Long-term Behavioral Changes Research Articles

Educational outcomes of digital serious games in nursing education: a systematic review and meta-analysis of randomized controlled trials

BackgroundAdvancements in digital technologies and the coronavirus disease pandemic have rapidly shifted educational practices towards engaging digital methods, such as serious games, significantly influencing healthcare education. Digital serious games enhance nursing education by effectively overcoming limitations such as limited training time and inadequate resources, thereby improving knowledge and skills. Few high-quality systematic reviews and meta-analyses were focused exclusively on randomized controlled trials (RCTs) of digital serious games to determine their effects in nursing education.ObjectiveTo evaluate the effects of digital serious games on nursing education through a systematic review and meta-analysis using the Kirkpatrick model to evaluate learning and behavioral changes.MethodsA systematic review and meta-analysis of RCTs was performed. Six databases were searched for articles published before April 2024. Risk of bias was assessed using the Revised Cochrane Risk of Bias tool for randomized trials. A sensitivity analysis was performed. Outcome variables were categorized according to the Kirkpatrick model. Effect sizes were determined using Hedges’ g in a random-effects model. Subgroup analysis was performed.ResultsThe quality appraisal results revealed that all the studies exhibited a low risk of bias across these domains. Eleven studies were included in the systematic review, and eight studies, in the meta-analysis. The intervention group showed significant improvements in knowledge (Hedges’ g = 0.75, 95% confidence interval (CI) = [0.27, 1.22], p = .002, I² = 90.51%), confidence (Hedges’ g = 0.73, 95% CI = [0.23, 1.24], p = .005, I² = 82.71%), and performance (Hedges’ g = 0.49, 95% CI = [0.17, 0.80], p = .003, I² = 56.60%). Subgroup analysis showed a significant improvement in knowledge when the intervention period exceeded 2 weeks (Hedges’ g = 0.53, 95% CI = [0.32, 0.74], p < .001, I² = 25.41%).ConclusionThis study demonstrates that digital serious games significantly enhance knowledge, performance, and confidence of nursing students, offering a valuable alternative to traditional methods and equipping them with essential clinical competencies. However, the observed high heterogeneity and limitations like brief intervention durations necessitate caution in result interpretation and highlight the need for further research to explore long-term effects and behavioral changes in nursing education.

Advancing primate conservation: a global collection of education and outreach initiatives.

This special issue on Primate Conservation Education and Outreach assembles the largest collection of conservation education interventions focused on primates to date, aiming to highlight the urgent need for educational initiatives to mitigate the ongoing threats to primate species. Despite decades of warnings from primatologists about the escalating risks to primate populations, including habitat loss, illegal hunting, and human-primate conflict, conservation education remains underdeveloped in the field of primatology. This issue explores 20 diverse case studies from across the globe, with contributions from field sites in Central and South America, Africa, and Asia. The education programmes discussed range in scope, duration, and target audience, with many linked to long-term research projects. Akey finding is the significant variation in programme design and evaluation methods, with challenges in assessing long-term behaviour change and conservation impact. The issue emphasises the importance of creative, participatory approaches such as puppet shows, community outreach, and place-based education, which have proven successful in fostering deeper engagement and understanding of primate conservation. Despite the barriers faced, including limited funding and cultural challenges, the authors stress the importance of both small-scale and long-term educational interventions in the global effort to protect primates. This volume serves as a call to action for primatologists to integrate conservation education into their research and outreach efforts, thereby contributing to the preservation of our closest living relatives.

Assessing the impact of environmental education in a critical orangutan landscape in West Kalimantan, Indonesia.

