Barriers and enablers for sufficient moderate-to-vigorous physical activity: The perspective of adolescents.

BACKGROUND: Interventions to improve physical activity (PA) among adolescents continue to be a public health priority. To promote PA more effectively, we need to identify the main factors contributing to (not) engagement in PA in the perspective of adolescents themselves. Thus, we explored the barriers and enablers for sufficient moderate-to-vigorous physical activity (MVPA) in adolescents from their point of view. METHODS: We used qualitative data collected as part of the international Health Behaviour in School-Aged Children study. We obtained data from 14-17 years old adolescents from the first year of Slovak high school. We conducted 11 online, semi-structured individual and group interviews with 24 participants in total (7 boys; mean age = 15.17, SD = 0.87) in Slovakia. We analysed the data using consensual qualitative research and thematic analysis. RESULTS: In the statements of adolescents, four main themes were identified regarding factors contributing to (not) engagement in PA among adolescents. 'Myself as a source' represents the importance of adolescents' own efforts, knowledge, physical predispositions and PA experience. 'How PA can be done' represents school as an opportunity for PA, and PA teachers and sports coaches as specialists who can create an enabling environment for sports. 'Others as a source' represents the social circle that can set a positive sports example and can encourage adolescent's efforts in PA. 'Factors outside' represents other factors that can inspire adolescents, e.g. by giving them a comfortable space and time to exercise, or can be a barrier to PA. CONCLUSION: The potential factors that include adolescents' perspectives can be more leveraged in designing supportive, inclusive, enjoyable, and skills-appropriate PA programmes.

Opportunities to strengthen resilience of health care workers regarding patient safety.

BACKGROUND: The COVID-19 pandemic endangered the quality of health care and the safety of patients and health care workers (HCWs). This provided challenges for HCWs' resilience and for hospital management and probably increased risks for patient safety incidents (PSI). HCWs may also have experienced psychological consequences as second victims of PSI, but evidence on this is lacking. Therefore, we mapped HCWs' experiences with PSI during the second wave of COVID-19, the associations of these experiences with the hospital management of patient safety culture and HCWs' interests in receiving further training. METHODS: We obtained data from 193 HCWs working at the COVID-related departments of one large hospital in eastern Slovakia via a questionnaire developed in direct collaboration with them. We measured PSI experiences as various HCWs' experiences with near miss and adverse events and the hospital management of patient safety culture using indicators such as risk of recurrence, open disclosure and second victim experiences. For analysis, we used logistic regression models adjusted for age and gender of the HCWs. RESULTS: One-third of the hospital HCWs had experienced PSI; these were more likely to expect adverse events to recur (odds ratio, OR = 2.7-3.5). Regarding the hospital management of patient safety culture, the HCWs' experiencing openly disclosed PSI was associated with one negative outcome, i.e. conflicts among colleagues (OR = 2.8), and one positive outcome, i.e. patients' acceptance of their explanation and apologies (OR = 2.3). We found no associations for any other essential domains after disclosure. PSI experiences were strongly associated with psychological indicators of second victimhood, such as sadness, irritability, anxiety and depression (OR = 2.2-4.3), while providing support was not. The majority of the HCWs would like to participate in the suggested trainings (83.4%). CONCLUSION: HCWs with PSI experiences reported poor hospital management of the patient safety culture, which might reflect they missed the opportunities to strengthen their resilience, especially during the COVID-19 pandemic.

Pandemic management impacts Slovak health care workers' quality of life during the second wave of the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic led to accepting a lot of various protective pandemic management-related measures (PanMan), which may have had a large impact on health care workers (HCWs) but evidence is scarce. We therefore explored the impact of measures during the second wave. We assessed the associations of PanMan with the Quality of Life (QoL) of hospital HCWs. METHODS: We collected data from 215 HCWs (77.7% females, mean age 44.4), who were working at the COVID-related departments of one large hospital in eastern Slovakia via a questionnaire, specifically developed in direct collaboration with them. We assessed PanMan related factors, such as COVID-19 experience, information overload, non-adherence of the public, work stress, barriers and facilitators of health care provision, and QoL related factors, such as impact on family life and activities, housekeeping, relationships with relatives and mental well-being. To analyse the data, we used logistic regression models adjusted for age and gender. RESULTS: PanMan greatly impacted the QoL of HCWs, in particular family life, housekeeping and mental well-being (odds ratio, 6.8-2.2). The most influential PanMan factors were COVID-19 experience (3.6-2.3), work stress (4.1-2.4) and barriers in health care provision (6.8-2.2). Perceiving work stress had a negative impact on all QoL domains, even on relationships with the greatest impact. Conversely, the PanMan factors reducing the negative impact on QoL were training and colleagues' support (0.4-0.1). CONCLUSION: PanMan had a strong negative impact on the QoL of hospital HCWs during the second wave of the COVID-19 pandemic.

