Positive Health Behavior Change Research Articles

Health Behavior Change and Complementary Medicine Use: National Health Interview Survey 2012.

Backgroundandobjectives: Complementary and alternative medicine (CAM) use has been associated with preventive health behaviors. However, the role of CAM use in patients’ health behaviors remains unclear. This study aimed to determine the extent to which patients report that CAM use motivates them to make changes to their health behaviors. Materials and Methods: This secondary analysis of 2012 National Health Interview Survey data involved 10,201 CAM users living in the United States who identified up to three CAM therapies most important to their health. Analyses assessed the extent to which participants reported that their CAM use motivated positive health behavior changes, specifically: eating healthier, eating more organic foods, cutting back/stopping drinking alcohol, cutting back/quitting smoking cigarettes, and/or exercising more regularly. Results: Overall, 45.4% of CAM users reported being motivated by CAM to make positive health behavior changes, including exercising more regularly (34.9%), eating healthier (31.4%), eating more organic foods (17.2%), reducing/stopping smoking (16.6% of smokers), or reducing/stopping drinking alcohol (8.7% of drinkers). Individual CAM therapies motivated positive health behavior changes in 22% (massage) to 81% (special diets) of users. People were more likely to report being motivated to change health behaviors if they were: aged 18–64 compared to those aged over 65 years; of female gender; not in a relationship; of Hispanic or Black ethnicity, compared to White; reporting at least college education, compared to people with less than high school education; without health insurance. Conclusions: A sizeable proportion of respondents were motivated by their CAM use to undertake health behavior changes. CAM practices and practitioners could help improve patients’ health behavior and have potentially significant implications for public health and preventive medicine initiatives; this warrants further research attention.

The Influence of Negative Mental Health on the Health Behavior and the Mortality Risk: Analysis of Korean Longitudinal Study of Aging from 2006 to 2014.

BackgroundSeveral studies have shown that negative mental health increases risky health behavior and mortality risk. We investigated the relationship between mental health and health behavior, and the causal association between mental health and mortality risk.MethodsWe used data from the 8-year (2006–2014) Korean Longitudinal Study of Aging with a cohort of 10,247 individuals (whom we divided into a younger group aged <65 years and an older group aged ≥65 years). Mental health was assessed with the following factors: depression, social engagement, and satisfaction of life. Health behavior was assessed with smoking, alcohol use, and regular exercise. Mortality risk was calculated using survival status and survival months as of 2014. Multiple logistic regression and Cox proportional hazard analysis were performed.ResultsNegative mental health was associated with current smoking and sedentary life style, but not with alcohol consumption. In addition, it was associated with an increase in all-cause mortality risk. The increase in mortality risk in the highest quartile (vs. lowest) was 1.71 times (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12– 2.62) and 2.07 times (HR, 2.07; 95% CI, 1.60–2.67) for the younger and older group, respectively.ConclusionOur results show that mental health affects health behavior and mortality risk. A key inference from this study is that improving mental health can lead to positive changes in health behavior and reduce the risk of mortality.

Examining the Impact of a Personalized Self-Management Lifestyle Program Using Mobile Technology on the Health and Well-Being of Cancer Survivors: Protocol and Rationale for a Randomized Controlled Trial (The Moving On Study).