Gunung Palung National Park (GPNP) and the surrounding region in West Kalimantan, Indonesia, host a significant population of Critically Endangered Bornean orangutans (Pongo pygmaeus wurmbii) amidst various conservation challenges, including habitat destruction, the illegal pet trade, and human-wildlife conflict. The Gunung Palung Orangutan Conservation Program (GPOCP) employs diverse strategies, including environmental education, to address these challenges. Environmental education helps to connect local students with conservation efforts, educate them about endangered endemic species, and highlight the relationship between human behavior and ecosystem health. Environmental education is critical in fostering sustainable behaviors and raising awareness about conservation issues, particularly in areas where human activities threaten primate biodiversity. Such programs can promote long-term conservation outcomes by engaging communities and empowering individuals to take action. Here, we review the effectiveness of GPOCP's environmental education initiatives, focusing on school visits conducted between 2016 and 2023 that concentrated on orangutan conservation. We analyze data from standardized pre- and post-activity surveys administered to students participating in puppet shows and lectures. Results indicate a substantial increase in knowledge and positive shifts in attitudes toward orangutan conservation among students. However, challenges remain in evaluating long-term behavioral changes and the relative contribution of different conservation interventions. Future efforts will explore tailored educational approaches and impact assessments to enhance conservation outcomes and foster community engagement in safeguarding Bornean orangutans and their habitat.

Nutritional knowledge, attitudes and behaviours in rugby league; influences of age, body composition and ancestry.

Rugby league is a physically demanding sport that necessitates considerable nutritional intake, focusing on quality and type, in order to optimize training and competition demands. However, rugby league athletes are reported to have inadequate nutrition intake to match these demands. Some factors that may determine an athlete's nutrition intake have been reported in other sports, including (but not limited to, knowledge, time, cooking skills, food costs, income, belief in the importance of nutrition, body composition goals, and family/cultural support). However, these potential factors are relatively unexplored in rugby league, where a range of personal (age, body composition) or social (ancestry) influences could affect nutritional intake. Further exploration of these factors is warranted to understand the knowledge, attitudes and behavior underlying rugby league athletes' nutritional intake that can provide practitioners with a more detailed understanding of how to approach nutrition behaviors and attitudes in rugby league athletes. The primary aim was to describe the nutrition behaviors and knowledge of rugby league athletes. A secondary aim was to compare nutrition knowledge and behavior based on age, body composition and self-identified ancestry. Fifty professional rugby league athletes anonymously completed a seventy-six-question online survey. The survey consisted of three sections : 1) sports nutrition knowledge, 2) attitudes toward nutrition on performance , and 3) nutrition behaviors. All participants completed the online survey without assistance using their own personal device, with data entered via REDCap during pre-season. Nutrition knowledge was compared based on age (years), body composition (body fat percentage (%)) and ancestral groups (Pasifika, Aboriginal and/or Torres Strait Islander (ATSI) and Anglo- European).Pearson correlation was used for the relationship between nutrition knowledge, age and body composition. An Analysis of Covariance (ANCOVA) was used to determine nutrition knowledge differences between ancestral groups with age and body composition as covariates. Attitudes and behaviors were compared based on age groups (<20, 20-24 and >25 y), ancestry and body composition. Attitudes and behaviors were analyzed by Pearson correlation for body composition, one-way ANOVA for age groups and ANCOVA for ancestry with covariates age and body composition. Overall athletes' nutrition knowledge score was reported as 40 ± 12% (overall rating "poor"). Nutritional behaviors were significant for body composition, as those with lower body fat percentage had higher intakes of vegetables and dairy products (p = 0.046, p = 0.009), and ate more in the afternoon (lunch p = 0.048, afternoon snack p = 0.036). For ancestry, after adjustment for both age and body composition, Pasifika athletes were more inclined to miss breakfast and lunch compared to their Anglo-European (p = 0.037, p = 0.012) and ATSI (p = 0.022, p = 0.006) counterparts and ate more fruit than Anglo-Europeans (p = 0.006, p = 0.016). After adjustment for body composition, ATSI athletes also viewed the impact of nutrition on mental health and well-being significantly lower than Pasifika (p = 0.044). These findings suggest differences exist within rugby league athletes based on ancestral backgrounds and body composition for nutrition attitudes, behaviors and knowledge. Such outcomes could be used when designing nutrition education interventions, with consideration given to these factors to optimize long-term positive behavior change.

