Why are pregnant women in Togo reluctant to undergo caesarean section? A systematic inventory of motives.

This study explored the reasons underlying pregnant women's reluctance to undergo cesarean sections in Togo, despite its importance in reducing maternal and neonatal mortality. A total of 397 pregnant women who expressed hesitancy toward cesarean sections were enrolled during routine prenatal care visits at the country's largest hospital. They completed a questionnaire comprising 72 statements addressing potential reasons for hesitancy toward cesarean sections. Their responses were analyzed using factor analysis, and the effects of participants' demographic characteristics on scores for each factor were assessed using ANOVA. A seven-factor structure of motives was found: Fear of Death (endorsed by 92% of the sample); Regaining Autonomy Quickly (87%); Financial Concerns (74%); Fear of Stigmatization (73%); Fear of Unsupportive Reactions from Spouses and Relatives (72%); Prevention Through Spiritual Interventions (70%); and Perceived Health Risks for the Mother and Baby (40%). Scores on these factors were related to participants' sociodemographic characteristics. Effectively addressing the low uptake of cesarean section requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various obstacles to this life-saving care.

Factors influencing physical activity behavior in older adults with subjective cognitive decline: an empirical study using SEM and fsQCA methods.

Objectives: Despite the evident potential benefits of engaging in physical activity (PA) for older adults with subjective cognitive decline (SCD), their PA levels remains low. Previous research has predominantly focused on PA behaviors in individuals with dementia/mild cognitive impairment, with limited attention given to those with SCD. Therefore, this study aims to identify key factors influencing PA behavior in older adults with SCD based on the Self-Determination Theory (SDT) and the capability-opportunity-motivation (COM-B) model. Methods: Three hundred and three individuals aged 60 and above with SCD participated in this study. A face-to-face structured questionnaire survey was conducted. Data were analyzed using Structural Equation Modeling (SEM) and Fuzzy Set Qualitative Comparative Analysis (fsQCA). Results: SEM results indicate that PA social support primarily influences PA behavior through three indirect pathways: the separate mediating effect of basic psychological needs, the separate mediating effect of motivation, and the chained mediating effect of both. Physical literacy, on the other hand, influences PA behavior through the separate mediating effect of motivation. Necessary conditions analysis by fsQCA reveals that no single factor is necessary for promoting PA behavior in older adults with SCD, while sufficiency analysis identifies four different combinations of factors leading to PA behavior. Conclusion: The model derived from the framework of SDT and the COM-B model effectively explains and predicts the interrelationships among variables. Physical activity behavior in older individuals with SCD is the result of multifactorial synergies.

Motivations for and Experiences With Antipsychotic Tapering Among Patients With Schizophrenia Seeking Guided Dose Reduction.

OBJECTIVE: Over time, most patients with schizophrenia wish to reduce or discontinue their antipsychotic medication treatment. In Denmark, a specialized government-funded outpatient clinic was established to offer guided antipsychotic dose reduction. This study aimed to provide data on motivations for and previous experiences with antipsychotic tapering among patients attending the clinic. METHODS: Patients completed an open-ended survey on their motivations for discontinuing or tapering antipsychotic medication and recorded their expectations about these outcomes. They also provided information on previous experiences with discontinuing medication and their level of symptoms, functioning, and side effects. RESULTS: The survey was completed by 76 (86%) of 88 patients. The main motivations for discontinuing antipsychotics were adverse effects (71%) and uncertainty about the necessity of taking antipsychotics (29%). Other factors included concerns about long-term effects, disagreeing with the diagnosis, experiencing an insufficient effect, and feeling stigmatized by taking medication. Previous experience with discontinuation of antipsychotics was reported by 42 patients, of whom 23 reported relapse as the outcome. Most patients believed they could succeed in dose reduction (N=73 of 75, 97%) or discontinuation (N=62 of 75, 83%). CONCLUSIONS: Motivational factors reported for professionally guided antipsychotic dose reduction align with previous studies examining patients choosing to discontinue these medications. Despite reports of relapse during prior discontinuation attempts, most patients still reported motivation for and belief in successful dose reduction or discontinuation. An understanding of patients' motivations and beliefs is paramount to an optimal treatment alliance. Offering guided dose reduction may reduce sudden and unsupported discontinuation of antipsychotics.

