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Background: The purpose of this scoping review was to systematically synthesize barriers and facilitators for physical activity (PA) among children and youth with autism spectrum disorders (ASD) across the socioecological model. Methods: Five electronic databases were searched in March 2022 for studies examining barriers and facilitators for PA among children and youth with ASD. An updated search was performed in April 2024. The framework synthesis method was utilized, and the socioecological model was the chosen framework. Results: Fifty-four studies published from 2008 to 2024 were included. Among the included studies, 57% included the perspectives of children and youth with ASD alone or together with proxies (eg, parents, teachers, and coaches), while 43% included only the perspectives of proxies. Barriers and facilitators on the intrapersonal and interpersonal levels were most substantial. The analysis led to 2 main categories of barriers and facilitators, those unique to children and youth with ASD, and those similar to what had been identified through research on children and youth, both typically developing and with other disabilities. Conclusions: This comprehensive scoping review shows the complexity of factors contributing to barriers and facilitators for PA among children and youth with ASD, and highlights both the factors unique to this population and more general factors affecting PA participation. The findings from this synthesis might be used to guide the development of inclusive PA in physical education, organized sports, and other community PA arenas. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore why and how the COVID-19 pandemic influenced local sport promotion policy in the Netherlands. We used a case study approach examining the Dutch context. We studied the perspectives of Local Sport Managers (LSMs) and (coordinators of) neighbourhood sport coaches (NSCs). We applied the principles of the Multiple Streams Framework (MSF) within a socioecological model of local sport promotion policy to examine whether the COVID-19 pandemic created a 'policy window' for policy change and if so why. Online questionnaires were sent to LSMs (n = 352, response 26%) and online group interviews (n = 11) were conducted with LSMs and (coordinators of) NSCs. Our study revealed the COVID-19 pandemic indeed opened a 'policy window' and resulted in local policy changes related to the facilities and public space (hardware), organisational actors (orgware) and organised activities (software). In most cases, this did not lead to totally new policy, but more a shift in focus. National politics as a response on the COVID-19 pandemic increased the generic awareness of the importance of sport for health. This helped in legitimising the existence of sport promotion policy for a broader purpose. It is important for LSMs and NSCs to take advantage of this 'policy window' and use it to create advocacy and support for sport promotion policy over a longer period. As policy change and implementation normally take a period of multiple years, the current Dutch policy framework provides (financial) opportunities for LSMs and NSCs to follow this through. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: The rural–urban healthcare disparity in India was exacerbated during the COVID-19 pandemic, with the second wave hitting rural areas particularly hard due to weak infrastructure. A study in Chhattisgarh aims to explore the experiences of severely ill COVID-19 survivors and caregivers to inform patient-centric care delivery in primary settings. Methods: In this qualitative study, we conducted in-depth interviews with seven patients and seven caregivers during home visits or telephonically to understand lived experiences of receiving care for COVID-19 in an ICU in the public health system. Socioecological model was used to guide the qualitative inquiry. Results: COVID-19 patients faced stigma due to their diagnosis. The survivors felt lonely due to isolation, uncertainty about their illness, and fear of death. Poor mental health during ICU stay affected their physical health. Patients with caregivers felt supported despite visitor restrictions. Transparent communication with health providers reduced distress. Conclusion: The study in Chhattisgarh, India, highlights ICU survivors' and caregivers' experiences, revealing fear and loneliness among patients. Effective communication and caregiver presence improve outcomes, emphasizing holistic support. There's an urgent need for palliative care integration, caregiver inclusion, and comprehensive post-discharge follow-up by primary-level practitioners in rural settings. Lack of state-level palliative care policy emphasizes the need for comprehensive initiatives to enhance healthcare outcomes. [ABSTRACT FROM AUTHOR]

Commercial sexual exploitation of children (CSEC) has emerged as a critical child protection and public health concern in recent years. While the phenomenon is prevalent globally, its impact is compounded in sub-Saharan Africa owing to the cultural and socioeconomic challenges that leave many households in the region vulnerable. The present study synthesized existing evidence using the socioecological model as a guiding framework to assess the risk and protective factors associated with CSEC in sub-Saharan Africa. A protocol for the study was published in PROSPERO (CRD42022331832) with pre-specified inclusion and exclusion criteria. Studies were screened and extracted from eight databases: PsycINFO, Scopus, Web of Science, PROQUEST (Social Science Premium), PubMed, CINAHL, EMBASE, and MEDLINE via Ovid. After an initial screening of 4,377 papers, seven studies were found eligible for the final review. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide for reporting systematic reviews. Included studies were appraised and rated using the Cambridge Quality Checklist and GRADE. Findings revealed risk factors, including adverse childhood experience and victimization, females aged 16 years and older, school dropouts, technology influence, child and parental alcohol use, and separation from caregivers. On the other hand, protective factors such as the number of female adolescents in a household, frequent health screening in schools, children being in school, and high parental monitoring were found to be associated with a lower risk of CSEC. Based on these findings, we recommend that interventions in sub-Saharan Africa adopt a holistic approach that addresses identified risk factors while harnessing protective factors to combat CSEC effectively. [ABSTRACT FROM AUTHOR]

Background The rural–urban healthcare disparity in India was exacerbated during the COVID-19 pandemic, with the second wave hitting rural areas particularly hard due to weak infrastructure. A study in Chhattisgarh aims to explore the experiences of severely ill COVID-19 survivors and caregivers to inform patient-centric care delivery in primary settings. Methods In this qualitative study, we conducted in-depth interviews with seven patients and seven caregivers during home visits or telephonically to understand lived experiences of receiving care for COVID-19 in an ICU in the public health system. Socioecological model was used to guide the qualitative inquiry. Results COVID-19 patients faced stigma due to their diagnosis. The survivors felt lonely due to isolation, uncertainty about their illness, and fear of death. Poor mental health during ICU stay affected their physical health. Patients with caregivers felt supported despite visitor restrictions. Transparent communication with health providers reduced distress. Conclusion The study in Chhattisgarh, India, highlights ICU survivors’ and caregivers’ experiences, revealing fear and loneliness among patients. Effective communication and caregiver presence improve outcomes, emphasizing holistic support. There’s an urgent need for palliative care integration, caregiver inclusion, and comprehensive post-discharge follow-up by primary-level practitioners in rural settings. Lack of state-level palliative care policy emphasizes the need for comprehensive initiatives to enhance healthcare outcomes.

Abstract Background There is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF. Methods Women of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels. Results Hospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding. Conclusions The cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford.

Abstract Introduction Mental health professionals, teachers, families, and public administrators are concerned about suicide rates among young people, particularly in the university context. For every ten college students worldwide, three attempt suicide in their lifetime, and two experience suicidal ideation. Reducing these rates requires interventions that recognize the problem in terms of risk factors and protective factors. Objective The general aim of the study was to map the protective factors for suicide among college students, as perceived by them, mental health professionals, and coordinators of undergraduate courses in a public university in the North of Brazil. Methods The study followed an exploratory, mixed-method design. Data were collected through interviews and the application of a questionnaire with 54 participants, including college students (n = 20), mental health professionals (n = 22), and course coordinators (n = 12). Data were analyzed using Content Analysis and simple descriptive statistics. Results The findings show that the protective factors for suicide most cited among the three groups were social support, strengthening of internal resources, institutional support, and finding meaning about the change to enter the university. Although the three audiences did not converge, the protective factors also frequently reported were psychological treatment, leisure activities, religious engagement, medical treatment, civic engagement, employability, opportunities for social ascension offered by the university, and quality family relationships. Conclusion It is suggested that these protective factors are considered when formulating policies to promote mental health and suicide prevention in the university environment.

