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Abstract Aim To explore enablers and barriers to the creation of an oral health training for care workers at specialized centres for children with disabilities in Ouagadougou. Design This was a formative study informed by the Theoretical Domains Framework using qualitative methods. Methods Qualitative observations and 14 semi‐structured interviews were conducted with care workers from six specialized centres for disability. Results Carer workers emphasized that a successful oral health training must account for available resources and competencies in each specific centre. Part of the training must be dedicated to oral hygiene targeted for people with disabilities and provide knowledge about risk factor management. Care workers must be empowered through the training with practical skills and tools to manage regular toothbrushing and identify oral health needs of their dependents. Conclusion This study gathered valuable and unique perspectives about the roles of care workers of children with disabilities in Ouagadougou and underscores the need for improving access to oral health and care services for children with disabilities in low‐resourced settings. Implications for Patient Care Teams planning oral health promotion activities in low resourced settings for vulnerable population groups can benefit from the methodology and results of this research for ensuring their interventions are appropriate and relevant. Impact This is a unique field study conducted in a scarcely researched area of caregiving practices for children with disabilities in a low‐income country, Burkina Faso. Results from the disability centre observations and interviews with local caregivers are of great value to any team planning health projects in similar low‐resourced settings. Psychiatric and mental health nursing practices are highly context‐dependent, thus using proposed qualitative methods can help to ensure that planned interventions are appropriate and relevant. Patient or Public Contribution There was no patient contribution in this study.

ABSTRACT Background In an increasingly digital age, students rely heavily on web resources to access health information. However, evaluating the reliability and relevance of such information is crucial for informed decision‐making. This study examines the importance of students' health information literacy skills (HILS) as mediators, particularly their ability to utilize web resources and successfully evaluate health information. Objectives This research investigates the mediating role of students' HILS in the relationship between their utilization of web resources and their proficiency in evaluating health information. Method An online survey was distributed to current students at a public university in Bangladesh as part of the data collection process for this study. Using Google Forms, the authors created a structured questionnaire. The survey was distributed through Messenger groups, Facebook pages and email invitations to reach the target audience effectively. The researchers thoroughly analysed the gathered data using structural equation modelling (SEM) techniques and SmartPLS‐4 software to look for correlations between the variables. Result The study revealed that among the 122 participants, a significant number (N = 47) accessed internet health information on an occasional basis, whereas 30 individuals reported using it infrequently. The data revealed that 58 individuals, accounting for 47.5% of the sample, possessed the necessary abilities to access and assess online health information. Additionally, 57 participants, representing 46.7% of the sample, demonstrated proficiency in conducting online health information searches. The measurement model demonstrated good convergent validity, as evidenced by composite reliability (CR) scores and Cronbach's ⍺ values over 0.700 and an average extracted variance (AVE) of 0.500. The structural model demonstrated R2 values exceeding 0.1, thus validating its dependable forecasting capability. Notable effects were seen, with f2 values of 0.335 and 0.317 for the challenges in accessing and evaluating health information (CAEHI) to health information evaluation (HIE) and CAEHI to HILS relationships, respectively. The mediation analysis found that HILS act as a mediator between types of web resources (TWRs) and HIE, with TWR having an indirect impact on HIE through HILS. Discussion The result supports all hypotheses. Therefore, it is evident that students' HILS mediate the relationship between utilization of web resources and their proficiency in evaluating health information. Conclusion This study's findings could significantly impact instructional practices meant to raise students' health information literacy. This initiative seeks to enable students to make informed decisions about their health by providing them with the necessary tools to analyse and evaluate health‐related information. Patient or Public Contribution Research on health information literacy can assist patients and the general public by instructing them on how to assess trustworthy online health resources. Students gave insightful feedback that assisted in shaping the study and guaranteeing its relevancy. If they better comprehend health information literacy, patients and the general public can use web‐based resources and critically evaluate health information more accurately.

Abstract Background and Aims Urban corporate sector relies heavily on workplace well‐being, with meditation being a potent stress reduction method that significantly enhances the quality of life (QoL) and wellness. The study aims to assess the effectiveness of meditation on wellness management among corporate employees in India. Methods The quasi‐experimental controlled study design was employed from May to June 2021, which assessed stress, QoL, and wellness indices (satisfaction with life, well‐being) with meditation practice as the intervention. The online questionnaire incorporates questions from the Depression, Anxiety, Stress Scale, World Health Organization (WHO) QoL Scale, Five‐item Satisfaction with Life scale and WHO‐5 Well‐being Index. A nonrandom sampling technique selected 146 and 74 subjects in the intervention and control groups, respectively, among the employees of Star health‐ and allied insurance company. The data was analyzed using SPSS V27 (©IBM SPSS Statistics). The Wilcoxon signed rank test for the dependent groups, and Mann–Whitney U test for the independent groups (between subjects) was performed. Results Among a total of 220 subjects who enrolled in the recruitment survey, 146 subjects underwent the intervention thus providing a response rate of 66.4%. For the intervention group, the difference (within group) in mean scores between baseline and endline assessment shows a reduction in stress (0.02) and significant improvement in QoL (0.21) and wellness indices (satisfaction with life: 0.21, well‐being: 0.24). The difference (between the experimental and control groups) in mean endline scores shows a decrease in stress (0.07), an increase in wellness indices (satisfaction with life: 0.12, well‐being: 0.23), and a significant change in the QoL (0.17). Conclusion Meditation intervention in corporate wellness programs enhances the QoL, wellness, and stress management, establishing the effectiveness of health profile‐raising ingenuities at the workplace.

ABSTRACT The escalating burden of lifestyle‐related diseases stands as a critical global public health challenge, contributing substantially to the prevalence of chronic conditions and a large portion of premature mortality. Despite this, concise evidence‐based lifestyle interventions targeting physical inactivity, nutrition, alcohol and smoking continue to be underutilised. Although good evidence exists for addressing the four lifestyle‐related risk factors independently, rarely do these present in isolation. Evidence is lacking regarding how to integrate interventions targeting multiple risk factors. Consequently, this paper aims to provide an overview of the evidence for delivering multiple interventions in primary healthcare settings. Different lifestyle factors are inter‐related, with decisions around ordering of the delivery of multiple lifestyle interventions an important consideration. There is evidence supporting the effectiveness of addressing some lifestyle factors simultaneously (e.g., physical activity and nutrition), although smoking cessation may be delivered best in a sequential approach. While the World Health Organisation highlights four key lifestyle factors (nutrition, physical activity, alcohol and smoking), incorporating additional elements such as sleep, mental well‐being and social connectedness offers a holistic framework for promoting well‐being. Despite the presentation of multiple behaviour risk factors being commonplace in healthcare settings, the evidence (outlined in the paper) for how best to deliver interventions to address this is limited, with further research and subsequent clinical guidance required. In order to address the barriers to delivering lifestyle interventions in primary care, innovation will be required. The use of non‐medical personnel, social prescribers and health coaches has the potential to alleviate time constraints, whilst mounting evidence exists for group consultations for addressing lifestyle‐related non‐communicable diseases (NCDs). If the challenges to implementation can be addressed, and if healthcare systems can adapt for the promotion of healthy lifestyles, the impact of NCDs can be mitigated.

