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.
British journal of health psychologyChris Keyworth, Katharina Sophie Vogt, Mark Conner, Christopher J Armitage, Tracy Epton, Judith Johnson
BACKGROUND: Healthcare professionals in the UK's National Health Service (NHS) are encouraged to deliver health behaviour change interventions during routine consultations. 'If-then' planning helps healthcare professionals to work with patients to identify and overcome barriers. However, in order to deploy such interventions, healthcare professionals must find them acceptable. AIMS: To use the Theoretical Framework of Acceptability (TFA) to understand the acceptability of interventions to support delivery of if-then planning interventions by: (a) exploring healthcare professionals' experiences of an online theory-based intervention which was designed to support them to deliver opportunistic health behaviour change interventions during routine clinical consultations, and (b) understanding the most prominent aspects of intervention acceptability to make recommendations for refinements and implementation. METHOD: Twenty-six NHS healthcare professionals (including nurses, physiotherapists, dieticians, doctors and midwives) participated in semi-structured interviews. The TFA informed both the design of the interview topic guide and the framework analysis, in which findings were mapped onto the TFA domains. RESULTS: Five TFA domains were prominent: affective attitude, burden, intervention coherence, perceived effectiveness, and ethicality. There were mixed attitudes, but HCPs were broadly positive (affective attitude), valued the brief format (burden), and felt it aligned with their professional values (ethicality). They understood the intervention (intervention coherence) and believed it addressed barriers to health behaviour change conversations (perceived effectiveness). CONCLUSIONS: The intervention was broadly acceptable to healthcare professionals, with key domains including affective attitude, burden, intervention coherence, perceived effectiveness and ethicality identified as important. These findings provide specific targets for refining the intervention and supporting its implementation in routine healthcare practice.
Journal of foot and ankle researchRyan H Nishi, Jenna Tsuzaki, Shashi Sharma, Matthew Kao, Cameron Nishida, Kyle K Obana, Julian Rimm, Kyle Ishikawa, Kore Liow, Enrique Carrazana
BACKGROUND: Tarsal tunnel syndrome (TTS) is a relatively uncommon compressive neuropathy of the posterior tibial nerve that is often underdiagnosed due to variable presentation and overlap with other conditions. As patients increasingly turn to YouTube for health information, concerns have arisen about the reliability and comprehensibility of such content. METHODS: On December 23, 2024, YouTube was queried using the terms "tarsal tunnel syndrome," "tarsal tunnel release," and "tarsal tunnel injection." After excluding duplicates, unrelated, non-English, and short (< 30 seconds) videos, 88 were reviewed and the 50 most-viewed were analyzed. Each was evaluated using three tools: the Journal of the American Medical Association (JAMA) benchmark criteria (0-4) for reliability, a 4-point Likert scale for comprehensibility, and a 19-point Tarsal Tunnel Syndrome-Specific Score (TTS-SS) for educational content. Video source, content type, and video power index (VPI) were also recorded. The Shapiro-Wilk test assessed normality, and Kruskal-Wallis and Wilcoxon rank sum tests compared group with Holm adjustment. RESULTS: The median TTS-SS educational content score was 5.2 (IQR 3.0-8.0). Mean JAMA and comprehensibility scores were 2.0 and 2.6, respectively. Only 10% of videos met all four JAMA criteria, and fewer than 20% were rated as highly comprehensible. Disease-specific videos had the highest TTS-SS (mean = 6.8), while non-surgical management scored lowest (mean = 2.8, p = 0.025). Videos by trainers and physical therapists had higher VPI (mean = 338.4) than those by physicians (mean = 0.26, p < 0.001), despite lower educational value. Surgical technique videos were least comprehensible (mean = 1.4) compared with other types (p < 0.05). CONCLUSION: Among the most-viewed English-language YouTube videos sampled at a single time point, content related to TTS demonstrated generally low educational completeness, reliability, and comprehensibility. While healthcare professionals produce more accurate content, their videos attract less engagement than those by non-physicians. Improving visibility of evidence-based videos is necessary to ensure patients receive accurate information for this underrecognized condition.
