SHARE Corona Surveys: study profile.

At the onset of the COVID-19 pandemic, the Survey of Health, Ageing, and Retirement in Europe (SHARE) was in a unique position to respond to the need for high quality survey data on people's changing living situations. Implemented as two telephone interviews in the summer of 2020 and 2021 in 27 European countries and Israel, the SHARE Corona Surveys present a great advantage by their integration into the longitudinal, multidisciplinary and ex-ante harmonised design of the SHARE study. This allows researchers to trace changes from the pre-pandemic period, through the different stages of the pandemic, and the post-pandemic situation. This article lays out the research aims and how the two Corona Surveys fit in the general design of SHARE. It presents the main design features of the SHARE Corona Surveys following the survey life cycle. It starts with information on procurement, contracting, funding, ethics, and data protection and sampling, followed by information on instrument design, translations, questionnaire content and interviewer training. Last, fieldwork, panel care and data processing are described. Focused on topics of health behaviour, health care, economics and social relationships, the balanced panel sample of the two SHARE Corona Surveys comprises more than 48,000 interviews and provides valuable information on how the 50+ population coped with the COVID-19 pandemic. The experience of implementing the SHARE Corona Surveys also offers insights into use of agile project management methods for large survey infrastructures and moving towards a multi-mode design in an ongoing panel data collection project.

Components of multiple health behaviour change interventions for patients with chronic conditions: a systematic review and meta-regression of randomized trials.

Interventions addressing more than one health behaviour at a time could be an efficient way of intervening to manage chronic conditions. Within a systematic review of multiple health behaviour change (MBHC) interventions, we identified key components of interventions in patients with chronic conditions, assessed how they are linked to theory, behaviour change techniques implemented, and evaluated their impact on intervention effectiveness. Studies were identified by systematically searching five electronic databases. Subgroup analyses and meta-regressions were conducted to analyse the association between intervention components and behavioural changes. In total, 61 studies were included spanning different chronic conditions (e.g., cardiovascular conditions, type 2 diabetes). Most interventions sought to change behaviours simultaneously (72%), often targeting the 'physical activity, diet and smoking' cluster of behaviours (33%), and were not theory informed (55%). A total of 36 behaviour change techniques were identified, most commonly goal setting behaviour and self-monitoring of behaviour. Subgroup analyses indicated that MHBC interventions delivered entirely face-to-face might not be as effective for physical activity outcomes, and not using goal setting (behaviour) might be more effective for smoking cessation outcomes. Meta-regressions indicated that a longer intervention duration may work best to achieve better physical activity outcomes. This review provides a comprehensive understanding of interventions and contributes to the field of MHBC by facilitating data-driven insights for future optimisation and dissemination.

Exploring Public, Practitioner and Policymaker Perspectives of Unhealthy Lifestyle Factors in the Context of Socioeconomic Deprivation: A Qualitative Study.