Abstract Background Mothers play a crucial role in influencing their daughters’ HPV vaccination decisions. Addressing barriers to receiving HPV vaccination among mothers of girls may achieve two goals in one strike: increasing vaccination coverage among both mothers and their daughters. This study aims to examine the HPV vaccination uptake and its determinants among mothers of girls in China at both the individual and interpersonal levels. Methods From July to October 2023, a cross-sectional online study was conducted to investigate HPV vaccine refusal for daughters aged 9–17 years among 11,678 mothers in Shenzhen, China. A randomized selection method was employed, targeting 11 primary schools and 13 secondary schools in Shenzhen. The research team invited mothers of girls to participate in an anonymous online survey. Multilevel logistic regression models (level 1: schools; level 2: individual participants) were employed to analyze the data. Results Among 11,678 mothers, 41.1% self-reported receiving at least one dose of HPV vaccination. Through multilevel logistic regression analysis, eight items measuring illness representations of HPV, which refers to how people think about HPV, were associated with higher HPV vaccination uptake (AOR: 1.02–1.14). These items included identity (identifying symptoms of HPV), timeline (whether HPV is acute/chronic), negative consequences, personal and treatment control (whether HPV is under volitional control), concern, negative emotions, and coherence (overall understanding of HPV). In addition, participants refusing HPV vaccines for the index daughters (AOR: 0.82, 95%CI: 0.76, 0.89) had lower vaccine uptake. Perceived more difficulties in accessing the 9-valent vaccines (AOR: 1.06, 95%CI: 1.04, 1.08) and more satisfaction with vaccine-related promotional materials (AOR: 1.50, 95%CI: 1.46, 1.54) at the individual level were associated with higher vaccine uptake. At the interpersonal factors, higher frequency of exposure to testimonials given by others about HPV vaccination on social media (AOR: 1.19, 95%CI: 1.14, 1.25) and thoughtful consideration of the veracity of the information (AOR: 1.11, 95%CI: 1.07, 1.16) were correlated with higher HPV vaccination uptake. Conclusions These findings offer essential implications for modifying HPV disease perceptions, addressing difficulties in accessing the 9-valent HPV vaccines, and enhancing health communication needs to improve HPV vaccine uptake among mothers of girls.

Abstract Background Advance care planning (ACP) can contribute to individuals making decisions about their healthcare preferences in advance of serious illness. Up to now, the acceptance level and associated factors of ACP among the public in China remain unclear. This study aims to investigate the acceptance level of ACP in China and identify factors associated with it based on the socioecological model. Methods A total of 19,738 participants were included in this survey. We employed a random forest regression analysis to select factors derived from the socioecological model. Multivariate generalized linear model analysis was then conducted to explore the factors that were associated with the acceptance level of ACP. Results On a scale ranging from 0 to 100, the median score for acceptance level of ACP was 64.00 (IQR: 48.00–83.00) points. The results of the multivariate generalized linear model analysis revealed that participants who scored higher on measures of openness and neuroticism personality traits, as well as those who had greater perceptions of social support, higher levels of health literacy, better neighborly relationships, family health, and family social status, were more likely to accept ACP. Conversely, participants who reported higher levels of subjective well-being and greater family communication levels demonstrated a lower likelihood of accepting ACP. Conclusions This study identified multiple factors associated with the acceptance level of ACP. The findings offer valuable insights that can inform the design and implementation of targeted interventions aimed at facilitating a good death and may have significant implications for the formulation of end-of-life care policies and practices in other countries facing similar challenges.

Background: There is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF. Methods: Women of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels. Results: Hospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding. Conclusions: The cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford. [ABSTRACT FROM AUTHOR]

Objective To explore the attitude of medical students to premarital sex and its association with social ecological risk factors, so as to provide scientific basis for sex education in schools and relevant departments. Methods From September to November 2021, an anonymous survey was conducted among 1 280 students from a medical college in Shanxi Province, including general demographic characteristics, socio-ecological risk factors, and attitudes toward premarital sexual behavior. Results There was 39.75 percent of the students who had a positive attitude toward premarital sex. After adjusting for general demographic characteristics, binary logistic regression analysis showed that in the household dimension, the approving rate about premarital sex of high-risk group (OR = 1.61, 95%CI: 1.01-2.54) was 1.61 times higher than in the low-risk group. In the time dimension, the approving rate about premarital sex of medium-risk group (OR = 1.57, 95%CI: 1.14-2.17) was 1.57 times more than the low-risk group, and compared with the low-risk group of the cultural dimension, the medium-risk group (OR = 1.96, 95%CI: 1.43-2.69) and the high-risk group (OR = 4.75, 95%CI: 3.24-6.97) were positively correlated with premarital sexual attitudes, that is, the higher the approval of premarital sex is, as the risk increased. The results of WQS model analysis showed that cultural dimension had the most influence on medical students' attitudes towards premarital sexual behavior, accounting for 45.40%, meantime, time dimension and family dimension accounted for 15.60% and 14.40%, respectively. Conclusion The positive attitude of medical students towards premarital sexual behavior is the result of the comprehensive effect of social and ecological risk factors. Besides the high-risk family factors and the medium-risk time factors, the medium and high-risk cultural factors increase the approval of premarital sexual behavior of medical students. Then, the cultural factors have the most influences on the outcome. [ABSTRACT FROM AUTHOR]

Introduction: Mental health professionals, teachers, families, and public administrators are concerned about suicide rates among young people, particularly in the university context. For every ten college students worldwide, three attempt suicide in their lifetime, and two experience suicidal ideation. Reducing these rates requires interventions that recognize the problem in terms of risk factors and protective factors. Objective: The general aim of the study was to map the protective factors for suicide among college students, as perceived by them, mental health professionals, and coordinators of undergraduate courses in a public university in the North of Brazil. Methods: The study followed an exploratory, mixed-method design. Data were collected through interviews and the application of a questionnaire with 54 participants, including college students (n = 20), mental health professionals (n = 22), and course coordinators (n = 12). Data were analyzed using Content Analysis and simple descriptive statistics. Results: The findings show that the protective factors for suicide most cited among the three groups were social support, strengthening of internal resources, institutional support, and finding meaning about the change to enter the university. Although the three audiences did not converge, the protective factors also frequently reported were psychological treatment, leisure activities, religious engagement, medical treatment, civic engagement, employability, opportunities for social ascension offered by the university, and quality family relationships. Conclusion: It is suggested that these protective factors are considered when formulating policies to promote mental health and suicide prevention in the university environment. [ABSTRACT FROM AUTHOR]