Ethical challenges of telepsychiatry

Telepsychiatry is shifting the focus of psychiatry and psychotherapy from personal interaction and relationship building to communication with technological mediators in the form of telecommunication, virtual reality (VR), social robots or artificial intelligence (AI). This article discusses the opportunities and risks of new technologies in psychiatric treatment, taking into account the principles of medical ethics. Telepsychiatric treatments can promote self-determination in the home environment as opposed to institutionalisation but carry the risk of uncontrolled data sharing. They harbour risks of potential harm such as social isolation, negative effects on the doctor-patient relationship and long-term changes in patient behaviour through, for example, VR. In terms of justice, demographic and psychopathological factors could result in unequal access to telepsychiatry, with questionable sustainability effects. The anonymity of telepsychiatry threatens alienation, while moral considerations cannot be replaced by AI for the time being. It is obligatory to carefully weigh up the benefits and risks of telepsychiatry, but especially in rural areas they could optimise care.Precisely because of ethical concerns, further intensive research is necessary to weigh up the risks and benefits. The development of telepsychiatric systems requires transdisciplinary co-operation. At a societal level, the significance of technologies as a supplement or replacement for the doctor-patient relationship needs to be discussed.

Urartu Yerleşim Arkeolojisine Yeni Bir Örnek: Tutmaç Taş Kale

Settlement Archaeology, one of the sub-branches of archaeology, is actually a science based on the use of science and natural sciences to understand, describe and explain long-term cultural and behavioural changes. This branch of science, which evaluates archaeological settlements according to environmental conditions, has been accepted since the 19th century. This branch of science, which has been applied on many settlements around the world, has not been tried on the centres of the Urartu Kingdom until now. The Urartu Kingdom, which existed between the 9th and 7th centuries BC, actually achieved this long-lasting sovereignty thanks to its ability to dominate the environmental conditions. In the Van Lake Basin, the main distribution region of the kingdom, some 120 fortresses dating back to the Urartu Period have been identified. The fortresses are mostly scattered around the fertile plains and plains where agriculture and animal husbandry activities were carried out. One of the centres where the kingdom spread is the Gürpınar Plain and the lands irrigated by the Hoşap water. Thanks to the excavations and surveys carried out in Gürpınar, we have information about the Urartian settlement order. One of these important settlements is Tutmaç Stone Fortress. Located within the borders of Tutmaç Quarter of Gürpınar, the Fortress shows a complete example of a rural tribal centre architecture with a pond, a flat settlement area and a surveillance Fortress connected to the Fortress. The place of the Fortress in the settlement pattern is discussed in this study. Key Words: Settlement Archaeology, Iron Age, Urartian, Gurpınar Plain, Tutmaç Stone Fortress

Fundamentals of leadership development: a randomized pilot study to evaluate implementation of a leadership curriculum for diversity, equity, and inclusion.

The Fundamentals of Leadership Development (FLD) Curriculum was created to increase integration of diversity, equity, and inclusion (DEI) in leadership skills. The pilot FLD course was utilized 1) evaluate short-term impact of the curriculum, and 2) evaluate optimal delivery methods of curricular interventions on diversity in a leadership context in a randomized fashion. After IRB approval, the pilot FLD course was opened to all SAGES Committee members for enrollment. All participants had access to the same online modules and discussion forum, but were randomized either to a 4-week longitudinal or 2-day intensive didactic session. Participants were asked to assess the curricular content after each online module and provide overall course feedback on all sessions. This data was collected along with leadership experience, course participation, and course completion data. A total of 79 participants registered for the FLD course, with 55 (69.7%) of participants completing the course. Of those that registered, 46 (58.2%) self-identified as underrepresented in medicine, 32 (40.5%) self-identified with she/her/hers pronouns, and 45 (57.0%) held an institutional leadership position. Fifty-nine (74.6%) participants were willing to be randomized. Course engagement was higher in the intensive course with 64.1% and 48.7% participation over days 1 and 2, respectively. In the longitudinal course, participation dropped off every week from 70%, 47.5%, 35%, and 27.5%, throughout the 4-week course. Participants who accessed the online modules spent a median time of 3h and 34min.User confidence after completion of each individual module were "somewhat confident" and "completely confident" for almost all survey respondents on a 5-tier Likert scale. The pilot FLD course appealed to SAGES members in leadership roles and who identified as. URiM. Course engagement was higher in the intensive course. Long-term behavior changes after course completion will need to be assessed with additional qualitative interviews. (300/300 words).

Long-Term Physical Activity Behavior Change in Pulmonary Rehabilitation: Promoting Motivation.

Long-Term Physical Activity Behavior Change in Pulmonary Rehabilitation: Promoting Motivation.