Australian journal of primary healthAbbie Lockwood, Iain Butterworth, April Gerolemou, Eh Ta Mue Lue, Boe Htoo, Zahir Azimi, Lisa Carson, Kaye Graves, Cheryl Martin, Simon Baker
BACKGROUND: Former refugee populations settling in regional Australia often experience low cancer literacy, delayed health-seeking and reduced engagement with cancer services. This study reports on the first phase of a community-led service improvement initiative designed to improve cancer literacy and access to culturally responsive cancer care for Karen and Afghan former refugees in Bendigo, Victoria. METHODS: A participatory, action-oriented service improvement approach was used, combining literature review, community consultation and health service engagement. Phase 1 involved a structured needs analysis including nine focus groups with Karen and Afghan community members (n = 128), alongside consultations with cancer service staff and health professionals. Findings informed the co-design of culturally responsive interventions and system-level improvements. A theory of change framework was developed to guide implementation and evaluation. RESULTS: The needs analysis identified limited cancer knowledge, fatalistic beliefs, mistrust of Western health systems and significant language and navigation barriers. System-level challenges included interpreter limitations, complex service pathways and limited culturally appropriate resources. In response, a cross-sectoral partnership implemented bicultural workforce development, in-language education programs, co-designed resources, navigation support and service system improvements. Early outcomes from 39 community education sessions (n = 412 participants) showed high reported uptake of knowledge (99%) and intention to use knowledge (92%). CONCLUSION: Early findings suggest that integrating community-led needs analysis with system-level service redesign shows promise for improving culturally responsive cancer care in regional settings. With former refugees increasingly settling in regional Australia, this place-based model provides a potential framework for strengthening equitable access to cancer prevention, screening and care for refugee populations.
Clinical obesityHelen M Parretti, Carly A Hughes, Sally Erskine, Nicholas Steel, Amy Jennings
This service evaluation of a primary care-based specialist weight management service reports data from 1094 patients over 5 years (2014-2019), including weight data at 1-year post-discharge. The results show clinically and statistically significant improvements in weight, diet, physical activity, quality of life, blood pressure and blood glucose control (in people living with type 2 diabetes). Change in weight was statistically significant for all timepoints in all subgroups. At 1-year completers (n = 560) had lost a mean of 8.3 kg (SD 0.3) and 133 patients (23.8%) had lost ≥ 10% of their starting weight. Using baseline observation carried forward analysis on the whole cohort (n = 1094) the mean weight loss at the end of the 1-year programme was 4.5 kg (SD 0.2) and 144 (13.2%) had lost ≥ 10% of their starting weight. A year after discharge completers demonstrated a mean weight loss of 8.3% (SD 10.3 n = 303) and 35.6% (n = 108) of completers had maintained ≥ 10% change in body weight. Analysis showed a mean weight loss of 2.5% (SD 6.8 n = 1094) in the whole cohort using baseline observation carried forward, demonstrating maintenance of weight loss and suggesting that specialist weight management services in primary care may be effective in the longer-term.
The Journal of school healthYui Morita, Aya Saitoh
BACKGROUND: This scoping review mapped evidence on whether school health education using active learning with peer-to-peer health communication is associated with behavior change among elementary and junior high school students and identified challenges to sustaining change. METHODS: Following PRISMA-ScR, we searched Ichushi Web, PubMed, and ERIC (February 14, 2024) for studies (2014-2024) evaluating peer-communication-based active learning in school health education with behavioral outcomes. FINDINGS: Seventeen studies were included; 14 reported behavioral change, 2 partial change, and 1 emotional change without clear behavioral outcomes. Nine studies used behavioral or learning theories, and in this small set of studies, theory-informed interventions were reported to show overall or partial behavioral change, most often with Social Cognitive Theory (5 studies). These findings should be interpreted cautiously given the heterogeneity of study designs and outcome measures. Key limitations were limited long-term follow-up assessing sustainability of behavior change (5 studies) and concerns about measurement reliability (4 studies). The included studies were heterogeneous in terms of interventions and outcome measures, and many relied on self-reported behavioral indicators. As this was a scoping review, no formal risk-of-bias assessment was conducted. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Schools may strengthen primary prevention by embedding structured peer interaction and theory-informed techniques, while ensuring inclusive participation and supports that do not depend on family resources. CONCLUSIONS: Peer-to-peer health communication-based active learning may support short-term behavior change, but sustainability and measurement quality remain major evidence gaps.