Introduction: Increased access to midwifery care is one strategy that could improve perinatal health outcomes and help address the maternal health crisis in the United States. A modifiable barrier to increasing the workforce is greater access to midwifery preceptors for clinical training. The objective of this research is to use the socioecological framework to identify midwives' perceptions of the barriers and facilitators to precepting students in clinical areas. Methods: Midwives attending a preceptor education and training workshop series responded to 3 different questions at the end of each session: (1) What makes precepting midwifery students challenging? (2) What makes precepting midwifery students possible? and (3) What makes precepting midwifery students worthwhile? Responses were coded to align with the socioecological framework, which distinguishes individual, interpersonal, community, institutional, and policy‐level influences. Results: Midwives' responses were spread across the levels of the socioecological model except for policy. Participants identified institutional influences such as support as factors that made precepting feasible, both individual and interpersonal factors such as time constraints as areas that presented challenges to precepting, and community factors, like the joy of sharing midwifery, contributing to what made precepting worthwhile. Discussion: Multiple levels of influence were identified in the preceptor process. Participants were internally motivated to precept while also articulating that to make precepting possible, there is a need for support from both colleagues and the greater systems within which they worked. Further studies are needed to investigate an ecosystem that facilitates an effective and sustainable model for midwifery precepting. Additionally, there is a need for efforts to engage and educate midwives in clinical practice about government advocacy that could actualize policy initiatives to support clinical midwifery education. [ABSTRACT FROM AUTHOR]

Background: Mothers play a crucial role in influencing their daughters' HPV vaccination decisions. Addressing barriers to receiving HPV vaccination among mothers of girls may achieve two goals in one strike: increasing vaccination coverage among both mothers and their daughters. This study aims to examine the HPV vaccination uptake and its determinants among mothers of girls in China at both the individual and interpersonal levels. Methods: From July to October 2023, a cross-sectional online study was conducted to investigate HPV vaccine refusal for daughters aged 9–17 years among 11,678 mothers in Shenzhen, China. A randomized selection method was employed, targeting 11 primary schools and 13 secondary schools in Shenzhen. The research team invited mothers of girls to participate in an anonymous online survey. Multilevel logistic regression models (level 1: schools; level 2: individual participants) were employed to analyze the data. Results: Among 11,678 mothers, 41.1% self-reported receiving at least one dose of HPV vaccination. Through multilevel logistic regression analysis, eight items measuring illness representations of HPV, which refers to how people think about HPV, were associated with higher HPV vaccination uptake (AOR: 1.02–1.14). These items included identity (identifying symptoms of HPV), timeline (whether HPV is acute/chronic), negative consequences, personal and treatment control (whether HPV is under volitional control), concern, negative emotions, and coherence (overall understanding of HPV). In addition, participants refusing HPV vaccines for the index daughters (AOR: 0.82, 95%CI: 0.76, 0.89) had lower vaccine uptake. Perceived more difficulties in accessing the 9-valent vaccines (AOR: 1.06, 95%CI: 1.04, 1.08) and more satisfaction with vaccine-related promotional materials (AOR: 1.50, 95%CI: 1.46, 1.54) at the individual level were associated with higher vaccine uptake. At the interpersonal factors, higher frequency of exposure to testimonials given by others about HPV vaccination on social media (AOR: 1.19, 95%CI: 1.14, 1.25) and thoughtful consideration of the veracity of the information (AOR: 1.11, 95%CI: 1.07, 1.16) were correlated with higher HPV vaccination uptake. Conclusions: These findings offer essential implications for modifying HPV disease perceptions, addressing difficulties in accessing the 9-valent HPV vaccines, and enhancing health communication needs to improve HPV vaccine uptake among mothers of girls. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) can contribute to individuals making decisions about their healthcare preferences in advance of serious illness. Up to now, the acceptance level and associated factors of ACP among the public in China remain unclear. This study aims to investigate the acceptance level of ACP in China and identify factors associated with it based on the socioecological model. Methods: A total of 19,738 participants were included in this survey. We employed a random forest regression analysis to select factors derived from the socioecological model. Multivariate generalized linear model analysis was then conducted to explore the factors that were associated with the acceptance level of ACP. Results: On a scale ranging from 0 to 100, the median score for acceptance level of ACP was 64.00 (IQR: 48.00–83.00) points. The results of the multivariate generalized linear model analysis revealed that participants who scored higher on measures of openness and neuroticism personality traits, as well as those who had greater perceptions of social support, higher levels of health literacy, better neighborly relationships, family health, and family social status, were more likely to accept ACP. Conversely, participants who reported higher levels of subjective well-being and greater family communication levels demonstrated a lower likelihood of accepting ACP. Conclusions: This study identified multiple factors associated with the acceptance level of ACP. The findings offer valuable insights that can inform the design and implementation of targeted interventions aimed at facilitating a good death and may have significant implications for the formulation of end-of-life care policies and practices in other countries facing similar challenges. [ABSTRACT FROM AUTHOR]

This research seeks to understand the challenges faced by settlement service providers (SSPs) in assisting humanitarian migrants to secure appropriate employment. In‐depth interviews with 26 SSPs identified that current impediments to facilitating humanitarian migrants' employment related to employment support programmes; settlement service partnerships; cultural appropriateness of services; employment readiness, experience, skills and knowledge; social support and networks; and limitations of funding and service agreements. While employment is recognised as key to effective settlement, the findings of this study show that employment services are not currently a focus of settlement services, that is, most employment services delivered by settlement services were coordinated as part of job preparedness or readiness programmes. The paper argues for government to ensure financial and human resources to enable SSPs to deliver services that can formally recognise and overcome barriers to humanitarian migrants' employment. [ABSTRACT FROM AUTHOR]

People living with HIV (PLWH) experience a disproportionate burden of mental health problems compared to people living without HIV. This systematic review aims to depict the spectrum of resilience resources that may promote the mental health of PLWH at the individual, interpersonal, organisational, community and policy levels. A systematic literature search was conducted in PsycINFO, Scopus, Medline and advanced Google Scholar. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Of the 591 studies identified, fourteen were included representing a total of 5,142 PLWH from China, Ghana, Nepal, Spain, Tanzania and the USA. Resilience resources were identified at the individual level (self-efficacy, self-esteem, acceptance, hope, optimism, religiosity/spirituality, belief in fate, mindfulness, strength and self-responsibility); interpersonal level (social support and parental monitoring); and community level (attending HIV clinic support groups and access to healthcare). All quantitative studies were cross-sectional, limiting inferences about causation or directionality. Future research should focus on resilience resources at the organisational and policy levels and incorporate longitudinal designs. [ABSTRACT FROM AUTHOR]

Background: Alcohol misuse is a significant health problem among forcibly displaced populations including male South Sudanese refugees in northern Uganda, yet interventions are sorely lacking. Developing an explanatory model of alcohol misuse in this population is the first step to designing appropriate and effective interventions. The aim of the current study was to examine alcohol misuse in this setting and to conceptualize an explanatory model of alcohol misuse. Method: A total of 57 interviews were conducted with male refugees (18+ years) with alcohol misuse (n = 17), their family members (n = 15), community and religious leaders (n = 15), and mental health and psychosocial support providers (n = 10) in Rhino Camp settlement in northern Uganda. A thematic analysis approach was used to inductively analyze the data. Results: Alcohol misuse was identified as a significant psychosocial problem among men in this setting. The adversity (e.g. trauma, loss, poverty), psychological distress (e.g. demoralization), perpetuators (e.g. ease of availability of alcohol, family conflict), and consequences of alcohol use (e.g. interpartner violence, exacerbated poverty) were identified. An explanatory model emerged from the data showing a reinforcing relationship in which adversity causes psychological distress, which leads to increased alcohol use via a number of personal, interpersonal, community and societal perpetuators, and over time increased alcohol use amplifies psychological distress which further increases alcohol misuse. Conclusions: Given the need to address alcohol misuse in this population, this explanatory model of alcohol misuse can be used to inform prevention and treatment interventions for alcohol misuse. These interventions should endeavor to address the identified determinants of alcohol misuse while being cognizant of the social and cultural considerations specific to males in this population.

