Self-care Research Articles

UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and LIfestyle in Children and adolescents through behavIOUral change actionS: the DELICIOUS project

Abstract Over the last decades, the abandonment of traditional dietary patterns and engagement in unhealthy lifestyles (including poor physical activity, prolonged screen time, poor sleep behaviours) in children and adolescents has been considered an important threat for the future health of the younger generations living in the Mediterranean area and the safeguard of the environment. The DELICIOUS project aims to promote healthy lifestyles among children and adolescents by implementing activities and tools to increase the adherence to the Mediterranean diet with an attention to the environmental impacts of dietary habits. The DELICIOUS project as a single-arm, uncontrolled behavioral intervention program providing formal and non-formal education activities, development of new snacks and recipe reformulation, web/mobile app development, and physical activities to school children and adolescents in five European countries. Over 2000 families joined a preliminary survey to investigate potential determinants of adherence to a healthy diet. Children and adolescents recruited from schools in the parterns’ countries are now currently being recruited to participate to the intervention activities. A web application for school canteen and a mobile application for parents have been developed to help both schools and families to track and provide healthy and sustainable meals. The project aims to increase awareness of the nutritional benefits and the sustainability aspects of the Mediterranean Diet and to promote consumers’ empowerment through an online platform for sustainable and healthy meal planning in the school canteen.

Resilience and mental and physical health of higher and lower educated youth during COVID-19

Abstract Background COVID-19 had a considerable impact on the mental and physical health of youth. To limit the impact of this crisis on their health, resilience was required. This study aims to discover how resilient, in terms of mastery, emotional reactivity and social support, groups of youth with different SES were during COVID-19, and what risk and protective factors they experienced. Methods Two qualitative datasets were analyzed. One dataset included 10 interviews of university students during April-May 2020, and the other dataset included 8 interviews with pre-vocational secondary education adolescents during October 2021 to March 2022. Interviews were held in person or online. Data were analyzed with thematic analysis in Atlas.ti. Results In general, university students displayed resilience despite the tumultuous beginning of the pandemic, and their mental and physical health was positive. Protective factors that helped them during COVID-19 were spending time with friends and family, being healthy and having a healthy lifestyle, and being able to avoid stressful situations. Risk factors that impacted their resilience were loneliness, COVID-19 anxiety, and missing stability and routine. Adolescents receiving pre-vocational secondary education showed mixed resilience later in the COVID-19 period, and they made negative observations about their health. Protective factors that helped them were achieving good results in school, hobbies, and avoiding stressful situations. Risk factors they experienced were lack of motivation and having difficulties at school. They experienced worry about school progress during COVID-19. Conclusions University students and lower educated adolescents seemed to have differing resilience during the impactful stages of COVID-19, possibly due to differences in their psychological development. To protect their well-being, it is important that policy makers consider the protective and risk factors that impact the health of youth during crises. Key messages • Resilience differs among the two different age groups and education levels. • Policy makers should consider the protective and risk factors that impact the health of youth during crises.

Associations between maternal health literacy and prenatal micronutrient intake in Hungarian women

Abstract Background Adequate level of health literacy (HL) is an important factor in pregnancy. Low HL may increase the risk of maternal and fetal complications (e.g., gestational diabetes mellitus, low birth weight). This study aimed to measure the levels of maternal HL and its associations with the consumption of folic acid (FoA), vitamin D (VD), and omega-3 fatty acids (FAs) during pregnancy in Hungarian women. Methods The questionnaire-based study was conducted at the Department of Obstetrics and Gynecology, University of Szeged among women who gave birth between June and September 2023 (N = 294). Sociodemographic, lifestyle, conception and pregnancy related questions were asked. HL was measured by the Maternal Health Literacy Inventory in Pregnancy (MHELIP) questionnaire (after the Hungarian adaptation); it contains 48 items representing four subscales (maternal health knowledge, search for maternal health information, assessment of maternal health information, and maternal health decision making and behavior). Data analysis was performed by SPSS 29.0. (Ethical permission: 5351) Results The mean age of women was 31.53 +-4.75 years. During pregnancy 84.5% of women consumed FoA, 61.8% VD and 41.8% omega-3 FAs. The total mean score of MHELIP on a scale 0-100 was 78.93 (95%CI: 77.77-80.08); the score of “search for maternal health information” subscale was the lowest [57.68 (95%CI: 56.20-59.16)], and the score of “maternal health decision making and behavior” was the highest [86.75 (95%CI: 85.62-87.87)]. Omega-3 FAs and VD consumption was significantly higher in women with higher total and subscales mean scores (except “search for maternal health information”), while FoA consumption was significant in case of “assessment of maternal health information”. (The results are preliminary.) Conclusions The association between micronutrient consumption and HL supports that using this tool during pregnancy the mothers who needs more support and health information can be identified. Key messages • The Maternal Health Literacy Inventory in Pregnancy questionnaire is a reliable tool for measuring health literacy in Hungarian pregnant women. • Maternal health literacy plays an important role in the healthier lifestyle, including prenatal vitamin/micronutrient consumption.

