Intrapersonal Levels Research Articles

Physical activity promotion and adults with intellectual disabilities: A neglected area.

The objective was to review physical activity (PA) promotion interventions among individuals with intellectual disability and provide recommendations for increasing PA. A systematic mapping review was conducted in which physical activity intervention studies for adults with a disability were identified, selected, and appraised. Data were extracted regarding the study design, results, and authors' recommendations. Data were analyzed using a social-ecological framework. A comprehensive search of the peer reviewed literature yielded 5 studies (3 quantitative, 1 mixed methods, and 1 pre-post delayed). Studies used physical activity promotion strategies at the intrapersonal, interpersonal, organizational, community, and policy levels have been used to date. Recommendations are presented for researchers and practitioners seeking to increase the level of PA of adults with intellectual disability.

Implementing an inpatient integrative medicine consult service for children with pain: A qualitative analysis

ObjectivesComplementary and integrative medicine (CIM) therapies show clinical benefits with minimal side effects, yet challenges to effective integration in hospital settings remain. The current study aimed to better understand the process of integration of CIM therapies at a large urban pediatric hospital from the perspectives of providers, parents, and administrators. DesignThe study employed an applied medical ethnography. SettingThe ethnography was conducted before, during, and after an Integrative Medicine Pain Consult Service (IM Pilot) was implemented at a large urban pediatric hospital during the spring of 2017. Main outcome measuresFieldwork interviews, participant observations, and document review captured aspects of the integration of CIM over a 6-month study period. Ethnographic analysis included thematic content analysis. Participants included providers (n = 10), administrators (n = 5), and parents of patients (n = 11). ResultsEmergent themes from analysis of the interviews and field notes were organized according to the socio-ecological model. Themes included facilitating factors for CIM pain management at the intrapersonal and community levels (Alignment with Parental Perceptions of Child Needs and Provider Desire to Offer Care, Alignment of CIM with Spiritual Beliefs and Community Norms) and barriers at the interpersonal, organizational, and political levels (Inter-professional Challenges, Lack of Logistics in Place for Referrals and Triaging Patients with Pain, Lack of Remuneration/Insurance Reimbursement for Care). ConclusionsTo address barriers, future efforts to implement integrative pain management programs in pediatric hospital settings may consider testing implementation strategies, including engaging program champions and family advocates, providing education on CIM professions and therapies to hospital staff, and billing for provider time rather than individual CIM therapies.

"Girls Aren't Meant to Exercise": Perceived Influences on Physical Activity among Adolescent Girls-The HERizon Project.

Background. Adolescent girls are less active than boys, with approximately 10% of girls in Ireland and the United Kingdom meeting the minimum recommended daily physical activity (PA) guidelines. This study investigated factors perceived to influence PA among adolescent girls from low socioeconomic areas in order to inform the design of a future intervention (The HERizon Project). Methods. A total of 48 adolescent girls (13–18 years) from low socioeconomic areas of the United Kingdom and Ireland participated in focus groups (n = 8), to explore perspectives of physical activity and the influence of gender within this. Focus groups were thematically analyzed and interpreted within a socioecological framework. Results. Most girls enjoyed PA and were aware of its benefits. They identified both barriers and facilitators to PA at intrapersonal (fear of judgement and changing priorities WITH age), interpersonal (changing social pressures and support from others) and organizational (delivery of PE) levels. Gender inequality was a multilevel factor, crossing all socioecological levels. Conclusion. Although many adolescent girls enjoy PA, their experiences appear to be limited by a fear of judgement and an overarching sense of gender inequality. Future interventions, such as the HERizon Project, should address influences at intrapersonal, interpersonal and organizational levels to promote positive PA experiences for adolescent girls.