Summary: Objectives: Infection prevention and control (IPC) contributes to the reduction of healthcare associated infections. Notwithstanding the global attention with available guidelines and tools, low- and middle-income countries (LMICs) still struggle to put into place effective IPC programmes. Here, we use a socioecological approach to summarize the findings of a recent workshop on the implementation of IPC activities in Cameroon. Study design: We conducted a cross-sectional study on the assessment of the IPC in Cameroon. Methods: Experts and key stakeholders involved in IPC in Cameroon evaluated the implementation of infection prevention and control during a 4-day workshop. Detailed summaries of workshop discussions and recommendations were created. Data were clustered into themes guided by the WHO core component of IPC. Results were analyzed using the socioecological model of Bronfenbrenner, McLeroy and the theory of Grol and Wensing on successful implementation of practices in healthcare settings. Results: Cameroon does not have an effective IPC programme in place but has developed some areas of the World Health Organization (WHO) IPC core components across the guideline level, the individual level, the organizational level, and the political level. Conclusion: Cameroon is still far from the norms and standards laid out by the WHO. The evidence generated from the current analysis should contribute to improve policies and strategies towards an effective IPC programme in Cameroon and other LMICs.

IntroductionHealth provider burnout is highly prevalent (28–51%) in the US and may contribute to a projected national health provider shortage by 2030. The Socioecological Model (SEM) is a proven conceptual framework used to identify influencing factors and design relevant solutions to improve health outcomes across multiple ecological levels. This study applied the SEM to identify modifiable drivers and solutions of burnout across multiple levels among US Military health providers.MethodsWe conducted a cross-sectional mixed methods study using an online survey (N = 129) and in-depth interviews (N = 25) of active duty military health providers. Our primary quantitative outcome was self-reported definite, unrelenting, or complete burnout. Our quantitative analysis included chi-square tests of association and bootstrapped multivariable logistic regressions to explore SEM-informed correlates of burnout, controlling for contextual variables. Our qualitative data explored providers individual experience with workplace stress and burnout, providing details on factors influencing burnout at the individual, interpersonal, organizational and military levels. The qualitative data was systematically coded and analyzed using grounded theory.ResultsAbout two-thirds (63%) of surveyed providers self-reported burnout. Individual-level factors significantly associated with burnout included a positive coping style (AOR = 0.21; 95% CI: 0.08–0.56), perceived control over workload (AOR = 0.17; 95% CI: 0.04–0.66), and satisfaction with the current job (AOR = 0.11; 95% CI: 0.03–0.39). At the organizational level, providers described as overworked (AOR = 10.58; 95% CI: 3.30–33.91) or in hectic or chaotic primary work areas (AOR = 7.54; 95% CI: 2.33–24.38) had higher rates of burnout. At the military level, providers who were happy with their career path and promotion plan (AOR = 0.16; 95% CI: 0.06–0.44) reported lower rates of burnout. The organizational level had the highest cumulative impact of modifiable factors on burnout (AOR: 0.15; 95% CI: 0.06, 0.36). Qualitative interviews corroborated survey findings and highlighted the individual level manifestations of burnout, the role of interpersonal support as mitigators of burnout and the complexity of governmental and military policies impacting provider wellness.DiscussionIdentified factors influencing burnout at various levels may inform potential data-driven interventions to ensure a functional and vibrant US Military health. Data-driven strategies may include opportunities to balance work demands with resources and ability to cope as well as improve positive coping skills, attitudes and experiences related to work.

Keren Dopelt,1,2 Einat Krispel,1 Nadav Davidovitch1 1School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; 2Department of Public Health, Ashkelon Academic College, Ashkelon, IsraelCorrespondence: Keren Dopelt, Department of Public Health, Ashkelon Academic College, Ben Zvi 12, Ashkelon, Israel, Tel +972-8-6789503, Email dopelt@bgu.ac.ilIntroduction: Negev Bedouin settlements suffer from poor infrastructure, and the population’s health status is low across all indicators. While it is difficult for Bedouin citizens of Israel to integrate into the Israeli employment market, integrating this population into the health system is far-reaching. The aim of this study is to analyze the barriers and motivational factors experienced by Bedouin doctors to promote public health in the Bedouin community in southern Israel and to examine the perceptions these doctors have around the concept of leadership in a public health setting.Methods: We conducted semi-structured interviews with Bedouin doctors from the Negev Bedouin community and analyzed them using thematic analysis.Results: Most interviewees saw themselves as leaders whose role was to improve public health in their community. They stressed the need for health leadership in Negev Bedouin society, and their desire to lead change in the community from within. All interviewees had grown used to a different way of life and a higher standard of living, and as a result, had difficulty returning home. Interviewees presented that trust in the health system is a critical factor for the success of health promotion programs. However, they noted the evolving trends of general mistrust in the government and its institutions that form the infrastructure for mistrust in the health system. Lack of time and workload were barriers to exercising leadership. Interviewees reported their perception of how socioeconomic status, the standard of living, and lack of infrastructure, education, and training affect health outcomes and collaboration potential.Discussion: This study presents a unique perspective on the views of doctors from the Negev Bedouin population on their involvement with grassroots leadership as a strategy to reduce health disparities in this community.Keywords: socioecological model, under-represented minorities, Negev Bedouin, health leadership, health policy, health inequalities

Children's independent mobility (CIM) is the freedom of children to move around their neighbourhood or community without adult supervision. The aim of this study was to explore experiences with CIM from the perspectives of children and their parents living in rural and remote areas of British Columbia, Canada. Semi-structured interviews were conducted with 21 parent–child dyads or triads (45 participants). Child participants aged 7–12 were invited to create and describe drawings, maps, or take images of their independent mobility. Artwork and interview transcripts were analysed following an inductive thematic approach and mapped to the social-ecological model. We developed four themes to describe rural and remote family perspectives on CIM: (1) natural places, spaces, and forces; (2) embracing informal and unstructured play destinations; (3) decision-making and knowing when they are ready; (4) neighbourhood and community environments. Children identified several environmental characteristics impacting their independent mobility including wildlife, seasonal weather patterns, and lack of destinations. Parents reported the environment of rural communities, including neighbourhood cohesiveness and people looking out for each other, as being supportive of CIM. To promote CIM in rural and remote areas, efforts should focus on providing education on wildlife encounters, creating safe and interesting destinations for play, and consider children's safety and connectivity in road design. [ABSTRACT FROM AUTHOR]

Objectives: Adolescents and young adults are the main target population for human papillomavirus (HPV). The study aimed to investigate school students' HPV vaccination intentions and explore the contributing factors from a socio‐ecological perspective. Design: A questionnaire survey was conducted in three secondary schools and three colleges in China. Sample: A total of 1756 students aged 14–22 years participated in this study. Among the 1756 participants, 182 students have received the HPV vaccine. For the remaining 1574 students, we analyzed their HPV vaccination intentions and the influencing factors. Measurements: Survey items for sociodemographics, knowledge and awareness of HPV, sexual intercourse and sexual knowledge, subjective socioeconomic status, self‐efficacy, eHealth literacy, perceived social support from family, and the availability of HPV vaccine information were measured. Results: Only 182 (10.4%) had received the HPV vaccine among the 1756 participants. Among the remaining 1574 students, the majority of the students (1403, 89.1%) were willing to receive the HPV vaccine. Binary logistic regression analysis showed that students who were female, had lower self‐efficacy, scored higher on sexual knowledge, believed vaccination preventing related diseases, worried about side effects after vaccination, thought oneself at risk of contracting HPV, had higher family support, knew the availability of the HPV vaccine in Mainland China from healthcare institutions, and with family residence in rural areas were more willing to receive the HPV vaccine. Conclusions: Students had high HPV vaccination intentions while had low vaccination rate. Intrapersonal, interpersonal and institutional or community factors predicted HPV vaccination intention. Public health nurses in communities and schools could target the modifiable factors to promote students' HPV vaccine uptake. [ABSTRACT FROM AUTHOR]