INTRODUCTION: Unhealthy lifestyle factors, such as smoking, high alcohol intake, poor diet and physical inactivity, are key risk factors for premature mortality. How unhealthy lifestyle factors are viewed in the wider context of socioeconomic deprivation is rarely considered. Understanding key stakeholder views on lifestyle factors in the context of deprivation is critical to intervention development and reducing harm in more deprived populations. The aim of this study was to explore public, healthcare professional and policymaker views around unhealthy lifestyle factors in the context of deprivation. The aim was broad to facilitate iterative development of ideas, as the views of this wide range of stakeholders are rarely captured. METHODS: Twenty-five adult members of the public in Scotland took part in four focus groups between August 2022 and June 2023. Eighteen semi-structured interviews were conducted with professionals: 12 primary-care practitioners and 6 public-health practitioners and policymakers. Reflexive thematic analysis was undertaken. RESULTS: Four main themes were developed: (1) Evolving complexity of lifestyle factors - the number of lifestyle factors that adversely impact health has grown, with increasingly complex interactions, (2) Social determinants of lifestyle - numerous links were made between socioeconomic conditions and unhealthy lifestyle factors by all participants, (3) Poverty as a fundamental social determinant - poverty was identified as a core factor for unhealthy lifestyle factors, and (4) Agency versus structure in relation to lifestyle - individual agency to address lifestyle factors was limited by structural constraints. Among professionals, understanding the challenging social determinants of unhealthy lifestyle factors was countered by a desire to support healthy change in those affected by deprivation. CONCLUSION: Public and professional views around lifestyle highlight an evolving understanding of the new and growing number of lifestyle factors as well as the increasingly complex interplay between lifestyle factors. Views of the social determinants of lifestyle and structural limits to agency strengthen arguments for reduced emphasis on individual-level responsibility for unhealthy lifestyle factors and for deeper integration of social determinants into lifestyle interventions. In addition to addressing poverty and socioeconomic inequalities directly, innovative policy, planning and legislation that incorporate wider approaches could tackle upstream determinants of numerous unhealthy lifestyle factors simultaneously. PATIENT OR PUBLIC CONTRIBUTION: Members of the public who participated in this study have made contributions by sharing their views and perspectives. The National Health Service Research Scotland Primary Care Patient and Public Involvement (NRS PPI) Group contributed to the development of this work. The NRS PPI Group was consulted as part of the preparatory work for H. M. E. F.'s doctoral thesis funding application. The findings of the qualitative work were presented to them, and they informed the interpretation of those findings and related work presented at conferences and public engagement events.

Impact of Oral Health Chatbot With and Without Toothbrushing Training on Childhood Caries.

OBJECTIVES: Standalone oral health chatbots targeting young children's oral health are rare. The aim of this research was to compare the effectiveness of a standalone chatbot and a combination chatbot with in-person toothbrushing training for caregivers in improving young children's oral health. METHODS: A randomised, parallel, 2-group pretest-posttest design was employed with 320 caregiver-child pairs (aged 6-42 months). Group I (160 pairs) used the 21-Day FunDee (modified) chatbot along with in-person toothbrushing training, whilst Group II (160 pairs) used only the 21-Day FunDee Plus chatbot. Oral examination assessed plaque levels and caries, whilst a self-administered questionnaire evaluated oral hygiene care, dietary practices, and oral health perceptions based on the protection motivation theory (PMT). Data were analysed using 2-way repeated-measures analysis of variance, a t test, and chi-square measures for group comparisons. RESULTS: The majority of caregivers were Muslim mothers. No significant differences were observed between groups at the baseline, 3-month, and 6-month follow-ups in mean dmft (Group I: 4.16, 4.64, and 5.30 vs Group II: 4.30, 5.54, and 5.82), mean plaque scores (Group I: 0.72, 0.53, and 0.55 vs Group II (0.84, 0.52, and 0.59), and most dietary habits. However, significant improvements were found within groups from baseline to follow-ups in plaque reduction, toothbrushing practices, overall knowledge score, PMT perceptions, proper tooth brushing, fluoride toothpaste usage, and dietary behaviours (frequency of bottle feeding, frequency of nocturnal bottle feeding, proportion of children who went to bed without consuming anything after cleaning their teeth before bedtime). The significant differences between groups were found in self-efficacy at all time points, but only at the 6-month evaluation for percentage of fluoride toothpaste and overall PMT perceptions. CONCLUSIONS: Both interventions were comparable in preventing caries, reducing plaque, improving feeding practices, increasing parental involvement in tooth brushing, and enhancing knowledge. The standalone chatbot 21-Day FunDee Plus presents a viable alternative for promoting oral health in young children.

Travel to malaria-endemic areas: using digital geo-location to assess potential exposure risks and health behaviours.