Socioeconomic inequalities in paediatric metabolic syndrome: mediation by parental health literacy.

BACKGROUND: Parental health literacy may explain the relationship between parental socioeconomic status (SES) and paediatric metabolic syndrome (MetS). For this reason, we assessed to what extent parental health literacy mediates the relationships between parental SES and paediatric MetS. METHODS: We used data from the prospective multigenerational Dutch Lifelines Cohort Study. Our sample consisted of 6683 children with an average follow-up of 36.2 months (SD 9.3) and a mean baseline age of 12.8 years (SD 2.6). We used natural effects models to assess the natural direct, natural indirect and total effects of parental SES on MetS. RESULTS: On average, an additional 4 years of parental education, e.g. university instead of secondary school, would lead to continuous MetS (cMetS) scores that were 0.499 (95% confidence interval (CI): 0.364-0.635) units lower, which is a small effect (d: 0.18). If parental income and occupational level were 1 SD higher, on average cMetS scores were 0.136 (95% CI: 0.052-0.219) and 0.196 (95% CI: 0.108-0.284) units lower, respectively; these are both small effects (d: 0.05 and 0.07, respectively). Parental health literacy partially mediated these pathways; it accounted for 6.7% (education), 11.8% (income) and 8.3% (occupation) of the total effect of parental SES on paediatric MetS. CONCLUSIONS: Socioeconomic differences in paediatric MetS are relatively small, the largest being by parental education. Improving parental health literacy may reduce these inequalities. Further research is needed into the mediating role of parental health literacy on other socioeconomic health inequalities in children.

Trajectories of stressful life events and long-term changes in mental health outcomes, moderated by family functioning? the TRAILS study.

PURPOSE: We assessed the association between trajectories of stressful life events (SLEs) throughout adolescence and changes in mental health from childhood to young adulthood. Further, we assessed whether family functioning moderated this association. METHODS: Data of the first six waves of the TRAILS study (2001-2016; n = 2229) were used, a cohort followed from approximately age 11 to 23. We measured SLEs (death of a family member or other beloved one, delinquency, moving, victim of violence, parental divorce, and sexual harassment) at ages 14, 16 and 19. Family functioning was measured at all six time points using the Family Assessment Device (FAD), and mental health was measured through the Youth/Adult Self-Report at ages 11 and 23. Latent class growth analyses (LCGA) were used to examine longitudinal trajectories and associations. RESULTS: We identified three SLE trajectories (low, middle, high) throughout adolescence, and found no significant associations between these trajectories and changes in mental health from childhood to young adulthood. Family functioning and SLE trajectories were significantly associated, however, the association of SLE trajectories and changes in mental health was not modified by family functioning. Mental health problems at age 11 increased the likelihood of high SLE trajectories during adolescence, and of experiencing negative family functioning. CONCLUSION: Experiencing SLEs throughout adolescence does not have a direct impact on changes in mental health from childhood to young adulthood, but early adolescence mental health problems increase the likelihood of experiencing SLEs.

Are adolescents' physical activity and body-related factors associated with medically attended injuries?

Background: Injuries are the major cause of disability and death during adolescence, representing a significant public health burden among youth. Body-related factors such as body composition and cardiovascular fitness (CVF) may affect adolescents' vulnerability to injuries. As evidence is lacking, we aimed to explore the associations of medically attended injuries with adolescents' physical activity (PA) and body-related factors, and whether these associations are modified by age, gender and family affluence. Methods: We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. We used binary logistic regression analysis to assess the association of medically attended injuries with adolescents' PA and body-related factors (body composition, CVF), considering age, gender and family affluence. Results: Adolescents were more likely to report medically attended injuries if they were physically very active (odds ratio/confidence interval OR/CI:2.76/1.83-4.15) or active (OR/CI:1.91/1.27-2.87) rather than inactive. Body-related factors were not associated with medically attended injuries among adolescents. Moreover, age, gender and family affluence did not modify the association of medically attended injuries with adolescents' PA and body-related factors. The only exception was the modifying effect of gender: the association of medically attended injuries with being very active was stronger in boys (OR/CI: 3.04/1.32-6.99). Conclusion: Very physically active adolescent boys are the most vulnerable group of adolescents in terms of injuries. PA promotion programmes should further consider gender-specific strategies aimed at preventing injuries.