Often, perpetrators of sexual violence first aggress in their teens. Presently, very little is known about environmental factors that may influence adolescents' engagement in sexual aggression. Drawing upon data collected at 27 high schools in the Northeast United States, this study is the first to test the association between community-level factors and male adolescents' sexual aggression. A series of backward linear regressions determined that 10 of 19 community variables were associated with males' sexual aggression, which were then used to generate a ratio of positive to negative correlates of sexual aggression for each high school. In multilevel analyzes, as hypothesized, the ratio of positive to negative correlates was positively associated with schools' sexual aggression perpetration rates. We discuss the study's implications for future sexual assault research and prevention interventions. [ABSTRACT FROM AUTHOR]

Background Health and healthcare are increasingly dependent on internet and digital solutions. Medically underserved communities that experience health disparities are often those who are burdened by digital disparities. While digital equity and digital health equity are national priorities, there is limited evidence about how community-based organizations (CBOs) consider and develop interventions. Methods We conducted key informant interviews in 2022 purposively recruiting from health and welfare organizations engaged in digital equity work. Nineteen individuals from 13 organizations serving rural and/or urban communities from the local to national level participated in semi-structured interviews via Zoom regarding their perspectives on digital health equity interventions. Directed content analysis of verbatim interview transcripts was conducted to identify themes. Results Themes emerged at individual, organizational, and societal levels. Individual level themes included potential benefits from digital health equity, internet access challenges, and the need for access to devices and digital literacy. Organizational level themes included leveraging community assets, promising organizational practices and challenges. For the societal level, the shifting complexity of the digital equity ecosystem, policy issues, and data for needs assessment and evaluation were described. Several example case studies describing these themes were provided. Discussion and conclusion Digital health equity interventions are complex, multi-level endeavors. Clear elucidation of the individual, organizational, and societal level factors that may impact digital health equity interventions are necessary to understanding if and how CBOs participate in such initiatives. This study presents unique perspectives directly from CBOs driving programs in this new arena of digital health equity. [ABSTRACT FROM AUTHOR]

Background: In Western Australia, the issue of bushfires (wildfires) poses a persistent health risk to both volunteer and career forestry firefighters, populations that have been historically understudied. Aims: This descriptive qualitative study aimed to examine firefighters' level of understanding concerning hazardous exposures, their Personal Protective Equipment (PPE) protocols and their decontamination practices. Methods: Guided by the socioecological model, 23 semi-structured interviews were conducted with firefighters representing both volunteer and forestry sectors. Key results: Results indicate a gap in knowledge regarding the health risks associated with bushfire-generated smoke and contaminants among volunteer firefighters. Forestry firefighters, conversely, showed a greater awareness of these risks. Social dynamics, such as peer pressure, were identified as historical deterrents to PPE use, although recent trends indicate positive change. Forestry firefighters also highlighted systemic shortcomings, including inadequate provision of respiratory protection and lack of decontamination facilities for cleaning themselves and their PPE. Conclusion: This study underscores the critical need for educational initiatives to address these gaps in understanding, along with organisational reforms to promote a culture encouraging PPE use and to provide essential resources for effective decontamination. Implications: This research emphasises that a multi-level approach is essential for safeguarding the health of firefighters in bushfire-prone environments. Volunteer firefighters in Western Australia have a significant knowledge gap about of bushfire smoke health risks and protection. Forestry firefighters are more informed but still face issues like inadequate respiratory protection and lack of decontamination facilities. Better education and essential resources are crucial to improving safety for all firefighters. [ABSTRACT FROM AUTHOR]

BackgroundThe advent of antiretroviral therapy has led perinatally HIV-infected (PHI) adolescents to live long, fulfilling lives through lifelong treatment. However, there is limited knowledge about the lived experiences and psychosocial and mental health challenges faced by PHI adolescents in sub-Saharan Africa, where 80% of PHI adolescents reside. To address this gap, we adapted the socioecological model to investigate the challenges and lived experiences of PHI adolescents in rural coastal Kenya.MethodsBetween October and November 2018, a sample of 40 participants (20 PHI adolescents and their 20 primary caregivers) participated in a qualitative study using an H-assessment data collection approach for adolescents and focus group discussions with caregivers. Data analysis was conducted using a framework approach on NVIVO 11 software.ResultsPHI adolescents from this setting experience many challenges across various levels of the ecosystem. At the individual level, challenges include living in denial, HIV status disclosure, antiretroviral adherence, internalized stigma, and mental health issues. Within the family, challenges such as parental loss, insufficient care from parents, and unacceptance lead to threats of harm. In the broader community, key challenges such as gossip, unsupportive community members, long waiting times at the health facility, isolation, rejection, and an unresponsive school system fail to address the needs of PHI adolescents. Finally, HIV-related stigma and discrimination manifested across different levels of the socioecological framework. To cope with these challenges, PHI adolescents often rely on privacy and social support from their families.ConclusionThe findings underscore the need to develop and implement multi-level adolescent-friendly interventions to address PHI adolescent challenges and guide future investment in adolescent’s health. Furthermore, there is a need to address internalized and interpersonal stigmas through individual-level interventions that promote resilience and the active involvement of adolescents, their caregivers, peers, and teachers who are their social support system.

Abstract Background Healthy lifestyles are crucial for preventing chronic diseases. Nonetheless, approximately 90% of Chinese community residents regularly engage in at least one unhealthy lifestyle. Mobile smart devices-based health interventions (mHealth) that incorporate theoretical frameworks regarding behavioral change in interaction with the environment may provide an appealing and cost-effective approach for promoting sustainable adaptations of healthier lifestyles. We designed a randomized controlled trial (RCT) to evaluate the effectiveness of a socioecological model-guided, smart device-based, and self-management-oriented lifestyles (3SLIFE) intervention, to promote healthy lifestyles among Chinese community residents. Methods This two-arm, parallel, cluster-RCT with a 6-month intervention and 6-month follow-up period foresees to randomize a total of 20 communities/villages from 4 townships in a 1:1 ratio to either intervention or control. Within these communities, a total of at least 256 community residents will be enrolled. The experimental group will receive a multi-level intervention based on the socioecological model supplemented with a multi-dimensional empowerment approach. The control group will receive information only. The primary outcome is the reduction of modifiable unhealthy lifestyles at six months, including smoking, excess alcohol consumption, physical inactivity, unbalanced diet, and overweight/obesity. A reduction by one unhealthy behavior measured with the Healthy Lifestyle Index Score (HLIS) will be considered favorable. Secondary outcomes include reduction of specific unhealthy lifestyles at 3 months, 9 months, and 12 months, and mental health outcomes such as depression measured with PHQ-9, social outcomes such as social support measured with the modified Multidimensional Scale of Perceived Social Support, clinical outcomes such as obesity, and biomedical outcomes such as the development of gut microbiota. Data will be analyzed with mixed effects generalized linear models with family and link function determined by outcome distribution and accounting for clustering of participants in communities. Discussion This study will provide evidence concerning the effect of a mHealth intervention that incorporates a behavioral change theoretical framework on cultivating and maintaining healthy lifestyles in community residents. The study will provide insights into research on and application of similar mHealth intervention strategies to promote healthy lifestyles in community populations and settings. Trial registration number ChiCTR2300070575. Date of registration: April 17, 2023. https://www.chictr.org.cn/index.aspx .