The influence of message frame and product type on green consumer purchase decisions : an ERPs study.

Green consumption is a crucial pathway towards achieving global sustainability goals. Product-oriented green advertisements can effectively stimulate consumers' latent needs and convert them into eventual purchasing intentions and behaviors, thereby promoting green consumption. Given that neuromarketing methods facilitate the understanding of consumers' decision-making processes, this study combines prospect theory and need fulfillment theory, employing event-related potentials (ERPs) as measures to explore changes in consumers' cognitive resources and emotional arousal levels when confronted with green products and advertising information. This enables inference regarding consumers' acceptance of purchasing and their psychological processes. Behavioral results indicated that message framing influences consumers' purchases, with consumers consuming more green in response to negatively framed advertisements. EEG results indicated that matching positive framing with utilitarian green products was effective in increasing consumers' cognitive attention in the early cognitive stage. In the late stage of cognition negative frames stimulated consumers' mood swings more, and the influence of product type depended on the role of message frames, and the consumption motivation induced by the product, whose influence was overridden by external evaluations such as message frames. These research findings provide an explanation for the impact of frame information on consumers' purchasing decisions at different stages, assisting marketers in devising diverse promotional strategies based on product characteristics to foster the development and practice of green consumption. This will further embed the concept of green consumption advocated by organizations such as the United Nations Environment Programme (UNEP), World Wildlife Fund (WWF), and Greenpeace into the public consciousness.

The Moral Brain: a Neuropsychiatric Perspective on Moral Behavior and Motivation.

This review explores the interplay between neurobiological, psychological, and social factors that underpin moral behavior and motivation. Integrating insights from neuropsychiatry, it examines the roles of key brain regions such as the prefrontal cortex, amygdala, and anterior cingulate cortex, as well as neurotransmitters like serotonin and dopamine, in shaping moral reasoning and ethical decision-making. The historical evolution of moral motivation theories, from ancient philosophy to modern psychological and neurobiological perspectives, provides a foundation for understanding intrinsic and extrinsic motivators, emotional influences, and the impact of social norms and cultural contexts. The review also addresses the effects of psychiatric disorders on moral behavior, highlighting how conditions like antisocial personality disorder, frontotemporal dementia, and schizophrenia can lead to moral deficits. By presenting a multidisciplinary approach, this review offers a comprehensive understanding of moral motivation and behavior, emphasizing the importance of fostering ethical conduct and addressing moral challenges in clinical, educational, and societal settings.

How influencers motivate inactive adolescents to be more physically active: a mixed methods study.

Introduction: Regular physical activity offers numerous health benefits, particularly for adolescents. However, only 14% of school-aged children in Switzerland achieve the World Health Organization's recommendation of 60 min of moderate to vigorous physical activity per day. Changing health behaviors is a complex process in which understanding behavioral and communication patterns is crucial. Because adolescents spend substantial time on social media channels and obtain information from them, these are potential channels for accessing health-related content. This study explores the questions of which influencers and what content motivate adolescents to be more physically active and whether influencers can impact enjoyment and the intention to engage in physical activity. Methods: The study employed a convergent mixed methods approach, combining self-assessment questionnaires and semi-structured interviews. Ninety-three adolescents aged 14-20 years who exercised < 1 h per day participated. They followed one of the six participating influencers on Instagram. Over 6 weeks, the questionnaires collected quantitative data, measuring enjoyment, stages of change, and physical activity levels. Furthermore, semi-structured interviews were conducted with 23 adolescents and six influencers to gain in-depth insights. Results: The quantitative findings indicate that adolescent followers enjoyed physical activity more after the social media intervention and at follow-up than at the beginning of the study. The followers' stages of change progressed over time. Compared with those following more athletic influencers, followers of nonathletic influencers (that is, a singer, a journalist, and an eFootballer) showed increased physical activity over time. Qualitative analysis highlighted Instagram factors influencing physical activity, including resonance with influencers' lifestyles and preference for simple, relatable activities. Authentic content was positively associated with increased exercise, particularly among already motivated followers. Discussion: Unexpectedly, nonathletic influencers, such as a singer, a journalist, and an eFootballer, motivated adolescents best despite their nontraditional focus on physical activity. Their success stems from relatable lifestyles and simple activities that are easily incorporated into their daily routines. Conversely, athletic influencers demonstrated challenging exercises that were fascinating but difficult to adopt. This finding suggests the potential for utilizing nonathletic influencers in future campaigns targeting inactive adolescents.