Stakeholders’ Perspectives on the Effects of a PEP Grant on a District-Wide CSPAP

A Comprehensive School Physical Activity Program (CSPAP) can help children be physically active for 60 min/day. Physical Education for Progress grants provided opportunities to improve physical education and physical activity programming. Purpose: This study explored stakeholders’ perspectives on the effects of a Physical Education for Progress grant on a district-wide CSPAP. Method: Stakeholders included physical educators (n = 10; K–12), administrators (n = 6), and one superintendent. Individual, semistructured interviews were used to examine how the grant affected stakeholders’ perspectives of the CSPAP. Results: The grant affected the CSPAP by providing (a) opportunities for professional development, (b) opportunities to establish a K–12 curriculum map, and (c) access to equipment and resources. Discussion: Framed in social ecological theory, intrapersonal, interpersonal, institutional, and community levels were influenced by the grant. Interactions between levels enabled changes in all CSPAP components, especially quality PE. Conclusion: A Physical Education for Progress grant is a successful mechanism to enhance a district-wide CSPAP.

Environmental and emotional predictors of cognitive styles of air traffic controllers

The article describes the theoretical and empirical study of cognitive styles of air traffic controllers as a guarantee of their professional success. The aim of the article was to present the results of the study, which were to establish the emotional predictors of cognitive styles of future air traffic controllers. The following methods were used for the study: “Gottschaldt’s figures”, “Comparison of similar drawings” by J. Kagan, “Free sorting of objects” by R. Gardner in the modification of V. Kolga, “Four-modal emotional questionnaire” by L.A. Rabinovych, “EmIn Emotional Intelligence Questionnaire” by D.V Lyusin, “Self-assessment of mental states” by G. Eisenk. The specifics of the manifestation of the following cognitive-stylistic parameters of air traffic controllers are analyzed: social field dependence-field independence, impulsivity-reflexivity, analyticity-syntheticity. Based on the analysis of the results of the study, it was found that the vast majority of respondents have the following cognitive styles: field-independent (77.7%), reflexive (74.4%), and slightly less synthetic (53.5%). Emotional intelligence at the intrapersonal and interpersonal levels of air traffic controllers is characterized by high rates in only half of the sample. Among emotions, almost half of the respondents are dominated by “joy” at a high level, “anger”, “fear” at a low level and “sadness” at a medium level. It was also found that two thirds of air traffic controllers are dominated by low levels of anxiety and frustration. Regression analysis revealed the influence of emotional characteristics on cognitive styles of future air traffic controllers: “aggression” is a predictor of “field dependence”, and “rigidity” and “joy” are predictors of analytical cognitive style.

Understanding the Pathways of Neighborhood Environmental Influences on Health Among U.S. Chinese Older Immigrants

Neighborhood environment has proven to be consequential for older Americans’ physical, mental and cognitive health. However, this topic is much less studied among older Asian immigrants, a fast growing immigrant group who embrace values of collectivism and community connections. The current study used the first wave data (N=2920) of the Population Study of Chinese Elderly (PINE), the largest population-based sample of Chinese older adults in the U.S., 1) to examine the direct associations between neighborhood environment (social cohesion, physical disorder) and health outcomes (self-rated health, depression, and cognitive health); and 2) to identify possible mediators at intrapersonal (sense of hopelessness, sense of mastery) and interpersonal levels (social engagement, cognitive engagement) through which neighborhood environment influences health. The results of Sobel tests from path analysis showed that neighborhood social cohesion was associated with better health outcomes on all the domains: self-rated health (b= 0.050, p<.01), depression (b= -0.202 p<.001), and cognitive health (b=0.092, p<.001), whereas neighborhood physical disorder was associated with poorer self-rated health (b= -0.069, p<.01) and more depressive symptoms (b=0.174, p<.001). Full and partial mediations were detected. For example, neighborhood physical disorder influences depression completely through intrapersonal traits, higher sense of hopelessness (b=1.879, p<0.001) and reduced sense of mastery (b= -2.656, p<0.001). Neighborhood social cohesion contributes to better cognitive health partially through increased social engagement (b=1.696, p<0.001) as well as cognitive activities (b=1.392, p<0.001). The findings identified the ecological component in resilience building processes, and provide evidence for mezzo-level intervention to improve health among aging U.S. Chinese immigrants.