Abstract Background and Aims The crises of the last decades have provided more evidence of the need for health literacy as a measure of resilience and preparedness. In this study the relationship between health literacy and health‐seeking behavior was investigated. Methods This study used a cross‐sectional design with a questionnaire of five sections dedicated to health‐seeking behavior, health literacy, family background, socioeconomic status and demographics. Health‐seeking behavior was used in three dimensions namely preference for hospitals, self‐medication, and herbal medicine. The questionnaire was completed by 262 students at the University of Ghana. Results A significant linear regression model (R = 0.39, R² = 0.15, Adjusted R² = 0.13, F = 8.89, p

Background Optimal self‐management is the key to home‐based cardiac rehabilitation for patients with heart disease. At present, there is a lack of a specific assessment tool to evaluate the home‐based cardiac rehabilitation self‐management behavior in patients with heart disease. Therefore, the aim of this study was to develop the Home‐Based Cardiac Rehabilitation Self‐Management Scale and validate its psychometric properties among patients with coronary heart disease. Methods and Results A multiphase cross‐sectional study was conducted that study covered 3 phases: (1) item generation and revision, (2) item evaluation and preliminary exploration, and (3) assessment of the psychometric properties of the scale. A scale with 21 items was developed to measure the home‐based cardiac rehabilitation self‐management behavior. The content validity index of the scale was 0.980. In exploratory factor analysis, the 5‐factor structure supported by eigenvalues and screen plot explained 74.326% of the total variation. In confirmatory factor analysis, all fitting indicators were acceptable, further supporting the construct validity of the scale. The criterion validity of the scale was 0.783. In the reliability analysis, the Cronbach's α coefficient of the scale was 0.882, with a dimensionality range of 0.780 to 0.936. The split‐half reliability coefficient and test–retest reliability coefficient were 0.774 and 0.770, respectively. Conclusions This study is the first to develop and validate a practical tool. This scale can comprehensively and accurately assess the self‐management behavior of patients with heart disease in a home‐based cardiac rehabilitation environment.

Abstract Objectives Health literacy (HL) about healthy cognitive aging is essential in preventing cognitive decline and promoting cognitive well‐being. It is important that one such HL module should be scientifically designed, delivered in a technically sound manner to the audience, and specific to the context. The present study thus aimed at developing and validating educational multimedia about cognitive health. Methods The study followed a methodological framework and was carried out across three phases, that is, identification of themes, development and validation of educational script and design, and validation of educational multimedia. The module was scripted based on the Integrated HL framework and the recommendations made during the modified nominal group technique among the research team. Seven speech‐language pathologists (SLPs), with expertise in the field of cognitive sciences, and 15 representatives of the general public validated the module using the Educational Content Validation Instrument in Health and the Patient Education Materials Assessment Tool for Audiovisual Materials questionnaire. Results The scientific content of the educational script received satisfactory agreements among the experts (content validity index [CVI]: 0.93) and representatives of the general public (CVI: 0.86). The technical aspects of the educational multimedia were rated to have high understandability (experts: 92.8%; representatives of general public: 98.8%) and actionability (experts and representatives of general public 100%). Conclusion Overall, the developed educational multimedia scored optimally with respect to the objective, structure, relevance of the content, actionability and understandability of the multimedia. The developed module holds the potential to be used at community and national level health educational programs or awareness campaigns to enhance public knowledge and beliefs pertaining to cognitive health. Patient or Public Contribution SLPs with expertise in the field of cognitive science and representatives from the general public were included to validate and obtain feedback on the developed educational multimedia.

Abstract Background Parent carers of disabled children are at increased risk of physical and mental health problems. The Healthy Parent Carers (HPC) programme is a manualised peer‐led group‐based programme that aims to promote parent carer health and wellbeing. Previously, the programme had been delivered in person, with recruitment and delivery managed in a research context. This study explored implementation by two delivery partner organisations in the United Kingdom. Facilitator Training and Delivery Manuals were modified for online delivery using Zoom due to COVID‐19. Methods The study methodology utilised the Replicating Effective Programs framework. A series of stakeholder workshops informed the development of the Implementation Logic Model and an Implementation Package. After delivering the programme, delivery partner organisations and facilitators participated in a workshop to discuss experiences of implementing the programme. A wider group of stakeholders, including commissioners, Parent Carer Forums and charity organisations representatives and researchers subsequently met to consider the sustainability and potential barriers to delivering the programme outside the research context. Results This study explored implementation by two delivery partner organisations in the United Kingdom that were able to recruit facilitators, who we trained, and they recruited participants and delivered the programme to parent carers in different localities using Zoom. The co‐created Implementation Logic Model and Implementation Package were subsequently refined to enable the further roll‐out of the programme with other delivery partner organisations. Conclusions This study provides insight and understanding of how the HPC programme can be implemented sustainably outside of the research context. Further research will evaluate the effectiveness of the programme and refine the implementation processes. Patient and Public Contribution Parent carers, delivery partner organisation staff and service commissioners were consulted on the design, delivery and reporting of the research.

Abstract Aims To describe sources of health information and health‐seeking behaviours of adults (aged ≥18) living in medically underserved communities in the Philippines. Design This is a secondary, quantitative analysis from a cross‐sectional parent study. Participants completed a 10‐item, self‐report survey on their sources of health information, healthcare providers sought for health and wellness and health‐seeking behaviours when ill. Responses were evaluated across two age groups (

Abstract Introduction Testicular cancer is the most common cancer in men aged 15–44 years in many countries. Most men with testicular cancer present with a lump. Testicular symptoms are more likely to occur secondary to benign diseases like epididymo‐orchitis, a common sexually transmitted infection. Gender and sexual minorities are at an increased risk of testicular diseases and health disparities. The aim of this study was to co‐design an inclusive community‐based campaign to promote testicular awareness. Methods This study uses the World Café methodology. Participation was sought from Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, health policy makers, media and marketing experts and graphic designers. Participants engaged in three rounds of conversations to co‐design the campaign. Data were collected using drawing sheets, artefact cards, sticky notes, coloured markers and a voice recorder. Deductive thematic analysis was conducted. Results Seventeen individuals participated in the study. Six themes emerged from the analysis as follows: (i) online communication; (ii) offline communication; (iii) behavioural targeting and education; (iv) campaign frequency and reach; (v) demographic segmentation; and (vi) campaign identity. The use of social media for campaign delivery featured strongly in all conversations. Participants also recommended offline communication using posters and radio/television advertisements to scale up the campaign and achieve wider reach. Advertisements to overcome embarrassment surrounding testicular health were particularly recommended. Participants emphasised that campaign delivery must be dynamic whilst ensuring that the health‐promoting messages are not diluted or lost. They stressed the importance of being inclusive and tailoring the campaign to different age groups, gender identities and sexual orientations. Conclusions Study recommendations will be used to design and deliver the campaign. Future research will be needed to evaluate the feasibility, acceptability, cost and effect of the campaign on promoting testicular awareness and early detection of testicular diseases. Patient or Public Contribution A participatory research approach was used to co‐design the campaign with members of Lesbian, Gay, Bisexual, Transgender and Queer+ (LGBTQ+) friendly organisations, LGBTQ+ student bodies, LGBTQ+ staff networks, LGBTQ+ sports clubs, men's health organisations, testicular cancer survivors, health policy makers, media and marketing experts and graphic designers.

Abstract This study examined sociodemographic factors associated with mothers seeking child feeding advice from health professionals (HPs). Cross‐sectional analysis of survey data from linked randomized controlled trials was conducted. Surveys asked which sources of feeding information mothers used when their child was 6 months and 5 years old. Logistic regression was used to examine associations between sociodemographic characteristics and use of information from HPs. Here, 947 and 405 mothers completed 6‐month and 5‐year surveys, respectively. At 6 months, multiparous mothers were less likely to seek advice from child and family health nurses (CFHNs) (adjusted odds ratio [AOR]: 0.558, 95% confidence interval [95% CI]: 0.416–0.749) and other HPs (AOR: 0.706, 95% CI: 0.542–0.919), unmarried mothers were less likely to seek advice from other HPs (AOR: 0.582, 95% CI: 0.342–0.990). At 5 years, mothers with household income ≥$80,000 p.a. were less likely to seek advice from CFHNs (AOR: 0.514, 95% CI: 0.302–0.875) and working mothers less likely to seek advice from general practitioners (GPs) (AOR: 0.581, 95% CI: 0.374–0.905). Mothers born in Australia were less likely to seek information from CFHNs (AOR: 0.462, 95% CI: 0.257–0.833) and GPs (AOR: 0.431, 95% CI: 0.274–0.677). There was a greater likelihood that multiparous mothers (AOR: 2.114, 95% CI: 1.272–3.516) and mothers of children whose fathers had not attended university (AOR: 2.081, 95% CI: 1.256–3.449) had never sought advice from CFHNs, and that mothers who had not attended university (AOR: 1.769, 95% CI: 1.025–3.051), multiparous (AOR: 1.831, 95% CI: 1.105–3.035) and employed (AOR: 2.058, 95% CI: 1.135–3.733) mothers had never sought advice from other HPs. Understanding sociodemographic factors associated with seeking child feeding advice from HPs may inform priorities for engaging families in health promotion.

