Influence Health Behaviors Research Articles

Abstract P1-08-11: Using co-design to develop culturally and linguistically appropriate breast cancer education materials

Abstract Background: Engaging diverse community members in research is vital to communicate and disseminate information to their communities. Co-design is a participatory approach to design solutions to problems and can be used to develop materials by bringing together individuals from diverse backgrounds. There is currently a gap in research of health education materials (i.e., Infographics) being created that employ a community co-design approach. We describe use of the co-design process to develop an infographic on breast cancer risk factors for broad community dissemination. Methods: The Community Leadership Committee (CLC) that represents the demographics of the Greater Los Angeles area was formed in 2015 and members were drawn from community and advocacy organizations, representing the four largest racial/ethnic groups (African American, Chinese, Latina, and Non-Hispanic White). The primary role of the CLC was to help create teachable, culturally-responsive materials on breast cancer and the environment. To address their communities’ informational needs about breast cancer and the environment, the CLC determined elected to develop infographics. Focus groups were held in summer of 2017 to evaluate the initial drafts of the infographics for clarity, utility, cultural and linguistic appropriateness and effectiveness. Focus group participants were recruited by the CLC members to and were conducted in English, Spanish, or Mandarin Chinese. Results: CLC members (N=18) informed the design and development of the infographic. Members of the CLC member ages ranged from 49 to 79. All members were female, 42%% were foreign-born, 34%% spoke Spanish, 20% spoke Chinese, and 75% were breast cancer survivors. A total of 6 focus groups were conducted with 53 women. The groups consisted of 4 groups in the English language [African American (N=12), non-Hispanic White (N=7), Chinese (N=9), and Hispanic/Latina (6)], one in Spanish (N=7), and Mandarin Chinese (N=12). The infographic went through 6 versions before being finalized, translated into Spanish and Chinese, and printed. Focus groups occurred between initial draft and draft #3. Some of the common themes included the importance of representation, readability, and visualization. CLC members preferred materials that included less text and more graphics to make it faster and easier to read. Collaboration with the CLC and findings from the focus groups led to the development and refinement of the final infographics Discussion: We have described the development of health education materials through a co-design process to increase the awareness of breast cancer risk. These findings emphasize the importance of involving people with lived experience and end users. Co-design is vital to ensuring the health education materials were appropriate, engaging, culturally and linguistically competent. Health education materials that resonate with their intended audience have the potential to influence health behaviors resulting in risk reduction. Citation Format: Michele Rakoff, Mayra Serrano, Susan Neuhausen. Using co-design to develop culturally and linguistically appropriate breast cancer education materials [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-11.

Factors affecting self-care among community-dwelling hypertensive older adults: A cross-sectional study.

To examine self-care behaviours among older adults with hypertension and identify related factors, including cognitive function, religious belief and comorbidities. A cross-sectional study. Self-care behaviours included diet and health. Participants completed a survey including items on demographics, disease-related characteristics and self-care behaviours and underwent cognitive function tests. Data were analysed using descriptive statistics, and multiple regression analysis was performed to analyse the factors affecting self-care. Regarding diet behaviour, older religious adults and those with higher scores on the Montreal Cognitive Assessment-Korean version had higher levels of self-care scores according to the HBP-SC. Regarding health behaviour, older adults with no comorbidities had higher levels of self-care scores according to the HBP-SC. Factors affecting self-care diet behaviour include religion and Montreal Cognitive Assessment-Korean version scores and those affecting health behaviour include comorbidities among older adults with hypertension. Therefore, to improve their self-care behaviours, their religious practices and comorbidities should be considered, cognitive function should be assessed, and tailored education should be provided. This study investigated factors affecting self-care behaviours of hypertensive older adults in South Korea. The self-care was divided into diet and health behaviours. The factors influencing diet behaviour were religion and Montreal Cognitive Assessment-Korean version scores, and the factor influencing health behaviour was comorbidities. We also investigated self-care behaviour patterns. Older adults with hypertension were good at controlling alcohol consumption and did not forget to fill prescriptions. However, they were poor at reading nutrition labels to check on sodium content and checking blood pressure at home. Therefore, nurses could develop interventions considering these influencing factors and behavioural patterns to improve self-care behaviours and enhance health for older adults with hypertension. Hypertension in older adults affects their health conditions and performance of self-care behaviours. Nurses could assess self-care based on diet and health behaviours. Additionally, further developing tailored programmes is recommended considering factors like religious belief, cognitive function and comorbidities. This study followed the STROBE guidelines. This study used a convenience sample of 105 participants aged≥ 65 years recruited from a Korean hospital.

