Satisfaction with a digital support tool targeting alcohol consumption: perspectives from participants in a randomized control trial.

AIM: Intervention design may be improved through evaluating the feedback from those who have been exposed to such interventions. As such, here the perspectives of the intervention group from a recent randomized control trial investigating the effectiveness of a digital alcohol intervention, in terms of perceived suitability and usefulness of the support tool they engaged with, were investigated. METHODS: Respondents (N=475; 45% of the intervention group) answered five quantitative questions addressing user experience, completed the 10-item System Useability Scale, and were offered the opportunity to write free-text feedback. Quantitative measures were analysed using ordinal and linear regression with baseline characteristics as predictors, and free-text responses were evaluated using content analysis. RESULTS: Overall, respondents were positive towards the intervention in terms of it fitting their needs, the usefulness of the tools included, and the usefulness of text message content. The intervention was perceived as more helpful by respondents with lower total weekly alcohol consumption, higher self-reported confidence in their ability to reduce their drinking, and the perceived importance there of, at baseline. The free-text comments revealed the value of reminders as prompts to reflect on one's own drinking behaviour. Nonetheless, criticisms of the intervention were voiced, primarily highlighting the repetitive nature of the reminders and the lack of individuation in advice. Some also feltlike the intervention was impersonal and targeted only a specific drinking pattern. CONCLUSIONS: Experiences of the intervention group in this trial were generally positive, though there may be demand for more individualised, targeted intervention design.

"How difficult it is to change dietary behaviour" experience of older people with sarcopenic obesity: a qualitative study.

BACKGROUND: Dietary intervention is an important method to manage sarcopenic obesity, but the implementation in real world is difficult to achieve an ideal condition. This study aimed to the experiences of older people with sarcopenic obesity during the implementation of dietary behavioural change (DBC) intervention. METHODS: This study is a semi-structured individual interview embedded within a pilot randomized controlled trial on community-dwelling older people with sarcopenic obesity. Purposive sampling was applied to invite 21 participants who had received a 15-week DBC intervention. The interviews were audio-recorded and transcribed verbatim. Content analysis was performed to analyze the data. RESULTS: The themes for facilitators included: (a) Attach importance to self's health; (b) Family's support; (c) Concern self's body shape; (d) Instructor's support; (e) Regular food diary taken. The themes for barriers included: (a) Difficulties of taking food diary; (b) Difficulties of calculating the food amount; (c) Yield to offspring's appetite; (d) Misjudging self's or family's appetite. CONCLUSION: Support from family members and instructor, caring about self's health and body image facilitated the intervention implementation. The complication of food amount estimation and diary record, personal sacrifice for next generations, and previous living experience were barriers for implementing the intervention. Overall, the older people with sarcopenic obesity can accept the design of DBC intervention program and have great willing to join.

Effectiveness of behavioural change interventions to influence maternal and child healthcare-seeking behaviour in low and lower-middle-income countries: A systematic review of literature.

While behavioural change interventions are utilized in low- and lower-middle-income countries and may be essential in reducing maternal and child mortality, evidence on the effectiveness of such interventions is lacking. This review provides evidence on the effectiveness of behavioural change interventions designed to improve maternal and child healthcare-seeking behaviour in low- and lower-middle-income countries. We searched three electronic databases (PUBMED, EMBASE, and PsycINFO) for articles published in English and French between January 2013 and December 2022. Studies that evaluated interventions to increase maternal and child healthcare utilization, including antenatal care, skilled birth care, postnatal care, immunization uptake, and medication or referral compliance, were included. We identified and included 17 articles in the review. Overall, 11 studies found significant effects of the behavioural change interventions on the desired healthcare outcomes, 3 found partially significant effects, and 3 did not observe any significant impact. A major gap identified in the literature was the lack of studies reporting the effect of behavioural change interventions on women's non-cognitive and personality characteristics, as recent evidence suggests the importance of these factors in maternal and child healthcare-seeking behaviour in low-resource settings. This review highlights some intervention areas that show encouraging trends in maternal and child healthcare-seeking behaviours, including social influence, health education, and nudging through text message reminders.