Abstract Aim To describe community healthcare professionals' experiences of preventing malnutrition among children in rural Bangladesh. Methods A descriptive qualitative study with a total of seven healthcare professionals were recruited from a non‐governmental organisation in rural Bangladesh. Individual in‐depth interviews were conducted in November 2018 using a semi‐structured interview guide. The audio‐recorded interviews were transcribed verbatim and analysed manually using content analysis. Results The data analysis resulted in two main categories: Implementation and practices in preventing malnutrition and Challenges in working with prevention of malnutrition. Education was considered an important and essential preventative intervention. Healthcare professionals faced challenges in their work in relation to socio‐cultural and climate factors. The findings indicate how healthcare professional identified the need for increased knowledge and resources in the community to promote nutritional health in children.

Abstract A systematic review conducted by Price and Keady (Journal of Nursing and Healthcare of Chronic Illness, 2, 88 and 2010) demonstrated that there was a dearth of health‐promoting literature available for people diagnosed with vascular dementia. The correlation between health behavior and the onset of cardiovascular change that can lead to vascular dementia had demonstrated a need for health education and health‐promoting information to be made accessible to vulnerable populations to ameliorate the risk of cognitive decline because of cardiovascular disease. Dementia is a progressive and life‐limiting condition and with limited treatment options and a lack of progress in identifying a way to delay onset or even cure the condition. Focus must be targeted towards risk reduction strategies that serve to reduce onset and decline and limit the global burden on not only the individual with the condition and their carers but also to the health and social care economy. To identify the progress that has been made in developing health‐promoting literature and patient education guidance since 2010 a systematic literature review was undertaken. Using thematic analysis, CINAHL, MEDLINE, and psych INFO databases were accessed and following PRISMA guidelines an inclusion and exclusion criteria was developed in order to locate peer‐reviewed articles. Titles and abstracts were reviewed to identify a match with key terms, and from 133 screened abstracts eight studies met the inclusion requirements. From the eight studies, thematic analysis was implemented to identify shared understanding of experiences relating to health promotion in vascular dementia. The methodology for the study was replicated from the authors’ previous systematic review in 2010. Five key themes were identified in the literature (Healthy heart healthy brain; Risk factors; Risk reduction/modification; Interventions; Absence of targeted health promotion). From what little evidence was available to review the thematic analysis has demonstrated developments in knowledge into the link between the onset of cognitive impairment and vascular dementia because of compromised cardiovascular health. Modifying health behavior has become essential in ameliorating the risk of vascular cognitive decline. With these developments the synthesis of the literature demonstrates that even with these insights there continues to be a lack of targeted material that individuals can access to understand the link between cardiovascular health and cognitive decline. It is recognized that maximizing cardiovascular health has the potential to lessen the risk of vascular cognitive impairment and vascular dementia developing and progressing yet targeted health promoting material remains lacking. With the developments in understanding the causal links between poor cardiovascular health, vascular cognitive impairment, and vascular dementia progress now needs to be made in developing targeted health promotion material for individuals to access to share this knowledge to reduce the potential onset and subsequent burden of dementia.

Abstract Background The national skin cancer screening (SCS) was introduced in Germany in 2008. However, public awareness and participation rates remain low. There are no campaigns or target group‐specific invitation strategies for SCS yet. Thus, our aim was to derive potential suggestions on how to best inform German residents about the possibility of SCS. Methods Semi‐structured, individual interviews with male and female German residents aged ≥35 years were conducted in Erlangen (Germany) to explore opportunities on raising awareness of SCS. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. Results Overall, 39 persons were interviewed. About 79.5% (31/39) had already undergone at least one SCS. Numerous opportunities to raise awareness of the possibility of SCS were suggested which were categorized into three main topics: the role of public promotion, health‐related caregivers, and health insurance. Similar themes were identified for inviting entitled persons to undergo SCS after 2 years. Furthermore, age‐dependent communication approaches were proposed, that is, younger persons should be approached electronically, while the older generation should be targeted with traditional media like mail. Conclusions The results of this project will inform stakeholders to take appropriate actions. The findings may contribute to increase participation rates in SCS and thus lead to earlier detection of skin cancer.

Abstract Aim To explore the quality‐of‐life among community‐dwelling older adults in China and to examine the associations between frailty, sociodemographic characteristics and quality‐of‐life. Design A cross‐sectional correlational study was adopted. Methods Questionnaire study of 311 community‐dwelling older adults using the Life Satisfaction Questionnaire and FRAIL scale. Results Highest quality‐of‐life was found for the physical symptoms factor and the lowest for quality of everyday activities/fun. Frailty was associated with total quality‐of‐life and the physical symptoms and sickness impact factors. For total quality‐of‐life, the odds of being in the group with a median score or more decreased for frail older people (OR 0.30) versus non‐frail and increased for those with medical insurance from employer versus basic (OR 2.30) and those doing exercise ≥30 min 3 days/week or more versus less (OR 2.12). Registered nurses caring for community‐dwelling older adults should screen for and prevent frailty and encourage exercise to improve their quality‐of‐life.

Abstract Aim The study aimed to evaluate a tailored reproductive health promotion programme based on the Precaution Adoption Process Model (PAPM) for young adults. Design This was a two‐group, non‐blinded randomized controlled trial. Methods This study was performed with women aged 18–25 who were not performing reproductive health‐related behaviour from September 2018 to November 2018 in Seoul, South Korea. The participants were stratified by stage of PAPM (1, 2 or 3) and were randomly allocated to the intervention group (n = 30) and the control group (n = 30). Women in the intervention group were given the programme, which was customized according to the stage of PAPM over 8 weeks, such as lectures, giving information, discussions, practical training, Q&A, case experience and counselling. The control group received educational material. The primary outcomes were reproductive‐health‐promoting behaviour and rate of contraception use. Results Reproductive‐health‐promoting behaviour was significantly higher in the intervention group than the control group post‐intervention, as were reproductive health beliefs, motivation and self‐efficacy.

Abstract Aims The first aim was to learn what books and other media the study participants would recommend for inspiring people to let go of anger towards themselves or others and have a kinder intention towards themselves or others. The second aim was to learn which media had these effects on participants, and how. The third aim was to compile lists of cited media that can be available to nurses and other healthcare professionals who want to utilize media therapy for the facilitation of forgiveness. Design Phenomenological qualitative. Methods Thematic analysis of semi‐structured interviews with 39 participants. Results A total of 166 diverse media were identified as useful for helping people forgive, which were compiled into tables and categorized into cross‐culturally useful forgiveness process themes. Findings also verified and expanded a previously compiled forgiveness guidance document that summarized the findings of 11 qualitative studies revealing how people forgive.