Threat Appraisal, Resilience, and Health Behaviors in Recovered COVID-19 Patients: The Serial Mediation of Coping and Meaning-Making.

Research indicates that both cognitive appraisal and personal resources can noticeably influence health behaviors, as individuals modify their health convictions and practices on the basis of threat appraisal, personality, and meaning. The aim of the current study was to investigate whether coping strategies and meaning-making can serially mediate the relationship of threat appraisal and resilience with health behaviors in recovered COVID-19 patients. Self-report measures of threat appraisal, resilience, coping, meaning-making, and health behaviors were completed by 266 participants (aged 17 to 78, 51.5% female) who had recovered from COVID-19. The serial mediation analysis showed that the relationship of threat appraisal and resilience with health behaviors was mediated by problem-focused coping, meaning-focused coping, and meaning-making, but not by emotion-focused coping. These results suggest that associations among threat perception, resilience, and health behavior depend to some extent on the interplay of coping and meaning-making, which reveals their unique role in the process of recovery from COVID-19, with potential implications for health interventions.

Generational differences in the relationship between media exposure and health behaviors during COVID-19 pandemic.

Based on a questionnaire survey (N = 857), this study analyzed generational differences in the public health behaviors of COVID-19 and provided an explanation for generational differences from the perspective of media exposure. There are significant differences in media exposure and health behaviors between the Mesozoic generation (35-55) and the young generation (18-34) during the lull. The Mesozoic generation paid greater attention to information on pandemics. Consequently, their health behaviors surpass that of the young generation. On the basis of social cognitive theory and protection motivation theory, this study develops a mediating model of media exposure on health behaviors, demonstrating that media exposure can influence health behaviors through the mediating effects of perceived severity, self-efficacy, and response efficacy, but not via perceived susceptibility. Moreover, a moderated mediation study found that generation moderates the indirect effect of media exposure on health behaviors via perceived susceptibility. Media exposure influences Mesozoic healthy behaviors positively by decreasing their perceived susceptibility. The implication of this study is that the development of health communication theory must account for generational differences and disease-specific characteristics.

Relationships Between Health Behaviors, Social Determinants of Health, and Patient Demographics in an Urban Northwest Indiana Hospital

Background: Social determinants of health (SDOH) contribute to over 50% of health outcomes and inequities. Healthcare institutions are increasingly implementing SDOH screenings and referrals. St. Mary Medical Center (SMMC) in Northwest Indiana was the first acute care hospital to implement a comprehensive SDOH pilot screening and referral program in Indiana using the validated Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE). This study is part of a three-phased Community-Based Participatory Research (CBPR) partnership between IUSM-NW and SMMC to examine and address SDOH within SMMC’s service area from January 2022-January 2025. This study’s research question is: What are the relationships between SDOH, behavioral, and demographic factors in SMMC’s inpatients?Methods: This descriptive study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral (tobacco use, alcohol use, physical activity), and health outcomes data for adult inpatient visits from January 2021 to June 2022. Data analysis was conducted in SPSS 28.0 using descriptive statistics (i.e., frequencies and central tendency) and tests of association including Chi-square, Fisher’s Exact, Wilcoxon-Mann Whitney, and Kruskal Wallis H (p<0.05). This study was exempted by Indiana University Human Research Protection Program (IRB # 14040).Results: This study included 4370 inpatients, who were predominantly White (75.7%), older adults (65 ± 24), and publicly insured (76.3%). There were significant relationships between SDOH and tobacco use, alcohol use, and physical activity. Tobacco use was significantly associated with the majority of SDOH including insurance type (p<.001), housing risk (p<.001), financial resource risk (p<.001), unmet transportation needs (p<.001), and overall social risk (p=.012).Conclusions: Understanding how SDOH influence health behaviors will inform efforts to develop, implement, and evaluate multi-level interventions. The next phases of this CBPR will use advanced statistical techniques to further explore these relationships, evaluate SMMC’s pilot program, and co-develop SDOH interventions.

