Lifestyle Behavior Change Research Articles

Efficacy of a Multimodal Digital Behavior Change Intervention on Lifestyle Behavior, Cardiometabolic Biomarkers, and Medical Expenditure: Protocol for a Randomized Controlled Trial.

The US Preventive Services Task Force recommends providers offer individualized healthy behavior interventions for all adults, independent of their risk of cardiovascular disease. While strong evidence exists to support disease-specific programs designed to improve multiple lifestyle behaviors, approaches to adapting these interventions for a broader population are not well established. Digital behavior change interventions (DBCIs) hold promise as a more generalizable and scalable approach to overcome the resource and time limitations that traditional behavioral intervention programs face, especially within an occupational setting. We aimed to evaluate the efficacy of a multimodal DBCI on (1) self-reported behaviors of physical activity, nutrition, sleep, and mindfulness; (2) cardiometabolic biomarkers; and (3) chronic disease-related medical expenditure. We conducted a 2-arm randomized controlled trial for 12 months among employees of an academic health care facility in the United States. The intervention arm received a scale, a smartphone app, an activity tracker, a video library for healthy behavior recommendations, and an on-demand health coach. The control arm received standard employer-provided health and wellness benefits. The primary outcomes of the study included changes in self-reported lifestyle behaviors, cardiometabolic biomarkers, and chronic disease-related medical expenditure. We collected health behavior data via baseline and quarterly web-based surveys, biometric measures via clinic visits at baseline and 12 months, and identified relevant costs through claims datasets. A total of 603 participants were enrolled and randomized to the intervention (n=300, 49.8%) and control arms (n=303, 50.2%). The average age was 46.7 (SD 11.2) years, and the majority of participants were female (80.3%, n=484), White (85.4%, n=504), and non-Hispanic (90.7%, n=547), with no systematic differences in baseline characteristics observed between the study arms. We observed retention rates of 86.1% (n=519) for completing the final survey and 77.9% (n=490) for attending the exit visit. This study represents the largest and most comprehensive evaluation of DBCIs among participants who were not selected based on their underlying condition to assess its impact on behavior, cardiometabolic biomarkers, and medical expenditure. ClinicalTrials.gov NCT04712383; https://clinicaltrials.gov/study/NCT04712383. RR1-10.2196/50378.

Dietary Health Communication and Conversation Analysis: A Scoping Review

ABSTRACT Globally, many people don’t eat a healthy diet despite policies and public health frameworks deployed to improve dietary status. Healthy diets can prevent, manage, and even reverse chronic disease, highlighting the importance of health professionals addressing healthy diets in clinical consultations. Conversation analysis (CA) is a method that can be used to understand dietary talk in these clinical consultations; however, it is unclear to what extent CA has been used for this purpose. Using PRISMA guidelines, a scoping review was conducted with the aim of identifying and summarizing research where CA was used to examine the dietary health conversations between health professionals and adults. A systematic search resulted in 4161 articles retrieved, with 13 studies meeting inclusion criteria. Included studies used CA to examine a variety of phases of dietary health encounters, including dietary assessment, advice-giving and resistance to this dietary advice, and dietary (lifestyle) behavior change negotiations, with n = 6 using audio or video recording, respectively. Studies were conducted in seven countries and across primary, secondary, and tertiary settings. We highlighted that dietary talk, irrespective of purpose (e.g., evaluation, assessment, or persuasion [e.g., behavior change]), is under-researched within the CA field. This is a need for further research using CA on dietary talk across a range of settings, conditions, populations, and talk purposes to understand how health professionals impact patient dietary behaviors. Such understanding has the potential to contribute to the improvement of dietary health communication approaches and patient outcomes.

An expert consensus on the most effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: protocol for an online modified Delphi study

IntroductionBehaviour change interventions are advocated as a key approach to manage behavioural risk factors such as insufficient physical activity, poor diet and smoking. Integrated motivational interviewing and cognitive behavioural therapy...