Habit and Mental Illness from an Hegelian Perspective

Hegel proposes cultivation of habit as one of the major cures for mental illness. According to him, habit not only involves embodiment and dexterity but also mental activities and ethical elements. The aim of this paper is to evaluate the types of habit Hegel prescribes for curing mental illness in his original works. A three-level framework comprising the intrapersonal, interpersonal, and spiritual levels is adopted, and results show that although Hegel points out that habit is ethical and spiritual in nature, in his discussions on mental illness Hegel makes the majority of references on habits that involves the body such as physical movement and laboring. Habits that belong to the interpersonal and spiritual aspects are relatively neglected. This paper proposes that habits in the interpersonal and family realms, habits that function in the transition from the subjective to objective spirit, and habits in the morality sphere, which are equally important in Hegel’s philosophy, should be taken into consideration in future research and interventions for mental illness.

Sistematização da criação das escolas em movimento: intervenção na saúde escolar

This systematization aims to show the process that originated the schools in the movement model, conceptually anchored to the ecological model whose purpose is to counteract the effects of a sedentary lifestyle, overweight, and childhood obesity at school. The work was conceived using existing structures installed in public institutions; this included, among the actions, the creation of spaces to promote health and physical activity. Under this perspective, RECAFIS (Costa Rican Network of Physical Activity for Health) from the Belen-Flores sector, in the province of Heredia, Costa Rica, was used; it served as a platform to implement this intervention model called schools in movement. This model was implemented in three public schools in the province of Heredia. The methodology consisted of observing the activities that boys and girls carried out during school time (breaks, physical education classes, classroom behavior). Subsequently, an activity plan was implemented to promote active styles at the interpersonal, intrapersonal, and organizational levels. The ecological model supported this work strategy. The experiences lived were systematized to guide the construction of interventions to promote active lifestyles in childhood within the school environment by stimulating basic motor skills such as skipping, jumping, and running. The interventions in which families, children, and institutions participated are included. Conclusions: The multi-level, inter-institutional intervention, based on the ecological theory, demonstrated its suitability to promote active lifestyles in the spaces of the academic levels and from Physical Education classes, through original interventions, which contemplate students’ tastes and interests to let them be more active and healthy without segregating overweight and obese schoolchildren due to the stigmatization effects and obstacles that this practice generated.

A Social Psychological Evaluation on Envy

Envy has serious effects on individuals in both intrapersonal and interpersonal levels. However, it has not attracted sufficient attention from the psychology literature in Turkey. This review aims to evaluate studies on envy from the social psychology perspective and to contribute to the literature related to this topic in Turkey. In the first part of the article, a definition for envy is provided on the basis of empirical studies and the difference between envy and jealousy, and envy and benign form of it (i.e. gıpta in Turkish) is discussed. The second part of the article reviews the effects of envy on daily life on the basis of empirical studies again. According to research, envy has a mediating role in the relationship between social media use and psychological well-being. In addition, envy, in organizational contexts, reduces constructive organizational behavior and increases destructive ones. The characteristics of organizational context, of employees and of the leader affect the level of envy experienced in the workplace. Finally, successful individuals feel discomfort and fear due to being the target of envy. The reactions to being at the target of envy differ according to personal, relational and cultural factors. As indicated by the research on this topic, envy affects human life in a broad context. More research needs to be done in Turkey on this emotion to have a more complete understanding. Keywords Envy, jealousy, benign envy, social comparison, social media

Canadian Dietitians' Understandings of, Attitudes Toward, and Engagement in Social Justice and Advocacy.

