Health Behavior Models Research Articles

Developing a Chain Mediation Model of Recurrence Risk Perception and Health Behavior Among Patients With Stroke: A Cross-sectional Study

PurposeTo understand the recurrence risk perception of stroke patients and develop a chain mediation model of recurrence risk perception and health behavior. MethodsA cross-sectional study and convenience sampling were used. Stroke survivors were recruited from the neurology departments of three tertiary hospitals. Their recurrence risk perception, behavioral decision-making, social support, self-efficacy, recurrence worry and health behavior were measured by relevant tools. Data was analyzed through one-way analysis and regression analysis; and the AMOS 21.0 software was used to explore the mediating relationships between variables. ResultsOf the 419 participants, 74.7% were aware of stroke recurrence risk. However, only 28.2% could accurately estimate their own recurrence risk. Recurrence risk perception was significantly correlated with behavioral decision-making, social support, self-efficacy, and health behavior (r = .19 ∼ .50, p < .05). Social support and recurrence risk perception could affect health behavior indirectly through self-efficacy, behavioral decision-making and worry. Behavioral decision-making acted as a main mediator between recurrence risk perception and health behavior, while the path coefficient was .47 and .37, respectively. The chain mediation effect between recurrence risk perception and health behavior was established with a total effect value of .186 (p < .01). ConclusionMost stroke survivors could aware recurrence risk but failed to accurately estimate their individual risk. In the mediation model of recurrence risk perception and health behavior, social support seemed to be an important external factor, while self-efficacy, behavioral decision-making and worry seemed to act as key internal factor. RegistrationThe research project was registered on 29 June 2020 (CTR200003XXXX).

Effects of a Customized Diet Education Program Using a Mobile Instant Messenger for People Undergoing Peritoneal Dialysis: A Feasibility Test

PurposeThe study was conducted to develop a customized diet education program using mobile instant messenger for people undergoing peritoneal dialysis (PD). Our goal was to examine the program’s effects on diet-related self-efficacy, dietary self-care compliance, and physiological indices (hemoglobin, albumin, potassium, and phosphorus). MethodsThis was a quasi-experimental study with a non-equivalent control group pre-post-test design. We applied the Cox interaction model of client health behaviors. Overall, 43 patients (21 in the experimental group and 22 in the control group) attending the renal clinic and undergoing PD at three hospitals were included. The experimental group underwent a customized diet education program using a mobile instant messenger for five weeks. Patients in the control group received routine care. This study was conducted in the following order: pre-test, treatment, post-test 1 (immediately after), and post-test 2 (four weeks after). ResultsThis study showed significant differences in dietary self-care compliance (F = 15.29, p < .001) and hemoglobin level (F = 7.55, p = .001) in interactions between times and groups. ConclusionsThe diet education program is an effective strategies to preventing complications and helping PD patients perform dietary self-care compliance through systematic and continuous interactions with educational nurse who is an expert in PD management of people undergoing PD.

Observation on the Effect of Parental Participation in Nursing Under the IMCHB Model in Neonatal Hypoxic-Ischemic Encephalopathy

Objective: To investigate the clinical effects of parental participation in nursing under the Interaction Model of Client Health Behavior (IMCHB) model in neonatal hypoxic-ischemic encephalopathy (HIE). Methods: The First Affiliated Hospital of Gannan Medical University included 46 newborns with HIE admitted from October 2021 to October 2023 into the study population. They were divided into a control group and an observation group according to the random number table method, with the control group adopting routine nursing, and the observation group implementing parental participation in nursing under the IMCHB model. The indicators of physical, intellectual, and psychomotor development of the two groups were compared before and after nursing. Results: The physical, intellectual, and psychomotor development of the observation group was higher than that of the control group after 3 months of nursing, and the difference was statistically significant (P &lt; 0.05). Conclusion: The implementation of the IMCHB model of parental participation in the clinical care of HIE neonates can further promote their physical, intellectual, and psychomotor development.

Tobacco Cessation Interventions in Non-Respiratory Cancers: A Systematic Review With Meta-analysis of Randomized Controlled Trials.

