Universal Prevention Research Articles

Effectiveness of a universal personalized intervention for the prevention of anxiety disorders: Protocol of a randomized controlled trial (the prevANS project)

BackgroundTo date, all preventive anxiety disorders interventions are one-fit-all and none of them are based on individual level and risk profile. The aim of this project is to design, develop and evaluate an online personalized intervention based on a risk algorithm for the universal prevention of anxiety disorders in the general population. MethodsA randomized controlled trial (RCT) with two parallel arms (prevANS vs usual care) and 1-year follow-up including 2000 participants without anxiety disorders from Spain and Portugal will be conducted.The prevANS intervention will be self-guided and can be implemented from the prevANS web or from the participants' Smartphone (through an App). The prevANS intervention will have different intensities depending on the risk level of the population, evaluated from the risk algorithm for anxiety: predictA. Both low and moderate-high risk participants will receive information on their level and profile (risk factors) of anxiety disorders, will have access to stress management tools and psychoeducational information periodically. In addition, participants with a moderate-high risk of anxiety disorders will also have access to cognitive-behavioral training (problem-solving, decision-making, communication skills, and working with thoughts). The control group will not receive any intervention, but they will fill out the same questionnaires as the intervention group.Assessments will be completed at baseline, 6 and 12-month follow-up. The primary outcome is the cumulative incidence of anxiety disorders. Secondary outcomes include depressive and anxiety symptoms, risk probability of anxiety disorders (predictA algorithm) and depression (predictD algorithm), improvement in physical and mental quality of life, and acceptability and satisfaction with the intervention. In addition, cost-effectiveness and cost-utility analyses will also be carried out from two perspectives, societal and health system, and analyses of mediators and moderators will also be performed. DiscussionTo the best of our knowledge, prevANS study will be the first to evaluate the effectiveness and cost-effectiveness of a personalized online intervention based on a risk predictive algorithm for the universal prevention of anxiety disorders. Trial registrationClinicalTrials.gov: NCT05682365.

Independent pragmatic replication of the Dove Confident Me body image program in an Australian Girls Independent Secondary School

Following calls for the independent replication of universal body image programs under diverse conditions, this research aimed to investigate whether the universal co-educational prevention program developed for audiences in the United Kingdom (Dove Confident Me, DCM), was an acceptable and effective intervention when delivered by teachers to adolescent girls attending a single-sex Australian school. Comprising two studies, Study 1, evaluated DCM among Grade 8 students (N = 198) at a single-sex private school, and compared the results with students (N = 208) s from a matched comparison group. No improvements were observed on outcome measures between the comparison and intervention girls over the three time points. Study 2 involved minor modifications to the aesthetics and content of the program, as well as the logistics of delivery. Delivered by teachers to Grade 8 students (N = 242 intervention and N = 354 comparison), there were significant improvements in acceptability of the modified DCM program, yet no interaction effects observed on outcome measures. While the program did no harm, it is possible that there are adjustments to the methods utilized and content of programs that are trialed in efforts to prevent body image concerns and eating disorders in the school setting.

Adult characteristics, skills, and approaches that facilitate supportive relationships with youth: A qualitative investigation of Sources of Strength

IntroductionSources of Strength is a universal prevention program for youth that provides tools and educational opportunities to promote wellness and reduce risk. A major aim of Sources is to build youth-adult relationships to support youth in times of distress. However, no study to date has investigated how adults effectively build relationships with youth despite this being critical to successful implementation of Sources. The present study explores both student and staff perspectives of what characteristics, skills, and approaches encourage the development of supportive student-adult relationships to inform efforts for successful intervention implementation. MethodsThis qualitative supplement to a Randomized Controlled Trial (RCT) of Sources, recruited 23 students in grades 9 to 12 for individual interviews and 11 staff members for focus groups from 2 high schools implementing the intervention. Semi-structured interview guides were used, and emergent themes were identified through process and pattern coding. ResultsKey facilitators of supportive and effective adult-youth relationships included perceptions of adults as approachable, caring, encouraging, and understanding. Successful adult advisors used humor and were perceived as invested and engaged in the lives of youth. Maintaining accountability for youth, balanced with intervention and provision of resources additionally emerged as a critical factor supporting positive relationships with youth. Sources itself emerged as a catalyst for the growth of these positive and supportive youth-adult relationships. ConclusionsTrusted adults are instrumental as both operators within prevention programs targeting young people and as facilitators in adult-youth relationships through leveraging key skills and approaches. These findings can inform quality implementation of interventions, like Sources, that embed adult-youth connections as a central feature of the program model.

