Cardiovascular health of Brazilian adolescents within the framework of Life's Essential 8: Findings from the ERICA study.

BACKGROUND: The Life's Essential 8 (LE8) is an official cardiovascular health (CVH) assessment tool, however, its use remains limited within the adolescent population. We aim to describe the prevalence of CVH in Brazilian adolescents using the LE8 framework and to analyze its distribution considering sociodemographic factors. METHODS: The sample comprised 36,956 adolescents aged 12 to 17 years, who participated in the Study of Cardiovascular Risks in Adolescents, a nationwide, cross-sectional, school-based study. CVH was assessed by the LE8 score (0-100 points), comprising eight metrics categorized into two domains: health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non-HDL cholesterol, blood glucose, and blood pressure). Sociodemographic factors were sex, age, type of school, skin color, and region of residence. The results were expressed as means with 95 % confidence intervals (95 % CI). RESULTS: The overall average score was 75.8 points (95 % CI: 75.3-76.3), classified as moderate CVH. The general score was higher among males (76.8; 95 % CI: 76.6-77.7) and younger adolescents (12-14 years old) (78.5; 95 % CI: 77.7-79.4). The health factors had a higher mean than behavioral factors (87.6, 95 % CI: 87.3-87.9 vs. 64.0, 95 % CI: 63.3-64.7). The best score was blood glucose (94.7; 95 % CI: 94.2-95.2), while the diet score was the lowest (48.5; 95 % CI: 46.3-50.6). CONCLUSION: The CVH of Brazilian adolescents is classified as moderate and varied according to sociodemographic characteristics. Intervention actions should prioritize behavioral factors to improve the LE8 score and consequently prevent cardiovascular events in adulthood.

Well-informed or misinformed? News-Finds-Me perception in shaping sexual and reproductive health knowledge and behavioral intentions among Chinese women.

The News-Finds-Me (NFM) perception reflects individuals' belief of being well-informed even without actively seeking out news on social media. Despite studies examining the NFM perception in political and COVID-19 contexts, its implications in specific health contexts and the underlying mechanisms toward behavioral outcomes remain largely unexplored. Through a nationwide online survey of Chinese women residing in both rural and urban areas, this study revealed a positive association between the NFM perception and sexual and reproductive health (SRH) misperceptions, as well as an overassessment of factual knowledge. Furthermore, this study identified the mediating roles of knowledge miscalibration and SRH misperceptions linking the NFM perception to SRH behavioral intention. Notably, the relationship between the NFM perception and knowledge miscalibration was contingent upon individual differences in optimism regarding personal risks related to SRH diseases. The findings of this study not only extend the negative implications of the NFM perception in the SRH context and behavioral outcomes but also provide practical guidelines for promoting effective health learning in the contemporary algorithm-driven information environment.

Quantitative Definition of Low-Health-Interest Populations by Using Regression Trees: A Nationwide Internet Survey in Japan.

BACKGROUND: Reducing health disparities is a public health issue. Identification of low-health-interest populations is important, but a definition of people with low health interest has not yet been established. We aimed to quantitatively define low-health-interest populations. METHODS: A nationwide cross-sectional internet survey was conducted in 2022. We compiled regression tree (RT) analyses with/without adjustment for age, sex, and socioeconomic status with the 12-item Interest in Health Scale (IHS, score range 12-48) as an explanatory variable and the 10 composite health behaviors as a dependent variable. We defined the first IHS branching condition from the root node as a lower-health-interest group and the terminal node with the lowest health behaviors as the lowest-health-interest group. RESULTS: The mean IHS value of 22,263 analyzed participants was 32.1 ± 5.6; it was higher in females and in those who were aged over 45 years, had a high education, a high income, or a spouse. The first branching condition was IHS 31.5, and the terminal node branched at 24.5, before/after adjustment for covariates. CONCLUSIONS: We determined the cutoff values of the IHS as <32 for a lower-health-interest group and <25 for the lowest-health-interest group. Using these cutoffs might enable us to reveal the characteristics of low-health-interest populations.

