Enhancing feedback by health coaching: the effectiveness of mixed methods approach to long-term physical activity changes in nurses. An intervention study.

BACKGROUND: Although knowledge of the barriers and motivators to physical activity participation among nurses is increasing, the factors influencing motivation methods' effectiveness are not completely defined. This study aimed to identify the methods that support increasing the level of daily physical activity and the factors that influence the effectiveness of motivation methods among nurses. METHODS: This study was based on an intervention study protocol. All registered nurses in clinical settings were invited to participate in the study. The study involved 71 professionally active nurses. A self-reported questionnaire was used to collect sociodemographic and employment data. The level of physical activity was assessed using the International Physical Activity Questionnaire, and the daily number of steps was assessed using a pedometer. Body composition was measured using a bioimpedance method, and the 5-year risk of cardiovascular events was assessed using the Harvard Score. The intervention included self-monitoring daily steps using a pedometer and completing a diary daily for one month. Additionally, a few-minute speech was sent to each participant via email on the intervention's 7th, 14th, and 21st days. RESULTS: The analysis revealed a higher value of physical activity recorded in the follow-up compared to the initial and final measurement in the Recreation domain [Met] (p < 0.001) and a higher value of daily steps in the follow-up compared to the final measurement (p = 0.005). Participants with a higher Harvard Score were more likely to increase their daily number of steps (OR = 6.025; 95% CI = 1.70-21.41), and nurses working in hospital wards were less likely to do so (OR = 0.002; 95% CI = 0.00-0.41). CONCLUSIONS: Recommendations for physical activity in the nursing population should focus on increasing leisure time physical activity and regular risk assessment of cardiovascular events. A mixed methods approach, such as feedback enhanced by health coaching, effectively achieves long-term physical activity changes in nurses.

Barriers in adopting health-promoting behaviours among nurses: A qualitative systematic review and meta-synthesis.

AIMS: Nursing is a highly stressful occupation where irregular shifts and working overtime lead to unhealthy behaviours. This qualitative systematic review and meta-synthesis aims to examine nurses' barriers in adopting health-promoting behaviours. METHODS: Six electronic databases were searched from their respective inception dates to October 2021: EMBASE, Web of Science, PubMed, PsycINFO, CINAHL and ProQuest Dissertations and Theses. The Critical Appraisal Skills Program checklist was used to appraise the quality of included studies. Data synthesis followed Sandelowski's and Barroso's two-step approach. RESULTS: Fourteen studies were included in this review, and three themes were generated as follows: (1) work environment and workplace culture, (2) nature of the job and (3) intrinsic factors. CONCLUSION: This review synthesized available evidence on the barriers nurses experienced while adopting health-promoting behaviours. Health-care institutions should target these factors when providing facilities and services to support nurses in adopting health-promoting behaviours. Policies should focus on workplace health promotion by advocating for healthy lifestyle policies. Future research should be conducted in more multicultural and geographically diverse regions to obtain a more global view of nurses' barriers to adopt health-promoting behaviours.

Association of electronic health literacy with health-promoting behaviours in adolescents.

AIM: This study aimed to determine the electronic health (e-health) literacy level of high school students and its relationship with their health-promoting behaviours. METHODS: This was a cross-sectional study conducted between April and May 2018. The study sample consisted of 409 students, who were aged between 14 and 19 years old, in three high schools located in the city centre of Denizli. Multiple regression analyses were performed to examine the predictive variables for six dimensions of health-promoting behaviours. RESULTS: In this study, the mean (SD) e-health literacy score of 27.89 (6.19) was slightly above moderate level. e-Health literacy was found to significantly predict all six dimensions of health-promoting behaviours positively, that is, e-health literacy was determined to predict the dimensions of nutritional behaviours (ß = 0.64, P < 0.001), life appreciation (ß = 0.55, P < 0.001), social support (ß = 0.72, P < 0.001), exercise (ß = 0.36, P < 0.001), stress management (ß = -0.22, P < 0.001) and health responsibility (ß = 0.68, P < 0.001). CONCLUSION: With e-health literacy significantly predictive of health-promoting behaviours, nurses are recommended to consider the e-health literacy levels of adolescents in the health-promoting programs they design.

Three-factor structure of the eHealth Literacy Scale and its relationship with nurses' health-promoting behaviours and performance quality.