I-PREGNO – prevention of unhealthy weight gain and psychosocial stress in families during pregnancy and postpartum using an mHealth enhanced intervention: a study protocol of two cluster randomized controlled trials

BackgroundThe transition to parenthood represents a critical life period with psychosocial, and behavioral changes and challenges for parents. This often increases stress and leads to unhealthy weight gain in families, especially in psychosocially burdened families. Although universal and selective prevention programs are offered to families, specific support often fails to reach psychosocially burdened families. Digital technologies are a chance to overcome this problem by enabling a low-threshold access for parents in need. However, there is currently a lack of smartphone-based interventions that are tailored to the needs of psychosocially burdened families.AimsThe research project I-PREGNO aims to develop and evaluate a self-guided, smartphone-based intervention in combination with face-to-face counseling delivered by healthcare professionals for the prevention of unhealthy weight gain and psychosocial problems. The intervention is specifically tailored to the needs of psychosocially burdened families during the pregnancy and postpartum period.MethodsIn two cluster randomized controlled trials in Germany and Austria (N = 400) psychosocially burdened families will be recruited and randomized to i) treatment as usual (TAU), or ii) I-PREGNO intervention (self-guided I-PREGNO app with counseling sessions) and TAU. We expect higher acceptance and better outcomes on parental weight gain and psychosocial stress in the intervention group.DiscussionThe intervention offers a low cost and low-threshold intervention and considers the life situation of psychosocially burdened families who are a neglected group in traditional prevention programs. After positive evaluation, the intervention may easily be implemented in existing perinatal care structures in European countries such as Germany and Austria.Trial registrationBoth trials were registered prospectively at the German Clinical Trials Register (Germany: DRKS00029673; Austria: DRKS00029934) in July and August 2022.

Effectiveness of population-wide screening and mass drug administration for leprosy control in Kiribati: the COMBINE protocol

IntroductionProgress towards leprosy elimination is threatened by increasing incidence in ‘hot-spot’ areas where more effective control strategies are urgently required. In these areas, active case finding and leprosy prevention limited...

Sex and Body Mass Index differences after one-year follow-up of an eating disorders risk factors universal prevention intervention in university students in Mexico City

Introduction. Interventions based on cognitive dissonance theory are the most effective for preventing eating disorders. Objective. To identify the changes at one year follow-up of a universal prevention intervention in disordered eating behaviors (DEB), thin-ideal internalization (TII), and drive for muscularity (DM). Method. A pre-experimental, pretest-posttest study was conducted on 602 university student subjects (76.1% women and 23.9% men) with an average age of 20.74 years at a public (30.6%) and a private university (69.4%) in Mexico City. A Split Plot ANOVA was performed with the intrasubject variable equal to each measurement (pretest, posttest, and follow-up), as well as the sex and body mass index (BMI) intersubject variables to analyze whether there was a significant interaction between these variables and the changes in dependent variables, as well as the changes through each measurement by group. Results. In the intrasubject analyses, statistically significant differences were found for DEB through the various measurements, without taking the interactions into account. Statistically significant interactions were observed between each measurement and BMI, and between each measurement and sex and BMI for the DM variable. Discussion and conclusion. Since a reduction of TII in women and DM in men was achieved, together with a decrease in DEB in women, the workshop can be said to have fully achieved its objectives for women and partly so for men.

Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder.

Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.

An Examination of School District Reopening Plans for Mental Health Supports amid COVID-19 School Reopening

Abstract The purpose of this exploratory qualitative study was to understand the types of mental health supports described in school district reopening plans in one southeastern state, and to understand school social workers’ involvement in developing these plans during the first full academic year of the COVID-19 pandemic. Publicly accessible school district reopening plans were collected from the 80 school districts in South Carolina, and 15 school social workers participated in virtual interviews. Out of the 80 school districts, 67 had reopening plans, and of those, only 43 percent mentioned mental health services and supports. Most school district reopening plans described Tier 1 universal prevention services and supports and a process for mental health assessment, identification, and referral. Fewer included Tier 2 early intervention and Tier 3 targeted and intensive services. Of the school social workers interviewed, only four were involved in helping to develop their school district reopening plans, and when involved, advocated for mental health services and supports for their students. The article concludes with a discussion of the study's implications for school social work practice.