BACKGROUND: Travellers frequently visit popular destinations like Brazil, India, Peru, Thailand, and Tanzania, each presenting varying malaria risks. The extent to which travellers enter high-risk malaria-endemic areas in destinations with heterogeneous malaria risk remains unclear. We used geo-location via smartphone application to (i) describe where travellers go within countries with heterogeneous malaria risk (Brazil, India, Peru, Thailand), and (ii) compare mosquito bite prevention behaviours between these destinations and Tanzania, considered entirely high-risk for malaria. METHODS: This analysis is a sub-study of the TOURIST2 cohort, which prospectively recruited 1000 travellers (≥ 18 years, travelling ≤ 4 weeks) from Swiss travel clinics (Zurich and Basel) between 09/2017-04/2019. We included 734 travellers to Brazil, India, Peru, Thailand, and Tanzania who provided geo-location data. Daily health and geo-location data were collected using a smartphone application. Malaria risk was categorised using 2022 malaria maps from the Swiss Expert Committee for Travel Medicine. RESULTS: Of the 734 travellers, 525 travelled to Brazil, India, Peru, and Thailand, and 225 to Tanzania. In Brazil, India, Peru, and Thailand, only 2% (n = 13) visited high-risk malaria areas. In Peru, 4% (n = 4) visited a high-risk area; in Brazil, 3% (n = 6); in Thailand, 2% when crossing the border into Myanmar (n = 3); and in India, 0%. Travellers to high-risk areas were more often male (62%), slightly older (median age 42.0), and planned longer trips (median 23.0 days) than other travellers. No participants were diagnosed with malaria. Travellers to Brazil, India, Peru and Thailand used mosquito bite prevention measures less frequently than travellers to Tanzania. Those in Tanzania had higher, but still suboptimal, use of insect spray (65% of travel-days). CONCLUSIONS: Travellers to Brazil, India, Peru, and Thailand rarely visited high-risk malaria areas, and their adherence to mosquito bite prevention measures was generally low. In Tanzania, adherence was higher but still suboptimal.

The Norwegian Counties Public Health Survey (NCPHS): a design study.

BACKGROUND: Effective public health initiatives should be founded on a comprehensive and robust understanding of health-related factors including societal and community contexts. The Norwegian Counties Public Health Survey (NCPHS) aims for insights into the adult population on topics relevant for planning public health practices at county and municipality levels. METHODS: The NCPHS includes a core questionnaire on public health-related topics and demographics, including indicators of socio-economy, with additional optional questions and scales varying across data collections. Samples are drawn from the Norwegian National Population Register and 'washed' against the Common Contact Register to retrieve digital contact information and exclude those who cannot be contacted electronically. NCPHS was piloted in 2015 and 2018 (four counties). After some revision of instruments and sampling procedures, surveys have been carried out in most Norwegian counties since 2019. The total number of participants has now passed 400,000. RESULTS: Expedient data analysis has enabled the Norwegian Institute of Public Health to present comprehensive reports within 6 weeks of completed data collections. In these, outcome variables are analysed against district (within counties), gender, age, educational attainment and self-reported sufficiency of household income. Tables are also made available at the municipality level. CONCLUSIONS: The NCPHS represents a valuable addition to existing data sources, providing critical information for planning purposes for local and regional public health authorities, for assessing trends over time, comparisons across counties and regions and for evaluation of policies and interventions. The value of such a system during times of crisis was demonstrated during the COVID-19 pandemic.

The Intersection of Sexual Orientation, Substance Use, and Mental Health: Findings from Hints 5.

