Health Education Practice Research Articles

Mental Health Literacy and School Behavioral Health: Introduction to the Special Issue

ABSTRACT Background Mental health literacy is a promising approach to meeting the growing behavioral health needs of youth, and schools offer an ideal setting for this work. Purpose In the introduction to this special issue, we provide an overview of mental health literacy and discuss the connection between mental health literacy and school behavioral health. Methods Literature on mental health literacy and research on school mental health literacy programs are synthesized, followed by an overview of the six papers included in this issue. Results The key components of mental health literacy are defined and contextualized alongside the importance of mental health literacy for promoting well-being. A brief history of research on mental health literacy programs is provided, noting the growth in application to school settings. Discussion Connections between mental health literacy and school behavioral health are discussed, highlighting opportunities for integration with schools’ multi-tiered systems of support. Translation to Health Education Practice This introduction concludes with a discussion of implications for aligning mental health literacy with Health Education.

The Longitudinal Implementation of a Mental Health Literacy Resource Among Grade 8 and 9 Students in a Catholic School Setting

ABSTRACT Background Mental disorders most likely manifest during adolescence, providing opportunities for schools and professionals to implement standardized mental health literacy (MHL) interventions to support improvement of mental health outcomes. Purpose This study aimed to evaluate the impact of an MHL intervention (the Guide) on knowledge, stigma, help-seeking and overall mental health among grade 8–9 students. Methods We developed a longitudinal cohort study to evaluate the Guide among 523 students, delivered across subsequent grade levels within a Catholic school board in Canada. We utilized validated measures to assess mental health knowledge, stigma, help seeking attitudes, and mental health across four time-points: baseline, end of grade 8, beginning of grade 9, and end of grade 9. Teachers undertook training to learn how to administer the intervention, utilize included teaching aids, and collect data. Results Students demonstrated improvements on knowledge and stigma at all measurement intervals, however statistically significant differences in help-seeking and well-being outcomes were not observed. Discussion This study suggests the plausibility of longer-term delivery of the Guide and similar resources in enhancing knowledge and reducing stigma among similar youth cohorts. Translation to Health Education Practice Certified Health Education Specialists may adapt the Guide to accommodate youth mental health needs in different contexts.

Research on Strategies for College Counselors in Conducting Mental Health Education for College Students

In recent years, with the rapid development of society and increasing competition, the mental health of college students has garnered more attention. Influenced by changes in their educational, family, and social environments, college students face new demands for mental health education. In the practice of mental health education, college counselors play a key role as guides in promoting students' holistic development, guardians in optimizing the university mental health education system, and managers in enhancing the effectiveness of mental health education. This paper first introduces common psychological issues among college students then discusses the necessity for college counselors to conduct mental health education from three perspectives, and finally proposes four strategies for counselors to implement mental health education, with the aim of providing a reference for student management in higher education institutions.

Examining the Utility of the Theory of Planned Behavior in Studying Intention to Reduce Drinking Among High-Risk College Students in the U.S.

ABSTRACT Background Alcohol consumption remains a significant public health issue among U.S. college students. Though prior research has examined behavioral and theoretical factors that predict heavy drinking, less attention has focused on exploring factors concerning alcohol reduction. Purpose The current study identified Theory of Planned Behavior (TPB) constructs associated with high-risk college students’ intent to reduce alcohol use. Methods High-risk college students (n = 822) from a large U.S. public university completed an online survey assessing their alcohol behaviors and the following TPB constructs: attitude, norms, perceived behavioral control, and intention to reduce alcohol use. Results After accounting for important covariates, a multivariate regression demonstrated that students’ attitude and norms were significantly associated with their intention to reduce alcohol use, while perceived behavioral control was not. Altogether, the TPB model explained 61% of the variance in their intention. Discussion The findings underscore the significant role theory, more specifically student’s attitudes and norms, can play in influencing intention to reduce alcohol use. Translation to Health Education Practice Incorporating norms and TPB communication strategies into campus alcohol intervention programs and aligning these efforts with competencies from the National Commission for Health Education Credentialing Inc. can enhance the design, implementation, and evaluation of theory-driven interventions.