Psychometric validation of the collective asset Utu: associations with coping strategies and resilience during adolescence

BackgroundUtu is a Kiswahili term with a long history of cultural significance in Tanzania. It conveys a value system of shared, collective humanity. While variants of Utu have been studied in other contexts, a measure of Utu that captures this important collective asset has not been developed in Tanzania. The aims of this study were to (1) examine dimensional constructs that represent Utu, (2) validate a measurement scale of Utu for use with adolescents, (3) examine differences between orphan and non-orphan adolescents in self-reported Utu and, (4) examine structural paths between adverse life experiences, coping strategies, Utu, and resilience. MethodsThis study collected survey data from adolescents from three districts in peri-urban Tanzania in two samples: 189 orphan adolescents ages 10–17 in May 2020 and 333 non-orphan adolescents ages 10–14 in August 2020. Confirmatory factor analysis was used to validate the hypothesized factor structure of the developed Utu measure. Structural equation models were used to examine path associations with adverse life experiences, coping and resilience.ResultsThe five dimensional constructs comprising the Utu measure included Resource Sharing, Group Solidarity, Respect and Dignity, Collectivity, and Compassion. Confirmatory factor analysis of the Utu measure demonstrated excellent fit (CFI = 0.98; TLI = 0.97; SRMR = 0.024; RMSEA = 0.046) and internal consistency (α = 0.94) among adolescents in this study. Positive, significant associations were found between Utu and coping (β = 0.29, p < 0.001) and Utu and intra/interpersonal and collective resilience (β = 0.13, p < 0.014). Utu was not significantly associated with adverse life experiences, age or gender.ConclusionsA five-dimensional measurement scale for Utu was validated in a sample of orphan and non-orphan adolescents in Tanzania. Utu is a collective asset associated with higher levels of reported resilience in both orphan and non-orphan adolescent populations in Tanzania. Promoting Utu may be an effective universal public health prevention approach. Implications for adolescent programming are discussed.

Explaining adult obesity, severe obesity, and BMI: Five decades of change

Obesity rates have increased across all segments of society since the late 1970s, but the reason behind population-level increases in body weight remains unclear. We used the 1971–2020 NHANES data to examine whether the observed trend in obesity prevalence is attributable to changing public health behaviors (i.e., intracohort change) or changing publics (i.e., cohort replacement). We partitioned total change in mean BMI, and rates of obesity and severe obesity, into its IC and CR components using linear and algebraic decomposition methods. We found that the IC mechanism (i.e., broad sectors of individuals changing) plays a dominant role in the overall increase in mean BMI, and obesity and severe obesity prevalence. Birth cohort membership (i.e., the CR mechanism) is also influencing mean BMI, and rates of obesity and severe obesity, but in differing ways. Specifically, the large positive IC and the small positive CR effects are amplifying one another, thus creating a steep increase in the observed rates of severe obesity. Conversely, the large positive IC effect is offset by a small negative CR effect, which created a more gradual rise in mean BMI and rates of obesity. Furthermore, we computed total change for models that entered separately sociodemographic, lifestyle, nutritional, and physical activity measures to estimate differences in mean BMI, and rates of obesity and severe obesity, among cohorts and time periods. Adjustment for all the compositional differences among the cohorts during the study period indicate that a combination of a more pronounced IC and a less pronounced CR drove the observed increase in mean BMI, and rates of obesity and severe obesity. Thus, “universal prevention” (i.e., entire community) strategies for healthy weight promotion may need to be combined with “selective prevention” (i.e., at-risk groups) and/or “targeted prevention” (i.e., at-risk individuals) approaches in order to reverse the obesity epidemic.