Clean-up actions as catalysts for sustainability and physical activity promotion

Abstract Issue The convergence of global sustainability and health promotion implies integrated policies and actions. Initiatives like the European Green Deal and the UN’s Sustainable Development Goals emphasize the urgent need to address climate change while promoting health through behaviours such as physical activity (PA). Description We explore the relationship between PA, sustainability, and health outcomes, highlighting the European Green Deal’s impact on PA promotion and the 2030 Agenda for Sustainable Development’s alignment with health behaviours. In addition, we further discuss the concept of “green exercise” and provide insights about how eco-friendly initiatives (e.g., plogging) may have dual benefits in both individual and environmental domains. Results Emerging eco-friendly activities, including plogging, plalking and pliking, directly benefit the environment, while holding the potential to contribute to PA accumulation. Walking while picking up litter (i.e., plalking) can represent up to 4-5 metabolic equivalents (METs), which corresponds to performing a moderate-intensity PA. If other activities - running or cycling - are performed while picking up litter, the number of METs (i.e., >6 METs) involved may correspond to performing a vigorous-intensity PA. Lessons The physiological impact of eco-friendly activities, such as litter picking, reveals their potential as moderate to vigorous-intensity PA, favouring compliance with WHO PA recommendations (i.e., 150 min/week). Integrated policies and actions are needed to address global challenges effectively, emphasizing the interconnectedness of PA promotion, sustainability efforts, and health outcomes. Key messages • Engaging in green initiatives fosters PA and supports the United Nations’ goals for health and sustainability. • Plogging and similar eco-activities offer dual benefits: cleaner environments and healthier lifestyles.

Focus on food instead of nutrients improves consumers’ understanding of meals’ nutrition quality

Abstract Background Nowadays, most of the information directed to consumers focuses on nutrients, ignoring the impact of the interactions between different foods, origin or degree of processing. The methodologies currently applied have led consumers to confuse foods with nutrients, meat and fish are often referred to as “proteins”, grains and potatoes are referred to as “carbohydrates, forgetting that these foods are source of other nutrients, such as fat, proteins or fibre. Furthermore, its efficacy is compromised by the difficulties of reading labels among consumers. Objectives This study aimed to evaluate the understanding about food and nutritional information presented in menus to consumers, comparing the nutrient-focused approach (Nutrition Declaration) and the new food-focused approach (infographic - based on the Portuguese food Guide, from previous research). Methods 4 different meals were created, 2 balanced and complete in terms of food and nutrient content and 2 unbalanced and uncomplete. A questionnaire was applied, evaluating the understanding of the balance and healthiness of the meals, using the two approaches (nutrient-focused and food-focused). The order of presentation of the approaches and the meals was randomized for all participants. The questionnaire was distributed online through snowball sampling. Results 221 individuals participated, mostly female (67%), aged 25 to 54 years old. Evaluation of meals (“how balanced” and “how complete” the meal is) using the Nutrition Declaration did not allow to distinguish the quality of meals (Mb = 3,8;Mc=4,0), in opposite the Infographic returned significant differences between M1/M2 (Mb = 4,3;Mc=4,4) and M3/M4 (Mb = 2,5;Mc=2,6) (p < 0.01) allowing consumers to perceive differences between meals. The percentage of consumers that respond “I don’t know” to these questions decreased using the food-focused tool (13% vs 2%). Conclusions The food-focused approach allows for better understanding of meals’ nutritional balance. Key messages • The infographic provides more information about the daily food portions and how different meals and types of food contribute for complying food and nutritional recommendations. • The use of the infographic in menus, recipes, cookbooks and clinical advice may improve better food choices and a healthier lifestyle.