BackgroundCancer survivorship in Ireland is increasing in both frequency and longevity. However, a significant proportion of cancer survivors are overweight. This has negative implications for long-term health outcomes, including increased risk of subsequent and secondary cancers. There is a need to identify interventions, which can improve physical and psychological outcomes that are practical in modern oncology care. Mobile health (mHealth) interventions demonstrate potential for positive health behavior change, but there is little evidence for the efficacy of mobile technology to improve health outcomes in cancer survivors.ObjectiveThis study aims to investigate whether a personalized mHealth self-management lifestyle program is acceptable to participants and can improve physical and psychological outcomes of a subgroup of cancer survivors with increased health risks related to lifestyle behaviors.MethodsA sample of 123 cancer survivors (body mass index >25 kg/m2) was randomly assigned to the control (n=61) or intervention (n=62) group. The intervention group attended a 4-hour tailored lifestyle information session with a physiotherapist, dietician, and clinical psychologist to support self-management of health behavior. Over the following 12 weeks, participants engaged in personalized goal setting to incrementally increase physical activity (with feedback and review of goals through short message service text messaging contact). Objective measures of health behavior (ie, physical activity) were collected using Fitbit (Fitbit, Inc). Data on anthropometric, physiological, dietary behavior, and psychological measures were collected at baseline (T0), 12 weeks (T1; intervention end), and 24 weeks (T2; follow-up). Semistructured interviews were conducted to explore the retrospective acceptability of the Moving On program from the perspective of the recipients.ResultsThis paper details the protocol for the Moving On study. The project was funded in August 2017. Enrolment started in December 2017. Data collection completed in September 2018. Data analysis is underway, and results are expected in winter 2019.ConclusionsThe results of this study will determine the efficacy and acceptability of an mHealth intervention using behavior change techniques to promote health behaviors that support physical health and well-being in cancer survivors and will therefore have implications for health care providers, patients, health psychologists, and technologists.International Registered Report Identifier (IRRID)DERR1-10.2196/13214

Evaluation of a Community Based Cardiac Rehabilitation Programme

The transition from hospital-based (phase II) to community-based (phase III) cardiac rehabilitation (CR) is an important step in the long-term maintenance of positive health behaviour change. PURPOSE: To evaluate the effect of participation in a phase III, community-based CR (CBCR) programme on selected fitness indices in comparison to a control group that received usual care advice and to explore participant experiences and perceived benefits in transitioning from hospital-based phase II CR to CBCR. METHODS: Following completion of phase-II CR, 95 individuals were referred to a 10-week CBCR exercise programme (intervention). A total of 22 (73% male) participants were unable to attend CBCR classes and were assigned to the control group. The remaining 73 (67% male) were assigned to the CBCR exercise program. Aerobic fitness (6MWT), functional upper (hand grip) and lower (timed sit to stand) limb strength, flexibility (sit and reach test) and body composition (waist & hip girth and BMI) were measured pre and post the intervention. All participants from the intervention group were invited to attend a focus group on completion and a thematic analysis was conducted. RESULTS: A total of 51 participants (69% male) completed the 10-week program (70% compliance). There was a significant improvement (p<0.05) in the timed sit to stand (26.5±7.21 v 21.4±5.65sec), 6MWT (505±66.6 v 534±71.9m),) and waist circumference (100.9±13.09 v 98.5±13.37cm) in the intervention group. There was no significant change in any of the fitness indices in the control group. The focus groups were attended by 20 participants (60% male). The main themes identified included the strong sense of need for CBCR programmes and the reassurance provided by the link between the hospital and community provider. Physical, psychological and social benefits were described including moving from fear to confidence in their ability to exercise. CONCLUSION: Participation in a 10-week CBCR programme resulted in improved lower limb strength, aerobic fitness and waist circumference with maintenance of all other measured fitness components. Participants self-reported an increased ability and motivation to undertake exercise. This study provides an important insight into the experience and benefits, both perceived and actual, in the early transition to CBCR.

A Systematic Mixed Studies Review of the Intersections of Social-Ecological Factors and HIV Stigma in People Living With HIV in the U.S. South.

The role of stigma on psychological wellness and treatment outcomes in people living with HIV (PLWH) has been well documented. However, within the context of the southern United States, the intersection between HIV-related stigma and social-ecological factors has been understudied. Thus, a results-based convergent, mixed synthesis design was used to examine the manifestations of HIV-related stigma in PLWH in the U.S. South. A literature search was conducted using PsycINFO, PubMed (includes MEDLINE), and CINAHL. The first level of screening by title and abstract was administered on 1,829 articles. A full-text screening of 169 studies was completed, and a total of 30 relevant articles were extracted. The mixed synthesis highlighted intervention strategies that can reduce HIV-related stigma while promoting positive health-behavior change. The findings of this review underscored the uniqueness of PLWH in the south and demonstrated the crucial role of intersectionality in investigating HIV-related stigma in treating and preventing HIV.