AIMS: To examine the factorial validity of the eHealth Literacy Scale among hospital nurses and to investigate the associations of its components with health-promoting behaviours and nursing performance quality. DESIGN: This cross-sectional study used survey data of 484 Korean hospital nurses, which were collected between March-May 2016. METHODS: The three-factor structure was tested using confirmatory factor analyses. Multiple linear regression was conducted to test associations of the three components' scores with health-promoting behaviours and self-rated nursing performance quality. RESULTS: The eHealth Literacy Scale supported a three-factor structure: awareness of internet health resources (awareness), having skills needed to access resources (skills), and the ability to evaluate the quality of internet health resources (evaluation). All the three components were significantly associated with higher quality of nursing performance and better interpersonal relations. Stress management, spiritual growth, and health responsibility were linked with evaluation or skills but physical activity and nutrition were not. CONCLUSION: Strategies to enhance eHealth literacy among nurses could improve nurses' health and further patient care. Training to build nurses' self-efficacy to evaluate internet health information could improve eHealth literacy and should be developed and examined. IMPACT: To improve nurses' health and patient care, training programs to build nurses' self-efficacy to access and evaluate internet health information should be developed.

A daily diary study of the relationships among daily self-compassion, perceived stress and health-promoting behaviours.

Previous studies consistently found that trait self-compassion is positively associated with health-promoting behaviours, and perceived stress mediates the relationship. The current study primarily aimed at examining whether state self-compassion varying from day to day (daily self-compassion) played the same role as trait self-compassion in improving health-promoting behaviours and whether or not perceived stress would be the mediator in this relationship. Eighty-nine Chinese employees were recruited to finish demographic information and the trait measure of self-compassion first, and then finish daily diaries for seven consecutive days. Daily diary measures included daily self-compassion, perceived stress and health-promoting behaviours including both eating behaviours and exercise behaviours. The results of 1-1-1 multilevel mediation analyses showed that, at both the within- and between-person level, daily self-compassion could positively predict daily eating behaviour through the reduction of perceived stress. However, daily self-compassion did not influence exercise behaviour at both levels. The results of 2-1-1 multilevel mediation analyses cross-validated the between-person relationships in the 1-1-1 multilevel mediation models. These results suggest that, both short-term interventions aiming at increasing state self-compassion and long-term interventions aiming at increasing trait self-compassion can benefit one's eating behaviours through the reduction of stress.

Effect of health promoting behaviours on caries prevalence in children aged 1-3 years from the Skierniewice region.

BACKGROUND: Health promoting behaviours have a decisive effect on the development and cours of caries at any age. OBJECTIVES: The aim of the study was to investigate the correlation between health promoting behaviours and the state of dentition in children aged 1-3 years by determining the child's age, the cause of the first visit at the dental office and evaluating the relationship between the intensity of dental caries and the frequency of oral hygiene practices as well as the consumption of sweet foods. MATERIAL AND METHODS: The study was conducted among 204 children aged 1-3 years from the town of Skierniewice and its vicinity, who visited the Dental Clinic at the Ogrodowa Medical Centre in Skierniewice in the years 2019 and 2020. The study consisted of two parts: a questionnaire and clinical examination. RESULTS: In the entire study group, active caries was found in 65.2% of children. Most of the children came for the first time to the dentist at the age of 3 years (37.5%), and the least number of them in the first year of age (22.6%). There was no significant correlation observed between the purpose of the visit (adaptation, check-up and treatment, pain) and the child's age (p> 0.05). The majority of children (67.6%) cleaned their teeth twice a day; and the value of their dmf index (2.00 ± 0.88) was significantly lower compared to those brushing teeth once a day: in the morning (2.82 ± 1.01) or in the evening (2.89 ± 0.93) (p <0.001). Only 8.8% of children did not eat sweets at all, while more than half (58.8%) consumed them more than once a day. The dmf index value significantly (p<0.001) increased with the frequency of sweets consumption from 0.37 ± 0.08 - never, through 1.73 ± 0.86 - once a day, to 2.99 ± 1.03 - often. CONCLUSIONS: The results of our study showed that health-promoting measures have a significant impact on the dental state of children aged 1-3 years.

Shift-work nurses' work environments and health-promoting behaviours in relation to sleep disturbance: A cross-sectional secondary data analysis.