Health expectations : an international journal of public participation in health care and health policyNicola Gadd, Simone Lee, Jessica Hughes, Matthew J Sharman, Ha Hoang, Kehinde Obamiro
INTRODUCTION: Understanding how individuals find bowel cancer and screening information and what influences awareness may support targeted interventions and encourage informed participation in screening programmes and support early detection. This study aimed to identify factors that influence remote community members information-seeking behaviours and awareness of bowel cancer and screening. METHODS: A qualitative study was conducted with 16 community members aged 50-years and over living in a remote Tasmanian community in Australia. Semi-structured interviews were informed by the Theoretical Domains Framework and Behaviour Change Wheel. Interview questions were reviewed by three consumers with lived experience of bowel cancer and screening to improve clarity and accessibility. Interviews were analysed using qualitative content analysis with inductive and deductive coding. RESULTS: Information‑seeking was shaped by self‑efficacy, health literacy, personal relevance, and social influences, with trusted healthcare providers playing a central role. Awareness influenced screening decisions, while screening experiences also built awareness across the screening pathway to diagnosis. Some participants screened with an understanding of the risks and benefits, while others complied without understanding why, and some with low awareness chose not to screen. Awareness most often developed through passive information exposure, including environmental cues, screening material prompts, and social influences of routine healthcare encounters, and conversations with family, friends, and healthcare providers, rather than through active information‑seeking. CONCLUSION: In this remote community, bowel cancer awareness was commonly shaped through passive exposure rather than deliberate searching and influenced the quality of screening decision‑making. Health promotion strategies that embed accessible, plain‑language information within everyday community and healthcare settings, and leverage trusted relationships, may better support informed and equitable participation in bowel cancer screening than approaches that rely on active information‑seeking. PATIENT OR PUBLIC CONTRIBUTION: Consumers with a lived experience of bowel cancer and screening contributed to this study by reviewing the interview guide structure and questions prior to the researchers undertaking the interviews. This improved the plain language and the participants understanding of the questions, with the addition of an introductory script outlining the study aims and process of the interview. The final interview guide was sent to the consumers for approval prior to the first interview being conducted. These consumers did not participate in this study. Remote Tasmanian community members who were eligible or previously eligible to participate in the National Bowel Cancer Screening Program contributed to this study as participants who shared their experiences and insights into bowel cancer and screening information-seeking behaviours and awareness.
Health expectations : an international journal of public participation in health care and health policyStephen Paull, Stephanie Smith, Jordan Bill, Joanna C Moullin, Tania Harris, Yvonne C Anderson
BACKGROUND: Childhood obesity prevalence is increasing globally, with Aboriginal and Torres Strait Islander children over-represented in Australian data. Evidence-based, community healthy lifestyle programs require culturally safe adaptation when implemented in new First Nations contexts, where prioritising access and engagement of First Nations groups is critical. This study aimed to identify Aboriginal community representatives' perspectives on potential barriers and enablers to recipient engagement and program implementation, and to identify cultural and place-based considerations to inform culturally safe adaptation of Whānau Pakari from Aotearoa/New Zealand for delivery as the Healthy Lifestyle Program in Boorloo/Perth, Western Australia. METHODS: A 3-h workshop was conducted with 29 Aboriginal advisors, with whole-group discussions and 5 facilitated breakout groups, to obtain Aboriginal community guidance on cultural and place-based considerations needed to adapt the program locally. Data were analysed by Framework Analysis using the updated Consolidated Framework for Implementation Research (CFIR) to identify barriers and enablers (determinants) of program engagement and implementation. Determinants were then reclassified inductively into themes to enhance participant relatability, supporting communication and feedback. RESULTS: A total of 44 potential determinants (16 barriers and 28 enablers) were mapped to 18 CFIR constructs across all five domains of innovation, outer setting, inner setting, individuals and implementation process. Three themes were identified from these determinants: acknowledging cultural context encompassed healing and self-determination, reclaiming knowledge and culture, and addressing limited access to health-promoting environments; guiding values included mutual respect, building and earning trust, and intergenerational learning; and program considerations included culturally secure practice, specific ways of working, and keeping families engaged. CONCLUSIONS: Aboriginal community guidance highlighted cultural and place-based priorities for program adaptation, and potential determinants of successful implementation within a prevailing healthcare service, iteratively informing program adaptation. This study used a unique methodological approach, prioritising participant voice alongside CFIR terminology, to provide rare evidence of pre-implementation First Nations engagement outcomes when adapting a program to integrate into the prevailing healthcare service. Partnership with First Nations communities is essential to implementing accessible, culturally safe models of care, thereby addressing health inequities. LIVED EXPERIENCE OR PUBLIC CONTRIBUTION: An established Cultural Advisory Group of 12 Aboriginal Elders worked in partnership with the Healthy Lifestyle Program, 10 of whom reviewed the identified themes and sub-themes throughout the analysis process. Two members were nominated by the group and reviewed the final draft manuscript. Identified determinants iteratively informed program adaptation, guided by the Cultural Advisory Group. This work was also supported and guided by a representative consumer body, Health Consumers' Council WA.