OurFutures Mental Health: Protocol for a randomised controlled trial of a school-based, universal mental ill-health prevention program

Mental disorders have significant impact on the health and well-being of young people in Australia and worldwide. Intervention during adolescence is critical for reducing immediate harm and preventing the development of chronic mental disorders. This paper describes the protocol for a randomised controlled trial designed to evaluate the effectiveness of an updated version of the OurFutures Mental Health program in promoting mental health knowledge and preventing symptoms of depression and anxiety.A two-arm cluster randomised controlled trial will be conducted from 2023 to 2024 with 1400 Year 8 students (aged 13-14years) from 14 secondary schools in Australia. Schools will be randomised to the OurFutures Mental Health intervention (n = 7), or an active control condition who will receive their usual health education curriculum (n = 7). OurFutures Mental Health is a six-lesson, online cartoon-based intervention. The intervention draws on cognitive-behavioural principles and incorporates psychoeducation, self-management, and interpersonal skill acquisition. Students will complete self-report surveys at baseline, post-intervention, and 3- and 9-months post-baseline. Primary outcomes are mental health knowledge and anxiety and depressive symptoms. Subgroup analyses will examine anxiety and depression symptoms for students reporting elevated levels of these symptoms at baseline. The primary timepoint is 3-months post-baseline. Ethical approval has been granted by the University of Sydney Human Research Ethics Committee and the study is currently under review at the State Education Research Application Process for research in government schools, and Catholic Education Dioceses in NSW. This trial is prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12622001582741).

A call to create evidence-based mental health promotion interventions for youth that are equitable across ethnic/racial subgroups: Advocates 4-ALL Youth.

Adolescents from historically racial and ethnic minoritized and low-income communities have higher rates of early-life and chronic difficulties with anxiety and depression compared to non-Hispanic White youth. With mental health distress exacerbated during and in the wake of the COVID-19 pandemic, there is a need for accessible, equitable evidence-based programs that promote psychological well-being, strengthen one's ability to adapt to adversity, and build self-efficacy prior to adolescence. An evidenced-based resiliency-focused health coaching intervention was adapted using a health equity implementation framework to meet the needs of a Title I elementary school in rural Alabama (AL) that serves over 80% Black and Hispanic students. To ensure that the program met local community needs while maintaining core program educational activities, all adaptations were documented utilizing a standard coding system. Leveraging an existing academic-community partnership with Auburn University and a local AL school district, a new program, Advocates 4-All Youth (ALLY), was created. Three major adaptations were required: (1) the use of local community volunteers (ALLYs) to deliver the program versus health coaches, (2) the modification of program materials to meet the challenge of varying levels of general and health-related literacy, and (3) the integration of the Empower Action Model to target protective factors in a culturally-tailored delivery to ensure key program outcomes are found equitable for all students. With continued increases in youth mental health distress, there is a need for the development of universal primary prevention interventions to promote mental well-being and to strengthen protective factors among youth from historically disadvantaged backgrounds. ALLY was created to meet these needs and may be an effective strategy if deemed efficacious in improving program outcomes.

A new era in child maltreatment prevention: call to action.

A new era in child maltreatment prevention: call to action.

Promoting mental health and well-being in schools: examining mindfulness, relaxation and strategies for safety and well-being in English primary and secondary schools—study protocol for a multi-school, cluster randomised controlled trial (INSPIRE)

There are increasing rates of internalising difficulties, particularly anxiety and depression, being reported in children and young people in England. School-based universal prevention programmes are thought to be one way of helping tackle such difficulties. This paper describes an update to a four-arm cluster randomised controlled trial (http://www.isrctn.com/ISRCTN16386254), investigating the effectiveness of three different interventions when compared to usual provision, in English primary and secondary pupils. Due to the COVID-19 pandemic, the trial was put on hold and subsequently prolonged. Data collection will now run until 2024. The key changes to the trial outlined here include clarification of the inclusion and exclusion criteria, an amended timeline reflecting changes to the recruitment period of the trial due to the COVID-19 pandemic and clarification of the data that will be included in the statistical analysis, since the second wave of the trial was disrupted due to COVID-19.Trial registration ISRCTN Registry ISRCTN16386254. Registered on 30 August 2018.