AIMS AND OBJECTIVES: To examine the association of nursing work environments and health-promoting behaviours with shift-work nurses' sleep disturbance. BACKGROUND: Shift-work nurses reportedly have sleep problems, which affect their sleep quality and quantity. Given the high risk of developing performance decrements and medication errors in sleep-disturbed nurses, factors related to sleep disturbance among shift-work nurses should be investigated. DESIGN: A cross-sectional secondary data analysis. METHODS: Our study analysed data from 339 nurses who had been involved in rotating shift work including night shifts for more than 6 months. To examine associations of nursing work environments and health-promoting behaviours with sleep disturbance, multiple linear regression models were generated. This study is reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guideline. RESULTS: Nurses with more collegial relations with physicians were significantly less likely to have high levels of sleep disturbance (B = -4.01, p = 0.04). Those with higher levels of sleep disturbance were significantly more likely to report less stress management (B = -9.56, p < 0.01) and higher health responsibility (B = 9.30, p < 0.01). CONCLUSIONS: To alleviate shift-work nurses' sleep disturbance, organisational supports for collaborative relations with physician and increased healthcare accessibility are needed. Individual nurses should develop healthy lifestyles to reduce occupational stress and alleviate sleep disorders. RELEVANCE TO CLINICAL PRACTICE: To improve shift-work nurses' sleep, collegial relations with physicians and healthy lifestyles should be promoted.

Associations of eHealth literacy with health-promoting behaviours among hospital nurses: A descriptive cross-sectional study.

AIMS: To investigate the associations of eHealth Literacy with health-promoting behaviours among hospital nurses in South Korea. BACKGROUND: Health-promoting behaviours of nurses are crucial for their own improved health and health-related behaviours of patients. eHealth literacy refers to the ability to search, understand and evaluate health information available online. With the growing use of the Internet, eHealth literacy is emerging as an important factor enhancing health-promoting behaviours. DESIGN: Descriptive cross-sectional design with self-reported questionnaires. METHODS: Data were collected between March-May 2016 from five hospitals in South Korea. Health-promoting behaviours and eHealth literacy were assessed using Health Promoting Lifestyle Profile-II and K-eHEALS, respectively. Multiple linear regression models were used to examine the associations of eHealth literacy and health-promoting behaviours. RESULTS: Nurses with high level of eHealth literacy had significantly positive overall health-promoting behaviours, stress management, interpersonal relations, self-actualization and health responsibility, but not for nutrition and physical activity. CONCLUSION: Improving eHealth literacy through various strategies could be an effective way to boost health-promoting behaviours among nurses. However, improvement of actual health-promoting behaviours such as nutrition and physical activity will require systematic and organizational changes.

The relationship between attitudes toward aging and health-promoting behaviours in older adults.

BACKGROUND: Identifying the factors that are associated with health-promoting behaviours in older adults is necessary to increase their willingness and motivation to participate in health-promotion activities. Understanding context-specific attitudes in relation to their influence on health-promoting behaviours is crucial in designing efficient interventions that foster health-promoting behaviours among older adults. AIM: This study aimed to examine the relationships between attitudes towards aging and health-promoting behaviours in older adults in Turkey. METHODS: The study used a descriptive-correlational design. A convenience sample of 448 community-dwelling older adults who were 65 years and older and cognitively intact were selected from 6 family health centres in the city of Denizli in Turkey. The data were collected between March and June of 2014 using the Attitudes to Aging Questionnaire and the Health-Promoting Lifestyle Profile II. Multiple linear regression analysis was performed to explore the predictors of health-promoting behaviours. FINDINGS: Attitudes toward aging, the psychosocial loss subscale, and education were statistically significant predictors of health-promoting behaviours. Attitudes toward aging were the strongest predictor of health-promoting behaviours in older adults. CONCLUSION: Attitude towards aging is a factor that affects health-promoting behaviours, and it should be considered during interventions for improving health promoting behaviours.

Cigarette smoking and health-promoting behaviours among tuberculosis patients in rural areas.