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationKrystal L Hodge, Caitlin Kownacki, Kaitlyn Streitmatter, Rebecca L Hagedorn-Hatfield, Karah Mantinan, Jennifer McCaffrey
BACKGROUND: As community nutrition education programs have expanded to include policy, systems, and environmental (PSE) initiatives to increase access to nutritious food and safe physical activity, the impact of these efforts on the consumption of healthier foods and physical activity levels is not clear. Research shows the effectiveness of PSE changes on individual-level behavior in controlled environments and in other public health disciplines. However, more evidence and guidance is needed to show the impact of PSE interventions in practice on individual-level nutrition and physical activity behaviors. The PSE Intervention and Evaluation Framework (PSE-IEF) was developed to explain the process by which implemented PSE activities may result in behavior changes within the priority audience. METHODS: Framework development involved a review and Theory of Change mapping process of a list of PSE changes used in the Supplemental Nutrition Assistance Program- Education (SNAP-Ed) Program, an environmental literature scan to identify relevant theories and related factors, and an expert review. The environmental scan examined how PSE changes are conceptualized as drivers of behavior change and how their impacts are measured at the individual level. Sources were identified through database searches, grey literature review, and citation tracking, with inclusion limited to U.S.-based, English-language documents published in the past 10 years. Twelve frameworks or theories were reviewed for their focus on individual behavior, ability to capture behavior change over time, and recognition of individual choice in when or whether change occurs. The PSE changes theory of change mapping results were reviewed for alignment with the selected framework and applied to a logic model for PSE implementers. Forty-five practitioners reviewed the framework for relevance, comprehensiveness, and comprehensibility, with revisions made iteratively until no substantial changes to structure or content were received. RESULTS: The final PSE-IEF describes how PSE programs are implemented at the organizational level and how they might impact the target audience at the individual level. To see outcomes at the individual level, organizational level activities must be completed, including staff awareness, engagement, action and maintenance activities to produce PSE outputs available for target audience use. Precaution Adoption Process Model stages of awareness, engagement, decision, action, and maintenance describe the responses at both the organizational and individual level over time. CONCLUSIONS: The resultant framework can be used to guide PSE intervention and evaluation in community-based programs and to increase the evidence base illustrating the impact of PSE interventions on individual behavior and health.
International journal of nursing practiceNedime Hazal Döner, Öznur Usta Yeşilbalkan, Şevki Çetinkalp
AIM: The aim of this study was to develop a mobile application for patients with Type 2 diabetes initiating insulin therapy for the first time and to evaluate its effects on insulin knowledge, insulin injection skills, self-management of insulin therapy and attitudes towards insulin use. METHODS: This randomized controlled study included 88 participants assigned by block randomization to intervention (mobile application, n = 44) and control (standard care, n = 44) groups. The intervention group received insulin training via the mobile app, whereas the control group received standard care. Data were collected at baseline (T1), on the 14th day (T2) and on the 28th day (T3) using the Patient Information Form, Insulin Knowledge Form, Insulin Treatment Assessment Scale, Insulin Treatment Self-Management Scale and Insulin Injection Skill Observation Form. RESULTS: In the intervention group using the mobile application, a statistically significant increase over time was observed in the levels of insulin-related knowledge, self-management of insulin treatment and insulin injection skills, whereas negative attitudes and perceptions regarding insulin treatment decreased (p < 0.05). No statistically significant change was observed in the control group (p > 0.05). CONCLUSION: The results obtained in the present study indicated that the mobile application developed for patients with Type 2 diabetes using insulin for the first time is effective in disease self-management, fosters positive behavioural changes and serves as a viable educational tool for individuals with Type 2 diabetes. The application can be integrated into routine nursing-led diabetes education programmes to enhance continuity of care and support patients during insulin initiation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06060743.