Objectives: In this study, we aimed to investigate (1) the association of tobacco and e-cigarette use with sexual orientation (LGBTQ and heterosexual individuals) and (2) the difference in the association of tobacco and e-cigarette use with self-reported depression by sexual orientation. METHODS: The data for this study were obtained from the Health Information National Trends Survey (HINTS 5, Cycle 4). Sample participants included 3583 adults (93.87% heterosexuals). We used multinomial regression to measure the relative risk ratios (RRRs) of being a former and current user versus never a user of tobacco and e-cigarettes and binomial regression to measure the odds ratios of depression between the LGBTQ and heterosexuals. RESULTS: Current smoking prevalence is higher among LGBTQ participants (17.3%) compared to heterosexuals (11.0%). The disparity is even greater for e-cigarette use, with 7.3% of LGBTQ participants being current users versus 2.8% of heterosexuals and 24.5% of LGBTQ participants being former users compared to 9.3% of heterosexuals. Compared to heterosexuals, the relative risk ratio of being a current tobacco user among the LGBTQ participants was about 1.75 times higher [RRR = 1.75, 95%CI = 1.16, 2.64], and that of e-cigarette use was about 2.8 times higher [RRR = 2.81, 95%CI = 1.57, 5.05]. Among current e-cigarette users, heterosexual participants had 1.9 percentage points [risk difference = 1.94, 95%CI = 1.20, 3.13] higher probability of depression, whereas among the LGBTQ participants, the risk was about 3.7 times higher [OR = 3.67, 95%CI = 1.06, 12.74]. CONCLUSIONS: Our findings conclude that the LGBTQ are more likely to use tobacco and e-cigarettes compared to heterosexuals and that the risk of depression from e-cigarette smoking is more pronounced among the LGBTQ participants.

Protection motivation theory and health behaviour: conceptual review, discussion of limitations, and recommendations for best practice and future research.

Protection motivation theory is a pre-eminent health behaviour theory purposed to predict participation in health protection and risk behaviours. It has been widely applied across multiple behaviours, populations and contexts. In this conceptual review, we summarise research applying the theory and identify shortcomings and evidence gaps that limit reported inferences and impede theory and intervention development. Accordingly, we provide recommendations for best practices and suggestions for future research to resolve these limitations. Limitations identified include a dearth of comprehensive theory tests, sparse evidence of theory sufficiency, a lack of studies including additional constructs, overuse of correlational and cross-sectional research designs, a paucity of intervention studies and tests of theory-consistent mechanisms of action, few tests intrapersonal and environmental moderators of theory effects and measurement concerns. We provide recommendations to address these limitations including conducting comprehensive theory tests in support of nomological validity; incorporating past behaviour and other constructs to establish theory sufficiency and extend its scope; adopting cross-lagged panel and factorial experimental research designs to test directional effects, permit better causal inference and test mechanisms of action; testing effects of moderators to identify conditions that may affect theory applicability and developing measurement standards for study constructs and adopting non-self-report behaviour measures.

Adolescents' health literacy is directly associated with their physical activity but indirectly with their body composition and cardiorespiratory fitness: mediation analysis of the Slovak HBSC study data.

BACKGROUND: Health literacy is a core public health issue in relation to children and adolescents associated with multiple health behaviours and health outcomes. The aim of the study is to test the direct associations between health literacy, physical activity behaviour, health outcomes of body composition and cardiorespiratory fitness among Slovak adolescents and possible indirect effect of health literacy on health outcomes of body composition and cardiorespiratory fitness mediated by adolescents' physical activity behaviour. METHODS: Data from the Slovak Health Behaviour in School-aged Children (HBSC) study conducted in 2022 were used. For the purposes of this study, a subsample of the adolescents (n = 508; mean age = 14.50; SD = 0.82; 54.3% boys) which provided HBSC questionnaire data on health literacy, moderate-to-vigorous physical activity and vigorous physical activity and participated in body composition (InBody 230) and cardiorespiratory fitness (20-m shuttle run test) measurements. Data were analysed using linear regression analysis. RESULTS: The findings showed that higher health literacy of the adolescents was directly associated with higher frequency of physical activity represented by moderate-to-vigorous physical activity and vigorous physical activity and only with the visceral fat area in the crude model. Furthermore, there was an indirect effect of health literacy on cardiorespiratory fitness and most of the body composition variables (except the Body Mass Index) which was mediated by physical activity of the respondents. CONCLUSIONS: Health literacy is indirectly associated to body composition and cardiorespiratory fitness through higher frequency of physical activity. It seems that health literacy as cognitive and social competencies need behavioural components to be involved in the proposed causal pathway between health literacy and health outcomes. Our findings may contribute to the process of creating a framework for future health literacy interventions in adolescents.