Exploring COVID-19 Vaccine Decision Making: Insights from 'One-Shot Wonders' and 'Booster Enthusiasts'.

Within the USA, the uptake of the updated COVID-19 vaccines is suboptimal despite health authority recommendations. This study used qualitative methods to examine factors influencing COVID-19 vaccine decision making and the effects of anxiety and depression on these decisions within the CHASING COVID Cohort (C3). Between October and December 2023, we conducted 25 interviews with participants from 16 different US states, 14 of whom endorsed recent symptoms of anxiety and/or depression. Using grounded theory methodology for coding and thematic analysis, we categorized participants into "One-Shot Wonders" and "Booster Enthusiasts". Our findings indicate that the US COVID-19 vaccination environment has shifted from active promotion to a notable absence of COVID-19 discussions, leading to reduced worry about infection and severe illness, diminished perception of the benefits of the vaccine on personal and community levels, and fewer cues to action. Initially influential factors like family, personal experiences, and physician recommendations lost impact over time. Although the relationship between symptoms of depression and anxiety and vaccination was not prominent, one case highlighted a direct relationship. The study emphasizes the importance of timely and accurate public health messaging adaptable to individuals' needs and misconceptions, highlighting the need for dynamic communication strategies in future initiatives with rapidly changing landscapes.

Subjective Cognitive Dysfunction in Chronic Illness: A Systematic Review and Meta-Synthesis.

BACKGROUND: Qualitative studies have examined the experiences of subjective cognitive dysfunction in specific populations or specific disease stages, but there has not yet been a systematic synthesis and evaluation of findings related to perceptions of subjective cognitive dysfunction in nondementia-related chronic illnesses. OBJECTIVE: The aim of this study was 2-fold: (1) to undertake a systematic review of experiences of subjective cognitive dysfunction in people with nondementia-related chronic disease and (2) to develop an explanatory framework to describe the experiences of living with subjective cognitive dysfunction. METHODS: Four databases were systematically searched for studies on subjective cognitive dysfunction up to June 2023. Qualitative synthesis was conducted on the final sample (N = 25) using Sandelowski's adaptation of Nobilt and Hare's reciprocal transactional analysis method. Critical appraisal was completed using the Critical Appraisal Skills Programme checklist. RESULTS: Through constant comparison of key concepts, findings were organized within 4 interrelated themes that informed a conceptual explanatory model of adapting to living with subjective cognitive dysfunction: (1) symptoms, (2) health care, (3) perceptions of self, and (4) relationships. Participants highlighted how subjective cognitive dysfunction affected interactions in health care settings and involved other symptoms that in turn complicated meaning, self-enhancement, and mastery. CONCLUSIONS: Our model of the process of adapting provides a new way to conceptualize cognitive dysfunction in chronic illness and suggests opportunities for health care professionals to support patients and their families. The results highlight the need for more research to better understand the role of subjective cognitive dysfunction in nondementia-related chronic illnesses.The review protocol was registered in PROSPERO (CRD42021231410).

Psychometric evaluation of the translated arabic version of the geriatrics health behavior questionnaire (GHBQ) for geriatric nurses: a cross-sectional study.