Bien que les interventions visant à modifier les comportements soient utilisées dans les pays à faibles et moyens revenus et qu'elles pourraient être essentielles pour réduire la mortalité maternelle et infantile, les preuves de l'efficacité de telles interventions font défaut. Cette revue synthétise les preuves de l'efficacité des interventions de changement de comportement conçues pour améliorer le recours aux soins maternels et infantiles dans les pays à faibles et moyens revenus. Nous avons identifiés dans trois bases de données électroniques (PUBMED, EMBASE et PsycINFO) les articles publiés en anglais et en français entre janvier 2013 et décembre 2022. Les études qui évaluaient les interventions visant à accroître l'utilisation des soins de santé maternelle et infantile, y compris les soins prénatals, les soins d'accouchement par du personnel qualifié, les soins postnatals, la vaccination et l'observance des traitements médicamenteux ou de référence, ont été incluses. Nous avons identifié et inclus 17 articles dans la revue. Dans l'ensemble, 11 études mettent en évidence des effets significatifs des interventions visant à modifier les comportements en matière de soins de santé, 3 mettent en évidence des effets partiellement significatifs et 3 n'observent pas d'impact significatif. Une lacune majeure dans la littérature est le manque d'études rapportant l'effet des interventions de changement de comportement sur les caractéristiques non cognitives et de personnalité des femmes, alors que des travaux récents suggèrent l'importance de ces facteurs pour le recours aux soins de santé pour la mère et l'enfant dans les environnements à faibles ressources. Cette étude met en lumière certains domaines d'interventions qui encourageraient les comportements de recours aux soins des mères et des enfants, notamment l'influence sociale, l'éducation à la santé et l'incitation par le biais de rappels par SMS.

Self-efficacy beliefs as key ingredients to healthy and sustainable lifestyles. A five-year longitudinal study on diet and physical activity habits of newly diagnosed patients with acute coronary syndrome.

Cardiovascular diseases represent a significant cause of morbidity and mortality worldwide, and an unhealthy lifestyle notoriously accounts for a large percentage of their risk. Identifying resources to stimulate lifestyle changes is an essential goal of primary and secondary cardiovascular prevention. Self-efficacy beliefs are among the major psychological factors proven to impact health status and lifestyle. This study aimed to confirm the role of self-efficacy beliefs by investigating their associations over 5 years of adherence to healthy lifestyles in terms of diet and physical activity in a sample of 275 newly diagnosed patients with acute coronary syndrome. Longitudinal profiles of lifestyles and self-efficacy beliefs in their improvement were identified through latent class growth analysis. Correlations were then performed to explore the associations between lifestyles and self-efficacy trajectories. Results showed a positive association between virtuous lifestyle profiles and high self-efficacy in implementing behavioural change. Finally, two logistic regressions were performed to test the hypothesis that a high self-efficacy profile would predict better lifestyles 5 years after the coronary event. This hypothesis was confirmed for diet. Overall, current findings confirm the importance of implementing repeated psychological interventions that promote patients' efficacy beliefs in self-regulating their behaviour changes over time.

Nudging intensive care unit personnel towards sustainable behaviour.

BACKGROUND: The health care sector is among the most carbon-intensive sectors, contributing to societal problems like climate change. Previous research demonstrated that especially the use of personal protective equipment (e.g., aprons) in critical care contributes to this problem. To reduce personal protective equipment waste, new sustainable policies are needed. AIMS: Policies are only effective if people comply. Our aim is to examine whether compliance with sustainable policies in critical care can be increased through behavioural influencing. Specifically, we examined the effectiveness of two sets of nudges (i.e., a Prime + Visual prompt nudge and a Social norm nudge) on decreasing apron usage in an intensive care unit (ICU). STUDY DESIGN: We conducted a field experiment with a pre- and post-intervention measurement. Upon the introduction of the new sustainable policy, apron usage data were collected for 9 days before (132 observations) and 9 days after (114 observations) the nudge interventions were implemented. RESULTS: Neither the Prime + Visual prompt nudge, nor the Social norm nudge decreased apron usage. CONCLUSIONS: While previous studies have found that primes, visual nudges and social norm nudges can increase sustainable behaviour, we did not find evidence for this in our ICU field experiment. Future research is needed to determine whether this null finding reflects reality, or whether it was due to methodological decisions and limitations of the presented experiment. RELEVANCE TO CLINICAL PRACTICE: The presented study highlights the importance of studying behavioural interventions that were previously proven successful in the lab and in other field contexts, in the complex setting of critical care. Results previously found in other contexts may not generalize directly to a critical care context. The unique characteristics of the critical care context also pose methodological challenges that may have affected the outcomes of this experiment.

