Health Promotion Strategies Research Articles

Patient Health Engagement Model (PHE) in Affecting Patient Activation and Self-efficacy Among Cardiac Patients

Background: Heart patients must be able to actively manage and take care of their disease, medication, and symptoms. On the other hand, following self-management recommendations also requires patient activation. Objectives: This study assessed the relationships of patient health engagement model (PHE) with self-efficacy and activation in cardiac patients. Methods: This descriptive-analytical study is cross-sectional. The sample size was determined to be 207 cardiovascular patients. Subjects were randomly selected from a list of patients referred to a government hospital in the south of Iran. The data collection tools included the Patient activation measurement (PAM-19), health promotion strategies (SUPPH), and Patient Health Engagement Scale (PHE-S). Data were analyzed using descriptive tests, linear regression, optimal scaling, correlation test, and categorical principal components analysis (CATPCA). Results: All subjects were in the third stage of the PHE model (median = 3). A total of (49.5%) of subjects had good self-efficacy, and 39.7% of patients had a good activation score. The PHE model predicted self-efficacy (P < 0.001, R = 0.264) and patient activation (P < 0.001, R = 0.252). Patient Health Engagement had stronger predictive power for the active participation dimension (P < 0.001, R = 0.222). Conclusions: It seems that PHE is shaped according to the patients' level of activation and self-efficacy. However, more studies need to be conducted. By focusing on the emotional states, mental processes, and behavior of the patients, the PHE model can enhance their engagement in the chronic disease care process. Nonetheless, further research is necessary.

Negative Self-Care Behaviours Among Diabetic Patients Bukittinggi, Indonesia

Diabetes mellitus is a chronic multifactorial endocrine disorder that affects approximately 5-10% of adults worldwide. In Indonesia, approximately 10.8 million people, which accounts for 10% of the population, suffer from diabetes. The current treatment considered suitable for diabetes management involves self-care management. Self-management plays a crucial role in achieving blood sugar control, reducing complications, improving quality of life, and lowering hospitalization rates. Negative self-care behaviors frequently observed among diabetes patients include consuming high-fat foods, sugary snacks, non-adherence to diabetes diet protocols. These unhealthy habits make it more difficult to regulate one's own health, which increases the risk of morbidity and death, uncontrolled blood sugar levels, and a decline in quality of life. The purpose of this study is to identify poor self-care practices among type 2 diabetes patients in the Bukittinggi health facilities' service region. Using a deliberate sample technique, a qualitative descriptive study was carried out in seven operational regions of the community health clinics in Bukittinggi, Indonesia. Participants were interviewed in semi-structured interviews, and a chollezi was used to analyze the data. There were 15 people in all, ages 30 to 69, who participated in this study. The participants had been diagnosed with diabetes for a duration of 2 to 21 years. The study identified four themes: unhealthy dietary behaviors, poor medication adherence, preference of unstandardized based herbal medicine, and surrender to Diabetic. Future research should focus on developing appropriate interventions and health promotion strategies

39 Are you well? An investigation into the health-related behaviours and wellbeing of Dundalk Institute of Technology (DKIT) students. A pilot study

