Child: care, health and developmentBente van der Meijden, Victoria von Salmuth, Alpheus Njewa, Alinafe Chisulanda Kusate, Ria Reis, Wieger Voskuijl
BACKGROUND: Cerebral palsy (CP) disproportionately affects children in low- and middle-income countries, where stigma and discrimination lead to marginalization and reduced participation. To design culturally appropriate community-based health promotion strategies that can address these challenges, the role of community stakeholders is crucial, yet unstudied in rural sub-Saharan Africa. This study aimed to explore stakeholders' perceptions, beliefs and attitudes towards children with CP and their caregivers in rural Malawi. METHODS: A qualitative study using semistructured focus group discussions was conducted with 68 stakeholders across five villages in Mangochi District, Malawi, from November 2022 to January 2023. Participants included traditional leaders, religious leaders, teachers, health surveillance assistants, traditional healers and community volunteers. Thematic analysis identified key themes regarding knowledge, perceptions, community participation and future needs. RESULTS: The following four major themes emerged: (1) limited knowledge about CP causes and treatment, with CP often attributed to infectious diseases, witchcraft or pregnancy complications; (2) perception of difficulties and their impact on the children and their caregivers; with financial constraints being named most and problems accessing education; (3) community participation and response; were stigma was identified as primary barrier to health promotion and community participation; and (4) future facilitators to improve quality of life including strong stakeholder willingness to support integrated care approaches. CONCLUSIONS: Community stakeholders demonstrated positive attitudes towards children with CP and willingness to support inclusive care programmes, despite limited disease-specific knowledge. Findings suggest that community-based health promotion interventions addressing knowledge gaps, reducing stigma and strengthening referral pathways could significantly improve outcomes for children with CP and their families in low-resource settings.
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of NursingSusana Malgrat-Caballero, Maite Franco, Oriol Planesas-Pérez, Estefania Garbero Garcia, Eleonora Alexandrova, Maria Z Techera, M Perea-Garcia, Belen Sendra Cri…
INTRODUCTION: Urinary incontinence (UI) is a prevalent geriatric syndrome that significantly affects the physical, psychological, and social well-being of older adults. Non-pharmacological interventions are recommended as the first-line approach, especially in frail older adults. DESIGN: This was a prospective pre-post observational study. METHODS: The study included sixty-one patients with rehabilitable UI who were admitted to an intermediate care hospital. The nurse-led multidisciplinary program integrated education, hygiene-dietary measures, pelvic floor physiotherapy, behavioral strategies, and transcutaneous electrical nerve stimulation (TENS). The primary outcomes were UI severity (International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)), voiding awareness, diurnal and nocturnal voids, disposable absorbent product use, functional status (Barthel Index), cognitive status (Pfeiffer test), and quality of life (EQ-5D). Data were collected at baseline and discharge. RESULTS: Data from 61 participants were analyzed. Significant improvements were observed in the ICIQ-SF scores (16.72 ± 3.39 vs. 9.10 ± 5.86; p < 0.001), daytime voiding awareness (83.6% vs. 100%; p = 0.002), nocturnal voiding awareness (66.7% vs. 88.5%; p = 0.002), nocturnal voids (3.46 ± 2.22 vs. 2.35 ± 1.68; p < 0.001), Barthel Index (49.83 ± 23.84 vs. 70.33 ± 19.59; p < 0.001), and EQ-5D scores (0.39 ± 0.28 vs. 0.56 ± 0.26; p < 0.001). The use of disposable absorbent products decreased from 98.36% to 62.30% (p = 0.065). The patient's cognitive status remained stable. The mean satisfaction with the program was 8.53/10. CONCLUSIONS: A nurse-led, multidisciplinary, non-pharmacological intervention effectively reduced UI severity, increased voiding awareness, enhanced functional autonomy, and improved the quality of life in older adults. These findings support the implementation of individualized, evidence-based programs in intermediate care settings. CLINICAL RELEVANCE: Non-pharmacological interventions led by advanced practice nurses provide effective, patient-centered management of urinary incontinence, improving autonomy and quality of life while potentially reducing healthcare costs.
Sexual healthAaminah Goolam, Grace Robin, Eli Ryan, Mikayla Napier, Brooke Dailey
BACKGROUND: The population of international students (IS) in New South Wales (NSW) continues to grow post-COVID-19, with IS a key priority within NSW Health HIV and sexually transmissible infection (STI) strategies and efforts. Evidence shows gaps in sexual and reproductive health knowledge (SRH), and barriers to accessing services, including stigma, unfamiliarity with the Australian healthcare system and service cost concerns. Although the existing NSW International Student Health Hub website provides tailored information, awareness and utilisation of statewide and local sexual health preventive services remains limited. METHODS: A partnership between Sydney Local Health District and the NSW Multicultural HIV and Hepatitis Service implemented a localised, culturally responsive health promotion program. Consultations with IS and student services informed strategies to improve SRH literacy, strengthen service navigation, and enhance supportive environments. Key strategies included developing a local International Student Health Directory, peer and service capacity building, dissemination of SRH information through culturally responsive health stalls, and a mobile STI screening clinic on a university campus. RESULTS: This review describes the program delivery between January 2024 and March 2026. More than 5000 international students engaged with 28 health promotion stalls, with >2500 health directories distributed. The peer capacity-building program trained 106 student leaders, with participant sexual health knowledge increasing from 75 to 91% in pre- and post-training assessments. Campus-based STI screening tested 22 students, and identified one undiagnosed case of syphilis. CONCLUSION: A health promotion program delivering localised, multifaceted and partnership-driven activities can strengthen IS SRH literacy, service navigation and engagement with demonstrated transferability across NSW.
Sexual healthSylvester Okeke, Eliza Basheer, Rochelle Avasalu, Carolyn Slattery, Belinda Meggitt, Limin Mao
BACKGROUND: This study evaluates the perceived impact and needed enhancement of a co-designed digital sexual and reproductive health (SRH) tool ('the Hub') developed to address SRH literacy gaps among international students (IS) in New South Wales, Australia. Despite Australia's large IS population and recognition of SRH as a fundamental human right, many report limited exposure to SRH information and face barriers to navigating health systems and accessing SRH services in host countries. METHODS: A mixed-methods evaluation was conducted comprising an online survey (August-October 2024; N = 129) and a focus group discussion (FGD) with professionals working with IS (N = 11). RESULTS: Survey findings indicate high acceptability and perceived usefulness of the Hub, with over 80% of participants rating content, including on the Australian health system, as high quality and most endorsing its design, tone, and usability. Although IS knowledge of HIV prevention and STI treatment was generally strong, gaps persisted regarding asymptomatic STIs, contraceptive limitations, and health system navigation. Notably, despite high awareness and favourable peer norms toward condom use and STI testing, testing uptake remained low: fewer than one in five sexually active IS reported STI (17.8%) or HIV (19.4%) testing in the previous 12 months. Qualitative FGD findings highlighted support for broader promotion strategies, including pre-arrival and campus-based dissemination, alongside needed enhancements to service navigation and cost transparency for SRH services. CONCLUSION: Overall, the Hub demonstrates feasibility and relevance as a digital intervention, though improved promotion and stronger linkage between knowledge and service uptake are essential to maximise public health impact.
Australian journal of primary healthAmireh Fakhouri, Sara L Newton, Lester Mascarenhas, Meredith Temple-Smith
BACKGROUND: In Australia, healthcare providers face significant challenges in meeting the niche health needs of refugees. Social determinants of health, including limited health literacy and finances, complicate refugees' access to treatment for conditions, such as chronic hepatitis B (CHB). Understanding the strategies utilised by a specialised general practice for refugees can offer guidance for treating this population. The aim of this study was to explore how primary care is currently managing CHB care tailored to refugees and to identify areas for potential improvements. METHODS: Between August and December 2024, we conducted 15 semi-structured interviews with nine general practitioners, four nurses, one pharmacist and one infectious disease specialist. We used a convenience sample and snowballing; most participants worked at a refugee-focused general practice in the west of Melbourne, Victoria, Australia. All interviews were recorded and transcribed; data were analysed descriptively. RESULTS: Primary healthcare providers in our study recognised the challenges of treating refugees with CHB, including low health literacy, and the cost of providing and seeking care. However, when compared with hospital services, the benefits of primary care include community integration and location, rapport development, and the availability of interpreter services. Subsidising primary care provider training and other costs were recommended. CONCLUSIONS: Primary care may be better positioned than hospital services to treat refugees with CHB. These findings support funding and improving CHB management in primary care to meet the needs of refugees, which will lead to better health outcomes for this disadvantaged population.