Abstract Background The COVID‐19 pandemic has globally impacted nursing education, particularly clinical learning opportunities for undergraduate nursing students. Purpose In this paper, we report on an educational activity wherein students participated in a COVID‐19 Rapid Antigen Testing (RAT) clinic on a Canadian university campus. Methods Between February–April 2021, in the second term of a five‐term accelerated program, nursing students (n = 60) participated in a nurse‐led COVID‐19 RAT clinic for students and staff living or working in congregate housing. Students participated in education activities which exposed nursing students to the full range of community health nursing roles in a pandemic. Results From clinical, research, policy, and public health, this educational activity acted as a microcosm of the critical roles that nurses employ in the health ecosystem. Conclusion We offer lessons learned about implementing this activity, and how these lessons can be applied to routine and exceptional nursing curriculum.

Abstract Background and Aim Polio eradication efforts including polio‐philanthropy have been coordinated and sustained since 1988, with the introduction of the Global Polio Eradication Initiative (GPEI). The polio fight is sustained in the name of evidence‐based benevolence or beneficent philanthropy from which Africa has benefited immensely. With the recorded polio cases as of 2023, more efforts and funds are required to eradicate polio. Hence, it is not yet “Uhuru.” Using the Mertonian lens, this study examines polio‐philanthropy in Africa, its unintended consequences, and crucial dilemmas, which could impact the polio fight and polio‐philanthropy. Methods This is a narrative review that relies on secondary sources obtained through a thorough literature search. Only studies published in English were utilized. The study synthesized relevant literature in line with the study objective. The following databases were consulted: PubMed, philosopher's index, web of knowledge, Google Scholar, and Sociological Abstracts. Both empirical and theoretical studies were utilized for the study. Results Despite significant achievements, the global initiative has shortcomings when examined through the Mertonian lens of manifest and latent functions. The GPEI sets a unilinear goal within multiple challenges. The activities of the philanthropic giants manifest in disempowering rigor, multisectoral neglect, and parallel (health) systems, sometimes, inimical to the national health system. Most philanthropic giants often operate vertically. It is observed that, apart from funding, the last phase of polio‐philanthropy will be defined by some crucial factors, the 4Cs: Communicable disease outbreaks, Conflict, Climate‐related disasters, and Conspiracy theory, which could impact the prevalence or resurgence of polio. Conclusion The polio fight will benefit from the persistent drive to reach the finish line as scheduled. The latent consequences or dysfunctions are general lessons for GPEI and other global health initiatives. Therefore, decision‐makers should calculate the net balance of consequences within global health philanthropy for appropriate mitigation.

Abstract There is growing recognition that engaging men in maternal, infant and young child nutrition (MIYCN) interventions can benefit child health and disrupt harmful gender norms. We conducted a cluster‐randomized controlled trial in Tanzania, which engaged men and women in behaviour change via mobile messaging (short message service [SMS]) and traditional interpersonal communication (IPC), separately and in combination. Here, we evaluate intervention effects on individual‐level men's MIYCN knowledge and discuss barriers to male engagement. Eligible clusters were dispensary catchment areas with >3000 residents. Forty clusters were stratified by population size and randomly allocated to the four study arms, with 10 clusters per arm. Data on knowledge and intervention exposure were collected from 1394 men through baseline and endline surveys (March–April 2018 and July–September 2019). A process evaluation conducted partway through the 15–18‐month intervention period included focus group discussions and interviews. Data were analysed for key trends and themes using Stata and ATLAS.ti software. Male participants in the short message service + interpersonal communication (SMS + IPC) group reported higher exposure to IPC discussions than IPC‐only men (43.8% and 21.9%, respectively). Knowledge scores increased significantly across all three intervention groups, with the greatest impact in the SMS + IPC group. Qualitative findings indicated that the main barriers to male participation were a lack of interest in health/nutrition and perceptions that these topics were a woman's responsibility. Other challenges included meeting logistics, prioritizing income‐earning activities and insufficient efforts to engage men. The use of a combined approach fusing IPC with SMS is promising, yet countering gender norms and encouraging stronger male engagement may require additional strategies.

Abstract There is evidence that physical inactivity and dietary factors are more common among modifiable risk factors for noncommunicable diseases (NCDs) which are on the rise in Malawi. Football has been shown to have a wide range of health‐related benefits in health education programs, including the promotion of physical activity as a potential intervention in addressing NCDs. In Malawi, few football‐based health promotion programs have been implemented to address NCDs. Among the programs implemented were the Federation Internationale de Football Association 11 for Health initiative which was a school‐based health education program for the youth and the Malawi Ministry of Health's SPORTS FOR HEALTH initiative targeting civil servants. These programs produced significant improvement in physical activity in the participants and also increased their knowledge of both communicable and NCDs. However, these initiatives were not rolled out to many sites across Malawi. As Malawi is tackling rising cases of NCDs, football can be used as a powerful tool in promoting physical activity and it also provides an important platform for the delivery of NCDs’ health promotion messages to a wider audience. Such football‐based initiatives must be designed to directly address modifiable risk factors of NCDs. For successful implementation, there must be a good collaboration among the Ministries of Health and Sports, local football leagues, and other stakeholders.

Abstract Background and Aim Assessing health promotion among adolescents is vital to identify healthy and unhealthy behaviors and to evaluate health promotion interventions. This study aimed to determine the validity and reliability of the Persian version of the Short‐Form Adolescent Health Promotion scale. Methods Three hundred and twenty‐seven adolescents were recruited through a multistage sampling method in this methodological study. The original version of the Adolescent Health Promotion scale was translated from English to Persian using the Backward–Forward translation protocol. Then, the scale's validity and reliability, including the face, content, construct validity, and reliability indices, were evaluated. The statistical analysis was performed using SPSS software version 24. Results The mean CVI and CVR were 0.99. The exploratory factor analysis revealed four factors covering 42.57% of the total variance. The factor loading order of the items did not exactly correspond to the order obtained in the English version of the scale's validity and reliability analysis. The obtained factors called included: life appreciation, stress management, nutrition, and health responsibility. In the current study, both Cronbach's ɑ and the intraclass correlation coefficient were calculated at 0.84 and 0.99. Conclusion The Persian version of the Adolescent Health Promotion scale developed in the present study is acceptable for the validity of the content, face, and reliability. However, the construct validity of this scale should be checked in other samples.

Abstract Despite a number of public health and policy‐based initiatives, Ireland's national breastfeeding rates are among the lowest globally. Regionally, the Mid‐West of Ireland has historically had low breastfeeding initiation rates, and parts of its major urban area such as Limerick City suffer the highest levels of economic deprivation in the country. In that context, this repeated cross‐sectional study analysed breastfeeding initiation trends in the Mid‐West of Ireland for two decades, from 2001 to 2020 inclusively. Statistical analysis revealed persistently low percentages of women initiating breastfeeding in the region. Time series analyses of the data demonstrated that overall breastfeeding rates are increasing, but continue to be lower than Irish national averages. From these findings and a narrative review of published research, we determined 10 plausible reasons for these consistently low breastfeeding rates. Arising from these, we propose ‘10 Priorities’ to increase the breastfeeding initiation rates in Ireland.

Abstract Background Adolescents who participate as peer leaders can benefit and acquire competencies from their peer leadership experience. Objectives To identify the competencies gained by adolescents who participated as peer leaders in a healthy lifestyle study and to determine whether the training characteristics were related to improvement in competencies. Design The present study was part of the European Youth Tackling Obesity (EYTO) project, a multicentre social marketing intervention involving four European countries. Setting and Participants Eighteen peer leaders (aged 13–15 years, three or five leaders per country) from disadvantaged neighbourhoods received training in designing and implementing activities for their peers. Measures The peer leaders' confidence, experience and interest in 11 tasks related to lifelong learning competencies were assessed with questions rated on a colour scale at baseline and at the end of the study. Results The peer leaders demonstrated improvements in experience, confidence and interest in different tasks, such as research, website or logo design, oral presentations, social media use and collaboration with people from other countries. They increased their confidence in management tasks (p = 0.03) and their confidence and experience in communication tasks (p = 0.01). The peer leaders from Spain and Portugal had greater improvements than those from the other countries. Conclusion The peer leaders improved their confidence in management tasks and their confidence and experience in communication tasks. Slight differences were detected in improvement in competencies by country, likely due to the differences in the peer training applied. Recommendations for peer leader training are proposed, although these results should be verified with larger sample size. Patient or Public Contribution The peer leaders contributed to the design and implementation of the training and intervention.