Rapid sleep education: If you could tell people one thing about sleep, what should it be?

Informal learning settings such as museums provide unique opportunities for educating a local community about sleep. However, in such settings, information must be capable of immediately inciting interest. We developed a series of sleep "icebreakers" (brief, informal facts) to determine whether they elicited interest in sleep and encouraged behavioural change. There were 859 participants across three cross-sectional samples: (a) members of the local museum; (b) Mechanical Turk workers who responded to a "sleep" study advertisement; and (c) Mechanical Turk workers who responded to a "various topics" study advertisement that did not mention sleep. All three samples demonstrated high interest in sleep topics, though delayed recall of the icebreakers was strongest in participants who expected to learn about the sleep topics. Icebreaker interest ratings were independent of age, gender and race/ethnicity, suggesting that sleep is a topic of universal interest. Importantly, regardless of demographics and sample, the more the icebreakers interested the participants, the more likely participants were to indicate willingness to donate to a sleep exhibit, change their sleep behaviours, and post to social media. Thus, sleep icebreakers can rapidly elicit people's interest, and future outreach efforts should couple icebreakers with opportunities for subsequent personalized learning.

Effectiveness of behavioural interventions to influence COVID-19 outcomes: A scoping review.

Behavioural non-pharmaceutical interventions (NPIs) (e.g., mask wearing, quarantine, restriction on gatherings, physical distancing) have been used to interrupt transmission of COVID-19 and to reduce the impacts of the pandemic. The aim of this scoping review was to document the efficacy of behavioural NPIs to positively influence COVID-19 outcomes. Following PRISMA guidelines, a systematic search was conducted of PubMed, ScienceDirect, Psych INFO, Medline, CINAHL and Scopus for studies published between January 2020 and February 2023. Seventy -seven studies were eligible to be included in the review. Majority of the studies were conducted in high-income countries, with fewer studies in low- or middle-income countries. School closure, mask wearing, and non-essential business closure and shelter-in-place orders were the most prevalent NPIs investigated. School closure and mask wearing reported high effectiveness while shelter-in-place orders reported less effectiveness. Shelter-in-place orders when used in conjunction with other measures, did not enhance effectiveness. Public event bans, physical distancing, handwashing, and travel restrictions were largely effective, while the effectiveness of gathering restrictions depended on the limitation on numbers. Early implementation was associated with a higher effectiveness in reducing COVID-19 cases and deaths, the use of behavioural NPIs in combinations was reported to yield more effective results. Moreover, behavioural NPIs were reported to be dependent on their consistent use and were difficult behaviours to maintain, highlighting the need for behavioural change. This review highlighted the effectiveness of behavioural NPIs to positively influence COVID-19 reduction outcomes. Further research to promote country- and context-specific documents that will enhance the effectiveness of behavioural NPIs.

Female solitary bees flexibly change foraging behaviour according to their floral resource requirements and foraging experiences.

Intraspecific variation in foraging behaviour is related to the floral resource requirements and foraging experiences of social bees. These behavioural changes influence their pollination efficiency. However, the extent of such behavioural changes in solitary bees, which constitute the majority of bee species, remains largely unknown. As pollen contains essential nutrients for ovarian and offspring development, a relationship between the resource requirements of female bees and their ovarian development is expected. Additionally, wing damage could reflect foraging experiences, as the wings are damaged during foraging. Here, we aimed to clarify the relationships between ovarian development, wing damage, foraging behaviours, and pollination efficiency in female long-horned bees (Eucera nipponensis and Eucera spurcatipes) visiting red clovers. The bee handling times were recorded. Wing damage and pollen load on the hind legs were confirmed and the number of pollen grains on bee's bodies was counted. We then dissected the bees and recorded the presence or absence of nectar and pollen in the digestive tubes, as well as the mature egg number. The mature egg number positively correlated with nectar feeding and pollen collection, whereas handling time decreased with wing damage. Bees with pollen loads on their legs attach more pollen grains to their bodies. Therefore, solitary bees flexibly change their foraging behaviour based on resource requirements and foraging experiences, and these behavioural changes can influence pollination efficiency. The asynchrony of foraging behaviours and pollination efficiency within a bee population may provide stable pollination for flowering plants throughout the season.

