Healthy Behaviors Research Articles

Fostering Mental-Wellbeing and Health Behavior through Online learning Measures and Cyber Resilience

Objective: Online learning tools and updated cyber-information can lead to improve overall health behavior and offer solutions for learners' mental well-being. A major role is played by digital technology in collaborating with innovative methods of learning to foster healthy behavior. This study attempted to examine how online learning techniques such as flipped learning and E-learning can help learners enhance cyber resilience and build a Metaverse, the online universe; and how this cyber resilience can further enhance students' health behaviors and mental-wellbeing. Method: A qualitative research design was adopted; data was collected through semi-structured interviews from a sample of 10 students, randomly identified from higher educational institutions in Turkey. Results: The content analysis of interview transcripts yielded the following results: that the metaverse integration of flipped learning and e-learning has proven to be a significant educational technique; that Cyber Resilience in digital settings plays a pivotal role in generating good learning experiences; that technological advancements in learning contexts express the interdependence of health behavior and mental health on technology; and that when e-learning and flipped learning incorporate with the metaverse, they demonstrate their potential for boosting health behavior and mental well-being. Findings: These findings will encourage policymakers and technology experts to emphasize the importance of creating secure digital environments, assisted by technology. Finally, this research sheds light on the complex interaction between education, technology, and well-being in the ever-changing metaverse context.

Exploring User Experiences with a Persuasive mHealth App for Breastfeeding: An Empirical Investigation

Women are increasingly turning to mHealth apps as primary sources for breastfeeding education and support. The rising prevalence of mHealth apps presents a unique opportunity to explore their impact on women’s breastfeeding experiences. Understanding user perspectives of these apps, especially focusing on their persuasive design aspects, can offer valuable insights for enhancing maternal and child health outcomes. These insights can optimize these technologies to align with user values and promote sustained healthy behaviors. This study aimed to undertake an empirical exploration of users’ experiences with the persuasive design features employed in the Milky Way mHealth app and align the findings with human values within the value-sensitive design (VSD) framework. Semi-structured interviews were conducted with a group of women who had used the Milky Way app. Interview data were analyzed using an inductive thematic approach. To provide insight into users’ values mediated by the app, a deductive analysis complemented by a data-driven inductive approach was performed. Data analysis was supported by NVivo data-management software. Findings from the study demonstrate that the persuasive design elements in the Milky Way app significantly influence users’ experiences. The analysis provided four primary themes: Informative, Easy to use, Credible, and Social connection. Overall, participants praised the app’s trustworthy educational content and support features as valuable resources for addressing breastfeeding challenges and obtaining reliable support. Participants expressed concerns about information overload and emphasized the importance of personalized support and evidence-based tailored recommendations. The results demonstrated that users’ values were expressed and embedded within the app. The analysis indicated an alignment between the app design features and the values and opinions of the users within the VSD framework. This study interprets women’s perspectives utilizing the Milky Way app and highlights the significance of its evidenced-based educational and support features. Further investigation into potential user values like privacy, remains crucial for a comprehensive user-centered app design. The empirical insights gained from this study contribute to future research, informing the development and design of ethically considerate persuasive mHealth apps to maintain their relevance in promoting positive user experiences and facilitating meaningful behavior change.

Machine learning approach to investigate pregnancy and childbirth risk factors of sleep problems in early adolescence: Evidence from two cohort studies