Included and engaged: the significance of perceived inclusion among healthcare workers.

PURPOSE: This study investigates the impact of perceived inclusion among healthcare employees on intrinsic motivation and its subsequent effects on work engagement and stress levels. Drawing from multiple theoretical frameworks, the study hypothesizes the following: (a) perceived inclusion positively influences employees' intrinsic motivation, and (b) perceived inclusion and intrinsic motivation serve as resources that enhance employee well-being by promoting work engagement and reducing stress. DESIGN/METHODOLOGY/APPROACH: Data were collected from 407 healthcare workers across the European Union. The research objectives were achieved through statistical analysis of the gathered responses. FINDINGS: The results indicate a positive relationship between perceived inclusion and intrinsic motivation. Importantly, both perceived inclusion and intrinsic motivation emerged as significant predictors of work engagement. Additionally, perceived inclusion was found to have a negative association with stress levels, underscoring its importance in healthcare management. RESEARCH LIMITATIONS/IMPLICATIONS: The study is subject to certain limitations, including the cross-sectional design and reliance on self-reported data, which may affect the generalizability of the findings. PRACTICAL IMPLICATIONS: The findings highlight the importance of fostering perceived inclusion and intrinsic motivation among healthcare employees to enhance work engagement and reduce stress, thus offering valuable insights for healthcare management practices. ORIGINALITY/VALUE: This study contributes to the existing literature by examining the complex interplay between perceived inclusion, intrinsic motivation, work engagement and stress within the healthcare sector. It also identifies avenues for future research in this area.

To reduce editor bias and increase diversity and transparency, editors must be motivated: Commentary on Sharpe (2024).

Sharpe (2024) summarized the factors leading to editorial bias, lack of diversity, and lack of transparency and indicated what might improve matters. Here, I argue that the suggestions that were made would be improved if more thought were given to how these changes impact the incentives of editors. I give examples in the areas of control of bias, encouragement of diversity, and increase of transparency, showing what might be done to incentivize editors, along with other stakeholders, to work on these issues. Perhaps most notably, I suggest that we might change the publication model to allow more individuals to take part by retaining peer review but not organizing the reviews around journals that each have a single chief editor. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cross-Cultural Differences in the Pathways to Internet Gaming Disorder.

BACKGROUND: No research to date has examined cross-cultural differences in the pathways to internet gaming disorder (IGD). The current study aimed to address this limitation by examining the relationships between nationality (Singaporeans vs. Australians), culture orientation, gaming motivations, and IGD. METHODS: Participants were 101 Singaporeans (55.4% males) and 98 Australians (52.0% males). They completed the Culture Orientation Scale, the Motives for Online Gaming Questionnaire, and the Internet Gaming Disorder Scale-Short-Form. RESULTS: A series of mediational analyses showed that Singaporeans tend to be more collectivistic (both horizontally and vertically). In turn, this culture orientation motivates them to play games for social reasons, increasing the risk for IGD. In contrast, Australians tend to be more individualistic (vertically only). In turn, this culture orientation motivates them to play games for competitive reasons, increasing the risk for IGD. CONCLUSION: Limitations include the use of samples from two countries only, precluding a generalization of the results. Future research directions include examining the role of game genres as a mediator in the nationality-IGD relationship.

Sonic ambiances through fundamental needs: An approach on soundscape interventions for intensive care patientsa).