Training of women in the methodology of Gamification for the promotion of healthy habits in children

Abstract Background It has been evidenced that gamification has scope in the change of people behavior and in the acquisition of knowledge, therefore this methodology contributes to the promotion of health and adapts to the needs of children from the language of play, which increases their motivation in health literacy processes, so it is necessary to encourage the acquisition of new methodologies for community mothers and women caregivers, who are configured as promoters of healthy habits with their children. Objectives To train 150 women in the methodology of Gamification for the promotion of healthy habits in children; for which 20 sessions were developed addressing the following modules: a) Empowerment of women b) Gamification methodology c) Healthy habits and lifestyles d) Healthy eating e) Physical activity. Results The training of women evidenced a) the empowerment and recognition as health promoters for their life and that of their community b) the identification of the methodology of gamification and its application in processes of promotion of healthy habits c) a high adherence in the participation and learning through gamification methodology, training 150 women through sessions mediated by Information and Communication Technologies (ICTs), Learning and Knowledge Technologies (TACs) and Technologies of Empowerment and Participation (TEP) enabling the participation of women from urban and rural territories, which accounts for an inclusive process and democratization of health knowledge, impacting both women and their families, communities and children under their care, an average of 5 members per woman, benefiting 750 people in health promotion actions. Conclusions 150 women were certified, who from the application of the gamification methodology promote healthy habits in children, in their families and their communities, starting from the recognition of the experience of these in themselves to be health promoters in their territories. Key messages • Training women in gamification methodologies to promote healthy habits in children strengthens the health system by empowering them in their role as health literacy teachers in their territories. • ICT, TAC and TEP enable access to health education from an inclusive process that democratizes knowledge so that communities are active agents in health promotion activities.

Changes in opinions on health insurance benefits deservingness in the Netherlands between 2013-2023

Abstract Background In many European countries, including the Netherlands, the healthcare system is financed according to the principles of solidarity. Although people are generally highly supportive of collectively financed healthcare services, some groups are considered more deserving of health insurance benefits than others. Increasing knowledge of the health risks of certain lifestyle choices and pressure on healthcare systems may result in changing opinions on the allocation of resources. Our study looks into changes in citizen’s opinions on the deservingness of different groups between 2013 and 2023. Methods Questionnaires were sent out to samples of 1.500 members of the Dutch Health Care Consumer Panel in 2013, 2015, 2017, 2019, 2021, and 2023. Response rates varied between 42% (2015) and 56% (2021). Deservingness was studied by asking respondents about their opinions on the amount of health insurance premium for different, opposing groups, for example older and younger people and those with a healthy and unhealthy lifestyle (group A should pay more, both groups should pay the same amount, or group B should pay more). Multinominal logistic regression models were used to examine changes in deservingness opinions over time. Results Our study showed year-to-year fluctuations in opinions on the premium amount for health insurance for different, opposing groups. However, no distinct increases or decreases were observed over the whole time period. This applies to both the general population and to people who do and do not belong to the different groups. Conclusions Although there are differences in the degree to which groups are considered deserving of health insurance benefits, deservingness opinions were found to be fairly stable in the Netherlands between 2013 and 2023. Our results do not point to increasing support for premium differentiation based on personal characteristics. This suggests that support for solidarity in healthcare financing is not in decline. Key messages • Opinions on the deservingness of health insurance benefits of different groups were found to be fairly stable in the Netherlands between 2013 and 2023. • No evidence of increasing support for premium differentiation based on personal characteristics was found.

A transnational movement to support the sustainable transition towards a healthy and Eco-friendly Agri-Food System through the promotion of MEDIET and its lifestyle in modern society: MEDIET4ALL

Abstract The Mediterranean diet is considered the world’s most evidence-based low processed eating pattern for promoting health and longevity while saving water/energy and conserving land. Unfortunately, due to the modern societal trends, adherence to the Mediterranean diet model is decreasing, while the consumption of takeout and ultra-processed foods and drinks (UPFDs) is exponentially growing, with alarming levels in many European-Mediterranean (EUR-MED) regions. The overall objective of “MEDIET4ALL” is to support the transition from UPFs culture to modern and sustainable Mediterranean diet through the creation of transnational movement aiming at implementing best practices and innovative solutions to enhance the convenience, modernity, competitivity, and shelf life of Mediterranean diet. To achieve this overall objective, different multidisciplinary tailored approaches are proposed. Specifically, multicenter databases of ingredients/food and their providers will be created to promote the accessibility. Additionally, a variety of highly nutritional and antioxidant-rich “Quick & Easy” recipes that respond to modern trends while following the Mediterranean diet and considering sustainability aspects will be developed. To preserve the eco-friendly and food safety characteristics and extend the shelf life of the Mediterranean diet products, active bio-packaging will also be designed. A strategic “MEDIET4ALL” platform and m-app integrating the abovementioned MEDIET4ALL products and combined Mediterranean lifestyle interventions tailored to each user profile will be developed. Traditional and technology-based awareness and motivational campaigns with extensive marketing and advertising actions to promote MEDIET4ALL movement are also programmed. Working under the concept of a multidisciplinary approach consortium, multiple impacts, particularly supporting the transition towards a healthy and sustainable MED diet and lifestyle, are expected.