BackgroundThis study aimed to predict early adolescent sleep problems using pregnancy and childbirth risk factors through machine learning algorithms, and to evaluate model performance internally and externally. MethodsData from the China Jintan Child Cohort study (CJCC; n=848) for model development and the US Healthy Brain and Behavior Study (HBBS; n=454) for external validation were employed. Maternal pregnancy histories, obstetric data, and adolescent sleep problems were collected. Several machine learning techniques were employed, including least absolute shrinkage and selection operator, logistic regression, random forest, naïve bayes, extreme gradient boosting, decision tree, and neural network. The area under the receiver operating characteristic curve, sensitivity, specificity, accuracy, and root mean square of residuals were used to evaluate model performance. ResultsKey predictors for CJCC adolescents’ sleep problems include gestational age, birthweight, duration of delivery, and maternal happiness during pregnancy. In HBBS adolescents, the duration of postnatal depressive emotions was the primary perinatal predictor. The prediction models developed in the CJCC had good-to-excellent internal validation performance but poor performance in predicting the sleep problems in HBBS adolescents. ConclusionThe identification of specific perinatal risk factors associated with adolescent sleep problems can inform targeted interventions during and after pregnancy to mitigate these risks. Health providers should consider integrating these predictive factors into routine pre- and postnatal assessments to identify at-risk populations. The variability in model performance across different cohorts highlights the need for context-specific models and the cautious application of predictive analytics across diverse populations. Future research should focus on refining predictive models to account for such variations, potentially through the incorporation of additional socio-cultural factors and genetic markers. This study emphasizes the importance of personalized and culturally sensitive approaches in the prediction and management of adolescent sleep problems, leveraging advanced computational methods to enhance maternal and child health outcomes.

The impact of chronic diseases on the health-related quality of life of middle-aged and older adults: the role of physical activity and degree of digitization

BackgroundThe incidence of chronic diseases is on the rise worldwide, with a high mortality rate in China, posing a serious threat to the health-related quality of life (HRQoL) of middle-aged and older adults. This study explores the association between chronic diseases and the HRQoL of middle-aged and older adults, as well as the role of physical activity (PA) and degree of digitization in this relationship.MethodsThe data used in this study was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which included 13,620 middle-aged and older Chinese adults (≥ 45 years). The study utilized correlation analysis, and bootstrapping to investigate the mediating role of PA and the moderating influence of the degree of digitization. Data analysis was conducted using SPSS 26.0.ResultsThe study findings indicate that the severity of chronic disease has a significant negative predictive effect on HRQoL (PCS, physical component summary; MCS, mental component summary) (PCS: β = -2.515, p < 0.01, MCS: β = -0.735, p < 0.01). Further analysis revealed that PA plays a mediating and masking role in the impact of chronic disease on PCS and MCS. Additionally, the degree of digitization moderates the relationship between chronic disease and PA, chronic disease and PCS, and PA and PCS.ConclusionFor middle-aged and older persons, chronic diseases have a detrimental effect on their HRQoL; nevertheless, PA can help. Furthermore, proper internet usage can help older individuals to some extent in mitigating the negative impact of chronic diseases. Therefore, it is encouraged to promote PA among the elderly with chronic diseases to improve their physical health, as well as to guide them in the proper use of the Internet to establish healthy behaviors.

Secondary Prevention Program through Hybrid Tele-Cardiac Rehabilitation using a Combination of Vigorous-intensity Interval Training and Low-Intensity Home-based Exercise in Patient with Refractory Angina Post-Percutaneous Coronary Intervention

Background: Refractory angina (RA) refers to symptoms lasting &gt;3 months due to reversible ischemia occurring with coronary artery disease, which cannot be controlled by increased medical therapy or revascularization including percutaneous coronary intervention (PCI). It may result in a significant impact on patient outcomes such as exercise limitation, biopsychosocial disorders, and decreased quality of life. Participation of patients with RA in cardiac rehabilitation (CR) reduces angina frequency and increases exercise capacity. Exercise-based CR also improves endothelial function, reduces oxidative stress and arterial stiffness, and improves myocardial perfusion. CR is also known as a secondary prevention program with the main goal to help patients return to their normal activities by increasing their functional capacity and preventing long-term complications. Case illustration: A 64-year-old male has undergone PCI and experienced RA. This patient was given a CR program to increase his functional capacity as a secondary prevention of cardiovascular disease through a center-based combined with a home-based CR program. Aerobic exercise given was hospital-based vigorous-intensity interval training and low-intensity home-based exercise. Problems found were refractory angina that often appeared during activity, and low cardiorespiratory endurance or muscular fitness. Angina symptoms and hand grip strength improved after 2 weeks, even though muscular fitness classification was still poor. During the program, he could achieve the exercise heart rate target without any symptoms. After 4 weeks, hand grip strength and physical activity were improved, and an exercise test revealed no symptoms during the test, appropriate hemodynamic response, and good fitness classification. However, there were still frequent VES with couplet episodes, so the patient was still classified as high-risk stratification. Although risk stratification was still high, the patient was allowed to enter phase III CR, with the prescription of moderate-intensity aerobic, low-intensity resistance, flexibility, and breathing exercises. These exercises were given based on recommendations for the average adult to maintain his level of physical activity and promote lifelong healthy behavior. Conclusion: Hybrid tele-cardiac rehabilitation through a combination of vigorous-intensity interval training and low-intensity home-based exercise in a patient with refractory angina post-PCI improved functional capacity as a key component for the prevention of long-term cardiac or non-cardiac complications.