Issue Addressed: There is an urgent need to investigate innovative and creative approaches in health promotion that support work towards health equity. In response, this study explores the potential for arts, and community music specifically, to strengthen individual and collective well-being., Methods: This study used a qualitative case study methodology that involved interviews, focus groups and ethnographic observation with participants (N = 13), facilitator (N = 1) and support staff (N = 2) of an established community music initiative conducted in an urban community. Data collection was conducted across 2023 and data analysis drew on a socioecological framework to explore potential individual and collective outcomes from the perspective of those involved in the initiative., Results: Findings point to outcomes across socioecological levels with researchers identifying positive health and well-being implications for participants including joy, healing and a sense of purpose, creative self-expression, confidence, social connection and contribution. Positive outcomes for the wider community were also identified including developing community ties, promoting safety and shaping and sharing of collective identity. Findings suggest community-led opportunities for engagement can support healing and empowerment for people who are marginalised, and this can enable active community participation related to challenging the status quo and developing a shared set of values. Potential implications of these outcomes in relation to broader societal transformations are discussed., Conclusions: This study highlights how community music, and the arts more broadly are working in communities in ways that support potential personal, community and societal transformations towards health equity. SO WHAT?: By developing coalitions and collaborating with diverse sectors, including the arts and social sectors, health promotion practitioners and researchers can harness the creative strengths and resources that exist within a community to support positive individual and collective well-being., (© 2024 The Author(s). Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

This study investigates whether systems-level interventions, specifically patient-centered culturally sensitive health care (PC-CSHC) from healthcare providers, office staff, and the clinic environment, moderate the relationship between health self-efficacy and patient engagement among Black American adults. An online survey was completed by 198 Black American adults. PC-CSHC from healthcare providers, office staff, and the clinic environment did not mitigate the adverse effects of low health self-efficacy on patient engagement. However, PC-CSHC from healthcare providers (b = 0.38) was as significant as health self-efficacy (b = 0.37) in predicting patient engagement, R 2  = 0.47, F(9, 177) = 19.61, p < 0.001. Provider-delivered PC-CSHC can enhance patient engagement among Black American adults. This systems-level approach has the potential to reach more patients than intrapersonal interventions alone and alleviates the undue burden placed on Black Americans to leverage intrapersonal strengths in the face of health disparities rooted in structural racism., (© 2024 The Author(s). Journal of Community Psychology published by Wiley Periodicals LLC.)

Background: In an increasingly digital age, students rely heavily on web resources to access health information. However, evaluating the reliability and relevance of such information is crucial for informed decision-making. This study examines the importance of students' health information literacy skills (HILS) as mediators, particularly their ability to utilize web resources and successfully evaluate health information., Objectives: This research investigates the mediating role of students' HILS in the relationship between their utilization of web resources and their proficiency in evaluating health information., Method: An online survey was distributed to current students at a public university in Bangladesh as part of the data collection process for this study. Using Google Forms, the authors created a structured questionnaire. The survey was distributed through Messenger groups, Facebook pages and email invitations to reach the target audience effectively. The researchers thoroughly analysed the gathered data using structural equation modelling (SEM) techniques and SmartPLS-4 software to look for correlations between the variables., Result: The study revealed that among the 122 participants, a significant number (N = 47) accessed internet health information on an occasional basis, whereas 30 individuals reported using it infrequently. The data revealed that 58 individuals, accounting for 47.5% of the sample, possessed the necessary abilities to access and assess online health information. Additionally, 57 participants, representing 46.7% of the sample, demonstrated proficiency in conducting online health information searches. The measurement model demonstrated good convergent validity, as evidenced by composite reliability (CR) scores and Cronbach's ⍺ values over 0.700 and an average extracted variance (AVE) of 0.500. The structural model demonstrated R 2  values exceeding 0.1, thus validating its dependable forecasting capability. Notable effects were seen, with f 2  values of 0.335 and 0.317 for the challenges in accessing and evaluating health information (CAEHI) to health information evaluation (HIE) and CAEHI to HILS relationships, respectively. The mediation analysis found that HILS act as a mediator between types of web resources (TWRs) and HIE, with TWR having an indirect impact on HIE through HILS., Discussion: The result supports all hypotheses. Therefore, it is evident that students' HILS mediate the relationship between utilization of web resources and their proficiency in evaluating health information., Conclusion: This study's findings could significantly impact instructional practices meant to raise students' health information literacy. This initiative seeks to enable students to make informed decisions about their health by providing them with the necessary tools to analyse and evaluate health-related information., Patient or Public Contribution: Research on health information literacy can assist patients and the general public by instructing them on how to assess trustworthy online health resources. Students gave insightful feedback that assisted in shaping the study and guaranteeing its relevancy. If they better comprehend health information literacy, patients and the general public can use web-based resources and critically evaluate health information more accurately., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Issue Addressed: Whilst there is a relationship between health literacy and health outcomes, the importance of social and personal demographic characteristics remains understudied., Identifying the factors responsible for creating health literacy challenges would help ensure that responses are tailored to individual or community needs., Methods: This survey included questions from five domains from the Health Literacy Questionnaire. Descriptive analyses and hierarchical regression were used to explore the relationship between the demographic characteristics and health literacy. Qualitative questions were subjected to thematic analysis, to identify the current barriers and proposed solutions., Results: A total of 255 participants completed the survey. Demographic characteristics that significantly predicted lower Health Literacy Questionnaire scores were having one or more chronic health conditions and living in an area of more socioeconomic disadvantage. Participants found 'navigating the health care system' the most difficult of the five elements measured. A total of 276 individual barriers to health literacy were identified and 162 solutions proposed., Conclusions: This study provides an overview of our sample's health literacy and how their social demographic characteristics may predict their health literacy challenges. Findings from this study can be used to develop targeted interventions to respond to specific health literacy challenges identified within this population. SO WHAT?: Distinct from other research, whereby solutions are proposed by researchers, the participants in this study were encouraged to share their health literacy challenges and outline potential solutions to address these in their local context., (© 2024 The Author(s). Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

The Aim: To explore and describe workplace stress levels and health-promoting behaviours reported by emergency nurses in China, and to investigate factors associated with workplace stress and health-promoting lifestyle behaviours among emergency nurses., Methods: A cross-sectional study was conducted between October 2019 and January 2020. Nurses (n = 1565) were recruited from the emergency departments of 54 hospitals within the Sichuan Province of West China. Each subject completed the Chinese versions of the Nurse Workplace Stress Scale, the Health-Promoting Lifestyle Profile (HPLP-II) and demographic questions. Linear regression analyses were used to identify associations between workplace stress and the health-promoting lifestyle and risk factors correlated with these two measurements., Results: Workplace stress was negatively associated with health-promoting behaviours. Linear regression analysis showed that gender, marital status, whether wages met expected standards and professional rank were found to be associated with health promotion behaviours; marital status, whether income met expected standards, the number of night shifts per month and health promotion behaviours were found to be associated with workplace stress., Conclusion: Higher levels of workplace stress are associated with lower levels of engagement in health-promoting behaviours, suggesting the potential for reducing workplace stress through the adoption of healthier habits. Policies should prioritize workplace stress by promoting healthy lifestyle initiatives., (© 2024 John Wiley & Sons Australia, Ltd.)