Public Health Challenges for 2050 in the Netherlands

Abstract Every 4 years, the National Institute for Public Health and the Environment (RIVM) carries out the Dutch Public Health Foresight Study, commissioned by the Ministry of Health. The ninth edition (PHFS-2024) compiles an outlook on future public health and the health care system in the Netherlands. It combines a business-as-usual Trend Scenario with literature study and a range of qualitative and mixed-methods approaches. The Trend Scenario comprises projections up to 2050 for a broad range of epidemiological indicators. Such as (healthy) life expectancy, disease burden, life style factors. The qualitative and mixed methods approaches supported an incremental intersubjective process. Methods were a focus groups study, stakeholder sessions and workshops. An important innovation in this study was the Citizen Council and Panel. The outcomes show that demographic development, in particular growth of the group people at high age with multimorbidity, will lead to high pressure on the formal and informal health care system but also on e.g. mental health. A life course approach applied shows that decreasing mental health of youth will have long term consequences. Also, overweight will deeply impact older people’s health in the future. Lastly, climate change in combination with e.g. energy transition will deeply affect our society and living environment. Next to these challenges, there will also be opportunities to improve health. Building a climate-proof living environment that also stimulates healthy life styles and social interaction is one of them. However, improving health has linkages with policy areas outside the traditional public health domain as well and requires, firstly, a Health in/for All Policies approach. Secondly a whole-of-society approach in which companies and civil organizations take action is needed. All these efforts can only be effective if people and communities are put at the core of all health policies.

Changes in Blood Pressure of Hypertension Patients With Therapy Non Pharmacological Use of Celery Leaves

Background High blood pressure or hypertension is one of the biggest causes of death in the world. Adopting a healthy lifestyle can prevent or slow the onset of hypertension and reduce cardiovascular risk Apiin and mannitol content in celery leaves have diuretic properties that help draw fluid and support kidney function in removing excess fluid from the body. This process can significantly lower blood pressure in people with hypertension Objectives to determine changes in blood pressure in hypertensive patients with non-pharmacological therapy using celery leaves Quasi-Experimental design method with Pre-test and Post-test control group design. Samples were taken using Purposive Sampling technique as many as 30 people Research Results From the characteristics of respondents and based on statistical tests with the Wilcoxon Test in the intervention group Pre-test Post-test obtained Asymp. Sig. value of 0.890 Conclusion There is no significant change between the intervention group and the control group in the provision of non-pharmacological therapy using Celery leaves Suggestions For people with hypertension to always seek information in improving self-management in order to reduce the risk of cardiovascular diseases such as hypertension.