MHealth learning strategies to support behaviour change in individuals using wheelchairs and/or scooters: a systematic review.

The purpose of this systematic review of the literature is to build understanding of the key elements and recommendations for the design of mHealth technology for individuals using wheelchairs and/or scooters and identify key features associated with the use of mHealth to support healthy behaviour changes for this population. Eight major electronic databases were systematically searched to identify mobile health (mHealth) interventions, which targeted adult WC/S users. Independent reviewers used Endnote and Covidence to manage articles meeting review criteria and to exclude duplicates. A quality assessment was conducted on each included article. Nine articles describing studies with diverse study designs met criteria to be included in this review. Several interactive application intervention features, such as participant collaboration and goal setting, and key technical features to support mHealth app development and utilisation were identified. Results found intuitive and simple designs of mHealth apps, with the ability to customise to support learning styles and preferences, support usability and acceptability by participants. More research is needed to evaluate best practices to support initial training of end-users, mHealth apps' ability to support long-term behaviour change and maintenance, and the understanding of active ingredients in complex interventions that include mHealth apps. Both interactive mHealth application intervention and technical features support healthy behaviour change among individuals using wheelchairs and scooters.

Relationship between eHealth Literacy and Health Promoting behaviors among nursing students

Background: Utilizing health literacy is important in establishing knowledgeable health advancements and practices, which can become deterrents to promoting a healthy lifestyle. Technological advancements improve health information availability and accessibility that potentially affect the users’ proficiency and their capability in applying the accessed health information. However, accessing health information via IT for health promotion requires e-health literacy. Purpose: The objective of the study is to determine the relationship between eHealth literacy and health-promoting lifestyle behaviors among nursing students. Methods: Descriptive-correlational study was applied to 131 nursing students recruited through a purposive sampling method from a nursing school in Philippines. The researchers adopted original English version of the e-Health Literacy Scale and Health-Promoting Lifestyle Profile II (HPLP) to collect the data. The gathered data were analyzed using descriptive analysis; frequency, percentage, mean, standard deviation, and test the correlation using Pearson's r correlation. Results: A total of 131 nursing students were employed in the study with a mean age of 20.14 (±1.22). Participants were female (71.8%) and are Level 1 students (44.3%) The mean of the total sum score for eHealth literacy was 31.24 (±4.30) while the over-all item mean was 3.92 (±0.54). On the other hand, the health-promoting behavior has a mean score of 2.43 (±0.43) while its subscales have a mean score of 2.46 (±0.45) for nutrition, 2.45 (±0.62) for physical activity, and 2.39 (±0.47) for health responsibility. It was found that eHealth literacy had a significant relationship with the students’ health-promoting behavior (r=0.245, p=0.005). Hence, students who have a high level of eHealth literacy are more inclined to perform healthy behaviors. Conclusion: The results of this study showed that the development of strategies to improve the e-health literacy of nursing students may contribute to the maintenance of their health-promoting behaviors. Identified intervention strategies based on eHealth literacy are needed to encourage healthy practices, which may reduce risks of illnesses due to unhealthy lifestyle behaviors among nursing students.

Nursing Care in Migrant People: An Approach from the Cultural Perspective

International migration is an issue of political, economic, and social relevance worldwide. Ensuring the right of international migrants to health protection is a challenge for countries of expulsion, transit, and destination. Nursing plays a vital role in ensuring that international migrants maintain a state of health that allows mobilization, through the prevention of diseases and accidents, the promotion of healthy behaviors, diagnosis and timely care of communicable and non-communicable diseases, so that the development of interventions in the areas of large migratory flows, helps to ensure safe migration from the approach of world health care.