Preparation for fatherhood: A survey of men's preconception health knowledge and behaviour in England.

MethodsA cross-sectional survey of men attending antenatal care with their partners at three London Maternity Units. We assessed level of pregnancy planning using the partner version of the London Measure of Unplanned Pregnancy (LMUP), preconception health behaviours, and whether they had sought information and health professional advice before conception.Main resultsWe recruited 573 men (91% response rate). Mean age was 34 years, 86% were in employment or full time education and 66% had a degree. Half were overweight or obese, 16% were still smoking and 79% had consumed alcohol in the three months before conception. Of 250 men answering questions about medication, a third were taking medication with potentially adverse effects on male reproductive health, while 23% reported taking pre-pregnancy vitamins.46.9% had looked at information about pregnancy from a variety of sources, including online, before their partner became pregnant. Assessed by the LMUP, 74% of pregnancies were planned. Male ‘planners’ were more likely than other men to reduce smoking, reduce alcohol consumption and to eat more healthily in preparation for pregnancy. However, 57% took no action to improve their health.Significance of the findingsIn a sample of relatively educated men accompanying their partners on an antenatal visit, nearly half had made at least one positive health behaviour change before pregnancy, but half were overweight or obese and a third were on medication that could impair male reproductive health. These findings, together with a high prevalence of alcohol consumption and smoking, indicate the need for greater paternal preconception health awareness and care. Innovative ways to promote positive messages about fatherhood, including medication review as part of preconception care, should be evaluated for impact on improving paternal reproductive health and pregnancy and neonatal outcomes.

Is There a Spillover Effect of Targeted Dietary Change on Untargeted Health Behaviors? Evidence From a Dietary Modification Trial.

Background. The gateway behavior hypothesis posits that change in a health behavior targeted for modification may promote positive changes in other untargeted health behaviors; however, previous studies have shown inconsistent results. Aims. To examine the patterns and predictors of change in untargeted health behaviors in a large health behavior change trial. Method. Using repeated-measures latent class analysis, this study explored patterns of change in untargeted physical activity, alcohol consumption, and smoking behavior during the first year of the Women's Health Initiative dietary modification trial that targeted total fat reduction to 20% kcal and targeted increased fruit and vegetable intake. Participants were healthy postmenopausal women who were randomly assigned to either the low-fat dietary change intervention (n = 8,193) or a control (n = 12,187) arm. Results. Although there were increases in untargeted physical activity and decreases in alcohol consumption and smoking in the first year, these changes were not consistently associated with study arm. Moreover, although the results of the repeated-measures latent class analysis identified three unique subgroups of participants with similar patterns of untargeted health behaviors, none of the subgroups showed substantial change in the probability of engagement in any of the behaviors over 1 year, and the study arms had nearly identical latent class solutions. Discussion and Conclusion. These findings suggest that the dietary intervention did not act as a gateway behavior for change in the untargeted behaviors and that researchers interested in changing multiple health behaviors may need to deliberately target additional behaviors.

Urban Minority Community Safety and its Impact on Physical Activity: The Center for Promoting Health and Health Equity-Racial and Ethnic Approaches to Community Health (CPHHE-REACH) Initiative

Background/PurposeDaily physical activity is known to improve personal health and well-being and can often be influenced by one's living environment. A qualitative secondary data analysis of a focus group study, performed by the Creighton University Center for Promoting Health and Health Equity (CPHHE) – Racial and Ethnic Approaches to Community Health (REACH), assesses behavioral changes in individuals who participated in newly established physical activities in faith-based organizations, local residential towers, and the local community health center. MethodApplying thematic analysis within the Health Belief Model framework, the investigators further investigated the relationships between its constructs and levels of physical activity in urban minority neighborhoods. ResultsResults indicated that residents who perceived their neighborhoods as unsafe had a negative attitude toward physical activity. In contrast, building social relationships and camaraderie that enhanced social cohesion were major themes that increased participants' self-efficacy, resulting in positive changes in health behavior. ConclusionCommunity partnerships had a positive impact on motivating individuals to live healthier lifestyles. An interesting concept was that of community efficacy, which reflects the community's confidence in its ability to generate behavioral changes in individuals.