Promoting Mental Health Help-Seeking Behaviors by Mental Health Literacy Interventions in Secondary Education? Needs and Perspectives of Adolescents and Educational Professionals.

Mental health literacy (MHL) interventions in secondary schools may help to improve competencies that adolescents require to stay mentally healthy and seek help if mental health problems arise. These MHL interventions should be tailored to the needs of adolescents and educational professionals (EPs) to reach sustainable implementation and long-term effectiveness. However, evidence is lacking on these needs. Thus, our aim was to explore their experiences with, and perspectives on, mental health help seeking and needs regarding MHL interventions. We performed online focus group discussions and interviews with adolescents (n = 21; 13-19 years) and EPs (n = 12) and analyzed the data using directed content analysis. We identified three themes related to mental health help seeking: (1) Limited MHL competencies of adolescents, (2) Limited competencies of EP to provide mental health support, and (3) Limited mental health promotion in the school environment. We further identified three themes regarding MHL interventions: (1) Addressing basic mental health knowledge and skills, (2) Interactive and easily accessible, and (3) Sustainable implementation. Improving the MHL competencies of adolescents and EPs, and creating a mental health-literate school environment can promote adolescents' mental health help seeking. Our findings highlight the importance of developing MHL interventions that are tailored to both adolescents' and EPs needs.

Low Health Literacy Is Associated with Poorer Physical and Mental Health-Related Quality of Life in Dialysed Patients.

Health-related quality of life (HRQoL) is an important health indicator in chronic diseases like kidney diseases. Health literacy (HL) may strongly affect HRQoL, but evidence is scarce. Therefore, we assessed the associations of HL with HRQoL in dialysed patients. We performed a cross-sectional study in 20 dialysis clinics across Slovakia (n = 542 patients, mean age = 63.6 years, males = 60.7%). We assessed the association of categorised HL (low, moderate, high) with the SF36 physical component score (PCS) and mental component score (MCS) using generalised linear models adjusted for age, gender, education, and comorbidity (Charlson Comorbidity Index, CCI). We found significant associations of HL with PCS and MCS in dialysed patients, adjusted for age, gender, education, and CCI. Low-HL patients had a lower PCS (B = -3.27, 95%-confidence interval, CI: -5.76/-0.79) and MCS (B = -6.05, 95%-CI: -8.82/-3.29) than high-HL patients. Moderate-HL patients had a lower MCS (B = -4.26, 95%-CI: -6.83/-1.69) than high-HL patients. HL is associated with physical and mental HRQoL; this indicates that dialysed patients with lower HL deserve specific attention and tailored care to have their HRQoL increased.

School Satisfaction and Its Associations with Health and Behavioural Outcomes among 15-Years Old Adolescents.

Background: Health and behavioural outcomes of adolescents have been shown to be related to school pressure, demands or unfavourable relationships with classmates or teachers. These associations may relate to school satisfaction, but evidence on this is lacking. Therefore, our aim is to explore the associations of school satisfaction with hopelessness, health complaints, fighting and truancy. Methods: Data come from the cross-sectional Health Behaviour in School-aged Children study collected in 2018 from Slovak 15-year-old adolescents (N = 816; 50.9% boys). School satisfaction was measured by school engagement and attitudes towards education, grouped as: satisfied (both positive), inconsistent (one positive, one negative) and indifferent (both negative). Hopelessness, health complaints, fighting and truancy were measured using self-report questionnaires. Logistic regression models were used to explore the associations of school satisfaction with hopelessness, health complaints, fighting and truancy separately. Results: Indifferent adolescents were more likely to feel hopeless, to frequently experience two or more health complaints, to be involved in a fight and to skip school (odds ratios/95%-confidence interval: 2.57/1.49-4.45; 2.51/1.48-4.25; 1.92/1.02-3.60; and 2.34/1.25-4.40, respectively) than satisfied adolescents. Inconsistent adolescents were more likely to frequently experience two or more health complaints than satisfied adolescents (1.72/1.05-5.79). Conclusions: School satisfaction affects adolescents' health and social behaviour and may threaten their healthy development.

Does it fit better? Measures of physical activity among adolescents in relation to health indicators.