Early life stress induces decreased expression of CB1R and FAAH and epigenetic changes in the medial prefrontal cortex of male rats.

Several studies in both animal models and in humans have provided substantial evidence that early life stress (ELS) induces long-term changes in behavior and brain function, making it a significant risk factor in the aetiology of various mental disorders, including anxiety and depression. In this study, we tested the hypothesis that ELS in male rats (i) leads to increased anxiety and depressive-like symptoms; and (ii) that these behavioral changes are associated with functional alterations in the endocannabinoid system of the medial prefrontal cortex (mPFC). We further assessed whether the predicted changes in the gene expression of two key components of the endocannabinoid system, cannabinoid receptor 1 (CB1R) and the fatty acid amide hydrolase (FAAH), are regulated by epigenetic mechanisms. Behavioral profiling revealed that the proportion of behaviorally affected animals was increased in ELS exposed male rats compared to control animals, specifically showing symptoms of anhedonia and impaired social behavior. On the molecular level we observed a decrease in CB1R and FAAH mRNA expression in the mPFC of adult ELS exposed animals. These gene expression changes were accompanied by reduced global histone 3 acetylation in the mPFC, while no significant changes in DNA methylation and no significant changes of histone-acetylation at the promoter regions of the analyzed genes were detected. Taken together, our data provide evidence that ELS induces a long-term reduction of CB1R and FAAH expression in the mPFC of adult male rats, which may partially contribute to the ELS-induced changes in adult socio-emotional behavior.

Considering the 24-Hour Activity Cycle in Older Adults.

Older adults are often advised to engage in more moderate-to-vigorous physical activity (MVPA). Although MVPA offers significant health benefits, focusing solely on MVPA may be difficult for many in this population due to their typically higher levels of sedentary behavior (SB). Increasing light-intensity physical activity (LIPA) can offer similar health benefits and be a more achievable starting point for inactive older adults. The 24-hour activity cycle provides a conceptual model that can assist healthcare providers in promoting physical activity. This model emphasizes the interaction between four key behaviors (i.e., sleep, sedentary behavior, LIPA, and MVPA) and presents a holistic approach to optimizing the balance of these activity behaviors. This article outlines strategies to help older adults increase their physical activity and reduce sedentary time within the 24-hour activity cycle, promoting sustainable, long-term behavior change in this population.

Behavioral Changes and Long-Term Cortical Thickness Alterations in Women with Fibromyalgia

ObjectivesThe purpose of this study was to examine long-term brain and behavioral changes in patients with fibromyalgia (FM) compared to healthy individuals. MethodsData from 33 female volunteers with FM and 33 healthy controls women paired by age and school degree were used to analyze the cortical thickness from high-resolution T1-weighted magnetic resonance imaging (MRI) obtained through a 3T-MRI scanner. Additionally, the Toronto Alexithymia Scale, the Positive and Negative Affect Scale, the emotion regulation questionnaire (ERQ), and the Hamilton Depression and Anxiety rating scales were used to evaluate the behavioral changes. ResultsThe findings indicate significant cortical structure differences in the right cerebral hemisphere between groups in the insular anterior cortex precentral and postcentral gyrus (P < .001). The FM group scored higher for alexithymia (P < .01), negative affect (P < .01), anxiety (P < .01), and depression (P < .01) symptoms, on the other hand, scored lower for positive affect (P < .01). No differences were found on the left cerebral hemisphere. Furthermore, there was a negative correlation between the right insular anterior cortex and Toronto Alexithymia Scale (P < .001). ConclusionThis study showed long-term brain and behavioral changes in patients with FM, suggesting notable neurophysiological alterations associated with this chronic pain condition. It provides new insights into how FM may affect brain health and potential biomarkers for the condition.

Maternal low-dose caffeine intake during the perinatal period promotes short- and long-term sex-dependent hormonal and behavior changes in the offspring.