Abstract Introduction For young adults, adjustment into student life can often be a difficult and challenging time with students facing academic demands, social network changes, financial constraints, and the transition to independence. As a result, many college students tend to engage in harmful health related behaviours which may consequently impact their overall wellbeing. Physical inactivity, alcohol abuse, smoking tobacco, and poor dietary habits are considered main contributing factors associated with chronic disease. In addition, risky health related behaviours and poor wellbeing are associated with attendance issues, cognitive decline, and poor academic performance in the student population. Aims To examine the health-related behaviours and wellbeing of students attending DKIT. Methods A cross-sectional sample of DKIT students over the age of 18 were recruited by convenience sampling through flyers, peer referrals and word-of-mouth. Participants provided informed consent prior to completing a fitness assessment and self-report survey to examine their body mass index (BMI), physical activity levels (IPAQ-SF), sporting participation, sedentary behavior, sleep quality (PSQI), dietary habits, smoking status, and alcohol consumption. Results In total, 169 students (52% Males and 45% Females) took part in the study. Of the sample, 32% were overweight or obese, 23% reported being insufficiently active, 27% did not take part in sport while the average sitting time of students on a typical weekday was 6 hours. In addition, 27% consumed alcohol at least once a week, 8% regularly smoke tobacco and 21% currently use E-cigarettes. Regarding dietary habits, only 50% of students had fruit and 45% had vegetables once or more a day. Finally, 56% of students experienced poor sleep quality and over 15% of the participants reported poor wellbeing. Conclusion Understanding these risky health related behaviours in the student population may help guide colleges and universities to adopt better health promotion strategies and interventions to increase awareness, further educate and provide additional support and opportunities for the wellbeing of students.

Effectiveness of mobile health for exercise promotion on cardiorespiratory fitness after a cancer diagnosis: A systematic review and meta-analysis.

Cancer survivors are at greater risk for cardiovascular-related mortality. Mobile health (mHealth) is an increasingly prevalent strategy for health promotion, but whether it consistently improves cardiorespiratory outcomes after a cancer diagnosis is unknown. We sought to determine the effectiveness of mHealth fitness/physical activity interventions on cardiorespiratory fitness outcomes among cancer patients and survivors. Leveraging MEDLINE/PubMed, Scopus, and ClinicalTrials.gov, we identified studies through May 2023. Included studies provided a quantitative evaluation of an mHealth intervention in a primary or secondary capacity on cardiorespiratory fitness (6-minute walk test, VO2max, 3-minute step test, or systolic blood pressure; or any mention of cardiac measure) and were meta-analyzed (using a random effects model) if they were a randomized controlled trial with sufficient quantitative information. Four coders were involved in applying inclusion/exclusion criteria, coding using a standardized data extraction sheet, and assessing study quality, with each study coded by at least two. Of 656 articles, nine (n = 392) met systematic review inclusion criteria (mean age range 19-62 years, 71.9% female, 60.9% breast cancer). Interventions included mobile apps (k = 6), smartwatches (k = 2), or a smartwatch plus a supplemental web/mobile/tablet app (k = 1); median duration of mHealth-use was 12 weeks. Seven (n = 341) fit criteria for meta-analysis. mHealth was associated with improved cardiorespiratory fitness (d = 0.33; 95% CI = 0.07-0.60) compared to a control group. Relationships remained after accounting for lipid-based outcomes (d = 0.30; 95% CI = 0.03-0.56). There was no evidence for heterogeneity or publication-bias. mHealth exercise interventions appear to be a viable strategy for improving cardiorespiratory fitness after a cancer diagnosis.

Child health-friendly neighbourhood: a qualitative study to explore the perspectives and experiences of experts and mothers of children under 6 years of age in Tehran, Iran

ObjectivesCreating health-supportive environments is one of the key strategies for health promotion. The WHO launched the Healthy Cities Initiative which has inspired other international organisations to develop settings-based health initiatives,...

AWARENESS AND ATTITUDE REGARDING EYE SCREENING PROGRAMS IN THE POPULATION OF SELANGOR, MALAYSIA BASED ON A CROSS-SECTIONAL STUDY

Introduction: Visual impairment significantly impacts individuals, causing functional and psychological challenges. Effective health promotion strategies require a robust foundation, necessitating an assessment of the awareness toward eye screening programs. This study aims to evaluate the awareness and attitudes of the public towards eye screening programs in Selangor, Malaysia. Methods: A cross-sectional study involved 388 adults aged 18 years and above. Data were collected using a self-administered questionnaire. Chi-square analysis assessed associations between knowledge and attitudes regarding screening programs for various eye diseases among adults. Results: A significant correlation was found between knowledge and attitudes toward different eye disease screening programs among adults in Selangor (p = 0.00). Additionally, associations were observed between age, marital status, residence area, education level, and knowledge of screening programs for different eye diseases (p < 0.05). Age, gender, residential area, and education significantly correlated with attitudes toward screening programs (p = 0.00). Conclusion: This study underscores the need for targeted initiatives to raise awareness of visual impairment and the importance of routine eye exams. Particularly, efforts should be directed toward the elderly and individuals with lower education levels.

