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Elise Verot,1 Claire Falandry,2 Véronique Régnier Denois,1 Corinne Feutrier,3 Boris Chapoton,1 Jean Okala,4 Sidonie Pupier,4 Vanessa Rousset,4 Françoise Bridet,3 Christine Ravot,2 Catherine Rioufol,5 Véronique Trillet-Lenoir,6 Magali Hureau,7 Franck Chauvin,1 Aurélie Bourmaud8 1University of Lyon, University of Saint-Etienne, Centre Hygée, HESPER EA 7425, Rue de la Marandière, Saint-Priest-en- Jarez, 42270, France; 2Oncogeriatrics Department, Lyon Sud Teaching Hospital & Claude Bernard University, Lyon, France; 3Transversal Unit of Patient Education of Department of Rhône, Hospices Civils de Lyon, Lyon 69004, France; 4Public Health Department, Centre Hygée, Institut de Cancérologie Lucien Neuwirth, HESPER EA 7425, Saint-Priest-en-Jarez 42270, France; 5Pharmacy Department, Lyon Sud Teaching Hospital & Claude Bernard University, Lyon, France; 6Medical Oncology Department, Lyon Sud Teaching Hospital & Claude Bernard University, Lyon, France; 7Department of Clinical Research and Innovation, Léon Bérard Cancer Centre, Lyon, France; 8Clinical Epidemiology Unit, Robert Debré Hospital, AP-HP, INSERM CIC-EC 1426; INSERM 1123 ECEVE, University of Paris, Paris, FranceCorrespondence: Elise VerotUniversity of Lyon, University of Saint-Etienne, Centre Hygée, HESPER EA 7425, Rue de la Marandière, Saint-Etienne 42270, FranceTel +33-682309796Email elise.verot@univ-st-etienne.frIntroduction: A patient education program has been developed in the field of cancer for supporting cancer patients undergoing oral anticancer therapies. Its implementation was tested in 3 different settings. The objectives of this study were to 1) identify barriers and facilitators for implementing the patient education program, 2) identify practices encouraging or hindering implementation and 3) produce recommendations for its dissemination.Methods: Twenty semi-structured interviews were conducted with caregivers from all three establishments.Results: The main factors associated with successful implementation were as follows: prescribers’ representations on patient education, considered of low value; on oral anticancer therapies, considered too dangerous to be handled by the patient him/herself, the indefinite legitimacy of certain professions in charge of patient education programs; patients’ engagement in their care pathway and provision of caregivers.Conclusion: Recommendations include developing patient education culture within the environment of the medical doctors’ curriculum, to consider contextual, pre-existing cooperative units for implementing patient education, to systematically send patients to patient education programs without practicing triage. Successful implementation of patient education critically depends on the prescribing physicians’ perceived value of patient education. Patient education should become mandatory, integrated as part of the cancer care pathway. Physicians lack the necessary time and/or means to assess patients’ capacity for engagement, without adequate strategies for their support. Therefore, physicians should systematically refer all patients to patient education, where nurses can tailor their coaching of cancer patients.Trial Registration: The study protocol was approved by the IRB SUD EST I (N° EudraCT: 2016-A00113-48). All participants were given written and verbal information about the study and gave informed consent to participate.Keywords: oral anticancer therapy, implementation science, patient education, theoretical domains framework