Abstract B015: Using co-design to develop culturally and linguistically appropriate breast cancer education materials

Abstract Background: Engaging diverse community members in research is vital to communicate and disseminate information to their communities. Co-design is a participatory approach to design solutions to problems and can be used to develop materials by bringing together individuals from diverse backgrounds. There is currently a gap in research of health education materials (i.e., Infographics) being created that employ a community co-design approach. We describe use of the co-design process to develop an infographic on breast cancer risk factors for broad community dissemination. Methods: The Community Leadership Committee (CLC) that represents the demographics of the Greater Los Angeles area was formed in 2015 and members were drawn from community and advocacy organizations, representing the four largest racial/ethnic groups (African American, Chinese, Latina, and Non-Hispanic White). The primary role of the CLC was to help create teachable, culturally-responsive materials on breast cancer and the environment. To address their communities’ informational needs about breast cancer and the environment, the CLC determined elected to develop infographics. Focus groups were held in summer of 2017 to evaluate the initial drafts of the infographics for clarity, utility, cultural and linguistic appropriateness and effectiveness. Focus group participants were recruited by the CLC members to and were conducted in English, Spanish, or Mandarin Chinese. Results: CLC members (N=18) informed the design and development of the infographic. Members of the CLC member ages ranged from 49 to 79. All members were female, 42%% were foreign-born, 34%% spoke Spanish, 20% spoke Chinese, and 75% were breast cancer survivors. A total of 6 focus groups were conducted with 53 women. The groups consisted of 4 groups in the English language [African American (N=12), non-Hispanic White (N=7), Chinese (N=9), and Hispanic/Latina (6)], one in Spanish (N=7), and Mandarin Chinese (N=12). The infographic went through 6 versions before being finalized, translated into Spanish and Chinese, and printed. Focus groups occurred between initial draft and draft #3. Some of the common themes included the importance of representation, readability, and visualization. CLC members preferred materials that included less text and more graphics to make it faster and easier to read. Collaboration with the CLC and findings from the focus groups led to the development and refinement of the final infographics Discussion: We have described the development of health education materials through a co-design process to increase the awareness of breast cancer risk. These findings emphasize the importance of involving people with lived experience and end users. Co-design is vital to ensuring the health education materials were appropriate, engaging, culturally and linguistically competent. Health education materials that resonate with their intended audience have the potential to influence health behaviors resulting in risk reduction. Citation Format: Mayra Serrano, Marisela Garcia, Katty Nerio, Shirley Brown, Florence Lin, Alice Loh, Ghecemt Lopez, Patricia D. Tucker, Kimlin T. Ashing, Leslie Bernstein, Shiuan Chen, Michele Rakoff, Susan Neuhausen. Using co-design to develop culturally and linguistically appropriate breast cancer education materials [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B015.

A process to foster pathology-related effects of design primes - how orthopedic patients might benefit from design features that influence health behaviour intention.