Learning tohealth yourself: a randomized, tailored self-regulation intervention among custodial employees

This intervention sought to bring about a dietary behavior change among individuals who are vulnerable to negative health outcomes and behaviors. Using a randomized controlled trial, we examined the efficacy of a six-week Education + Self-Regulation intervention against an Education Only condition in reducing saturated fat intake among custodial workers (N = 54). Assessments were made at baseline, 4 weeks, 6 weeks and 6 months. The intervention group reported lower saturated fat intake and greater self-regulation than the Education Only control group throughout the intervention period and higher self-efficacy at week 6. Despite a fading of intervention effect at 6 months, Education + Self-Regulation participants continued to report lower saturated fat intake relative to their baseline. Supplementing health education with self-regulatory skills is an effective strategy for positive health behavior change. The authors provide recommendations for engaging non-clinical health psychologists in community-level chronic disease prevention and health promotion efforts.

Changes in student physical health behaviour: an opportunity to turn the concept of a Healthy University into a reality.

Previous studies have reported a high prevalence of unhealthy behaviours in the student population, which the Healthy University concept is now seeking to address, by taking a settings approach to health promotion. This study investigated how far students are already seeking to make changes to improve their health behaviour while in a university setting, to help inform the development of Healthy Universities. Data on student health behaviour change, health indicators and demographics were gathered from 550 students attending two London universities, via an online questionnaire released through the student union email system at one university and through iPads at a student centre at the other. In total, 84% of respondents reported making changes to try to become healthier while at university, primarily for proactive health reasons rather than reacting to a perceived health or weight issue. Universities and student unions were reported as influencing behaviour change by only five students. Compared with previous studies, a higher proportion of respondents were pursuing healthier lifestyles, including only 11% reporting they smoked. There were some statistically significant demographic differences as regards alcohol consumption, physical activity, the types of food students were seeking to avoid and the reasons for this. The findings provide a novel perspective on student health behaviour and suggest that the traditional stereotype of a hedonistic student lifestyle freed from family constraints may need to be reassessed. Universities and student unions appear to have a significant opportunity to build on a more health conscious cohort of students, employing targeted approaches where appropriate, to encourage positive health behaviour change and make the Healthy Universities concept a reality, with important public health implications.

Exploring cancer survivors' views of health behaviour change: "Where do you start, where do you stop with everything?"

Physical activity (PA) and a healthy diet can improve the well-being of cancer survivors. However, cancer survivors often do not engage in these behaviours. This study aimed to explore barriers and facilitators to engaging in these behaviours following cancer treatment. During the development of a Web-based intervention to enhance health-related quality of life in cancer survivors, 32 people who had completed treatment for breast, colon, or prostate cancer were presented with an intervention for PA and healthy eating. In-depth think-aloud and semi-structured interviewing techniques were used to elicit perceptions of both behaviours. Data were analysed using thematic analysis. Some individuals reported implementing positive health behaviour changes to maintain health and prevent recurrence, or to help them to move forward after cancer. However, others reported feeling abandoned, and many did not report an intention to engage in lifestyle changes. Individuals discussed contextual and health-related barriers that were specifically linked to their situation as post-treatment cancer survivors: individuals described uncertainty about how to implement adaptive changes and perceived a lack of support from health care providers. Others viewed behaviour change as unnecessary or undesirable, with some arguing that non-modifiable factors contributed more to their cancer diagnosis than lifestyle-related factors. For many participants in this study, the period that follows treatment for cancer did not represent a "teachable moment." A variety of complex and heterogeneous factors appeared to impact motivation and may limit cancer survivors from engaging with diet and PA changes.