Lifestyle Coach Perceptions of Barriers and Facilitators to Participation and Lifestyle Change Among Black and Latinx National Diabetes Prevention Program Participants

ABSTRACT Background Despite the disproportionate impact of type 2 diabetes on racial/ethnic marginalized groups, interventions have not effectively engaged and retained these populations. To effectively meet the needs of these groups, a better understanding of barriers and facilitators to lifestyle change and participation in interventions is needed. Purpose The social determinants of health (SDOH) framework was utilized to examine barriers and facilitators in the National Diabetes Prevention Program (DPP) from the perspective of Lifestyle Coaches delivering the intervention to Black or Latinx participants. Method Using an online survey, coaches reported on barriers observed among participants and strategies to facilitate engagement and retention in the National DPP. We qualitatively coded and summarized responses. Results Black and Latinx participant-serving coaches shared five of the seven most endorsed barriers. Both groups of coaches shared the same four most endorsed facilitators. Discussion Results illustrate the impact SDOH have on one’s ability to participate in diabetes prevention and enact lifestyle change, suggesting that an adapted approach may help to reach Black and Latinx participants. Translation to Health Education Practice This project informs future National DPP implementation. Competencies in the following areas are addressed: Assessment of Needs and Capacity (I), Evaluation and Research (IV), and Advocacy (V).

The Effect of Continuous Care Model Based Education on Quality of Life, Sleep Quality, and Fatigue in Patients Undergoing Coronary Artery Bypass Surgery

ABSTRACT Background Postoperative care strategies, such as self-care education and cardiac rehabilitation, are critical in mitigating readmissions and enhancing patient outcomes following Coronary Artery Bypass Surgery. Purpose The purpose of this study was to design and develop a program that leads to acceptance, increased insight, and appropriate action to control the disease and its potential psychological complications. Methods This randomized control trial involved 140 patients scheduled for coronary artery bypass surgery at a rehabilitation clinic in 2023. The intervention followed the Continuous Care Model, encompassing familiarization, sensitization, control, and evaluation phases. Results Post-intervention, the intervention group exhibited a significantly higher mean quality of life score than the control group (p < .001). Furthermore, a notable difference in mean sleep quality scores between the control and intervention groups was observed post-intervention (p = .026). Discussion Patient education based on the Continuous Care Model effectively enhances quality of life sleep and reduces fatigue in patients undergoing coronary artery bypass surgery. Translation to Health Education Practice The study provides empowerment through patient and family education on self-care practices. Implementing of the Continuous Care Model as a non-invasive, cost-effective method can be considered in the patient education unit of hospitals.

Mental Health Literacy in the Middle School English Language Arts Classroom: Perspectives from Teachers and Social Support Staff

ABSTRACT Background The prevalence of mental health challenges among adolescents warrants innovative school-based approaches that support students’ mental health literacy (MHL). Purpose In this qualitative case study, we interrogated the experiences of three eighth-grade English Language Arts (ELA) teachers and two of their school’s social support staff as they conceptualized, developed, and delivered a novel MHL unit of study within their existing curricular framework. In doing so, we sought to better understand the experiences of these school professionals to inform future iterations of the unit. Methods We explicated focus group data to identify themes that emerged regarding participant goals, experiences, and outcomes as they related to unit planning, delivery, and recommendations. Results Generally, practitioners advocated for increased collaboration with each other to overcome professional apprehension and streamline efforts, a need for such a curriculum to enhance student wellbeing, and having access to more school-provided resources. Discussion Themes are contextualized within the current landscape of school MHL programming, and suggestions are highlighted to advance this ELA curriculum-based work. Translation to Health Education Practice Health Educators’ expertise can supplement the ELA curriculum with targeted MHL lessons for students, alleviating teacher role confusion and advancing the goals of the unit by providing psychoeducation.

Turkish validity and reliability of the universal mental health literacy scale for adolescents (10-14 years): A methodological study.