Issue Addressed: Sexual minority women (SMW) experience inequities in health outcomes. The extant literature consistently suggests that SMW are much less likely than their heterosexual peers to engage in cervical screening. Using participant's voices, the focus of this study was to explore the ways in which cervical screening rates for SMW might be improved., Methods: An online survey was completed by SMW (N = 177) aged 25-69 based in Aotearoa New Zealand and representing a range of sexual identities, ethnicities, and geographical regions. The analysis presented here was derived from open-ended qualitative responses to a single survey item: What do you think could be done to encourage more SMW (lesbians, wahine takatāpui, bisexual women, etc.) to engage in smear testing?, Results: Analysis of the data generated three main themes around how public health services could encourage more SMW to engage in cervical screening: Inclusive health services, clarity of information, and targeted health promotion., Conclusion: The analysis showed that the inherent heteronormativity among health care professionals and the lack of clear and consistent information specific to SMW may be key factors contributing to lower rates of engagement in screening. SO WHAT?: Given that not engaging in screening is the main risk factor for cervical cancer, it is imperative that active consideration is given to these issues with a view to increasing participation rates among SMW., (© 2024 The Author(s). Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Issue Addressed: This study explored trends in public support for obesity prevention policies in Western Australia (WA)., Methods: A series of cross-sectional surveys of a representative sample of WA adults aged 25-49 years (N = 11 534) were undertaken between 2012 and 2020 as part of an evaluation of the LiveLighter® mass media campaign, a component of a statewide healthy lifestyle education and promotion programme. Computer-assisted telephone interviews were used to gauge support for a range of obesity prevention initiatives that could be implemented by government., Results: A majority of respondents supported a range of obesity prevention policies, including taxes on sugary drinks, urban planning regulations, food labelling and packaging regulations, restrictions on advertising and sponsorship, bans on the sale and marketing of unhealthy food and drink in retail environments and support for education and campaigns. Obesity prevention policies were highly supported by women, people with a healthy weight, and those who had completed secondary school. Support for regulation was high compared to other studies. Notably, there were significant increases in support between baseline and 2020 for 'taxing soft drinks and using the money to reduce the cost of healthy food' (72% cf. 80%) and 'restricting junk food promotions/advertisements on public transport' (73% cf. 83%)., Conclusions: There is substantial public support for regulatory action on obesity prevention in WA, providing strong rationale for government interventions to improve nutrition and reduce obesity. The LiveLighter® programme may have contributed to increases in support for obesity prevention policies in WA. SO WHAT?: There is potential to implement robust obesity prevention policies in WA., (© 2023 State of Western Australia. Health Promotion Journal of Australia © 2023 Australian Health Promotion Association.)

Issue Addressed: Community participation in planning, delivery, and evaluation of health promotion (HP) programs is a poorly explored topic. However, this approach has the potential to improve health outcomes and reduce health inequities, particularly for residents of rural and remote areas., Methods: This case study describes the outputs of an academic-health service partnership in rural Victoria. The collaboration has led to the implementation and ongoing evaluation of a microgrant program for HP which integrates community participation principles in the foundations of the program and its evaluation., Results: To date, 10 funded projects have been brought to completion, with COVID-19 having disturbed both grant distribution and funded activity implementation. Semi-structured interviews with health service officers served to clarify conceptualisation and operationalization of HP principles. Focus groups with health service management and officers contributed to building an overarching evaluation framework for the HP team's activities. Finally, the specific methodological evaluation framework for the microgrant program was developed through a collaborative workshop with the HP team and grantees., Conclusions: Fostering community participation in HP planning, delivery, and evaluation, especially in rural areas, is feasible as evidenced by the experience described in this case study. The forthcoming evaluation results will help clarify the impact of community participation on health-related outcomes. SO WHAT?: Documentation and dissemination of processes used to increase community participation in HP programs is essential to grow the knowledge base around what works and what doesn't, and for whom., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Issue Addressed: Universities are a crucial setting to address and promote optimal mental health of young Australians. However, there is a lack of knowledge of universities' views of current implementation of health and wellbeing initiatives. Therefore, we examined the views of Australian universities on the implementation of health and wellbeing policies and programs within Australian universities., Methods: An online survey of Australian universities asked respondents to rate their level of agreement with five statements pertaining to the implementation of health and wellbeing policies and programs for students within Australian universities using a 5-point Likert scale (strongly agree to strongly disagree)., Results: Eleven universities completed the survey (28.2% response rate). All respondents (n = 11) agreed that universities play a crucial role in supporting the health and wellbeing of their students and report access to sufficient expertise to do this. Approximately three-quarters (8/11) agreed that universities know what policies and programs to implement to support their students' health and wellbeing. There was less agreement that universities have sufficient resources (2/11 agree) or access to sufficient information about the health and wellbeing of their student population (3/11 agree) to support the implementation of health and wellbeing policies and programs., Conclusions: Australian universities demonstrated strong organisational commitment to supporting the health and wellbeing of their students but highlighted some key barriers to implementation. SO WHAT?: Findings from this preliminary research highlight potential barriers and facilitators to the implementation of health and wellbeing policies and programs in Australian universities, and potential foci for future research., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Issue Addressed: The Sydney Local Health District (SLHD) Health Promotion Unit was awarded a Cancer Institute NSW grant to raise awareness of bowel cancer and promote the National Bowel Cancer Screening Program (NBCSP) among Aboriginal communities in SLHD. The COVID-19 pandemic thwarted initial plans for face-to-face workshops and plans pivoted to digital products and dissemination of messages on a range of communication platforms., Discussion: The coronavirus (COVID-19) pandemic provided staff with the freedom, flexibility, and ability to be creative in ways not possible prior to the pandemic and ultimately ended up with a superior product with a reach further than anticipated. A more comprehensive suite of digital resources addressing barriers to bowel cancer screening in the Aboriginal community was produced that is able to be used more broadly. These resources have reached a much larger population group through websites, social media, as well as TV and radio advertisements, and have the potential to be used and adapted in other local health districts and states across Australia., Conclusion: Adapting an Aboriginal bowel cancer screening awareness program to a digital platform is a promising approach. SO WHAT?: COVID-19 provided an opportunity to create new long-lasting partnerships and to be creative beyond the scope of the original grant. This in turn produced a product with a reach further than anticipated that can also be built on and sustained., (© 2023 Australian Health Promotion Association.)

Abstract Aim To understand the meanings and practices of the physical activity (PA) engaged in by Moroccan women in an Islamic urban environment. Design Quasi‐ethnographical study. Methods 13 semi‐structured interviews and 15 observation sessions of the PA engaged in by women. Results The concept of PA fits into the holistic approach of Islam. The social and cultural conditions of those who regularly practise PA are diverse. The community collaborates to overcome difficulties involved with this practice. The flexibility of issues such as gender segregation and clothing, Islam as a stimulus for PA, health as a value, the promotion of a rights and duty‐based model for health care user, the community co‐creation of the PA offer, and the power of organized civil society could inspire new strategies for the promotion of PA among Muslim women in other contexts.