BACKGROUND: The Geriatrics Health Behavior Questionnaire (GHBQ) is essential for assessing health-related behaviors among older adults populations. This study focuses on the translation, cultural adaptation, and psychometric evaluation of the Arabic version of the GHBQ to ensure its relevance and accuracy for Arabic-speaking older adults individuals. METHODS: This cross-sectional study was conducted at the Cairo University Educational Hospital's outpatient clinic. The GHBQ was translated and culturally adapted through a systematic process, including initial translation, back-translation, expert review, and pilot testing. The psychometric properties of the Arabic-translated GHBQ were evaluated using a sample of 200 older adults Arabic-speaking participants. Reliability was assessed using Cronbach's alpha (α) and Intraclass Correlation Coefficient (ICC). Validity was evaluated through Content Validity Index (CVI), Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA). RESULTS: The Arabic GHBQ demonstrated excellent reliability with Cronbach's alpha values ranging from 0.74 to 0.87 across subscales and ICC values confirming reproducibility (ICC = 0.82). The CVI indicated strong content validity (average CVI = 0.91). EFA revealed a five-factor structure, explaining 72% of the variance, with all factor loadings exceeding 0.60. CFA supported the questionnaire's structure with fit indices meeting recommended criteria: χ²/df = 2.05, NFI = 0.92, TLI = 0.94, GFI = 0.90, SRMR = 0.05, AIC = 140.35, and BIC = 160.22. Criterion validity was confirmed through significant correlations with established health behavior measures (r = 0.63, p < 0.001). CONCLUSIONS: The culturally adapted Arabic version of the GHBQ is a reliable and valid tool for assessing health behaviors in the older adults population in Egypt. This instrument can aid healthcare providers in identifying and addressing health behaviors, ultimately improving the well-being of this demographic. Future research should focus on expanding the sample and comparing the GHBQ with other similar tools used in Arabic-speaking populations.

Disparities in Healthcare-Seeking Behavior and Decision Preference Among Hispanics: A Comparative Study Across Races/Ethnicities, SES, and Provider Types.

Purpose: Hispanics, the largest minority in America, have increased risk of several medical issues and face noteworthy health disparities. This study compares care-seeking behaviors and choice experience among Hispanics, Asians, Blacks, and Whites, considering SES (income, education, and insurance status) and across five healthcare provider (HCP) types. Concurrent analysis provides a comprehensive view of how and where inequity manifests in healthcare. Methods: A cross-sectional online survey assessed 1485 adults (Hispanic=314, Asian=313, Black=316, White=542, recruited through a panel agency) of the frequency of visiting primary care providers, dentists, optometrists, gynecologists, and specialists for chronic conditions. Participants also rated the importance of self-selecting a HCP and difficulty in finding one. Results: Whites visited each HCP most regularly. Compared to Asians, more Hispanics saw specialists regularly (45.1% vs 56.5%, p=0.042), and Blacks saw dentists less (47.0% vs 38.3%, p=0.028) and gynecologists more often (21.2% vs 33.1%, p=0.024). No other frequency differences were observed among minorities. Low-income participants across four races saw dentists and gynecologists with comparable infrequency. Hispanics and Asians assigned similarly significantly lower self-choice importance and experienced more difficulty relative to Whites or Blacks. Participants with lower income or education visited HCPs less regularly yet perceived the same choice importance as higher-SES peers (p>0.05). Notably, discrepancies in visit frequency between Whites and minorities were more pronounced in higher-SES than lower-SES group. Differences in experiencing care-seeking difficulty were associated with income (p=0.029) and insurance type (p=0.009) but not education (p>0.05). Conclusion: Higher income and education increase healthcare utilization; however, racial disparities persist, particularly among higher-SES groups. Despite similarities among minorities, the extent of disparities varied by SES and provider type. The findings help explain evident inequity in healthcare access and health outcomes. Tailored patient education, culturally-specific navigation support, and more inclusive services are needed to address barriers faced by minorities and disadvantaged populations.

Beyond the needle: a qualitative exploration of Sierra Leonean healthcare workers' post COVID-19 vaccination experiences.