Mental health literacy enables adolescents to acquire information that will accompany them in their future lives and to define their attitudes and behaviors. This study evaluated the Turkish validity and reliability of the Universal Mental Health Literacy Scale for Adolescents (10-14 years). This is a methodological, correlational, cross-sectional, and descriptive study. The study was conducted with 223 adolescents. Data were collected by 'Information Form' and 'Universal Mental Health Literacy Scale for Adolescents.' Exploratory Factor Analysis, Confirmatory Factor Analysis, and Pearson Correlation analysis were used to assess the validity and reliability of the UMHL-A. Item Content Validity Index (I-CVI) scores ranged from 0.94 to 0.96, while the Scale Content Validity Index (S-CVI) was 0.95. For 'Help-seeking and Stigma dimensions' χ2/df = 3.347, NFI = 0.804, IFI = 0.854, TLI = 0.778, CFI = 0.849, RMSEA = 0.103. For 'Knowledge of Mental Health and Knowledge of Mental Illnesses dimensions' χ2/df = 1.959, NFI = 0.731, IFI = 0.847, TLI = 0.774, CFI = 0.837, RMSEA = 0.066. The internal consistency and time stability were affirmed by a Hotelling T-square value of 15.241 and an F-test result of 27.793. This study reveals that the Turkish validity and reliability of the Universal Mental Health Literacy Scale for Adolescents is a valid and reliable tool for assessing mental health literacy among adolescents. The UMHL-A scale is a valid tool to evaluate critical aspects of mental health literacy in adolescent populations and can be used in both research and clinical practice in mental health education and intervention. It is recommended that the Turkish version of the Universal Mental Health Literacy Scale should be used to determine resilience in adolescents.

Benefits and Drawbacks of International Medical Elective Databases in Abroad Elective Research: A Narrative Review.

International medical electives (IMEs) are considered high-impact practice in global health education. Nevertheless, international medical elective (IME) research remains scarce, with only a few new publications appearing each year. The discrepancy between the many unanswered questions regarding IMEs and the lack of opportunities to perform research in this field has been further aggravated by the COVID-19 pandemic. Elective databases cataloguing structured IME reports/testimonies could offer a viable solution here. This narrative review provides a balanced and objective evaluation of the strengths and weaknesses of elective databases, summarizing their potential usefulness in IME research. The methodology employed was a multidisciplinary narrative review of the published and grey literature on databases cataloguing IME testimonies. Elective databases offer numerous benefits to the IME researcher. Their size allows for large analyses, built on hundreds of equally structured elective testimonies. Pre-defined outcomes, such as the elective destination, elective discipline or duration, are queried in a standardized way, allowing for a broad set of research questions. Elective databases are usually open-access, not confined to a single university, and free to use. Most databases also offer user-friendly filter functions, permitting targeted analyses centered around a particular outcome. A major drawback is that reports are rarely verified. Subject to several forms of bias (eg, recall and reporting bias), elective databases may not be suitable for all types of research questions, and the report quality is often inhomogeneous. Above all, they rarely allow for an informational depth that may result from qualitative face-to-face interviews. Elective databases could be a valuable supplement to interview-based elective research, potentially allowing for larger and broader analyses not confined to single institutions.

Research on Mental Health Education for College Students from the Perspective of Comprehensive Education

In today's higher education environment, mental health issues among college students are becoming increasingly prominent, significantly affecting their academic performance, daily life, and future development. To address this issue, the concept of comprehensive education has emerged, emphasizing a holistic, comprehensive, and continuous approach to student education. This paper aims to explore mental health education for college students from the perspective of comprehensive education, analyzing the current state of college students' mental health and its influencing factors, while proposing targeted educational goals, content, and methods. Through the analysis of successful case studies, this paper highlights the importance of mental health education in promoting the overall development of college students and looks ahead to future research directions in this field. The findings will provide theoretical support and practical guidance for the practice of mental health education in higher education institutions.

Drug-Related Violence, Substance Abuse, and Mental Health Challenges in a Southeastern American Indian Tribe: A Qualitative Study

ABSTRACT Background Drug-related violence [DRV] and substance abuse impact the mental health of economically challenged minority community members. DRV challenges to mental health promotion are exacerbated in American Indian [AI] communities. Purpose To investigate psycho-social and environmental factors influencing DRV, substance abuse, and mental health challenges within the Lumbee, a southeastern American Indian Tribe. Methods In-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders were conducted. Results Findings align with existing research, revealing the influence of poor socioeconomic conditions, poor coping strategies, broken family structures, and failed federal policy. The substantial influence of local Christian churches on beliefs, attitudes, and practices of the Lumbee community vis-à-vis DRV and mental health was recognized. Discussion Findings indicated that social-environmental factors, seemingly independent of drug use/violence prevention and treatment, play important roles in the Lumbee community’s ability to recover from mental health consequences of DRV. Identifying barriers to, and facilitators of, prevention and treatment are critical to improving the welfare of tribal communities. Translation to Health Education Practice Major competencies associated with this research apply to Areas I & II, Assessment of Needs/Capacity and Planning. Identification of DRV and mental health education, prevention and treatment barriers are critical to quality-of-life improvement in tribal communities.