Considering the high rates of persistent tobacco use, effective cessation interventions are needed for cancer patients and caregivers. Despite the need, there is a significant lack of research on tobacco cessation, especially for non-respiratory cancers (breast, prostate, colorectal, cervical, and bladder cancer). The objective was to evaluate tobacco use and tobacco cessation interventions among patients and caregivers for non-respiratory cancers. Randomized controlled trials assessing tobacco cessation interventions were identified. Five electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through July 2023. Studies exclusive to lung, oral, thoracic, and head and neck cancers were excluded. Effect sizes were estimated; risk of bias was assessed. Of 3,304 studies, 17 were included. Interventions included behavioral (n = 6), pharmacotherapy (n = 2), and a combination (n = 9) treatment. Eight studies included a health behavior model; mean behavioral change techniques were 5.57. Pooled magnitude of the odds of cessation was positive and significant (odds ratio = 1.24, 95% confidence interval [Lower Limit 1.02, Upper Limit 1.51]) relative to usual care/placebo. Cumulative meta-analysis examined the accumulation of results over-time and demonstrated that studies have been significant since 2020. Two studies included caregivers' who were involved in the provision of social support. Current interventions have the potential to reduce tobacco use in non-respiratory cancers. Results may be beneficial for promoting tobacco cessation among non-respiratory cancers. There is a considerable lack of dyadic interventions for cancer survivors and caregivers; researchers are encouraged to explore dyadic approaches.

Development of a postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract: a reliability and validity study

ObjectiveTo develop a comprehensive compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts and to assess its reliability and validity.MethodDrawing on the Interactive Model of Health Behavior, we conducted a literature review and semi-structured interviews to create a pool of 36 items. The items underwent rigorous evaluation through the Delphi method, face validity checks, and item analysis, leading to a reduction to 18 items. To assess the scale's reliability and validity, we collected data from 225 parents of children with congenital cataracts. We employed SPSS version 25.0 for data analysis and evaluated construct validity using exploratory factor analysis, content validity, internal consistency reliability, and test–retest reliability.ResultsThe compliance scale for postoperative visual function rehabilitation in children with congenital cataracts comprises 5 dimensions and 18 items. Exploratory factor analysis extracted 5 common factors, with a cumulative variance contribution rate of 68.178%. Item-level content validity index ranged from 0.730 to 1.000, and the content validity index of the scale was 0.963. The total Cronbach's alpha coefficient, split-half reliability, and test–retest reliability of the scale were 0.855, 0.778, and 0.859, respectively.ConclusionsThe compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts demonstrates acceptable reliability and validity. It serves as a valuable reference for developing standardized nursing programs for these children in clinical practice.

Skin cancer risk behaviors in sexual minority men: A mixed methods approach.

Sexual minority men experience disproportionately elevated rates of skin cancers, likely driven by excess ultraviolet radiation exposure-namely through tanning behaviors. However, limited integrated theoretical models exist to explain sexual minority men's elevated skin cancer risk. The aim of the current study is to further test and refine an integrated theory of skin cancer risk behaviors among sexual minority men by incorporating minority stress into the integrated health behavior model of tanning. The study employed a parallel mixed methods design, with a Phase 1 qualitative stage (N = 30) and a Phase 2 quantitative stage (Model 1: N = 320; Model 2: N = 319). In both phases, participants were sexual minority men, equally stratified as those with versus without recent tanning exposure and were recruited from across the United States. Qualitative and quantitative data supported the overall integrated model, with some quantitative paths varying depending on the tanning behavior outcome. Overall, appearance-related motives to tan and beliefs that tanning regulates affect emerged as the most consistent proximal predictors. Minority stress significantly predicted holding more positive attitudes toward tanning as an effective affect regulation strategy. The results from this mixed methods study support the inclusion of minority stressors into the adapted integrative health behavior model of tanning. Replication within prospective designs would strengthen the evidence for this model, which may be helpful in guiding future skin cancer prevention programs tailored to sexual minority men. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors Influencing Insulin Adherence among Outpatients with Type 2 Diabetes Mellitus and the Impact of Pharmaceutical Intervention: A Randomized Clinical Trial