PURPOSE/OBJECTIVE: This project aimed to educate nurses on teaching patients about the safe management and removal of Jackson-Pratt (JP) drains at home. Using a multimodal learning approach allowed staff and patients to practice the procedure and build confidence to independently perform a JP drain removal. The project objective was to ensure that patients safely remove their own JP drain at home without complications. DESCRIPTION: After 2 extensive literature searches on the adverse effects of a delayed drain removal and the benefits of an at-home drain removal, a teaching plan was developed, which included a handout for the nurses with key teaching points, a patient education handout, and face-to-face education with staff for hands-on practice. OUTCOMES: This is an ongoing project that was initiated in February 2025. Although this is a new project, close to 100 drains have been successfully removed at home with no complications reported. CONCLUSIONS: By teaching nurses to educate their patients on JP drain management and removal at home, our staff was able to ensure patient safety and comfort. By educating patients on proper care and removal of their JP drains, bedside nurses improved patient satisfaction, reduced the risk of complications, decreased resource utilization, while not compromise patient outcomes.
BMJ openRosain Stennett, Sujane Kandasamy, Diana Sherifali, Russell J de Souza, Dipika Desai, Matthew Yw Kwan, Joanne A Smith, Thera Edwards, Georgiana Gordon-Strachan…
BACKGROUND: Most non-communicable diseases (NCDs) develop through multiple complex pathways that involve non-modifiable and modifiable risk factors. Prevention efforts optimally involve a life course approach that promotes healthy eating and physical activity because behaviours adopted early in adolescence and young adulthood are likely to be sustained and can prevent NCDs in later life. This research protocol describes a community-based co-designed study taking place in Canada and Jamaica that positions youth aged 15-25 as agents-of-change in their communities to increase knowledge and develop tools to adopt and promote sustainable practices and healthy active living. METHODS: The SCORE! Youth Sustainability Healthy Active Living (SCORE! Youth-SHAL)-Community Engagement and Co-design is a multimethod community-based participatory research (CBPR) study to be conducted in two sequential stages. Stage 1 involves community contextual mapping, a maximum of two community engagement workshops along with key informant interviews with both youth and stakeholders. Stage 2 includes a co-design workshop with local youth to develop customised healthy active living activities. Participants will be recruited using convenience and purposive sampling. Workshops and interviews will be audio-recorded and transcribed. Data will be collected to understand the SHAL intervention's feasibility, fidelity and contextual fit across diverse settings. Content and thematic analysis will occur concurrently and iteratively with data collection. ETHICS AND DISSEMINATION: This study has approval from Hamilton Integrated Research Ethics Board in Health Sciences, Brock University Research Ethics Board, The University of the West Indies-Mona Campus Research Ethics Committee, and Ministry of Health and Wellness, Jamaica-Advisory Panel on Ethics and Medico-Legal Affairs. Findings assist in finalising a SHAL intervention for youth in equity-deserving populations. We will also publish the study results in an academic journal and present at conferences, webinars and workshops.
INTRODUCTION: Mental health and well-being are urgent priorities across circumpolar regions, where suicide and psychological distress contribute substantially to premature mortality and disability. Indigenous communities in Arctic and sub-Arctic settings continue to face profound inequities linked to colonisation and intergenerational trauma, while also advancing wellness frameworks grounded in cultural continuity, language, land and self-determination. Progress in mental health promotion and suicide prevention depends on timely, consistent and culturally relevant population-level information. Yet mental health surveillance remains fragmented, and the literature has not been comprehensively mapped to describe how public health surveillance systems are designed, governed, implemented and used in Indigenous contexts. This review aims to inform culturally grounded mental health and wellness surveillance in circumpolar Indigenous contexts. This will be achieved by mapping how public health surveillance systems involving Indigenous Peoples are designed, governed, implemented and used, and identifying transferable lessons for circumpolar monitoring. METHODS AND ANALYSIS: This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews and will be reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Using a Population-Concept-Context framework, we will include peer-reviewed and grey literature published in the past 20 years (English and Scandinavian languages) describing public health surveillance systems implemented with, by or for Indigenous communities. This will cover the period of January 2006 to August 2026. Mental health, suicide, substance use and wellness-related systems will be prioritised. Searches will be conducted in MEDLINE, Embase and APA PsycInfo, complemented by targeted grey literature searching of relevant organisational and government sources. A health sciences librarian will execute all database searches and export results for screening. One reviewer will conduct the grey literature searches, documenting search dates, sources and retrieval decisions. Two reviewers will independently screen all records retrieved and extract data using a structured charting tool capturing system characteristics, governance and data stewardship, ethics, implementation considerations, uses of surveillance information and circumpolar relevance. Findings will be summarised descriptively and synthesised using inductive content analysis to identify recurring constructs, patterns and evidence gaps. The review is anticipated to commence in August 2026 and to be completed by September 2027. ETHICS AND DISSEMINATION: Ethics approval is not required for this review of publicly available literature. Results will be disseminated through peer-reviewed publication, presentations to relevant Indigenous and public health partners, and knowledge products tailored to circumpolar surveillance planning.
BACKGROUND: Ergonomics is fundamental to improving safety and efficiency in offices. Therefore, the purpose of this study was to assess the effect of a health education intervention on office workers' knowledge, attitude, and practice (KAP) regarding ergonomics and to determine their predictors. METHODS: For this intervention study, 230 office workers were split into two equal groups. A validated KAP office ergonomics questionnaire and a health education intervention were given to the intervention group, while the control group only received the questionnaire. Three months later, both groups received a post-test questionnaire. RESULTS: The post-test KAP scores of the intervention group were significantly higher than those of the control group (37.2 versus 30.9, 23.4 versus 28.3, and 17.0 versus 10.3, respectively, P < 0.05). Workers' office ergonomics knowledge, attitude, and practice scores significantly improved following the health education intervention (P < 0.05). Adequate knowledge and a positive attitude were significantly predicted by being younger (adjusted OR: 7.8 and 10.7), having a high level of education (adjusted OR: 8.9 and 2.5), using a computer (adjusted OR: 7.0 and 5.0), working long hours on a computer (adjusted OR: 3.1 and 3.0), and having a short job duration (adjusted OR: 5.2 and 12.3) within the intervention group. There was a significant positive correlation between the knowledge and practice scores (r = 0.469, P < 0.05). CONCLUSIONS: The outcomes of the study demonstrated that office workers who received health education had significantly enhanced their KAP after a three-month follow-up. This highlights the importance of office workers' ergonomics education to ensure workplace safety and improve their well-being and productivity. TRIAL REGISTRATION: The study was retrospectively registered at the Pan African Clinical Trial Registry (PACTR) (ID: PACTR202604893125732) on 29 April 2026.
Scandinavian journal of painKine Gjesdal, Svetlana Skurtveit, Ane Djuv, Aksel Paulsen, Gabriela Rolova, Cille Sevild, Torgeir Gilje Lid
BACKGROUND: Chronic pain is a global public health issue, severely affecting quality of life, functional capacity, and healthcare resources. Effective management requires adequate health literacy, yet limited health literacy is associated with greater pain burden and poorer outcomes. This underlines the need for interventions that can strengthen patients' health literacy skills. Thus, the aim of the present study was to investigate longitudinal changes in health literacy following participation in a multidisciplinary primary care pain management intervention. METHODS: This longitudinal study reports health literacy outcomes from a multidisciplinary, personalized pain management intervention that was developed in accordance with the Medical Research Council framework. Forty-three participants with chronic non-cancer pain completed the full intervention. Health literacy was measured using the Norwegian version of the Health Literacy Questionnaire (HLQ) at baseline, midpoint, and post-intervention. Changes over time were analyzed using paired-sample t-tests. RESULTS: Statistically significant improvements were observed in five HLQ domains from baseline to midpoint and in eight domains from baseline to post-intervention. "Having sufficient information to manage my health" showed the largest increase among Domains 1-5, whereas "Navigating the healthcare system" showed the largest increase among Domains 6-9 and improved significantly across all time-point comparisons. CONCLUSION: Participants demonstrated improvements in several dimensions of health literacy during participation in the intervention, particularly in domains related to having sufficient information to manage health and active self-management. These findings support further investigation of tailored, multidisciplinary approaches to strengthening health literacy among people with chronic pain. TRIAL REGISTRATION: NCT05828121 Date: 04-25-2023.