Purpose: To explore Canadian dietitians' understandings of, attitudes towards, and engagement in socially just dietetic practice and advocacy.Methods: An online semi-qualitative survey sent to Canadian dietitians.Results: Respondents' understanding of social justice and socially just dietetics practice highlights the unique ways that social injustice and health inequities may be addressed by dietitians. Overall, respondents had a positive attitude toward dietitians' roles in social justice advocacy. Support for dietitians' advocacy roles was highest for food-related concerns, but it declined for concerns with indirect connections to dietitians' food and nutrition expertise (e.g.,environment). However, respondents still had uncertainty and divided perspectives concerning if and how social justice fits within dietitians' scope of practice. They also had concerns about barriers that they felt limit dietitians' ability to perform socially just practice. Respondents shared efforts to engage in socially just practice at intrapersonal, interpersonal, and structural levels.Conclusions: Dietitians could be a critical influence on the determinants of health. This research points strongly to the need for a framework for socially just dietetic practice and advocacy that delineates what social justice looks like across the array of settings in which dietitians practice and within the array of fora that dietitians advocate to support nutrition and health.

Application of social ecological model to Taiwanese end-of-life communication and healthcare planning

<h2>ABSTRACT</h2><h3>Background</h3> Cultural and social backgrounds shape how people regard health, illness and death, and also play a significant role in end-of-life (EOL) decision-making in the face of uncertainty and distress. EOL communication and planning can be complex in a society where families play an important role in decision-making for EOL care in Taiwan. <h3>Aim</h3> This study aimed to identify the significance of cultural, community, interpersonal and individual determinants of EOL communication and healthcare planning. <h3>Methods</h3> A social ecological model was applied to underpin the study. A random sample of 2000 adults aged 20 years or above was selected from the electoral roll in a metropolitan area in southern Taiwan. Adults were told that if they did not wish to participate in the study, they could either return a non-participation form or not complete the questionnaires. Hierarchical multiple regression analyses were used to determine the significance of different societal levels of factors on EOL communication and healthcare planning. <h3>Findings</h3> Four hundred and seventy-four valid questionnaires were returned. Hierarchical multiple regression analyses revealed that the models of modified Measures of Public Preferences (<i>p</i> < .0001) were significant, with 22.7% of variance in facilitation, 81.9% of variance in content and 22.9% of variance in support being explained by variables at cultural, community, interpersonal and intrapersonal levels. The model of Advance Directives Attitude Survey (<i>p</i> < .0001) was significant with 25.6% of variance being explained by variables at cultural, community, interpersonal and intrapersonal levels. <h3>Discussion</h3> This study offers empirical evidence embedded within a social ecological perspective of the significance of cultural, social and contextual factors on individuals' preferences for EOL communication and healthcare planning. <h3>Conclusion</h3> Such information is important to enable health professionals to prepare individuals and their families for dealing with challenges related to EOL communication and healthcare.

Association of ABC (HbA1c, blood pressure and LDL-cholesterol) goal achievement with visit-to-visit ABC variability and postprandial dysmetabolism in type 2 diabetic patients.

Although roles of ABC (HbA1c, blood pressure [BP] and LDL-cholesterol) goal attainment on CVD risk outcomes have been well established, it is less studied whether ABC goal attainment associates with ABC variability, non-traditional risk factors. Intrapersonal mean levels and standard deviation (SD) of HbA1c, BP and LDL-cholesterol, fasting and post-breakfast plasma glucose (PG) and serum triglyceride (TG) during 12 months were calculated in 168 type 2 diabetes patients (aged 62.3 years, 53.6% men). Associations of ABC goal attainment with non-traditional glycemic, BP and lipid risk factors were analyzed. Among 168 patients, 92 (54.8%), 91 (54.2%) and 111 (66.1%) patients achieved HbA1C, BP and cholesterol goal, respectively, and 47 (28.0 %), 45 (26.8 %), 63 (37.5 %) and 13 (7.7 %) achieved triplegoal, dual-goal, single-goal and no-goal, respectively. Achieving more ABC goals was associated with stepwise decreases in mean levels and SD of fasting and post-breakfast PG, and HbA1c. It was also associated with stepwise decreases in mean levels and SD of fasting and post-breakfast TG, and LDL-cholesterol. Further, achieving more ABC goals was associated with stepwise decreases in brachial pulse pressure and mean levels and SD of systolic BP. ABC goal achievement was associated with a broad range of non-traditional glycemic, BP and lipid risk factors in type 2 diabetic patients. Reaching more ABC treatment targets may be important for reductions in long-term ABC variability and postprandial dysmetabolism.

Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model-A Multi-Method Qualitative Study of Hong Kong.

End-of-life (EOL) care for terminal illness and life-limiting conditions is a sector in the health service spectrum that is drawing increased attention. Despite having the world’s longest life expectancy and an ever-escalating demand for long-term care, Hong Kong’s EOL care was underdeveloped. The current study aims to provide a holistic picture of gaps and issues to EOL care in Hong Kong. Data collection was conducted using a multi-method qualitative approach that included focus groups and in-depth interviews with key informants and stakeholders, and longitudinal case studies with patients and families. Deductive thematic analysis was used to examine service gaps in current EOL care through the lens of a socioecological model where gaps and issues in various nested, hierarchical levels of care as well as the relationships between these levels were studied in detail. Using the model, we identified gaps and issues of EOL care among older populations in Hong Kong at the policy, legal, community, institutional, as well as intrapersonal and interpersonal levels. These include but are not limited to a lack of overarching EOL care policy framework, ambiguity in the legal basis for mental incapacity, legislative barriers for advance directives, inadequate capacity, resources, and support in the community to administer EOL care, inadequate knowledge, training, and resources for EOL care in health and social care sectors, inadequate medical-social interface, general reluctance and fear of death and dying, as well as the cultural interpretation of filial piety that may lengthen the suffering of the dying patients. Findings highlight the multi-level gaps and issues of EOL care in a place where western and eastern culture meet, and shed light on how best to design more effective and comprehensive policy interventions that will likely have a more sustainable and instrumental impact on facilitating person-centered EOL care during the end of life.

Requirements for (web-based) physical activity interventions targeting adults above the age of 65\u2009years \u2013 qualitative results regarding acceptance and needs of participants and non-participants

BackgroundIt remains unclear how physical activity (PA) interventions need to be designed to reach older adults and to be widely accepted in this target group. The aim of this study was to assess the acceptance of a web-based PA program, including individual intervention components as well as relevant contextual factors, and to specify requirements for future interventions.MethodsTwo hundred sixty-six participants of a PA intervention completed a questionnaire covering individual program components (content, structure, and context). Further, 25 episodic guided interviews focusing on reasons for (non-) participation were conducted with 8 participants and 17 non-participants. Following qualitative content analysis, different requirements were identified and organized based on the social-ecological model, resulting in a profile of requirements.ResultsBased on the participants’ and non-participants’ statements, six different levels of requirements affecting acceptance of and successful participation in a web-based PA intervention were identified. The individual fit was influenced by an interaction of different factors at the intrapersonal, sociocultural, content, spatial, digital and organizational levels. Several age- and gender-specific requirements were noted in the interviewed older adults. Men and women, as well as younger (< 70 years) and older (≥70 years) adults differed in terms of perceived enjoyment and benefits of socializing while exercising together, the time expenditure perceived to be acceptable, previous digital skills, as well as in perceptions that ambience and accessibility of exercise facilities in the neighborhood were important.ConclusionsTo motivate older adults to engage in PA and address different needs in terms of life circumstances and quality of life as well as differences in technical affinity, different requirement profiles should be included in the process of intervention development and implementation. Participatory development loops and modular offer formats are recommended for this.

