Mental Difficulties Research Articles

The Art of Not Stopping: Grit Among the Breadwinner Senior Citizens in Pilar, Bataan

Approximately fifty percent of elderly individuals in the Philippines are currently employed. A significant number of them are exposed to health hazards and have a low socioeconomic level despite having worked for a considerable number of years. The current study aims to provide a detailed account and analysis of the core essence of the experience of breadwinner senior citizens as they strive to maintain their grit for numerous years. The findings revealed four themes, or 4K of grit, namely: keep on, keep at, keep up, and keep growing. Each theme generated subthemes that further elaborated on the experiences of breadwinner senior citizens. Keep on is divided into five subthemes: familial’s sake, financial autonomy, fortitude in the past, and founding leisure. Keep at is divided into two themes, namely the personification of aging and perceived hardships. Meanwhile, the keep-up had four subthemes: guarding the mind, being God-centered, getting support, and having greater focus in the body. Lastly, the keep growing is composed of two themes the steadfastness in work and senescence’s’ joy. While the participants have shown resilience in the face of several challenges, it is strongly recommended that local government agencies improve and closely supervise the current program and activities aimed at addressing the financial difficulties as well as the physical and mental difficulties of the breadwinner senior citizens. More so, the said research will add additional fund of knowledge in the field of gerontology and psychology in the Philippines.

Domestic difficulties faced by women with a severe mental disorder: A qualitative study

When the family is considered as a system, individuals with a severe mental disorder can be affected by all the processes and conditions in the family. Women with a severe mental disorder are also affected by many factors such as their place in the family and society, gender roles and gender inequality. In the study, the authors aimed to determine domestic difficulties faced by women diagnosed with a severe mental disorder who were followed in a Community Mental Health Center in a province in the west of Türkiye. The study was a descriptive qualitative research design. Women who were diagnosed with a severe mental disorder, who were followed by the for mentioned Community Mental Health Center and who met the inclusion criteria were included in the study. The data collected using the one-on-one interview method were analyzed with the content analysis method. After the analysis of the data, the following four main themes related to the difficulties experienced in the family by women with a severe mental disorder identified: domestic violence, being both a sick person and a caregiver, stigma and coping strategies. It was concluded that women individuals with a diagnosis of a severe mental disorder experienced not only mental disorder-related difficulties but also difficulties of being a woman in the society brought about by their gender roles.

Network Analyses Applied to the Dimensions of Cancer-Related Fatigue in Women With Breast Cancer.

Understanding cancer symptom cluster through network analyses is a new approach in oncology, revealing interconnected and influential relationships among reported symptoms. We aimed to assess these relationships using network analysis in posttreatment breast cancer patients, focusing on the five dimensions of cancer-related fatigue (CRF), and on other common difficulties encountered by oncological patients (i.e., pain, anxiety, depression, sleep difficulties, cognitive impairments, and emotion regulation and mental adaptation difficulties). This study involved a complementary analysis of data from two interventional studies. Participants completed questionnaires before and after the intervention, with baseline scores being used in this article. Partial correlation network analysis modeled the relationships between symptoms in five distinct networks, each of them including one specific dimension of CRF. The core symptom in each network was identified based on the highest centrality indices. Depression emerged as the core symptom in all networks, strongly associated with all fatigue dimensions (partial correlations ranging from 0.183 to 0.269) except mental fatigue. These findings indicate robust connections between symptoms, as variations in depression scores directly or indirectly influence fatigue and other symptoms within the cluster. Our results support the multidimensional aspect of CRF, and its links with other common symptoms. To effectively reduce patient CRF, interventions should address not only fatigue but also the closely related symptoms from the cluster, such as depression, given its centrality in the cluster. ClinicalTrials.gov (NCT03144154 and NCT04873661). Retrospectively registered on May 1, 2017 and April 29, 2021, respectively.