BACKGROUND: Measuring physical activity (PA) is one of the pillars of successful health promotion; however, we struggle to find a tool enabling the identification of risk groups. The current standard approach of assessing moderate-to-vigorous physical activity (MVPA) every day does this inadequately. The aim of this study is to explore whether three other indicators of adolescents' PA can identify such risk groups in a better way. METHODS: We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. Sufficient PA was indicated by the following four indicators: (i) MVPA every day, (ii) MVPA 5-7 days a week, (iii) engagement in organized sports (team or individual) and (iv) combining MVPA 5-7 days a week and engagement in organized sports. We used binary logistic regression analysis to assess the association of various indicators of adolescents' PA with body composition, cardiovascular fitness and self-rated health (SRH), considering age and gender. RESULTS: Being active based on various indicators was associated with better health outcomes, with the strongest associations for the indicator combining MVPA 5-7 days a week and engagement in organized sports. The only exceptions were the non-significant associations of active adolescents (being active 5-7 days per week or engaged in organized sports) with cardiovascular fitness and SRH. CONCLUSIONS: Measuring PA using an indicator that combines MVPA 5-7 days a week and engagement in organized sports is the most valid using three health indicators as criteria.

How Do Patients Understand Questions about Lower Urinary Tract Symptoms? A Qualitative Study of Problems in Completing Urological Questionnaires.

Lower urinary tract symptoms are common complaints in ageing people. For a urological evaluation of such complaints in men, the International Prostate Symptom Score (IPSS) is used worldwide. Previous quantitative studies have revealed serious problems in completing this questionnaire. In order to gain insight into the nature and causes of these problems, we conducted a qualitative study. Not only the purely verbal IPSS was studied but also two alternatives, including pictograms: the Visual Prostate Symptom Score (VPSS) and the Score Visuel Prostatique en Image (SVPI). Men aged 40 years and over with an inadequate level of health literacy (IHL; n = 18) or an adequate level of health literacy (AHL; n = 47) participated. Each participant filled out one of the three questionnaires while thinking aloud. The analysis of their utterances revealed problems in both health literacy groups with form-filling tasks and subtasks for all three questionnaires. Most noticeable were the problems with the IPSS; the terminology and layout of this form led to difficulties. In the VPSS and SVPI, the pictograms sometimes raised problems. As in previous research on form-filling behavior, an overestimation by form designers of form fillers' knowledge and skills seems to be an important explanation for the problems observed.

Job Leaving Intentions of Dentists Associated With COVID-19 Risk, Impact of Pandemic Management, and Personal Coping Resources.

Objectives: The COVID-19 pandemic caused risks and burdens for health professionals and might result in job leaving intentions. To assess the potential risks, we explored the association of the job leaving intentions with exposure to COVID-19 risk, impact of pandemic management on professional and personal life, and personal coping resources among Slovak dentists in the first wave of the outbreak. Methods: We obtained data from 500 dentists (66.8% females, M/SD = 43.8) registered with the Slovak Chamber of Dentists using an online questionnaire. Data were analysed using logistic regression models adjusted for age and gender. Results: Nearly 40% of dentists reported job leaving intentions after the first wave of the pandemic outbreak. Job leaving intentions were associated with exposure to COVID-19 risks (odds ratios, ORs, varying from 1.6 to 4.7), impact of pandemic management on professional and personal life (Ors from 1.6 to 2.9), and personal coping resources (Ors from 0.4 to 0.6). Conclusion: Better management of exposures to risks and impact on professional and personal life, as well as building better personal coping resources may prevent the loss of a valuable workforce in dental care.

Psychological Responses of Health Care Workers Are Strongly Associated With Pandemic Management.

Background: Globally, governments adopted protective measures to stabilize the worsening COVID-19 pandemic situation. These measures had a large impact on health care workers (HCWs) and could make the work environment more stressful for them. Therefore, we explored the associations of the psychological responses of HCWs and pandemic management among Slovak health care workers during the second wave of the pandemic. Materials and Methods: We obtained data about psychological responses, COVID-19 experiences, information overload, non-adherence of the public, work stress and barriers and facilitators of health care provision from HCWs at the COVID-19-related departments of one hospital that mainly covered eastern Slovakia (215 health care professionals, 77.7% females, M/SD = 44.4). Data were analyzed using logistic regression models adjusted for gender. Results: Pandemic management was most strongly associated with psychological responses, such as irritability, sadness, anxiety, dizziness, and back pain, in health care workers. The non-adherence of the public had the strongest associated psychological impact on HCWs, mostly affecting anxiety and irritability (odds ratios, ORs varying from 3.9 to 7.0). From the barriers and facilitators of health care provision, the use of personal protective equipment had the most impact psychologically, whereas efficient department management was most protective, with ORs around 0.3. Conclusion: Pandemic management has a large impact on health care workers, and promoting resilience may seriously decrease job-related stress and associated psychological responses of HCWs.