A growing body of literature mainly in the context of consumer research indicates that the formal-aesthetic and conceptual design of objects can influence users' thoughts, emotions and even behavioural patterns. While there is strong evidence regarding these effects on actual purchasing decisions, evidence on the effect of aesthetic design features (e.g., haptics, colour) on health-related mental concepts and intentions for health behaviour change is scarce. Based on insights from material and conceptual priming, this article illustrates the research-driven and evidence-based design process of two design primes and comprises pre-tests and an experiment in two settings on the effect of design on health behaviour focusing i.a. on intention for health behaviour change. In an evidence-based and research-driven process, two lecterns were designed to work as primes, i.e., to have a positive vs. negative influence on several mental constructs (sense of control, sense of coherence, resiliency, self-efficacy) and health-related intention. The lecterns differed mainly in terms of aesthetic appearance (e.g., material, colour, proportion, steadiness). They were tested in (a.) a university setting with students (n = 83) and (b.) a clinical setting with orthopaedic rehabilitation patients (n = 38). Participants were asked to perform an unrelated task (evaluation of an unrelated product) while standing at and using the lecterns. Overall, t-tests and Mann-Whitney-U tests show no significant differences but differing tendencies in a mentioning task. When asked to name health-promoting activities, in the clinical setting, participants using the "positive" prime (i.e., the steady lectern, n = 13) mentioned more sport-related aspects on average and a higher portion of sport-related aspects of their answers than participants using the "negative" prime (n = 11). In the university setting (positive: n = 36; negative n = 38), no such differences emerged. This finding gives reason to believe that the prime might be specifically effective in the clinical setting as it relates to physical activity being the most relevant topic of the patients' pathology.

Factors Affecting Fatigue in Patients with Rheumatoid Arthritis

Background: Despite the fact that disease activity, including blood inflammation level, has been lowered with the recent improvement in rheumatoid arthritis treatment, the number of patients appealing of symptoms, such as fatigue, is maintained at a certain level. Fatigue is the most common subjective symptom of patients with rheumatoid arthritis and a major factor influencing health behavior and quality of life. Therefore, this study aimed to identify the factors affecting fatigue to prepare basic data for the development of interventions to improve the quality of life of participants with rheumatoid arthritis.Methods: Cross-sectional data collected using structured questionnaires and medical record reviews were analyzed for 246 rheumatoid arthritis outpatients from a university-affiliated hospital.Results: Level of fatigue was an average of 4.4 out of 10, and 56.5% was evaluated as a remission level based on the disease activity score 28 (DAS28). Factors significantly affecting fatigue were pain and learned helplessness. Higher levels of pain and learned helplessness were associated with higher levels of fatigue.Conversely, there was no statistically significant difference in the fatigue levels of the participants according to the DAS28, objective disease activity index.Conclusions: To reduce the fatigue levels of the participants with rheumatoid arthritis, learned helplessness, including pain control, should be lowered. The participant’s attitude towards the disease should be evaluated and the participants should be actively supported to obtain hope for remission, if clinically encountered with participants.

The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go?

In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go?

"I see salt everywhere": A qualitative examination of the utility of arts-based participatory workshops to study noncommunicable diseases in Tanzania and Malawi.

The burden of noncommunicable diseases (NCDs) including hypertension, diabetes, and cancer, is rising in Sub-Saharan African countries like Tanzania and Malawi. This increase reflects complex interactions between diverse social, environmental, biological, and political factors. To intervene successfully, new approaches are therefore needed to understand how local knowledges and attitudes towards common NCDs influence health behaviours. This study compares the utility of using a novel arts-based participatory method and more traditional focus groups to generate new understandings of local knowledges, attitudes, and behaviours towards NCDs and their risk factors. Single-gender arts-based participatory workshops and focus group discussions were conducted with local communities in Tanzania and Malawi. Thematic analysis compared workshop and focus group transcripts for depth of content and researcher-participant hierarchies. In addition, semiotic analysis examined the contribution of photographs of workshop activities to understanding participants' experiences and beliefs about NCD risk factors. The arts-based participatory workshops produced in-depth, vivid, emotive narratives of participants' beliefs about NCDs and their impact (e.g., "… it spreads all over your body and kills you-snake's poison is similar to diabetes poison"), while the focus groups provided more basic accounts (e.g., "diabetes is a fast killer"). The workshops also empowered participants to navigate activities with autonomy, revealing their almost overwhelmingly negative beliefs about NCDs. However, enabling participants to direct the focus of workshop activities led to challenges, including the perpetuation of stigma (e.g., comparing smells associated with diabetes symptoms with sewage). Semiotic analysis of workshop photographs provided little additional insight beyond that gained from the transcripts. Arts-based participatory workshops are promising as a novel method to inform development of culturally relevant approaches to NCD prevention in Tanzania and Malawi. Future research should incorporate more structured opportunities for participant reflection during the workshops to minimise harm from any emerging stigma.