Behind Bars and Beyond: Navigating the Terrain of Gender Justice in Indian Prison

The research aims to compile data on the challenges faced by women in prison and the available legal remedies for their plight. To guarantee women prisoners' protection and provide a non-custodial degree of punishment, the Bangkok Rules was established in 2010 by the United Nations General Assembly. Overcrowding, inadequate sanitation and cleanliness, poor nutrition, a lack of education, violence, and the hazards of pregnancy and child care are merely some of the physical and mental difficulties that women confront in prisons in India. Women are safeguarded against exploitation and granted access to essentials by a multitude of laws, regulations, and standards. In reaction to human rights violations against such convicts, the Indian judiciary has vigorously interpreted Articles 19, 21, 22, 37, and 39 A of the Indian constitution. What options does a woman have when "caretakers" are turned into abusers? Their predicament is exacerbated by the prevailing state of prisons, gender bias, abuse while incarcerated, harsh treatment of children, inadequacy of fundamental human rights, and restricted availability of prison resources. The research envisages the pressing need for improvements by addressing women's rights, challenges, and variables in prison.

Investigating Physical, Social, Emotional, and Health Frailties of Cancer Survivors after Cancer Treatment: The Urgent Call for Tailored Multidisciplinary Survivorship Plans in Italy.

Understanding the specific needs of cancer survivors is essential for healthcare policy. In Italy, dedicated studies are lacking, so we aimed to investigate the physical, mental, social, and health difficulties encountered by these patients. We conducted a cross-sectional study on breast or colorectal cancer survivors (people 5+ years free from it and its treatments) using an ad hoc survey including validated questionnaires (Grauer-Palombi, SF-36, PREDIMED). Participants were recruited within the Oncology Unit of the "Policlinico Tor Vergata", Italy. A total of 62 patients (80.6% females; years range: 37-87) agreed to be interviewed. A profile of cancer survivors was drafted: an overaged person with multiple co-morbidities, not well-nourished, adhering to the Mediterranean diet, reporting critical conditions as for physical and functional status. The mean number of co-morbidities was 3.6 ± 2.4 SD, with a statistically significant difference between age groups (under and over 65). Compared to the general population, the sample showed more frailties, especially when >65. The risk of having multimorbidity (four or more co-morbidities) significantly increased in those over 65 (OR: 4.72; CI: 1.43-15.59). There is an urgent need for survivorship care planning for the patient-centered continuum of care. Assessing and monitoring their specific needs will help propose appropriate and tailored responses.

Forming inflection and word-formation operations in preschoolers with mental retardation

Introduction. At the present stage of societal development, great attention is paid to issues affecting the psychological and pedagogical support in the educational process of children with disabilities. One general pattern of dysontogenetic development is violation of speech mediation. The most important areas of assistance to children with special educational needs are: identifying speech defect specifics and creating additional special conditions that will facilitate assimilation of educational programs and the social development of each student’s personality. The study aims to develop and test a program for forming inflection and word-formation operations in preschoolers with mental retardation. Materials and methods. The study involved 92 preschoolers aged 6-7 with mental retardation. The research methods were: Methodology of psycholinguistic study of oral speech disorders in children by R.I. Lalaeva, Diagnostics of oral speech of children aged 4-7 by N.V. Nishcheva; mathematical statistics: χ2-Pearson criterion. Results. The ascertaining experiment showed that preschoolers with mental retardation are characterized by predominantly low level of formation of inflection and word-formation operations. Specific difficulties were identified: omission or incorrect use of prepositions in speech; errors in changing nouns in indirect cases; deficiencies in the agreement of an adjective with a noun in the neuter gender; lexical substitutions of nouns, verbs when forming new words using suffixes and prefixes; replacement and incorrect use of suffixes while forming relative and possessive adjectives, etc. After the formative experiment, significant shifts occurred both in the level of noun inflection operations (χ2 = 19.739; p ≤ 0.05) where the number of children at a low level decreased from 64% to 32%, and in the level of verb word-formation operations (χ2 = 30.61; p ≤ 0.05) where the number of children at an average level increased from 39% to 58%. Conclusion. Preschoolers with mental retardation experience difficulties in grammatically designing speech utterances. The data obtained in the experiment show that speech difficulties are due to the delayed development of inflection and word-formation operations and the qualitative peculiarity of the manifestation of the defect. Studying grammatical operations in young children with mental retardation and the specifics of the manifestation of this disorder in written speech is a promising further direction.