Behaviourally informed, patient-led interventions to reduce missed appointments in general practice: a 12-month implementation study.

BACKGROUND: Scalable, positive, behaviourally informed interventions may help people remember to attend their primary care appointment or cancel in good time, but have not yet been implemented long term. AIM: To examine effects of social norms and making active commitments on missed and cancelled appointments in primary care over 12 months and explore implementation factors. DESIGN AND SETTING: A mixed-methods design evaluation and implementation study led by a Patient Participation Group (PPG) member in a large GP practice in the West Midlands. METHODS: Following a 6-month baseline, waiting room notices were redesigned to emphasise positive social norms for desired behaviours. When booking appointments, receptionists were trained to invite patients to (i) verbally actively commit to cancelling if needed; (ii) write down their own appointment details. Monthly missed appointments (MAs) and cancellations were statistically compared with baseline averages and seasonally equivalent months. To explore implementation, reception staff completed a knowledge, attitude, and behaviour questionnaire at 9 months, analysed descriptively. Study team field notes were thematically analysed. RESULTS: Across 12 intervention months there was a mean of 37.67 fewer MAs per month (20% reduction) and 102.66 more cancellations (21.07% increase) compared with 6-month baseline means [MAs t(11) = -6.15, P < 0.001; cancellations t(11) = 3.637, P = 0.004] with statistically significant differences in seasonally equivalent months [MAs t(5) = -4.65, P = 0.006; cancellations t(5) = 3.263, P = 0.022]. Receptionists (n = 12) reported implementing the strategies except when facing pressures; knowledge and attitudes varied. CONCLUSIONS: Behaviourally informed interventions reduced primary care MAs longer term; PPGs and practice teams can work together on quality improvement projects with support from leaders to prioritise and embed new practices.

A qualitative investigation of perceptions towards antibiotics by members of the public after choosing to pledge as an Antibiotic Guardian.

INTRODUCTION: Antimicrobial resistance is one of the biggest threats facing global humanity. In 2014, Public Health England (now the UK Health Security Agency) launched the Antibiotic Guardian (AG) campaign as a national health promotion initiative to increase public and health professionals' commitment to reducing the threat of antibiotic resistance (ABR). The aim of this research study was to gain a snapshot of public AG attitudes towards antibiotic use, the AG campaign and illness postpledge. METHODOLOGY: This research used an exploratory study design using thematic and framework analysis of semistructured, in-depth interviews. A purposive convenience sampling strategy was used to recruit 10 participants; adults in the general population who had registered with and chosen an AG pledge via the AG online platform during November 2020 were eligible for inclusion. Interviews were conducted via Zoom. RESULTS: Six main themes were identified: campaign awareness, motivators to pledge (uncertainty about the future of ABR, personal gratification, personal responsibility, moral obligation and COVID-19), perceptions of personal responsibility (and patient perspectives of moral obligation in clinicians), the impact of the campaign and campaign promotion. Pledging appeared to solidify existing perceptions AGs held. Behavioural motivations for responsible antibiotic behaviours stemmed from perceptions of personal responsibility, moral obligation and concerns about ABR. AGs attributed responsibility to variable patterns in overprescribing. Perceptions towards COVID-19, coinciding with the previously established study period, appeared mixed. AGs were keen to promote responsible perceptions in relation to antibiotics, resistance and the AG campaign. However, poor social acceptability of ABR concern was raised as a barrier to campaign promotion. DISCUSSION: The AGs' longstanding commitment to antimicrobial resistance demonstrates the importance of a pre-existing interest in the public's self-reported judicious behaviours and decision to pledge to an ABR-focused campaign. Presenting the local and global threat to human mortality and morbidity in a more relatable format in public messaging should be considered in future strategies promoting ABR awareness and shifts in public perceptions. More frequent messaging to existing AGs is further recommended to propagate positive behaviour change among a wider audience. PATIENT OR PUBLIC CONTRIBUTION: This study was based on interviews with adult members of the public who had pledged to be AGs via the website www.AntibioticGuardian.com. Interviews were based on the public's perceptions of the AG campaign, antibiotic use and ABR.