Effects of neighborhood features on healthy aging in place: the composition and context of urban parks and traditional local coffeeshops in Singapore

BackgroundHealthy aging in place is affected by what the neighborhood provides for older adults. The mixed-methods ethnographic study explored the built environmental and contextual effects of urban parks and traditional local coffeeshops (kopitiam) on health practices among older adults in Singapore.MethodsA door-to-door survey with 497 older adults from 32 residential blocks in a public housing town assessed exercise and smoking. The walking distances from the residential blocks to the facilities were calculated. Regression analysis examined the associations between the distance and rates of exercise and smoking. Ethnographic assessment data contextualized the quantitative findings.ResultsOlder adults’ exercise was associated with proximity to an urban park but not traditional local coffeeshops. High rates of smoking were clustered in the housing blocks close to the coffeeshops, which provided casual drinking places with smoking tables. The proximity to the coffeeshops was significantly associated with increased smoking and decreased exercise. A walking distance of 200 m to the park and coffeeshops was found to discriminate the outcomes.ConclusionsThe findings suggested that walking distances of a few blocks influenced health behaviors among older adults. Their smoking habits appeared to be maintained through environmental features and cultural norms attached to the coffeeshops. Policy of urban planning and redevelopment for the aging population needs to consider the socioecology of healthy aging in place.

Meaning in life and health behavior habits during the COVID-19 pandemic: Mediating role of health values and moderating role of conscientiousness.

An increasing number of studies have explored health behavior changes since the COVID-19 outbreak, however, the potential mechanism leading to the acquisition of COVID-19-related health behavior habits remains largely underexplored. The current study aimed to investigate how meaning in life contributed to the Chinese general public's acquisition of COVID-19-related health behavior habits, and whether health values would play a mediating role and conscientiousness would play a further moderating role in this relation. A total of 1024 Chinese participants (age range = 17-63 years; 67.29% females) were recruited by posting flyers on an open-access web forum. All participants voluntarily completed a series of online anonymous questionnaires assessing conscientiousness, meaning in life, health values and health behavior habits. Results showed that (1) the majority of the respondents reported the acquisition of COVID-19-related health behavior habits, and meaning in life positively predicted COVID-19-related health behavior habits; (2) health values mediated the link between meaning in life and health behavior habits; and (3) conscientiousness moderated the indirect effect, such that the indirect effect was stronger among individuals with low conscientiousness. These findings have important implications for revealing the reconstruction of the Chinese public's health behavior habits and its potential mechanism that meaning in life influences health behavior habits through health values during the COVID-19 pandemic, particularly for individuals with low conscientiousness.

The Impact of COVID-19 on Maintaining Physical Activity and Its Associated Factors among Medical Students.