AbstractBackgroundMethodsResultsConclusionsAbstinence has long been considered the defining feature of recovery from substance use disorder, with a focus on individual level factors associated with abstinence rather than identifying individual and socioecological factors that support recovery. This paper proposes greater consideration of dynamic behavioral ecological influences on recovery and offers an expanded contextualized approach to understanding and promoting recovery and predicting dynamic recovery pathways.Conceptual and empirical bases are summarized that support moving beyond research, treatment, and policy agendas that focus narrowly on the individual as the fundamental change agent in recovery and that emphasize changes in substance use as the primary outcome metric. A model is presented that expands the scope of recovery-relevant variables to include dynamically-varying ecological contexts that variously support or hinder recovery along with an expanded scope of functional and contextual outcome variables.Examining behavior patterns through time in changing environmental contexts that include community and neighborhood-level variables and social determinants of health is critical for understanding recovery and developing multi-level interventions to promote change. Molar behavioral and ecological perspectives are needed to understand how recovery is influenced by broader contextual features in addition to individual determinants. This paper provides concrete recommendations for the pursuit of this broadened research agenda.Individual pathology-based approaches to understanding and promoting substance use disorder recovery are too narrowly focused. This review calls for greater consideration of the dynamic behavioral ecological and temporally extended contexts that contribute to harmful substance use and systemic changes necessary to promote and sustain recovery. [ABSTRACT FROM AUTHOR]

Background: Based on findings from a recent systematic review of the methodological aspects related to data collection for the walk-along interview (WAI) method applied to healthy older adults, complementary questions emerged, among them, what are the main outcomes of studies that have used the WAI? Objective: The aim of this systematic review is to identify the outcomes of published studies that have used the WAI method to identify correlates of the perceived neighborhood environment on walking activity in healthy older adults. Methods: In accordance with the PRISMA guidelines, a date-unrestricted search spanning four databases was performed. Of the 164 articles identified in the initial search, 31 articles published between 2012 and 2022 met the inclusion criteria. Results: The extracted outcomes were classified into two categories: (1) the relationship between the physical characteristics of the environment and walking among healthy older adults (e.g., pedestrian infrastructure, safety, access to facilities, aesthetics and environmental conditions) and (2) the facilitators and barriers to walking, based on the dimensions of the socioecological model. Conclusions: This review provides a valuable resource for researchers, students and professionals who wish to work with the WAI method, working on aging and age-friendly cities policies. [ABSTRACT FROM AUTHOR]

Background and Objectives Food insecurity is considered an increasing public health problem worldwide with adverse effects, especially among older adults. Although the literature related to food insecurity among older adults in low- and middle-income countries (LMIC) are expanding, little is known about existing patterns and knowledge gaps in these settings. This scoping review aims to provide a comprehensive overview of the current research related to food insecurity among older adults in LMIC. Research Design and Methods A systematic search was conducted in November 2021 and revised in July 2022 on six databases using terms related to food insecurity and older adults. Data were extracted, and the emerging themes from the main findings were summarized using a social-ecological model (SEM). Results Forty-one studies met the inclusion criteria. Almost half (48.8%) were published in the last 2 years and utilized a quantitative approach (n  = 38). Only one study was conducted in a low-income country. Using the SEM, most studies included in this review focused on addressing the relationship between food insecurity with intrapersonal factors. Discussion and Implications Several gaps in the current literature were identified. There is a lack of longitudinal and qualitative studies available on this topic. Also, only 15 LMIC were represented in the literature. A critical point in this review is that only a few studies addressed the relationship between food insecurity and the policy/social structure, institutional, community, and interpersonal levels. These identified gaps can serve as a guide for future research on this topic. [ABSTRACT FROM AUTHOR]

Research on older people’s artistic participation has mainly focused on its benefits. Fewer studies have addressed the antecedents of older people’s artistic participation, especially the barriers to artistic practices, and particularly those related with contextual factors. In this study, we examined from a socioecological perspective which contextual barriers older artists perceive when they are carrying out their artistic practices. We conducted semi-structured individual interviews with 30 older visual artists and craftspeople. We found six themes relating to contextual barriers to the artistic practice: changes in cultural context; value of arts and crafts; dissemination of artistic work; financial difficulties; discrimination against women; and the covid-19 pandemic. Our study expands on previous research on antecedents of artistic participation among older people, and specifically on barriers. Finally, our study suggests the need to decrease these barriers by implementing programmes aimed at older artists maintaining their artistic practices for as long as possible.

Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care. A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19). A purposive sampling strategy was used, recruiting women via social media platforms from rural communities across the state. The Socioecological Model (SEM) was used as a framework to organise the findings. Study participants reported multilevel barriers and enablers to accessing perinatal care in their own communities. Intrapersonal factors included financial resources, transportation, self-advocacy, health literacy, rural stoicism, personal agency, and cost of care. Interpersonal factors included factors such as ineffective relationships, poor communication, and care provider accessibility. Organisational factors included inequitable distribution of services, under-resourcing of perinatal services in rural areas, technology-enabled care models and access to continuity of care. Community factors included effective or ineffective interprofessional or interorganisational collaboration. Policy factors included centralisation of perinatal care, lack of funded homebirth and midwifery care pathways and access to free perinatal care. Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collaboration and communication between clinicians and services, technology enabled care and free perinatal care. [ABSTRACT FROM AUTHOR]

Introduction: Health provider burnout is highly prevalent (28-51%) in the US and may contribute to a projected national health provider shortage by 2030. The Socioecological Model (SEM) is a proven conceptual framework used to identify influencing factors and design relevant solutions to improve health outcomes across multiple ecological levels. This study applied the SEM to identify modifiable drivers and solutions of burnout across multiple levels among US Military health providers., Methods: We conducted a cross-sectional mixed methods study using an online survey ( N  = 129) and in-depth interviews ( N  = 25) of active duty military health providers. Our primary quantitative outcome was self-reported definite, unrelenting, or complete burnout. Our quantitative analysis included chi-square tests of association and bootstrapped multivariable logistic regressions to explore SEM-informed correlates of burnout, controlling for contextual variables. Our qualitative data explored providers individual experience with workplace stress and burnout, providing details on factors influencing burnout at the individual, interpersonal, organizational and military levels. The qualitative data was systematically coded and analyzed using grounded theory., Results: About two-thirds (63%) of surveyed providers self-reported burnout. Individual-level factors significantly associated with burnout included a positive coping style (AOR = 0.21; 95% CI: 0.08-0.56), perceived control over workload (AOR = 0.17; 95% CI: 0.04-0.66), and satisfaction with the current job (AOR = 0.11; 95% CI: 0.03-0.39). At the organizational level, providers described as overworked (AOR = 10.58; 95% CI: 3.30-33.91) or in hectic or chaotic primary work areas (AOR = 7.54; 95% CI: 2.33-24.38) had higher rates of burnout. At the military level, providers who were happy with their career path and promotion plan (AOR = 0.16; 95% CI: 0.06-0.44) reported lower rates of burnout. The organizational level had the highest cumulative impact of modifiable factors on burnout (AOR: 0.15; 95% CI: 0.06, 0.36). Qualitative interviews corroborated survey findings and highlighted the individual level manifestations of burnout, the role of interpersonal support as mitigators of burnout and the complexity of governmental and military policies impacting provider wellness., Discussion: Identified factors influencing burnout at various levels may inform potential data-driven interventions to ensure a functional and vibrant US Military health. Data-driven strategies may include opportunities to balance work demands with resources and ability to cope as well as improve positive coping skills, attitudes and experiences related to work., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Olapeju, Dong, Soh, Mushtaq, Chang, Riegleman, Hemmer, Schwab, Shanahan, Johnson-Boua and Durning.)