A Content Analysis of College Students’ Health Behaviors

ABSTRACTBackground: The perception of college students’ health is overall positive, yet research indicates that they engage in negative behaviors that can lead to long-term health consequences. Purpose: The purpose of this study was to explore the feasibility of a course activity as an opportunity for students to assess their own health behaviors, which could increase the likelihood of students adopting healthier behaviors. Method: A content analysis of 100 students’ Lifestyle Analysis assignments was conducted and the results were analyzed. Results: Results reveal that unhealthy eating, smoking, and lack of exercise are the most commonly reported negative behaviors and are reinforced by social support networks, stress, busy schedules, and habitual behaviors. Most common healthy behaviors to adopt are exercise and better eating habits and would be supported by help from friends and family, internal motivation, and goal-setting. Although past research indicates that setting specific time frames for adoption of healthier behaviors is critical, over half of the students failed to do so. Discussion: Discussion of results includes the use of a guided assignment to identify students’ perceptions of negative behaviors, the consequences of the behaviors, and positive alternative behaviors to adopt. Translation to Health Education Practice: Results provide valuable insight into the value of guided self-reflection in fostering positive health behavior change.

EHealth Literacy and Health Behaviors Affecting Modern College Students: A Pilot Study of Issues Identified by the American College Health Association.

BackgroundThe eHealth Literacy Scale (eHEALS) has been widely adopted by researchers to understand how eHealth literacy can be put into context. eHealth researchers need to know how to promote positive health behavior changes across college students, given the importance of the Internet to acquire and use health information. The American College Health Association identified a set of key health issues that affect college students today. By understanding how eHEALS might be related to college students’ maintenance of their health and their use of online health resources, researchers will be provided with a better understanding of eHealth literacy and its pragmatic implications for health campaigns and future interventions.ObjectiveThe goal of the study was to examine what eHEALS reveals about college student health behaviors identified by the American College Health Association. To understand college student current health maintenance and their intentions to maintain their health and use online resources, the theory of planned behavior was used as the theoretical framework for the study.MethodsData were collected via a survey of 422 college students that included the eHEALS measure and questions about health issues based on the recommendations of the American College Health Association. These questions asked about college student current health, subsequent use of online health resources, and their intention to maintain their health and make use of such resources in the future.ResultseHEALS was positively and significantly associated with all 8 areas of health issues identified by the American College Health Association for college student current maintenance of health and use of online health resources and for future intention of health maintenance and use of online resources. Key issues that emerged with eHealth literacy were maintaining safe sex practices and seeking out related information, seeking out information on an exercise regime, information on vaccinations, and maintaining a balanced diet.ConclusionsThese results suggest several areas that may be targeted for future health campaigns toward college students. In addition, eHEALS was found to be a useful instrument for college students in the United States. Lastly, these results point to a need to deliver targeted information to college students, particularly since eHEALS captures literacy based on positively phrased items.

Anticipated health behaviour changes and perceived control in response to disclosure of genetic risk of breast and ovarian cancer: a quantitative survey study among women in the UK

BackgroundGenetic risk assessment for breast cancer and ovarian cancer (BCOC) is expected to make major inroads into mainstream clinical practice. It is important to evaluate the potential impact on women...

Starting Off on the Best Foot: A Review of Message Framing and Message Tailoring, and Recommendations for the Comprehensive Messaging Strategy for Sustained Behavior Change

ABSTRACTHealth promotion programs represent a salient means through which physical activity promoters can cultivate positive health behavior change and maintenance. The messages communicated within these programs serve as an essential component as they are often used to convey valuable information, resources, or tools that facilitate health behavior initiation and sustained engagement. Identifying the most effective way to communicate health promotion information is, therefore, of considerable importance to ensuring that people not only attend to these messages, but also connect with and internalize the information conveyed within them. This paper was written to (1) summarize and evaluate the most prominent reviewed research approaches of message framing and tailoring to message design; and (2) offer a comprehensive messaging strategy to promote sustained health behavior change. A review of the literature demonstrated that a messaging strategy that has consistently led to healthy behavior change has yet to be identified. Furthermore, scholars have articulated that a multi-theoretical approach that places emphasis on facilitating motivation and healthy behavior change needs to be employed. Thus, this paper proposes and provides recommendations for employing the Comprehensive Messaging Strategy for Sustained Behavior Change (CMSSBC), which advocates tailoring messages to peoples’ stage of change and framing them to focus on self-determined motives and intrinsic goals.