We explored the underpinnings of providing positive listener experiences for intensive care unit (ICU) patients with compositions of added sounds. Our objective was to derive an approach to such interventions based on soundscape perception and need fulfillment. In one study, we gathered qualitative empirical data about imagined soundscapes where nine fundamental needs were fulfilled. Hierarchical clustering and thematic analysis showed that imagined soundscapes clustered into four types of sonic ambiances, i.e., affective connotations with soundscapes: Comfortable, Pleasurable, Motivating, or Stimulating ambiances. We derived four design parameters to achieve these ambiances with sound compositions: eventfulness, sonic ambiance qualities, narrative structure, and sound distribution. A sound artist was asked to use these parameters to create sound compositions. In a listening experiment, we examined their effects on the perceived pleasantness and eventfulness of soundscapes and on listeners' experienced pleasure and arousal. Soundscapes were perceived as pleasant with varying eventfulness in line with our structured approach. We found a strong correlation between pleasantness and with listener's pleasure and a moderate correlation between eventfulness and with listener's arousal. Finally, we suggested that in future research, three sonic ambiance types should be considered rather than four. Concluding, we showed that our need-driven approach could form a promising way to support ICU patients.

Avoiding siloed approaches: Integrating psychological insights into sustainable farming.

This study enhances our understanding of the psychological factors influencing farmers' adoption of sustainable farming practices, specifically those related to achieving NetZero emissions. It achieves this by integrating various psychological theories with practical farming methods within the context of Behavioral-Adoption and Purpose-Driven contexts. The research consisted of two studies. Study 1 employed Exploratory Factor Analysis (EFA) to analyze responses from 438 UK farmers regarding their attitudes toward a series of Net Zero policy commitments, drawing on psychological theories including the Unified Theory of Acceptance and Use of Technology, the Theory of Planned Behavior, the Prototype Willingness Model, Implementation Intentions, Self-Determination Theory, Eudaimonia, and the Integrated Model of Health Literacy. The findings revealed a new Integrated Motivation Model for Sustainable Farming that comprises seven factors: Agricultural Commitment and Stewardship, Sustainable Farming Readiness and Confidence, Sustainable Incentive Engagement and Acceptance, Climate Adaptation Competence and Confidence, Net Zero Accountability and Reporting Commitment, Community Influence and Commitment in Sustainable Farming, and Innovation and Technological Competence. Study 2 validated these factors through the development of a 21-item Integrated Motivation Model for Sustainable Farming scale and use of Confirmatory Factor Analysis (CFA) to confirm the 7-factor structure using a subsample of 418 UK farmers from Study 1 and an additional 230 US farmers. Furthermore, Study 2 tested the concurrent validity of the new scale by demonstrating significant associations with reported sustainable farming behaviors. These findings underscore the complex interplay of motivational, cognitive, and social processes influencing sustainable farming practices. The integrated psychological model developed through this research provides parsimonious and valuable insights for policymakers to foster sustainable practices in farming effectively. The confirmation of this model across farming populations enhances its generalizability and potential to guide targeted interventions aimed at achieving behavioral change in pursuit of Net Zero targets in agriculture.

The Effects of Post-Earthquake Trauma Levels of Nursing Students on their Academic Motivation and Career Decisions.

OBJECTIVES: This study was carried out to determine the effects of post-earthquake trauma levels of nursing students on their academic motivation and career decisions. METHODS: The sample of this descriptive study consisted of 228 students studying at Gaziantep Islamic Science and Technology University, Department of Nursing. The data were collected using an online questionnaire created by the researchers. This online questionnaire form consists of seven questions about socio-demographic characteristics, and it also includes the Determination of Post-Earthquake Trauma Levels Scale, Academic Motivation Scale, and Career Decision Scale. SPSS 23.0 package program was used for the analysis of the data, and P < 0.05 was accepted for the level of significance. RESULTS: It was determined that the post-earthquake trauma level of the students was above the moderate level (63.49 ± 17.29) and that the extrinsic motivation-identified regulation, extrinsic motivation-external motivation, and intrinsic-knowledge levels were more affected by the earthquake (P < 0.05). In addition, it was determined that the mean Career Decision Scale score of the students (74.20 ± 17.35) was below the average. CONCLUSIONS: It was determined that post-earthquake trauma level had positive effects on intrinsic motivation-stimulation, extrinsic motivation, and amotivation, but had no effect on career decision.

Impact of financial incentives introduced during the COVID-19 pandemic on nursing staff: a mixed-method protocol.