Risky health behaviours and chronic conditions among aged persons: analysis of SAGE selected countries.

BACKGROUND: Increasing trends in risky health behaviours contribute to chronic health problems among the rapidly growing ageing population. Therefore, we examined the association between risky health behaviours and chronic health conditions among persons 50 years and older. METHODS: This study was a secondary analysis of longitudinal survey data from the 2007 Study on Global Ageing and Adult Health (SAGE Wave 1) conducted by the World Health Organization. Multilevel logistic regression techniques were used to examine high social cohesion among the aged. The output was reported as odds ratios (OR) and adjusted odds ratios (aOR). RESULTS: Generally, the level of chronic conditions was 81.5% for all countries. Older adults in Ghana had the highest chronic conditions (94.0%) while the Russian Federation recorded the lowest (58.6%). The risk of chronic conditions was higher among the oldest-old (OR = 1.70, 95% CI = 1.29, 2.25), those who smoke tobacco (OR = 1.13, 95% CI = 1.01, 1.25) or drink alcohol (OR = 1.17, 95% CI = 1.06,1.29), and among those who live in rural areas (OR = 1.31, 95% CI = 1.16, 1.49). However, the odds were lower among females (OR = 0.88, 95% CI = 0.69,0.85), and those who were not working (OR = 0.52, 95% CI = 0.47, 0.58). CONCLUSION: We conclude that it is important to improve the health status of older people. To achieve this, there must be interventions and policies to facilitate the adoption of healthy or physically active lifestyles among older people. This could be achieved by strengthening advocacy and health education about the dangers of living a sedentary lifestyle, consuming alcohol and tobacco. Whatever behavioural change interventions, advocacy and health education must target high-risk sub-populations including the oldest-old, and those with low economic status. Given the regional disparities identified, it is necessary to prioritise older people residing in rural areas. The study underscores a need to provide more primary healthcare facilities in the rural areas of the countries included in this study. Such an initiative is likely to increase accessibility to healthcare services and information that would impact positively on the lifestyle behaviours of older people.

Psychometric evaluation of the Protection Motivation Theory scale in assessing fall protection motivation among older adults to reduce fall risk.

BACKGROUND: Protection Motivation Theory could be another potential and good framework that addresses essential elements in a behavioural change leading to positive fall protective behaviours. The positive behavioural change could reduce the risk of falls and improve the quality of life of the older community. The study aims to evaluate the reliability and validity of the culturally adapted Protection Motivation Theory scale for older adults' fall protection motivation or protective behaviours to reduce fall risk. METHODS: A cross-sectional study was conducted to establish a psychometric instrument validation. A total of 389 participants aged 55 years and above were included. The study was conducted in Sarawak, Malaysia, from November 2021 to January 2022 in two phases, translation of the PMT Scale, cross-cultural adaptation, face validation and pre-testing of the PMT Scale. The participants were selected using multistage random sampling in a primary healthcare clinic. Data entry and statistical analysis were performed using IBM SPSS version 26 for exploratory factor analysis and SmartPLS version 3.3.7 for confirmatory factor analysis using partial least square structural equation modelling. RESULTS: The Kaiser-Meyer-Olkin value was 0.760, Bartlett's sphericity test was significant and the total variance explained was 61%. It identified 31 items within eight dimensions of the Protection Motivation Theory scale. The Higher Order Constructs' measurement model indicates that the convergent and discriminant validity were established (Cronbach's alpha and composite reliability: ≥ 0.740; average variance extracted: 0.619 to 0.935 and Henseler's Heterotrait-Monotrait criterion for all constructs' discriminant validity: < 0.9). Test-retest for the intraclass correlation coefficient was 0.745. The model's coefficient of determination demonstrated R2 = 0.375. CONCLUSION: Overall, the Protection Motivation Theory Scale has established its reliability and validity for assisting older adults in the community. The Protection Motivation Theory Scale could be used in fall prevention interventions by promoting fall protective behaviours to reduce fall risk among community-dwelling older adults. The scale could assist healthcare providers in assessing the intention of older adults to use fall protective behaviours to reduce fall risk and serve as an alternative reference in developing fall prevention education in a fall prevention strategy.