Disease burden and symptom management in type 2 diabetic patients: A phenomenological study.

This study was conducted to address the experiences of diabetic patients from a psychosocial perspective, examine the burden of disease, and determine their practices for symptom management. In this study, a phenomenological research design, a qualitative research design, was used. The study included 20 diabetic patients. Individual and face-to-face interviews were performed, and Colaizzi's phenomenological analysis method was used to analyze the data. As a result of the data analysis, four categories (challenges with care and treatment, coping with the disease, effects, and healthy life behaviors) and eleven main themes (knowledge, application, symptoms, support resources, spiritual coping methods, physical coping methods, physical effects, spiritual effects, social effects, physical practices, and psychological practices) emerged. It was concluded that the disease burden of diabetic patients is intense and that the participants of the study were not effective in coping with the disease through symptom management and found spirituality important in coping.

Finances and Fights: How Military Members’ Financial Attitudes and Behaviors Are Linked to Romantic Relationship Processes and Outcomes

Grounded in the theory of planned behavior and family systems theory, this study examined the notion that financial attitudes are a driving force in financial management behaviors and healthy financial behaviors, in turn, have implications for couple relationship processes and outcomes. This study was based on the experiences of a sample of service members, who may be at elevated financial and relational risk given the transitional nature of military life (N= 255 U.S. service members). Evidence from a path model largely supported study hypotheses and suggested that financial attitudes were directly and indirectly associated with a range of relationship processes and outcomes via financial management behaviors. When service members reported positive attitudes toward financial management behaviors, they tended to engage in healthier financial behaviors, and healthier financial behaviors were related to salient relational factors, such as greater agreement on spending with partners, better relationship satisfaction, and greater relationship commitment.

Multispecies probiotic intake during pregnancy modulates neurodevelopmental trajectories of offspring: Aiming towards precision microbial intervention

Recent research highlights the pivotal role of the maternal gut microbiome during pregnancy in shaping offspring neurodevelopment. In this study, we investigated the impact of maternal intake of a multispecies probiotic formulation during a critical prenatal window (from gestational day 6 until birth) on neurodevelopmental trajectories in mice. Our findings demonstrate significant and persistent benefits in emotional behavior, gut microbiota composition, and expression of tight junction-related genes, particularly in male offspring, who exhibited heightened sensitivity to the probiotic intervention compared to females. Additionally, we observed elevated gene expression levels of the anti-inflammatory cytokine IL-10 and the oxytocin receptor (Oxtr) in the prefrontal cortex (PFC) of exposed juvenile offspring; however, these changes persisted only in the adult male offspring. Furthermore, the sustained increase in the expression of the proton-coupled oligopeptide transporter 1 (PepT1), which is involved in the transport of bacterial peptidoglycan motifs, in the PFC of exposed male offspring suggests a potential mechanistic pathway underlying the observed sex-dependent effects on behavior and gene expression. These results underscore the potential of prenatal multispecies probiotic interventions to promote long-term neurodevelopmental outcomes, with implications for precision microbial reconstitution aimed at promoting healthy neurodevelopment and behavior.

Association of dietary behavior patterns of middle-aged and older adults with their obesity metabolic phenotype: a cross-sectional study