AIMS AND OBJECTIVES: To explore cigarette smoking and health-promoting behaviours among disadvantaged adults before their tuberculosis diagnosis and after their tuberculosis treatment. BACKGROUND: Although tuberculosis infection is associated with impaired immune function, healthy lifestyle habits can play a role in improving the immune system. However, limited research has explored the health-promoting behaviours and cigarette smoking habits among tuberculosis patients in Taiwan. DESIGN: A cross-sectional retrospective study with a convenience sample. METHODS: This study was conducted between May 2013-June 2014 with 123 patients at a rural district hospital in Chiayi County, Taiwan. Statistical analyses included descriptive statistics, univariate analysis and stepwise regression analysis. RESULTS: Tuberculosis tended to be associated with less education, male sex, malnutrition, cigarette smoking and unhealthy lifestyle habits before the tuberculosis diagnosis. The percentage of smoking decreased from 46·9% before to 30·2% after the tuberculosis diagnosis. Body mass index and health-promoting behaviours also significantly improved after tuberculosis treatment. After controlling for potential confounding factors, multivariate analysis identified chronic disease and completed treatment as significant factors that were associated with current health-promoting behaviours. CONCLUSIONS: A high prevalence of cigarette smoking and low levels of health-promoting behaviours were observed before the diagnosis and during or after completing tuberculosis treatment. RELEVANCE TO CLINICAL PRACTICE: This study's findings indicate the importance of promoting healthy lifestyle changes among tuberculosis patients; aggressive measures should be implemented immediately after the first diagnosis of tuberculosis. Furthermore, health promotion and smoking cessation programmes should be initiated in the general population to prevent activation of latent tuberculosis infection, and these programmes should specifically target men and rural residents.

Explaining the perspective of people living with HIV on health-promoting behaviours based on Pender's model: A directed content analysis.

AIM: Health-promoting behaviours are an important challenge in people living with HIV (PLHIV). Knowing PLHIV's perspective can be helpful for more effective health-promoting behaviour planning. Therefore, the present study aims to explain PLHIV's perspective on health-promoting behaviours based on Pender's health-promotion model. DESIGN: A qualitative study with a directed content analysis approach. METHODS: Altogether, 17 PLHIV referring to the Behavioural Diseases Consultation and Control Center in Tehran, Iran and were selected through purposive sampling. The data were collected through semi-structured individual interviews and the results were analysed through directed content analysis based on Pender's model. Data management was done by MAXQDA V10. RESULTS: Data analysis led to the extraction of 396 codes in 35 subcategories and 15 main categories in 6 constructs of Pender's model, including the perceived benefits (health assurance and optimal disease control), perceived barriers (insufficient knowledge and awareness, lack of motivation, adverse outcomes of the disease and socioeconomic status), perceived self-efficacy (endeavouring to have a healthy lifestyle, responsibility for one's health and that of others), activity-related affect (positive and negative feelings), the interpersonal influences (family, friends and relatives and social media) and situational influences (the resources available to the community and community's culture). PATIENT OR PUBLIC CONTRIBUTION: In this study, the contribution of PLHIV was used and their perspectives were surveyed. The findings of this study can help policymakers and planners formulate health policies to select the most appropriate strategies and approaches to promoting effective healthy behaviours among PLHIV.

Understanding perspectives on health-promoting behaviours among older adults with hypertension.

PURPOSE: Health-promoting behaviours (HPBs) are considered the key to determining health among older adults with hypertension. Increasing our understanding of older adults' views on HPBs could facilitate the development of interventions aimed at improving their quality of life. This study aims to describe the perceptions of older adults with high blood pressure concerning their HPBs and associated factors. METHODS: Semi-structured interviews with 40 individuals in Thailand were used to collect the data, which were analysed using thematic analysis. RESULTS: The results were categorized into five main themes related to personal, social, and environmental factors. Older adults explained that their experiences with HPBs involve taking responsibility for controlling blood pressure by following a doctor's prescription, modifying their lifestyles to be healthier, sustaining social relationships, and experiencing spiritual growth through religious practices for inner peace. Older adults also identified environmental factors that influenced their engagement in HPBs depending on their residential areas. CONCLUSIONS: The findings of this study highlight the importance of practices in which professionals support and encourage older adults to perform HPBs to maintain health and improve their well-being.

Pathways from emotional intelligence to well-being and health outcomes among unemployed: Mediation by health-promoting behaviours.

This study investigated whether health-promoting behaviours mediate the relationship between emotional intelligence (EI) and well-being and health outcomes in the unemployed population. Spanish unemployed (N = 530) completed questionnaires of EI, health-promoting lifestyles, subjective well-being and perceived health. Path-analytic results showed that EI predicted well-being and self-reported health. Health-promoting behaviours: spiritual growth, stress management and physical activity, partially mediated the link between EI and well-being and health outcomes. Findings are discussed in terms of the role that promoting health behaviours might play regarding to well-being and health outcomes after job-loss, and in developing of EI and health-promotion programmes for unemployed populations.

