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Background: In 2018, it was found that only a quarter of Grade 3 children in India were reading at grade level. A growing demand for English education has further limited children's literacy achievement. Despite a strong evidence base in favour of using systematic phonics for building English literacy skills, many teachers in India continue to use rote‐methods of literacy instruction. Objectives: We aimed to examine the efficacy of GraphoLearn (GL) English Rime, a computer‐assisted reading intervention, in improving the foundational literacy skills of 1st and 2nd grade students who were attending an English medium school in India. Methods: A total of 136 students across 6 classrooms were randomly allocated to play either GL or a control math game over a 5‐week intervention period. Students were pre‐ and post‐tested on various English literacy skills using tasks built into the GL software as well as through oral and paper‐based tasks. Results and Conclusions: Students who played GL showed significantly greater and faster development on in‐game measures of letter‐sound knowledge, rime unit recognition, and word recognition as compared to students who did not play GL. In addition, GL resulted in greater effects on these measures for students with stronger English literacy skills prior to the start of the intervention. No differences were found between groups on the oral and paper‐based tasks. Implications: GL was able to quickly and effectively teach critical sub‐skills for reading. However, a lack of effects on the out‐of‐game measures opens the door for further discussion on the successful implementation of such interventions. Lay Description: What is already known about this topic:India has an ongoing literacy crisis with many children failing to acquire functional literacy skills.Under‐resourced schools,outdated pedagogical methods, and a demand for English‐medium education are partially to blame.Globally, technology is being increasingly looked at to help improve student learning levels across all subject areas.There are a lack of studies examining the efficacy of various ed‐tech tools to improve literacy in the context of India.What this paper adds:The study aimed to test GraphoLearn English (GL), a mobile game designed to teach and practice early reading skills through phonics with first and second graders.Results showed that children who played GL outperformed those who did not play on critical literacy skills such as letter‐sound knowledge and word recognition.In addition, GL was more effective for those who had higher pre‐existing English literacy skills.However, improvements were only seen on measures assessed in the game and not on measures assessed orally or on paper.Implications for practice and/or policy:GL and other educational technologies can be extremely effective tools which allow for an individualized learning experience.However, it is important that for any educational game, learning moves beyond the game itself.Teachers are critical players in this process and must ensure that tech‐based instruction is integrated with teacher‐led instruction.Policy makers and school administration must ensure that teachers are adequately trained on when, with whom, and how to use such technologies before they are introduced. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to develop a comprehensive model and investigate the relationship between identified factors of green marketing strategies and green consumer behavior, such as green brand positioning (GBP), green brand knowledge (GBK), attitude toward green brands (ATGB), willingness to pay (WTP) a premium, and green purchase intention (GPI). A questionnaire survey was deployed to collect data from the young consumers, from 600 students studying at nine state universities of India by employing stratified random sampling method. The results of the study suggest that a firm's green marketing strategies had an impact on green consumer behavior. The study found that GBP and GBK affect consumers green brand attitudes separately. Similarly, consumers green brand attitudes influence GPI. Meanwhile, WTP premium significantly moderates relationship between attitude toward green brand and GPI. The findings of this study suggest that marketing managers should consider a firm's GBP strategy as an important component in developing promotional messages that generate positive customer responses to the firm's green initiatives. A well‐implemented GBP strategy can lead to a more favorable GBK among consumers. As a result, it would assist in the development and promotion of green brands for businesses. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is a significant public health concern in India, with Kerala being labeled as the diabetes capital of the country. The study aims to evaluate the prevalence, treatment, and management of diabetes to examine the unmet need for care to propose cost-effective strategies. Design: A cross-sectional study was conducted on a geographically defined cohort population in Ernakulam. Sample: This paper presents diabetes data of adults ≥30 years enrolled from the community cohort. The interviews were conducted with 997 participants at their residence. Measurement: Random blood glucose was assessed for each participant using a finger prick test. Results: The overall prevalence of diabetes was 30.1%, of which 4.1% of participants had undiagnosed diabetes. Among those with diabetes, 86.3% were aware of their diagnosis; among those aware, 86.5% were on treatment. Among those on treatment for diabetes, 54% achieved controlled blood sugar. Conclusion: The challenge in diabetes management is controlling the blood glucose levels of people who adhere to treatment. Younger employed females from lower-income quartiles have the highest risk. The study also raises questions about quality and strategies for medication compliance. The findings inspire future research on care needs, policies, and program responses to reduce the diabetes disease burden. [ABSTRACT FROM AUTHOR]