Aims. This study aimed to identify and analyze the factors significantly influencing long-term insulin medication adherence among outpatients and to evaluate whether pharmaceutical interventions targeting these factors can improve patient medication adherence and glycemic control. Methods. A cohort of 180 patients was recruited from a tertiary hospital in Nanjing, China. Factors potentially influencing insulin adherence were scrutinized employing the KAP (knowledge, attitude/belief, and practice) health behavior model. Baseline characteristics were extracted from the hospital information system, while patient knowledge of the disease and medication, medication adherence, medication beliefs, and management self-efficacy were assessed, respectively, using self-developed questionnaires, MMAS-8, C-DMSES, and BMQ scales. Univariate and multivariate analyses were conducted to determine the impact of these factors on insulin adherence. Following this, participants were randomly allocated to either the intervention or control group. The intervention group received three months of weekly telephone sessions and educational interventions targeting facets such as medication knowledge and beliefs, while the control group received standard care. After the intervention, insulin adherence and glycemic control conditions of both groups were collected and re-evaluated. Results. After excluding lost-to-follow-up patients, 152 individuals were analyzed (intervention: 75 and control: 77). Multivariate analyses revealed factors influencing insulin adherence, including age, diabetes duration, health insurance status, HbA1c level, disease and medication knowledge, diabetes management self-efficacy, and medication beliefs (P&lt;0.05). Before targeted pharmaceutical care, no significant differences existed in insulin adherence, HbA1c levels, management self-efficacy, knowledge, or medication beliefs between intervention and control groups (P&gt;0.05). However, subsequent pharmaceutical intervention notably improved adherence, HbA1c levels, self-efficacy, knowledge, and medication beliefs (P&lt;0.05). Conclusion. This study examines the impact of glycemic control, health insurance status, management self-efficacy, level of knowledge, and medication beliefs on improving insulin medication adherence in patients with type 2 diabetes mellitus. Targeted pharmaceutical intervention can enhance medication adherence, improve glucose control, and promote rational insulin use. This trial is registered with ChiCTR2300074444.

Preferences for and intention to use an app for premenstrual mental health symptoms using the Health Behaviour Model (HBM)

Premenstrual symptoms are common, with premenstrual syndrome and premenstrual dysphoric disorder associated with decreased wellbeing and increased suicidality. Apps can offer convenient support for premenstrual mental health symptoms. We aimed to understand app preferences and Health Belief Model (HBM) constructs driving app use intention. An online survey was delivered. Structural equation modelling (SEM) explored HBM constructs. Data from 530 United Kingdom based participants who reported their mental health was impacted by their menstrual cycle (mean age = 35.85, SD = 7.28) were analysed. In terms of preferred app features, results indicated that symptom monitoring (74.72%, n = 396) and psychoeducation (57.92%, n = 307) were sought after, with 52.64% (n = 279) indicating unwillingness to pay for an app for mental health symptoms related to the menstrual cycle. Regarding HBM results, Satorra–Bentler-scaled fit statistics indicated a good model fit (χ2(254) = 565.91, p < 0.001; CFI = 0.939, RMSEA = 0.048, SRMR = 0.058). HBM constructs explained 58.22% of intention to use, driven by cues to action (β = 0.49, p < 0.001), perceived barriers (β = −0.22, p < 0.001), perceived severity (β = 0.16, P = 0.012), and perceived benefits (β = 0.10, p = 0.035). Results indicate that app developers should undertake co-design, secure healthcare professional endorsement, highlight therapeutic benefits, and address barriers like digital discomfort, privacy concerns, and quality.

Effect of Cox’s Interaction Model of Client Health Behavior Combined with Huangqi and Dangshen Decoction on Female Pelvic Floor Dysfunction