Sarcopenia and associated factors among older adults at high risk of dementia

Abstract Background Sarcopenia and dementia share pathophysiological pathways and risk factors, including advanced age, physical inactivity, unhealthy diet, smoking and diabetes. Older adults at high risk of dementia may face increased susceptibility to sarcopenia, which can also exacerbate cognitive decline. Thus, this study aims to estimate the frequency of sarcopenia and its associated factors within this vulnerable population. Methods This cross-sectional analysis includes data from a subset of older adults (≥65 years of age) enrolled in the MIND-Matosinhos randomized controlled trial, a community-based cognitive decline prevention program. Per the European Working Group on Sarcopenia in Older People, probable sarcopenia is defined as low muscle strength (handgrip strength <16 kg for women and <27 kg for men). Sociodemographic, lifestyle and health-related data were collected via structured questionnaires. To assess factors associated with sarcopenia, odds ratios (OR) and respective confidence intervals (95% CI) were estimated using logistic regression. Results A total of 157 participants (58.6% female), with a median age of 73 years (range: 65 to 85 years), were included. The overall prevalence of sarcopenia was 21.7% (n = 34). After adjusting for sex, age and education, inadequate adherence to Mediterranean Diet (MD) (OR = 10.90; 95% CI:1.41-84.52), current smoking status (OR = 5.06; 95% CI:1.06-24.18) and poorer self-perceived health (OR = 2.74; 95% CI:1.03-7.28) were positively associated with sarcopenia. No other statistically significant associations were found. Conclusions The observed sarcopenia frequency underscores the need for enhanced screening and management of this condition in community settings and among those at dementia risk. Inadequate adherence to MD, smoking and poor self-perceived health, seem to be associated with sarcopenia in older adults at high risk of dementia. Sarcopenia prevention should involve a holistic approach to promoting a healthy lifestyle. Key messages • Sarcopenia was observed in 21.7% of older adults at high risk of dementia, indicating a significant burden on this vulnerable population. • Inadequate adherence to the Mediterranean diet, smoking and poor self-perceived health were associated with sarcopenia.

The Workplace Health Promotion project in an Italian manufacturing

Abstract Introduction The Workplace Health Promotion (WHP) program aims to improve employee’s health and well-being in the workplace by intervening in lifestyles. The objective of our study was to assess the impact of the WHP promoted by the Local Health Authority Tuscany South-East at a manufacturing. Methods The program was set at the STOSA Company in Radicofani (Siena, Italy) between 31 May 2017 to 31 December 2021, with a one-year interruption due to the COVID-19 pandemic. Based on an assessment of the workers’ health status, we identified nutrition and fighting smoking as areas of intervention. The WHP project was integrated into the company policy and targeted all staff. Evaluation of interventions was conducted using an anonymous paper questionnaire (Regional Decree no. 1565, Annex 3) administered in three moments: at the beginning of the project (T0), one year later (T1), and at the end (T2). We conducted a descriptive and inferential analysis (chi-square test) with R. Results We collected 131 (T0), 136 (T1), and 123 (T2) responses. The cohort is composed entirely of males (T0 M:F 122:8, T1 130:6, T2 109:14). The median age is 40 years (SD 8.24 (T2)). There is a statistically significant difference in the perception of health status by education (p<.001), type of work (p<.001), smoking habit (p<.001), and the change in smoking habit (p<.001). The whole sample positively evaluated the interventions on nutrition and fighting to smoke. Moreover, the entire sample reported improvements in their diet since the beginning of the project. Conclusions The COVID-19 pandemic caused difficulties in carrying out the project and possible changes in workers’ lifestyles. However, positive outcomes were observed in the targeted areas. The company has evaluated positively the WHP’s project and decided to maintain the good practices acquired. Key messages • The workplace represents a privileged setting to promote healthy lifestyles and prevent non-communicable diseases. • Collaborations between health authorities and other sectors are strategic to reach the general population.

Favourable lifestyle changes 1 year after acute myocardial infarction

Abstract Background Acute myocardial infarction (AMI) is a life-threatening event that should be an excellent motivator to adopt a healthy lifestyle. We aimed to evaluate the proportion of patients with AMI who reported favourable lifestyle changes 1 year after AMI. Methods Harnessing a nationwide prospective cohort of patients with AMI in Switzerland, ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled in the AMIS Plus registry between 2012 and 2022 were followed-up 1 year after the event by telephone interview. Favourable lifestyle changes, often addressed in hospitals or rehabilitation programmes were defined as smoking cessation, weight reduction (for overweight patients at index presentation), dietary changes, increased physical activity and stress reduction. Self-reported lifestyle changes were stratified according to AMI type, sex, and age. Results From 7906 AMI patients, 7234 (91.5%) with follow-up data were included. Of these, 5627 (77.8%) were male, 1607 (22.2%) female, 4664 (64.5%) had a STEMI, and 2570 (35.5%) a NSTEMI. At a median follow-up of 397 (interquartile range 371 to 465) days, 861 (50.9%) smokers at the time of the AMI had quit smoking, 1297 (35.0%) overweight patients had lost weight, 2567 (44.8%) patients had implemented nutritional changes, 2415 (41.2%) had increased their physical activity, and 1729 (30.5%) had reduced their stress levels. Patients with STEMI were more likely to stop smoking (53.0% vs. 45.1%, p=0.005), change their diet (46.4% vs. 41.6%, p<0.001), increase their physical activity (43.5% vs. 36.8%, p<0.001), or reduce stress (31.4% vs. 28.7%, p=0.04) compared to NSTEMI patients. Male sex was associated with smoking cessation [52.5% vs. 44.4%; p=0.008; age-adjusted odds ratio (OR), 0.78; 95% confidence interval (CI), 0.61-0.99; p=0.043], dietary change (47.8% vs. 33.7%; p<0.001; age-adjusted OR, 0.67; 95% CI, 0.58-0.77; p<0.001), and an increase in physical activity (43.5% vs. 32.9%; p<0.001; age-adjusted OR, 0.77; 95% CI, 0.67-0.88; p<0.001). However, after adjusting for age, stress reduction was comparable between males and females (30.9% vs. 28.9%; p<0.001; age-adjusted OR, 1.09; 95% CI, 0.94-1.26; p=0.25). Conclusions A substantial proportion of patients with AMI in Switzerland reported favourable lifestyle changes within 1 year after the index event. In general, STEMI as well as male patients were more likely to report multiple favourable lifestyle changes. Nevertheless, there is still room for improvement in terms of secondary prevention measures.