This paper studies the impact of demographic factors on the performance of women‐owned micro‐enterprises in North India. Data were collected from 100 women entrepreneurs through self‐structured questionnaire using stratified random sampling technique. Sales turnover and net profit margin are taken as dependent variables. Multivariate regression analysis was applied to study the impact of various demographic factors. The results indicate registration status, legal ownership, nature of business, age, education, family income, size of business and employees positively affect the net profits and sales turnover of the enterprises. However, the numbers of products offered have a negative effect on the sales and net profits margin. The factors identified in this study, which have a positive impact on the net profits and sales turnover, are important in making entrepreneurial decisions that can enhance the performance and may help for economical production. [ABSTRACT FROM AUTHOR]

Introduction: Poor medical information transfer across healthcare visits and providers poses a potential threat to patient safety. Patient‐held health records (PHRs) may be used to facilitate informational continuity, handover communication and patient self‐management. However, there are conflicting opinions on the effectiveness of PHRs, other than in maternal and child care. Moreover, the experiences of users of PHRs in low‐ and middle‐income countries are critical in policy decisions but have rarely been researched. Aim: This study aimed to explore similarities and differences in the perspectives of patients, carers and healthcare providers (HCPs) on the current PHRs for diabetes and hypertension in Kerala. Methods: A qualitative design was used comprising semistructured interviews with patients with diabetes/hypertension (n = 20), carers (n = 15) and HCPs (n = 17) in Kerala, India. Data were analysed using thematic analysis. Results: Themes generated regarding the experiences with PHRs from each user group were compared and contrasted. The themes that arose were organized under three headings: use of PHRs in everyday practice; the perceived value of PHR and where practice and value conflict. We found that in the use of PHRs in everyday practice, multiple PHRs posed challenges for patients carrying records and for HCPs locating relevant information. Most carers carried all patients' past PHRs, while patients made decisions on which PHR to take along based on the purpose of the healthcare visit. HCPs appreciated having PHRs but documented limited details in them. The perceived value of PHRs by each group for themselves was different. While HCPs placed value on PHRs for enabling better clinical decision‐making, preventing errors and patient safety, patients perceived them as transactional tools for diabetes and hypertension medications; carers highlighted their value during emergencies. Conclusion: Our findings suggest that users find a variety of values for PHRs. However, these perceived values are different for each user group, suggesting minimal functioning of PHRs for informational continuity, handover communication and self‐management. Patient and Public Involvement: Patients and carers were involved during the pilot testing of topic guides, consent and study information sheets. Patients and carers gave their feedback on the materials to ensure clarity and appropriateness within the context. [ABSTRACT FROM AUTHOR]

Background: In July 2022, self‐collection became universally available as part of Australia's National Cervical Screening Program. This change aims to address screening inequities experienced among underscreened populations, including women of Indian descent. This study explored experiences of cervical screening, alongside the acceptability of self‐collection, among women of Indian descent living in Victoria, Australia. We also aimed to articulate the informational needs to promote self‐collection among this population. Methods: Five focus group discussions with 39 women living in Victoria were conducted in English (n = 3) and Punjabi (n = 2). Transcripts were thematically analysed, as informed by the Theoretical Framework of Acceptability. Results: Women were motivated by the choice to self‐collect, perceiving the ability to maintain modesty and greater autonomy as key enablers. Healthcare practitioners were seen as central in supporting patient‐centred models of care. Perceived barriers to self‐collection included concerns around its accuracy and women's confidence in collecting their own sample. Widespread dissemination of culturally tailored promotion strategies communicating concepts such as 'privacy' and 'accuracy' were suggested by women to promote self‐collection. Conclusion: Self‐collection was highly acceptable among women of Indian descent, particularly when assured of its accuracy, and sociocultural norms and previous screening experiences are considered. This study highlights the huge potential that self‐collection can play in increasing equity in Australia's cervical screening programme. Patient or Public Contribution: Members of the public were involved in focus group discussions. Findings were summarised and disseminated via a poster. A bicultural worker was involved in all stages of the research. [ABSTRACT FROM AUTHOR]

Objectives: The study documents the lived experience of nurses coping with the double burden of external demands and internal stressors while providing care during the COVID‐19 pandemic in India. Methods: This qualitative study interviewed 18 female nurses who worked in the COVID wards of a major hospital in India. The one‐on‐one telephonic interviews were conducted with respondents based on three broad open‐ended questions. Thematic analysis was conducted. Results: Three themes were identified: (i) external demands such as availability, utilization, and management of resources; (ii) internal psychological stressors, such as emotional exhaustion, moral anguish, and social isolation; and (iii) promotive factors such as the roles of the state and society, and of patients and attendants Conclusions: Findings suggest that despite limited resources and facilities, nurses ploughed through the pandemic with their resilience and the state's and society's promotive factors. To improve health care delivery in this crisis, the role of the state and healthcare system has become important to prevent the workforce from crumbling. The sustained attention of the state and society is required to reinstate motivation among nurses by raising the collective value of their contribution and capability. [ABSTRACT FROM AUTHOR]