BACKGROUND: Digital health literacy (DHL) may be associated with health-related quality of life (HRQoL) in older adults with type 2 diabetes, but the behavioural and contextual correlates of this association remain unclear. This study examined that association, the indirect association through proactive health behaviours (PHB), and potential effect modification by the digital healthcare environment. METHODS: A cross-sectional survey was conducted from July to August 2025 among older adults with type 2 diabetes recruited by convenience sampling from primary healthcare chronic disease management registries in Huai'an, China. DHL, PHB and four single-item digital healthcare environment indicators were assessed using structured instruments, and HRQoL using the EuroQol five-dimensional three-level questionnaire (EQ-5D-3L) and EuroQol Visual Analogue Scale (EQ-VAS). Adjusted indirect-association (5000 bias-corrected bootstrap resamples) and effect-modification analyses used heteroscedasticity-consistent type 3 (HC3) standard errors. RESULTS: Among 1053 participants, the mean DHL score was 21.24±10.43, the mean PHB score 76.75±9.88 and the mean EQ-5D-3L utility score 0.968±0.069. The adjusted total association between DHL and utility was significant (B=0.000569, 95% CI 0.000228 to 0.000910), whereas the direct association was not (B=0.000152; p=0.338). The indirect association through PHB was significant (B=0.000418, bias-corrected 95% CI 0.000260 to 0.000619) and accounted for 73.5% of the total. There was no robust evidence of effect modification for EQ-5D-3L utility: interactions with remote service use and online health management use reached significance only under HC3 inference and were not reproduced in sensitivity analyses. An exploratory positive PHB-by-remote-service-use interaction was observed for the supplementary EQ-VAS outcome. CONCLUSIONS: Higher digital health literacy was associated with better HRQoL among older adults with type 2 diabetes, with a significant cross-sectional indirect association observed through proactive health behaviours. No robust effect modification was identified for the primary EQ-5D-3L outcome. These findings support further longitudinal and intervention research on digital health capabilities and proactive health behaviours in this population.
JMIR research protocolsSiu-Lun Chow, King-Wa Fu, Isaac Chun-Hai Fung, Patrick Ip, Mike Yat-Wah Kwan, Hai Liang, Frank Reichert, Zion Tsz Ho Tse
BACKGROUND: Regular and sustained handwashing is a key preventive measure for reducing the transmission of infectious diseases among school-aged children. Virtual reality (VR) interventions have demonstrated potential to facilitate behavioral change by creating immersive environments in which behavioral and environmental variables can be systematically manipulated. Compared with conventional verbal or video-based instruction, VR-based handwashing education may provide students with more interactive and experiential learning opportunities, and may improve cleaning of commonly missed areas, such as the wrists. However, evidence on school-based VR interventions for handwashing education in Hong Kong remains limited. OBJECTIVE: This study aims to evaluate the effectiveness of a customized VR intervention for teaching handwashing skills to secondary school students in Hong Kong. The intervention teaches the 7-step handwashing technique recommended by the Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region. The study will assess changes in handwashing performance and examine the longer-term effects of the intervention on handwashing habits, behavioral determinants, and hand hygiene. METHODS: A 3-arm randomized controlled trial will be conducted with approximately 500 students allocated to 3 groups on a school-class basis. Each group will receive 2 educational sessions with different interventions over 1 school year (10 months). The first intervention group will receive 2 VR game sessions focusing on handwashing skills. The second intervention group will receive 1 VR game session followed by 1 video session reviewing participants' gameplay from the first session. The control group will receive 2 video-based handwashing education sessions. Pre- and postintervention UV fluorescence imaging of participants' hands will serve as the primary outcome measure. The secondary outcomes will be assessed through surveys administered before the intervention, immediately after the intervention, and at a 4-month follow-up. The survey will measure self-efficacy, hand hygiene knowledge, handwashing habits and intentions, attitudes, subjective norms, perceived behavioral control, VR embodiment, and VR experience. RESULTS: The project was funded in March 2026, and recruitment was conducted from May to August 2026. As of August 2026, 9 schools had confirmed participation, with approximately 500 students expected to be recruited. Data collection is scheduled from September 2026 to June 2027. Data analysis is planned for August 2027, and the study findings are expected to be released in September 2027. CONCLUSIONS: This study will contribute to the development of VR-assisted infection prevention strategies. It addresses several research gaps by developing an evidence-based and feasible VR hand hygiene program for school settings, examining the sustainability of intervention effects, identifying factors and barriers underlying behavioral change in hand hygiene, and exploring handwashing patterns through hand motion data. Findings and implementation experiences from this project may also inform the development of other VR-based health promotion interventions.
Journal of medical systemsTim Wilhelmi, Vanessa Bartsch, Marius Platt, Asarnusch Rashid, Johannes Hornig, Martin Krusche, Axel J Hueber, Daniel Fink, Alexander Pfeil, Gabriel Dischereit…
Patients with rheumatic diseases have persistent information needs that are not fully addressed in routine care. We developed and evaluated guideline-grounded, large language model (LLM) chatbots to support patient self-management and education in rheumatology.Ten disease-specific chatbots based on German guidelines were co-developed and deployed through 13 rheumatology centres and six patient organisations. Chatbot users rated responses and completed a questionnaire. User questions, feedback, and response characteristics were analysed using category-based coding and a six-dimensional LLM-as-a-judge assessment, with LLM-based ratings compared with rheumatologist ratings in random subsets.Between September 2025 and January 2026, 6291 questions were recorded. Thirteen question categories were identified, most commonly disease-specific questions (50.2%), medication and monitoring (37.3%) and diagnostics (28.2%). The chatbots were unable to answer in 263 interactions (4.2%). Of 2671 responses rated by users, 2481 (92.9%) received a positive rating. Insufficient detail was the most common reason for negative ratings (125/190, 65.8%). Among 602 questionnaire respondents, 84.6% reported that the chatbot was easy to use, 84.1% that answers were easy to understand, and 80.2% that it was a useful addition to patient education. In the LLM-based evaluation, 95.3% of answers were rated as completely safe and 79.1% as completely correct. Guideline adherence was assessed separately, with 45.0% rated as fully adherent; agreement with physician assessment was weak.Guideline-grounded chatbots received predominantly positive user feedback in real-world use, while LLM-based evaluation suggested that most responses were safe and correct. User questions and feedback may help guide iterative improvements to source content and patient education materials. Further studies are needed to evaluate educational effectiveness and independently validate response quality and clinical safety.
PloS oneYan Tang, Junjun Zhou, Wan Ying Gan, Kim Geok Soh, Kim Lam Soh
BACKGROUND: Fear of hypoglycaemia (FoH) can interfere with diabetes self-management in adults with type 2 diabetes mellitus (T2DM). Educational and behavioural interventions may address hypoglycaemia-related worry and avoidance, but evidence focused on adults with T2DM remains limited. This systematic review and meta-analysis examined the effects of structured educational and behavioural interventions on FoH in this population. METHODS: Nine databases were searched from inception to 31 December 2025 for randomised controlled trials of educational and behavioural interventions addressing FoH or FoH-related outcomes in adults with T2DM. Data were pooled using random-effects models, estimating standardised mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using Tau² and I², and a 95% prediction interval was estimated. Small-study effects and additional sensitivity analyses were examined. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was assessed using GRADE. The review was registered with PROSPERO (CRD42025630957). RESULTS: Eleven RCTs involving 1,096 participants were included. The exploratory pooled average effect favoured educational and behavioural interventions for reducing FoH (SMD = -1.89; 95% CI -2.54 to -1.25; p < 0.00001). Heterogeneity was substantial (Tau² = 1.10; I² = 95%), and the 95% prediction interval crossed the line of no effect (95% PI -4.34 to 0.56), suggesting that effects may differ across future similar studies. Funnel plot asymmetry and Egger's regression test suggested possible small-study effects. Trim-and-fill findings were estimator-dependent and suggested possible attenuation of the pooled estimate in exploratory analysis. The certainty of evidence was very low because of risk of bias, substantial heterogeneity, indirectness, and possible small-study effects. CONCLUSION: Very low-certainty evidence suggests that structured educational and behavioural interventions may reduce FoH in adults with T2DM; however, the magnitude and generalisability of this effect remain uncertain. Further RCTs with standardised FoH measures, longer follow-up, and clearer reporting of intervention components and fidelity are needed.
The government's first Men's Health Strategy outlines a comprehensive framework for improving health outcomes among men by addressing preventable morbidity, reducing health inequalities and enhancing engagement with health services. Within community settings, the strategy emphasises early intervention, accessible care pathways and the promotion of health-seeking behaviours among diverse male populations. This article discusses how community-based provision delivered through primary care, public health initiatives, outreach programmes and multidisciplinary collaboration supports the implementation of the Men's Health Strategy in practice.