Maternal caffeine crosses the placenta and mammary barriers, reaching the baby and, because his/her caffeine metabolism is immature, our hypothesis is that even a low caffeine intake (250 mg/day), lower than the dose limit recommended by the World Health Organization, can promote caffeine overexposure in the offspring, leading to short- and long-term changes. Pregnant Wistar rats received intragastric caffeine (CAF) (25 mg/Kg/day) or vehicle during the gestation and lactation periods. We evaluated morphometrical, metabolic, hormonal, and behavioral parameters of male and female offspring at different ages. Even a low caffeine intake promoted lower maternal body mass and adiposity, higher plasma cholesterol and lower plasma T3, without changes in plasma corticosterone. Female CAF offspring exhibited lower birth weight, body mass gain and food intake throughout life, and hyperinsulinemia at weaning, while male CAF offspring showed reduced food intake and lower plasma T3 at weaning. At puberty and adulthood, male CAF showed higher preference for palatable food, aversion to caffeine intake and higher locomotor activity, while female CAF only showed lower preference for high fat diet (HFD) and lower anxiety-like behavior. At adulthood, both male and female offspring showed higher plasma T3. Male CAF showed hypertestosteronemia, while female CAF showed hypoinsulinemia without effect on glucose tolerance. A low caffeine intake during the perinatal period affects rat's offspring development, promoting sex-dependent hormonal and behavior changes. Current data suggest the need to review caffeine recommendations during the perinatal period.

Revolutionizing cancer survivorship: Using human-centered design to build an innovative model for whole-person healing.

355 Background: The cancer care system has struggled for decades to deliver meaningful post-tx survivorship care, relying on patient uptake of clinical guidelines for surveillance, and SCPs for health promotion and managing late effects. On paper, we know how to support survivors. However, there is a lack of “comprehensive guidance on patient-centered practices that specifically address how cancer patients experience their care or how to personalize survivorship so that it meets patients’ unique needs” (Mead et al, 2020). Tofill this gap, we developed an evidence-based, community-delivered model for whole-person healing throughout acute and extended survivorship. Methods: We co-designed a new care model with 24 survivors, shaped by their lived experience &amp; unmet needs. The pilot comprised: A) 2-day in-person retreat to evaluate healing modalities (incl. yoga, journaling, group discussion, nutrition coaching, songwriting); B) a 3-hour human-centered design workshop defining “thriving,” mapping survivorship challenges/gaps &amp; crafting an ideal care map; C) 8-12 weeks of facilitated organic social engagement with their retreat cohort. We conducted the intervention 3x (6/2003-3/2024) with 7-9 participants aged 29-60. Pre-intervention &amp; 4-month post-intervention surveys measured QOL, symptoms &amp; self-efficacy. Participants also did a qualitative survey post-intervention, sharing preferences &amp; activity impact. Results: The model addresses cancer's proximal/distal psychological, emotional, physical &amp; existential impacts. It builds a connected survivor community &amp; drives long-term behavior change with group accountability. The intervention: A) reduced fears of recurrence &amp; preoccupation with functional concerns &amp; indicated positive changes in self-concept; B) improved social connectedness. 86% agreed/strongly agreed they felt seen &amp; understood; 100% strongly agreed that they can implement 1+ new wellness/healing tool in daily life; 80% increase in confidence keeping emotional distress from interfering with life; 40% reduction in perception of cancer/Tx causing negative changes in self-concept; 60% increase in confidence keeping fatigue from interfering with life. Conclusions: A new model of post-treatment survivorship care is needed that aligns with oncology and primary care delivery, builds on the modern wellness movement, and is able to be sustained in daily life. Survivorship can be delivered in the community leveraging in-person/virtual retreats, workshops, apps and social networks. This intervention shows potential to transform survivorship care delivery &amp; radically improve outcomes.

Mind the intention-behavior gap: a qualitative study of post-myocardial infarction patients’ beliefs and experiences with long-term supervised and self-monitored physical exercise