INTRODUCTION: The COVID-19 pandemic has had a major impact on nursing staff, resulting in alarming turnover rates. As part of the Quebec (Canada) government's response to the pandemic, nurses have been offered exceptional financial incentives. Considering the cost of these measures, the current article presents the research protocol of a study aiming to explore the impact of financial incentives on full-time equivalent, and retention rates among the nursing staff in two healthcare settings in Quebec. METHODS AND ANALYSIS: A sequential mixed design (QUANT→QUAL) will be used. The quantitative phase will involve a quantitative descriptive analysis and the qualitative phase will consist of a qualitative descriptive study. Administrative data (working hours, employment status and retention rate) will be analysed over a 4.5-year follow-up (from 1 January 2019 to 30 June 2023) to explore the impact of the financial incentives. Focus groups will explore nurses' views on financial incentives. The results will inform the development of future interventions to mitigate attrition problems among nurses and ultimately improve access to and the continuity of public health services. ETHICS AND DISSEMINATION: The study has been approved by ethics committees of the participating healthcare settings (Comité d'éthique de la recherche sectorial en santé des populations et première ligne du CIUSSS de la Capitale-Nationale; Comité d'éthique de la recherche du CISSS de Chaudière-Appalaches). The results will be disseminated mainly in scientific publications and at academic conferences in addition to presentations tailored to various non-academic audiences.

GABA (gamma-aminobutyric acid) levels in dorsal anterior cingulate cortex are negatively associated with food motivation in a pediatric sample.

Food motivation varies between individuals, affecting body weight and risk for eating disorders. Prior neuroimaging studies in youth and adults have revealed functional and structural alterations in the anterior cingulate cortex [ACC] in those with obesity and disordered eating but have not investigated their neurochemical underpinnings. In a sample of 37 children aged 4 to 13 years old, we used Magnetic Resonance Spectroscopy [MRS] to assess levels of γ-aminobutyric acid [GABA] - the major inhibitory neurotransmitter in the human brain - quantified relative to creatine in a 27-ml voxel including the dorsal ACC. We used the CEBQ to assess trait food motivation. In analyses adjusting for age, lower GABA+/Cr levels in the dorsal ACC were associated with higher trait enjoyment of food. Higher enjoyment of food scores were in turn associated with higher energy intake during an ad libitum test meal and during a postprandial task assessing intake in the absence of hunger, and higher body weight. Our results indicate a role for GABA function in the dorsal ACC in determining individual variation in food motivation in children.

"Do we register our deaths?": Motivations and barriers to death registration in Ghana.

Death registration is generally low in sub-Saharan African countries, including Ghana. This study investigated the factors that motivate and serve as barriers in registering for a death certificate. A cross-sectional qualitative study design was used to interview twelve birth and death registration officers in Ghana. The interviews were analysed using Atlas.ti version 7.5. The results show that death registration in Ghana is generally low. Processing of a deceased person's estate emerged as the main motivation for the registration of death. Other motivators included the obligation to register deaths and the requirement of death certificates for burial. The barriers to death registration included the governance system at the cemetery, the hastiness in burying the dead, the perception of cost of death certificates, and less importance attached to death registration. Policymakers should consider these factors in the design of interventions to increase the rate of death registration in Ghana.

Cadence-Based Pedometer App With Financial Incentives to Enhance Moderate-to-Vigorous Physical Activity: Development and Single-Arm Feasibility Study.