Supporting Adolescents with Mental Health Problems in Secondary Education: Feasibility of a Supported Education Intervention.

Mental health problems in adolescence can have a profound influence on school functioning, educational attainment and thus future societal participation. Supported education (SEd) is a potentially useful method for educational professionals to help adolescents with mental health problems in secondary school improve their functioning by stimulating collaboration, ownership, and participation. In this study, we examined the feasibility of SEd in secondary education by examining its acceptability, implementation, and preliminary effectiveness. We performed a mixed-methods study using quantitative data (questionnaires) and qualitative data (interviews) from educational professionals (EP) and adolescents, aged 13-17, about their experiences with a SEd intervention. Regarding the acceptability of the intervention, three main themes emerged: (a) structure, (b) autonomy, and (c) applicability of the intervention. Themes regarding the implementation were: (a) lack of time, (b) personal attitude, (c) mastery, and (d) complexity of the school environment. The findings show that, for those that followed the intervention, SEd is a promising approach to support adolescents with mental health problems to improve their functioning and participation in school. Further research is needed on the effectiveness of the intervention.

Family Socioeconomic Status and Adolescent School Satisfaction: Does Schoolwork Support Affect This Association?

Background: The aim of this study is to explore the association of family socioeconomic status (SES) and internal and external schoolwork support with adolescents' school satisfaction and whether schoolwork support modifies these associations. Methods: Data come from the cross-sectional Health Behavior in School-aged Children study collected in 2018 from Slovak 15-year-olds (N = 1127; 52.7% boys). SES was measured by Family Affluence Scale (low; middle; high). School satisfaction was measured via school engagement and attitudes toward education. Schoolwork support was measured regarding two groups of sources inside and outside the family, separately. Logistic regression models were used to explore the associations of SES and schoolwork support with school satisfaction as well as the moderating effect of schoolwork support. Results: Adolescents with low SES were more likely to feel indifferent toward school and education (odds ratios/95%-confidence interval: 1.77/1.26-2.49), and similarly, adolescents who did not have schoolwork support inside or outside the family (1.38/1.02-1.87, and 1.50/1.01-2.22, respectively). Schoolwork support moderated the associations of SES with school satisfaction. Adolescents with low and middle SES without support inside or outside the family were more likely to feel indifferent than satisfied (2.72/1.21-6.10; 3.00/1.27-7.06; and 2.86/1.05-7.80; 6.04/1.72-21.24, respectively). Conclusion: Adolescents from low and middle SES without schoolwork support inside or outside the family are more likely to feel indifferent toward school and education.

Body image, body composition and environment: do they affect adolescents' physical activity?

BACKGROUND: Most adolescents are less physically active than recommended, despite the strong effort of various stakeholders to promote physical activity (PA). Body image and body composition may play an important role not only in directly facilitating adolescents' PA but also in enabling environment-related factors. As evidence is lacking, we aimed to assess the associations of adolescents' PA with body-related and environment-related factors, whether this differs by age and gender, and whether these factors interact. METHODS: We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. We used multinomial logistic regression analysis to assess the association of adolescents' PA with body-related factors (body image, body composition) and environment-related factors (PA-promoting environment, less leisure constraints), taking into account age and gender. RESULTS: Adolescents who perceived their body as not too fat were more likely to be physically very active rather than inactive [odds ratios (ORs)/95% confidence interval (CI) 2.15/1.44-3.22], and similarly those who were not overweight/obese (3.24/2.09-5.01) and perceived less leisure constraints (1.74/1.44-2.11). In older adolescents and in girls, the association of adolescents' PA with body composition and environment-related factors was stronger. The association of adolescents' PA with perceiving less leisure constraints was stronger among adolescents who did not perceive their body as too fat (OR/95% CI 1.98/1.26-3.14), and for those who were not overweight/obese (OR/95% CI 1.62/1.01-2.57). CONCLUSION: Adolescents' PA is associated with both body-related and environment-related factors. These associations are stronger in girls and older adolescents, if co-occurring.