Pay Attention to Hypertension (PAtH): Findings from a cardiovascular health promotion intervention for adults with intellectual disabilities participating in Special Olympics programming.

Cardiovascular disease (CVD) affects adults globally. People with intellectual disabilities (PWID) may be at higher risk of CVD and associated risk factors (e.g. obesity, hypertension, and diabetes). We developed Pay Attention to Hypertension (PAtH), a cardiovascular health promotion intervention, and tested its impact on changes in blood pressure (BP), lifestyle behaviours and health-related empowerment among PWID. PAtH was developed with a Special Olympics community organisation that supports PWID in developing self-confidence and social skills through participation in sports. The 6-month intervention consisted of 1-h individualised virtual sessions delivered monthly by nursing students/novice nurses. Sessions covered specific themes, including monitoring BP, adopting healthy lifestyles and managing stress, and were individually tailored to the capacities and needs of participants. A single group pre-post-intervention design was used to assess the intervention's effects among participants who completed the intervention and data collection. Data included baseline and follow-up BP measurements from 7-day logbooks and questionnaires assessing lifestyle behaviours [physical activity (PA), screen time and diet], and health-related empowerment. Seventy-four participants were included in the analyses. Between baseline and follow-up, there were no changes in systolic and diastolic BP, PA or leisure screen time. The proportion of participants who reported adding salt when cooking decreased from baseline to follow-up (19.7% vs. 12.7%, P=0.034), and we found improvements for several items measuring health-related empowerment (P≤0.003). Improvements in health-related empowerment were found following PAtH. More intensive interventions may be needed to result in changes in lifestyle behaviours and BP. The integration of adapted cardiovascular health promotion initiatives within well-established community organisations such as Special Olympics is a promising avenue to contribute to cardiovascular health promotion among PWID.

Impact of COVID-19 led transition of work culture and travel to work patterns on society and environment in Delhi

Globally, COVID-19 has led to changes in daily lifestyle and travel behavior. There was a shift from in-person physical jobs to work-from-home culture, even for those jobs that required in-person presence at the job location. However, this was not true for everyone, and a majority continued to travel to work. The limited capacity of public transport services and the fear of exposure to the virus restrained people from practicing their conventional mobility choices. We explore the impact of COVID-19 on the nature of jobs and related changes in work travel patterns by population groups for Delhi using in-person surveys conducted during 2021 in six localities of Delhi. We also estimated the short- and long-term impacts of altered behavior on expenditures and equivalent CO2 emissions.As per the analysis, lower income groups, having no vehicles, with lesser qualifications, and employed as daily wagers, had limited capacity to change to work-from-home during COVID-19. We observed an increased dependency on personal motorized vehicles, leading to increased expenditures and reduced affordability. Adopting work-from-home during COVID-19 helped reduce equivalent CO2 emissions per working member by 39%. However, as the work at the site resumes, the emissions are expected to increase. The study shows that COVID-19 led to short-term benefits, but in the long term, the externalities will likely increase. Working from home during the pandemic provides short-term benefits; the social benefits are not equally distributed, and the transport emissions shall increase in the long term.

Establishing consensus on lifestyle recommendations and behaviour change strategies to promote brain health-focussed care for multiple sclerosis: A modified e-Delphi study.

Establishing consensus on lifestyle recommendations and behaviour change strategies to promote brain health-focussed care for multiple sclerosis: A modified e-Delphi study.

Longitudinal Changes in Lifestyle Behaviors and Cardiovascular Health During the Transition to Fatherhood: The Dad Bod Study Rationale and Design.