BACKGROUND: Promotional activities, such as social marketing approaches, are important for raising cancer awareness and increasing breast cancer screening participation. Such interventions are designed to facilitate change and maintain positive health behaviors at both the community and society level. With the growing use of these promotional activities in public health, it is pertinent to map available studies to inform future evaluations and the development of effective interventions. OBJECTIVE: This study aimed to review existing studies on how social marketing interventions have been used to promote breast cancer screening and early diagnosis. The specific objectives were to assess the characteristics of social marketing interventions aimed at promoting breast cancer screening, identify the methodological approaches used in evaluating the interventions, identify the outcomes used to measure the impact of social marketing interventions for breast cancer screening, and assess the impacts of social marketing interventions when promoting breast cancer screening. METHODS: A comprehensive literature search was performed in 6 electronic databases to identify qualitative and quantitative evaluations of social marketing interventions targeting breast cancer screening and early diagnosis. Titles and abstracts were reviewed independently by two reviewers, followed by data extraction and verification. The methodological quality was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions. Outcomes were categorized using an adapted version of key performance indicators and metrics related to social media use in health promotion. RESULTS: Overall, 15 research articles were eligible and analyzed. The 4 types of social marketing interventions identified were health professional and educational strategies, social media or mass media campaigns, community outreach campaigns, and video-based marketing. The predominant intervention source was public health government bodies, followed by regional health services, cancer charities, and educational institutions. Most interventions were designed to influence breast cancer screening behaviors by raising awareness through advertisements, educational interventions, and fundraising activities. Most interventions reached a large audience (>500 people), but participants had mixed awareness and perceptions toward social marketing strategies, and the outcomes were shaped by demographic factors such as cultural backgrounds, age, education, marital status, and occupation. Knowledge gaps, cost concerns, and the lack of physician recommendations also constituted key barriers to screening uptake. Behavior change outcomes were sparingly assessed in most interventions, thereby contributing to limited understanding of mechanisms affecting screening uptake. CONCLUSIONS: Available evidence suggests that social marketing interventions may enhance breast cancer screening and early diagnosis. However, robust evaluations of these interventions and assessment of behavior change outcomes could be performed in future research by using well-established evaluation frameworks and reporting guidelines. Developers and funders of these campaigns should also consider using an evaluation plan before conducting the actual campaign.
Acta oncologica (Stockholm, Sweden)Julie Gehl, Tatiana Michel, Erik Rokkones, Soleakhena Ken, Gregor Sersa, Irene Torres-Espallardo, Ester Orlandi, Laura Ridolfi, Nina Schmidt, Ingrid Kruecken, …
BACKGROUND AND PURPOSE: High-tech medical resources play an increasingly important role in cancer diagnosis and treatment. However, accessing information about these technologies remains challenging due to their complexity and a lack of clear information pathways to obtain reliable information. This, in turn, contributes to inequalities in healthcare. Patient/material and methods: The Joint Action Network of Expertise on Cancer (JANE-2) is one of the largest networks under Europe's Beating Cancer Plan. In JANE-2, the work package on High-Tech Medical Resources comprises seven domains of rapidly evolving technologies, namely Nuclear Medicine, Radiomics, Innovative Radiotherapy, Innovative Surgery, Physical Methods of Ablation, Cell Therapies, and Ex-vivo Testing of Agents. Leaders from these domains, together with patient representatives, have authored a review of the challenges of providing patients with information about high-tech medical resources, and have proposed potential solutions. RESULTS: This article describes the challenges associated with providing adequate information to patients, the resulting consequences, and potential solutions. The article also specifically describes technologies related to the seven high-tech domains that are central to cancer treatment. Patient information tools related to these technologies are provided as supplementary material to the article. INTERPRETATION: Cancer diagnosis and treatment are not only becoming increasingly effective but also more complex with the adoption of novel technologies. This article discusses the challenges and potential solutions related to the availability of patient information and provides examples of patient information tools for seven key and rapidly advancing technologies.
Hu li za zhi The journal of nursingPei-Chun Tsai, Chin-Yen Wu, Chih-Hsuan Chen, Hsuan-Ping Chang, Ching-Yao Chen
BACKGROUND & PROBLEMS: Patients undergoing hemodialysis require adequate self-care ability to balance disease control with daily life activities. Inadequate self-care may lead to complications such as dyspnea, electrolyte imbalance, and catheter-related infections, increasing the risk of re-hospitalization. Based on a situational assessment and cause analysis, the authors identified the self-care implementation rate among hemodialysis patients to be only 65.8%. The major contributing factors included incomplete delivery of health education by nursing staff, inconsistent handover of education evaluation results information, patients' limited absorption of verbally delivered health education, and the absence of appropriate, practical educational support tools. PURPOSE: This project was designed to improve the rate of successful self-care implementation among hemodialysis patients using diversified improvement strategies to reduce repeated hospitalizations and enhance patient quality of life. RESOLUTION: A health education evaluation and handover checklist, a catheter care manual, educational videos, teaching models, and an app-based interactive quiz game on catheter-related infection prevention were developed. Through inter-professional collaboration, a food water-content chart was designed, home care experiential learning sessions were conducted, and a discharge passport was provided to integrate health education content and establish continuous care records. RESULTS: After implementation of the project interventions, the self-care implementation rate among hemodialysis patients increased from 65.8% to 90.5%, achieving the project's targeted goal. CONCLUSIONS: Integrating visual materials, multimedia educational tools, and experiential learning courses has the potential to enhance the effectiveness of health education and learning motivation among hemodialysis patients, thus improving their self-care ability. In addition, these strategies may reduce the time required by nursing staff to deliver health education and thus improve the efficiency of clinical nursing care.
JAMA network openCarol Maher, Luke Wolfenden, Nicole Nathan, Jacinta Brinsley, Ty Ferguson, Rachel Curtis, Rosa Virgara, Alyce Barnes, Svetlana Bogomolova, Kylie Brannelly, Dyl…
IMPORTANCE: Extended education programs reach tens of millions of children globally during discretionary hours when physical activity competes with screen use, yet scalable strategies to improve movement behaviors are limited. OBJECTIVE: To evaluate the effectiveness of Activated Outside School Hours Care (OSHC), a policy-based intervention to improve physical activity and screen time practices in extended education settings. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial was conducted in Australia's system of organized before- and after-school care in 3 Australian states (South Australia, New South Wales, and Western Australia) between August 1, 2022, and December 31, 2024, with assessments at baseline, 3 months, and 12 months. INTERVENTION: Activated OSHC is a web-based intervention offering voluntary accreditation to services aligning their policies with national physical activity and screen time guidelines through staff training. Services were randomized 1:1 to intervention or usual practice, in which services continued their typical programming. MAIN OUTCOMES AND MEASURES: The primary outcome was service-level adherence to OSHC sector physical activity and screen time guidelines. Secondary outcomes included staff physical activity-enabling behaviors, children's moderate-to-vigorous physical activity and recreational screen time, and availability of physical activity equipment, assessed through direct observation. Intention-to-treat and per-protocol analyses were performed. RESULTS: Of 197 services (101 in the intervention group and 96 in the control group), 182 (92%; 90 in the intervention group and 92 in the control group) completed the 12-month follow-up. Of the 101 services in the intervention group, 48 (48%) achieved accreditation within 12 months. Intention-to-treat analyses showed no significant effects for guideline adherence or children's activity levels. However, the services in the intervention group demonstrated greater staff physical activity-promoting behaviors during before-school care (odds ratio [OR], 1.72; 95% CI, 1.27-2.33) and greater availability of physical activity equipment during before- (OR, 1.21; 95% CI, 1.00-1.46) and after-school care (OR, 1.16; 95% CI, 1.04-1.30). In per-protocol analyses, accredited services were more likely than controls to meet all guidelines (OR, 7.35; 95% CI, 1.39-38.86), with improved after-school screen time adherence (OR, 5.63; 95% CI, 1.16-27.22). In per-protocol analyses, accredited services showed greater staff physical activity-enabling behaviors (OR, 3.00; 95% CI, 2.10-4.28), and children engaged in more physical activity during before-school care (incidence rate ratio, 1.23; 95% CI, 1.05-1.43) compared with controls. CONCLUSIONS AND RELEVANCE: This randomized clinical trial found few population-level changes in intention-to-treat analyses. However, services achieving accreditation demonstrated consistent improvements in guideline adherence, staff behaviors relating to physical activity, and children's physical activity. The intervention was effective when implemented, but limited uptake constrained population-level impact. The accreditation model is viable for practice improvement, but policy- or system-level strategies may be needed to drive widespread adoption. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12622000393752.