BackgroundMiddle-aged and elderly individuals are the most susceptible groups for metabolic diseases, with their dietary behaviors being significant influencing factors. Exploring the association between overall dietary behaviors and obesity metabolic phenotypes is crucial for early prevention and control of chronic diseases, precision treatment and personalized interventions.MethodsWe conducted a cross-sectional study of 15,160 middle-aged and older adults between June 2019 and August 2021 to collect information on their body mass index (BMI), biochemical indices and disease history. The population was classified into four categories by the criteria of obesity metabolic phenotypes: metabolically healthy non-obesity (MHNO), metabolically unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). Scores were calculated based on compliance with healthy eating behavior patterns (appropriate or light dietary taste, moderately soft and hard food, slightly hot food temperature, medium or slow eating speed, daily intake of dietary supplements and eating with others), and the population was categorized into subgroups 0–2 (did not meet and met only 1 or 2), 3–4 (met 3 or 4), 5–6 (met 5 or 6). The relationship between dietary behavior patterns and different obesity metabolic phenotypes in middle-aged and elderly people were analyzed by multi-categorical logistic regression model.ResultsCompared with the 5–6 subgroup, the dietary behavior patterns of 0–2 and 3–4 scores were risk factors for MUNO, MHO and MUO (P < 0.05), and the lower the scores of the dietary behavior patterns, the higher the multiplicity of the occurrence of MUNO, MHO and MUO, especially for females and adults between 45–60 years old. Appropriate or light dietary taste, moderately soft and hard food, and slightly hot food temperature were protective factors for MUNO and MUO (P < 0.05); medium or slow eating speed and daily intake of dietary supplements were protective factors for MUNO, MHO and MUO (P < 0.05).ConclusionDietary behavior patterns in middle-aged and older adults are associated with different obesity metabolic phenotypes, and healthy dietary behaviors may be beneficial for the prevention and control of MUNO, MHO and MUO.

The role of health education in improving student health in Indonesian schools

Health plays an important role in supporting educational success, with healthy students tending to have better concentration, endurance and motivation to learn. To achieve this, schools implement health education programmes aimed at improving students' knowledge, attitudes and skills in maintaining and improving their health. The programme includes formal and informal activities integrated in the curriculum, extracurricular initiatives and school health projects. Effective health education holds the potential to address these issues. While existing research has shown that health education can improve students' knowledge, attitudes, and skills related to health, direct evidence of its effect on students' health remains limited. The implications of health education are profound, including improved health knowledge, positive attitudes toward health, and the development of vital health maintenance skills. Additionally, it fosters a healthy learning environment, which is conducive to improved academic outcomes. Future interventions may involve the development of tailored materials, the integration of technology, and collaborative endeavors across multiple stakeholders. In conclusion, health education is a potent tool for enhancing student well-being and, consequently, educational success. By addressing health challenges and promoting healthy behaviors, health education contributes significantly to creating a brighter and healthier future for students in Indonesia and beyond.

Discordance Between Mealtimes Reported by Trial Participants with Type 2 Diabetes and Healthcare Professionals.

Healthy lifestyle behaviors are essential in the treatment of type 2 diabetes, and meal registration is therefore important. Manual meal registration is cumbersome and could be automated using continuous glucose monitoring (CGM). If such an algorithm is based on patient-reported meals, potential errors might be induced. Thus, the aim was to investigate potential errors in patient-reported mealtimes and the effect on automatic meal detection. Two healthcare professionals (HCPs) reported the mealtimes of the 18 included patients based on the patients' CGM data to assess the agreement between HCP- and patient-reported mealtimes. A developed meal detection algorithm based on detecting the post-prandial glucose response using cross-correlation was used to assess the impact of errors in patient-reported meals. The results showed poor disagreement between HCP- and patient-reported meals and that the meal detection algorithm had a moderately better performance on the HCP-reported meals. Therefore, the possibility of errors in patient-reported mealtimes should be considered in the development of meal detection algorithms. However, more research is needed to confirm the results of this study.

Development, validity and reliability of the healthy lifestyle behavior scale

BackgroundHealthy lifestyle behaviors encompass activities aimed at promoting, maintaining, or reclaiming health. Evaluating these behaviors accurately requires comprehensive, valid, and reliable tools.AimsThis study aimed to develop the Healthy Lifestyle Behavior Scale and evaluate its psychometric properties in the Turkish population.MethodsFor this methodological research, a cross-sectional online-based survey was conducted between 21 March 2023 and 31 March 2023 among 330 participants who were recruited via convenience sampling. The initial item pool included 90 items across seven domains (exercise, health responsibility, preventive health actions, sleep, stress and social support, nutrition, smoking, and alcohol). The content validity of the scale was verified by taking expert opinions. Construct validity and reliability were assessed using principal component analysis (PCA) and Cronbach's alpha.ResultsA total of 330 people were recruited for the study (65.2% female, mean age 34.2 ± 9.4 years). The final scale comprised 34 items: 5 on exercise, 4 on health responsibility, 4 on preventive health actions, 2 on sleep, 5 on social support, 3 on stress management, 5 on nutrition, 4 on smoking and 2 on alcohol. The construct validity analysis revealed a 9-factor structure explaining 62.35% of the variance (Kaiser–Meyer–Olkin value = 0.807). Internal consistency was confirmed with Cronbach's alpha (α = 0.863 for the scale, > 0.7 for subscales) and high item-total correlation.ConclusionsOur newly developed Healthy Lifestyle Behavior Scale demonstrated good validity and reliability. It outperformed existing scales, boasting higher alpha values for subfactors and explained variance. This scale is a robust tool for assessing healthy lifestyle behaviors in adults.