Despite the importance of the transition to fatherhood as a critical life stage among young adult men, much remains unknown about the factors predictive of ideal cardiovascular health (CVH) and how CVH is impacted as young men face new roles and responsibilities associated with fatherhood. To address this gap, the Dad Bod Study is a prospective, longitudinal and observational study designed to examine how fatherhood affects young men's CVH. A total of 125, first-time prospective fathers (men, 19-39 years) will be enrolled and followed over 1.5 years. Metrics of the American Heart Association's "Life's Essential 8" as well as demographic, social, and psychosocial factors will be collected at four time points ((baseline (during the pregnant partner's 2nd trimester) 1-month postpartum, 6-months postpartum, and 1-year postpartum). The primary aims are to measure predictors of CVH among first-time fathers and describe longitudinal changes in CVH. A secondary aim is to identify best practices for recruitment, retention, and remote data collection in this population. The Dad Bod Study offers a novel examination of CVH among first-time fathers, exploring how new paternal roles and responsibilities impact cardiovascular health. Findings may provide key insights into critical CVH behaviors and risk factors to monitor, preserve, and improve as young men transition to fatherhood.

Increases in Psychological Stress Are Associated With Higher Fasting Glucose in US Chinese Immigrants.

The majority of Chinese Americans is foreign-born, and it is well-documented that immigration to the United States (US) leads to increased risk for chronic diseases including type 2 diabetes. Increased disease risk has been attributed to changes in lifestyle behaviors following immigration, but few studies have considered the psychosocial impact of immigration upon biomarkers of disease risk. To examine associations ofpsychological stress and social isolation with markers of type 2 diabetes risk over time among US Chinese immigrants. In this longitudinal study of 614 Chinese immigrants, participants completed assessments of perceived stress, acculturative stress, negative life events, and social isolation annually atthree time points. Fasting blood samples were obtained at each time point to measure blood glucose, glycated hemoglobin, and insulin resistance. Mean duration between baseline and follow-up assessments was approximately 2 years. Increases in migration-related stress, perceived stress and social isolation were associated with significant increases in fasting glucose at follow-up independent of age, body mass index, length of US residence, and other potential covariates. Moreover, increases in glucose varied depending on perceived stress levels at baseline, such that those with higher baseline stress had a steeper increase in glucose over time. Psychological stress and social isolation are associated with increases in fasting glucose in a sample of US Chinese immigrants. Findings suggest that the unique experiences of immigration maybe involved in the risk of developing type 2 diabetes, a condition that is prevalent among US Chinese despite relatively low rates of obesity.

Abstract B043: Improving quality of life for Hispanic breast cancer survivors: A culturally tailored education intervention

Abstract Purpose: To evaluate the effectiveness of the Breast Cancer Education Intervention (BCEI) program in increasing knowledge and awareness of survivorship topics among survivor advocates and survivors, and to assess the impact of survivorship care plans on quality of life. Breast cancer survivorship care is crucial for improving the quality of life among survivors. Hispanic/Latino women face greater challenges and disparities in accessing survivorship care due to cultural, socioeconomic, and systemic barriers. The BCEI program, adapted from the National Cancer Institute’s model, aims to address these disparities through culturally tailored survivorship education and support. Methods: The BCEI program was piloted with a group of 8 Hispanic/Latino breast cancer survivors, in collaboration with Cancer Support Community Arizona (CSCAZ). This six-month program, created and delivered in Spanish, consisted of bi- monthly in-person sessions and phone check-ins. The educational sessions featured topics such as emotional and physical changes, lifestyle behaviors, nutrition, exercise, and psychological distress along with the introduction of a personalized survivorship care plan. These sessions provided a sense of community and emotional support with essential knowledge and understanding of the cancer journey, addressing gaps caused by language barriers in clinical settings, and the lack of Spanish language support groups. Survivor advocates underwent specialized training to effectively support the survivor participants. Data for the BCEI program was collected through pre and post survey evaluations, participant check-ins, and qualitative feedback. Survivors were paired with bilingual Patient Navigators, who connected them to resources in the community. Results: Preliminary results show a significant improvement in survivors’ knowledge and satisfaction with survivorship care. Participants demonstrated an increased awareness of the importance of survivorship care plans and showed positive changes in lifestyle behaviors. The results highlighted the program’s cultural tailoring and sense of community as key success factors. Conclusion: The Breast Cancer Education Intervention program demonstrates potential in addressing health disparities in breast cancer survivorship among Hispanic/Latino women. Building on this success, we are expanding the BCEI program to include a second iteration focused on Black and African American breast cancer survivors, who also face similar challenges and disparities. The program will be implemented in collaboration with the Coalition of Blacks Against Breast Cancer (CBBC). Citation Format: Idali Cuellar, Farhia M. Omar. Improving quality of life for Hispanic breast cancer survivors: A culturally tailored education intervention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B043.