Stay-home orders and the shutdown of university campuses and fitness centers have greatly influenced health behaviors, resulting in a widespread reduction in physical activity. This study aimed to identify factors associated with maintaining physical activity among Jazan University medical students during the COVID-19 shutdown. An official Arabic short form of the International Physical Activity Questionnaire was used to assess physical activity before and during the COVID-19 home quarantine. Differences between groups were examined using chi-square analyses and the Mann-Whitney U test. Multinomial logistic regression was used to test whether certain demographic and exercise-related variables were significant predictors of maintaining physical activity levels during the COVID-19 pandemic. More than half of the participants (53%) reported no change or increased physical activity level. Several factors were significantly related to physical activity heterogeneity including income (p = 0.04), fitness center membership (p < 0.01), usage of fitness tracker devices (p < 0.01), and the purchase of physical activity equipment during the COVID-19 pandemic (p < 0.01). The odds of maintaining physical activity were higher among those who tracked their physical activity (AOR = 6.160; 95% CI = 3.782-10.032, p < 0.001). Similarly, the odds of maintaining physical activity were higher among those who purchased home-exercise equipment during the pandemic (AOR = 2.243; 95% CI = 1.386-3.632, p = 0.001). Understanding the factors affecting physical activity behaviors is an essential step toward addressing the reduction in physical activity. This could help maintain physical activity levels during a potential future pandemic-related shutdown.

Knowledge and Perception of Risk in Pregnancy and Childbirth among Women in Low-Income Communities in Accra

Perception and knowledge of risk factors for pregnancy influence health behaviors during pregnancy and childbirth. We used a descriptive qualitative study to examine the perception and knowledge of risk factors in pregnancy and childbirth in low-income urban women in Ghana. Over the course of three-months, 12 focus group discussions and six individual interviews were conducted with 90 participants selected from six communities in the study area. Data were analyzed using inductive-thematic content analysis. Findings revealed that participants had knowledge of some risk factors, although some had superstitious beliefs. Participants viewed pregnancy as an exciting and unique experience, but also challenging, with a host of medical and psychological risks. Pre-existing medical conditions (e.g., diabetes), lack of physical activity, poverty, poor nutrition, and lack of social support were identified as conditions that could lead to negative pregnancy outcomes. Superstitious beliefs such as exposure to “evil eye” during pregnancy, as well as curses and spells, were also identified as risk factors for pregnancy complications. This research has implications for policies and programs to improve pregnancy outcomes for low-income women in Ghana. Thus, we recommend social and economic support programs as well as health education to change misperceptions about pregnancy risk and to support other efforts being made to improve maternal health outcomes.

The Role of Family Social Networks in Cardiovascular Health Behaviors Among Asian Americans, Native Hawaiians, and Pacific Islanders.

Asian American, Native Hawaiians, and Other Pacific Islander (AANHPI) populations experience significant disparities in cardiovascular health. AANHPI populations also have strong, family-centered social relationships and networks. Since social networks may influence health behaviors, this review aimed to summarize research on the relationship between family social networks and cardiovascular health behaviors among AANHPI individuals. Current evidence suggests that family social network structures may play a particularly important role in smoking, dietary pattern, and physical activity behaviors among AANHPI individuals. Family networks may hinder or promote healthy behaviors through several social network mechanisms including social support, social influence, and social control. These effects vary across different AANHPI subgroups. Recommendations for future research on the role of social networks in health behaviors among AANHPI individuals are provided. Drawing on methodological advances and interventions that leverage social networks in AANHPI populations may be an avenue to improve health and reduce disparities.

A 10+10+30 radio campaign is associated with increased infant vaccination and decreased morbidity in Jimma Zone, Ethiopia: A prospective, quasi-experimental trial.

Mass media interventions have the potential to reach large audiences and influence health behaviours and outcomes. To date, no study has evaluated the effect of a radio-only campaign on infant vaccination coverage, timeliness, and related morbidity in a low-income country. We implemented the "10+10+30" radio campaign involving broadcasting a weekly 10-minute radio drama series on vaccination, followed by a 10-minute discussion by community health workers, and then a 30-minute listener phone-in segment in Jimma Zone, Ethiopia for three months. To assess the impact of 10+10+30, which was aired on a community radio station, we recruited mothers of infants up to 5 weeks old in intervention district clusters that were inside the radio station's reception range (n = 328 dyads) and control district clusters that were outside of the range (n = 332 dyads). Intention-to-treat and per-protocol analyses, adjusted for pre-intervention differences between the districts, were conducted to examine the co-primary outcome of Penta-3 vaccination coverage and timeliness as well as those of other vaccines and outcomes related to infant morbidity. Both intention-to-treat and per-protocol analyses revealed higher vaccine coverage (p<0.001) and more timely vaccine administration (p<0.001) in the intervention district relative to the control district, with infants in the intervention district being 39% more likely to receive a Penta 3 vaccination (adjusted RR: 1.39, p<0.001). In addition, adjusted regression analyses of maternal retrospective reports over a two-week period revealed 80% less infant diarrhoea (RR: 0.20, p<0.001), 40% less fever (RR: 0.60, p<0.001) and 58% less cough (RR: 0.42, p<0.001) in the intervention district relative to the control district. This study provides compelling initial evidence that a radio drama integrated with discussion and phone-in components may improve infant vaccination coverage and timeliness, and may reduce infant morbidity. Randomized controlled trials are needed to confirm and extend these findings with other samples.