A study protocol for a cluster randomized controlled trial to test the applicability of the South African diabetes prevention program in the Eastern Cape Province of South Africa.

BACKGROUND: Convincing evidence supports the effectiveness of lifestyle interventions in preventing the occurrence of diabetes in high-income countries, however little is known about appropriate interventions for use in African countries, where there are higher relative increases in diabetes prevalence. The South African Diabetes Prevention Programme (SA-DPP) was initiated with the aim of preventing or delaying the occurrence of diabetes among South Africans (SAs), through interventions, targeting lifestyle changes related to diet and physical activity. The purpose of the current project is to implement and evaluate the suitability and applicability of the SA-DPP developed and tailored in urban populations in the Western Cape Province, in peri-urban populations in the Eastern Cape Province of SA. METHODS: The SA-DPP, which is an cluster randomized control trial, will be implemented in adults aged 30-65 years residing in the OR Tambo district, Eastern Cape, SA. Participants will be recruited using self-selected sampling techniques and 24 clusters across peri-urban communities will be randomly allocated to participate in the lifestyle intervention, facilitated by non-professional health workers (NPHW). The diabetes risk screening will follow a two-staged approach, including the community-based screening, using the African diabetes risk score (ADRS), followed by a clinic-based risk status assessment by an oral glucose tolerance test (OGTT) to exclude unknown diabetes. The lifestyle-change objectives of the current programme relate to, 1) < 30% of total energy intake from fat; 2) < 10% of total energy intake from saturated fat; 3) > 15 g of fibre/1000 kcal; 4) > 4 h/week moderate level of physical activity; and 5) > 2% body mass index (BMI) reduction. DISCUSSION: The SA-DPP could represent a successful model for the prevention of diabetes and potentially other lifestyle-related diseases in SA and other countries in the region that are confronted with similar challenges. TRIAL REGISTRATION: PACTR202205591282906.

Promoting physical activity-related health competence to increase leisure-time physical activity and health-related quality of life in German private sector office workers.

BACKGROUND: Office workers (OWs) are at risk of low levels of health-enhancing physical activity (HEPA) and impaired health-related quality of life (HRQOL). Interventions based on physical activity-related health competence (PAHCO) aim to facilitate long-term changes in HEPA and HRQOL. However, these assumptions rely on the changeability and temporal stability of PAHCO and have not been tested empirically. This study therefore aims to test the changeability and temporal stability of PAHCO in OWs within an interventional design and to examine the effect of PAHCO on leisure-time PA and HRQOL. METHODS: Three hundred twenty-eight OWs (34% female, 50.4 ± 6.4 years) completed an in-person, three-week workplace health promotion program (WHPP) focusing on PAHCO and HEPA. The primary outcome of PAHCO as well as the secondary outcomes of leisure-time PA and HRQOL were examined at four measurement points over the course of 18 months in a pre-post design by employing linear mixed model regressions. RESULTS: PAHCO displayed a substantial increase from the baseline to the time point after completion of the WHPP (ß = 0.44, p < 0.001). Furthermore, there was no decrease in PAHCO at the first (p = 0.14) and the second follow-up measurement (p = 0.56) compared with the level at the end of the WHPP. In addition, the PAHCO subscale of PA-specific self-regulation (PASR) had a small to moderate, positive effect on leisure-time PA (ß = 0.18, p < 0.001) and HRQOL (ß = 0.26, p < 0.001). The subscale of control competence for physical training (CCPT) also had a positive small to moderate effect on HRQOL (ß = 0.22, p < 0.001). CONCLUSION: The results substantiate PAHCO's theoretical characteristics of changeability and temporal stability, and underline the theoretically postulated effects on leisure-time PA and HRQOL. These findings highlight the potential of PAHCO for intervention development, which can be assumed to foster long-term improvements in HEPA and HRQOL in OWs. TRIAL REGISTRATION: The study was retrospectively registered in the German Clinical Trials Register, which is an approved Primary Register in the WHO network, at the 14/10/2022 (DRKS00030514).