Self-Compassion, Adaptive Reactions and Health Behaviours Among Adults With Prediabetes and Type 1, Type 2 and Gestational Diabetes: A Scoping Review.

Engaging in health-promoting behaviours has health benefits for people with prediabetes or diabetes. People experience negative affect after diagnoses, which can impede self-regulation of health behaviours. Self-compassion, extending care to oneself in difficult times, can mitigate negative affect and promote self-regulation. This scoping review explored the relationship between self-compassion and adaptive affect, self-regulation and engagement in health-promoting/management behaviours among people with prediabetes or diabetes. We conducted a scoping literature search from 6 databases for studies and conference abstracts. Randomized controlled trials and cross-sectional, longitudinal, observational and qualitative designs focused on self-compassion were included. Eligible studies included adults with diabetes (prediabetes, type 1, type 2 and gestational), measured self-compassion using a validated Self-Compassion Scale (quantitative) or included the 3 components (qualitative) and investigated: negative affect, health promoting/management behaviours and/or self-regulation. After deduplication, 5,338 quantitative and 953 qualitative abstracts, and 18 conference proceedings were screened leaving 35 articles. Full-text screening retained 11 eligible studies (6 cross-sectional studies, 2 randomized controlled trials, 2 longitudinal studies and 1 qualitative study). Higher self-compassion was associated with decreased negative affect in 9 studies and was positively associated with well-being in 1 cross-sectional study. Self-compassion led to decreased negative affect and improved blood glucose in 2 interventions. Five studies found positive associations between self-compassion and health-promoting/management behaviours. One qualitative study found self-compassion to benefit affective reactions, health-promoting behaviours and self-regulation. This review shows that self-compassion is linked to adaptive behavioural and affective responding among people with prediabetes and diabetes, and the need for more research on self-compassion and self-regulation in these populations.

The effects of a nurse-led lifestyle intervention program on cardiovascular risk, self-efficacy and health promoting behaviours among patients with metabolic syndrome: Randomized controlled trial.

BACKGROUND: Metabolic syndrome is a cluster of cardio-metabolic risk factors and a major burden for public health due to its increasing prevalence and adverse effects on cardiovascular health. Lifestyle modification is the first-line intervention for metabolic syndrome management. However, adopting healthy behaviours is challenging among patients with metabolic syndrome. OBJECTIVE: To examine the effects of a nurse-led lifestyle intervention program on cardiovascular risks, self-efficacy and the implementation of health promoting behaviours. DESIGN: A two-armed randomized controlled trial. SETTINGS AND PARTICIPANTS: A total of 173 patients that satisfied the metabolic syndrome definition of International Diabetes Federation was recruited from a hospital in North China. METHODS: The participants were randomly assigned to either attend the lifestyle interventions (n = 86) or receive usual care from the study hospital (n = 87). The lifestyle intervention followed the framework of Health Promotion Model and consisted of one face-to-face education session (30-40 min), one educational booklet and six telephone follow-ups (bi-weekly, 20-30 min per call) in three months. The Framingham 10-year risk score was calculated to measure the participants' cardiovascular risks at baseline and 3-month. The Self-rated Abilities for Health Practices and Health Promoting Lifestyle Profile II was employed to measure the self-efficacy and health promoting behaviours at baseline, 1-month, and 3-month. The generalized estimating equation model was employed to examine the effects of the lifestyle intervention program. RESULTS: No difference was detected in the baseline characteristics between the two groups. Decreased cardiovascular risk was found in the lifestyle intervention group, but no significant group-by-time effect was detected. The self-efficacy for nutrition, stress dimension and sum score of health promoting behaviours revealed significant improvements at 1-month (all p < 0.05). Significant improvements were also detected in all subscales, total scale of self-efficacy, all dimensions and the sum score of health promoting behaviours at 3-month (all p < 0.05). CONCLUSIONS: The nurse-led Health Promotion Model guided lifestyle intervention program effectively improved the self-efficacy and implementation of health promoting behaviours in patients with metabolic syndrome. We recommend that nurses apply lifestyle interventions in routine care for patients with metabolic syndrome. Tweetable abstract: The RCT revealed that nurse-led lifestyle intervention was effective to improve self-efficacy and healthy behaviours among 173 MetS patients.

Factors Influencing Health Promoting Behaviours in Women of Reproductive Age in Iran: Based on Pender's Health Promotion Model.