Abstract Background and Aims The last decade has witnessed unprecedented growth in mobile phone use. It links millions of previously unconnected people. The ubiquity of mobile phones, which allows for use of the short message service (SMS), offers new and innovative opportunities for disease prevention and health education. SMS usage appears to be a feasible, popular, and effective way of improving health literacy. This study measured the effect of SMS health education on the improvement of health management in Shenzhen, China. Methods This was a community‐based randomized controlled study. A total of 32 communities were randomly chosen out of 320, then about 200 participants were randomly sampled from each selected community. The subjects were equally divided into two groups at random. About half of the participants received health intervention messages via Internet‐based SMS for almost a year. The data were analyzed by descriptive and inferential statistical methods. Results The proportion of participants involved in self‐health management increased from 30.92% to 38.68% over the year (χ2 = 42.49, p 0.05). No statistical difference in the prevalence of chronic disease (15.16% and 13.89%, p > 0.05) was found before and after the intervention in the intervention group. The prevalence in the intervention group was lower after the intervention than it was in the control group (17.33%, χ2 = 14.45, p

Abstract Suboptimal infant young child feeding practices are frequently reported globally, including in Indonesia. This analysis examined the impact of a package of behaviour change interventions on breastfeeding practices in Malang and Sidoarjo Districts, East Java Province, Indonesia. The BADUTA study (which in the Indonesian Language is an acronym for BAwah DUa TAhun, or children aged less than 2 years) was an impact evaluation using a cluster‐randomized controlled trial with two parallel treatment arms. We conducted household surveys in 12 subdistricts from Malang and Sidoarjo. We collected information from 5175 mothers of children aged 0–23 months: 2435 mothers at baseline (February 2015) and 2740 mothers at endline (January to February 2017). This analysis used two indicators for fever and diarrhoea and seven breastfeeding indicators (early initiation of breastfeeding, prelacteal feeding, exclusive breastfeeding under 6 months, predominant breastfeeding, continued breastfeeding, age‐appropriate breastfeeding and bottle‐feeding). We used multilevel logistic regression analysis to assess the effect of the intervention. After 2 years of implementation of interventions, we observed an increased odds of exclusive breastfeeding under 6 months (adjusted odds ratio [aOR] = 1.85; 95% confidence interval [CI]: 1.35–2.53) and age‐appropriate breastfeeding (aOR = 1.39; 95% CI: 1.07–1.79) in the intervention group than in the comparison group, at the endline survey. We found significantly lower odds for prelacteal feeding (aOR = 0.52; 95% CI: 0.41–0.65) in the intervention than in the comparison group. Our findings confirmed the benefits of integrated, multilayer behaviour change interventions to promote breastfeeding practices. Further research is required to develop effective interventions to reduce bottle use and improve other breastfeeding indicators that did not change with the BADUTA intervention.

Abstract Communities and Hospitals Advancing Maternity Practices (CHAMPS) is a public health initiative, operating in Mississippi since 2014, to improve maternal and child health practices and reduce racial disparities in breastfeeding. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, this study assessed CHAMPS, which used a Quality Improvement intervention at hospitals, and engaged intensively with local community partners. The study team assessed outcomes through quantitative data (2014–2020) from national sources, Mississippi hospitals, community partners and CHAMPS programme records, and qualitative data from focus groups. With 95% of eligible Mississippi hospitals enrolled into CHAMPS, the programme reached 98% of eligible birthing women in Mississippi, and 65% of breastfeeding peer counsellors in Mississippi's Special Supplemental Nutrition Programme for Women, Infants and Children. Average hospital breastfeeding initiation rates rose from 56% to 66% (p

Abstract The Baby‐Friendly Hospital Initiative is a global health promotion intervention that outlines the Ten Steps hospitals should implement to support newborns' breastfeeding. This US‐based study aimed to determine which hospital characteristics and community factors are associated with hospitals' attainment of Baby‐Friendly designation. We used a cross‐sectional design and used 2018 data from the Baby‐Friendly, USA Inc. designation program merged with the American Hospital Association annual survey data set. Multilevel logistic regression analysis was used to assess hospital characteristics of interest among the sample consisting of 312 Baby‐Friendly hospitals and 1449 non‐Baby‐Friendly. Our results show that Baby‐Friendly hospitals are more likely to be government nonfederal hospitals, in the Midwest or South regions, serve communities with higher birth totals, and reside in competitive markets. Based on the results of this study, hospitals should seek further and examine their community's characteristics and structures to identify opportunities and encourage the attainment of improved breastfeeding initiatives such as Baby‐Friendly designation.

Abstract China has the largest and fastest‐growing breast milk substitutes (BMSs) market and a disproportionately low exclusive breastfeeding rate. Many BMS manufacturers have established Chinese e‐commerce stores. This marketing is of concern as it is likely to undermine breastfeeding. This study aimed to identify: (1) the marketing themes and strategies used to promote BMSs on the Chinese BMSs e‐commerce websites; (2) if and how digital BMSs marketing may deviate from the World Health Organization Code of Marketing of Breast Milk Substitutes (the Code) recommendations. Content analysis was conducted on the flagship websites of 10 BMSs companies on the Chinese e‐commerce platform “TMall” in July 2019. The main landing page (n = 10) of the flagship TMall website and the product description page (n = 113) of all individual formulas (Stages 1–3) within each company's TMall website were examined. The content was analysed and coded using an iterative thematic analysis approach. Emphasis on Premiumization and Science & Nutrition was the most commonly used marketing approaches. A total of 27.4% of the product description pages sampled used images of infants (

Background Heart‐healthy lifestyles promote lifelong cardiovascular health. However, patients with hypertrophic cardiomyopathy are often advised to avoid strenuous exercise because of the risk of sudden cardiac death. Given these restrictions, this study explored youth and parent perceptions of a heart‐healthy lifestyle and the barriers and facilitators to this lifestyle. Methods and Results Youth and parents were purposefully recruited at 2 Canadian hospitals for this photovoice project. Participants were given cameras and took pictures of everyday heart‐healthy or heart‐unhealthy choices. Photos were discussed during one‐on‐one qualitative interviews with youth and parents separately to understand the photos’ meaning and significance. Inductive descriptive thematic analysis was employed. A total of 16 youth (median age, 14.4 years [range, 10.5–17.7 years]; 63% boys) and 16 parents (100% women) participated. A total of 15 youth were activity restricted. Data analysis revealed 7 categories organized into perceptions of healthy living (health is holistic and individualized) and factors influencing engagement in healthy living (self‐awareness, ownership and autonomy, feeling restricted and peer pressure, support from parents, and support from the cardiologist). Participants had a complex understanding of health and discussed the importance of physical, mental, and social well‐being. Youth used self‐awareness and taking responsibility as facilitators of healthy living. Healthy living was shaped by peers, parent role‐modeling, and cardiologist recommendations. Conclusions This study depicts the realities for youth with hypertrophic cardiomyopathy and can be used to inform the development of responsive interventions. Holistic, patient‐specific interventions may be more successful, and strategies such as shared decision making may be important to promote self‐awareness and autonomy.

Traditionally, the prevention of cancer (and other chronic diseases) has been considered primarily linked to personal responsibility, for which interventions must be based on health education information enabling individuals to make knowledge‐based decisions to improve their lifestyle. However, lifestyle is conditioned by environmental factors (including dimensions such as the context of economics, transport, urbanism, agriculture or education) that may render healthy behavioural choices either easier or, alternatively, impossible. This article reviews the conceptual underpinnings of the behavioural‐structural dichotomy. We believe that it is advisable to opt for multilevel strategies that take into account all the determinants of health, using structural and behavioural approaches, rather than only the latter, as has been done until now.

Abstract Aim To assess the effect of a health promotion course on knowledge and attitudes towards chronic non‐communicable diseases (CNCDs) among undergraduate students in a Jordanian university. Design A one‐group pre‐test–post‐test study design was used. Methods A convenience sample of 178 undergraduate students registered in a 3‐credit health promotion course was enrolled in the study and completed both pre‐ and post‐tests. This course is offered as an elective course for undergraduate students by the Faculty of Nursing at a large public university in Jordan. Twelve, one‐hour interactive sessions regarding CNCDs topics were delivered over 3 weeks as part of the health promotion course. A computer‐based questionnaire was used to evaluate students’ knowledge and attitudes towards CNCDs including diabetes, hypertension and cancer, before and after undertaking the course. Results There was a significant improvement in the overall knowledge (Cohen's d effect size (d) = 1.08) and attitudes (d = 0.62) among all the students, regardless of gender. The overall knowledge and attitudes scores were significantly higher among females in the pre‐test, but the differences in their overall scores became insignificant in the post‐test. Education on specific topics was effective in improving university students’ knowledge and attitudes about health‐promoting behaviours, thereby preventing CNCDs. It is important to incorporate health promotion education regarding CNCDs into university curricula using innovative approaches to enhance healthy behaviours in young adults.