Motivational Interviewing to Promote Oral Health in Adolescents

PurposeMotivational interviewing (MI) is a counseling strategy to help people change their behaviors. This single-blinded randomized controlled trial evaluated the effectiveness of MI in improving adolescents' oral health. MethodsFifteen secondary schools were randomly assigned to three groups: (I) prevailing health education, (II) MI, and (III) MI coupled with interactive dental caries risk assessment (MI + RA). Adolescents (n = 512) with unfavorable oral health behaviors (infrequent toothbrushing and/or frequent snacking) were recruited; 161, 163, and 188 in groups I–III, respectively. Participants in the three groups received their respective interventions. At baseline and after 6 and 12 months, participants completed a questionnaire on their oral health self-efficacy and behaviors. Their oral hygiene (dental plaque score) and dental caries (number of decayed surfaces/teeth status) were recorded. ResultsCompared with group I, subjects in groups II and III were more likely to reduce their snacking frequency (odds ratios [95% confidence intervals {CIs}]: 7.12 [1.80–28.16] and 11.17 [2.90–42.98], respectively) and increase their toothbrushing frequency (odds ratios [95% CIs]: 5.26 [2.28–12.16] and 11.45 [4.99–26.26], respectively) after 12 months. Taking group I as a reference, groups II and III had lower number of new carious teeth △D ICDAS II 1-6MFT (β [95% CI]: −.24 [−.44 to −.04] and −.31 [−.51 to −.11], respectively). ConclusionsMI was more effective than prevailing health education strategy in eliciting positive changes in adolescents' oral health behaviors and preventing dental caries.

Positive affective processes underlie positive health behaviour change

Positive health behaviours such as physical activity can prevent or reverse many chronic conditions, yet a majority of people fall short of leading a healthy lifestyle. Recent discoveries in affective science point to promising approaches to circumvent barriers to lifestyle change. Here, we present a new theoretical framework that integrates scientific knowledge about positive affect with that on implicit processes. The upward spiral theory of lifestyle change explains how positive affect can facilitate long-term adherence to positive health behaviours. The inner loop of this spiral model identifies nonconscious motives as a central mechanism of behavioural maintenance. Positive affect experienced during health behaviours increases incentive salience for cues associated with those behaviours, which in turn, implicitly guides attention and the everyday decisions to repeat those behaviours. The outer loop represents the evidence-backed claim, based on Fredrickson’s broaden-and-build theory, that positive affect builds a suite of endogenous resources, which may in turn amplify the positive affect experienced during positive health behaviours and strengthen the nonconscious motives. We offer published and preliminary evidence in favour of the theory, contrast it to other dominant theories of health behaviour change, and highlight attendant implications for interventions that merit testing.

Effect of goal attainment theory based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: Randomized study

Effect of goal-attainment-theory-based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: randomized study BackgroundThe behavioral modification strategies should be explored at the time of admission to lead the maximum effect of cardiovascular risk management. AimsThis randomized study aimed to elucidate the effects of a nurse-led theory-based education program in individuals with a first episode of acute myocardial infarction on cardiovascular risks, health behaviors, and quality of life over 6 months. MethodsThe study involved a convenience sample of 64 patients with acute myocardial infarction who were randomly assigned to either the education group or the control group. The goal-attainment-based education program was designed to set the mutually agreed goals of risk management and the behavioral modification strategies for achieving those goals. Those in the control group received routine management only. The participants in both groups were contacted at 6–8 weeks and at 6 months after discharge to measure outcome variables. Repeated measure ANOVA was conducted using SPSSWIN (version 20.0) to determine the significance of differences in outcome variables over 6 months between the groups. ResultsBoth groups showed significant positive changes in cardiovascular risks, health behaviors, and quality of life over 6 months. The 2-year risk of cardiovascular disease was significantly reduced in both study groups, but with no significant interaction effect (F=2.01, p=0.142). The performance and maintenance of health behaviors (F=3.75, p=0.029) and the mental component of quality of life (F=4.03, p=0.020) were significantly better in the education group than the control group. ConclusionApplying a goal-oriented education program at an early stage of hospital management improved and maintained blood glucose, health behaviors, and mental component of the quality of life up to six months in individuals with a first episode of myocardial infarction. Further studies are warranted to explore the role of behavioral modification mediating between cardiovascular risk management and quality of life in this population.