Attendance, Weight Loss, and Participation in a Behavioural Diabetes Prevention Programme.

BACKGROUND: Weight loss in diabetes prevention programmes has been shown to be associated with participants' age, socio-economic status, and ethnicity. However, little is known about how these differences relate to attendance and whether such differences can be mediated by other potentially modifiable factors. Differential effectiveness across these factors may exacerbate health inequalities. METHOD: Prospective analysis of participant data collected by one provider of the standardised national NHS diabetes prevention programme in England. Mediation analysis was performed via a structural equation model to examine whether the number of attended sessions mediated the associations of age, socio-economic status, and ethnicity with follow-up weight. The group-level factor of number of attended sessions was examined using multiple linear regression as a benchmark; multilevel linear regression using three levels (venue, coach, and group); and fixed effects regression to account for venue-specific and coach-specific characteristics. RESULTS: The associations of age, socio-economic status, and ethnicity with follow-up weight were all mediated by the number of attended sessions. Group size was associated with attendance in an inverted 'U' shape, and the number of days between referral and group start was negatively associated with attendance. Time of day, day of the week, and the number of past groups led by the coach were not associated with attendance. CONCLUSION: Most of the differences in weight loss initially attributed to socio-demographic factors are mediated by the attendance of the diabetes prevention programme. Therefore, targeted efforts to improve uptake and adherence to such programmes may help alleviate inequalities.

The development of the Dutch "National model integrated care for childhood overweight and obesity".

BACKGROUND: Childhood obesity is a chronic disease with negative physical and psychosocial health consequences. To manage childhood overweight and obesity, integrated care as part of an integrated approach is needed. To realise implementation of this integrated care, practical guidance for policy and practice is needed. The aim of this study is to describe the development of a Dutch national model of integrated care for childhood overweight and obesity and accompanying materials for policy and practice. METHODS: The development of the national model was led by a university-based team in collaboration with eight selected Dutch municipalities who were responsible for the local realisation of the integrated care and with frequent input from other stakeholders. Learning communities were organised to exchange knowledge, experiences and tools between the participating municipalities. RESULTS: The developed national model describes the vision, process, partners and finance of the integrated care. It sets out a structure that provides a basis for local integrated care that should facilitate support and care for children with overweight or obesity and their families. The accompanying materials are divided into materials for policymakers to support local realisation of the integrated care and materials for healthcare professionals to support them in delivering the needed support and care. CONCLUSIONS: The developed national model and accompanying materials can contribute to improvement of support and care for children with overweight or obesity and their families, and thereby help improve the health, quality of life and societal participation of these children. Further implementation of the evidence- and practice-based integrated care while evaluating on the way is needed.

A pilot study evaluating the feasibility of assessing undergraduate pharmacy and medical students interprofessional collaboration during an online interprofessional education intervention about hospital discharge.

BACKGROUND: Interprofessional education (IPE) has been identified as a strategy towards improving competence at interprofessional working and collaboration within teams. Entrustable professional activities (EPAs) provide a framework for translating competencies into elements of clinical practice, some of which in healthcare are inherently interprofessional. However, it is challenging to reconcile that entrustment decisions about student competence in an interprofessional activity are made about an individual without considering the dynamics and tensions between interprofessional team members and the task itself. This can influence students' development and demonstration of competence at interprofessional collaboration. METHODS: In this study, undergraduate medical and pharmacy students worked in pairs online (Zoom) to undertake the hospital discharge process (a professional activity reliant on interprofessional collaboration) for a simulated patient, producing a hospital discharge letter and completing a consultation with the simulated patient. The online sessions were recorded and interprofessional behaviours were assessed using a validated scale completed by an interprofessional assessment team. Students undertook this IPE intervention three times after receiving feedback and a period of reflection each time. RESULTS: Eighteen students participated across the entire intervention and 27 one-hour online IPE sessions were completed and recorded. Students demonstrated statistically significant improvements in interprofessional behaviours across the three iterations (p < 0.05 for all the sessions). The discharge letter students produced also improved over the three sessions (p = 0.01). Students found the educational sessions useful and relevant. CONCLUSION: This online IPE intervention provided the students with an authentic opportunity to work collaboratively. At the end of each iteration, students received feedback about their work as a team and about the discharge letter, helping students to reflect and purposefully develop their performance. The IPE intervention with this assessment strategy is feasible and allows student development to be captured but has proved to be time and resource intensive.