Online paedophiles and the criminal justice experience: A qualitative perspective

BackgroundOnline forums provide a conduit for anonymous communication within deviant subcultures, such as online paedophiles. This helps to build virtual communities of support. ObjectiveThis study explores the experience of paedophiles in the criminal justice system as reported by those who experienced it on such a forum. By analysing and understanding the experiences disclosed by these individuals, we may be able to design more targeted prevention strategies and treatment options.Participants and Setting.Data are from one online forum discussion thread that includes 595 online forum posts by 212 unique usernames ranging over 11 years from 2012 to 2023. This forum claims to be an anonymous “therapeutic community” for paedophiles and does not allow the sharing of media (e.g., videos or images). MethodsThis study uses an inductive approach to analyse the posts and discover the perspective and concerns of users who have experienced or are faced with prosecution and punishment. ResultsSeven main themes emerged from the posts on this thread: support and praise, techniques of neutralisation, life in prison, anxiety and mental health, relationships, therapy, and difficulties post-prison. ConclusionsThe forum provided an important source of support among a virtual community of people who shared similar sexual interest in children and feel rejected and demonised by mainstream society. The thread functioned like an “echo chamber” that reinforced a positive view of users' deviant interest. Individuals who had been prosecuted for their offending were returning to the forum, which may encourage reoffending. Parole boards and probation officers may need to consider limiting or restricting access to the Internet, particularly the Tor network, when setting release conditions. Implications for treatment focus on challenging the justifications and excuses used by paedophiles.

Global and inclusive considerations for the future of ACEs research

Exposure to Adverse Childhood Experiences (ACEs) can increase the risk of physical, mental, behavioral, and educational difficulties across the lifespan. ACEs research to date has largely had an individualistic approach, considering experience impacting one person within their own family. In order to be more relevant across societies and cultures around the globe, there is a need to build on current ACEs research by also considering broader aspects of the social ecology including individual, societal, and cultural factors. This commentary discusses the limitations of the current ACEs research and the need to also consider social and methodological aspects of adversity. The importance of considering protective factors is also discussed.

Anxiety's correlation with sleepiness and memory among security officers during the COVID-19 pandemic.

In the working population especially among older adults, anxiety problems have grown dramatically. This element has a significant impact on employee absenteeism and problems with physical and mental health. It was widely known that security personnel had several physical and mental difficulties during their various work hours. It is important to investigate the effects of anxiety on them. The present study aims to provide insights into the prevalence of anxiety disorders and explore the correlations between anxiety symptoms, sleep, and memory during the COVID-19 pandemic. To conduct a cross-sectional study, 42 older adult participants between the ages of sixty to seventy years were chosen and the procedure was explained.Data were gathered by giving instructions on how to complete the self-reported Generalized Anxiety Disorder Assessment -7 (GAD-7), the Epworth Sleepiness Scale, and the revised Everyday Memory Questionnaire. A total of 36 out of 42 participants (85.71%) experienced moderate to severe anxiety. Anxiety and sleep had a correlation of 0.8, while anxiety and memory had a correlation of 0.87 with a positive EMQ-R relationship. Moreover, there was a statistically significant association between sleep and memory, with a positive correlation of 0.73. The study concludes that, there is a substantial prevalence of anxiety accompanied by notable insomnia and memory problems in elderly security officers. Our findings indicate a clear relationship between sleep disturbances, memory issues, and most prevalent anxiety symptoms. These results emphasize the importance of incorporating mental health assessments and addressing an effective treatment for anxiety.