Health expectations : an international journal of public participation in health care and health policyStephanie P Cowdery, Patricia M Livingston, Thach Tran, Antonina Mikocka-Walus, Anna Ugalde, Eva Yuen, Hannah Jongebloed, Natalie Winter, Nicole Kiss, Nikki Mc…
BACKGROUND: Informal carers are essential in supporting people with cancer yet often experience unmet supportive care needs. AIMS: The aim of this study was to examine (a) access to supportive care services (b) perceived barriers to accessing services, and (c) the potential influence of carer health literacy on access and barriers to supportive care among carers across three priority population groups (rural-remote-dwelling, LGBTIQA+ and culturally and linguistically diverse (CALD)). METHODS: Cross-sectional online survey of Australian adult cancer carers. Supportive care use, access barriers, and health literacy (Health Literacy of Caregivers Scale - Cancer (HLSC-C)) were assessed. Logistic regression examined differences across priority groups, and mediation analyses explored the role of health literacy. RESULTS: Among 1154 carers, 61.9% accessed some supportive care (46.7% formal services), yet 86.6% reported at least one barrier, with 71.0% reporting two or more. Common barriers were time constraints, service availability, and long wait times. Compared to non-priority population carers, rural/remote carers had higher odds of reporting limited local availability and services not available when needed (aOR = 5.08 for both). CALD carers had higher odds of reporting a barrier (aOR = 1.81), including long wait times, cost, and lack of culturally appropriate services (aOR = 33.03). Health literacy significantly mediated the association between CALD status and reported barriers. CONCLUSIONS: Cancer carers have limited access to supportive care and face systemic barriers. Inequities remain, particularly for carers from rural/remote areas and those from CALD backgrounds. To improve equity, there is a need for co-designed, accessible interventions that address health literacy and the diverse geographic, cultural, and linguistic needs of carers. PATIENT OR PUBLIC CONTRIBUTION: People with lived experience of cancer caregiving were included on this study's advisory committee. In this role, their expertise informed the study design, including the development of the questionnaire, the Participant Information and Consent Form (PICF), and recruitment processes. They were also invited to contribute to data interpretation and the preparation of this manuscript. The lead consumer representative (NR) is listed as a co-author on this manuscript.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationLeah Seamark, Olivia Radcliffe, Marianne Williams, Jim Gotto, Bridie Watson, Jenna Trudgeon, Sue Reeves, Yvonne Jeanes
INTRODUCTION: The only treatment for coeliac disease is the exclusion of all gluten from the diet. Adherence to a gluten free (GF) diet requires knowledge acquisition and changes in behaviours. The service evaluation aimed to evaluate the impact of a dietitian-led webinar for adults with coeliac disease. METHODS: The pre-recorded dietitian-led webinar had been developed by specialist dietitians and gastroenterologists and was integrated into a patient pathway. A pre- and post-webinar online survey was designed to evaluate the impact of the webinar for adult patients with coeliac disease. Patients were invited to complete an online survey prior to accessing the webinar. Four weeks later, the patients were invited to complete the post-webinar survey. RESULTS: The webinar was accessed by 1050 adults with coeliac disease, of which 57% were diagnosed within the preceding 8 weeks. In patients who completed both surveys, there was a significant improvement in confidence (p < 0.001) and knowledge (p < 0.001) to follow a GF diet (n = 165). Among patients who reported gastrointestinal symptoms on gluten ingestion (n = 71), a greater proportion reported satisfactory symptom relief after watching the webinar (p = 0.02). Behaviours to minimise gluten ingestion were positively impacted, whereby a higher proportion of patients reported to 'doing things to avoid eating gluten when preparing in the home' and 'having GF foods on hand while they are out' (p < 0.05). CONCLUSION: The dietitian-led webinar enabled timely access to high-quality resources from specialists. Access to the webinar positively impacted knowledge and behaviours to minimise gluten ingestion. This is a practical and inexpensive solution to enable specialist dietitians to utilise their skills and finite time for appointments with patients with more complex presentations.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsM J Sharman, M Mclaughlin, P McCue, T Washington, V J Cleland
ISSUE ADDRESSED: Government policy largely determines the transport-related physical activity (TRPA) environment-an environment central to global PA promotion frameworks (e.g., Global Action Plan on Physical Activity). However, little is known about this policy environment-a knowledge gap this study aimed to fill in Tasmania. METHODS: Guided by the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework, the World Health Organisation's Health Enhancing Physical Activity Policy Audit Tool (PAT) Version 2 was contextualised to reflect the study's subnational and TRPA focus (PAT-C). In 2024, a five-person Tasmanian multi-sector project team completed the PAT-C. The audit included 20 policy documents systematically extracted from Tasmanian government websites screened for TRPA relevance. After PAT-C completion, a SWOT analysis underpinned by the CAPPA identified strengths, weaknesses, opportunities and threats of the TRPA policy environment. RESULTS: Key strengths were: 9/20 policy documents directly supported TRPA; many agencies/formal groups/mechanisms within/outside of subnational government provide TRPA leadership/advocacy. Main weaknesses were: 11/20 policy documents made no/indirect TRPA reference; certain settings and population groups for TRPA targeting were overlooked across policies; disclosure of consultation and policy cross-referencing was inconsistent; missing were mechanisms to ensure evidence-based policy, a TRPA communication strategy, dedicated funding, specific targets, robust measures and comprehensive TRPA intervention evaluation. Targeted advocacy addressing TRPA-related policy environment omissions was a key opportunity. Fluctuating political commitment and operating environments were important threats. Conclusion and So what: Many gaps in the TRPA environment were identified that, if filled, could support population-level health gain by tackling upstream influences on physical activity.
The Medical journal of AustraliaGloria T Y Lau, Pam Laird, Robyn Aitken, Melanie Barwick, Liam Bedford, Emily R Bowden, Jamie Everingham, Angela Fuery, Reece Griffin, Neha Jain, Mina Kinghorn…
OBJECTIVE: To identify barriers and facilitators to the timely detection and optimal management of chronic wet cough (CWC) in children from the perspectives of carers, across multiple, diverse First Nations Australian communities. STUDY TYPE: Qualitative participatory action research study. SETTING AND PARTICIPANTS: Eight Australian communities across three states and territories. Semi-structured interviews and focus groups with 167 parents and carers of Aboriginal children were conducted between May 2021 and July 2023. MAIN OUTCOME MEASURES: Barriers to and facilitators of detection and management of CWC in Aboriginal children in a primary care setting. RESULTS: Key barriers identified included inadequate health promotion, the common perception that CWC is normal and high turnover among health staff, leading to mistrust of newly onboarded health staff. The overarching facilitator identified was knowledge dissemination through health promotion, delivered in person by Aboriginal health staff using culturally secure resources, supplemented by posters placed in the community and the use of radio and social media. Individual communities expressed varied preferences regarding specific health promotion methods and designs. Communities valued staff who had spent considerable time within the community, allowing for the development of trust and rapport. CONCLUSION: The barriers and facilitators to detecting and managing CWC in children were generally consistent across the settings we studied. Implementation approaches to facilitate care require tailoring to local settings. Further, to reduce identified barriers for the detection and management of CWC in children, the incorrect perception that CWC is normal must be addressed and the potential harms of staff turnover need to be recognised.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsSarah Turner, Sara Dingle, Melissa Ensink, Emily Tomlinson, Tristan Duncan, Carah Figueroa, Shane Kavanagh
ISSUE ADDRESSED: Artificial intelligence (AI) is transforming public health and health promotion (PHHP) practice, creating a need for graduates who can use AI ethically, critically and effectively. Although AI is increasingly being incorporated into higher education, the focus has been on individual units or assessment tasks, with limited guidance available for embedding AI capabilities across entire courses. This study responded to this gap by developing a curriculum framework for integrating AI capability across postgraduate PHHP programmes. METHODS: An iterative co-design approach was undertaken within a large Australian university to develop an AI curriculum framework for the Master of Public Health and Master of Health Promotion programmes. The framework was informed by competency-based education and integrated curriculum design principles. It was also aligned with local institutional AI principles and mapped to international accrediting competencies. RESULTS: The resulting 'ECHA' framework comprises four principles: Ethical and Responsible Use of AI; Critical Appraisal; Human-Centred Decision-Making and Professional Judgement; and Applied AI Literacy and Safe Practice in PHHP. Each principle is accompanied by discipline-specific learning outcomes, curriculum content and core graduate skills. CONCLUSIONS: The new framework offers a practical, programme-wide model for integrating AI capability into postgraduate PHHP education. Embedding AI within existing professional competency frameworks supports coherent curriculum design while preserving the human-centred values underpinning professional practice. SO WHAT?: This paper provides a coordinated, competency-informed approach to course-wide AI curriculum design, intended to assist universities in preparing PHHP graduates to use AI ethically, critically and responsibly.