Evaluation of university food environment and healthy space policy implementation at university

Abstract Issue/problem Unhealthy diets, along with factors like tobacco, alcohol, and inactivity, contribute significantly to non-communicable diseases (NCDs). Prevention strategies should prioritize reducing exposure to these risk factors. It’s also crucial to consider environmental well-being alongside promoting health. Description of the problem During 2023/2024, university cafeterias (UC) were evaluated for healthy eating standards compliance, resulting in a noticeable presence of unhealthy foods together with plastic use, alcohol and tobacco consumption. This led to the development of an accreditation program to boost UC as healthy spaces. Results The developed program includes 5 mandatory standards and 42 recommendations. Priority objectives are offering healthy food options like fruit, avoiding alcohol and sugary drink ads, banning tobacco, promoting physical activity, and reducing waste for example by encouraging unpackaged water consumption. Our policy emphasizes evaluation and monitoring, so accreditation is valid only for two years. Our goal is to establish UC as sustainable, healthy spaces. To encourage compliance, we offer institutional financial support and accreditation seals to UC, showcasing their commitment to community health. Implementation begins in the 2024/2025 academic year, with an initial evaluation scheduled at that time. Lessons Monitoring UC food offerings is crucial for ensuring healthier options. Cafeterias play a key role in promoting healthy habits. Creating environments with healthier options can mitigate non-communicable disease risk factors presence. Key messages • University cafeterias are pivotal in fostering a healthy lifestyle. • Prioritizing policies to address non-communicable diseases is crucial. Clear programs are essential for sustained effectiveness.

Healthy Lifestyle Behaviors of Research Assistants and Final-Year Students in the Medical Faculty

Healthy Lifestyle Behaviors of Research Assistants and Final-Year Students in the Medical Faculty

Cancer Prevention in People Experiencing Mental Ill-Health: A co-designed Patient Navigation Concept

Abstract Introduction People experiencing mental ill-health have greater disparities in cancer specific morbidity and mortality. Factors influencing cancer prevention include increased risk behaviours and frequent encounters with barriers to health care utilization. The Patient Navigation Model (PNM) has been proven to reduce barriers in accessing cancer preventive care in vulnerable populations. To facilitate successful implementation, the conceptual features of the PNM were co-designed with patients and other relevant stakeholders. Methods Twelve focus groups were conducted in January 2024 at four pilot sites in Austria, Greece, Poland, and Spain. Iterative focus group discussions were carried out following key considerations for the PNM as outlined by DeGroff et al., audio recorded and transcribed verbatim. Transcripts were analysed deductively using a directed content analysis while allowing for potential inductive emergence of codes and topics. A total of 50 participants attended, representing five groups (individuals with mental ill-health, care givers, care team members, representatives of mental health organizations, and representatives of service managers). Results The co-design focus groups allowed for the PNM to be contextually adapted to each pilot site, but similarities in the approach emerged within the following four themes: 1) the requirement for a person-centred approach, 2) consideration of both person-specific and context-specific needs, 3) flexibility and competencies of navigators and 4) variation of navigation services (e.g., improving health literacy, promoting a healthy lifestyle, and providing practical support). Conclusions Participatory approaches in co-designing interventions allow for context specific development of interventions to meet the requirements of people with complex needs. Co-designing the PNM is part of activities of the CO-CAPTAIN project funded by the European Union’s Horizon Europe Programme (GA 101104784). Key messages • The Patient Navigation Model for Primary Cancer Prevention is a tailored intervention aiming to meet the needs of individuals experiencing mental ill-health. • The conceptual features of the Patient Navigation Model for Primary Cancer Prevention were co-designed with patients and other relevant stakeholders.

