Home-Isolation Care in Newly COVID-19-Positive Elderly Patients: A Caregiver-Centric Explanatory Framework.

Objectives: This community-based study aimed to identify the effect of different behavioral factors of family caregivers on the decision for home-isolation-based treatment of a new COVID-19-diagnosed elderly individual. It also explored the facilitators and barriers contributing to the decision-making process. Methods: A mixed-methods design was adopted to study the role of behavioral constructs such as risk tolerance, risk aversion, regret aversion, loss aversion, self-efficacy, and risk perception in healthcare-seeking decisions. By integrating the findings from the quantitative and qualitative parts, a framework was developed. Results: Self-efficacy, risk perception, and risk tolerance related to different issues were crucial factors behind the healthcare decision. However, regarding the various issues under consideration, risk perception followed by risk tolerance were the significant predictors for decision-making. Conclusion: To enhance appropriateness and equity in emergency healthcare-seeking, interventions should target risk tolerance and risk perception, taking into account the awareness levels of caregivers and the target population's risk and regret aversion. Such integrated approaches can improve the quality of care for elderly patients in home-based settings.

School-based intervention on behavioral intention of adolescents regarding healthy diet in India.

Introduction: Adolescence is a distinctive period of life when intense physical, psychological, and cognitive development occurs. A healthy diet helps prevent various forms of malnutrition and non-communicable diseases (NCDs) like diabetes, heart disease, stroke, and cancer. The current study aimed to assess the change in behavioral intentions (measured based on the TPB) toward healthy dietary practices through health promotion intervention among adolescents studying in selected schools in an urban area of West Bengal, India. Methods: The current study was a non-randomized controlled interventional study conducted among adolescents in either seventh, eighth, ninth, or tenth grades and aged between 12 and 16 years. Two-step cluster analysis with maximum likelihood estimation identified the intenders of a healthy diet. The intervention effect was measured using Relative Risk (RR) for being in the higher intention cluster through Generalized Linear Model (GLM) with a log-linear link under Poisson distribution assumptions and robust standard errors. A P-value of 0.05 or lesser was considered statistically significant. Results: There was no statistically significant difference in the mean score of "Attitude" in both groups. The mean score of "Subjective Norm" among the intervention group increased after intervention, and the difference was statistically significant. The mean score of "Perceived behavioral control" in the intervention group increased after the intervention, but the difference was statistically not significant. The intervention group's post-intervention proportion of intenders increased, and the difference was statistically significant. The relative risk of becoming an intender for healthy diet consumption in the Intervention group compared to the Control group was 2.07 (1.44-2.97). Conclusions: The intervention package effectively brought about a positive change in behavioral intention toward healthy dietary practices among adolescents. Model-based and construct-oriented intervention packages can be adopted in school-setting to promote behavioral intention toward a healthy diet.

Perceived behavioral control regarding regular physical activity and healthy diet: An observational study among school-going adolescents in an urban area of West Bengal, India.

BACKGROUND: Healthy children are the foundation for a healthy and developing nation. Perceived behavioral control (PBC), comprising control belief and perceived power, is a person's perception of the ease or difficulty of performing the behavior of interest. For facilitating regular physical activity and regular healthy dietary practices among the adolescents, PBC is an important construct to develop and implement appropriate interventions. The aim is to assess PBC to perform regular physical activity and regular healthy dietary practices and measure their statistical relationship among the school-going adolescents in an urban area in West Bengal. MATERIALS AND METHODS: A school-based cross-sectional study was conducted among 251 adolescents aged 12-16 years after taking consent and assent for participation in the study. Data were collected with self-administered questionnaire on sociodemographic variables and the two domains of PBC, i.e., control beliefs and perceived power, related to regular physical activity and regular healthy dietary practices. Each PBC total score was calculated by multiplying control belief score and perceived power score for each respondent. Partial correlation coefficient was calculated between regular healthy dietary practices and regular physical activity. RESULTS: Among the total 251 responses analyzed, 34.7% and 27.5% students belonged to age group 14 and 15, respectively. It was observed that the mean (± standard deviation) score of PBC regarding regular healthy dietary practices was 100.7 (±27.7) and for regular physical activity was 106.0 (±21.4). The correlation between PBC of regular healthy dietary practices and regular physical activity was 0.421 and was statistically significant. CONCLUSION: In case PBC score over any behavior is higher, behavioral intention and ultimately chances of performing that particular behavior increases. Designing appropriate school-based health promotion strategies can lead to healthier children fostering regular healthy dietary practices and regular physical activity in their homes and communities.

