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More than a third of women in Nepal have to carry water from source to home to satisfy their families' daily needs. A cross-sectional study was carried out in a hilly area in Nepal to assess water-carrying practices and their association with women's health. Quantitative interviews were conducted with 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water carrying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive physical stress due to water carrying during the dry season. Women suffered from a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk category of water carrying was significantly associated with uterine prolapse (OR = 1.44, 95%CI = 1.12-1.85, p = 0.031) and pain in the hips (OR = 1.69, 95%CI = 1.27-2.26, p

In this mixed-methods study, we will examine the role of self-determination for the improvement of physical activity in older adults. A within-person intervention study with intensive-longitudinal assessment (35 days) is planned where participants (targeted N = 20) formulate a physical activity goal and corresponding implementation intentions. During the intervention period, participants will additionally get an autonomy-supportive intervention consisting of being provided with the opportunity to review and alter their goals and implementation intentions. Before and after the intervention, a subsample of participants will be interviewed regarding their physical activity and acceptability of the intervention.

BACKGROUND Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19, and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and thereby prevent the spread of COVID-19. However, randomized trials during a pandemic are largely absent, wherefore there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. The present study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app to promote hand hygiene in the context of the COVID-19 pandemic. OBJECTIVE The goal was to identify the most effective combination and sequence of three theory- and evidence-based intervention modules (Habit, Motivation, Social Norms) to promote hand hygiene. To this aim, nine versions of Soapp were developed (conditions) and two optimization criteria were defined: i) condition with largest increase in hand hygiene at follow-up and ii) condition with highest engagement, usability and satisfaction based on quantitative and qualitative analyses. METHODS The study design was a parallel randomized trial with nine intervention conditions defined by the combination of two intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants of the Swiss general population (N = 232 randomized). Randomization was performed by Qualtrics and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, assessed via an electronic diary. Secondary outcomes were user engagement, usability and satisfaction, assessed at follow-up. Participants were further invited for semi-structured exit interviews (n = 9). A set of Anovas was performed to test the main hypotheses while thematic analysis was performed to analyze the qualitative data. RESULTS Results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect of time and intervention condition. Likewise, no between-group difference in engagement, usability and satisfaction emerged. Seven themes (e.g., "variety and timeliness of the workload", "social interaction") were found in the thematic analysis. CONCLUSIONS The effectiveness of Soapp in promoting hand hygiene laid the foundations for the next evaluation phase of the app. More generally, the study provided support for the value of digital interventions in pandemic contexts. The current findings evidenced no differential effect of intervention condition of a habit, motivation and social norms module on hand hygiene, engagement, usability and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. CLINICALTRIAL ClinicalTrials.gov: NCT04830761. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2021-055971.

Increasing demands on ecosystems, decreasing biodiversity, and climate change are among the most pressing environmental issues of our time. As changing weather conditions are leading to increased vector-borne diseases and heat- and flood-related deaths, it is entering collective consciousness: environmental issues are human health issues. In public health, the field addressing these issues is known as environmental health. This field addresses both the effects people have on their environment as well as the effects of the environment on people. Psychology, as a discipline concerned with explaining, predicting, and changing behavior has much to contribute to these issues because human behavior is key in promoting environmental health. To date, however, an integrative view of environmental health in psychology is lacking, hampering urgently needed progress. In this paper, we review how the environment and human health are intertwined, and that much can be gained through a systemic view of environmental health in psychology. Based on a review of the literature, we suggest that psychologists unite efforts to promote an integrative science and practice of environmental health psychology, and jointly address environmental-health related behavior. The research agenda for this field will include integrating behavior change theory and intervention approaches. Thereby, psychology can potentially make an important contribution to sustained environmental health for generations to come.