The global health crisis precipitated by the COVID-19 pandemic underscored the necessity of swift vaccine development and distribution to curb virus transmission. However, discussions on vaccine acceptance and hesitancy have predominantly focused on pre-vaccination attitudes, often overlooking the significance of post-vaccination experiences in shaping individual and communal attitudes toward vaccines. This oversight is particularly critical among healthcare workers in low- and middle-income countries (LMICs), who play a dual role in combating the pandemic and influencing public vaccine sentiment. Using the theory of planned behavior, this study explores the post-vaccination experiences of healthcare workers in Sierra Leone and assesses how these experiences influence their attitudes toward vaccine safety, efficacy and their advocacy for vaccine uptake within their communities. Employing a qualitative design, the study interviewed 24 healthcare workers, 21 of whom were vaccinated against COVID-19. Semi-structured interviews, conducted in English or Krio, were audio recorded, transcribed verbatim and analyzed using thematic analysis to identify key themes. Three themes were identified: positive vaccination experiences exceeding initial expectations, strong belief in the vaccine's protective benefits and active roles in vaccine advocacy. Despite initial hesitations due to concerns over potential adverse effects, participants reported no significant issues post-vaccination, fostering trust in vaccine safety and effectiveness. Healthcare workers' positive post-vaccination experiences significantly bolster their vaccine advocacy, influencing their recommendations to patients, friends, families, colleagues and community members. This study highlights the importance of understanding and leveraging healthcare workers' experiences to enhance public trust and vaccine uptake, crucial for pandemic response efforts in LMICs.

Quality of reporting health behaviors for multiple sclerosis (QuoRH-MS): A scoping review to inform intervention planning and improve consistency of reporting.

BACKGROUND: Multiple sclerosis (MS) is a neurological condition that necessitates a multidisciplinary approach to aid those living with MS in managing their disease. Health behavior, or lifestyle modification, is an emerging approach to MS self-management. MS researchers utilize measurement tools to ensure that interventions are best suited to the outcomes, thereby potentially influencing practice. The aim of this study was to investigate which tools are being used for health behavior management studies in people living with MS and develop an aid for tool selection. METHODS: A scoping review guided by the PRISMA-Sc checklist and the JBI manual for evidence synthesis was employed with a systematic search strategy executed across four scientific databases: Medline, PubMed, CINAHL, and Cochrane Libraries. The types of assessment tools used were extracted from the included studies. Each tool was categorized into the health behavior intervention discipline (nutrition, exercise, and psychology) and then subcategorized by the tool's purpose. The frequency of use was determined for each tool. Reporting of validation of the assessment tools were collated to inform a tool selection checklist. RESULTS: The review identified a total of 248 tools (12 nutrition, 55 exercise, and 119 psychology unique reports) from 166 studies. Seventy-seven multidimensional tools were identified including measures of quality of life, fatigue, and functional scales. Only 88 studies (53%) referred to the validity of the tools. The most commonly reported tools were the dietary habits questionnaire (n = 4, nutrition), 6-minute walk test (n = 17, exercise), Symbol Digits and Modalities Test, and Hospital Anxiety and Depression Scale (n = 15 each, psychology) with the Expanded Disability Status Scale reported 43 times. CONCLUSION: Evidence from interventions may inform practice for health professionals. This review provides insights into the range of tools reported across health behavior intervention studies for MS and offers a guide toward more consistent reporting of study methods.

Stage of Change of Transtheoretical Model for Nine Health-Related Behaviors Among Hypertensive Patients: Cross-Sectional Study.

Aim: This study aimed to determine the current stage of change (SOG) toward seven healthy eating behaviors and two healthy lifestyle behaviors related to blood pressure (BP) control. The lifestyle behaviors included smoking Behavior and practicing regular exercise, while the dietary behaviors included the DASH diet guidelines. Methods: A total of 1109 outpatients participated in this cross-sectional study that was conducted between 2021 and 2022 in Jordan. A staging algorithm assessed SOG for several BP control-related behaviors for diagnosed hypertension patients. Data were collected by a structured interview-based questionnaire. Results: There was a high degree of maintenance toward consuming diets with high grains, fruit, vegetables, meat, and poultry, less saturated fat, and more low-fat dairy products. More than half of the participants were in the pre-action stage for quitting smoking, practicing physical exercise, and consuming sweets and added sugars. Significant associations were observed between the degree of maintenance for several behaviors (p < 0.01). Age, income, education level, disease duration, and nutrition consultation availability were the most related factors to the SOG of the studied behaviors (p < 0.01). Conclusion: Patients with hypertension in Jordan are still in the pre-action stages for quitting smoking, practicing physical exercise, and consuming 5 servings of refined sweets and added sugars weekly. The current outcome suggests a need for nutritional counseling, education, and interventions to raise awareness of lifestyle factors influencing BP among hypertension patients.