Frailty and related factors among community-dwelling older adults in Türkiye

Abstract Background Frailty in elderly can lead to complex challenges in the follow-up and management of health services. Ensuring comprehensive primary care services and social support can avert, reverse, or mitigate frailty in old age. We aimed to evaluate frailty and its associated factors in individuals aged ≥65 years. Methods We conducted a cross-sectional study in patients applying to primary care centres in 2024, in a city where 10% of the population is elderly. The centres were divided into clusters based on the socioeconomic status of the regions they serve, and nine were randomly selected by weight. A total of 1154 elderly who consecutively presented were included. A questionnaire including sociodemographic characteristics, Edmonton Frailty Scale, Loneliness Scale for the Elderly (LSE), Charlson Comorbidity Index (CCI), International Falls Effectiveness Scale (FES-I) was applied to the elderly. Results The mean age was 71.3±5.3 years, and 50.8% were male. In the study, 20.1% were frail, and 19.6% were apparently vulnerable. It was found that those aged 70-79 and ≥80 years, women, deceased/separated from their spouses, those with low education, those whose occupation was housewife, those earning below minimum wage, those who lived alone, non-exercisers, those taking >8 medications/day, and those who had ≥2 falls/last year were more frail. In multivariate logistic regression analysis, illiteracy (Odds ratio-OR:15.2, 95%CI:1.7-135.5), taking >8 medications/day (OR:4.1, 1.7-9.9), falling ≥2 times/last year (OR:3.4, 1.8-6.4) and ≥4 points on the CCI (OR:1.9, 1.0-3.4) were found to be predictors of frailty. Each score on the FES-I and LSE increased the risk of frailty by 1.08 (1.05-1.11) and 1.13 (1.08-1.17) times, respectively. Conclusions One in five people was found to be frail. Low education level, >8 medications/day, ≥2 falls in the last year, severity of comorbidity, fear of falling, and high levels of loneliness were found to be predictive factors for frailty. Key messages • Encouraging a healthy lifestyle to prevent comorbid diseases and early interventions to avoid falls can reduce frailty. • Providing social activities in primary care and promoting the elderly to participate in these activities can help prevent loneliness, which is a risk factor of frailty.

Practicing what you preach. Do cardiology trainees in the United Kingdom follow the lifestyle advice that they would give to patients?

Abstract Background The role of lifestyle factors in determining the risk of cardiovascular disease is well established. As a result, lifestyle modification is recommended as part of numerous European Society of Cardiology guidelines. However, it remains uncertain how closely cardiologists adhere to guidelines in their personal life. Poor lifestyle among clinicians can contribute to poor health and may increase absenteeism and potentially reduce the quality of patient care. Purpose To establish whether cardiology trainees in the UK follow appropriate guideline-directed lifestyle advice in their personal life. Methods All cardiology trainees within the UK were eligible to participate in the 2023 British Junior Cardiologists' Association (BJCA) training survey and the survey was advertised through national and local campaigns. The survey contained questions on smoking status, alcohol intake, healthy diet, partaking in regular exercise, frequency of adequate quality of sleep, and demographic questions. Responders were eligible for inclusion if they consented to participate in health and wellbeing survey questions, and if they had completed four demographic questions. Results Of the 398 responders to the 2023 BJCA survey, 212 consented to answer health and wellbeing questions (66% male, age 34±4 years, 42% had dependents) and were included. Responders included trainees representing all four UK nations. Very few cardiology trainees were current smokers either of cigarettes/cigars (n=2, 1%), or e-cigarettes (n=2, 1%), with 12 (6%) being ex-smokers. Few trainees (n=13, 6%) consumed alcohol above the UK recommended maximum of 14 units per week (Fig 1A). However, only 14% (n=29) regularly achieved 30 minutes of moderate or 15 minutes of intense exercise on at least 5 days each week (Fig 1B). Most trainees (n=167, 80%) only obtained adequate sleep on four or fewer nights each week (Fig 1C). Only 37% (n=78) of trainees agreed or strongly agreed that they were able to maintain a healthy diet most days (Fig 1D). Conclusions Most UK cardiology trainees followed guidance related to smoking and alcohol intake. However, far fewer trainees followed healthy lifestyle guidance relating to exercise, sleep, and diet. Whether these findings are similar across other ESC nations should be investigated. Further work is required to establish the impact of healthy living on clinician working activity and subsequent quality of patient care. Training bodies should consider how occupational factors may contribute to a trainee’s adverse healthy living.