A cross-sectional study on assessment of perceived threat to cervical cancer using health belief model among women in a slum area of Kolkata.

BACKGROUND: Despite the implementation of various cervical cancer preventive strategies by the Government of India, there is a scarcity of knowledge and consequent low utilization of cervical cancer screening services among women in India. This contributes to the burden of cervical cancer among Indian women. This study was conducted to assess perceived threat-regarding cervical cancer among women and to identify its explanatory factors in a slum area of Kolkata. MATERIALS AND METHODS: A cross-sectional study was conducted among 192 adult women from May to September 2019 in Kolkata. The multistage sampling technique was used using a structured schedule. Perceived threat to cervical cancer was measured using a composite score including perceived susceptibility and perceived severity constructs of the health belief model. Data were analyzed by descriptive statistics and multivariable logistic regression model using SPSS software version 16. RESULTS: Overall, 22.9% of the participants had satisfactory levels of perceived threat to cervical cancer. Statistically significant association was found between unsatisfactory levels of perceived threat with reproductive age group (adjusted odds ratio [AOR] = 3.01; P = 0.036), education level up to primary (AOR = 2.89; P = 0.026), and unsatisfactory knowledge (AOR = 2.94; P < 0.001) among respondents. The multivariable regression model was of good fit. CONCLUSION: The study population had very unsatisfactory levels of perceived threat to cervical cancer. Thus, to increase cervical cancer screening uptake among women, it is necessary to tailor robust behavior change communication campaigns to increase the perception of susceptibility and severity, thereby increasing the perception of threat of cervical cancer among women.

Determinants of Treatment Adherence Among Patients Living With Noncommunicable Diseases: A Mixed-Method Study in a Rural Area of West Bengal.

The multisectoral impact of the COVID-19 pandemic can impair treatment adherence of patients with noncommunicable diseases (NCDs). This mixed-method study, conducted from November 2020 to January 2021, assessed the quantum of their treatment adherence and its determinants in rural West Bengal. Quantitative data were collected from 213 NCD patients while qualitative exploration for barriers of treatment adherence was conducted as 6 in-depth Interviews. Treatment adherence was assessed by "Medication Compliance Questionnaire" and "Adherence to Healthy Lifestyle and Follow-up Advice" Questionnaire. A total of 39.4% were nonadherent to medications while 67.1% had nonadherence to healthy lifestyle and follow-up advice. Significant predictors associated with nonadherence were increasing age, female gender, lower socioeconomic status, decreasing patient empowerment, and decreasing trust in the medical profession. Economic crisis, fear of contagion, and nonavailability of investigation facilities were some new emerging barriers in addition to preexisting barriers of treatment adherence. Therefore, measures for improving patient empowerment and patient-provider relationship by motivation and counseling, taking proper care of vulnerable patients affected by the pandemic, and correcting deficiencies at the health-system level should be given utmost priority.

Role of Threat and Coping Appraisal in Protection Motivation for Adoption of Preventive Behavior During COVID-19 Pandemic.

With more than 100 million cases and over 2 million deaths globally, the COVID-19 pandemic continues to remain a major threat. Identifying the behavioral factors influencing preventive behaviors for COVID-19 are crucial in devising public health policies to promote essential strategies to combat the pandemic in an efficient manner. The current study was therefore conducted to estimate the prevalence of COVID-19 preventive behaviors and measure their association with behavioral constructs like threat perception, response efficacy, and self-efficacy, as per socio-demographic background. A region-stratified online survey focusing on the constructs of protection motivation theory, for example, threat and coping appraisal for preventive health practices against COVID-19, was carried out among adult users of social media in India. Generalized linear models with cluster-adjusted-robust standard errors were used to analyze the responses and model the preventive practices among the study population. Analysis of a total 2,646 responses revealed that proper perceptions regarding cause, symptoms, and transmission of COVID-19 were prevalent in the majority of the respondents. The majority of the participants reported frequent use of face masks (93.20%), followed by frequent washing of hands with soap and water (84.90%). The majority of the respondents affirmed that, though not frequently but sometimes, they avoid touching the face with unclean hands. Frequently covering mouth with the crook of the elbow while sneezing and coughing, and maintaining physical distance when outside was noted among 74.14 and 83.84%, respectively. The proportion of participants frequently using sanitizers to clean hands and those infrequently practicing the same were comparable. Self-efficacy for preventive practices and threat-appraisal of COVID-19 illness were identified as important determinants of the selected COVID-19 preventive behaviors, independently. The analysis confirmed that practices of the behaviors were mostly synergistic to each other. Current findings highlight that formulation of precise risk communication strategies to improve perceptions regarding threat appraisal and self-efficacy could facilitate desirable practices, which are also effective in the prevention of airborne infections and, hence, may contribute toward broader policy directions. The evidence urges the implementation of precision-driven risk communication and diffusion of these practices to attain behavioral herd immunity.