202 Football Cooperative, a community-based physical activity social intervention for men: The development of an implementation strategy for scale-up

Abstract Purpose Gender-sensitised health promotion strategies are crucial for men for several reasons including; Addressing male-specific health issues, Improving mental health, and promoting healthy lifestyles. Football Cooperative (FC) provides social games aimed at enhancing overall health and well-being among men and has the potential to return benefits including decreased blood pressure, heart rate, and fat mass, which presents solutions to address existing challenges in men’s health. This study aims to evaluate FC and gain insights into operating characteristics, both internally and externally, and learn from good practices, to develop a scalable implementation strategy for FC. Methods The Consolidated Framework for Implementation Research (CFIR) guided qualitative data collection from various stakeholders for this study, including; Interviews (n = 26), Ad hoc Interviews (n = 9), and Focus Groups (n = 3). Ethnographic data was collected through researcher participation in weekly games and completing reflective logs (n = 8). Data was recorded, transcribed verbatim, and analysed via thematic analysis. This analytical approach was guided by CFIR and in collaboration with a multi-disciplinary research team. Results Six main determinants were identified from the data including 1: Culture defined by inclusivity and diversity, developing community, creating a pressure-free environment and embracing values such as respect, 2: Game Characteristics - which are the structure of how games are implemented, 3: Motivations to Participate - which are the key factors that bring men to FC games, 4: Benefits of Participation is concerned with the positive benefits the games have on their lives, 5: Facilitators of Participation defined by anything that makes games accessible to men, and 6: Barriers to Participation is defined by anything that make participation challenging. Conclusions Various elements are essential to replicating FC at new sites and their inclusion should form a final strategy. Bringing the FC Culture to new venues, avoiding late start times, and ensuring flexibility when working with new stakeholders regionally are important, as are branding and communication alignment. Volunteer recruitment and management are at the core of FC and policy to support this is critical, as is the accessibility of games in terms of price, ability, and ease of joining games. Funding South East Technological University & UEFA

Health promotion for dementia risk reduction in Indigenous populations of Canada, Aotearoa New Zealand, United States of America, and Australia: Scoping review protocol.

Health promotion programs and strategies have the potential to support people to live healthier lives. Dementia, a collective name for brain disorders that impact thinking and memory, affects over 55 million people worldwide. Currently, there is no cure for dementia, so prevention is critical. Health promotion has the potential to reduce dementia by targeting the twelve potentially modifiable risk factors. A project currently being undertaken by the research team aims to strengthen the quality of clinical care and health services that specifically address dementia risk for Australian Aboriginal and Torres Strait Islander peoples. One of the intended strategies supporting the project's aim is the need for appropriate and safe health promotion programs and resources that support dementia risk reduction. Consequently, the aim of this scoping review is to identify and determine the quality and appropriateness of existing health promotion programs and resources aimed at dementia risk reduction developed or modified for Indigenous populations of Canada, the USA, Aotearoa New Zealand, and Australia that could be incorporated into the broader project. The Joanna Briggs Institute method for scoping reviews will be used to identify programs and resources focussed on dementia risk reduction for Indigenous peoples. Searches will be limited to the English language and literature published since January 2010. Databases to be searched include: CINAHL, Medline, PsychInfo, PubMed, Scopus and Google. Data that answers the research questions will be extracted from the literature and recorded on a data charting form. A combination of quantitative and qualitative methods will be used to analyse the findings of the scoping review. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Aboriginal and Torres Strait Islander members of the research team.