Many women in low-income countries carry heavy loads of drinking water for their families in difficult terrain. This can adversely affect their health and well-being. The present study is the first to investigate the physical burden of water carrying and women’s psychosocial well-being, and how this relationship is moderated by environmental and health conditions. Trained local interviewers conducted interviews with 1001 women across five rural communities in Nepal. In addition, objective measurement was used to assess the weight carried and distance from the water source. The physical burden of water carrying was calculated from weight, distance, and frequency of trips. Its association with psychosocial well-being was modeled using generalized estimating equations. Two additional models included the terrain and uterine prolapse as moderators. The physical burden of water carrying is directly related to higher emotional distress and reduced daily functioning. This correlation was exacerbated for women carrying in hilly versus flat terrain, and for those who had uterine prolapse. Our results underline the importance of adequate water access for women’s psychosocial well-being, especially for vulnerable populations such as women with impaired health (e.g., uterine prolapse) or those living in hilly terrain. The results further highlight the interconnectedness of the Sustainable Development Goal (SDG) 6: water access, SDG 3: health and well-being, and SDG 5: gender equality.

Increasing demands on ecosystems, decreasing biodiversity, and climate change are among the most pressing environmental issues of our time. As changing weather conditions are leading to increased vector-borne diseases and heat- and flood-related deaths, it is entering collective consciousness: environmental issues are human health issues. In public health, the field addressing these issues is known as environmental health. This field addresses both the effects people have on their environment as well as the effects of the environment on people. Psychology, as a discipline concerned with explaining, predicting, and changing behavior has much to contribute to these issues because human behavior is key in promoting environmental health. To date, however, an integrative view of environmental health in psychology is lacking, hampering urgently needed progress. In this paper, we review how the environment and human health are intertwined, and that much can be gained through a systemic view of environmental health in psychology. Based on a review of the literature, we suggest that psychologists unite efforts to promote an integrative science and practice of environmental health psychology, and jointly address environmental-health related behavior. The research agenda for this field will include integrating behavior change theory and intervention approaches. Thereby, psychology can potentially make an important contribution to sustained environmental health for generations to come. published

Long-term management and use of community-based safe water systems are essential to reduce water-related health risks in rural areas. Water sector professionals frequently cite water users’ sense of ownership for the water system as essential for its continuity. This study aims to provide the first insight into users’ understanding of psychological ownership, as well as generalizable data, regarding safe water management in rural Nepal. In this convergent mixed-methods study, we conducted 22 qualitative and 493 quantitative interviews with community members in five districts of Nepal, where spring-fed piped water supplies were previously implemented through a demand-led, participatory planning approach. We analyzed the qualitative data by thematic analysis and modeled quantitative routes to and consequences of psychological ownership in generalized estimating equations. Findings from qualitative and quantitative analyses converged to show that community members’ decision-making, investment of labor and money, and knowledge about the water system were associated with greater psychological ownership. Psychological ownership was related to greater acceptance and responsibility for maintenance and use, as well as greater confidence in functionality of the water system, but not to its actual functionality. The results highlight the potential of psychological ownership and community participation for the longevity of community-based safe water infrastructure.

Recent developments in high- and middle-income countries have exhibited a shift from conventional urban water systems to alternative solutions that are more diverse in source separation, decentralization, and modularization. These solutions include nongrid, small-grid, and hybrid systems to address such pressing global challenges as climate change, eutrophication, and rapid urbanization. They close loops, recover valuable resources, and adapt quickly to changing boundary conditions such as population size. Moving to such alternative solutions requires both technical and social innovations to coevolve over time into integrated socio-technical urban water systems. Current implementations of alternative systems in high- and middle-income countries are promising, but they also underline the need for research questions to be addressed from technical, social, and transformative perspectives. Future research should pursue a transdisciplinary research approach to generating evidence through socio-technical "lighthouse" projects that apply alternative urban water systems at scale. Such research should leverage experiences from these projects in diverse socio-economic contexts, identify their potentials and limitations from an integrated perspective, and share their successes and failures across the urban water sector.