Huangqi and Dangshen have significant medicinal and medical value as natural bio-based materials, but there are few studies on female pelvic floor dysfunction. We aimed to explore the effect of the Cox’s interaction model of client health behavior (Cox-IMCHB) combined with Huangqi and Dangshen decoction on female pelvic floor dysfunction. 166 postpartum patients with Qi-deficiency syndrome of pelvic floor dysfunction were selected from Tongren Hospital of Wuhan University hospital and divided into two groups, Group A and Group B, each consisting of 83 cases. The allocation was done using the random number table method. Patients in Group A received routine nursing and biofeedback electrical stimulation treatment, while patients in Group B received Cox-IMCHB combined with Huangqi and Dangshen decoction based on Group A. We compared the clinical efficacy, syndrome efficacy, pelvic floor muscle strength scores, sexual life quality scores, VAS score, pelvic floor functional exercise compliance score, and the incidence of urinary incontinence and pelvic organ prolapse between the two groups. The results showed that Group B had better clinical efficacy and syndrome efficacy, as well as a higher total effective rate (clinical efficacy: 91.57% vs. 72.29%; syndrome efficacy: 95.18% vs. 74.70%). Moreover, compared to Group A, Group B had higher scores of pelvic floor muscle strength and sexual life quality, a lower proportion of mild pain (85.54% vs. 71.08%), and higher scores of pelvic floor functional exercise compliance. The scores of pelvic floor functional exercise compliance in both groups tended to increase with time, and there was an interactive effect between groups and time (intergroup effect: F = 322.900, time effect: F = 186.200, interaction effect: F = 27.410). The incidence of urinary incontinence (2.41% vs. 14.46%, ϰ2 = 6.319) and pelvic organ prolapse (3.61% vs. 16.87%, ϰ2 = 9.608) in group B was lower (all P &gt; 0.05). The combination of Cox-IMCHB with Huangqi and Dangshen decoction can improve the pelvic function and exercise compliance of patients with pelvic floor dysfunction, relieve pain, and have significant clinical effects, which are worthy of promotion and application.

Structural equation models of health behaviour, psychological well-being, symptom severity and quality of life in abdominal bloating.

The objective of this study was to investigate the inter-relationship between psychosocial variables and their impact on symptom severity and quality of life (QoL) concerning abdominal bloating. The study adopted a cross-sectional design with purposive sampling. Participants who consented and met the criteria for bloating based on the Rome IV classification completed designated questionnaires. Independent variables comprised health beliefs, intentions, health-promoting behaviors, social support, depression, and anxiety, while dependent variables included bloating severity (general and within 24 h) and QoL. Structural Equation Modeling (SEM) was conducted utilizing Mplus 8.0 to analyze the relationships between these factors. A total of 323 participants, with a mean age of 27.69 years (SD = 11.50), predominantly females (64.7%), volunteered to participate in the study. The final SEM model exhibited good fit based on various indices (CFI = 0.922, SRMR = 0.064, RMSEA (95% CI) = 0.048 (0.041-0.054), p-value = 0.714), with 15 significant path relationships identified. The model explained 12.0% of the variance in severity within 24 h, 6% in general severity, and 53.8% in QoL. The findings underscore the significant influence of health beliefs, intentions, behaviors, social support, depression, and anxiety on symptom severity and QoL in individuals experiencing abdominal bloating.

204 Advancing our Communal Understanding of Rectal cancer Disparities and Identifying Opportunities for Improvement (ACUeRDO)

OBJECTIVES/GOALS: Mechanisms underlying racial and ethnic disparities in rectal cancer care remain poorly understood. We aimed to identify barriers and facilitators to care among rectal cancer patients who identify as Hispanic/Latino (H/L) and to understand how these factors may differ based on rurality, social/physical context, and community support. METHODS/STUDY POPULATION: We utilized qualitative methods and a community-based participatory research framework, including partnership with a community-based organization and oversight from a community advisory board. We developed an initial semi-structured interview guide based on an ecological model of health behavior and then iteratively refined it with the assistance of our partners to incorporate unique aspects of the H/L community in a culturally appropriate manner. Eligible patients and their caregivers are invited to participate in hour-long interviews in both English and Spanish, depending on participants’ preferences. All interviews are recorded, translated, transcribed, and coded. Findings will be compiled and fed back to participantsand community stakeholders as a part of a community forum. RESULTS/ANTICIPATED RESULTS: We identified 6 areas for discussion based on our model: health beliefs (perceived severity, benefit, and barriers; self-efficacy), health literacy, others’ experiences with cancer, patient-provider relationship (patient-provider communication; provider-provider communication; language; cultural competency; discrimination), sources of support, and access to care. Participants are currently being recruited by clinical providers, through flyers in the cancer center, or via outreach from our community partner. We have interviewed 8 participants to date, with discussions ranging from the shock of the initial diagnosis, difficulties with navigating specialty care, and the complexities of shared decision making. We are expecting a total of 30-40 interviews to reach thematic saturation. DISCUSSION/SIGNIFICANCE: We hope to improve our understanding of mechanisms underlying racial and ethnic disparities in rectal cancer care and to identify potential targets for improvement. We plan to use our results to develop community-based policy interventions to improve care delivery, patient experience, and health equity.