Factors Influencing Health Seeking Behaviour among Persons with Diabetes Attending Urban Health Care Settings.

Health seeking behaviour can influence outcomes in chronic diseases such as diabetes. As diabetes burden is higher in urban areas and under half receive adequate diabetes care and support in Nepal, this study aimed to assess factors influencing health behaviour among persons with diabetes attending urban health care settings. A cross-sectional study was conducted at two private healthcare settings with a pretested semi-structured questionnaire to assess health behaviour in particular with gender and regular diabetes follow-up. Bivariate analysis alongwith univariate and multivariate logistic regression was used to assess factors that influence HSB (P<0.05). Adjusted odds were reported within 95% confidence intervals. Among 385 PWDs (42.3% women) with a median diabetes duration of 7 years (IQR: 3 to 14 years), three fourths (75.1%, 95% CL: 70.5 to 79.1%) reported regular follow-up for diabetes care. After adjusting for confounders, the odds of regular follow-up were higher for those with a family history of diabetes (AOR: 1.82, 95% CI: 1.11 to 3.00) and non-smokers (AOR: 2.08, 95% CI: 1.34 to 3.61). The odds of follow-up were lower among the elderly (? 60 years) (AOR: 0.59, 95% CI: 0.35 to 0.97) and those with a family income below 35,000 Nepali rupees (AOR:0.39, 95% CI: 0.23 to 0.67). A plurality of health seeking behaviours such as regular follow-up care, taking glucose lowering medications and diabetes information seeking was observed among persons with diabetes attending private urban heath care settings during the COVID-19 pandemic period. Older age, family history of diabetes, non-smoking status and low family income were found to influence regular follow-up. In particular, psychosocial mechanisms that influence behavior among persons who smoke may need exploration.

Theories, models and strategies in developing an effective HIV/AIDS campaign in South Africa

There is no doubt that the impact of media messages and campaigns has helped toinform, sustain and shape attitudes on a health issue such as HIV/AIDS. They have beenheralded as the most important tools in raising awareness but little is known about howmuch impact they have had in changing people’s behaviour. The purpose of HIV/AIDShealth communication and campaigns is to educate by improving health, reducing therisks of HIV infections and promoting the well-being of individuals and communities.Most HIV/AIDS campaigns have been unsuccessful in achieving this goal because of poorconceptualisation and narrow strategic approaches. In fact, the media has been blamedfor perpetuating confusions around the disease. Another problem may be that mosthealth programme interventions have not been based on theories and models. Theoriesplay a pivotal role in planning and implementing campaign strategies. Theories andmodels can be used to help campaign developers understand the nature of the targetedbehaviour, suitable programmes for the targeted people, the methods that can be usedto accomplish change, and the outcomes for the evaluation. Media messages andcampaigns, if designed properly, can have a major impact on behavioural change. Inthis paper, I shall look at media messages and campaigns on HIV/AIDS, and address theapplication of health communication theories in influencing health behaviour. Finally,I shall look at how theories can be used to develop effective health campaigns targetingthe people of South Africa.

Ecological model of health behaviour of hypertensive stroke patients at the end of recovery period.