INTRODUCTION: Health promotion behaviours are considered as preventives of non-communicable diseases and key determinants of maintaining and improving the health status. AIM: This study aimed to investigate and identify effective factors on health-promoting behaviours based on Pender model in women of reproductive age from February to April 2017, in Savojbolagh, Iran. METHODS: This cross-sectional study is conducted on 240 women aged between 15 to 49 years in Savojbolagh, Iran, in 2017. The questionnaire consisted of several items, including socio-demographic characteristics, health-promoting lifestyle profile-II (HPLP-II), self-efficacy, social support and constructs of Pender's health promotion model. SPSS-18 software has been applied for statistical analysis. RESULTS: The mean age of the women was 31.10 ± 7.29 years. Total HPLP-II score was 106.64 ± 11.93. The highest and the lowest mean in the subscales were belonged to nutrition and physical activity, respectively. According to the bivariate analysis, the total HPLP-II score is significantly related to prior health-related behaviour (p = 0.000). There was a statistically significant relationship between stress management and the variables including perceived benefits, perceived barriers, prior health-related behaviour, situational influences, commitment to a plan of action (p < 0.05). Also, health responsibility had a statistically significant relationship with self-efficacy (p < 0.05). CONCLUSION: According to our results, it can be inferred that there is a problem with the HPBs of women. Considering that health-promoting behaviours like physical activity had a low score, it is a necessity to plan and perform interventions for improving health promotion behaviours.

Socioeconomic inequality in the provision of health advice in dental setting in England, Wales and Northern Ireland.

OBJECTIVE: To assess socioeconomic inequalities in health advice provided in dental setting. METHODS: Data were from the Adult Dental Health Survey, 2009 of England, Wales and Northern Ireland. Index of Multiple Deprivation, occupational classification and education were used to assess differences in advice on diet, oral hygiene and dental visits using logistic regression. RESULTS: The analysis included 6279 participants with complete data. There were significant socioeconomic inequalities in all health advice provided in dental setting. Those with a higher level of education had significant odds ratios of 1.36 (1.06-1.75), 1.40 (1.15-1.70), and 1.82 (1.47-2.25) for having advice on diet, dental visits and oral hygiene, respectively compared to those with lower education. CONCLUSION: Inequalities in health advice in the dental setting resemble inequalities in oral health. This implies that those who are most likely to need behaviour-related advice do not receive it. Health policies should address the underpinning causes of inequalities in health advice. PRACTICE IMPLICATIONS: Growing evidence supports the importance of health advice given in dental practice. More time and greater resources should be allocated for comprehensive health advice particularly to the socially disadvantaged to reduce inequalities and subsequently promoting health-related behaviours.

Change in health behaviours following acute coronary syndrome: Arab-Jewish differences.

BACKGROUND: Health-promoting behaviours after acute coronary syndrome (ACS) are effective in preventing recurrence. Ethnicity impacts on such behaviours. We assessed the independent association of Arab vs. Jewish ethnicity with persistence of smoking and physical inactivity 6 months after ACS in central Israel. DESIGN: Prospective cohort study. METHODS: During their admission for ACS and subsequently 6 months later, 420 patients were interviewed about their smoking and exercise habits. The association of ethnicity with health-promoting behaviours was assessed by logistic regression adjusting for socio-demographic and clinical covariates. RESULTS: Smoking prevalence and physical inactivity were substantially higher among Arab patients than Jewish patients at admission (gender-adjusted prevalence rate ratio (RR) 2.25, 95% CI 1.80-2.81, p < 0.01 and RR 1.46, 95% CI 1.28-1.67, p < 0.001, respectively). The relative differences increased at 6 months (RR 2.94, 95% CI 2.13-4.07, p < 0.001 and RR 3.00, 95% CI 2.24-4.04, p < 0.001, respectively). Excess persistent smoking at 6 months among Arab vs. Jewish patients who were smokers at admission (adjusted OR 2.05, 95% CI 1.00-4.20, p = 0.049) was largely mediated through the 3.5-fold higher participation of Jewish patients in cardiac prevention and rehabilitation program (CPRP) (OR adjusted also for CPRP 1.31, 95% CI 0.59-2.93, p = 0.51). Greater persistent sedentary behaviour at 6 months among nonexercisers at admission among Arab patients (adjusted OR 3.68, 95% CI 1.93-7.02, p < 0.001) was partly mediated through attendance of CPRP (OR adjusted also for CPRP 2.38, 95% CI 1.19-4.76, p = 0.014). CONCLUSIONS: Culturally sensitive programmes need to be developed to enhance CPRP participation and favourable health-promoting changes among Arab patients. A comprehensive understanding of the determinants of the Arab-Jewish differences in efficacious health-promoting behaviours is crucial to inform appropriate ethnic-specific health-promoting strategies.