Preventive Gambling Programs for Adolescents and Young Adults: A Systematic Review

Gambling disorder in youth is an emerging public health problem, with adolescents and young adults constituting a vulnerable age group for the development of gambling-related problems. Although research has been conducted on the risk factors for gambling disorder, very few rigorous studies can be found on the efficacy of preventive interventions in young people. The aim of this study was to provide best practice recommendations for the prevention of disordered gambling in adolescents and young adults. We reviewed and synthesized the results of existing RCTs and quasi-experimental studies covering nonpharmacological prevention programs for gambling disorder in young adults and adolescents. We applied the PRISMA 2020 statement and guidelines to identify 1483 studies, of which 32 were included in the systematic review. All studies targeted the educational setting, i.e., high school and university students. Most studies followed a universal prevention strategy, that particularly targeted adolescents, and an indicated prevention strategy for university students. The reviewed gambling prevention programs generally showed good results in terms of reducing the frequency and severity of gambling, and also regarding cognitive variables, such as misconceptions, fallacies, knowledge, and attitudes towards gambling. Finally, we highlight the need to develop more comprehensive prevention programs that incorporate rigorous methodological and assessment procedures before they are widely implemented and disseminated.

Implementation of a Universal School-Based Child Sexual Abuse Prevention Program: A Longitudinal Cohort Study.

Child sexual abuse (CSA) is a public health problem of considerable magnitude. The prevailing primary prevention strategies are universal, school-based CSA prevention programs, some of which have been designated as evidence-based, such as Safe Touches. However, to reach their public health impact potential, effective universal school-based CSA prevention programs require effective and efficient dissemination and implementation strategies. The purpose of this study was to demonstrate the reach and effectiveness of a school-based CSA prevention curriculum, Safe Touches, when implemented on a wide scale. Using a longitudinal cohort design, children in second grade classrooms in public elementary schools in five counties received the Safe Touches workshop and completed surveys designed to assess gains in knowledge at four timepoints (one week prior, immediately post-workshop, 6- and 12-months post-workshop). In total, the Safe Touches workshop was delivered in 718 classrooms in 92% of school districts, reaching ~14,235 second graders. Multilevel models (n = 3,673) revealed that Safe Touches significantly increased CSA-related knowledge, and that these gains were maintained 12-months post-workshop (ps < .001). There were some small but significant time-varying effects among participants in schools with a greater percentage of low income and minority students, but these effects largely disappeared 12-months post workshop. This study demonstrates that a single-session, universal school-based CSA prevention program can effectively increase children's knowledge when implemented and disseminated on a wide scale and knowledge gains can be retained 12-months post intervention.

Examination of the Effectiveness of a Universal Prevention Program to Enhance Understanding and Regulating Others’ Emotions for Children in Terms of Implicit and Explicit Affect

IntroductionUchida &amp; Yamasaki (2012, 2022) have developed a universal prevention program to enhance understanding and regulating others’ emotions for elementary and junior high school students. In recent years, affect and emotions are popular research topics in the domains of psychology and brain science. Most research has thus far focused on the effects of explicit affect on health and adjustment. However, an increasing number of studies have started to examine the effects of implicit affect on psychological outcomes. Although the program was developed for enhancing coping of explicit emotions for health and adjustment, the effectiveness needs to be examined also in terms of implicit affect.ObjectivesThe purpose of this study was to examine the effectiveness of this program in terms of implicit and explicit affect.MethodsParticipants were 6th-grade children in a public elementary school in Japan. The final sample was 61 children (32 boys and 29 girls). Participants completed a battery of two questionnaires just before (Time 1) and just after (Time 2) the intervention program. The questionnaires were the Implicit Positive and Negative Affect Test for Children (IPANAT-C) for assessing implicit positive and negative affect (IPA and INA) and the Japanese version of the Positive and Negative Affect Schedule for Children (PANAS-C) for measuring explicit positive and negative affect (EPA and ENA). The universal intervention program that was one of the programs we developed for children’s health and adjustment was implemented over four regular classes targeting all children in their homeroom classes.ResultsData were analyzed by 2 (pre-intervention and post-intervention periods) x 2 (boys and girls) analyses of variance (ANOVA) with the hoc tests using Holm corrections. First, regarding the EPA and IPA, there was a significant main effect of periods (Fs (1, 59) = 6.82 and 4.54, p &lt; .05, respectively), revealing in the post hoc tests that they significantly increased at the post-intervention period. In contrast, regarding ENA and INA, there was no significant main effect of periods. Moreover, regarding EPA, there was a significant main effect of sex. No significant period x sex interactions were found in any affect.ConclusionsThese results revealed that the current program was effective in enhancing explicit and implicit positive affect. On the other hand, no significant effects were found in enhancing explicit and implicit negative affect. The necessity of future research that will examine the sustainability of the effectiveness of the program is discussed, along with several limitations.Disclosure of InterestNone Declared