Health Literacy and Change in Health-Related Quality of Life in Dialysed Patients.

Health-related quality of life (HRQoL) is likely to deteriorate with the progression of chronic kidney disease (CKD). This change may be worsened by low health literacy (HL). We performed a longitudinal study at over 20 dialysis clinics in Slovakia (n = 413; mean age = 64.8 years; males = 58.4%). We assessed the association of three HL groups with a change in HRQoL over two years using binary logistic regression adjusted for type of vascular access, dialysis effectiveness, comorbidity, age and gender. We found that patients with low HL had poorer HRQoL at baseline in comparison to high-HL patients. We did not find significant associations of lower HL with the deterioration of mental or physical HRQoL after two years. In the adjusted model, patients with lower HL were not more likely to have deteriorated physical (low-HL patients: odds ratio/95% confidence interval: 0.99/0.53-1.84; moderate-HL patients: 0.97/0.55-1.73) or mental HRQoL (low-HL patients: 1.00/0.53-1.87; moderate-HL patients: 0.95/0.53-1.70) in comparison to high-HL patients. The HRQoL of lower-HL patients is worse at baseline but develops similarly to that of high-HL patients during dialysis treatment. Their relative HRQoL, thus, does not worsen further, but it does not improve either. Tailoring care to their needs may help to decrease the burden of low HL in dialysed patients.

A longitudinal qualitative study to explore and optimize self-management in mild to end stage chronic kidney disease patients with limited health literacy: Perspectives of patients and health care professionals.

OBJECTIVES: Limited health literacy (LHL) is associated with faster kidney deterioration. Health care professionals (HCPs) promote self-management to maintain kidney function, which is difficult for patients with LHL. Evidence lacks on perceived barriers and best strategies to optimize their self-management. Our study aims to explore experiences with and barriers for self-management from the perspectives of LHL patients and HCPs to identify strategies to optimize self-management. METHODS: We performed a longitudinal qualitative study with semi-structured in-depth interviews and focus group discussions among CKD patients and LHL (n = 24) and HCPs (n = 37) from general practices and hospitals. RESULTS: Four themes arose among patients: (1) CKD elusiveness, (2) suboptimal intake of knowledge (3) not taking a front-seat role, and (4) maintaining change. Among HCPs, three themes emerged: (1) not recognizing HL problems, (2) lacking effective strategies, and (3) health care barriers. CONCLUSION: We suggest three routes to optimize self-management: providing earlier information, applying person-centered strategies to maintain changes, and improving competencies of HCPs. PRACTICE IMPLICATIONS: HCPs need to explain CKD self-management better to prevent kidney deterioration. New interventions, based on behavioral approaches, are needed to optimize self-management. HCPs need training to improve recognition and support of LHL patients.

Multiple health risk behaviors and mental health from a life course perspective: The Dutch TRAILS study.

We examined trajectories of multiple health risk behavior (MHRB) patterns throughout adolescence, and changes in mental health from childhood to young adulthood. Further, we assessed how continuity or onset of MHRBs overall were associated with subsequent changes in mental health, and whether this varied by type of MHRBs. We used six waves of the prospective Dutch TRAILS study (2001-2016; n = 2229), covering ages 11 until 23. We measured MHRBs (substance use: alcohol misuse, cannabis use, smoking; and obesity-related: overweight, physical inactivity, irregular breakfast intake) at three time points during adolescence. We assessed mental health as Youth/Adult Self-report total problems at ages 11 and 23. Latent class growth analyses and ANOVA were used to examine longitudinal trajectories and associations. We identified six developmental trajectories for the total of MHRBs and mental health. Trajectories varied regarding likelihood of MHRBs throughout adolescence, mental health at baseline, and changes in mental health problems in young adulthood. We found no associations for the continuity of overall MHRBs throughout adolescence, and neither for early, mid- or late onset, with changes in mental health problems in young adulthood. However, continuity of MHRBs in the obesity-related subgroup was significantly associated with an increase in mental health problems. Adolescents with the same MHRB patterns may, when reaching adulthood, have different levels of mental health problems, with mental health at age 11 being an important predictor. Further, involvement with obesity-related MHRBs continuously throughout adolescence is associated with increased mental health problems in young adulthood.

Co-Creation of a Multi-Component Health Literacy Intervention Targeting Both Patients with Mild to Severe Chronic Kidney Disease and Health Care Professionals.

Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients' competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients' needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.