BackgroundMany post-myocardial infarction (MI) patients struggle with physical activity behavior change (BC) for life-long secondary prevention. There is limited knowledge about factors influencing long-term physical activity BC among post-MI patients. This qualitative study aimed to explore the beliefs and experiences related to post-MI patients’ physical activity BC process following a year’s participation in a supervised and self-monitored exercise program: the Norwegian Trial of Physical Exercise After MI (NorEx).MethodsWe conducted a qualitative study, performing in-depth semi-structured interviews with a randomly selected sample of NorEx participants when they were scheduled for cardiopulmonary exercise testing after one year of participation. Interviews were transcribed verbatim and the data was analyzed by applying reflexive thematic analysis.ResultsSeventeen participants (n = 4 female [24%]; median age, 61 years; median time since index MI, 4 years) were recruited and interviewed once. Analysis resulted in four main themes (nine sub-themes): (1) Personal responsibility to exercise (Exercise is safe, Health benefits, Habitual exercise); (2) Peer social support for a sense of safety and belonging (Social exercise, Supervision is preferred); (3) Research participation transformed exercise beliefs (High-intensity exercise is superior, Personal Activity Intelligence (PAI) promotes exercise adherence); and (4) Mind the intention-behavior gap (Initial anxiety, Lack of continued follow-up).ConclusionsSeveral participants reported that they were able to maintain exercise BC during a year’s participation in NorEx. Nevertheless, a perceived lack of continued and individualized follow-up made some participants struggle with motivation and self-regulation, leading to an intention-behavior gap. Therefore, our findings suggest there is a need for individualized and continued social support and supervision from health and exercise professionals to maintain long-term exercise BC for secondary prevention among post-MI patients.Trial registrationThe NorEx study has been registered at ClinicalTrials.gov (NCT04617639, registration date 2020-10-21).

Designing for Sustained Motivation: A Review of Self-Determination Theory in Behaviour Change Technologies

Abstract Recent years have seen a surge in applications and technologies aimed at motivating users to achieve personal goals and improve their wellbeing. However, these often fail to promote long-term behaviour change, and sometimes even backfire. We consider how self-determination theory (SDT), a metatheory of human motivation and wellbeing, can help explain why such technologies fail, and how they may better help users internalize the motivation behind their goals and make enduring changes in their behaviour. In this work, we systematically reviewed 15 papers in the ACM Digital Library that apply SDT to the design of behaviour change technologies (BCTs). We identified 50 suggestions for design features in BCTs, grounded in SDT, that researchers have applied to enhance user motivation. However, we find that SDT is often leveraged to optimize engagement with the technology itself rather than with the targeted behaviour change per se. When interpreted through the lens of SDT, the implication is that BCTs may fail to cultivate sustained changes in behaviour, as users’ motivation depends on their enjoyment of the intervention, which may wane over time. An underexplored opportunity remains for designers to leverage SDT to support users to internalize the ultimate goals and value of certain behaviour changes, enhancing their motivation to sustain these changes in the long term.

A single exposure to brivaracetam or perampanel does not cause cell death in neonatal rats.

Exposure to a range of anti-seizure medications (ASMs) during early brain development adversely impacts neurodevelopmental outcomes in both animal models and in clinical studies. Many ASMs, including phenobarbital, phenytoin, valproate (VPA), and benzodiazepines, are associated with acute neurotoxicity (cell death), impaired synaptic development, and long-term behavioral changes following gestational or neonatal exposure in animals. This is mirrored in clinical studies which show lasting neurodevelopmental deficits following early-life or gestational exposure to these drugs. Brivaracetam (BRV) and perampanel (PER) are two newer generation anti-seizure medications and are of interest based on their mechanisms of action (SV2A modulator, AMPA antagonist, respectively), as other drugs with these mechanisms of action do not trigger acute neurotoxicity. Both BRV and PER show anti-seizure efficacy in developing animals, but potential neurotoxicity of these drugs is unexplored. To address this gap, we treated postnatal day (P)7 Sprague-Dawley rats with BRV (20, 40, 80 mg/kg) and PER (0.1, 0.9, 2.7 mg/kg), and assessed the induction of cell death across a range of vulnerable brain regions 24 h after exposure. Cell death was assessed using pathogreen staining. In each of the regions examined (dorsal striatum, nucleus accumbens, motor cortex, cingulate cortex, lateral thalamus, septum, hippocampus), VPA, which served as a positive control, significantly increased cell death as measured by the numer of pathogreen positive cells. By contrast, neither BRV nor PER increased the number of pathogreen positive cells in any region examined. Our results suggest that BRV and PER may have a positive safety profile-at least with respect to acute induction of cell death - and therefore may offer a safer option for the treatment of early life seizures.

Together we win! Narratives of couples pursuing a healthy diet and physical activity: A qualitative study.