Using an ecological model of health behaviour to identify factors associated with smoking behaviour among Buddhist novices in Thailand: a cross-sectional digital survey

ObjectiveBuddhist novices reside in Buddhist temples, which are legally designated as smoke-free areas. Nevertheless, similar to other men in their age group, they are susceptible to various risk factors that...

Abstract P219: Moderated-Mediated Effects of Environmental Barriers and Income Level on Exercise Determinants Among Black Americans With Hypertension

Introduction: Black individuals are disproportionately affected by hypertension and due to racial disparities have fewer opportunities to engage in preventive measures such as exercise compared to their White counterparts. There is a dearth of research employing a theory-driven approach to comprehensively investigate the factors contributing to disparities in exercise participation among racial groups, both at the individual and environmental levels. The I-Change Model is a contemporary health behavior model comprising three primary pillars hypothesized to influence health behavior: Awareness, Motivation, and Action/Planning. What sets this model apart is its unique emphasis on the proximity of the barrier construct to predicting behavior execution, a feature that may contribute to disparities in exercise participation, including racial disparities. Hence, this observational study aimed to apply the ‘I-Change model’ to identify factors that contribute to exercise behaviors among Black and White individuals with Hypertension. Methods: We used the I-Change model, which includes mediating behavioral determinants, along with moderators that include environmental barriers (e.g., access and transportation to a supportive exercise environment), and income (low vs. moderate and above) to gain a better understanding of racial disparities in exercise participation. Individuals with hypertension (n= 370) that comprised of Black (n= 142) and White (n= 228) adults who were recruited via an online recruitment platform and completed a survey that included validated theoretical constructs. Hayes PROCESS 4.0 Macro (model #16) for SPSS was used to construct the theoretical model and analyze the data. The model included race (x), exercise time (y), behavioral determinants (mediators), environmental behaviors, and income (moderators between mediators and exercise time). Results: I-Change determinants (risk of heart disease, planning, exercise knowledge, exercise partner/social support) mediated the relationship between race and exercise time (β= .24, 95% CI .098, .394) in favor of White participants. Moderated-mediation effects were found on barriers that interacted between planning and exercise time (β= .03, 95% CI .0018, .0674), and income which interacted between social support and exercise time, (β= .05, 95% CI .0004, .1056). Conclusion: Intervention work at the community level for low-income Black individuals with hypertension supported by a theoretical framework is needed. Specifically, an exercise promotion program that supports the development of I-Change determinants, which provides an accessible and supportive environment, would be helpful in providing equitable exercise opportunities for Black individuals with hypertension.

A Community-Based Participatory Approach in Applying the Sociocultural Resilience Model in U.S–Mexico Border Communities

Abstract: Background: Behavioral models play a key role in identifying pathways to better health and provide a foundation for health promotion interventions. However, behavioral models based in epidemiological research may be limited in relevance and utility in practice. Objectives: We describe a participatory approach within a community-based participatory research partnership for integrating epidemiological and community perspectives into the application of the sociocultural resilience model (SRM). The SRM posits that cultural processes have a symbiotic relationship with health-promoting social processes, which contribute to the health advantages among Mexicanorigin and other Latinx populations. Methods: Community action board members engaged with academic partners to interpret and apply the SRM to a community-clinical linkages intervention implemented in the context of three U.S.–Mexico border communities. In a two-day workshop, partners engaged in a series of iterative discussions to reach common definitions and measures for SRM constructs. Results: Partners described daily cultural processes as the food they eat, how they communicate, and a collectivist approach to getting things done. For intervention activities, the partners opted for intergenerational storytelling, sharing of food, and artistic forms of expression. Partners included measures of cultural nuances such as border identity and the complexities that often arise from navigating bicultural norms. Conclusions: Collaborative approaches within community-based participatory research partnerships can facilitate the adaptation and measurement of conceptual health behavior models in community practice.