Neural Conversational Agent for Weight Loss Counseling: Protocol for an Implementation and Feasibility Study.

Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals of motivational interviewing (MI), a client-centered yet directive counseling modality. However, training health care providers to be proficient in MI is expensive and time-consuming, resulting in a lack of trained counselors and limiting the widespread adoption of MI in clinical practice. Artificial intelligence (AI) counselors accessible via the internet can help circumvent these barriers. The primary objective is to explore the feasibility of conducting unscripted MI-consistent counseling using Neural Agent for Obesity Motivational Interviewing (NAOMI), a large language model (LLM)-based web app for weight loss counseling. The secondary objectives are to test the acceptability and usability of NAOMI's counseling and examine its ability to shift motivational precursors in a sample of patients with overweight and obesity recruited from primary care clinics. NAOMI will be developed based on recent advances in deep learning in four stages. In stages 1 and 2, NAOMI will be implemented using an open-source foundation LLM and (1) few-shot learning based on a prompt with task-specific instructions and (2) domain adaptation strategy based on fine-tuning LLM using a large corpus of general psychotherapy and MI treatment transcripts. In stages 3 and 4, we will refine the best of these 2 approaches. Each NAOMI version will be evaluated using a mixed methods approach in which 10 adults (18-65 years) meeting the criteria for overweight or obesity (25.0≥BMI≤39.9) interact with NAOMI and provide feedback. NAOMI's fidelity to the MI framework will be assessed using the Motivational Interviewing Treatment Integrity scale. Participants' general perceptions of AI conversational agents and NAOMI specifically will be assessed via Pre- and Post-Interaction Questionnaires. Motivational precursors, such as participants' confidence, importance, and readiness for changing lifestyle behaviors (eg, diet and activity), will be measured before and after the interaction, and 1 week later. A qualitative analysis of changes in the measures of perceptions of AI agents and counselors and motivational precursors will be performed. Participants will rate NAOMI's usability and empathic skills post interaction via questionnaire-based assessments along with providing feedback about their experience with NAOMI via a qualitative interview. NAOMI (version 1.0) has been developed. Participant recruitment will commence in September 2024. Data collection activities are expected to conclude in May 2025. If proven effective, LLM-based counseling agents can become a cost-effective approach for addressing the obesity epidemic at a public health level. They can also have a broad, transformative impact on the delivery of MI and other psychotherapeutic treatment modalities extending their reach and broadening access. PRR1-10.2196/60361.

The effect of an educational intervention on healthy lifestyle knowledge and behaviour among middle-aged women

Objectives: This study aimed to assess the impact of an educational intervention on middle-aged women’s knowledge and behaviour regarding various aspects of a healthy lifestyle. Design: Quasi-experimental study involving 150 middle-aged women (divided into experimental and control groups). Setting: Participants were selected from health centres of Tehran, Iran. Method: Data collection included demographic information, knowledge of a healthy lifestyle and healthy lifestyle behaviour. Participants in both the intervention and control groups completed the questionnaires before and 2 months after the educational intervention. The intervention involved 10 minutes of face-to-face training followed by distribution of training booklets provided by the Ministry of Health in Iran. Statistical analyses were conducted using SPSS. Results: Within the intervention group, significant differences were observed in total healthy lifestyle knowledge and subscales for physical activity knowledge, anthropometry knowledge, healthy diet knowledge, and smoking knowledge, between the pre- and post-intervention periods. Other than for smoking behaviour, there was no significant difference in healthy behaviours pre- and post-intervention for the experimental and also the control group. Conclusion: While there was an increase in knowledge about healthy lifestyles following the intervention, this knowledge increase was not associated with a change in healthy lifestyle behaviours. Attention should therefore be given to other influences including socio-economic factors, mental health status, environmental factors, cultural influences, duration of the intervention and psychological factors if changes in healthy behaviour are to be achieved.