Behavioural Factors Influencing Consumer Acceptance of Sustainable Healthy Food: A Review and Research Agenda

ABSTRACTHuman and planetary health goals have coalesced within consumer food choices. Food‐based dietary guidelines provide expert recommendations on what to eat, however, adherence is low and few include sustainability recommendations. This systematic review sought to extract consumer behavioural findings specifically related to ‘healthy sustainable diets’ to gain insights into the levers of food‐related behavioural change. Data analysed from 57 studies reveal that while 27 discrete behavioural theories underpinned conceptualisation of research, just three dominate this literature: Theory of Planned Behaviour, Transtheoretical Model and Social Practice Theory. Correspondingly, studies were mainly concerned with motivation, attitudes, intentions and practices. Promising research directions are emerging from investigations into the roles of emotions, meat attachment and types of knowledge. Those sustainable healthy food behaviours (SuHeFB) most investigated were meat consumption reduction, plant‐based food consumption, and alternative‐to‐animal protein food product acceptance. In addressing the perplexity surrounding consumer inertia in altering dietary habits, this review provides a comprehensive SuHeFB construct typology and a justification for directing research attention towards the phenomenon of amotivation. In addition, 31 future research questions are posited under six related SuHeFB themes.

Acceptance and commitment coaching for music performance anxiety in adolescent singers.

Most of the anxiety disorders, particularly social anxiety, seem to develop either during childhood or adolescence. Adolescent singers who experience physical, mental and emotional changes along with voice change are particularly prone to the development of MPA. However, adolescence also seems to be an opportune time to instil healthy behaviours in singing students as they are more likely to remember these coping strategies, owing to the release of dopamine and the 'reminiscence bump'. As this period of a singer's life is wrought with inevitable anxiety development, the additional aim of the study was to develop a coaching framework which can be used by singing teachers in their practice. Mindset training for adolescents seems crucial to help them continue singing through puberty so they do not drop out of singing lessons or choir during voice change and identity development. The study aimed to determine if Acceptance and Commitment coaching could be used with adolescent singers with MPA and to record and analyse rich qualitative data in the form of semi-structured participant interviews and questionnaires. When their perception of MPA symptoms and physiological and psychological arousal before a performance changed, their behaviour and reactions changed accordingly. The change took place over a period of time, which was characterised by discoveries about themselves, confusion in understanding new concepts and letting go of old habits. Interestingly, by the end of the coaching sessions, their preoccupation with pleasing the audience and appearing perfect on stage was replaced by a new-found delight in pursuing values and goals related to their singing. Along with this came the acceptance of themselves and others as individuals with the potential for growth and change and the capacity to learn from mistakes. This study marks the first investigation into the effectiveness of using of ACC as an intervention for MPA in adolescent singers undergoing puberty by a singing teacher. The results are promising and suggest that ACC is an effective MPA intervention for adolescent singers to cope with inevitable development-related anxieties and keep them engaged in the activity of singing during their pubertal years.

Nutrition and physical activity practices in family day care: A cross-sectional survey of Australian family day care educators.