Trailblazer in Health Education: The Legacy of Thomas Denison Wood.

Thomas Denison Wood, often regarded as the "Father of Health Education," was a pioneering figure in the early 20th century whose work laid the foundation for modern health education. His contributions were instrumental in integrating health education into the public school curriculum in the United States. Wood advocated for a holistic approach to health, encompassing physical fitness, hygiene, nutrition, mental health, and preventive care. His key achievements include the development of comprehensive health education programs, leadership in professional organizations, and the establishment of the New York City School Health Program. Wood authored several influential books, such as "Health by Stunts" (1901) and "A Textbook of Hygiene" (1915), which provided practical guidance on maintaining health and were widely used in educational settings. His work emphasized the importance of lifelong health education, beginning in childhood and continuing throughout life. Through his writings, teaching, and advocacy, Wood significantly shaped the field of health education, and his legacy continues to influence health education practices today.

Public Opinion for Physician Assisted Suicide/Euthanasia: Implications for Health Education

ABSTRACT Background Health care, social/psychological service and Health Education professionals are essential to euthanasia/physician assisted suicide (PAS). Public opinion can influence legalization of euthanasia/PAS. Purpose To determine levels of public support for PAS/euthanasia in South Carolina. Methods A cross-sectional, random-digit dial sample was utilized. The question: “Do you Strongly Agree, Agree, Disagree or Strongly Disagree that … . When a person has a disease that cannot be cured, doctors should be allowed by law to end the patient’s life by some painless procedure if the patient and his or her family request ending the life,” was included in the survey. Frequency counts and bivariate cross-tabulations were generated via chi-square. Results Respondents (59.6%) favored euthanasia/PSA. More than one-fifth (21.9%) indicated Strong Agreement while 37.7% simply Agreed; 15.2% Disagreed Strongly and 22.5% simply Disagreed. Discussion Overall results suggest that South Carolinians support euthanasia/PAS which varies in association by age, gender, race and political party affiliation. Results are consistent with national opinion on euthanasia/PAS. However, support is lower among specific categories of South Carolinians. Translation to Health Education Practice Study results have implications for Health Educators in regard to advocacy, mass communication and leadership/project management for euthanasia/PAS policy, legislation and intervention.

Helping Students Make Meaningful Connections: A Cross-Sectional Survey of College Student Loneliness

ABSTRACT Background Young adults are experiencing high levels of anxiety, depression, and loneliness. At colleges and universities across the United States, programs exist to address student mental health needs exacerbated by the COVID-19 pandemic. Purpose Current levels of loneliness among students (n = 487) at a Midwest university were researched to compare with previous trends and develop clearer recommendations for purposeful interventions. Methods This study utilized a cross-sectional study design with the UCLA Loneliness Scale during the fall 2022 semester. Results Higher levels of loneliness were linked to the demographics of identifying as cis-males, non-binary, and/or students of color. Students who had greater than 4+ h of social media usage per week and first year students also displayed the highest levels of loneliness. Qualitative data from student participants highlighted the importance of having a peer attend events with them, familiarity of event structures, and expanding access to counseling services and mentorship programs. Discussion Intentional development of programs needs to be prioritized to address student loneliness on campus. Translation to Health Education Practice With the increase in loneliness across the United States, there existopportunities for mentoring programs for struggling students and to build community to normalize the promotion of mental and emotional health resources.