Australian occupational therapy journalHelen M Bourke-Taylor, Tricia Mackay, Monica Leo, Loredana Tirlea
UNLABELLED: Health disparities experienced by mothers of children with disability highlight the need for mental health and wellbeing interventions. This study investigated the health behaviour, health-seeking, mental health, wellbeing and longitudinal outcomes for participating mothers in the Healthy Mothers Healthy Families (HMHF) e-workshop package. METHODS: Data were collected at baseline (T1), post-intervention (T2), 6 weeks post-workshop (T3), and 12 weeks post-workshop (T4). The HMHF package included: three, 2-hour HMHF e-workshops facilitated by trained peer facilitators, messaging group support, electronic workbook, and online modules. Outcome measures included the Health Promoting Activities Scale (HPAS); Depression Anxiety Stress Scale (DASS-21); Psychological General Wellbeing Index - subscales wellbeing (PGWBI-PWB), vitality (PGWBI-VT) and general health (PGWBI-GH); Family Empowerment Scale - Cohesion (FES-C); Family Environment Scale - Family (FES-Family); and My Families Accessibilities and Community Engagement (MyFACE). CONSUMER/COMMUNITY INVOLVEMENT: This project is about a co-designed intervention that is delivered by trained consumers. RESULTS: Outcomes for mothers (N = 56) from T1-T4: HPAS increased (Δ = 8.90, 95% CI 6.70-11.10, P < 0.001); Psychological distress decreased, with lower DASS Depression (Δ = -3.16, 95% CI - 4.84 to -1.47, P < 0.001), Stress (Δ = -6.45, 95% CI - 8.67 to -4.24, P < 0.001), and Anxiety (Δ = -2.26, 95% CI - 3.88 to -0.65, P = 0.006). Improvements were observed for psychological wellbeing and vitality, and for family environment, while no significant changes were found for general health or attitudes to community accessibility (MyFACE). Mothers reported improved stress management, diet, physical activity, participation in leisure, and self-concept. CONCLUSION: The HMHF package was effective in promoting positive and sustained mental health and wellbeing at 12-week follow-up. Increased engagement in health-promoting activities is indicative of effective inclusion of healthy habits in the daily routines of mothers who participated in the workshops. This online, group-based programme with occupational therapy foundations supported the health and empowerment of mothers who participated. Future development of similar programmes is recommended.
The Journal of school healthKate Maston, Jessica Godward, Lyndsay Brown, Sarah K Stevens, Andrew Mackinnon, Aliza Werner-Seidler
BACKGROUND: Sleep education remains largely absent from high school health curricula, despite widespread insufficient sleep in adolescents. This pilot study evaluated Sleep Ninja for the Classroom, a curriculum-aligned sleep health education program for Australian high schools. METHODS: Participants were teachers (N = 12) and students in Year 7-8 (N = 428). Using a single-arm pre-post design, all students received the three-lesson program during regular health classes. Student sleep knowledge and behaviors were assessed, and a program evaluation examined student- and teacher-rated acceptability, appropriateness, and feasibility. RESULTS: Improvements were observed in students' sleep knowledge, satisfaction with current sleep pattern, frequency of daytime napping, earlier weekend rise time (mean = 25-min), and weeknight bedtime (mean = 6-min). No changes were found in other sleep behaviors. Students spending < 8 h in bed at program commencement showed the most significant changes in bedtimes (mean = 54-min earlier on weeknights and 39-min earlier on weekends). Acceptability was high, with most students reporting the program was relevant and engaging, and all teachers rating the program as appropriate and feasible to implement. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Sleep Ninja for the Classroom is a brief, acceptable sleep education program that could be considered for inclusion in high school health curricula. CONCLUSIONS: This study provides preliminary evidence for an Australian curriculum-aligned sleep education program. Controlled studies are needed to evaluate longer-term outcomes and sustainable implementation.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationSarah Browne, Aoife Dooley, Eamon Lovett, Aisling Ní Fhionnghalaigh, Aideen O'Neill
BACKGROUND: The quality of food environments in secondary schools in the Republic of Ireland (ROI) varies depending on local practices. Funding for free hot school meals recently increased significantly with phased implementation and priority for universal access in primary schools and among 'disadvantaged' status schools at the secondary level. Engagement with students, in the context of rapidly changing school food policies, is lacking. This study explored students' views about the food environment in secondary schools using a system-based approach and identified student priorities for actions and policies to support school food environments that are healthy for people and planet. METHODS: A cross-sectional qualitative study design using participatory methods was used. Public secondary schools were recruited in 2023 and 2024. Fourth year students volunteered to participate in one CO-CREATE Dialogue Forum