Nutrition‐sensitive agriculture (NSA) interventions offer a means to improve the dietary quality of rural, undernourished populations. Their effectiveness could be further increased by understanding how household dynamics enable or inhibit the uptake of NSA behaviours. We used a convergent parallel mixed‐methods design to describe the links between household dynamics—specifically intrahousehold power inequalities and intrahousehold cooperation—and dietary quality and to explore whether household dynamics mediated or modified the effects of NSA interventions tested in a cluster‐randomized trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN). We use quantitative data from cross‐sectional surveys in 148 village clusters at UPAVAN's baseline and 32 months afterwards (endline), and qualitative data from family case studies and focus group discussions with intervention participants and facilitators. We found that households cooperated to grow and buy nutritious foods, and gendered power inequalities were associated with women's dietary quality, but cooperation and women's use of power was inhibited by several interlinked factors. UPAVAN interventions were more successful in more supportive, cooperative households, and in some cases, the interventions increased women's decision‐making power. However, women's decisions to enter into negotiations with family members depended on whether women deemed the practices promoted by UPAVAN interventions to be feasible, as well as women's confidence and previous cultivation success. We conclude that interventions may be more effective if they can elicit cooperation from the whole household. This will require a move towards more family‐centric intervention models that empower women while involving other family members and accounting for the varied ways that families cooperate and negotiate. Key messages: Household cooperation and intrahousehold power inequalities may influence children's and mothers' dietary diversity in rural OdishaThese factors partly determine the effects of nutrition‐sensitive agriculture (NSA) interventions tested in Upscaling Participatory Action and Videos for Agriculture and Nutrition, indicating that NSA interventions may be more effective if they include multiple family members.There is wide heterogeneity in household dynamics and the constraints that families face. Further research is needed to identify how interventions can respond to this heterogeneity so that NSA interventions are effective in an inclusive and empowering way. [ABSTRACT FROM AUTHOR]

Purpose: This feasibility study examined the aggression management training (AMT) interventions on self‐esteem, impulsivity, and aggressive behavior among adolescents residing in delinquent or observation homes. Methods: A quantitative research approach with the quasi‐experimental nonequivalent control group (comparison) pretest and Posttest design was adopted. A total of 32 male adolescents (16 each in experimental and comparison groups) residing in two different observation homes in the state of Bihar, India were selected by convenience sampling technique. The study evaluated the following outcome measures: self‐esteem, impulsivity, and aggressive behavior for both groups at baseline and 1 month. AMT was administered to the experimental group bi‐weekly for 4 weeks covering four components in 8 sessions. Results: We analysed the data with independent and paired t‐tests for between and within the group differences, and Pearson correlation for a relationship. AMT intervention improved self‐esteem and reduced aggressive behavior and impulsivity among adolescents residing in delinquent homes. A correlation was found between aggression and impulsivity, and between self‐esteem and impulsivity. Psychiatric nursing Implications: The study had provided initial evidence for practice that can help psychiatric nurses significantly implement these types of interventions among significant, vulnerable, and ignored groups of adolescents detained in observation homes to prevent the occurrence of repeat offenses. [ABSTRACT FROM AUTHOR]

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Background: Sleep disturbance negatively affects recovery and survival of patients in intensive care units (ICUs). Aims and Objectives: This study aimed to measure the noise levels and evaluate the impact of a white noise app on the sleep quality of critically ill patients. Design: A quasi‐experimental time series pre‐test–post‐test control group design with repeated measures was adopted. Methods: The study was conducted in the high dependency unit (HDU) of a selected tertiary care hospital in Mangalore, Karnataka State, India. Conscious oriented patients with systolic blood pressure ranging from 100/70 to 140/90 mm Hg and hearing acuity of at most 20 dB in both ears were included in the study. Noise levels in the HDU were measured using calibrated sound level meter on weekdays/weekends in three different shifts and an average of 24 readings was obtained per shift. A 4‐point Likert scale was used to assess the sleep quality. The intervention included administration of white noise app twice a day, for three consecutive days by using different masking sounds such as white noise on day 1 which resembles to a humming AC conditioner, pink noise on day 2 which resembles to the sound of ocean waves and brown noise on day 3 which resembles a steady rainfall. The app was used with the help of JBL earphones C10SI an excellent noise cancellation and noise isolating earphone. Results: Among the 54 subjects, the mean age of the patients was 40.28 years, majority 34 (63%) were males. The noise level in the ICU was more than 60 dB. There was a significant difference in the sleep quality after the application of the white noise app in the experimental group on Day 1 (Z = −3.996; P =.001), Day 2 (Z = −3.302; P =.001), and Day 3 (−2.822; P =.005) compared to the control group. Conclusion: Adoption of technology driven noise reduction applications would enhance the quality of sleep among the ICU patients. Relevance to clinical practice: The use of a technology‐driven application helps control noise levels which promotes improved sleep quality among critically ill patients in the intensive care units. [ABSTRACT FROM AUTHOR]