10.G. Practice session: Innovation technology to promote healthy lifestyles: teachings from multi-national EU funded projects

Abstract The global burden of disease attributable to lifestyle risk factors is constantly escalating on a worldwide scale. Inadequate diet and sedentary behaviors stand out as particularly impactful contributors to chronic non-communicable diseases, resulting in millions of deaths annually and projecting stable, alarming trends for the foreseeable future. These statistics raise significant concerns among public health experts, particularly regarding the pervasive influence of unhealthy lifestyles on younger generations. This demographic cohort’s susceptibility poses a substantial threat to the future trajectory of non-communicable diseases and places immense strain on healthcare systems and global health outcomes. In light of these challenges, the imperative for public health initiatives and interventions aimed at promoting healthy lifestyles becomes glaringly apparent. Addressing the root causes of unhealthy behaviors through targeted interventions is essential to reverse the projected trends and mitigate future health risks. Public health authorities shoulder the responsibility of prioritizing such endeavors, as they play a pivotal role in shaping environments conducive to healthy living for present and future generations alike. Embracing innovative methodologies, leveraging technological advancements, and adopting modern approaches are imperative to engage and mobilize younger populations effectively. Initiatives funded by entities such as the European Union serve as promising examples, highlighting the potential for collaborative efforts to drive meaningful change. Sharing the methodologies and findings of such projects within the public health community can catalyze knowledge dissemination and foster collaboration, ultimately amplifying the impact of intervention strategies worldwide. By prioritizing intervention studies for behavioral change, stakeholders can collectively address the pressing challenge of lifestyle-related diseases and pave the way for healthier, more resilient communities. The aim of this workshop is to provide an overview of multi-national EU funded projects aiming to promote healthy lifestyles in the Mediterranean region. Key messages • Innovative and more modern approaches are needed to improve the diet in the Mediterranean region. • Children and adolescents are the main targets to counteract the rise of non-communicable diseases.

Restoring trust in vaccination through collective engagement with key populations in Eastern Europe

Abstract Issue/problem COVID-19 vaccination rates remained below 50% in Moldova, North Macedonia, and Serbia, especially among vulnerable populations like pregnant women and those with chronic diseases. This was strengthened by a lack of targeted communication and training for healthcare workers, and COVID-19 fatigue. Strategies to increase vaccine demand and confidence are a global priority, especially among vulnerable populations. Description of the solution From May 2022 to April 2024, the USAID MOMENTUM Routine Immunization Transformation and Equity project employed behavior integration to design a social and behavior change strategy, centering on vaccination as a part of a healthy lifestyle. It was implemented through continuing medical education (CME) and community engagement (CE) workshops with vulnerable populations, supplemented by cross-country learning exchanges. The outcomes provide a framework for public health initiatives aimed at boosting vaccine uptake through innovative, behavior-based methods. Results 1,618 healthcare professionals, able to reach 2.5 to 4.8 million patients, received training in immunization, COVID-19 vaccines, and quality health service, and 99% indicated confidence in applying the knowledge. 265 CE workshops, engaging 4,079 patients, increased awareness and addressed concerns related to vaccination. Of 3,223 patients who were followed up, 47% reported setting an appointment with their doctor regarding vaccination, 27% discussed vaccination with their partners, and 7% proceeded to receive the COVID-19 vaccine. Lessons Behavior Integration helped address key barriers to vaccination and informed the design of strategies (i.e. situating COVID-19 vaccination as part of a healthy lifestyle). Establishing trust with healthcare providers and patients through collective engagement improved health behaviors. Focusing on health as a wider priority helped re-establish the significance of vaccination as part of a healthy lifestyle. Key messages • Behavior science and behavior integration helped identify and address barriers, as well as design tailored interventions to improve vaccination demand and confidence. • Collective engagement, focused on integration of COVID-19 vaccination as part of a healthy lifestyle, achieved results through addressing vaccine hesitance from both sides of the equation.