The interplay among COVID-19 economic recovery, behavioural changes, and the European Green Deal: An energy-economic modelling perspective.

In the EU, COVID-19 and associated policy responses led to economy-wide disruptions and shifts in services demand, with considerable energy-system implications. The European Commission's response paved the way towards enhancing climate ambition through the European Green Deal. Understanding the interactions among environmental, social, and economic dimensions in climate action post-COVID thus emerged as a key challenge. This study disaggregates the implications of climate ambition, speed of economic recovery from COVID-19, and behavioural changes due to pandemic-related measures and/or environmental concerns for EU transition dynamics, over the next decade. It soft-links two large-scale energy-economy models, EU-TIMES and NEMESIS, to shed light on opportunities and challenges related to delivering on the EU's 2030 climate targets. Results indicate that half the effort required to reach the updated 55% emissions reduction target should come from electricity decarbonisation, followed by transport. Alongside a post-COVID return to normal, the European Green Deal may lead to increased carbon prices and fossil-fuel rebounds, but these risks may be mitigated by certain behavioural changes, gains from which in transport energy use would outweigh associated consumption increases in the residential sector. Finally, the EU recovery mechanism could deliver about half the required investments needed to deliver on the 2030 ambition.

Transition from physical to online shopping alternatives due to the COVID-19 pandemic - A case study of Italy and Sweden.

Using 530 responses from an online questionnaire, this study aims to investigate the transition from physical to online shopping alternatives during the first wave of the COVID-19 pandemic at the individual level. The focus areas of the study are Sweden and Italy, two European countries that implemented contrasting prevention measures. This study analyses the impacts of the pandemic on the transition to online shopping activities, and identifies who among the respondents changed their shopping behaviour the most and how; and what the different shopping strategies are and who adopted them. Multivariate statistical analyses, including linear and binary logistic regressions and multinomial logit models, were used to analyse the dataset. In the analysis, the dataset was split between Italy and Sweden to take into account the contrasting prevention measures and the different social and economic backgrounds of the two countries; the results of this study confirm and highlight these differences. Moreover, the socio-demographic and household structures of the respondents were found to influence the amount and the direction of change in shopping behaviour during the first wave of the pandemic. The study also indicates some policies that can be implemented and/or further strengthened to increase the resilience of citizens in facing pandemics and to derive benefit from the behavioural changes that took place during the first wave of the pandemic.

A systematic review of country-specific drivers and barriers to household food waste reduction and prevention.

Food waste is a global challenge that threatens the sustainable development of human societies. Although food waste is produced in all stages of the food supply chain, household food waste is the biggest contributor to the food waste fraction. In this research, we systematically reviewed 54 empirical studies to explore drivers and barriers to household food waste reduction and prevention. Key aspects, such as comprehension and perception of food waste issues, practices and lifestyles, were examined. Our findings suggest that a great understanding of the impact of one's food waste on health, environment and economy directly promotes food waste management. Additionally, the food waste issue is not attributed to a single factor, it may differ varies across countries. The majority of the reviewed literature on household food waste comes from European countries, where similar geographical, economic and cultural characteristics may lead to comparable drivers and barriers. This could be the reason for showing optimistic experience to the respective food waste management interventions. However, the applicability of these findings and interventions to regions beyond Europe are uncertain. Future studies should also be expanded to include regions such as Asia, North America, Africa, Oceania, Latin America and the Caribbean. To support the sustainable management of household food waste, mapping country-specific food waste determinants is crucial in developing easy-to-implement food waste interventions that can specifically address the food waste issue in each country.