Inhibitory control training to reduce appetitive behaviour: a meta-analytic investigation of effectiveness, potential moderators, and underlying mechanisms of change.

BACKGROUND/AIMS: Inhibitory control training (ICT) is a cognitive intervention that has been suggested to reduce problematic appetitive behaviours, such as unhealthy eating and excessive alcohol consumption. We conducted a meta-analytic review of ICT for reducing appetitive behaviours. METHODS: Two meta-analyses were conducted for behavioural (objective) outcomes and self-report outcomes, along with 14 moderator analyses, and two secondary analyses investigating changes in cue-devaluation and inhibitory control. RESULTS: The review included 46 articles (67 effect sizes and 4231 participants) and four appetitive health behaviours (eating, drinking, smoking, gambling). A significant effect of ICT on behavioural outcomes was found (SMD = 0.241, p .001). The self-report outcomes meta-analysis was not significant (p > .05). Secondary analyses also demonstrated greater inhibitory control (p < .05) and cue devaluation (p < .05) following ICT. CONCLUSIONS: This meta-analytic review is the largest synthesis of ICT interventions for appetitive behaviours. ICT significantly reduced problematic eating behaviours when adopting behavioural outcomes, but this was not found for other appetitive behaviours. ICT also significantly improved inhibitory control and reduced cue evaluations. Further studies are required before drawing any conclusions regarding impacts on other appetitive behaviours.

Breast cancer risk and prevention in 2024: An overview from the Breast Cancer UK - Breast Cancer Prevention Conference.

The Breast Cancer UK-Breast Cancer Prevention Conference addressed risk from environmental pollutants and health behaviour-related breast-cancer risk. Epidemiological studies examining individual chemicals and breast cancer risk have produced inconclusive results including endocrine disrupting chemicals (EDCs) Bisphenol A, per- and polyfluorinated alkyl substances as well as aluminium. However, laboratory studies have shown that multiple EDCs, can work together to exhibit effects, even when combined at levels that alone are ineffective. The TEXB-α/ß assay measures total estrogenic load, and studies have provided evidence of a link between multiple-chemical exposures and breast cancer. However, prospective studies using TEXB-α/ß are needed to establish a causative link. There is also a need to assess real-life exposure to environmental-chemical mixtures during pregnancy, and their potential involvement in programming adverse foetal health outcomes in later life. Higher rates of breast cancer have occurred alongside increases in potentially-modifiable risk factors such as obesity. Increasing body-mass index is associated with increased risk of developing postmenopausal breast cancer, but with decreased risk of premenopausal breast cancer. In contrast, lower rates of breast cancer in Asian compared to Western populations have been linked to soya/isoflavone consumption. Risk is decreased by breastfeeding, which is in addition to the decrease in risk observed for each birth and a young first-birth. Risk is lower in those with higher levels of self-reported physical activity. Current evidence suggests breast-cancer survivors should also avoid weight gain, be physically active, and eat a healthy diet for overall health. A broad scientific perspective on breast cancer risk requires focus on both environmental exposure to chemicals and health behaviour-related risk. Research into chemical exposure needs to focus on chemical mixtures and prospective epidemiological studies in order to test the effects on breast cancer risk. Behaviour-related research needs to focus on implementation as well as deeper understanding of the mechanisms of cancer prevention.

Association between social jetlag and leisure-time physical activity and muscle strengthening exercise in young adults: findings from a nationally representative sample in South Korea.