per school on the idea: How to make our school food environment better for our health and the planet? Data were analysed using content analysis. The systems-based action scales model was applied to categorise students' recommendations for a desired system. RESULTS: Sixty-two students (55% female) aged 15-17 years in eight schools (including four schools designated 'disadvantaged' status) participated in dialogue forums. Issues with time, space and mealtime infrastructure were reported by students. Dissatisfaction with food quality and lack of variety were reported by some. Practices that identify students accessing free school meals risk perpetuating stigma. Food and packaging waste and catering for diverse food cultures and health needs were students' primary concerns from a planetary health perspective, with a small minority suggesting more plant-based food options. Limited opportunities to influence school food were reported. In the desired system, food choice, taste and quality, food and packaging waste, adequate spaces to eat and socialise, improved break-time logistics (e.g., food ordering system, time available, queue systems), and structures for participation and influence were priorities for students. CONCLUSION: The CO-CREATE Dialogue Forum was an effective method for exploring school food, with students demonstrating systems thinking ability in considering a range of factors shaping their environments. Their ideas and solutions are important to inform policy and practice at local school, public health and government levels.
Global health actionDilara Canbay Özdemir, Melike Karabulut Özer
Despise the existence of numerous community-based health literacy interventions worldwide, our understanding of their impact on equity and the influence of national policy frameworks and implementation considerations remains limited. This narrative review aims to conduct a comparative analysis of community-based health literacy programs and national policy frameworks post-2020, with a focus on implementation characteristics, system-level integration, and implications for equitable public health initiatives. Effective interventions across various countries exhibited three key action-relevant features: integration into national prevention and broader primary care strategies; utilization of hybrid delivery models combining digital technology with in-person contact; and active targeting of socioeconomically disadvantaged groups. Government-led models demonstrated superior scalability and sustainability, whereas community-based models enhanced outreach to marginalized populations. However, the majority of programs rely on short-term or output-based indicators to assess success, with insufficient evidence regarding their long-term impact on equity. Although digitalization increased accessibility on a large scale, there is a risk of reinforcing existing inequalities in the absence of inclusive design and digital support. This study provides a policy-focused synthesis that positions community-based health literacy as a viable public health intervention rather than merely an educational endeavor. This review provides practical guidance for integrating health literacy into national preventive efforts by identifying transferable implementation characteristics and governance requirements.
Global health actionHimadri Pal, Judy Bettridge, Paula Dominguez-Salas, Delia Grace
BACKGROUND: Over the past two decades, food safety training interventions in LMICs have increased significantly, yet improvements in food hygiene and safety outcomes remain inconsistent. This limited effectiveness may reflect a lack of contextual adaptation and a failure to align training materials with the socio-economic constraints of participants. OBJECTIVE: To evaluate LMIC food safety training interventions and their educational materials on a novel framework, and to propose a checklist for the efficacy of future programs. METHODS: Relevant literature on training interventions was systematically identified, and only studies with accessible training materials were included. Interventions were evaluated using a novel qualitative framework, encompassing image-text ratios, readability grade, training design, incentives, and outcome parameters. Novel concepts, 'Engagement features' and 'Contextual-fit factors' were also developed, and the correlations between them were tested. RESULTS: A total of 28 studies met the inclusion criteria with available training materials. Infographics from 13 studies demonstrated a satisfactory balance of images and text. The readability assessment revealed an average result comparable to the US grade 6 level (5.90 ± 1.74), potentially hindering comprehension for low-literacy populations. Incentives were commonly used (n = 18), most frequently as non-cash economic incentives. Change in knowledge was the most measured outcome, and studies reporting null or negative results lacked several engagement and contextual-fit elements. CONCLUSIONS: This study uses innovative methods to identify and shed light on the existing gaps in food safety trainings. Based on these findings, it proposes a 35-point checklist to support the development of more engaging, comprehensible, and contextually appropriate programs.