Health Care Seeking Behavior in a Scheduled Tribe Community in India: A Mixed Methods Research Using the Framework of Andersen's Behavioral Model.

India's scheduled tribe population very often bears the brunt of inequity in accessing health care. The mixed-method research assessed the health care seeking behavior (HSB) of a tribal community residing in the eastern fringes of Kolkata metropolis. An adult, preferably the head, in 209 households was interviewed followed by qualitative interviews with relevant stakeholders. Conceptual framework of Andersen's behavioral model helped in identifying the potential predisposing, enabling, and need factors that influenced HSB. A total of 25.4% respondents reportedly sought informal care during last illness episode. Multivariable hierarchical-regression model (Nagelkerke R2 = 0.381) showed that respondents' education level [adjusted odds ratio (AOR) = 2.52], household size (AOR = 3.14), nonenrollment to health insurance (AOR = 2.47), decision making by household head (AOR = 2.40), distance from the nearest urban primary health center (AOR = 3.18), and poor perception to illness severity (AOR = 2.24) were significantly associated to inappropriate HSB. Predominant health system barriers that emerged from qualitative interviews were irregular logistics, unfavorable outpatient timing, absence of female doctors, and nonretention of doctors at local urban primary health center. Community level barriers were poor awareness, self-medication practices, poor health insurance coverage, and poor public transportation. Recognition of these determinants may help in developing health promotion interventions tailored to their needs.

Determinants of menstrual hygiene among school going adolescent girls in a rural area of West Bengal.

BACKGROUND: Menstrual hygiene is a neglected issue in rural India. Lack of menstrual hygiene in adolescent girls can make them susceptible to various morbidities, for example, reproductive tract infection and urinary tract infection and their long-term consequences, for example, cervical cancer, infertility, and ectopic pregnancy. This study aims to find out the determinants of menstrual hygiene among the school going adolescent girls in a rural area of West Bengal. OBJECTIVES: To elicit the menstrual hygiene practices among the study population and to find out the association of poor menstrual hygiene practices with sociodemographic factors, such as age, occupation and education of the parents, housing, and presence of sanitary toilet. MATERIALS AND METHODS: A descriptive, cross-sectional study was conducted among 307 school going adolescent girls of 12-17 years age group in a rural area of West Bengal. RESULTS: Majority of the students in both schools (62.9%) were Hindu, general caste (54.1%) and belonged to nuclear family (69.7%). Most of the parents in both schools had completed their education up to primary level. Bivariate analyses were done, and the significant factors predicting good menstrual hygiene were entered into the multivariable logistic regression model. It revealed that good menstrual hygiene was more among those whose mothers were educated (adjusted odds ratios [AOR] 2.3 [1.06-5.01]), and who were homemakers (AOR 2.3 [1.06-5.01]). CONCLUSIONS: Menstrual hygiene among the study population was found to be poor. The improving education level of the mothers can go a long way in improving menstrual hygiene practice.

Personal vis-a-vis social responsibility for disparities in health status: An issue of justice.

Health inequities are disparities which can be avoided through rational actions on the part of policymakers. Such inequalities are unnecessary and unjust and may exist between and within nations, societies, and population groups. Social determinants such as wealth, income, occupation, education, gender, and racial/ethnic groups are the principal drivers of this inequality since they determine the health risks and preventive behaviors, access to, and affordability of health care. Within this framework, there is a debate on assigning a personal responsibility factor over and above societal responsibility to issues of ill health. One school of philosophy argues that when individuals are worse-off than others for no fault of their own, it is unjust, as opposed to health disparities that arise due to avoidable personal choices such as smoking and drug addiction for which there should (can) be a personal responsibility. Opposing thoughts have pointed out that the relative socioeconomic position of an individual dictates how his/her life may progress from education to working conditions and aging, susceptibility to diseases and infirmity, and the consequences thereof. The existence of a social gradient in health outcomes across populations throughout the world is a testimony to this truth. It has been emphasized that assuming personal responsibility for health in public policy-making can only have a peripheral place. Instead, the concept of individual responsibility should be promoted as a positive concept of enabling people to gain control over the determinants of health through conscious, informed, and healthy choices.