JAMA network openJunne Kamihara, Angel M Cronin, Hajime Uno, Miki Horiguchi, Lauren Fisher, Jaclyn Schienda, Rebecca Vanderwall, Moran Snir, Guy Snir, Emilie Simmons, Andrew Kh…
IMPORTANCE: Adolescents and young adults (AYAs) with hereditary cancer predisposition face high rates of lifetime cancer risk. Models to support their understanding of cancer risk have not been developed. OBJECTIVE: To assess the effect of an electronic chatbot-based cancer risk communication tool on AYAs' understanding of cancer risk. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted at the Dana-Farber Cancer Institute, Emory University/Children's Healthcare of Atlanta, University of Chicago, and University of Utah Huntsman Cancer Institute between December 20, 2022, and May 30, 2025 and compared cancer predisposition visits alone vs visits with an electronic chatbot-based cancer risk communication tool, AYA Risk Information and Screening Education, using baseline and follow-up surveys to assess changes in knowledge of cancer risk by age 30 years and over their lifetime, knowledge of recommended screening, and level of psychological distress. Eligible participants were English speakers aged 12 to 24 years, who had 1 of 9 hereditary cancer predisposition syndromes. The primary analysis was conducted according to the intention-to-treat principle. Data were analyzed from July 21 to September 3, 2025. INTERVENTION: Chatbot-based intervention with cancer risk and recommended screening information tailored to each syndrome. Additional links to resource pages with chat summary content (learn), recommended age-based screening (plan), guidance about talking with peers (share), links to support organizations (connect), and coping and bereavement support (grow). MAIN OUTCOMES AND MEASURES: The primary outcome was knowledge of cancer risk. The secondary outcomes were knowledge of recommended screening and level of psychological distress. RESULTS: Of 798 AYAs assessed, 106 AYAs were randomized and enrolled (54 to the intervention group and 52 to the control group). Participants' mean (SD) age was 18.3 (SD, 3.9) years, and 64% (68 of 106) were girls or women. At baseline, 38% of AYAs (20 of 52) in the control group and 52% (28 of 54) of AYAs in the intervention group had accurate knowledge of cancer risk by age 30 years. Following the clinic visit, 37% (19 of 52) of AYAs in the control group and 78% (42 of 54) in the chatbot-based intervention group had accurate knowledge, reflecting greater improvement in knowledge of cancer risk by age 30 years (OR, 3.50; 95% CI, 1.45-9.19; P = .005). AYAs in the intervention group had non-statistically significant improvements in knowledge of recommended screening (OR, 2.17; 95% CI, 0.85-5.59; P = .11) and reductions in distress compared with AYAs in the control group (distress thermometer, β = -0.50; 95% CI, -1.09 to 0.08; P = .09). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, use of a chatbot-based intervention combined with a cancer predisposition clinic visit improved knowledge of cancer risk by age 30 years over a clinic visit alone, without increasing distress. Combining human interaction in the clinic with personalized, accurate electronic information can support AYAs with cancer predisposition and other serious conditions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04323774.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsM Casey, J E Porter, R Eime
INTRODUCTION: Physical activity (PA) is essential for health and wellbeing, yet participation among women from culturally and linguistically diverse (CALD) backgrounds remains low due to complex, multi-level barriers. Co-design is increasingly recognised as a means of developing culturally relevant and sustainable interventions, but its application within local government-led PA programmes is limited. METHODS: Guided by the socioecological model (SEM), this study examined how co-design can be operationalised within a local government context to plan and deliver PA opportunities, alongside an exploratory analysis of short-term outcomes. A mixed-method participatory design was conducted across four phases: planning, co-creation, implementation and evaluation. SEM informed identification of barriers and enablers during workshops, while co-design principles guided collaborative strategy development. Data collection included co-design workshops (n = 76 women), pre- and post-intervention surveys (baseline n = 42; follow-up n = 21), a staff focus group and interviews with women (n = 3). Quantitative data were analysed using paired t-tests; qualitative data were thematically analysed to examine co-design processes and participant experiences. RESULTS: Co-design resulted in the development and implementation of culturally relevant programmes including group-based exercise, women's football, netball and water safety, incorporating features such as childcare, safety and opportunities for social connection. Quantitative findings indicated modest increases in PA (+34 min/week, p = 0.25), and improved physical health (p = 0.02). Qualitative findings highlighted outcomes associated with enhanced social connections and sense of empowerment, and the importance of iterative programme adaptation. CONCLUSION: Integrating SEM and co-design offers a robust framework for addressing multi-level barriers and supporting inclusive PA programmes within local government practice and strengthening community capacity and equity in health. SO WHAT?: These findings provide actionable evidence for local governments seeking to implement inclusive, culturally responsive PA initiatives, positioning co-design as a scalable approach to addressing participation inequities among women from CALD backgrounds.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsJoclyn Kernot, Shoshannah Kiriam, Sarah Seekamp, Kate Little, Kellie Hunt, Erin Lister, Carol Maher, Jacinta Brinsley
ISSUE ADDRESSED: Rural Australian youth face persistent mental health inequities yet are rarely meaningfully involved in designing the services meant to support them. This study aimed to explore through co-design what rural young people need and want in their community to support their mental health and wellbeing, with a secondary aim of evaluating the co-design process itself. METHODS: Three co-design workshops were conducted with 20 participants (13 young people aged 12-17 years and seven adults) in Kimba, South Australia, using the Double Diamond design framework and PRODUCES co-production principles. Workshops followed a Discover-Define-Develop-Deliver progression. Qualitative content analysis of workshop outputs and focus group data informed findings, alongside descriptive analysis of post-workshop feedback surveys. Study findings were subsequently interpreted through the PROSECO process evaluation framework, applied retrospectively. RESULTS: Co-designers prioritised practical, occupation-based wellbeing activities, ultimately prototyping a Basic Car Maintenance Workshop and a community Colour Fun Run. Most participants reported feeling able to contribute (72%) and that the process was helpful (96%). Five themes emerged from the process evaluation: factors influencing engagement, experiences of the co-design process, workshop environment and participation, impact and continuation, and voice and inclusion. CONCLUSIONS: Flexible, context-sensitive facilitation, anonymous contribution methods, and deliberate management of group dynamics were critical enablers of meaningful youth participation in this rural setting. SO WHAT?: Practical, occupation-based activities co-designed with rural youth can serve as accessible preventative mental health interventions. Embedding structured co-design evaluation frameworks prospectively would strengthen future practice and replication.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsPaola Borquez-Arce, Eva Ignatious, Kym Berchtenbreiter, Jazmina L Gonzalez Cruz, Jacqueline Frayne, Jennifer Stone
INTRODUCTION: Chronic diseases are a leading cause of illness, disability, and death in Australian women. Co-design research methodologies offer promising approaches to developing community-centred solutions that improve engagement with preventive health. This community-driven research explored ways to improve the prevention and early detection of chronic diseases in healthy women (without symptoms of disease). METHODS: A Double Diamond approach guided the project. Areas of interest were identified through a Community Conversation, followed by co-investigation of digital health promotion strategies for women. An online survey (n = 145) and in-depth interviews (n = 21) explored women's knowledge of chronic disease risk, risk prediction tools and screening. Thematic analysis informed key principles, which were ranked by a Consumer Reference Group and an Expert Reference Group to define a framework for digital health promotion strategies supporting self-management of chronic disease risk. These informed the development of a "Quick Guide" for digital health promotion to support risk management in women. The guide was refined through iterative feedback and tested for acceptability by health promotion professionals (n = 6). RESULTS: Key themes included the need for tailored and accessible health information, convenience and affordability, and the recognition of how fear and mistrust influence health behaviours. Community connection and storytelling were prominent, as was targeting younger audiences through education and social media. The Quick Guide was deemed acceptable by professionals, especially useful for early-career practitioners. CONCLUSION: This co-design project led to a practical Quick Guide to support the development of community-driven digital health promotion strategies for managing chronic disease risk in healthy women. SO WHAT?: Future research may explore its real-world application in digital campaigns and test its integration into primary care and community health services.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsLaura J Kennedy, Sara F L Kirk, Alisson Dykeman, Meaghan Sim, Jeanna Parsons Leigh, Catherine L Mah
BACKGROUND: Healthy eating policies are of growing importance to the management of retail food environments in healthcare (e.g., hospital cafeterias). Several researchers have begun to analyse health promoting benchmarks within these policies. However, little is understood about the relationship between policy and continuous quality improvement (CQI) for health promotion in healthcare. Furthering our understanding of benchmarks within these policies could provide insight into how we can measure and create standards in health promotion. This policy analysis examined publicly accessible healthcare healthy eating policies in Canadian health authority jurisdictions, up until November 22, 2022. METHODS: Data was extracted using a monitoring and evaluation framework for evaluating nutrition policies in publicly funded institutions, with adaptations based on organisational CQI concepts. Policy components analysed included: policy design, nutrient profiling systems, nutrition standards, evaluation, and monitoring. A second reviewer independently extracted data and peer debriefing was completed on the extractions. RESULTS: This analysis identified five healthy eating policies meeting the inclusion criteria, from Alberta, British Columbia, Newfoundland and Labrador, Nova Scotia, and Winnipeg, Manitoba. Policies included nutrient profiling, including benchmarks for selling healthy, moderately healthy, and less healthy food and beverages. Other benchmarks were mentioned but contained fewer indicators (e.g., fundraising, catering, and advertising). Policies included benchmarks about product and placement (e.g., healthier items in visible places) but less about price. The included policies promoted collaboration amongst healthcare providers but lacked details about evaluation and monitoring. CONCLUSION: This policy analysis suggests that different healthcare settings may require different benchmarks, tailored to their contexts. Furthermore, standardisation may not be optimal if further experimentation is needed to identify benchmarks for health promotion practices, as is common in healthcare CQI. Policy implementation requires a combination of top-down and bottom-up approaches, and collaboration with multiple partners may be necessary for success. Benchmarking processes are a potential strategy for understanding improvements to other aspects of the food environment beyond nutrient standards. SO WHAT: CQI and retail food environments each focus on customer satisfaction and costs, thus sharing alignments. CQI benchmarking processes are a potential strategy for understanding improvements to other aspects of the food environment beyond nutrient standards. Further exploration is needed to implement and monitor benchmarks over time.