Maternal depression and parenting stress in English-speaking Latina mothers with a history of adverse childhood experiences

BackgroundIn the United States, Latinx populations report higher prevalence of adverse childhood experiences (ACEs) compared to non-Latinx White populations. ACEs have been associated with maternal depression and parenting stress, while social support often functions as a protective factor. However, these relationships have not been adequately researched in Latinx samples. ObjectiveThis research aims to clarify the prevalence of maternal ACEs, and the relationships between ACEs, maternal depression, parenting stress, and social support among a sample of English-speaking Latina mothers. Participants and SettingParticipants were 167 English-speaking Latina mothers (average age of 29 years old) with at least one pre-kindergarten aged child recruited from 12 Title-I public elementary schools. MethodRecruitment happened as part of a quasi-experimental effectiveness trial of a universal school-based prevention program. Data from baseline assessments were analyzed using linear regression and bootstrapping was used to assess mediation. Outcome67.7% of the sample reported 1 or more ACEs. Multiple regression demonstrated that ACEs (b = 0.30, p <.001) and parenting stress (b = 0.66, p <.001) predicted depression; depression (b = 0.36, p <.001) and social support (b = -0.40, p =.025) predicted parenting stress. The effect of ACEs on parenting stress was mediated by depression (β = 0.15, 95% CI [0.063, 0.24]). The relationship between depression and parenting stress was moderated by social support (b = -0.08, p =.006). ConclusionsResults suggest that ACEs increase the likelihood of depression and parenting stress; however, social support may buffer the effects of depression on parenting stress among Latinx families, thus increasing family well-being.

Universal Teacher-Child Interaction Training in early childhood special education: A cluster randomized control trial

Growing evidence suggests that Teacher-Child Interaction Training-Universal (TCIT-U) is effective for increasing teachers' use of strategies that promote positive child behavior, but more rigorous research with larger, diverse samples is needed to understand the effects of TCIT-U on teacher and child outcomes in early childhood special education. Using a cluster randomized control trial, we evaluated the effects of TCIT-U on (a) teacher skill acquisition and self-efficacy and (b) child behavior and developmental functioning. Teachers in the TCIT-U group (n = 37) exhibited significantly greater increases in positive attention skills, increased consistent responding, and decreased critical statements relative to teachers in the waitlist control group (n = 36) at post and 1-month follow-up (d's range from 0.52 to 1.61). Teachers in the TCIT-U group also exhibited significantly fewer directive statements (d's range from 0.52 to 0.79) and greater increases in self-efficacy compared to waitlist teachers at post (d's range from 0.60 to 0.76). TCIT-U was also associated with short-term benefits for child behavior. Frequency (d = 0.41) and total number of behavior problems (d = 0.36) were significantly lower in the TCIT-U group than in the waitlist group at post (but not follow-up), with small-to-medium effects. The waitlist group, but not the TCIT-U group, demonstrated an increasing trend in number of problem behaviors over time. There were no significant between-group differences in developmental functioning. Current findings build support for the effectiveness of TCIT-U as universal prevention of behavior problems with an ethnically and racially diverse sample of teachers and children, including children with developmental disabilities. Implications for implementation of TCIT-U in the early childhood special education setting are discussed.

Rehabilitation - Is an Important Aspect of Universal Health Coverage

Rehabilitation is important, as are other facets of universal health coverage such efficient illness prevention, treatment, and palliative care. A person who has undergone rehabilitation can participate in school, job, recreation, and important life responsibilities including caring for family members. Rehabilitation enables a child, adult, or senior to be as independent as possible in daily activities. A health issue that could be treated by rehabilitation affects an estimated 2.4 billion individuals worldwide. The need for rehabilitation services is anticipated to increase globally as a result of changes in population health and features. People are living longer but with more chronic illness and incapacity, for instance. Rehabilitation needs are now mostly unmet. More than half of the population does not obtain the necessary rehabilitation services in several low- and middle-income nations. Rehabilitation and other healthcare programs have been severely impacted by the COVID-19 pandemic.