Physical activity, body weight, and liver function as factors increasing Insomnia index among Korean adults: a cross-sectional analysis.

This study aimed to elucidate the relationship between physical activity, body weight, liver function, and insomnia in Korean adults, thereby providing a foundation for health promotion strategies. We recruited 11,645 adults (8,051 males and 3,594 females). Participants underwent assessments using the Korean version of the Insomnia Severity Index, measures of physical activity (PA), anthropometric data (body weight, height, body mass index [BMI], and waist circumference [WC]), and liver function (alanine aminotransferase, aspartate aminotransferase [AST], and gamma-glutamyl transferase). One-way ANOVA revealed significant differences among male groups in height (p < .001), weight (p = .036), BMI (p = .002), diastolic blood pressure (p = .008), AST (p = .036), recreational PA (p = .026), moderate PA (p < .01), vigorous PA (p < .01), and moderate-to-vigorous PA (p < .001). Similarly, significant differences were found among female groups in height (p < .001), weight (p = .001), BMI (p = .006), WC (p = .013), moderate PA (p < .001), vigorous PA (p < .001), and moderate-to-vigorous PA (p < .001). To prevent insomnia, it is essential to enhance physical activity and manage factors related to body weight and liver function, such as BMI, WC, and AST. Increasing moderate-to-vigorous physical activity is particularly crucial, as it has a substantial positive impact on reducing body weight and improving liver function.

The health behaviors differences among male and female school-age adolescents in the Middle East and North Africa region countries: a meta-analysis of the Global School-based Student Health Survey data.

Understanding gender disparities in adolescent health behaviors is crucial for developing targeted health promotion strategies. This study uses data from the Global School-based Student Health Survey (GSHS) across 17 MENA countries to analyze gender differences in adolescent health behaviors, aiming to provide a comprehensive overview for both boys and girls. This meta-analysis incorporates data from recent years of the GSHS, covering 17 MENA countries. The objective was to assess and compare health behaviors between adolescent girls and boys. A random-effects model was employed to calculate odds ratios for gender comparisons in these behaviors. Statistical analyses and modeling were performed using JAMOVI software. In most MENA countries, boys consumed more vegetables compared to girls. Girls were less likely to frequent fast food establishments (OR = 0.82, 95% CI: 0.69-0.98) and generally exhibited better self-care behaviors. Boys reported a higher prevalence of physical altercations (OR = 2.18, 95% CI: 1.88-2.51) and were more involved in fights (OR = 3.00, 95% CI: 2.46-3.67). Girls were more likely to miss school without permission and were consistently described as kinder and more helpful across various income levels. However, in some countries such as Oman and Tunisia, boys missed school more frequently. There were no significant gender differences in parental oversight of homework or knowledge of students' activities, but girls were reported to have stronger parental relationships and better parental understanding of their problems and free time, with exceptions in Morocco and the Palestinian Territory-Gaza. Boys were more likely to engage in smoking (OR = 3.57, 95% CI: 2.69-4.76) and other substance use. Conversely, girls reported higher levels of physical inactivity and loneliness, but also demonstrated greater kindness and helpfulness in school settings and stronger parental relationships. Policymakers in the MENA region should develop and implement gender-specific interventions targeting key areas such as hygiene practices, physical activity, and substance use. By focusing on these targeted strategies, they can address the distinct health behaviors and needs of both boys and girls. Effective interventions in these areas are crucial for improving overall health outcomes and promoting healthier lifestyles, thereby enhancing adolescent health and well-being across the region.

Single or Multiplayer Mode? Examining the Effects of Exergames in Improving Physical Health and Well-Being Among Older Adults.