Would shared decision-making be useful in breast cancer screening programmes? A qualitative study using focus group discussions to gather evidence from French women with different socioeconomic backgrounds

BackgroundTo inform the development of an online tool to be potentially used in shared decision-making about breast cancer screening, French women were questioned about participation in breast cancer screening, the health professional’s role, and their perceptions of the proposed tool.MethodsWe organised focus group discussions with 55 French women. Two different strategies were used to recruit women from high and low socioeconomic backgrounds. We applied both inductive and deductive approaches to conduct a thematic analysis of the discussions. We analysed the responses by using the main determinants from different health behaviour models and compared the two groups.ResultsIndependently of socioeconomic status, the most important determinant for a woman’s participation in breast cancer screening was the perceived severity of breast cancer and the perceived benefits of its early detection by screening. Cues to action reported by both groups were invitation letters; recommendations by health professionals, or group/community activities and public events were reported by women from high and low socioeconomic backgrounds, respectively. Among other positive determinants, women from high socioeconomic backgrounds reported making informed decisions and receiving peer support whereas women from low socioeconomic backgrounds reported community empowerment through group/community events. Fear of cancer was reported as a barrier in both groups. Among other barriers, language issues were reported only by women from low socioeconomic backgrounds; women from high socioeconomic backgrounds reported breast cancer screening-related risks other than overdiagnosis and/or overtreatment. Barriers to accessing the online tool to be developed were mainly reported by women from high socioeconomic backgrounds.ConclusionLimitations in implementing shared decision-making for women from low socioeconomic backgrounds were highlighted. An online tool that is suitable for all women, regardless of socioeconomic status, would provide “on-demand” reliable and tailored information about breast cancer screening and improve access to health professionals and social exchanges.

The Relationship Between Proximity of Collegiate Recreation Facilities and Usage Levels

The purpose of this study was to further explore the relationship between travel time and frequency of visits to collegiate recreation facilities. After surveying all students using collegiate recreation facilities at a large public southeastern US university, the local address of the 559 respondents was converted into travel time to their preferred facility using their preferred transportation method. This travel time was compared with swipe data on visits to the facility over a semester. A multinomial logistic regression was conducted to analyze the relationship between collegiate recreation facility usage level and travel time. Results support past research and ecological models of health behaviors demonstrating that proximity of recreation facilities is positively associated with higher usage by college students.

Between now and later: a mixed methods study of HPV vaccination delay among Chinese caregivers in urban Chengdu, China

BackgroundAdolescent girls in China have a low HPV vaccination rate. Although vaccination is recommended by the Chinese health authorities, the cost is not covered by the national immunisation programme. Vaccination delay, among other reasons such as supply shortage and poor affordability, may contribute to low uptake. This sequential mixed methods study aimed to identify potential factors of delayed HPV vaccination among Chinese adolescent girls.MethodsQuantitative data about the attitudes and perceptions of HPV vaccination were collected from 100 caregivers of 14–18-year-old girls using an online survey in Chengdu, China. The survey data informed a subsequent qualitative study using four focus group discussions. We conducted a descriptive analysis of the survey data and a thematic analysis of the qualitative data. The findings were interpreted using a health behaviour model adapted from the Health Belief Model and the Andersen’s Behavioural Model for Health Services Use.ResultsA total of 100 caregivers – 85 were mothers and 15 were fathers – participated in the survey; 21 caregivers joined focus group discussions. When asked about their intended course of action if the 9vHPV vaccine was out-of-stock, 74% chose to delay until the 9vHPV vaccine is available while 26% would consider 2vHPV or 4vHPV vaccines or seek alternative ways to procure the vaccine. Qualitative results confirmed that caregivers preferred delaying HPV vaccination for adolescent girls. The intent to delay was influenced by systemic barriers such as supply shortage and individual-level factors such as a preference for the 9vHPV vaccine, safety concerns, inadequate health communication, and the belief that adolescents were unlikely to be sexually active.ConclusionIn urban areas, Chinese caregivers’ intent to delay vaccination in favour of 9vHPV vaccine over receiving the more accessible options was influenced by a mix of individual and contextual factors. Focussed health communication strategies are needed to accelerate HPV vaccination among adolescents.