Abstract Perceptions of parenting competence are composed of self‐efficacy and satisfaction with parenting. Parenting competence is linked to differential outcomes across numerous parenting domains. To date, few studies have explored the relationships between maternal self‐efficacy and food parenting practices, deploying different measures and age ranges, and yielding conflicting findings. Therefore, the current study sought to explore relationships between the two dimensions of perceived parenting competence and the use of controlling and positive food parenting practices. UK mothers (N = 269) of 18‐ to 59‐month‐old children completed measures of both dimensions of perceived parenting competence (i.e., parenting self‐efficacy and satisfaction) and of controlling (maladaptive) and positive (health promoting) food parenting practices. Relationships were found between perceptions of competence and use of food parenting practices. Self‐efficacy and satisfaction with parenting were positively associated with the use of most positive food parenting practices. Greater parenting satisfaction, but not parenting efficacy, was associated with lower use of some of the potentially detrimental controlling food parenting practices. Neither parenting self‐efficacy nor satisfaction with parenting were related to mothers' reported use of pressure to eat. In conclusion, supporting and promoting greater maternal self‐efficacy and satisfaction with parenting may be a useful target for public health interventions and for professionals working with families with the aim of promoting optimal parenting to support children's development of healthy eating habits. Future research should seek to further elucidate the current findings with a longitudinal design.

Background: There is wide variation in premature mortality rates in adults with severe mental illness (SMI) across London, with Tower Hamlets (a highly deprived and ethnically diverse area) scoring the highest., Objective: To identify examples of best practice and co-design recommendations for improving physical health checks and follow-up care amongst people with SMI in Tower Hamlets., Methods: Data were collected through online questionnaires (using SMI physical health best practice checklists), one-on-one interviews (n = 7) and focus groups (n = 3) with general practices, secondary mental health services, commissioners and leads of community services and public health programmes, experts by experience and community, voluntary and social enterprise organisations in Tower Hamlets. Data were analysed using deductive and inductive thematic analysis., Results: Twenty-two participants representing 15 general practices (out of 32), secondary mental health services, commissioners and public health leads completed the online questionnaires. Twenty-one participants took part in interviews and focus groups. Examples of best practice included cleaning and validating the SMI register regularly by general practices, knowing the number of patients who had been offered and/or received physical health checks, having clear pathways to community and specialist care services, using various communication methods and having a key performance indicator (KPI) for tailored smoking cessation services for people with SMI. Recommendations included adopting evidence-informed frameworks for risk stratification and utilising the wider primary care workforce with specific training to follow up on results, offer interventions and support navigating pathways and taking up follow-up care. Incentivising schemes were needed to deliver additional physical health check components such as oral health, cancer screening, Covid-19 vaccination and sexual health checks. Including KPIs in other community services' specifications with reference to SMI people was warranted. Further engagement with experts by experience and staff training were needed., Conclusion: The present initiative identified best practice examples and co-designed recommendations for improving physical health checks and follow-up care in deprived and ethnically diverse people with SMI., Patient or Public Contribution: This initiative was supported by three experts with experience, and two community organisations, who were involved in data curation and interpretation, development of recommendations and/or dissemination activities including writing this manuscript., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Abstract Aim To develop and evaluate the reliability and validity of the COSCHN, a scale that aims to measure community orientation among community health nurses in Fiji. Design Descriptive cross‐sectional design. Methods A self‐administered questionnaire that included the 51 items in the preliminary COSCHN was distributed to community health nurses in Fiji from April–July 2016. Results Exploratory factor analysis of 226 responses (77.4% response rate) to the COSCHN revealed 30 items loading on four factors: Community Initiative Promotion, Consensus Building for Community Needs and Activity Goal, Commitment towards Work and Community Members and Mutually Trusting Relationships with Community Members towards Empowerment. Confirmatory factor analysis with high‐order factor modelling revealed a reasonable fit to the data. Cronbach's α values for the COSCHN and the four factors ranged from 0.78–0.94. Weak correlations were noted for concurrent validity, while known‐groups validity and time stability were generally satisfactory.

Abstract Background To increase the influenza vaccination rate in Chiburijima Island, we diversified vaccination places from a single clinic to the seven town halls from all the districts. Methods We retrospectively analyzed influenza vaccination coverage, vaccinees' district of residence, and location of vaccination place, from prevaccination screening questionnaires between October 2007 and March 2018. Except for home‐visiting vaccination services, before 2011, influenza vaccination was provided only at a single clinic; after 2012, it was provided at the seven town halls in addition to the clinic. We calculated the vaccination rates among residents of Chiburijima Island, stratified by age groups and districts of residence. Results Estimated influenza vaccination rates for all ages increased from 38% in 2007 to 58% in 2017. There was a 14% increase in coverage in 2010 (the year following the 2009 H1N1 pandemic) and a slight increasing trend after 2012. The vaccination coverage of residents, particularly of people ≥65 years old and living >1 km from the former vaccination place, increased after diversification of the vaccination place. Conclusions Influenza vaccination rate in Chiburijima Island increased by 20% between 2007 and 2017, although the rate among the elderly Japanese people decreased by 4% based on the national data of routine immunization. Shortening the distance to vaccination places might improve the coverage as elderly people are often restricted due to transportation means. Sustained and multifaceted strategies are necessary for better immunization coverage.

Abstract Aim The interventions based on adopting a healthy lifestyle during pregnancy have conflicting results. This study aimed to compare health‐promoting, dietary patterns and social support in normal and overweight pregnant women. Design An unmatched case–control design was used. Methods A total of 360 pregnant women were selected using multistage cluster sampling and divided into two groups of normal and overweight cases. Data were collected using demographic and obstetrics characteristics, health‐promoting lifestyle, perceived social support and eating behaviour questionnaires. Results The evaluation of the health‐promoting behaviours and dietary patterns demonstrated a significant difference between the mean of total scores and their subdomains including self‐actualization, nutrition, consumption of healthy and low‐fat foods, fast food and sweets, as well as emotional eating and accidental planning. There was no significant difference between the two groups about social support.

Abstract Background Little is known about the prevalence of healthy lifestyle (HLS) discussions between providers and older cancer survivors. Methods We utilized cross‐sectional data from older cancer survivors (≥65 years) seen at 12 southeastern cancer centers during 2013‐2015. Data on demographics, time since diagnosis, weight, height, and healthy behaviors were collected. Respondents were asked if providers (oncologists, other physicians, and/or nurses) discussed exercise, healthy diet, weight management, and/or smoking cessation during clinical encounters. Descriptive statistics and bivariate associations between HLS topics and survivor characteristics were calculated. Results Among 1460 cancer survivors, mean age was 74 years (SD 6), most were white (81%), and >1 year postdiagnosis (84%). The majority (71%) reported discussing at least one of three HLS topics (exercise 49%, healthy diet 53%, vegetable consumption 28%); 17% received counseling on all three. Weight loss was recommended to 33% of overweight/obese survivors and smoking cessation to 85% of current smokers. Oncologists and nurses discussed HLS less frequently compared to other physicians. Younger survivors (65‐74 years) received recommendations for exercise, weight loss, and tobacco cessation more often than older survivors (≥75 years). Compared to white respondents, minorities reported discussions on all topics more often except for tobacco cessation. Excluding tobacco cessation, survivors with recent cancer diagnoses (1 year postdiagnosis. Conclusion Despite the American Cancer Society's recommendations, older survivors reported a low prevalence of HLS discussions with their providers, with some variation by demographic groups. Strategies are needed to promote these important discussions in this population.