Objective: This study assesses the impact of single-player and multiplayer exergaming modes on improving exercise intentions, reduction of fear of falling, and emotional well-being among older adults, primarily from low socioeconomic status (SES) backgrounds-a group often underrepresented in exergame research. Method: We engaged 48 participants, primarily from low-SES communities in Singapore for a 4-week community-based exergaming intervention. Participants were divided into four groups as follows: (1) conventional exercise alone, (2) exergames alone, (3) exergames with a health coach, and (4) exergames with a peer. Using two-way repeated-measures ANOVA, we analyzed the effects of these interventions. Results: The findings revealed that all exergaming modes positively influenced exercise intentions, fear of falling, and emotional well-being to varying extents. Notably, exergaming with a health coach significantly improved participants' exercise intentions and emotional well-being, underscoring the value of expert guidance in motivating and supporting older adults in adopting healthier lifestyles. Exergaming with a peer was most effective in reducing fear of falling, highlighting the importance of social support and peer interaction in addressing physical health concerns among this population. Conclusion: This study emphasizes the potential of tailored exergame interventions incorporating various social interactions to improve health outcomes for older adults, contributing to more inclusive health promotion strategies.

Using Online Memes to Communicate About Health: A Systematic Review.

We conducted a systematic review of the literature on online health memes to (a) detect and describe the available research, (b) identify key findings, and (c) delineate future research needs/opportunities. Databases, communication and public health journals, and ancestry search. Empirical studies, in English, published in peer-reviewed academic journals, and focused on memes to discuss health-related topics. We scrutinized 357 empirical articles and included 35. Descriptive summary of the locations where studies were conducted, the health topics addressed, theories and methods used, features of memes analyzed, study outcomes, and researchers' challenges. Most studies were conducted in the USA (n = 14); focused on COVID-19 (n = 15); were a-theoretical (n = 19); and quantitative (n = 19). Most explored the themes and use of the memes available online (n = 19); compared meme variations (n = 12) by health issue, content, or participants' group; examined meme' effects on health outcomes (n = 1); or evaluated memes as part of a health campaign (n = 3). We summarized the studies' limitations and key findings. Memes are a promising message strategy for health promotion and education, but more research is necessary. Considering the information retrieved, we provide five specific recommendations for future research directions when studying health memes, including suggestions on the multiple health issues to address and promising theories to adopt and expand.

Research on the Promotion Strategy of Mindfulness Training Under the Guidance of The Tao Te Ching on Employees' Mental Health

The impact of mindfulness training on mental health has become the focus of people's attention. A large number of studies have shown that mindfulness training can effectively improve an individual's mood mood, improve emotional regulation, reduce stress and anxiety, and improve the mental health of an individual. The Tao Te Ching is a classic of Taoist philosophy, and its core ideas emphasize conforming to nature, ruling by non-action, and inner harmony. Under the guidance of the Tao Te Ching, mindfulness training can help employees better understand their work and life, adjust their mentality, effectively cope with workplace pressure, and improve their mental health. The purpose of this study was to explore the impact of mindfulness training under the guidance of Tao Te Ching on employees' mental health, and to propose corresponding mental health promotion strategies.

The correlation between healthy lifestyle habits and all-cause and cardiovascular mortality in Guangxi