Objectives: Infection prevention and control (IPC) contributes to the reduction of healthcare associated infections. Notwithstanding the global attention with available guidelines and tools, low- and middle-income countries (LMICs) still struggle to put into place effective IPC programmes. Here, we use a socioecological approach to summarize the findings of a recent workshop on the implementation of IPC activities in Cameroon., Study Design: We conducted a cross-sectional study on the assessment of the IPC in Cameroon., Methods: Experts and key stakeholders involved in IPC in Cameroon evaluated the implementation of infection prevention and control during a 4-day workshop. Detailed summaries of workshop discussions and recommendations were created. Data were clustered into themes guided by the WHO core component of IPC. Results were analyzed using the socioecological model of Bronfenbrenner, McLeroy and the theory of Grol and Wensing on successful implementation of practices in healthcare settings., Results: Cameroon does not have an effective IPC programme in place but has developed some areas of the World Health Organization (WHO) IPC core components across the guideline level, the individual level, the organizational level, and the political level., Conclusion: Cameroon is still far from the norms and standards laid out by the WHO. The evidence generated from the current analysis should contribute to improve policies and strategies towards an effective IPC programme in Cameroon and other LMICs., Competing Interests: None declared., (© 2024 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.)

Puerto Rico is a territory of the United States, making Puerto Ricans vulnerable to damaging colonial policy. The purpose of this article is to utilize the socioecological model (SEM) to evaluate how the Jones Act impacted Puerto Rico after Hurricane María, examining colonialist policy as a social determinant of health (SDOH) in Puerto Rico.Levels of the SEM used in this examination included: individual, institutional, community, policy, and context.Evaluation of the Jones Act using the model demonstrated relationships between all socioecological levels. The Jones Act caused delays and increased prices for goods needed to rebuild community utility infrastructure, which led to extended closures of institutions like workplaces, schools, and hospitals, and ultimately contributed to increased acute and chronic physical and mental illness among Puerto Ricans.This evaluation establishes that colonialist policy negatively impacts the health of Puerto Ricans, positioning colonialism as an SDOH. [ABSTRACT FROM AUTHOR]

Background: The advent of antiretroviral therapy has led perinatally HIV-infected (PHI) adolescents to live long, fulfilling lives through lifelong treatment. However, there is limited knowledge about the lived experiences and psychosocial and mental health challenges faced by PHI adolescents in sub-Saharan Africa, where 80% of PHI adolescents reside. To address this gap, we adapted the socioecological model to investigate the challenges and lived experiences of PHI adolescents in rural coastal Kenya., Methods: Between October and November 2018, a sample of 40 participants (20 PHI adolescents and their 20 primary caregivers) participated in a qualitative study using an H-assessment data collection approach for adolescents and focus group discussions with caregivers. Data analysis was conducted using a framework approach on NVIVO 11 software., Results: PHI adolescents from this setting experience many challenges across various levels of the ecosystem. At the individual level, challenges include living in denial, HIV status disclosure, antiretroviral adherence, internalized stigma, and mental health issues. Within the family, challenges such as parental loss, insufficient care from parents, and unacceptance lead to threats of harm. In the broader community, key challenges such as gossip, unsupportive community members, long waiting times at the health facility, isolation, rejection, and an unresponsive school system fail to address the needs of PHI adolescents. Finally, HIV-related stigma and discrimination manifested across different levels of the socioecological framework. To cope with these challenges, PHI adolescents often rely on privacy and social support from their families., Conclusion: The findings underscore the need to develop and implement multi-level adolescent-friendly interventions to address PHI adolescent challenges and guide future investment in adolescent's health. Furthermore, there is a need to address internalized and interpersonal stigmas through individual-level interventions that promote resilience and the active involvement of adolescents, their caregivers, peers, and teachers who are their social support system., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wanjala, Nyongesa, Luchters and Abubakar.)

The socio-ecological model (SEM) is a widely used framework that can be applied to heat-related illness (HRI) in the context of multiple influencing factors that exist in society. Leaders and policymakers must intervene to mitigate the deleterious effects of climate change on those at risk. The purpose is to introduce the SEM as a framework to address the complex factors contributing to the impact of excess heat. Conceived through the SEM, the compounding and cumulative impact of excess heat resulting in HRI is operationalized. The SEM provides a structure for understanding the complex nature of climate change and HRI and proposed interventions. The prevention of HRI is dependent on actions, related to practice, education, research, and advocacy across multiple levels of the SEM. The SEM has the potential to target HRI at all levels of society to reduce the harm of excess heat. • The socio-ecological model can be applied to climate change and heat-related illnesses. • The socio-ecological model highlights the cumulative impacts of excess heat. • Heat-related illnesses can be mitigated by intervening at various levels in society. • Clinicians can decrease the harm of excess heat by intervening at all levels. • Addressing impacts at the policy level requires compliance from organizations. [ABSTRACT FROM AUTHOR]

Background: Sedentary behavior (SB) is detrimental to cardiometabolic disease (CMD) risk, which can begin in young adulthood. To devise effective SB-CMD interventions in young adults, it is important to understand which context-specific sedentary behaviors (CS-SB) are most detrimental for CMD risk, the lifestyle behaviors that co-exist with CS-SBs, and the socioecological predictors of CS-SB., Methods: This longitudinal observational study will recruit 500 college-aged (18-24 years) individuals. Two laboratory visits will occur, spaced 12 months apart, where a composite CMD risk score (e.g., arterial stiffness, metabolic and inflammatory biomarkers, heart rate variability, and body composition) will be calculated, and questionnaires to measure lifestyle behaviors and different levels of the socioecological model will be administered. After each visit, total SB (activPAL) and CS-SB (television, transportation, academic/ occupational, leisure computer, "other"; ecological momentary assessment) will be measured across seven days., Discussion: It is hypothesized that certain CS-SB will show stronger associations with CMD risk, compared to T-SB, even after accounting for coexisting lifestyle behaviors. It is expected that a range of intra-individual, inter-individual, and physical environment socioecological factors will predict CS-SB. The findings from this study will support the development of an evidence-based, multi-level intervention to target SB reduction and mitigate CMD risk in CBYA., Competing Interests: Competing Interests The authors have no potential, perceived, or real conflict of interest to disclose.