Background: The cultural and social norms in India stipulate that family and preferably children of the older person, provide the support and care that is needed. In recent years, we have witnessed an overall upsurge in interest in informal care from all countries in the developed world considering their ageing populations. The older people living alone group is, especially interesting in this matter, since it seems to deviate from the expectations of extended family living. Objective: The aim was to describe older persons' experiences of informal care when living alone in India. Methods: The study has a hermeneutic design, analysing interviews of older persons living alone in India. Results: Findings revealed informal care as the thematic patterns: Informal care as a fundamental human responsibility, an obligation and thereby a way to act in 'common sense'. It was a way of 'paying‐back' care that they had received from others in their life history, motivated by governmental care was not presented as an option. Informal care also created safety by the provision of alert and actionable care by loved ones, including spatial safety. Most of the informants experienced themselves as informal caregivers assisting others in need even if they themselves were old and fragile. Providing self care was also seen as a part of informal care conducted by capable and worthy persons. They also pointed out their own obligation to seek informal care and even to listen to the suggestions of younger generations regarding the type and scope of care. Conclusions/Implications for practice: Informal care in India is not only dependent on having children who ensure that you receive the care you need. Extended family, neighbours and friends feel a basic human obligation to care for the older people in their environment. This responsibility is deeply rooted even within the older people who become fragile in old age. [ABSTRACT FROM AUTHOR]

Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10–19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016–2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age‐ and sex‐specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%–46%; boys 11%–28%) and state (girls 7%–62%; boys 4%–32%). Iron deficiency (ferritin < 15 μg/L) was the strongest predictor of anaemia (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [3.21,6.83]), followed by haemoglobinopathies (HbA2 > 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol <20 ng/ml) (OR: 1.86, 95% CI: [1.23,2.80]) and zinc deficiency (serum zinc < 70 μg/L) (OR: 1.32, 95% CI: [1.02,1.72]). Regional models show heterogeneity in the strength of association between factors and anaemia by region. Adolescent anaemia control programmes in India should continue to address iron deficiency, strengthen strategies to identify haemoglobinopathies and other micronutrient deficiencies, and further explore geographic variation in associated factors. Key messages: The Comprehensive National Nutrition Survey (CNNS) 2016–2018 is the only nationally representative survey to measure haemoglobin, haemoglobinopathies, biomarkers of micronutrient deficiencies, diet and social factors in Indian adolescents aged 10–19 years.Using CNNS data, we found that 28.5% of adolescents (girls: 39.6%, boys: 17.6%) were anaemic, with variation by region or state.Our prevalence estimates translate to 72 million adolescents being anaemic, with Uttar Pradesh having twice as many anaemic adolescents as any other state.Iron deficiency, haemoglobinopathies, vitamin A deficiency and zinc deficiency were associated with an increased risk of anaemia; these associations may vary subnationally. [ABSTRACT FROM AUTHOR]

Maternal iodine (I) status is critical in embryonic and foetal development. We examined the effect of preconception iodine supplementation on maternal iodine status and on birth outcomes. Non‐pregnant women in Guatemala, India and Pakistan (n ~ 100 per arm per site) were randomized ≥ 3 months prior to conception to one of three intervention arms: a multimicronutrient‐fortified lipid‐based nutrient supplement containing 250‐μg I per day started immediately after randomization (Arm 1), the same supplement started at ~12 weeks gestation (Arm 2) and no intervention supplement (Arm 3). Urinary I (μg/L) to creatinine (mg/dl) ratios (I/Cr) were determined at 12 weeks for Arm 1 versus Arm 2 (before supplement started) and 34 weeks for all arms. Generalized linear models were used to assess the relationship of I/Cr with arm and with newborn anthropometry. At 12 weeks gestation, adjusted mean I/Cr (μg/g) for all sites combined was significantly higher for Arm 1 versus Arm 2: (203 [95% CI: 189, 217] vs. 163 [95% CI: 152, 175], p < 0.0001). Overall adjusted prevalence of I/Cr < 150 μg/g was also lower in Arm 1 versus Arm 2: 32% (95% CI: 26%, 38%) versus 43% (95% CI: 37%, 49%) (p = 0.0052). At 34 weeks, adjusted mean I/Cr for Arm 1 (235, 95% CI: 220, 252) and Arm 2 (254, 95% CI: 238, 272) did not differ significantly but were significantly higher than Arm 3 (200, 95% CI: 184, 218) (p < 0.0001). Nominally significant positive associations were observed between I/Cr at 12 weeks and birth length and head circumference z‐scores (p = 0.028 and p = 0.005, respectively). These findings support the importance of first trimester iodine status and suggest need for preconception supplementation beyond salt iodization alone. [ABSTRACT FROM AUTHOR]