American journal of health promotion : AJHPKhansaa Abdullah, Elizabeth Ablah, Vicki Collie-Akers, Laurie P Whitsel
ContextPhysical inactivity is a major contributor to chronic disease, disability, and premature mortality in the United States and is associated with substantial healthcare expenditures. Although regular physical activity improves health outcomes, individuals with chronic conditions often require structured supervision to exercise safely and effectively. Building upon this context, the objective of this review is to synthesize evidence on the clinical, psychosocial, and economic impacts of supervised exercise interventions (SEIs) and to examine policy and implementation factors influencing their adoption. To achieve this objective, a structured literature review was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework.Eligibility CriteriaStudies published in English between 2010 and 2024 that involved adults aged 18 years or older and evaluated supervised exercise interventions with reported clinical, psychosocial, economic, or policy-related outcomes were included.Study SelectionPubMed, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using predefined keywords. Reference lists of relevant studies were also reviewed to identify additional eligible articles.Main Outcome MeasuresClinical outcomes (eg, mortality, aerobic capacity, HbA1c), psychosocial outcomes (eg, adherence, depression, quality of life), and economic and policy outcomes (eg, cost-effectiveness, reimbursement).ResultsTwenty studies met the inclusion criteria. Across cardiovascular, metabolic, oncologic, pulmonary, and geriatric populations, SEIs were associated with improved clinical outcomes, including reduced rehospitalization and mortality, enhanced aerobic capacity, improved glycemic control, and reductions in fatigue and depressive symptoms. SEIs were cost-effective across disease categories, with several studies reporting healthcare cost savings within 1 year. However, disparities in referral and participation persisted among racial and ethnic minorities, rural populations, and individuals with lower socioeconomic status.ConclusionSEIs are effective and scalable strategies for managing chronic diseases and preventing secondary complications. Evidence indicates that supervised exercise improves clinical, psychosocial, and economic outcomes across diverse populations. Expanding reimbursement and strengthening integration within health systems will be critical to improving equitable access to SEIs.
Journal of the International Society of Sports NutritionNagham Sannan, Hassan Younes, Nour El Helou
BACKGROUND: A longitudinal controlled intervention study aimed to assess the impact of a nutrition education program on Lebanese athletes' nutritional knowledge, eating habits, body composition and performance. METHODS: A sample of 198 athletes was divided into an intervention group (IG) and a control group (CG). The intervention group followed a 4-month intensive nutrition education program set to ensure sufficient time for meaningful learning and behavior change, while remaining short enough to maintain participant engagement and minimize dropout. The athletes' nutritional status and performance were assessed before and after the intervention using a validated food frequency questionnaire, knowledge and eating habits questionnaires, four 24-h recalls, a beep test to estimate VO2 max and one-repetition maximum tests to measure muscle strength. Paired-sample t-tests, McNemar's test and Mixed Factorial Anova test were conducted to examine the effects of the nutritional education program on nutrition knowledge, hydration status, eating habits and performance within both groups. RESULTS: The nutritional knowledge score increased in both groups after the intervention, with a significantly greater improvement of 23% observed in the IG (from 62.6% to 77.1%; p < 0.001). The IG also demonstrated a notable improvement in eating habits compared to the CG (p < 0.001). Following the intervention, body fat percentage decreased from 21.3% ± 6.0% to 18.8% ± 6.0% (p < 0.001), and waist circumference significantly decreased in the IG (p < 0.001). The IG increased their consumption of vegetables (p < 0.001) and yogurt (p = 0.002) and decreased their intake of sugars (p < 0.001) and sunflower oil (p = 0.002). Improvements in both aerobic and strength performance were observed in the IG (p < 0.001). CONCLUSIONS: The nutrition education program led to significant improvements in athletes' nutritional knowledge and eating habits, which consequently resulted in enhanced performance.