Effects of noise sensitivity and listening effort on perceptual ratings of background noise.

Previous research suggests that noise sensitivity is related to inefficient auditory processing that might increase the mental load of noise and affect noise evaluation. This assumption was tested in an experiment using a dual-task paradigm with a visual primary task and an auditory secondary task. Results showed that participants' noise sensitivity was positively correlated with mental effort. Furthermore, mental effort mediated the effect of noise sensitivity on loudness and unpleasantness ratings. The results thus support the idea that noise sensitivity is related to increased mental effort and difficulties in filtering auditory information and that situational factors should be considered.

Mental health outcomes of offspring exposed to parental intimate partner violence in Rwanda

BackgroundChildren who witness parental intimate partner violence (IPV) are more likely to develop mental health issues compared to those who do not witness such violence.ObjectiveThe main objective of this study is to assess the association between parental intimate partner violence and child mental health outcomes.MethodologyThis cross-sectional study involved 548 participants divided into two groups: parents (N = 304) and offspring (N = 244). The participants were recruited from Mageragere Sector in the City of Kigali (urban), as well as Mbazi and Ruhashya sectors in Huye District (rural). To assess the difference about mental difficulties reported by the offspring, a Mann-Whitney U test was employed to compare the responses of parents and their children on mental health outcomes. Additionally, multiple linear regression analysis was conducted to explore the association between parental intimate partner violence (IPV) and the mental health outcomes of their offspring.ResultsThe results highlighted significant levels of mental and emotional challenges in children, as reported by both parents and the children themselves. Depression and youth conduct problems were more prevalent among the children compared to their parents, whereas anxiety and irritability were more commonly reported by parents than by their children. Intimate partner violence showed to be a predictor of irritability and anxiety symptoms in offspring. In terms of irritability, depression, and youth conduct problems they were identified as predictors of anxiety symptoms. Particularly, anxiety and irritability were revealed to predict youth conduct problems.ConclusionThe study indicates that parental intimate partner violence (IPV) has an impact on the mental well-being of their offspring. Furthermore, it was observed that there is not only a correlation between IPV and poor mental health outcomes, but also a connection between different mental conditions, implying that children exposed to IPV are more prone to experiencing a range of mental issues. As a result, intervention programs should place emphasis on addressing the mental disorders of both parents and children.

Analysing Coverage of Maternal Mental Health in Indian Newspapers: A Content Analysis

Issues related to maternal mental health, such as anxiety, depression, and psychosis both during and after pregnancy, have attracted international attention. The World Health Organization has documented a notable occurrence, particularly in developing nations. The function of print media in raising awareness about these concerns is vital. This study investigates the extent to which Jaipur's daily newspapers in 2022 address the topic of maternal mental health. The objective is to evaluate how often this issue is covered and the influence it has on women's knowledge and understanding. A descriptive survey study methodology was employed to collect data from 250 women. The data collection process involved purposive sampling and the use of questionnaires. An examination of the content of Rajasthan Patrika and Dainik Bhaskar in July 2022 found that there was no reporting or discussion on maternal mental health. According to surveys, 35% of the participants reported experiencing mental difficulties when they were pregnant, although a majority of 84% did not actively seek medical assistance. Many respondents (90%) expressed the opinion that newspapers should publish articles on this subject. The study finds that there is a notable disparity in media coverage of maternal mental health in Jaipur, indicating a requirement for heightened awareness and focused health communication initiatives.

Minding mentalizing - convergent validity of the Mentalization Breakdown Interview.