OBJECTIVES: Social jetlag (SJL), which is characterised by a misalignment between biological and social time, is associated with cardiometabolic risk factors. This study investigated the relationship between SJL, leisure-time physical activity (LTPA) and muscle strengthening exercise (MSE) in young adults. STUDY DESIGN: This was a cross-sectional study. METHODS: This cross-sectional study included a nationally representative sample of young adults aged 19-29 years (n = 2113). SJL was calculated as the difference in the midpoint of sleep onset and offset time between weekdays and weekends. The dependent variables were engagement in ≥150 min/week of moderate-to-vigorous LTPA and engagement in MSE ≥2 days/week based on guidelines provided by the World Health Organisation. Logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Non-linear relationships were estimated using restricted cubic spline regression. RESULTS: The study population comprised 975 men and 1138 women. Among participants, 4.6% had <0 min, 41.9% had 0-59 min, 25.7% had 60-119 min and 27.7% had ≥120 min SJL. Those with ≥120 min SJL had a reduced likelihood of achieving the recommended level of LTPA (OR: 0.71, 95% CI: 0.52-0.95) and MSE (OR: 0.73, 95% CI: 0.55-0.97). In the non-linear model, an inverse U-shaped association was observed, wherein the highest probability of meeting the recommended level of LTPA and MSE was observed in those with 45 min SJL, decreasing after this threshold. CONCLUSIONS: Individuals with ≥120 min SJL were less likely to engage in the recommended level of both aerobic and anaerobic exercise. Although future studies using a longitudinal design are required to elucidate the causal relationship between SJL and physical activity, the current findings suggest that physical inactivity during leisure time may play an important role in the increased risk of cardiometabolic abnormalities in young adults with SJL.

Investigating the impact of COVID-19 on international student wellbeing in Australia.

ISSUE ADDRESSED: International students are at a heightened risk of experiencing negative health and wellbeing outcomes, which was further exacerbated during the COVID-19 lockdowns. This research sought to explore the impact of the COVID-19 pandemic on the health and wellbeing of international students in Australia. METHODS: Thirty-one international students participated in qualitative in-depth interviews between March and April 2022 to explore their experiences of health and wellbeing during 2020-2021 while they lived and studied in Australia. Interviews were coded and analysed thematically using NVivo software. RESULTS: Findings highlight the impact of the pandemic on international students' mental, social and financial wellbeing, including worry about loved ones, social isolation, financial and employment insecurity and challenges related to online learning. The pandemic exacerbated and brought more attention to existing issues and placed students in unequal positions in relation to domestic students and each other. CONCLUSIONS: The COVID-19 pandemic has increased students' vulnerability to poor mental health and to a range of social and financial issues. SO WHAT?: The findings of this study highlight the need for support strategies to improve international students' mental health and social wellbeing outcomes in Australia.

People with long-term conditions are more adherent to protective behaviours against infectious disease.

Objectives: To investigate the relationship between long-term condition (LTC) status and adherence to protective behaviours against infectious disease (face covering, physical distancing, hand hygiene). Study design: Representative cross-sectional observational survey in summer 2020 in Scotland. Methods: Independent variable is LTC status (LTC, disability, no LTC); dependent variable is adherence to protective behaviours (face covering, hand hygiene, social distancing); moderator variables are age, gender and area deprivation; mediator variables are perceived threat and psychological distress. P values of p < 0.05 were taken as statistically significant. Results: 3972 participants of whom 2696 (67.9 %) indicated not having a LTC. People with no LTC had lowest adherence to protective behaviours, perceived threat and psychological distress. Age did not moderate the relationship between LTC status and adherence; females were more adherent than males and this gender difference was greater in people with disability compared to people with no LTC; adherence was greater for people with a LTC in the more deprived areas compared to the least deprived areas whereas adherence in those with no LTC was not related to area deprivation; threat appraisal partially mediated the relationship between having a LTC or disability and adherence; psychological distress did not mediate the relationship between LTC status and adherence. Conclusions: This study addresses a gap in evidence about protective behaviours of people with LTCs. Perceptions of threat may be useful intervention targets against winter flu and during future pandemics in order to protect people with LTCs who are one of the most vulnerable groups of the population.

Abuse and neglect as indicators of unhealthy behaviours among 15-year-old schoolchildren in Albania.

