims. The mixed methods evaluation revealed that the users experienced the game as educational and fun. Future research may focus on assessing the effect of the serious game on learning outcomes and health choices in randomized trials.

“These attitudes are a pressure”: women with disabilities’ perceptions of how stigma shapes their sexual health choices

Women with disabilities face numerous barriers to achieving sexual health on an equitable basis to others, including stigma about disability and sexuality. Yet, how specific stigmatising beliefs about disability and sexuality influence the choices women with disabilities make about their sexual health has not been studied widely. The present study sought to address this gap in the context of Sierra Leone. Semi-structured interviews were conducted with women with disabilities (N = 32) and women without disabilities (N = 10). Societal stigma of disability linked with witchcraft was seen as a deterrent to accessing sexual and reproductive health services. Stigma about women with disabilities as burdens and about childless women with disabilities as pitiable were perceived as sources of pressure on disabled women’s reproductive choices. Concurrently, women with disabilities rejected common stigmatising beliefs held about their lives. Results are discussed in terms of practical implications for healthcare providers and policymakers in Sierra Leone.

UTILIZATION AND CHOICE OF HEALTH CARE: EMPIRICAL EVIDENCE FROM INDIA

Utilization and choice of health care services are two important decision-making issues once an individual perceives or realizes illness. Identifying and measuring the factors that influence health care utilization and choice are important concern for policy makers, to reduce health system inequality. Both demand and supply side factors influence the above-mentioned choice decisions. However, the nature and severity of illness can also affect the above choice decisions. This study has identified and measured the role of disease specification as an important determinant of choice decision along with its influence on other factors. This study also explored the regional and socio-economic variation of factors which hinder the utilization of government-provided health care services. Analyzing the data of women and child household members, the study found that disease specification affects the choice of health care provider and even influences the role of other important factors.