From sculpting an intervention to healing in action

ABSTRACT Black/African Americans have the most severe and disproportionate burden of HIV of all racial/ethnic groups in the United States. Oppression operates at four interrelated levels (i.e., socio-structural (macro), institutional (exo), community/family (meso), and inter- and intrapersonal (micro)) that perpetuate the HIV epidemic in Black/African American communities. Oppressive (e.g., racist and sexist) cultural scripts transferred to individuals through community, family and interpersonal relationships may play a role in HIV/STI risk. However, socio-behavioral health interventions or behavioral risk reduction interventions have traditionally focused solely on individual-level health risk behaviors allowing invisible, inequitable socio-structural factors to continue unchallenged. A new intervention, Black Men and Women: Empowering Self, Relationships and Community, was sculpted from two existing interventions Community Wise and Men of African American Legacy Empowering Self (MAALES) to develop awareness of oppressive cultural scripts operating on interpersonal and intrapersonal levels and to take action against these oppressive messages to reclaim identity, restore relationships, and build community. This paper summarizes the theory and selected sociodramatic components of the intervention that promote healing in action to reduce HIV/STI risk among heterosexually identified, low-income African American men and women with multiple sex partners. Lessons learned in theory, research and practice are also discussed.

Using Intervention Mapping to Develop Health Education and Health Policy Components to Increase Breast Cancer Screening and Chemotherapy Adherence Among Syrian and Iraqi Refugee Women in Beirut, Lebanon.

Introduction: Despite the continuous increase in the incidence of metastatic breast cancer among Syrian and Iraqi refugee women residing in camp settings in Lebanon, mammography and chemotherapy adherence rates remain low due to multiple social, economic, and environmental interfering factors. This in turn led to an alarming increase in breast cancer morbidity and mortality rates among the disadvantaged population.Methods: Intervention mapping, a systematic approach which guides researchers and public health experts in the development of comprehensive evidence-based interventions (EBIs) was used to plan a health education and health policy intervention to increase breast cancer screening and chemotherapy adherence among Iraqi and Syrian refugee women aged 30 and older who are residing in refugee camps within the Beirut district of Lebanon.Results: The generation of the logic model during the needs assessment phase was guided by an extensive review of the literature and reports published in peer-reviewed journals or by international/local organizations in the country to determine breast cancer incidence and mortality rates among refugee women of Syrian and Iraqi nationalities. The underlying behavioral and environmental determinants of the disease were identified from qualitative and quantitative studies carried out among the target population and also aided in assessing the sub-behaviors related to the determinants of breast cancer screening and chemotherapy completion as well as factors affecting policy execution to formulate performance objectives. We then developed matrices of change objectives and their respective methods and practical applications for behavior change at the intrapersonal, interpersonal, organizational, and societal levels. Both educational components (brochures, flyers) and technological methods (videos disseminated via Whats app and Facebook) will be adopted to apply the different methods selected (modeling, self-reevaluation, consciousness raising, persuasion, and tailoring). We also described the development of the educational and technological tools, in addition to providing future implementers with methods for pre-testing and pilot-testing of individual and environmental prototype components.Conclusion: The use of intervention mapping in the planning and implementation of holistic health promotion interventions based on information collected from published literature, case reports, and theory can integrate the multiple disciplines of public health to attain the desired behavioral change.

The role of registered nurses in primary care and public health collaboration: A scoping review.

AimThe purpose of this work was to examine the roles of Registered Nurses (RNs) in primary care (PC) and public health (PH) collaboration. Additionally, we aimed to explore whether the current scope of practice for RNs is adequate to support their roles in PC/PH collaboration.DesignA scoping review of current literature relating to the RN’s role in PC/PH collaboration was conducted using the PRISMA 2009 checklist.MethodsThe review used key terms: primary care, public health, collaboration, nursing and nurse role across six electronic databases; 23 articles that were included in the final review were published over a 7‐year span.ResultsFour key RN roles relating to PC/PH collaboration were identified: relationship builder, outreach professional, programme facilitator and care coordinator. RNs supported transitions in chronic disease, communicable disease care and maternity care at various healthcare system levels including systemic, organizational, intrapersonal and interpersonal levels.