Diseases of poverty and lifestyle, well-being and human development.

The problems of the haves differ substantially from those of the have-nots. Individuals in developing societies have to fight mainly against infectious and communicable diseases, while in the developed world the battles are mainly against lifestyle diseases. Yet, at a very fundamental level, the problems are the same-the fight is against distress, disability, and premature death; against human exploitation and for human development and self-actualisation; against the callousness to critical concerns in regimes and scientific power centres.While there has been great progress in the treatment of individual diseases, human pathology continues to increase. Sicknesses are not decreasing in number, they are only changing in type.The primary diseases of poverty like TB, malaria, and HIV/AIDS-and the often co-morbid and ubiquitous malnutrition-take their toll on helpless populations in developing countries. Poverty is not just income deprivation but capability deprivation and optimism deprivation as well.While life expectancy may have increased in the haves, and infant and maternal mortality reduced, these gains have not necessarily ensured that well-being results. There are ever-multiplying numbers of individuals whose well-being is compromised due to lifestyle diseases. These diseases are the result of faulty lifestyles and the consequent crippling stress. But it serves no one's purpose to understand them as such. So, the prescription pad continues to prevail over lifestyle-change counselling or research.The struggle to achieve well-being and positive health, to ensure longevity, to combat lifestyle stress and professional burnout, and to reduce psychosomatic ailments continues unabated, with hardly an end in sight.WE THUS REALISE THAT MORBIDITY, DISABILITY, AND DEATH ASSAIL ALL THREE SOCIETIES: the ones with infectious diseases, the ones with diseases of poverty, and the ones with lifestyle diseases. If it is bacteria in their various forms that are the culprit in infectious diseases, it is poverty/deprivation in its various manifestations that is the culprit in poverty-related diseases, and it is lifestyle stress in its various avatars that is the culprit in lifestyle diseases. It is as though poverty and lifestyle stress have become the modern "bacteria" of developing and developed societies, respectively.For those societies afflicted with diseases of poverty, of course, the prime concern is to escape from the deadly grip of poverty-disease-deprivation-helplessness; but, while so doing, they must be careful not to land in the lap of lifestyle diseases. For the haves, the need is to seek well-being, positive health, and inner rootedness; to ask science not only to give them new pills for new ills, but to define and study how negative emotions hamper health and how positive ones promote it; to find out what is inner peace, what is the connection between spirituality and health, what is well-being, what is self-actualisation, what prevents disease, what leads to longevity, how simplicity impacts health, what attitudes help cope with chronic sicknesses, how sicknesses can be reversed (not just treated), etc. Studies on well-being, longevity, and simplicity need the concerted attention of researchers.THE TASK AHEAD IS CUT OUT FOR EACH ONE OF US: physician, patient, caregiver, biomedical researcher, writer/journalist, science administrator, policy maker, ethicist, man of religion, practitioner of alternate/complementary medicine, citizen of a world community, etc. Each one must do his or her bit to ensure freedom from disease and achieve well-being.Those in the developed world have the means to make life meaningful but, often, have lost the meaning of life itself; those in the developing world are fighting for survival but, often, have recipes to make life meaningful. This is especially true of a society like India, which is rapidly emerging from its underdeveloped status. It is an ancient civilization, with a philosophical outlook based on a robust mix of the temporal and the spiritual, with vibrant indigenous biomedical and related disciplines, for example, Ayurveda, Yoga, etc. It also has a burgeoning corpus of modern biomedical knowledge in active conversation with the rest of the world. It should be especially careful that, while it does not negate the fruits of economic development and scientific/biomedical advance that seem to beckon it in this century, it does not also forget the values that have added meaning and purpose to life; values that the ancients bequeathed it, drawn from their experiential knowledge down the centuries.The means that the developed have could combine with the recipes to make them meaningful that the developing have. That is the challenge ahead for mankind as it gropes its way out of poverty, disease, despair, alienation, anomie, and the ubiquitous all-devouring lifestyle stresses, and takes halting steps towards well-being and the glory of human development.