BackgroundAdherence to healthy lifestyle habits has become a mainstream approach for lessening the burden of cardiovascular disease (CVD) during initial prevention efforts. The purpose of this study was to investigate the prevalence of four healthy lifestyle habits, the associated factors, and their impact on all-cause and cardiovascular mortality among residents of Guangxi Zhuang Autonomous Region.MethodsFrom 2015 to 2019, individuals between the ages of 35 and 75 from Guangxi Zhuang Autonomous Region were recruited through the ChinaHeart Million Person Project. Our study examined four healthy lifestyle habits: not smoking, no or moderate amounts of alcohol, sufficient leisure time physical activity (LTPA) and a balanced diet.ResultsOut of the 19,969 individuals involved, the majority, 77.3% did not smoke, while 96.7% had limited alcohol intake, 24.5% engaged in sufficient LTPA, 5.5% followed a balanced diet, and merely 1.7% adhered to all four healthy lifestyle habits. Participants who were women, older, nonfarmers, living in cities, with a high income or level of education, or had hypertension or diabetes were more likely to follow all four healthy lifestyle habits (p < 0.001). People who followed the three healthy lifestyle habits had reduced chances of death from all cause (HR 0.34[95% CI:0.15,0.76]) and cardiovascular-related death (HR 0.23 [95% CI: 0.07, 0.68]) (p < 0.01) over a median period of 3.5 years.ConclusionsIn Guangxi Province, the level of adherence to healthy lifestyle habits is very minimal. Therefore, population-specific health promotion strategies are urgently needed.

Recreational Physical Activity and the Mediterranean Diet: Their Effects on Obesity-Related Body Image Dissatisfaction and Eating Disorders.

Obesity is a non-communicable disease that is associated with a number of serious physical and mental health conditions. The present study examines the effect of recreational physical activity and the Mediterranean diet on body image dissatisfaction and propensity for eating disorders. It is based on 1311 participants categorized by body mass index (BMI) into a normal ΒΜΙ group (NBG; N = 513), an overweight and obese ΒΜΙ group (OBG; N = 492), and a control group (CG; N = 309). All participants completed the Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS), Rosenberg Self-esteem Scale (RSES), Eating Attitudes Test-26 (EAT-26), Mediterranean Diet Score (MedDietScore), and Fitness Evaluation and Fitness Orientation subscales from the original Multidimensional Body-Self Relations Questionnaire (MBSRQ). The results of the multiple regression analysis indicated that the overall prediction of the variables was statistically significant. A multivariate analysis of variance (MANOVA) demonstrated the existence of significant interactions between groups and gender across a range of scales. Despite higher body image dissatisfaction in the OBG group, they maintained positive self-esteem and did not exhibit eating disorder tendencies. Notably, women reported greater dissatisfaction than men across all three groups. Our findings have practical implications for public health promotion strategies, policymaking, future research, and clinical practice. Encouraging regular exercise and adherence to the Mediterranean diet could improve body satisfaction and reduce eating disorder risk. Policymakers can advocate for community-based policies promoting physical activity and healthy eating habits.

How the faculty across higher education institutes are facilitated to develop skills on student mental health and well-being? – A scoping review

ABSTRACT Students in higher education institutes (HEI) often face mental health issues that challenge their well-being. Faculty members, as crucial points of contact for academic programmes, play a pivotal role in supporting their well-being. Some HEIs offer training programmes to support the faculty in this role. We conducted a scoping review to examine such faculty training programmes by considering data from four of the 10,362 studies and 21 university sources for analysis. Synthesizing the data, we identified the components, format, mode, and evaluation of faculty training programmes. The components were based on the RAKSHAKA framework, which includes resources, affective skills, knowledge in recognising students in distress, severity identification of mental health issues, health promotion, assistance and support strategies, knowledge on roles and boundaries, and access to student services. The proposed framework would provide academics and HEI administrators a reference for implementing faculty training programmes to support student mental health and well-being.

Review of Tobacco Taxes Advocacy in Indonesia: A Health Promotion Strategies

Review of Tobacco Taxes Advocacy in Indonesia: A Health Promotion Strategies

A qualitative analysis of workers perceptions on the role of management in promoting health behaviour, informed by the COM-B model.

The primary objective of this study was to explore the viewpoints held by employees at a pharmaceutical manufacturing workplace in a middle-income country regarding management's role in promoting health behaviours in the workplace. This study used transcripts of focus group discussion from an original study that investigated employee perceptions of factors associated with healthy behaviours among South African pharmaceutical manufacturing factory workers. Participants felt that workplace managers could improve capability through health promotion strategies, supportive leadership and promoting a culture of health. They could provide opportunity through employee engagement programs and resources, and physical activity opportunities were specifically identified. This study demonstrates that managers in a middle-income country have the potential to contribute to workplace health in a range of ways that include addressing capability, opportunity and motivation of their workers.