Global health actionRupinder Sahota, Akash Porwal, Namita Wadhwa, Anshita Sharma, Raghwesh Ranjan, Divya Santhanam, Mahendra Soni, Ashish Bandhu, Christian Bottomley, Tanya Marcha…
BACKGROUND: In low- and middle-income countries, breaking the intergenerational cycle of malnutrition requires the promotion of healthy nutrition practices and behaviours during pregnancy and early motherhood. OBJECTIVE: This study aimed to explore nutrition practices and behaviours among pregnant women and mothers of children under 2 years who were exposed to the Cash-Plus intervention in tribal districts of Rajasthan, India. METHODS: Data was collected in December 2024 through in-depth interviews with 46 women which included parity-2 pregnant women and mothers of young children (below 2 years of age), 36 husbands and 34 other family members; plus 7 focus group discussions with 23 frontline workers of four intervention districts. A framework analysis approach was used to identify emerging concepts around practices and behaviours. RESULTS: Participants were positive about the intervention, potentially reflecting the study design. They reported improved practices related to antenatal care, pregnancy weight monitoring and gain, dietary diversity, early and exclusive breastfeeding, and child feeding. These were influenced by the combined effect of consistent interpersonal counselling from trained frontline workers and conditional cash transfers. Counselling improved knowledge and motivation, while cash transfers enabled adoption of resource-dependent practices. Involvement of husbands and mothers-in-law supported the uptake and sustenance of practice and behaviours, alongside emerging peer and community influences. CONCLUSIONS: The Cash-Plus intervention supported improvements in maternal and child nutrition practices and behaviours through interacting behavioural, economic and social pathways. Findings highlight the importance of integrated, family-centred approaches that address knowledge and structural barriers, alongside ensuring inclusive intervention design in vulnerable settings.
Global public healthMartin Mickelsson, Emma Oljans
Antimicrobial resistance (AMR) is a global health challenge that encompasses social, economic, and ecological risks, and the relationship between human, animal, and environmental health is emerging as a key factor. Addressing AMR means developing capacities across health sectors, with training of health practitioners through higher education institutions (HEIs) essential for strengthening one's health literacy. This paper explores how Zimbabwean University lecturers and students co-create an understanding of AMR, contributing to the development of AMR literacy. A participatory qualitative study using research workshops was conducted at two Zimbabwean HEIs, engaging 60 interdisciplinary participants in vignette-based discussions of AMR. Using thematic analysis, three key themes were identified: (1) reflective engagement with antimicrobial use impacting environmental, human, and animal health; (2) preventive actions to protect environmental, human, and animal health; and (3) holistic health promotion grounded in social and ecological care. AMR literacy is outlined as interdisciplinary and context-dependent, encompassing biomedical understanding, critical ethical reflections, and pluralistic reasoning, enabling context-relevant approaches and decision-making. This study contributes to global health research by highlighting the potential of participatory and contextually sensitive educational approaches to address AMR. Operationalising AMR literacy could support cross-sectoral collaboration among health practitioners, strengthening global health efforts to address sustainable health challenges.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and GynaecologyErica A Mitchell, Patricia N E Roberson, Oluwafemifola Oyedeji, Ellen Oakes, Jordan Tasman, Rebecca Purvis, Lynlee Wolfe, Jill M Maples
Gestational Diabetes Mellitus (GDM) is a common pregnancy complication associated with adverse health outcomes. Health risks are reduced when GDM is well-controlled. Education and social support are key to optimal management; yet support people are rarely included in education. Semi-structured interviews were conducted with 10 healthcare providers (i.e., physicians, dieticians) to understand their perspectives on a) the role of support people in self-management, and b) including support people in education. Thematic analysis was used to identify common themes across interviews. Three themes emerged: (1) knowledge, (2) engagement, and (3) impact. Understanding what causes GDM is essential, and educating support people can improve engagement in implementing lifestyle changes and supporting patients in management. Social support can also reduce patient burden and stress. While relationship strain is possible, patients and support people who approach management together may find that it strengthens their relationship. Implications for designing education for patients and support people are discussed.