Mentalizing difficulties are central to borderline personality disorder (BPD), have severe consequences, and are an explicit focus in mentalization-based treatment. The significance of mentalizing capacity as a predictor or mediator of change is however still uncertain due to a scarcity of research. The Mentalization Breakdown Interview (MBI) was developed as a time saving tool for studying psychotherapy processes and outcome in borderline pathology. This study aimed to investigate the convergent validity of reflective functioning (RF) ratings based on the MBI (MBI-RF) by a comparison with the gold standard, i.e., RF assessments based on the Adult Attachment Interview (AAI-RF). A secondary aim was to investigate how MBI-RF relates to core symptoms of BPD, levels of functional impairment and symptom distress compared with AAI-RF. Forty-five patients with BPD or significant BPD traits were included. MBI-RF and AAI-RF were rated using the Reflective Functioning Scale. Levels of MBI-RF and AAI-RF and the correlation between the measures were calculated, as well as their associations with the Difficulties in Emotion Regulation Scale, Levels of Personality Functioning-Brief Form 2.0, Work and Social Adjustment Scale, Patient Health Questionnaire, Depression, Generalized Anxiety Disorder-7, self-harm, suicide attempts, and PD diagnostics. The correlation between MBI-RF and AAI-RF was 0.79 (p<0.01), indicating high convergent validity. There were few significant associations between MBI-RF and AAI-RF and clinical measures. The study provides support for the convergent validity of the MBI as a BPD-focused RF assessment method. The MBI has the potential as a time saving, reliable and valid method to be applied in treatment research on patients with borderline pathology. The results indicate that measures of MBI-RF and AAI-RF are different from clinical symptoms. ClinicalTrials.gov ID NCT04157907.

Exploring Young Adults' Reluctance to Engage With Psychiatric Hospitals in Erbil, Iraq: Identifying Barriers to Psychiatric Care.

In Erbil, Iraq, the reluctance of young adults to engage with psychiatric services is influenced by a complex array of barriers, including stigma-related, attitudinal, and instrumental factors that hinder effective mental healthcare access. This study aimed to identify these specific barriers to accessing psychiatric care among young adults in Erbil. The study utilized a cross-sectional online survey conducted between April 5th and May 1st, 2024. Data collection was carried out through purposive sampling and involved a comprehensive questionnaire. Electronic informed consent was obtained from all participants before they started the survey, which collected demographic data and utilized the Barriers to Access to Care Evaluation (BACE v3) tool. Statistical analysis was conducted using SPSS version 27 (IBM Corp., Armonk, NY). Descriptive statistics (frequency and percentage) were used for categorical data, while the mean and standard deviation characterized continuous variables. Chi-square tests, including Fisher's exact test and odds ratio (OR), were used to analyze categorical data, with a significance level set at p < 0.05. A total of 407 participants were enrolled in the study. The study highlighted several barriers to mental health care. Stigma-related barriers were significant, with participants fearing being seen as weak (mean score = 2.14, SD = 0.96) and concerns about being labeled "crazy" (mean score = 1.80, SD = 1.19). Regarding attitudinal barriers, there was a notable preference for dealing with issues independently (mean score = 2.04, SD = 0.98) and a tendency towardresolving problems without professional help (mean score = 1.88, SD = 0.98). Additionally, instrumental barriers were identified, including the rare availability of culturally diverse mental health professionals (mean score = 1.78, SD = 1.09) and practical difficulties such as arranging transportation to appointments (mean score = 0.61, SD = 0.87). The study demonstrated that young adults in Erbil face significant stigma and attitudinaland instrumental barriers to accessing psychiatric care. In response to these findings, it is recommended for the government to prioritize mental health awareness, actively destigmatize mental health issues, and improve service accessibility to foster a supportive care environment. Additionally, mental health professionals and educational institutions should collaborate to provide targeted support programs and resources for young adults.

Self-reported problems and functional difficulties in anxious pregnant women in Pakistan: The use of a patient-generated mental health outcome measure.