The impacts of cancer treatment on lifestyle habits and mental health in Vietnamese women: an exploratory qualitative study.

This qualitative study explores the experiences of women after cancer treatment in terms of habit changes and mental health impact. The study involved 10 women who had undergone cancer treatment, recruited from three major hospitals in Hanoi, Vietnam. Data were collected through semi-structured interviews, which were transcribed and analyzed using thematic analysis. The findings of the study shed light on the various factors influencing lifestyle behavior and mental health changes among women after cancer treatment. Ten participants, aged 39 to 64 years, shared experiences including dietary changes, sleep disruptions, and reliance on non-scientific sources for health decisions. Initially shocked by their diagnosis, many transitioned to acceptance, adopting a "giving-in" attitude. Cultural beliefs, word-of-mouth sharing, and social support networks played significant roles in shaping post-treatment lifestyle changes, coping mechanisms, information-seeking behaviors, and mental health. The study highlights the need for accessible and scientifically verified information for women after cancer treatment to make informed decisions about their health. It emphasizes the importance of addressing traditional beliefs and promoting evidence-based practices. Moreover, the study underscores the importance of social support and relationships in coping with the challenges of post-cancer experiences.

Does the Association between Changes in Health Behaviors and Weight Gain Differ by Race and Ethnicity During the (COVID)-19 Pandemic? Findings from a Population-based Study

Objectives: We examined racial and ethnic differences in the association between changes in lifestyle behaviors and weight gain during COVID-19. Methods: We obtained data from a 2020 national survey involving 2,709 adult Americans. The outcome of interest was self-reported weight change status; behavioral measures included changes in exercise time, screen time, fast food meals consumed, and alcohol and tobacco use. We performed weighted multivariable logistic regression analyses to examine the association. Results: Non-Hispanic (NH) black adjusted odds ratio (AOR) (AOR = 1.59, 95% CI: 1.21-2.10) and Hispanic respondents (AOR = 1.89; 95% CI: 1.48-2.42) were more likely to experience weight gain, relative to the NH white respondents. Among NH Whites, changes in exercise time (AOR = 0.93), screen time (AOR = 1.16), fast-food meals consumptions (AOR = 1.14), and being drinkers (AOR = 1.35) and smokers (AOR = 0.53) were associated with weight gain; while among Hispanics, only changes in exercise time (AOR = 0.92) and screen time (AOR = 1.14) were associated with weight gain. Changes in exercise time (AOR = 0.94) among NH Blacks and changes in screen time (AOR = 1.16) among NH Asians were associated with weight gain. Conclusions: Risk factors of weight gain differ across racial and ethnic groups during the COVID-19 pandemic. Tailored intervention strategies are warranted to address specific risk behaviors within each racial and ethnic group.

An approach to persons who are not willing to engage in behavioural change.