Gamified Interventions for Promoting the Psychosocial Well-Being of School-Aged Children: A Scoping Review.

Gamified health interventions can offer child-centered and tailored health-promoting strategies. Evidence suggests that its various mechanics foster engagement that can be utilized to promote health and well-being and influence health behavior. At present, psychosocial challenges among school-aged children are becoming a global predicament. We conducted a scoping review to explore the range and nature of evidence on gamified interventions for promoting the psychosocial well-being of school-aged children from the general population. We followed the Arksey and O'Malley framework and extracted sources of evidence from five databases. Our review findings were summarized with basic numerical analysis and provided with narrative accounts based on a gamification taxonomy and the Template for Intervention Description and Replication (TIDieR). We identified 12 gamified interventions and included 23 records that reported their development and evaluation. Theories on emotions, behaviors, social skills, and mental health were commonly applied frameworks. Narrative was found as the most commonly used gamification mechanic (11/12, 91.7%), followed by avatar and tasks (10/12, 83.3%), feedback system and level progression (9/12, 75%), points (7/12, 58.3%), badges (5/12, 41.7%), progress bar (4/12, 33.3%), and virtual goods, reminders, and time pressure (2/12, 16.7%). The included sources of evidence reported significant improvements in some of the measured psychosocial outcomes; however, studies on this domain for this particular target group are still considerably limited. Further research is needed to determine how the applied theories and gamification mechanics brought about the change in psychosocial outcomes, bridging the gap in current evidence.

Credibility of the evidence on green space and human health: an overview of meta-analyses using evidence grading approaches

Green space is an important part of the human living environment, with many epidemiological studies estimating its impact on human health. However, no study has quantitatively assessed the credibility of the existing evidence, impeding their translations into policy decisions and hindering researchers from identifying new research gaps. This overview aims to evaluate and rank such evidence credibility. Following the PRISMA guideline, we systematically searched PubMed, Web of Science, and Embase databases for systematic reviews with meta-analyses concerning green spaces and health outcomes published up to January 15, 2024. We categorized the credibility of meta-analytical evidence from interventional studies into four levels (i.e., high, moderate, low, and very low) using the Grading of Recommendation, Assessment, Development and Evaluations framework, based on five domains including risk of bias, inconsistency, indirectness, imprecision, and publication bias. Further, we recalculated all the meta-analyses from observational studies and classified evidence into five levels (i.e., convincing, highly suggestive, suggestive, weak, and non-significant) by considering stringent thresholds for P-values, sample size, robustness, heterogeneity, and testing for biases. In total, 154 meta-analysed associations (interventional=44, observational=110) between green spaces and health outcomes were graded. Among meta-analyses from interventional studies, zero, four (wellbeing, systolic blood pressure, negative affect, and positive affect), 20, and 20 associations between green spaces and health outcomes were graded as high, moderate, low, and very low credibility evidence, respectively. Among meta-analyses from observational studies, one (cardiovascular disease mortality), four (prevalence/incidence of diabetes mellitus, preterm birth, and small for gestational age infant, and all-cause mortality), 12, 22, and 71 associations were categorized as convincing, highly suggestive, suggestive, weak, and non-significant evidence, respectively. The current evidence largely confirms beneficial associations between green spaces and human health. However, only a small subset of these associations can be deemed to have a high or convincing credibility. Hence, future better designed primary studies and meta-analyses are still needed to provide higher quality evidence for informing health promotion strategies. The National Natural Science Foundation of China of China; the Guangzhou Science and Technology Program; the Guangdong Medical Science and Technology Research Fund; the Research Grant Council of the Hong Kong SAR; and Sino-German mobility program.