Munch & Move is a New South Wales (NSW) Ministry of Health program offering family day care (FDC) educators training to support children's healthy behaviours. This study examined educators' nutrition, physical activity and screen time practices and relationships between Munch & Move training and professional development (PD) on these practices. NSW FDC educators (n = 186) completed an online survey from July 2020-June 2021. Differences between groups based on Munch & Move training (trained; not trained) and PD (those who completed PD ≥1 time per year; those who completed PD <1 time per year or never) were tested using bivariate analyses. A significantly higher proportion of educators trained in Munch & Move offered information to families regarding food serving sizes, nutrition policies, and children's physical activity and screen time. Over one-third in both groups did not meet the guideline of no screen time for children under 2 years old. Compared with those who completed PD ≥1 time per year, a significantly higher proportion of educators who completed PD <1 time per year or never did not provide families with nutrition guidelines or resources. Educators trained in Munch & Move, and those who completed PD more frequently, demonstrated better nutrition, physical activity and screen time practices in several areas. SO WHAT?: This study demonstrated benefits of the Munch & Move program, implemented with support from Local Health District health promotion officers, and highlighted key areas for improvement in healthy practices in FDC.

Perceived barriers and criteria for referral to pulmonary rehabilitation used in primary health care by general practitioners

Introduction: Chronic obstructive pulmonary disease encompasses both pharmacological and non-pharmacological components. The most cost-effective non-pharmacological component is pulmonary rehabilitation, an individualised, comprehensive intervention, including exercise training, education, and behavior change, to improve the physical and psychological condition and promote adherence to long-term healthy behaviors. The aim was to understand the habits and barriers perceived by Portuguese general practitioners when referring people with chronic obstructive pulmonary disease to pulmonary rehabilitation and the criteria valued in decision-making. Methodology: We conducted a cross-sectional study to assess general practitioners' knowledge, referral practices, and perceived barriers regarding pulmonary rehabilitation using an online questionnaire. The questionnaire evaluated knowledge of PR benefits, referral criteria, and existing barriers. Results: Sixty-one responses were obtained, of which 31.1% (n=19) never referred to PR. Of those who were referred, the most used criterion for referral, 78.5% (n=33), was functional limitation. This criterion was considered extremely important for referral by 64% (n=39) of the participants in this study. Discussion: To increase referrals to pulmonary rehabilitation, doctors must raise awareness of the advantages of these programmes. Publicising existing programmes is essential to ensure that general practitioners know these responses. Information from the assessment of the impact of pulmonary rehabilitation programmes on a person's condition should be shared. Conclusion: Insufficient available PR programmes, Lack of patient adherence and feedback of programme outcomes and lack of knowledge of referencing criteria are the most perceived barriers by general practitioners to referring patients to pulmonary rehabilitation programmes.

Hispanic and non-Hispanic parents’ health behaviour predicts preschool children’s behaviour in low-income communities in the United States

Objective: Despite public health efforts, most children in the United States do not meet nutrition and physical activity guidelines. Moreover, there are nutrition-related health disparities between non-Hispanic and Hispanic communities. Caregivers are critical role models that shape health behaviours in children. To promote healthy behaviours, health promotion interventions must consider the entire family unit. This study aimed to assess the impact of parent’s health behaviours on children’s health behaviours in a sample of non-Hispanic and Hispanic low-income parents. Design: A mixed-methods design was used to identify how parent health behaviours including fruit and vegetable intake, beverage intake, physical activity, and screen time influence corresponding child health behaviours. In addition, the study aimed to investigate whether the strength of association between parent and child health behaviours varied as a function of ethnicity. Survey data and semi-structured qualitative interviews were utilised for the analyses. Setting: The study was a part of the Culture of Wellness in Preschools Programme, a multi-level obesity prevention programme. The data were obtained from the parent wellness workshops, a direct education intervention aimed at increasing fruit and vegetable consumption and physical activity among parents and their children. Data Analysis: The quantitative analyses utilised survey data from the Family Wellness pre-survey. Hierarchical linear regression models assessed the relationship between parent–child-health behaviours. Interaction terms were created to understand if this relationship varied as a function of ethnicity. Data from qualitative interviews were analysed using thematic analysis to gain an in-depth understanding of the relationship between parent and child health behaviours. Results: Parent health behaviours significantly predicted child health behaviours across all models, and these relationships did not vary as a function of ethnicity. The quantitative data were supported by the qualitative analysis: parents modelled health behaviours and thus influenced their child’s health behaviour through a variety of mechanisms. Conclusion: Future efforts to promote a healthy lifestyle in children should engage with both family practices and the wider social context.