College Students’ Preference and Information Comprehension of Different Forms of Diabetes Education Materials Under Different Reading Scenarios

ABSTRACT Background There is a lack of research on diabetes education for healthy college students. Purpose To examine the effect of three different forms of diabetes education materials on college students’ information comprehension under focused and fragmented reading scenarios. Methods A total of 300 college students divided into six groups were enrolled in this study with a response rate of 91.45%, with each group representing different reading scenarios with different forms of education materials (text, icon, and illustration). A questionnaire survey was conducted to assess the understanding (information perception and memory retention) of participants. Results There was similar influence of different forms of education materials on college students’ perception and memory retention in the context of focused reading. In contrast, under the fragmented reading scenario, materials with illustrations were the most effective. Discussion The form of education materials is crucial for information comprehension of college students in the scenario of fragmented reading rather than focused reading. Translation to Health Education Practice It is necessary to design visually appealing health education materials to promote diabetes education among college students.

Factors affecting antibiotics consumption among the elderly population in Thailand

Background: The consumption of antibiotic among the elderly population has raised concerns in Thailand due to its correlation with antimicrobial resistance (AMR) infections. Moreover, it is also related to adverse drug reactions resulting from impaired drug excretion and elimination. Contributing factors to antibiotic consumption in the elderly population are insufficiently understood in Thailand. Objectives: The purposes of this study were to determine the prevalence of antibiotic consumption behaviour among the elderly population and to identify associated factors. Methods: A cross-sectional study was conducted using survey data from the National Statistic Office, which included only elderly individuals. Bivariate analysis with a generalized linear mixed model (GLMM) was performed to screen for significant independent variables with a significance level below 0.05. All significant variables were included in the multivariable analysis, which revealed adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results: Of 9,104 elderly people, the prevalence of antibiotic consumption was found to be 7.77% (95% CI: 7.21% - 8.31%). The multivariable GLMM analysis demonstrated that being free from underlying diseases (AOR= 2.16, 95% CI: 1.63-2.88, p-value &lt; 0.001), having transportation expenses (AOR = 2.11, 95% CI:1.49-2.99, p-value &lt; 0.001), experiencing pain and discomfort symptoms (AOR =1.66, 95%CI: 1.27-2.16, p-value &lt; 0.001), having anxiety and depression (AOR = 1.66, 95%CI: 1.27-2.16, p-value = 0.012), having moderate to poor level of knowledge (AOR = 2.42 95% CI: 1.55-3.78 and (AOR=2.71, 95% CI:1.75-4.21), and not receiving information regarding antibiotic use and its resistance (AOR = 5.12, 95%CI: 4.12-6.36, p-value &lt; 0.001) were the major contributing factors to antibiotic consumption behaviours in the elderly population. Conclusion: The prevalence of antibiotic consumption in the elderly population may contribute to emergence of AMR infections and increased mortality rates. Implementing clinical practice guidelines and health education programs is essential to control antibiotic prescriptions and discourage self-medication in Thailand.

The Psychological Tapestry of Orthorexia Nervosa: Unpacking its Intricate Relationship with Self-Esteem, Anxiety, and Eating Attitude

ABSTRACT Background Orthorexia nervosa is a pathological obsession concerning healthy eating with associated restrictive behavior. They firmly restrict their diet, eating only things that they believe are pure or beneficial. Purpose This study aimed to understand the orthorexia nervosa tendencies among young adults and their association with anxiety, self-esteem, and eating attitude. Method Purposive sampling was employed for selecting 274 young individuals to participate in this cross-sectional research. Data was collected from an online survey using Test of Orthorexia Nervosa-17, generalized anxiety disorder-7, Rosenberg self-esteem inventory, and eating attitude test-26. Result There were 210 females and 64 males. We identified a tendency of orthorexia nervosa in 105 (38.32%) of participants. A high score on disordered eating attitude was found in people with a tendency for orthorexia nervosa. Level of education (negative), self-esteem and eating attitude (positive) predicted orthorexia nervosa. Discussion Study has shown a statistically significant relationship between orthorexia nervosa and eating attitude. Further clinical study is necessary to determine the cause-and-effect link to psychiatric comorbidities. Translation to Health Education Practice Focusing on consuming healthy food is desirable; however, young adults need education regarding the physiological and mental implications of pathological obsession of eating healthy food.