Parental Patterns of Alcohol Consumption During the COVID-19 Pandemic: Scoping Review.

BACKGROUND: The declaration of the COVID-19 pandemic led to public health restrictions that impacted the lives of people across the globe. Parents were particularly burdened with balancing multiple responsibilities, such as working from home while caring for and educating their children. Alcohol use among parents is an area that warrants further exploration. OBJECTIVE: This study aimed to investigate patterns of parental alcohol consumption during the COVID-19 pandemic, focusing on relative changes in the frequency and quantity of alcohol use compared to prepandemic use, nonparent adult samples, or both. METHODS: A scoping review informed by the methodology of Arksey and O'Malley explored patterns of parental alcohol consumption during the COVID-19 pandemic. Searches were conducted in CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms were created using the Joanna Briggs Institute framework of Population, Concept, and Context, with the population being parents and the concept being alcohol consumption during the COVID-19 pandemic. RESULTS: The database search yielded 3568 articles, which were screened for eligibility. Of the 3568 articles, 40 (1.12%) met the inclusion criteria and were included in the scoping review. Findings indicated the following: (1) having children at home was a factor associated with parental patterns of alcohol use; (2) mixed findings regarding gender-related patterns of alcohol consumption; and (3) linkages between parental patterns of alcohol use and mental health symptoms of stress, depression, and anxiety. CONCLUSIONS: This scoping review revealed heterogeneous patterns in parental alcohol use across sociocultural contexts during the COVID-19 pandemic. Given the known harms of alcohol use, it is worthwhile for clinicians to assess parental drinking patterns and initiate conversations regarding moderation in alcohol use.

Gender Disparities in the Association Between Educational Attainment and Cardiovascular-Kidney-Metabolic Syndrome: Cross-Sectional Study.

Background: Cardiovascular-kidney-metabolic (CKM) health is affected by social determinants of health, especially education. CKM syndrome has not been evaluated in Chinese population, and the association of education with CKM syndrome in different sexes and its intertwined relation with lifestyles have not been explored. Objective: We aimed to explore the association between educational attainment and the prevalence of CKM syndrome stages in middle-aged and older Chinese men and women as well as the potential role of health behavior based on Life's Essential 8 construct. Methods: This study used data from the nationwide, community-based REACTION (Risk Evaluation of Cancers in Chinese diabetic individuals: a longitudinal study). A total of 132,085 participants with complete information to determine CKM syndrome stage and education level were included. Educational attainment was assessed by the self-reported highest educational level achieved by the participants and recategorized as low (elementary school or no formal education) or high (middle school, high school, technical school/college, or above). CKM syndrome was ascertained and classified into 5 stages according to the American Heart Association presidential advisory released in 2023. Results: Among 132,085 participants (mean age 56.95, SD 9.19 years; n=86,675, 65.62% women) included, most had moderate-risk CKM syndrome (stages 1 and 2), and a lower proportion were at higher risk of CKM (stages 3 and 4). Along the CKM continuum, low education was associated with 34% increased odds of moderate-risk CKM syndrome for women (odds ratio 1.36, 95% CI 1.23-1.49) with a significant sex disparity, but was positively correlated with high-risk CKM for both sexes. The association between low education and high-risk CKM was more evident in women with poor health behavior but not in men, which was also interactive with and partly mediated by behavior. Conclusions: Low education was associated with adverse CKM health for both sexes but was especially detrimental to women. Such sex-specific educational disparity was closely correlated with health behavior but could not be completely attenuated by behavior modification. These findings highlight the disadvantage faced by women in CKM health ascribed to low education, underscoring the need for public health support to address this inequality.

The relationship between the environment and physical activity-related motivational trajectories.