This study aimed to construct a structural equation model guided by the ecological model to explore the factors influencing health behaviour among hypertensive stroke patients 6 months post-stroke. Health behaviour is important for recurrence prevention in hypertensive stroke patients. Moreover, previous studies have indicated that health behaviour at the end of the recovery period is of particular concern. The ecological model provides an integrated perspective for explaining the factors influencing health behaviour. A cross-sectional study guided by the STROBE. A total of 121 hypertensive stroke patients were included to assess stroke knowledge, health belief, depression, family function, chronic illness resource and health behaviour. A structural equation model was used to explore the health behaviour's factors and pathways. In the final ecological model, sex, education level, depression and chronic illness resource directly affected health behaviour. Stroke knowledge directly affected health behaviour and indirectly affected health behaviour through health belief and chronic illness resource. Family function indirectly affected health behaviour through health belief, depression and chronic illness resource. Health belief affected health behaviour indirectly through depression and chronic illness resource. Hypertensive stroke patients' health behaviour is jointly and interactively influenced by stroke knowledge, health belief, depression, family function and chronic illness resource. In particular, chronic illness resource is an important mediator of health behaviour. For clinical practitioners, health behaviour of men and patients with low educational levels should be specifically focused on. Additionally, it is necessary to provide stroke knowledge, establish health beliefs, control depression emotion and improve family function. Furthermore, chronic illness resources should be improved particularly due to its important mediating role. Participants completed demographic and disease-related questionnaires during hospitalisation and completed other questionnaires when returning to hospital at 6 months follow-up.

6.O. Workshop: Urban design interventions for fostering mental health and mental health literacy

Abstract With roughly half of the global population living in cities and an expected rise up to 85 % by 2050, urban environments are central to public health. Yet, they are often perceived as health risk factors due to e.g., noise, pollution, crowding, and anonymity. Indeed, mental disorders show higher incidence in urban contexts compared to rural areas, generally increasing, e.g., due to the Covid19-pandemic as well as to climate change. However, we argue that there is also a rich potential of urban environments to act as resource for mental health and to address mental health issues in the public space. Design interventions such as urban furniture, art and information elements can act as perceived affordances, signifiers and situative stimuli to influence health behaviour, social discourse and individual mindsets regarding mental health. Furthermore, by considering their unique potentials and resources during the design process, the specific surroundings of these interventions can become an integral part of the actual design. As a result, this might change citizens’ perspective on the urban setting as such. While there exists a large body of literature as well as case studies focusing on physical health promotion by urban design interventions, evidence regarding its mental correlate is still scarce. This workshop aims at collecting and elaborating on features in the urban space as potential resources to foster mental health as well as mental health literacy. To that aim, first, three seven-minutes-presentations introduce different disciplinary perspectives on the topic: Starting from a psychological point of view, the relationship between urban environments and mental health will be outlined. Based on insights from human geography, social determinants of urban settings will be elaborated and participatory approaches will be presented as a crucial method for designing effective intervention. Synthesizing these insights, the role of design to influence health behaviour will be discussed and afterwards illustrated using the example of a trail-based design concept as the backdrop for the interactive part. In the second part of this session, first, co-creation methods (such as mindmapping and brainwriting) will be applied together with participants to brainstorm relevant categories, features and potentials of the urban space to foster mental health and mental health literacy. Participants will then be asked to contribute their expertise from their specific field of work particularly with regards to increasing mental health literacy in citizens. This exercise will be highly valuable for participants to acquire interdisciplinary knowledge regarding the influence of urban design interventions and mental health and broaden their perspective and knowledge regarding urban mental health and the built environment. Learnings and variations of this exercise could be also applicable in other settings such as rural communities or semi-public spaces. Key messages • This workshop aims at understanding how features of the urban space can be utilised to foster mental health and mental health literacy. • By co-creatively sharing and elaborating on insights from various disciplines, participants broaden their horizons regarding the interrelations between the urban built environment and mental health.