Association Between Socio-Emotional Health, Physical Activity and Screen Time Among Children

ABSTRACT Background Technological advancements have led to increased screen time and decreased Moderate to Vigorous Physical Activities (MVPA) among children. The impact of MVPA on children’s mental health is less explored compared to adults. Purpose This study investigated the relationship between children’s social-emotional health, MVPA, and screen time across different socioeconomic statuses (SES) in Bandar Abbas, Iran. Methods Primary school children completed questionnaires (n = 1041), analyzed for MVPA, screen time, and emotional health indicators. Results Lower SES children showed higher MVPA levels (23.11% active) than higher SES counterparts (11.8% active), but higher SES children exceeded 2 hours of screen time more (58.7% vs. 44.5%). Happiness correlated positively with MVPA, while worries negatively impacted MVPA. Sadness and worries increased screen time. Discussion Poor socio-emotional health was linked to increased screen time and decreased MVPA, limiting physical activity opportunities. Significant SES disparities suggest tailored interventions are crucial. Translation to Health Education Practice Addressing socio-emotional well-being is vital for promoting healthier lifestyles among Iranian children, emphasizing strategies to mitigate screen time and enhance MVPA.

Perceptions of ChatGPT in healthcare: usefulness, trust, and risk.

This study explores the perceptions of ChatGPT in healthcare settings in Taiwan, focusing on its usefulness, trust, and associated risks. As AI technologies like ChatGPT increasingly influence various sectors, their potential in public health education, promotion, medical education, and clinical practice is significant but not without challenges. The study aims to assess how individuals with and without healthcare-related education perceive and adopt ChatGPT, contributing to a deeper understanding of AI's role in enhancing public health outcomes. An online survey was conducted among 659 university and graduate students, all of whom had prior experience using ChatGPT. The survey measured perceptions of ChatGPT's ease of use, novelty, usefulness, trust, and risk, particularly within clinical practice, medical education, and research settings. Multiple linear regression models were used to analyze how these factors influence perception in healthcare applications, comparing responses between healthcare majors and non-healthcare majors. The study revealed that both healthcare and non-healthcare majors find ChatGPT more useful in medical education and research than in clinical practice. Regression analysis revealed that for healthcare majors, general trust is crucial for ChatGPT's adoption in clinical practice and influences its use in medical education and research. For non-healthcare majors, novelty, perceived general usefulness, and trust are key predictors. Interestingly, while healthcare majors were cautious about ease of use, fearing it might increase risk, non-healthcare majors associated increased complexity with greater trust. This study highlights the varying expectations between healthcare and non-healthcare majors regarding ChatGPT's role in healthcare. The findings suggest the need for AI applications to be tailored to address specific user needs, particularly in clinical practice, where trust and reliability are paramount. Additionally, the potential of AI tools like ChatGPT to contribute to public health education and promotion is significant, as these technologies can enhance health literacy and encourage behavior change. These insights can inform future healthcare practices and policies by guiding the thoughtful and effective integration of AI tools like ChatGPT, ensuring they complement clinical judgment, enhance educational outcomes, support research integrity, and ultimately contribute to improved public health outcomes.

Teacher-Preschool Student Relationships and Their Associations with Child Mental Health Problems

ABSTRACT Background In low- and middle-income countries, despite increasing early childhood education opportunities, research on quality and monitoring systems remains limited. This includes a lack of validated tools for assessing teacher-student relationships, which are crucial for child development but often characterized by conflict and low closeness in poor settings. Purpose This study aims to validate the Student-Teacher Relationship Scale – Short Form (STRS-SF) in Brazilian preschools and examine its correlation with socioemotional development and mental health symptoms in children aged 4 to 5. Methods Conducted in public preschools in Embu das Artes, the study involved 489 children and used the STRS-SF to assess teacher-student relationships and their impact on children’s emotional and behavioral symptoms through univariate logistic regression analysis. Results Confirmatory factor analysis confirmed the scale’s construct validity for the “closeness” and “conflict” dimensions, with factor loadings over 0.40. Significant associations were found between the conflict dimension and externalizing symptoms and delays in socioemotional development among preschoolers. Discussion The findings validate the STRS-SF as an effective tool for evaluating teacher-student relationships in early education settings. Translation to Health Education Practice Regular assessment of teacher-student relationships is essential for early detection and intervention in developmental delays, mental health issues, and social performance challenges.