BACKGROUND: High levels of physical activity are key to improving health outcomes, yet many people fail to take action. Using pedometers to target steps per day and providing financial incentives is a simple and scalable approach to promoting public health. However, conventional pedometers do not account for "intensity" and "duration," making it challenging to efficiently increase people's moderate-to-vigorous physical activity (MVPA), which is expected to improve health outcomes. Based on these rationales, we developed a smartphone app that sets step cadence as a goal (defined as a daily challenge of walking more than 1500 steps in 15 minutes twice a day, which is a heuristic threshold for moderate physical activity) and provides financial incentive when the challenge is met. OBJECTIVE: This study aimed to evaluate the feasibility of our novel app and explore whether its use can increase users' daily MVPA. METHODS: A single-arm pre-post study evaluated the feasibility and efficacy of the app. A total of 15 participants used app 1 (an app without financial incentives) for the first period (4 weeks) and then switched to app 2 (an app with financial incentives) for the second period (4 weeks). The primary outcome was the difference between the first and second periods in the number of successful challenge attempts per week. Secondary outcomes were differences between the first and second periods in daily steps and distance walked. Exploratory outcomes included the difference between the first and second periods in daily "heart points" as measured by Google Fit, a publicly available app that measures users' daily MVPA. RESULTS: The number of successful challenge attempts per week increased significantly compared to the first period (5.6 times per week vs 0.7 times per week; P<.001). Although not statistically significant, there was a trend toward an increase in the mean steps per day and distance walked per day (6586 steps per day vs 5950 steps per day; P=.19; and 4.69 km per day vs 3.85 km per day; P=.09, respectively). An exploratory end point examining daily MVPA by "heart points" collected from Google Fit also showed a significant increase compared to the first period (22.7 points per day vs 12.8 points per day; P=.02). CONCLUSIONS: Our app using step cadence as a goal and providing financial incentives seemed feasible and could be an effective app to increase users' daily MVPA. Based on the results of this study, we are motivated to conduct a confirmatory study with a broader and larger number of participants. TRIAL REGISTRATION: UMIN 000050518; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057420.

'For me it's just the conversation:' responsive feeding influences among early childhood educators.

OBJECTIVE: Early learning and childcare (ELCC) programmes play an important role in shaping children's eating behaviours and long-term health by establishing a responsive feeding environment that encompasses not only mealtime behaviours but also extends to play activities and language used throughout the day. Despite their potential benefits, many ELCC centres do not consistently implement responsive feeding behaviours, facing challenges with organisational and behavioural changes within these environments. This study aims to identify influences on responsive feeding behaviours among early childhood educators prior to an intervention. DESIGN: A qualitative study guided by the Behaviour Change Wheel framework and Capability Opportunity Motivation - Behaviour (COM-B) model. Semi-structured interviews and focus groups were conducted, recorded and transcribed verbatim. Thematic analysis was employed to identify themes, categorising them within the corresponding COM-B domains. SETTING: Canada. PARTICIPANTS: Forty-one ELCC staff in various roles across eight centres from two provinces in eastern Canada. RESULTS: Fifteen influences, spanning across all six domains of the COM-B model, were identified, highlighting gaps in educators' knowledge and skills, varied approaches to food and feeding, and the interactions with children, parents, and co-workers on mealtimes dynamics. Additionally, costs, centre location and other physical resources emerged as enabling opportunities for responsive feeding behaviours. CONCLUSIONS: These findings offer a comprehensive exploration of the diverse factors influencing responsive feeding behaviours among educators, each varying in its potential for future behaviour change intervention.

The Role of Critical Thinking in Mitigating Social Network Addiction: A Study of TikTok and Instagram Users.

This study addresses the growing concern of social network (SN) addiction, with a focus on TikTok and Instagram. Guided by the Uses and Gratifications Theory (UGT), we explored the motivations (escapism and social interaction), attitudes (critical thinking), and states (flow and sense of belonging) that influence SN use. Our objective was to investigate whether critical thinking acts as a protective factor against SN addiction. A sample of 332 university students completed questionnaires assessing motivations, attitudes, states, and SN addiction. Critical thinking was measured using the Critical Thinking Attitude Scale (CTAS), and critical thinking skills were assessed through the Critical Reasoning Assessment (CRA). Statistical analyses revealed significant associations between motivations, critical thinking, states, and SN addiction. Specifically, critical thinking (CTAS scores) demonstrated a negative correlation with SN addiction (r = -0.34, p < 0.01), indicating that higher critical thinking is associated with lower SN addiction. Regression analysis further indicated that escapism (ß = 0.45, p < 0.01) and social interaction (ß = 0.31, p < 0.05) positively predicted SN addiction, while critical thinking negatively predicted SN addiction (ß = -0.28, p < 0.01). Additionally, states of flow and sense of belonging showed significant positive correlations with SN addiction (r = 0.42, p < 0.01 and r = 0.37, p < 0.01, respectively). These findings highlight the potential of critical thinking as a safeguard against SN addiction. This study offers valuable insights into the intricate dynamics of SN use, with implications for promoting healthier digital engagement. Understanding the factors influencing SN addiction and the roles of motivations, dispositions, and states can inform interventions aimed at fostering responsible and mindful online behaviors.