The study explores motivational profiles for physical activity, using self-determination theory's full continuum of motivational regulations, and examines their stability over three months. Furthermore, it investigates whether physical environment and community characteristics are associated with transitioning between profiles, as well as the sociodemographic differences in these motivational transition pathways. Data were collected from 305 U.S. residents at three time points. The three profiles-'low in motivation' (23.5 % of the sample in wave 1), 'self-determined motivation' (41.4 %), and 'ambivalent motivation' (35.0 %)-were relatively stable. Staying in the low-in-motivation profile was negatively associated with being active in social settings, community support, perceived environmental restorativeness, and availability of physical activity opportunities. Having a higher education and income, being male, employed, married or in a partnership, and identifying as White were associated with being in a motivationally positive profile in the last wave of the study. These profiles reported higher activity and life satisfaction.

What Is Behavioral Complexity? Lay Perceptions of Characteristics of Complex Behavior.

A behavior's complexity may impact habit formation, with implications for habit-based public health and environmental intervention designs. However, there are varying conceptualizations of behavioral complexity, hindering the synthesis of findings. To develop a unified definition, the aim of this study was to explore perceptions of behavioral complexity and identify behaviors that exemplify aspects of complexity. Participants (N = 225) completed a questionnaire concerning the complexity of various health and environmental behaviors, the importance of complexity characteristics previously identified by researchers (novelty, difficulty, steps, planning, immediacy of reward, time, attention, skill, mental resources, self-efficacy, motivation for a behavior, and supportiveness of the context) and demographics. Participants considered all proposed characteristics to be important. Complex behaviors (e.g., abstaining from smoking and taking insulin shots), compared to simple behaviors (e.g., eating fruit and stretching), are more likely to be true to the previously identified characteristics. Perceived complexity is influenced by several salient characteristics. Results may contribute to a synthesized definition and underpin future research to better identify behavior change techniques to foster habitual behaviors of varying complexity. Hence, researchers, practitioners, and policymakers may identify common barriers and facilitators of behavior to target in interventions. However, further research is required to contextualize the findings.

Effects of a digital intervention on physical activity in adults: A randomized controlled trial in a large-scale sample.

Background: Physical inactivity is associated with health risks, contributing to various diseases and all-cause mortality. Despite recommendations for regular physical activity (PA), many adults remain inactive, influenced by socioeconomic and environmental factors. Digital interventions, particularly web-based PA programs, offer promising possibilities to promote PA across populations. These programs vary in their effectiveness, reflecting differences in design, user engagement, and behavior change techniques employed. Objective: This study evaluates the effectiveness of the 12-week multimodal web-based TKFitnessCoach. The PA online program is part of the TK-HealthCoach. This study investigates the program's impact on self-reported PA levels, goal attainment, healthrelated quality of life, body weight, and eating behavior, comparing an interactive personalized web-based intervention and non-interactive web-based health information. Methods: In a randomized controlled trial (RCT), participants were allocated to either the intervention group (IG), receiving access to the interactive TK-FitnessCoach, or the control group (CG) that was provided a static website with evidence-based information on PA. The study targeted a German-speaking adult population interested in improving health behavior. Data was assessed at T0 (beginning of the study), T1 (postintervention), T2, 6 months, and T3, 12 months follow-ups, focusing on self-reported PA at T3 and on various secondary outcomes. Results: We achieved equally distributed sociodemographics in both the IG and the CG with a mean age of 42.8 (IG), resp. 43.1 years (CG), and female participants of 76.1 % (IG), resp. 74.7 % (CG). PA at baseline was 277.9 min/week in the IG and 273.3 min/week in the CG. Both, the IG (n = 1153 in the Intention-to-treat (ITT) dataset) and CG (n = 1177 in the ITT dataset) exhibited significant increases in PA over time (IG(T3-T0) = 72.92 min/week; CG(T3-T0) = 74.12 min/week).However, the study did not find significant differences in the effectiveness of the interactive TK-FitnessCoach compared to the non-interactive control in terms of improving PA and related health outcomes. The intensity of using the TK-FitnessCoach was not associated with PA. Conclusions: Both programs were effective in promoting PA among adults, with no significant differences observed between the two RCT groups. This highlights the potential of digital interventions in addressing physical inactivity, suggesting that the effectiveness of such programs may not solely depend on their interactivity but also on the quality and relevance of the information provided. Further research is needed to explore optimization strategies for such interventions, especially for persons with low PA, including user engagement, behavior change techniques, and the integration of objective PA tracking methods. Trial registration: German Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249.