OBJECTIVE: Health literacy is considered a prognostic determinant for patients with heart failure (HF), and the recognition of disease names could be fundamental to this. This study examined the proportion of patients with HF who recognized their disease name and its association with prognosis. METHODS: From January 2021 to June 2023, 188 hospitalized patients with HF (Stage B-D, median age 81 years) were asked to recall their disease name before discharge. Recognition accuracy was evaluated using a standardized scoring system, and interobserver agreement was confirmed. In a subset, communicative and critical health literacy (CCHL) was assessed. Prognostic outcomes included all-cause mortality and all-cause hospitalization after discharge. RESULTS: The recognition score showed high interobserver reliability (κ = 0.85). Seventy-two patients (38%) failed to recognize their primary diagnosis. Those without recognition had significantly lower CCHL scores than those with recognition (p < 0.01). During a median follow-up of 280 days, 76 patients (40%) experienced adverse events. In univariate analyses, lack of diagnosis recognition was associated with an increased risk of adverse outcomes, but this association disappeared after adjustment for age, cognitive function, and HF severity. CONCLUSION: A substantial number of older patients with HF did not recognize their primary diagnosis, but disease recognition was not an independent determinant of prognosis.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyHeba Saeid Mohamed, Omaima M Ali Kattabei, Hassan Hussein Ahmed, Heba M Elfeky, Rania Reda Mohamed
BACKGROUND AND PURPOSE: This study investigated the effect of Global Postural Re-Education (GPR) versus conventional physical therapy in text neck syndrome (TNS). A prospective, single-blinded, parallel-group randomized controlled trial design was used. METHODS: Sixty participants with TNS (aged 18-40 years) were randomly assigned to either conventional treatment or GPR plus conventional treatment. Both groups received supervised therapy for three sessions per week over 4 weeks. Outcome measures included craniovertebral and shoulder angles assessed by photogrammetry, pain intensity via Visual Analog Scale, and Cervical Range of Motion via a smartphone application (Clinometer). Measured before and after the intervention. RESULTS: Within-group analyses showed significant improvements in pain and CROM in both groups (p < 0.001). However, the between-group analysis revealed no superiority of GPR for pain or CROM (p > 0.05). In contrast, GPR demonstrated statistically significant superiority in postural correction, with greater improvements in craniovertebral angle (MD: 2.14°; 95% CI: 0.69-3.59; p = 0.005) and shoulder angle (MD: 3.2°; 95% CI: 0.33-6.07; p = 0.03), exceeding MCID thresholds and indicating clinically meaningful benefits. However, these findings should be interpreted with caution because of the longer session duration in the GPR group. DISCUSSION: Incorporating Global Postural Reeducation (GPR) into conventional treatment provided significant additional benefits for postural parameters (craniovertebral and shoulder angles) in individuals with text neck syndrome. However, GPR demonstrated no added superiority over conventional treatment alone regarding pain intensity and cervical range of motion outcomes.
Healthcare professionals (HCPs) play a critical role in obesity management, yet many report inadequate training, low confidence and stigma-related attitudes. While education programmes have been developed to address these issues, evidence of their effectiveness remains mixed. This study aimed to evaluate the effectiveness of structured education and training programmes in improving HCPs' practice competencies in obesity management. We searched MEDLINE, EMBASE, CINAHL, Web of Science, ERIC and Google Scholar for studies published from 2020 assessing structured obesity management education programmes for HCPs. Eligible studies reported outcomes related to practice competencies (knowledge, skills and practice behaviours, confidence, attitudes) or patient outcomes (weight loss). Standardised mean differences (SMDs) were pooled using random-effects meta-analysis. Heterogeneity was assessed using I2 and Q statistics, and subgroup analyses explored potential sources. Studies not included in the meta-analysis were summarised descriptively. Eighteen studies were included from 1683 records. Pooled analysis of four RCTs and three non-RCTs showed a significant improvement in practice competencies (SMD = 0.41, 95% CI 0.12-0.70, p < 0.01) with high heterogeneity (I2 = 60%). Effects were significant in RCTs (SMD = 0.53, 95% CI 0.10-0.95, p = 0.01), but not non-RCTs (SMD = 0.25, 95% CI -0.04 to 0.55, p = 0.09). Interventions lasting ≥ 4 h produced larger, significant effects (SMD = 0.68, 95% CI 0.30-1.07, p < 0.01), while shorter interventions did not. Quasi-experimental studies supported improvements across HCP competencies and occasionally, patient outcomes. Structured education and training programmes may improve HCP competencies in obesity management, particularly confidence, with stronger effects generally observed in longer, more comprehensive interventions (≥ 4 h).
Pediatric obesityAnna Wittmann, Pia Späth, Feline Zocher, Eckard Nagel, Michael Lauerer, Magdalena Schellenberg
BACKGROUND: Weight management and maintenance of healthy habits are crucial in combating paediatric obesity. This systematic review examines outcomes beyond BMI in teleintervention maintenance programmes, with a focus on sustaining a healthy lifestyle. METHODS: A PubMed, LIVIVO and Web of Science search was conducted for publications between 2012 and 4 November 2025 to identify primary studies evaluating teleintervention maintenance programmes of at least 12 weeks' duration, delivered to children and adolescents with overweight or obesity following structured obesity treatment. We extracted healthy lifestyle parameters (e.g., quality of life), behaviour change (e.g., diet) and clinician-reported outcomes (e.g., BMI). Quality assessment was tailored to study type. As data did not permit meta-analysis, we performed a narrative synthesis. RESULTS: Screening 2543 articles yielded 6 RCTs and 2 pre-post studies. Findings highlight improvements in psychosocial outcomes (e.g., social well-being), lifestyle modifications in daily choices (e.g., dietary patterns) and behaviours (e.g., screen time), and statistically significant outcomes including reductions in body fat percentage, metabolic profile improvements, cardiovascular enhancements and BMI stabilisation. Feasibility insights were also gained. CONCLUSION: Teleintervention maintenance programmes following structured paediatric obesity treatment were associated with stabilisation of previously achieved weight-related and behavioural gains, rather than greater weight loss than comparator care, alongside consistently high feasibility and substantial reductions in healthcare visits and cost. Given the heterogeneity of designs and outcomes, findings should be interpreted as directional rather than pooled effect estimates, and a human component may be necessary to sustain them.
Rhode Island medical journal (2013)Mohamad Y Fares, Tarishi Parmar, Peter Boufadel, Mohammad Daher, Jonathan Berg, Adam Z Khan, Brian W Hill, John G Horneff, Joseph A Abboud
OBJECTIVES: Chatbots have been increasingly recognized as modern tools that provide patients with reliable health-related information. This study aimed to evaluate and compare ChatGPT-3.5 and GPT-4's ability to answer glenohumeral osteoarthritis-related questions. METHODS: Fifteen questions were derived from the 2020 AAOS Clinical Practice Guidelines for the Surgical Management of Glenohumeral Joint Osteoarthritis. Questions were categorized into three groups: risk factors, implant/intraoperative considerations, and pain/functional outcomes. ChatGPT-3.5 and GPT-4 were prompted with these questions, and responses were evaluated by four fellowship-trained shoulder and elbow surgeons. Each response was rated on a scale (scores:1-5) based on relevance, accuracy, clarity, completeness, and evidence-based support. Data was analyzed descriptively and statistically to compare the scores between ChatGPT-3.5 and GPT-4. RESULTS: Average score for ChatGPT-3.5 was 19.7/25, with "Risk Factor" prompts achieving the highest mean score. GPT-4 averaged 18.7/25, with "Functional Outcomes" prompts scoring highest. However, there were no statistically significant differences between different prompt themes for GPT-3.5 and GPT-4. "Clarity" category received the highest score for GPT-3.5, while "Relevance" was highest for GPT-4. Both models scored lowest on "Evidence-based" prompts. On the Flesch- Kincaid scale, GPT-3.5 responses had a significantly higher score of 18.3 compared to GPT-4's 15.4, indicating a more difficult reading level in GPT-3.5's responses. CONCLUSION: Both ChatGPT-3.5 and GPT-4 performed adequately in providing well-informed medical responses to patient queries about glenohumeral osteoarthritis. Future chatbot versions should focus on providing evidence-based content through systematic and reliable reviews of literature, in an accessible readable manner.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsSiona Fernandes, Eleanor Holroyd
ISSUE ADDRESSED: Physical activity (PA) and sport are mechanisms that promote health and social belonging, yet evidence of policies promoting sports participation and inclusion for Australia's growing migrant population is limited. This study examined how Australian federal, Victorian state and local government (LG) policies address migrant inclusion and equitable sports participation, with a secondary focus on Asian Indians, Australia's largest Asian ethnic group. METHODS: Twenty public-facing policy documents drawn between 2014 and 2024 were systematically selected and thematically analysed (federal: n = 10, state: n = 2, LGs: n = 8) using content analysis with 10 predefined categories drawn from migrant-contextual PA domains and planning aspects. RESULTS: Fifteen documents referenced migrant-specific keywords. Key categories included social and cultural contexts, physical environment and target groups. Sociocultural framing in national and LG documents highlighted sport's role in migrant integration. Victorian LGs adapted the physical environment to accommodate informal and culturally specific sports (e.g., kabaddi), fee-free options and multisport facilities. Few national sport-sector documents distinctly target migrants. Immigration-sector documents identified new arrivals, highlighted cross-government partnerships that integrated sport within workplace initiatives, and adopted a migrant-focused evaluation framework. Most documents lacked actionable migrant-focused initiatives and details on budget, timeframes or legal compliance. CONCLUSION: Migrant inclusion is gaining attention in national sport policy initiatives but is insufficiently addressed in state-level documents. Intersectional approaches, targeted planning, collaboration between sport, immigration and health sectors, and increased political advocacy could advance migrant equity.