OBJECTIVE: We assessed the independent associations of lifetime child abuse and neglect indices with behavioural characteristics of children. STUDY DESIGN: A cross-sectional study was conducted in Albania in 2022. METHODS: Participants consisted of a nationwide representative sample of 1877 schoolchildren aged 15 years (55 % girls; response: 96 %). Data on lifetime child abuse and neglect were collected, along with behavioural factors and sociodemographic characteristics. Binary logistic regression was used to assess the independent associations of child abuse and neglect with behavioural factors of schoolchildren. RESULTS: Irrespective of sociodemographic characteristics, lifetime physical abuse was positively related to lifetime smoking (OR = 1.8, 95%CI = 1.4-2.3), lifetime alcohol consumption (OR = 2.4, 95%CI = 1.9-2.9), and breakfast skipping (OR = 1.3, 95%CI = 1.0-1.6). Furthermore, positive independent factors associated with emotional abuse included lifetime alcohol intake (OR = 1.7, 95%CI = 1.3-2.1) and breakfast skipping (OR = 1.4, 95%CI = 1.0-1.8). Additionally, positive factors associated with lifetime emotional neglect consisted of lifetime smoking (OR = 2.2, 95%CI = 1.6-3.0) and alcohol intake (OR = 2.0, 95%CI = 1.5-2.6), and a lower fruit consumption (OR = 1.7, 95%CI = 1.3-2.3). Positive factors associated with lifetime sexual abuse included lifetime alcohol consumption (OR = 2.4, 95%CI = 1.4-4.1) and especially smoking (OR = 4.3, 95%CI = 2.6-7.3). Also, lifetime witnessing of family violence was positively related to lifetime smoking (OR = 2.7, 95%CI = 1.8-4.1) and alcohol intake (OR = 1.7, 95%CI = 1.2-2.6). CONCLUSIONS: We evidenced strong and consistent links between child maltreatment indices and unhealthy behavioural practices among 15-year-old children in Albania. These findings underscore the potential impact of early trauma on developmental trajectories. The association between child abuse and the adoption of detrimental behaviours highlights the urgent need for comprehensive support and intervention strategies to break the cycle of harm.

Utilising the COM-B model to interpret barriers and facilitators to cervical cancer screening in young women.

As most women now reaching the age for cervical cancer screening (24.5 years old) in the UK will be HPV vaccinated, their current perspectives on screening can inform effective interventions to increase screening uptake (and thus, early detection). Twenty-four interviews were conducted with women aged 24-30 years old to explore their views on cervical cancer screening (n = 12 attendees and n = 12 non-attendees). Reflexive thematic analysis generated six themes that were then mapped onto the COM-B model. Reflective motivations (e.g. reassurance) were key facilitators to screening attendance for both groups. Social opportunities (e.g. open communication) contrasted between the groups, with attendees more likely to have discussed screening with friends. Automatic motivations (e.g. embarrassment) were key barriers to attending screening in both groups. Notably, HPV vaccination did not factor into the decision to attend screening. Interventions to increase screening uptake may target motivational and social factors.

Child drowning in Indonesia: insights from parental and community perspectives and practices.

Child drowning is a significant public health issue in Indonesia, however, there is insufficient understanding of the issue and its associated risk factors within communities. This qualitative study aimed to explore parental and community perceptions and practices related to child drowning in Indonesian communities, and the perceived causes and risk factors. Seven focus group discussions (n = 62) were conducted with parents of children aged under-5 years and village community leaders in seven villages across all districts of Lombok Island, West Nusa Tenggara Province of Indonesia. Participants were recruited using purposive and snowball sampling. The thematic analysis, guided by Braun and Clarke's framework, used both deductive approaches, utilizing the Health Belief Model's constructs and inductive approaches. Most participants were unaware of the susceptibility of their children and others in their community to drowning and of the potential severe outcomes of drowning such as injury, disability and death. Participants generally associated drowning with beaches or open seas. Unprotected wells, tubs and buckets were identified as notable risk factors for child drowning in and around the home, shaped by some experience of child drowning incidents in the community. Supervision was identified as protective factor, however, mothers were often unavailable to supervise children, and supervision responsibility was often delegated to other family and community members. This study highlights the urgent need to enhance public awareness regarding children's susceptibility to drowning. Further exploration of local contexts and social determinants of drowning in Indonesian communities is crucial for ensuring effective water safety and drowning prevention strategies.