Evaluating the Population-Based Usage and Benefit of Digitally Collected Patient-Reported Outcomes and Experiences in Patients With Chronic Diseases: The PROMchronic Study Protocol.

BACKGROUND: Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients' perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PREMs) is becoming more and more important to identify gaps in care provision, prioritize services most valuable to patients, and aid patients' self-management. OBJECTIVE: This study aims to measure the potential benefits and effectiveness of using electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures in a structured and population-based manner to enhance health care for chronic disease patients in Germany. METHODS: This prospective cohort study aims to evaluate the potential benefits of PROM usage in patients with chronic diseases. We evaluate whether (1) digitally collected PROMs and PREMs can be used for health system performance assessment by generating a representative response of chronically diseased individuals with asthma, chronic obstructive pulmonary disease, diabetes, and coronary artery disease across Germany, and (2) based on the PROMs and PREMs, low-value care can be identified. As patient-reported outcomes (PROs) are rarely presented back to patients, (3) this study also examines patients' reactions to their PROM scores in the form of digital PRO feedback. For these purposes, randomly selected patients from a nationwide German insurer are digitally surveyed with generic and disease-specific PROMs and PREMs, as well as additional questions on their health-related behavior, 4 times over 1 year. Individual PRO feedback is presented back to patients longitudinally and compared to a peer group after each survey period. Patient-reported data is linked with health insurance data. Response rates, changes in health and experience outcomes over time, self-reported changes in health behavior, and health care system usage will be analyzed. RESULTS: The PROMchronic study explores the usage of PROMs in patients with chronic diseases. Data collection began in October 2023, after the initial invitation letter. All the 200,000 potential patients have been invited to participate in the study. Data have not yet been analyzed. Publication of the interim results is planned for the autumn of 2024, and the results are planned to be published in 2025. CONCLUSIONS: We aim to fill the research gap on the population-based usage of PROMs and PREMs in patients with chronic diseases and add to the current understanding of PROM data-sharing with patients. The study's results can thereby inform whether a health care system-wide approach to collecting PROMs and PREMs can be used to identify low-value care, assess quality variation within and across chronic conditions, and determine whether PRO feedback is helpful and associated with any changes in patients' health behaviors. TRIAL REGISTRATION: German Clinical Trials Register DRKS00031656; https://drks.de/search/en/trial/DRKS00031656. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56487.

Acceptability of a Portable Exercise Bike in Older Adults With Cardiovascular Diseases.

BACKGROUND: Ways to help older adults overcome barriers to performing regular exercise is a challenge to nurses. OBJECTIVE: The study evaluated the acceptability of a portable exercise bike for arm/foot pedaling among older patients with cardiovascular diseases (CVDs). METHODS: Participants reported their physical activity levels using the International Physical Activity Questionnaire (short form) and thereafter performed two 6-minute-long arm/foot pedal biking sessions using a portable exercise bike. Participants provided qualitative feedback (one open-ended question) on the bike while exercising and completed the quantitative Acceptability Use Questionnaire following the two exercise sessions. RESULTS: Twenty-five older adults (52% male and 48% female), with a mean (SD) age of 70 (6.4) years and a body mass index of 30 (7.4), completed the study. Most participants performed moderate to light physical activity at home with a daily mean (SD) sitting/sedentary time of 8 (3.4) hours. The mean scores from the Acceptability Use Questionnaire and the participants' comments alluded to the bike's multitasking utility and acceptability. Three broad themes derived from the qualitative analysis were: (1) the acceptability of the bike with participants who had musculoskeletal problems; (2) the ability to operate and use the bike for aerobic exercise engaging both arms and legs; and (3) the importance of overall utility, ease of use, and cost of the bike. CONCLUSIONS: The portable exercise bike was found acceptable in a group of older adults with CVDs. The bike has the potential to be applied in home-based exercise interventions.