The Journal of school healthMaryam Karkhaneh, Nasrin Omidvar, Farid Zayeri, Vahid Yazdi Feyzabadi, Hamid Abbasi, Saeid Doaei, Azam Doustmohammadian
BACKGROUND: The Nutrition-Friendly School Initiative (NFSI) is a whole-school approach designed to address the triple burden of malnutrition among school-aged children. However, evidence on its implementation across diverse settings remains fragmented. METHODS: This scoping review followed Arksey and O'Malley's framework and searched PubMed, Web of Science, Embase, Scopus, and gray literature sources for studies explicitly implementing the NFSI framework. FINDINGS: Sixteen records were included. Evidence suggests that NFSI implementation improves nutrition knowledge, dietary behaviors, and selected health outcomes, including BMI, stunting, and micronutrient status. Major facilitators included institutional commitment, multisectoral collaboration, and stakeholder engagement. Common barriers were limited resources, insufficient training, weak policy enforcement, and sociocultural resistance. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Integrating NFSI principles into education and public health systems may strengthen school nutrition policies and reduce health inequities. Sustainable implementation requires cross-sector collaboration, equitable resource allocation, supportive school food environments, and stronger monitoring systems, particularly in resource-constrained settings. CONCLUSION: The NFSI is a promising framework for promoting child nutrition and health, but stronger long-term evaluations and more comprehensive implementation strategies are needed.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsFarwa Rizvi, Victoria White, Patricia M Livingston, Kylee Bellingham, Sue-Anne McLachlan, Jennifer Philip
BACKGROUND: Participation in breast cancer screening among culturally diverse women in Australia remains below national targets. Healthcare providers, particularly general practitioners (GPs), play a pivotal role in bridging communication and knowledge gaps and in advocacy, especially for under-screened South Asian (Pakistani and Indian) women. OBJECTIVE: To explore communication and health education strategies used by healthcare providers to encourage breast cancer screening among culturally diverse South Asian women living in Victoria. METHODS: A qualitative study involving semi-structured interviews with 15 GPs and non-primary healthcare providers in Victoria, Australia. Participants were recruited using purposive and snowball sampling methods, drawing from primary care, specialist networks and peer-to-peer referrals. Reflexive thematic analysis was applied to identify communication strategies and system-level insights. RESULTS: Three major themes were identified: (1) encouraging health engagement; (2) communication strategies; (3) cultural sensitivity of healthcare providers. Trust-building strategies were important in encouraging health engagement and reducing resistance to screening and misconceptions. Participants reported low levels of health literacy, including limited awareness of BreastScreen Victoria's free service. While interpreters aided communication, they also posed challenges in maintaining efficient consultations. Healthcare providers promoted patient-centred, visual resources to support screening discussions. Cultural sensitivity was emphasised through the use of culturally competent tools and healthcare providers' ongoing cultural training. Existing screening informational resources were considered insufficient to address the cultural preferences of screening South Asian women. CONCLUSIONS: Strengthening breast cancer screening for culturally diverse women relies on building trust through culturally competent healthcare providers who can support their patients' engagement with screening through empowering communication, tailored tools and shared decision-making. SO WHAT: Healthcare providers are key enablers of breast cancer screening participation among South Asian women. Investing in culturally competent communication, tailored resources and workforce training could substantially improve screening engagement among South Asian women who remain under-screened despite access to free screening services.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsFrancis Nona, Britta Wigginton
Climate change is already impacting the livelihoods and lifeways of Indigenous peoples globally, including in the Zenadth Kes (Torres Strait) communities of the continent now called Australia. To date, Indigenous perspectives and Knowledges remain underexplored in public health scholarship. Few culturally grounded, place-based methods exist to engage respectfully with these sensitive issues. In this article, we present the findings of ArtVoice, an arts-based, community-driven qualitative method rooted in Indigenous epistemologies and relational ways of knowing. ArtVoice, as a 'method-in-place', invited community members to express their experiences, hopes and concerns about climate change through creative artworks. Field visits and yarns were guided by cultural protocols, Indigenous self-determination and cultural authority supported by a participatory approach. We present the reflections on the process and practice of applying ArtVoice in decolonising and culturally responsive ways, while upholding local protocols for managing and re-representing Knowledges. This article attempts to decolonise health promotion research while simultaneously honouring Indigenous Knowledge systems. Elucidating the tensions and opportunities of these distinct knowledge systems helps us document the complexities of decolonising research practice and dissemination.
BACKGROUND: Pre-emptive kidney transplantation is the preferred treatment in patients with end-stage kidney disease (ESKD); however, many patients must unavoidably initiate dialysis prior to transplantation. Prolonged dialysis exposure is associated with increased morbidity and mortality, mandating prompt transition to transplant when possible. Delays in transplant readiness are unfortunately prevalent and are often driven by fragmented communication, limited education, and system-level barriers. OBJECTIVE: To reduce time from dialysis initiation to deceased donor kidney transplant (DDKT) activation among pediatric patients through a single-center quality improvement initiative. METHODS: This quality improvement (QI) project was conducted at a tertiary children's hospital affiliated with a pediatric outpatient dialysis unit. Baseline data from 2023 demonstrated a median dialysis-to-DDKT activation time of 211.5 days. Interventions were implemented in 2024 through three Plan-Do-Study-Act cycles (PDSA): (1) establishment of a multidisciplinary Guidance and Planning clinic for early transplant education; (2) implementation of biweekly transplant-dialysis coordination meetings supported by expanded transplant coordinator staffing; (3) distribution of a bilingual patient education booklet at dialysis initiation. The primary outcome measure was time to DDKT activation. Trends were evaluated using descriptive statistics and a run chart. RESULTS: In 2024, 10 patients initiated dialysis during the intervention phase. Excluding 2 patients who were activated for transplantation prior to outpatient dialysis initiation, the median time from dialysis initiation to DDKT activation decreased by 38%, from 211.5 days in 2023 to 130.5 days in 2024. Sixty percent of patients initiating dialysis in 2024 underwent transplantation within the same calendar year. Process measures demonstrated successful implementation of interventions. CONCLUSIONS: Implementation of a structured quality improvement approach was associated with reduced time to transplant activation in pediatric dialysis patients. Improved communication, education, and transplant coordination may represent modifiable factors that may enhance transplant readiness and outcomes.
The Journal of school healthKhadija Daoudi, Abdellah Gantare
BACKGROUND: Adolescence is a critical developmental period during which health-related behaviors consolidate. In Moroccan secondary schools, health education remains largely educator-guided, with limited evidence of classroom communication. This study analyzes how verbal interaction patterns structure health education delivery at middle and high school levels. METHODS: An exploratory mixed-methods study was conducted in five Moroccan secondary institutions (N = 169 students). Verbal interactions (1024 utterances) were coded using the Roter Interaction Analysis System (RIAS), adapted to the Moroccan educational context. Pre- and post-intervention questionnaires assessed short-term knowledge acquisition. Qualitative and quantitative analyses examined speech distribution, functional communication categories, and developmental differences. RESULTS: Educators produced 57.5% of utterances. Instrumental communication predominated (62%-67%), while affective exchanges represented approximately one-third of interactions. Middle school sessions combined directive guidance with experiential anchoring, whereas high school sessions demonstrated increased dialogic debate and argumentative engagement. Knowledge scores improved significantly across all sessions (p < 0.001), with improvements evident in both middle and high school interventions. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Findings highlight interactional competence as a measurable pedagogical skill and support the integration of structured communication training modules and developmentally adapted dialogic strategies within secondary educator preparation programs. CONCLUSION: The findings suggest that secondary health education operates as a negotiated communicative process in which language shapes participation, learning, and emerging health literacy.