The Effects of Diverse Interventions on Diabetes Management Among Arabs With Diabetes: A Systematic Review.

AIM: To identify, describe, and critically evaluate the effects of various interventions on diabetes management outcomes among Arabs with diabetes. DESIGN: A systematic review. DATA SOURCES: The search was conducted across three databases: PubMed, CINAHL and the Cochrane Collaboration in December 2023. REVIEW METHODS: Screening involved randomised controlled trials and nonrandomised studies that focused on the effects of interventions on diabetes management among Arab with diabetes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the review process. Two researchers independently applied eligibility criteria. Data extraction captured key study details, and methodological quality was assessed using Downs and Black's checklist. This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42024555668). RESULTS: Thirty-five articles were reviewed, yielding 65 outcomes. Effective interventions included personalised care, patient-centred education and direct patient contact through lifestyle modifications, advice, feedback, motivational conversations and calls. These approaches improved haemoglobin A1c, fasting blood glucose, physical activity and medication adherence. Conversely, nonpersonalised remote monitoring and social media interventions showed no significant improvements. Notably, tailored nutritional and physical activity advice positively impacted body mass index and systolic blood pressure among Arab women with diabetes. CONCLUSION: The findings underscore the effectiveness of personalised care and direct patient contact in optimising diabetes management among Arabs with diabetes. IMPACT: This review highlights the importance of prioritising direct patient contact over remote methods such as social media in interventions on diabetes management among Arabs with diabetes. It emphasises the need for culturally sensitive approaches, particularly for women. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution, as this study constitutes a review of existing research.

The iterative development and refinement of health psychology theories through formal, dynamical systems modelling: a scoping review and initial expert-derived 'best practice' recommendations.

This scoping review aimed to synthesise methodological steps taken by researchers in the development of formal, dynamical systems models of health psychology theories. We searched MEDLINE, PsycINFO, the ACM Digital Library and IEEE Xplore in July 2023. We included studies of any design providing that they reported on the development or refinement of a formal, dynamical systems model unfolding at the within-person level, with no restrictions on population or setting. A narrative synthesis with frequency analyses was conducted. A total of 17 modelling projects reported across 29 studies were included. Formal modelling efforts have largely been concentrated to a small number of interdisciplinary teams in the United States (79.3%). The models aimed to better understand dynamic processes (69.0%) or inform the development of adaptive interventions (31.0%). Models typically aimed to formalise the Social Cognitive Theory (31.0%) or the Self-Regulation Theory (17.2%) and varied in complexity (range: 3-30 model components). Only 3.4% of studies reported involving stakeholders in the modelling process and 10.3% drew on Open Science practices. We conclude by proposing an initial set of expert-derived 'best practice' recommendations. Formal, dynamical systems modelling is poised to help health psychologists develop and refine theories, ultimately leading to more potent interventions.

Perceptions and expectations of an artificially intelligent physical activity digital assistant - A focus group study.

Artificially intelligent physical activity digital assistants that use the full spectrum of machine learning capabilities have not yet been developed and examined. This study aimed to explore potential users' perceptions and expectations of using such a digital assistant. Six 90-min online focus group meetings (n = 45 adults) were conducted. Meetings were recorded, transcribed and thematically analysed. Participants embraced the idea of a 'digital assistant' providing physical activity support. Participants indicated they would like to receive notifications from the digital assistant, but did not agree on the number, timing, tone and content of notifications. Likewise, they indicated that the digital assistant's personality and appearance should be customisable. Participants understood the need to provide information to the digital assistant to allow for personalisation, but varied greatly in the extent of information that they were willing to provide. Privacy issues aside, participants embraced the idea of using artificial intelligence or machine learning in return for a more functional and personal digital assistant. In sum, participants were ready for an artificially intelligent physical activity digital assistant but emphasised a need to personalise or customise nearly every feature of the application. This poses challenges in terms of cost and complexity of developing the application.