Associations between perceived cancer impact and measures of health behavior in survivors of childhood cancer.

PURPOSE: Perceived cancer impact (PCI) is the degree to which one feels cancer has impacted one's life. It is unknown if PCI is associated with health behaviors. The aim of this study is to determine associations between PCI and health behaviors in childhood cancer survivors. METHODS: Participants were ≥ 5-year survivors enrolled in the St. Jude Lifetime (SJLIFE) cohort. The Brief Cancer Impact (BCIA) assessed PCI across four domains (caregiving/finances, diet/exercise, social/emotional functioning, religiosity). Responses were categorized as negative, neutral, or positive impact. Smoking, risky drinking, illicit drug use, and diet quality data were obtained via self-report. Physical activity (PA) was assessed via self-report and actigraphy. Cross-sectional and longitudinal associations between PCI and health behaviors were evaluated via multivariable logistic regression. RESULTS: A total of 3623 participants (mean age 30.4 ± 8.3 years, 49.6% female, 81.5% NH White) were included in baseline cross-sectional analysis; 1709 had a second visit 5.0 ± 1.4 years later and were included in longitudinal analysis. At baseline, the percentage of participants who endorsed cancer as having a negative impact on caregiving/finances was 37.5%, diet/exercise 30.5%, social/emotional functioning 40.6%, and religiosity 8.7%. Negative and neutral PCI across all four domains were cross-sectionally associated with all behaviors except illicit drug use. Negative and neutral PCI at the first time point across all four domains were associated with smoking, diet quality, and PA (ORs ranging from 1.35 to 2.41) in longitudinal analyses. CONCLUSIONS: Endorsing negative or neutral PCI is associated with adverse health behaviors. IMPLICATIONS FOR CANCER SURVIVORS: Promoting optimal health behavior should include addressing PCI.

Application of an Adapted Health Action Process Approach Model to Predict Engagement With a Digital Mental Health Website: Cross-Sectional Study.

BACKGROUND: Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown. OBJECTIVE: This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website. METHODS: Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages). RESULTS: Participants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (ß=.66; P<.001), outcome expectancies (ß=.49; P<.001), self-efficacy (ß=.44; P<.001), and perceived risk (ß=.17-.18; P<.001) significantly predicted intention, and intention (ß=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage (ß=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant (ß=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1% and 1.4% of the variance in choice to engage and level of engagement, respectively. CONCLUSIONS: Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement.

Relationships Among the Endorsement of Superwoman Schema and Health Outcomes.

OBJECTIVE: To examine associations among endorsement of elements of the superwoman schema (the obligation to manifest strength and the obligation to help others) and health outcomes and to test if stress mediates the association between the obligation to manifest strength and depression in adult Black women. DESIGN: Cross-sectional design. SETTING: Community space in the Chicago metropolitan area. PARTICIPANTS: Ninety-one adult Black women. METHODS: Participants completed questionnaires to assess endorsement of superwoman schema roles, physical activity, healthy eating, weight satisfaction, depression, and stress. Height and weight were collected by research assistants. We used descriptive statistics, bivariate correlations, multiple regression models, and linear mediation analysis to analyze data. RESULTS: Higher levels of obligation to suppress emotions were associated with lower physical activity, r(88) = -0.25, p < .05. Obligation to manifest strength was associated with higher levels of stress, r(79) = 0.53, p < .01, and symptoms of depression, r(71) = 0.36, p < .01. Stress mediated the relationship between the obligation to manifest strength and depression with a significant indirect effect, b = 0.37, SE = 0.10, 95% confidence interval [0.20, 0.60]. CONCLUSION: Our findings offer insight into the psychological and social processes that affect Black women and may aid in the development of culturally responsive prevention and intervention programs at individual and community levels to reduce chronic diseases.