Background: While the scientific community widely recognizes the benefits of physical activity (PA) in oncology supportive care, cancer survivors who have undergone chemo- or radio-immunotherapy treatments struggle to meet PA recommendations. This underscores the importance of identifying factors influencing active lifestyle adoption and maintenance and proposing a multilevel model (micro-, meso-, and macrolevel) to better understand facilitators and barriers. Currently, no socioecological model explains an active lifestyle in the posttreatment phase of breast, colorectal, prostate, and lung cancers., Objective: The objective is to identify factors influencing an active lifestyle in cancer survivorship and assess the feasibility of an individualized program targeting an active lifestyle. The objectives will be addressed in 3 stages. Stage 1 aims to elucidate factors associated with the active lifestyle of cancer survivors. Stage 2 involves developing an explanatory model based on previously identified factors to create a tailored health education program for an active lifestyle after oncology treatments. Stage 3 aims to evaluate the feasibility and potential effects of this personalized health education program after its national implementation., Methods: First, the exploration of factors influencing PA (stage 1) will be based on a mixed methods approach, using an explanatory sequential design and multilevel analysis. The quantitative phase involves completing a questionnaire from a socioecological perspective. Subsequently, a subset of respondents will engage in semistructured interviews to aid in interpreting the quantitative results. This phase aims to construct a model of the factors influencing an active lifestyle and develop an individualized 12-week program based on our earlier findings (stage 2). In stage 3, we will implement our multicenter, multimodal program for 150 physically inactive and sedentary cancer survivors across metropolitan France. Program feasibility will be evaluated. Measured PA level by connected device and multidimensional variables such as declared PA and sedentary behaviors, PA readiness, motivation, PA preferences, PA knowledge and skills, and barriers and facilitators will be assessed before and during the program and 52 weeks afterward., Results: The institutional review board approved the mixed methods study (phase 1) in April 2020, and the intervention (phase 3) was approved in March 2022. Recruitment and data collection commenced in April 2022, with intervention implementation concluded in May 2023. Data collection and full analysis are expected to be finalized by July 2024., Conclusions: The Determinants and Factors of Physical Activity After Oncology Treatments (DEFACTO) study seeks to enhance our understanding, within our socioecological model, of factors influencing an active lifestyle among cancer survivors and to assess whether a tailored intervention based on this model can support an active lifestyle., Trial Registration: ClinicalTrials.gov NCT05354882; https://www.clinicaltrials.gov/study/NCT05354882., International Registered Report Identifier (irrid): DERR1-10.2196/52274., (©Albane Aumaitre, Rémi Gagnayre, Aude-Marie Foucaut. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 16.05.2024.)

Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations., (Published by Elsevier Inc.)

The interplay of influences shaping dietary behaviors of adolescents needs to be well-understood to develop effective strategies stimulating healthy and sustainable behaviors. This study aimed to identify the most relevant, urgent, changeable and effective motivators and barriers of healthy and sustainable dietary behaviors among adolescents (10-19 years), as perceived by an inter- and transdisciplinary expert panel. Experts working in practice (N = 19) and academia (N = 13) - in the field of sustainability, health, nutrition and/or education - participated in this exploratory mixed-methods study. Five online semi-structured focus groups were conducted (6-7 participants). Data was thematically analyzed by two coders independently, using the socioecological framework. Subsequently, the same experts individually selected the five most relevant determinants and rated those on their urgency, changeability and effectiveness through an online questionnaire (N = 21). Participants revealed a wide system of 31 main determinants including 173 sub-determinants that motivate or hinder healthy and sustainable eating among adolescents. This system of determinants was mapped on the different layers of the socioecological model: individual factors (25 motivators; 30 barriers), social environments (15 motivators; 13 barriers), physical environments (18 motivators; 15 barriers), macro-level environments (19 motivators; 38 barriers). 'Role of peers' (social environment) was selected most as a determinant to be targeted in interventions (N = 13; urgency (M = 6.38) changeability (M = 3.85), effectiveness (M = 5.62)), followed by 'food environment around school' (N = 9; urgency (M = 5.78) changeability (M = 3.44), effectiveness (M = 5.44)), 'social influences' (N = 7; urgency (M = 5.43) changeability (M = 4.00), effectiveness (M = 5.71)), 'autonomy in development' (N = 7; urgency (M = 6.00) changeability (M = 4.29), effectiveness (M = 5.86)) and 'food availability' (N = 7; urgency (M = 6.29) changeability (M = 3.29), effectiveness (M = 6.29)). The prioritized determinants indicate that adolescents should be provided more supportive social and physical environments that promote healthy and sustainable dietary behaviors, taking into account their growing autonomy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Mandatory and restrictive health regulations during the corona pandemic caused psychic disorders in many people, which even led to clinically relevant mental disorders. At the same time, there was gradually a polarization of opinions among the population. In order to improve future pandemic management, an integrative understanding of these psychosocial processes therefore seems useful. Here we start theoretically with the mental effects of inconsistencies of the information environment by referring to concepts such as the theory of cognitive dissonance. In a next step, we use the psychodynamic theory to understand the affective-motivational defense mechanisms underlying these cognitive states and processes. However, a broader theoretical framework of psychoanalysis seems to make sense, because self-referential processing also influences the style of thinking. For this reason, we use a more comprehensive psychological systems theoretical framework model to integrate these different perspectives. This integrative view refers in part to basic knowledge of health psychology regarding the resistance of unhealthy ways of thinking and behaviors and the possibilities for interventions for change. We then extend this model to a broader picture that also covers the relationship between men and their environment. This results in the perspective of a multidimensional socioecological theoretical framework, which as a heuristic reference model and related to other ecological approaches could also be helpful for various theoretical questions for public health, and could provide a better public understanding of health issues. In line with this perspective, we hypothesize that with regard to the coronavirus disease 2019 pandemic, the acceptance of public health narratives could be increased if a more consistent picture of the scientific descriptions and explanations of the pandemic - similar to the model proposed - could be provided, which would enable the understanding of the origin, course and countermeasures, and thus could have positive collective psycho-hygienic effects., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: This scoping review examines the current literature on technology-based, eHealth interventions that integrate community and clinical approaches for family-based pediatric weight management., Background: Telehealth and eHealth interventions for weight management are increasingly commonplace; however, it is unclear in the current literature how family-based, pediatric, healthy-weight interventions integrate technology. Additionally, multilevel approaches to address childhood obesity, including working with clinical and community partners, are currently considered best practice and within the socioecological framework for sustainability of outcomes. Little is known how current family based pediatric healthy weight interventions integrate eHealth and multi-level approaches., Methods: Guided by Arksey and O'Malley's scoping review framework, a scoping literature review was conducted. Four databases were searched to identify studies conducted between 2010 and 2022 that addressed multilevel, family-based, pediatric weight management interventions that also integrated technology. Studies were excluded that did not include at least 2 of the 4 components and that did not include technology to some degree., Results: A total of 15 articles were included in the scoping review. All articles included some type of technology in the intervention. Twelve articles included a family-based approach, and only 1 article fully used a holistic approach to family-based, pediatric weight management that included technology and integrated clinical and community approaches to address the complexity of childhood obesity., Conclusions: There are several family-based, pediatric weight management interventions that incorporate an eHealth component. There is a gap in the literature about programs that use both technology and integrate multilevel clinical and community approaches for treatment. Additionally, gaps exist in information about adolescent, family-based, weight management interventions, and there are opportunities for nutrition and dietetic professionals to become more involved with technological and multilevel approaches in family-based pediatric weight management., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)