The role of sanitation in malnutrition--a science and policy controversy in India.

Over the past decade, India's economic growth has been remarkable - yet almost half of India's children under 5 remain stunted. The National Food Security Bill is the country's response to this critical situation. Studies reveal that Indian children are chronically undernourished, not only because of lack of food but also because of recurring gastrointestinal infections. The stunting problem revolves more around lack of sanitation than food insecurity. Despite acknowledging that malnutrition is 'complex and multidimensional', government action has consisted largely of nutritional interventions and subsidized food. Although improvements in sanitation would be the most effective way to reduce excessively high levels of chronic undernutrition and stunting, a review of policy formulation and implementation reveals deficits and disconnects with available scientific evidence. It is time to change these mistaken assumptions and focus on improving access and use of safe sanitation facilities to achieve India's nutritional goals.

Social determinants of good hand-washing practice (GHP) among adolescents in a rural Indian community.

A cross-sectional study was conducted in 5 randomly selected villages to assess prevalence of good hand-washing practice (GHP) among adolescents, and describe the social determinants. The prevalence of adolescent GHP was 32.1% (95% CI = 27.1, 37.1). Logistic regression established 5 significant positive predictors-maternal GHP, presence of sanitary latrine, availability of soap at hand-washing locations, in-house water supply, and higher per capita income. Our research provides a scope for better understanding of the socioeconomic determinants of GHP in a rural Indian setting, and may find implications in the Total Sanitation Campaign launched by Government of India.

Health promotion for prevention and control of non-communicable diseases: unfinished agenda.

The magnitude of Non Communicable diseases demands urgent attention. Common, preventable risk factors underlie most NCDs. These include behavioural risk factors and metabolic risk factors. The prevalence of these, varies between income groups and differs with gender. Majority of events occur in individuals with modest elevations of multiple risks rather than with significant elevation of a single risk factor. The need of the hour is to adopt a process which addresses the upstream determinants through enabling people, to increase control over their health and its determinants, thereby promoting and sustaining good health The answer lies in Health Promotion which involves changing behaviour at multiple levels. In order to change, there is need to understand and apply the models which have been widely used to empower people to make healthy choices. These include the Health Belief, Self-Efficacy, Social Learning and Self-empowerment models.Changing behaviour, however, is a process, not an event. Different strategies are most effective at different Stages of Change. The contextual determinants of health and health behaviour also significantly influence the risks of NCDs.Till date, there has been limited focus on these issues. We urgently, need a close look at policies and their impact on health. With increasing burden of NCDs, the Health Sector will face strain on services delivery and budgets. Special policies and programs are necessary for the disadvantaged poor to address their differential vulnerabilities and risks. The unfinished agenda of NCD prevention and control needs to be addressed urgently with an integrated comprehensive framework of Health Promotion.

Health promotion education in India: present landscape and future vistas.

'Health promotion is the process of enabling people to increase control over and to improve their health'. This stream of public health is emerging as a critical domain within the realm of disease prevention. Over the last two decades, the curative model of health care has begun a subtle shift towards a participatory model of health promotion emphasizing upon practice of healthy lifestyles and creating healthy communities. Health promotion encompasses five key strategies with health communication and education as its cornerstones. Present study is an attempt to explore the current situation of health promotion education in India with an aim to provide a background for capacity building in health promotion. A systematic predefined method was adopted to collect and compile information on existing academic programs pertaining to health promotion and health education/communication. Results of the study reveal that currently health promotion education in India is fragmented and not uniform across institutes. It is yet to be recognized as a critical domain of public health education. Mostly teaching of health promotion is limited to health education and communication. There is a need for designing programmes for short-term and long-term capacity building, with focus on innovative methods and approaches. Public health institutes and associations could play a proactive role in designing and imparting academic programs on health promotion. Enhancing alliances with various institutes involved in health promotion activities and networking among public health and medical institutes as well as health services delivery systems would be more productive.