Experiences of Postpartum Follow-Up and Participation in a Lifestyle Intervention after Gestational Diabetes: A Qualitative Study.

BACKGROUND/OBJECTIVES: Gestational diabetes is associated with an increased risk of future type 2 diabetes and cardiovascular disease, but healthy lifestyle changes can prevent the development of these diseases. This study aimed to identify factors that can improve intervention programmes and postpartum support after gestational diabetes. METHODS: Twenty-two women who had experienced gestational diabetes in Norway participated in in-depth interviews following a six-month intervention programme focusing on healthy lifestyle changes. Participants were included 3-12 months after giving birth. The data were analysed using reflexive thematic analysis. RESULTS: Four themes were developed: (1) A status report on my health and lifestyle-crucial for recognising the need for change; (2) encouragement and cheering on: getting started and maintaining changes; (3) life's challenging moments: looking after the baby and prioritising one's own health; and (4) the first period with the newborn baby-a good time to make changes. Participants described maternity leave as a suitable time for lifestyle change. Adequate information about and insight into their health were important for success. The focus on small changes motivated them to improve their lifestyle. Participants emphasised individualised help, support from others, noticing an improvement and seeing a positive effect on their family members as motivational factors for maintaining the changes. However, they found it difficult to prioritise themselves and to maintain lifestyle changes in challenging life situations and transitional phases. CONCLUSIONS: The study findings can help support the development of future intervention programmes for women who have experienced gestational diabetes.

Optimizing EFL learning: exploring the role of learner background factors and the nuances of their effects on intrinsic and extrinsic motivation among university students in a mixed-methods study.

INTRODUCTION: Motivation is a driving force behind man's behavior which has led to many psychological studies throughout the world. Moreover, it is the fuel for successful learning. While intrinsic motives provide the internal rewards, extrinsic motivation supplies the required external rewards to keep the engine of learning running. Knowing the factors which impact intrinsic/extrinsic motivation helps educators target their efforts at a higher level and make more informed decisions. METHOD: This study intends to examine how intrinsic vs. extrinsic motivation may be influenced by demographics including learners' background factors of major, age, and occupation and to determine the relationships that may exist between intrinsic and extrinsic motivation. To this end, an explanatory sequential mixed-methods research was conducted at one of the public universities in Shiraz on the majors of Elementary Education, Educational Affairs, Social Studies and Theology, and the Arabic language which were selected through cluster sampling. These students were having their English courses at the university. Based on Krejcie and Morgan's formula for sample size, a questionnaire was administered to 100 participants to collect quantitative data. Moreover, semi-structured interview sessions were conducted with one fourth of the participants. RESULTS: Using Multiple Analysis of Variance (MANOVA) and Pearson correlation, we found that learners' background factors of age, field of study and professional status did not affect intrinsic nor extrinsic motivation. However, significant and positive relationships were found between intrinsic motivation and total motivation index, and between extrinsic motivation and total motivation index. Qualitative data obtained from the interviews were analyzed using a thematic analysis. The results of the interviews showed some new illuminating trends as revealed from the participants' responses and it was found that most interviewees followed intrinsic motives and considered motivation as a factor of great significance. CONCLUSION: In the English as a Foreign Language (EFL) context in which our study was conducted, instructors can follow more similar classroom motivational techniques and strategies since neither type of motivation was influenced by the variables of different major, age and occupation. Though many studies have shown that EFL learners are more extrinsically motivated in comparison with ESL ones, our study revealed that participants were more intrinsically motivated. Thus, this study may be replicated in other educational contexts such as an ESL context. The study can also be repeated in some universities in which other educational systems such as coed education is used to see the possible similarities and differences. Motivation is the important stimulant to impel the learners to achieve their learning goals; thus, it should receive sufficient attention in various educational settings.