Ranking Barriers, Motivators, and Facilitators to Promote Physical Activity Participation of Persons With Dementia: An Explorative Study.

Community-dwelling persons with dementia are inactive most of the day. The purpose of this study was to rank the barriers, motivators, and facilitators that hamper or promote physical activity (PA) participation for persons with dementia. This could provide knowledge that can be used to design effective interventions to promote PA participation for persons with dementia. Twenty community-dwelling persons with dementia, mean (SD) age = 79 (5.4) years, 25% female, mean (SD) Mini-Mental Status Examination score = 23 (3.5); their informal caregivers, N = 20, mean (SD) age = 70 (11.5) years, 85% female; and an expert group of physiotherapists, N = 15, mean (SD) age = 41 (12.4) years, 73% female, were asked to rank preselected barriers, motivators, and facilitators of PA participation for persons with dementia. These statements were categorized at the intrapersonal, interpersonal, and community levels. Persons with dementia and their informal caregivers selected only motivators and facilitators as being important for PA participation, with the motivator "beneficial health effects" considered the most important. The experts had a different perspective on PA participation; half of their ranked top 10 most important factors were barriers to PA participation for persons with dementia. This could be explained by the more critical role of a therapist, focusing on symptom control and treatment of disability; in this case, the elimination of barriers to maintain PA participation in their patients. Furthermore, all groups prioritized statements at the intrapersonal level. The results of this study suggest a difference in perspective between the more optimistic view of persons with dementia and their informal caregivers and the more critical view of physiotherapy experts regarding the most important factors that influence PA participation. In addition, there was a strong focus on the individual characteristics that influence PA behavior that warrant personalized interventions to promote PA in persons with dementia.

Multi-level barriers to reaching HIV testing among young heterosexual African migrants from HIV-endemic countries in Ottawa

The Joint United Nations Programme on HIV and AIDS (UNAIDS) and the Public Health Agency of Canada wish to reach, test and treat at least 90 percent of undiagnosed people living with HIV. Fourteen percent (9,090 of 63,100) of Canadians living with HIV were unaware of their status by the end of 2016. Evidence about barriers before and after reaching testing is required to inform policy and practice in planning more equitable HIV testing interventions. We conducted face-to-face semi-structured interviews among twenty young heterosexual African migrants from HIV-endemic countries between May and October 2017. Participants included fourteen men and six women aged 18–29 years to identify barriers to reaching HIV testing services in Ottawa. We used Grounded Theory informed by a socio-ecological framework and a framework of access to care. Participants described access barriers and enablers at the testing stages of approachability, acceptability, and availability. Participants were, however, often unable to recognize the need for HIV testing, unable to actively seek and choose HIV testing and reach HIV testing at the intrapersonal, interpersonal, organizational, community, and policy levels. Lack of outreach programs and inability to obtain required information about HIV testing options was a major access barrier among young men in this study. Young heterosexual African women experienced unique barriers even after reaching testing, such as, not being taken seriously by healthcare providers. Our analysis showed multi-level determinants influence our populations HIV testing, both before and after reaching testing services. These determinants have practical implication for researchers, policymakers, affected communities and patients.

Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review

Children and adolescents with a lower socioeconomic position have poorer dietary behaviours compared to their counterparts with a higher socioeconomic position. A better understanding of the mechanisms behind such socioeconomic inequalities is vital to identify targets for interventions aimed at tackling these inequalities. This systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth. A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The dietary behaviours included in the reviewed studies were the intake of fruit and vegetables, sugar-sweetened beverages, unhealthy snacks/fast food and breakfast. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self-efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. Few studies including mediators at the organisational, community or policy levels were found. Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating inequalities in dietary behaviours among youth. Rigorous studies exploring organisational, community and policy level mediators are warranted.