Metabolic syndrome (MetS) is a major risk factor for non-communicable diseases, including type 2 diabetes mellitus, cardiovascular disease, and cancer. The risk of MetS can be transmitted via epigenetic processes from both the mother and the father. Therefore, it is essential that both members of a couple are targeted in pre-conception nutrition and physical activity-based lifestyle programs. However, lifestyle interventions targeting both members of a couple are scarce in the literature. This study, therefore, aimed to explore the barriers and facilitators of a couples-based lifestyle intervention. Nulliparous couples who had an interest in having children in the future were recruited to the study and each member interviewed separately to gain insight into to gain insight into designing future couples-based lifestyle interventions. Interviews were conducted between June and October 2021. Reflexive thematic analysis (RTA) was applied to conduct and analyse semi-structured, in-depth interviews with nulliparous couples who had an interest in having children in the future. Four major themes were identified in nine couples aged 25-34 years (here referred to as "millennials"): Millennials are committed to preparation for their future offspring; millennials know features of a good program likely to have high adherence and long-term behavior change; millennials acknowledge the importance of couples-based programs; and millennials appreciate that future global emergencies may require lifestyle modifications. This study found that millennial couples showed a strong intention to create optimal emotional, financial, and health conditions for their children. They supported couples-based approach (CBA) lifestyle interventions to mitigate potential epigenetic risks. Couples believed that participating together in these programs would enhance adherence to healthy habits, promoting long-term well-being. The findings advocate for exploring and testing CBA interventions that target both partners, as joint participation not only aids in healthy conception and reduces metabolic syndrome risks but also establishes a foundation for family health. These insights highlight the potential of CBA interventions to positively impact future generations.

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

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

Travel behaviour transformations in Indonesia: Assessing the long-term impact of COVID-19 on mobility patterns

This study examined the long-term impacts of the COVID-19 pandemic on mobility patterns in Indonesia, focusing on the transition from pre-pandemic norms to the endemic phase. Using quantitative methods and retrospective data analysis, we explored changes in travel behaviour, including mode choice, trip frequency, and travel time. We identified travel behaviour in three phases: pre-pandemic, pandemic (March 2020 to the end of January 2022), and transition to endemic (the data collection period: July – August 2022). Our investigation of the shifts in travel behaviour across these periods enabled us to distinguish between temporary fluctuations and enduring, potentially long-term changes in behaviour. The empirical investigation revealed significant alterations in trip frequency that persisted during the endemic phase, suggesting that these changes in mobility are likely to continue. Factors influencing these shifts include socioeconomic characteristics, work modalities, and attitudes toward health protocols. This study contributes to the understanding of pandemic-induced travel behaviour transformations and provides insights for policymakers and transportation planners to adapt to these changes in the Southeast Asian context.

The effect of anhedonic traits on snack food consumption and interoception of food-related pleasure and bodily sensations

Human eating behaviour is driven by the need to secure energy demands and the desire for pleasure. Signals from the body guide this behaviour, relying on the ability to sense internal sensations. Impaired interoception has been linked to unhealthy eating habits. However, the impact of anhedonia (reduced ability to experience pleasure) on interoception and eating behaviour has not yet been studied and could enhance our understanding of eating behaviour. We conducted a cross-sectional study using self-report measures on 309 Chinese consumers with high (n = 150) and low (n = 159) anhedonic traits to explore differences in interoceptive experiences of snack food consumption. Specifically, we investigated interoceptive awareness, intuitive eating, and food-related pleasure using validated questionnaires. Additionally, we examined snack intake frequency, drivers of snack food consumption and post-ingestive sensations using self-developed questionnaires. We hypothesised that individuals with high anhedonic traits would exhibit low interoceptive awareness and lower intensity of interoceptive sensations linked to snack food consumption. Consistent with our hypotheses, low interoceptive awareness and intuitive eating were observed in individuals with high anhedonic traits. Furthermore, individuals with high anhedonic traits reported lower food-related pleasure, lower healthy snack intake frequency, and lower intensity of post-ingestive sensations for healthy snacks compared to the group with low anhedonic traits. Differences detected between groups were mainly detected for healthy snacking and not unhealthy snacking. Understanding how anhedonic traits relate to food pleasure and bodily sensations related snack consumption can provide novel insights and clarify focus areas for developing strategies supporting interoceptive awareness for long-term dietary behaviour changes.