With its unique position, primary health care (PHC) can provide health promotion and prevention services, including lifestyle behavioural counselling. Unhealthy lifestyle behaviours are very prevalent among patients attending PHC, with many patients unwilling to change or in the precontemplation stage. While patients in the contemplation stage are better managed using the 5As approach of motivational interviewing counselling, those unwilling or not ready for change necessitate a different approach, such as the 5Rs of motivational interviewing (MI) counselling. The 5Rs MI approach holds promise in motivating unwilling individuals to consider embarking on the journey of behavioural change. The 5Rs approach is not a stand-alone checklist of tasks implemented in isolation but is best integrated within a theoretical behavioural change framework. Of the four health-related behavioural change theoretical frameworks that are frequently used, the transtheoretical stages of the change model are the most used. This continued professional development article provides a summary review of the literature on behavioural change theories as they apply to lifestyle health behaviour change and presents the 5Rs approach as a feasible and practical approach to manage patients who are unwilling to change or in the precontemplation stage. This offers a beacon of hope for improved patient outcomes in a PHC system saddled with high prevalence of modifiable unhealthy lifestyle behaviours.

Moving Beyond Raising Awareness: Addressing Barriers

Awareness of issues and health concerns can prompt individuals to change their lifestyle behaviors. In fact, awareness is typically one of the first steps towards behavior change. However, awareness alone does not necessarily initiate or sustain behavioral changes. Specifically, many individuals experience significant barriers that prevent behavior change. Providers can address such barriers through ecological models of behavior change. Including concepts from an ecological model in health care settings can support positive lifestyle behavior change post-diagnosis. Moving beyond awareness alone and addressing barriers to change is an important goal that ultimately increases the probability of change for patients.

Understanding resilience: Lifestyle-based behavioral predictors of mental health and well-being in community-dwelling older adults during the COVID-19 pandemic

BackgroundChanges in sleep, physical activity and mental health were observed in older adults during early stages of the COVID-19 pandemic. Here we describe effects of the COVID-19 pandemic on older adult mental health, wellbeing, and lifestyle behaviors and explore predictors of better mid-pandemic mental health and wellbeing.MethodsParticipants in the Adult Changes in Thought study completed measures of lifestyle behaviors (e.g., sleep, physical activity) and mental health and wellbeing both pre-pandemic during regular study visits and mid-pandemic via a one-time survey. We used paired t-tests to compare differences in these measures pre- vs. mid-pandemic. Using multivariate linear regression, we further explored demographic, health, and lifestyle predictors of pandemic depressive symptoms, social support, and fatigue. We additionally qualitatively coded free text data from the mid-pandemic survey for related comments.ResultsParticipants (N = 896) reported significant changes in mental health and lifestyle behaviors at pre-pandemic vs. mid-pandemic measurements (p < 0.0001). Qualitative findings supported these behavioral and wellbeing changes. Being male, never smoking, and lower pre-pandemic computer time and sleep disturbance were significantly associated with lower pandemic depressive symptoms. Being partnered, female, never smoking, and lower pre-pandemic sleep disturbance were associated with higher pandemic social support. Pre-pandemic employment, more walking, less computer time, and less sleep disturbance were associated with less pandemic fatigue. Participant comments supported these quantitative findings, highlighting gender differences in pandemic mental health, changes in computer usage and physical activity during the pandemic, the value of spousal social support, and links between sleep disturbance and mental health and wellbeing. Qualitative findings also revealed additional factors, such as stresses from personal and family health situations and the country’s concurrent political environment, that impacted mental health and wellbeing.ConclusionsSeveral demographic, health, and lifestyle behaviors appeared to buffer the effects of the COVID-19 pandemic and may be key sources of resilience. Interventions and public health measures targeting men and unpartnered individuals could promote social support resilience, and intervening on modifiable behaviors like sleep quality, physical activity and sedentary activities like computer time may promote resilience to fatigue and depressive symptoms during future community stressor events. Further research into these relationships is warranted.