Anxiety during pregnancy affects women worldwide and is highly prevalent in Pakistan. The Psychological Outcome Profiles (PSYCHLOPS) questionnaire is an instrument used in therapy to assess patient-generated problems and the consequent functional difficulties. Using the PSYCHLOPS, we aimed to describe the type of problems and the consequent functional difficulties faced by anxious pregnant women in Pakistan. Secondarily, we sought to explore if a cognitive behavioral therapy (CBT)-based intervention brought about changes in the severity score for certain problems or functional difficulties. Anxious pregnant women were recruited from the Obstetrics/Gynecology Department of a tertiary hospital in Rawalpindi, Pakistan. Of 600 pregnant women randomized to receive a psychosocial intervention for prenatal anxiety delivered by non-specialist providers, 450 received ≥1 intervention session and were administered the PSYCHLOPS. Eight types of problems were identified; worries about the unborn baby's health and development (23%), concerns about family members (13%), and financial constraints (12%) were the most frequently reported primary problems. Severity scores between baseline and the last available therapy session indicated the largest decrease for relationship problems (mean = 2.4) and for concerns about family members (mean = 2.2). For functional difficulties, 45% of the participants reported difficulties in performing household chores, but the intervention showed the greatest decrease in severity scores for mental or emotional functional difficulties. Focus on certain types of patient-generated problems, e.g., relationship problems, could anchor therapy delivery in order to have the greatest impact. Tailored CBT-based intervention sessions have the potential to address important but neglected problems and functional difficulties in anxious pregnant women.

Supporting the mental health of young people from ethnically diverse groups during the transition from primary to secondary school

Background: The transition from primary to secondary school is a pivotal period in young people’s lives and can significantly impact their mental health. However, the experiences of young people from ethnically diverse groups during this crucial period of physical, social and emotional development are under-researched, limiting the evidence base for meaningful support. Objectives: This study explored the experiences of young people from ethnically diverse groups during primary-secondary school transition and co-designed ideas for culturally sensitive support. It explicitly focused on the intersection between ethnic and cultural identity, primary-secondary transition and mental health. Methods: The study employed participatory design to collaborate with seven young people from ethnically diverse groups and a peer researcher. Four online workshops mapped participant experiences and ideas concerning the primary-secondary transition, identity and mental health. These were developed into implications for practice, policy and research. Results: Participants highlighted feeling unprepared for the transition, with some experiencing poor mental health and difficulty navigating their ethnic and cultural identity during this time. Participants’ ideas for future transition experiences included: supporting a longer transition period, schools promoting diversity among students and staff, enabling education on ethnicity and culture, breaking stereotypes, enabling mutual learning among staff and students and enabling an open and caring environment to support mental health. Conclusions: The study provides an in-depth understanding of experiences of young people from ethnically diverse groups during primary-secondary transition and suggests ways of supporting multi-faceted transitions and mental health, with a key focus on ethnic and cultural identity formation.

A Cross-sectional study to assess the mental health problems during menstrual cycle among adolescent girls in the rural area of Wardha District

Introduction It is essential to improve global public health and to achieve sustainable developmental goals. Mental health problems are common during menstruation in adolescent girls. Menstrual problems affect academic performance, personal lives, and social lives. Menstrual problems are both affective and somatic. This study is undertaken to study the Impact of Menstruation on the Mental Health of young adolescent girls. The participants ‘ ages range from 15 to 19 years. Adolescent coping method ds Mental health, psychological well-being, and spiritual well-being were assessed. Menstrual-phase respondents exhibited increased psychological traits as a measure of adolescent girls’ coping with mental difficulties. Objectives To evaluate menstruation-related knowledge, attitude, sources of information, and psychological well-being To determine the mental health problems during the menstrual cycle. To find out the association between sociodemographic variables and mental health problems during menstrual cycle Methods A cross-sectional study was conducted in a rural area of the Wardha district. This study used a descriptive cross-sectional research design. A sample of 364 individuals was selected using random sampling. The inclusion criteria were adolescent girls aged 15–19 years who attained menstruation. Exclusion criteria: Girls younger than 15 years and above 19 years, as well as those who were hesitant and uncomfortable asking for information to participate in the study, were excluded. Outcomes Adolescent girls experienced menstruation-related psychosocial issues that are not uncommon. Menstrual distress, burden, stigma, lack of counselling services, lack of preparation menarche, lack of easy access to clean resources, vacy concerns when changing pads are necessary, lack of facilities for disposing sanitary napkins, and inadequate psychological and social support. Most girls experienced stress, mood swings, and restlessness during their menstrual cycle. These findings are consistent with past studies that found that the majority of girls were agitated during menstruation. Approximately 25% of them felt ashamed and guilty about their pubertal changes, and experienced menarche in fear, shyness, and sadness. On the first day of menstruation, girls report psychological problems such as anxiety, trouble concentrating, sadness, irritability, and excitement7. Approximately two-thirds of teenagers in the current study were unaware that menarche occurred earlier.