Socioecological influencers of health-promoting lifestyles in Chinese: a preliminary survey using convenient samples.

Healthy lifestyles are considered important means to reduce the burden of diseases. This cross-sectional study was conducted based on the Ecological Model of Health Behavior (EMHB) to analyze the factors associated with the health-promoting lifestyles of Chinese residents. We carried out a cross-sectional investigation in July 2023. Our investigated factors included social-demographic characteristics (including sex, age, education level, employment status, marital status, personal monthly income, and daily behavioral habits [which were measured by a questionnaire)], health literacy [which was measured by the Chinese version of the Health Literacy Scale Short-Form scale (HLS-SF12)], and family health [which was measured by the Chinese version of the Short-Form of the Family Health Scale (FHS-SF)]. Our outcome was health promoting lifestyle, which was measured by a revised version of Health Promoting Lifestyle Profile-II (HPLP-IIR). Data were analyzed using stepwise regression. A total of 1,402 participants were enrolled. Higher scores of HLS-SF12 (β = 0.467), having regular exercise (β = 0.212), and regular physical examination (β = 0.088) were associated with better health-prompting lifestyles. However, older age (≥60 years) (β = -0.046), drinking (β = -0.066), and sleeping time (5-6 h/day) (β = -0.048) were associated lower levels of health-prompting lifestyles. Living with family (β = 0.077), FHS-SF (β = 0.104), and married (β = -0.077) were significant influencers. Unemployed (β = -0.048), receiving retirement pay (β = -0.053), and economic support provided by parents (β = 0.094) were associated with better health-prompting lifestyles. There were multiple influencing factors of the six dimensions of the HPLP-IIR. Our findings indicate that community residents with higher health literacy, better family health, and health-related behaviors tend to have better health-promoting lifestyles. Our findings have confirmed the complex impacts of social-ecological factors on health-promoting lifestyles, which may help policy makers with health-promotion strategies making and also help researchers to control for confounding in study design.

Health Behavior Models and Mental Health Literacy in Realizing Family Resilience

Health Behavior Models and Mental Health Literacy in Realizing Family Resilience

Predictors of unmet needs among people with diabetes mellitus type 2 in Gampaha district of Sri Lanka.

Diabetes mellitus is a significant contributor to the disease burden in Sri Lanka. Despite government efforts to improve access to care for those with chronic illness, major gaps remain. We assessed the prevalence and correlates of unmet needs among persons with diabetes mellitus type 2 to inform policies on improving healthcare access in a predominantly tax-funded public healthcare system. A descriptive cross-sectional study identified 401 persons with diabetes mellitus type 2 using a multi-stage cluster sampling method from 1767 individuals aged 40-69 from the Gampaha district, just north of the capital Colombo. An interviewer-administered questionnaire gathered data on unmet needs for physician care, medicines, and investigations during the preceding year. Associated factors, identified from the health behaviour model, were examined using binomial logistic regression with significance set at p<0.05. One-fifth experienced an unmet need (95%CI:15.7-23.7), with 16% for physician care (95%CI:12.7-20.2), 4.2% for medicines (95%CI:2.5-6.7) and 6.0% for investigations (95%CI:3.9-8.8). People who frequently visited a private provider experienced less unmet needs overall. Being female (AOR 0.50; 95%CI:0.27-0.92) and having a higher income (AOR 0.37; 95%CI:0.16-0.83) reduced unmet need for physician care. Absence of other major chronic illnesses (AOR 0.31; 95%CI:0.12-0.80) and having a regular care provider in the public (AOR 0.24; 95%CI:0.07-0.89) or private sectors (AOR 0.18; 95%CI:0.05-0.68) reduced unmet need for investigations with the latter also reducing unmet need for medicines (AOR 0.11; 95%CI:0.02-0.77). Despite Sri Lanka having a predominantly publicly financed healthcare system, persons with diabetes mellitus experienced unmet healthcare needs, mainly for physician care which varied with socio-economic characteristics. It is important to ensure uninterrupted care, universally for all, through patient-centred models of care linked to a regular provider. Health planners should take account of unmet needs when expanding public sector coverage for chronic illness care.