A Qualitative Study of Cognitive, Behavioral, and Psychosocial Challenges Associated With Pediatric Type 2 Diabetes in Ethnic Minority Parents and Adolescents.

Purpose The purpose of this descriptive qualitative study was to explore cognitive, behavioral, and psychosocial challenges associated with having and/or parenting an adolescent with pediatric type 2 diabetes (T2D) from the perspectives of ethnic minority parents and adolescents. Methods Ethnic minority (79.2% non-Hispanic black, 29.6% Hispanic) adolescents (n = 14, 78.6% female, 14.7 ± 1.9 years) and their parents (n = 13, 100% female) participated in either individual family interviews or multifamily focus group sessions. Sessions were audio recorded, transcribed, and coded by a team of 4 raters. QSR NVivo 10 was used to perform a content analysis and to extract coded adolescent and parent responses. Results Six themes corresponding to 3 broad categories (cognitive, behavioral, and psychosocial challenges) emerged. Regarding cognitive challenges, families described difficulties learning about a new disease and managing youth knowledge deficits and/or superficial knowledge. In terms of behavioral challenges, parents and adolescents discussed ongoing difficulties with making and maintaining positive youth health behavior changes as well as with ensuring regimen adherence. Finally, managing youth emotions related to diabetes and navigating social relationships with peers and other family members around the disclosure of T2D were the primary psychosocial challenges to emerge. Conclusions Directions for future research include developing and evaluating brief family interventions and adolescent psychosocial screening measures. Recommendations for clinical practice include increasing family knowledge of T2D, enhancing parenting skills for managing youth behavior change, and conducting routine psychosocial screening during follow-up clinic visits.

Making the continuum of care work for mothers and infants: Does gender equity matter? Findings from a quasi-experimental study in Bihar, India.

BackgroundImprovements in continuum of care (CoC) utilization are needed to address inadequate reductions in neonatal and infant mortality in India and elsewhere. This study examines the effect of Ananya, a health system training and community outreach intervention, on reproductive, maternal and newborn health continuum of care (RMNH CoC) utilization in Bihar, India, and explores whether that effect is moderated by gender equity factors (child marriage, restricted mobility and low decision-making control).MethodsA two-armed quasi-experimental design compared districts in Bihar that did/did not implement Ananya. Cross-sections of married women aged 15–49 with a 0–5 month old child were surveyed at baseline and two year follow-up (baseline n = 7191 and follow-up n = 6143; response rates 88.9% and 90.7%, respectively). Difference-in-difference analyses assessed program impact on RMNH CoC co-coverage, defined by 9 health services/behaviors for the index pregnancy (e.g., antenatal care, skin-to-skin care). Three-way interactions assessed gender equity as a moderator of Ananya’s impact.FindingsParticipants reported low RMNH CoC co-coverage at baseline (on average 3.2 and 3.0 of the 9 RMNH services/behaviors for Ananya and control groups, respectively). The Ananya group showed a significantly greater increase in RMNH CoC co-coverage (.41 services) compared with the control group over time (p<0.001), with the primary drivers being increases in clean cord care, skin-to-skin care and postpartum contraceptive use. Gender equity interaction analyses revealed diminished intervention effects on antenatal care, skilled birth attendance and exclusive breastfeeding for women married as minors.ConclusionAnanya improved RMNH CoC co-coverage among these recent mothers, largely through positive health behavior changes. Child marriage attenuated Ananya’s impact on utilization of key health services and behaviors. Supporting the health system with training and community outreach can be beneficial to RMNH CoC utilization; additional support is needed to adequately address the unique issues faced by women married as minors.