AI시대 속의 다문화 가족이 처한 현실에 관한 논의

The purpose of this study is that in the AI era, now we are faced up that the multi-cultural families and their members are experiencing the realistic difficulties which was brought about by the multi-cultural phenomenon, so I would like to suggest that how can our society have receptive attitude for them and also suggest about care plan for them. Our reality is facing a national crisis of population decline and labor shortage. The world is changing at a very rapid pace, and technological civilization is becoming more advanced. However, the area where progress is particularly slow is in terms of immigrants settling into Korean society, learning the Korean language, and accepting to Korean culture, just like as soul-food. It is also time for us to pay attention to the physical, mental and psychological difficulties which the members of multi-cultural families are experiencing. It is time for us to need some concerns and cares about that quick change from unfamiliarity to familiarity within their family relationships, in adjusting in school life of their children, and in their living environment. Counseling and therapeutic approaches to these people should also be implemented in parallel with Korean language education and cultural adaption education. It is also necessary to refine laws and systems. We must recognize that these people are also members of our society, and we need to put our heads together for the wisdom.

Fresh goose-fat to cure a nightmare?

The health problems of the draughtsman Nebre involving the intervention of deities are well-known in Egyptological literature. Several stelae set up by him bear witness of his gratitude for the benevolence shown by deities in curing sicknesses within his family.&#x0D; The texts of two ostraca – one of which unknown so far – present more insight into the mental difficulties of this prominent member of the Deir el-Medina community and the remarkable proposed medical prescription.

Implementing a student-centered stroke intervention and prevention education program; evaluating motivation, cognitive load, and performance among middle school students.

In this study, we investigated the association between motivation, cognitive load, difficulty, and performance in a stroke education outreach program implemented for middle school students. Various interactive instructional activities were developed to engage students throughout the program to assess cognitive and intrinsic load arising from learner implementation of various tasks in a stroke education program for middle school kids. Performance was measured using a post-test to assess knowledge gained by the 6th, 7th, and 8th-grade middle school students. A short questionnaire was also administered to collect data on students' motivation using the ARCS model to asses attention, relevance, confidence, and satisfaction. In addition, we evaluated difficulty level and cognitive load. The relationship between performance and motivation was assessed using Pearson's correlation. In our results, there was no significant difference (p > 0.05) in performance between the 6th, 7th, and 8th-grade students. The difference in performance, cognitive load (mental effort and difficulty), or motivation between the 6th, 7th, and 8 t-grade students was not significant (p > 0.05). The correlation between motivation and performance was significant (r = 0.87, p = 0.001), while the correlation between mental effort and performance was not significant (r = 0.34, p = 0.270). Also, the correlation between difficulty and performance was not significant (r = 0.38, p = 0.361). In the ARCS motivation model, attention, and confidence received the lowest mean scores (3.9), while relevance received the highest score (4.3). Our findings reveal the importance of implementing novel activities to enhance students' motivation to improve performance in the implementation of stroke education outreach programs for middle school students.