Preventing diabetes: What overweight and obese adults with prediabetes in the United States report about their providers’ communication and attempted weight loss

ObjectiveTo investigate what overweight or obese adults with prediabetes in the United States report being told by providers about 1)havingprediabetes, 2) diabetes risk, and3) losingweight and the associations of these communications with attempted weight loss. MethodsData from 2015 to 2018 National Health and Nutrition Examination Surveys (NHANES) for adults with a body mass index in the overweight or obesity ranges and HbA1c in the prediabetes range were examined (n = 2085). Patient reported data on what providers told them about having prediabetes, being at risk for diabetes, and losing weight were compared with attempted weight loss. ResultsMost participants (66.4%) reported never being told they had prediabetes nor being at risk for diabetes, 13.0% reported being told they had prediabetes, 10.6% at risk for diabetes, and 8.0% both messages. 18.3% of participants reported being told to lose weight. Participants who reported being told they had prediabetes and at increased diabetes risk were more likely to report attempted weight loss (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI) 1.1–3.2). Reporting that they were told to lose weight was not significantly associated with an increase in reported weight loss attempts. ConclusionsIn this cohort of individuals with overweight/obesity and prediabetic HbA1c values, low rates communications with providers about prediabetes and diabetes risk were reported. When both were discussed, patients reported greater attempted weight loss. These findings draw attention to the potential impact that provider communications about prediabetes and diabetes risk may have on lifestyle behavior change.

Understanding the disconnect between lifestyle advice and patient engagement: a discourse analysis of how expert knowledge is constructed by patients with CHD

Objective Adherence to healthy lifestyle advice is effective in prevention of non-communicable diseases like coronary heart disease (CHD). Yet patient disengagement is the norm. We take a novel discursive approach to explore patients’ negotiation of lifestyle advice and behaviour change. Method A discourse analysis was performed on 35 longitudinal interviews with 22 heterosexual British people in a long-term relationship, where one had a diagnosis of CHD. The analysis examined the relationships between patients’ constructions of expert knowledge and the implications of these accounts for patients’ dis/engagement with lifestyle advice. Results Expert knowledge was constructed in four ways: (1) Expert advice was valued, but adherence created new risks that undermined it; (2) expert knowledge was problematised as multiple, contradictory, and contested and therefore difficult to follow; (3) expert advice was problematised as too generalised to meet patients’ specific needs; and (4) expert advice was understood as limited and only one form of valued knowledge. Conclusion Patients and partners simultaneously valued and problematised expert knowledge, drawing on elaborate lay epistemologies relating to their illness which produced complex patterns of (dis)engagement with expert lifestyle advice. Recognition of the multiple and fluid forms of knowledge mobilised by CHD patients could inform more effective interventions.

Relationship Between COVID-19-related Anxiety and Changes in Lifestyle Behaviors Among Older Adults in Iran

Relationship Between COVID-19-related Anxiety and Changes in Lifestyle Behaviors Among Older Adults in Iran

Application of artificial intelligence technology in monitoring students' health: Preliminary results of Syiah Kuala Integrated Medical Monitoring (SKIMM).

Health promoting university is a holistic approach to health that uses higher education settings to create a learning environment that improves the health and well-being of the campus community in a sustainable manner. The utilization of technology such as artificial intelligence (AI) could be one of the main success factors in the implementation of health-promoting universities to increase the effectiveness and efficiency of all stages of activities carried out in health promotion and prevention efforts. Integrated monitoring with the utilization of AI in this program is conducted to evaluate the health status of the students. The Syiah Kuala Integrated Medical Monitoring (SKIMM) has three components of continuous health status evaluation: vital signs, nutritional status, and burnout status. Health status monitoring was conducted continuously for three months among medical students at the Faculty of Medicine Universitas Syiah Kuala, Banda Aceh, Indonesia. This system uses the WhatsApp application as a platform to monitor health status. Student health monitoring in this program consists of two main activities: the health measurement phase and the health monitoring phase. The use of the SKIMM system to monitor students' vital signs, nutritional status and burnout status through the use of AI significantly raises students' awareness to conduct timely self-examination and enables sustainable healthy lifestyle behavior change. The adoption of AI technology allows for continuous health promotion to the entire academic community, including students in implementing the health promoting university.