Background: Health literacy is a critical health determinant. To implement initiatives aiming at improving health literacy among children, adapted measurement tools are needed., Objective: This study aimed to translate, adapt, and test the Health Literacy Survey Child Questionnaire-15 (HLS-Child-Q15) to assess health literacy among French-speaking 8- to 11-year-old pupils., Methods: The HLS-Child-Q15 was translated and adapted to the French context to become the HLS-Child-Q15-FR. A cross-sectional survey was carried out using a written, self-reported questionnaire to assess the psychometric properties of the HLS-Child-Q15-FR., Key Results: Translation and adaptation of the HLS-Child-Q15 German-French translated versions were cross-referenced. Back-translation led to minor refinements. Qualitative pre-test among children led to simplifications in wording and structure. Validation of the HLS-Child-Q15-FR. Four trained interviewers collected data among 3,107 pupils in 74 elementary schools of the Auvergne-Rhône-Alpes region. HLS-Child-Q15-FR showed good reliability (alpha = 0.83). Exploratory factor analysis showed a two-factor model related to health care and primary prevention. Construct validity analyses suggested removing 3 items. External validity analyses indicated a significant and moderate relationship with perceived self-efficacy., Conclusion: This study aimed to address the issue of measuring health literacy among French-speaking 8- to 11-year-old pupils. The HLS-Child-Q15-FR showed a high internal consistency. Statistics suggested a two-dimensional thematic scale. These findings should be further investigated. [ HLRP: Health Literacy Research and Practice . 2023;7(3):e144-e153. ].

Background: Young people use digital technology on a daily basis and enjoy web-based games that promote social interactions among peers. These interactions in web-based communities can develop social knowledge and life skills. Intervening via existing web-based community games represents an innovative opportunity for health promotion interventions., Objective: The aim of this study was to collect and describe players' proposals for delivering health promotion through existing web-based community games among young people, elaborate on related recommendations adapted from a concrete experience of intervention research, and describe the application of these recommendations in new interventions., Methods: We implemented a health promotion and prevention intervention via a web-based community game (Habbo; Sulake Oy). During the implementation of the intervention, we conducted an observational qualitative study on young people's proposals via an intercept web-based focus group. We asked 22 young participants (3 groups in total) for their proposals about the best ways to carry out a health intervention in this context. First, using verbatim transcriptions of the players' proposals, we conducted a qualitative thematic analysis. Second, we elaborated on recommendations for action development and implementation based on our experiences and work with a multidisciplinary consortium of experts. Third, we applied these recommendations in new interventions and described their application., Results: A thematic analysis of the participants' proposals revealed 3 main themes and 14 subthemes related to their proposals and process elements: the conditions for developing an attractive intervention within a game, the value of involving peers in developing the intervention, and the ways to mobilize and monitor gamers' participation. These proposals emphasized the importance of interventions involving and moderating a small group of players in a playful manner but with professional aspects. We established 16 domains with 27 recommendations for preparing an intervention and implementing it in web-based games by adopting the codes of game culture. The application of the recommendations showed their usefulness and that it was possible to make adapted and diverse interventions in the game., Conclusions: Integrated health promotion interventions in existing web-based community games have the potential for promoting the health and well-being of young people. There is a need to incorporate specific key aspects of the games and gaming community recommendations, from conception to implementation, to maximize the relevance, acceptability, and feasibility of the interventions integrated in current digital practices., Trial Registration: ClinicalTrials.gov NCT04888208; https://clinicaltrials.gov/ct2/show/NCT04888208., (©Philippe Martin, Boris Chapoton, Aurélie Bourmaud, Agnès Dumas, Joëlle Kivits, Clara Eyraud, Capucine Dubois, Corinne Alberti, Enora Le Roux. Originally published in JMIR Serious Games (https://games.jmir.org), 09.06.2023.)

Background: Innovative methods for smoking prevention interventions need to be investigated to increase attractiveness, access hard-to-reach populations, and increase effectiveness. We studied the feasibility and immediate effects of an intervention to reinforce norms and behaviors of young people related to antismoking, integrated into a popular online community game. Methods: A pilot randomized controlled trial was conducted through the HABBO online community. The intervention group was exposed to repeated discussion sessions with small groups of peer players and two facilitators once a week for 1 month (four sessions), inside the game. The control group had access to antismoking information websites. Process indicators (attractiveness, participation) and immediate outcomes (norms and intentions with regard to smoking) were assessed by questionnaire. Results: One hundred sixteen players were invited to participate in the intervention; 10 did not meet eligibility criteria, 30 were allocated to the intervention group, and 76 to the control group. Median age was 23. Twenty-four percent were not in education, employment, or training. A median of eight players attended each session and the median number of exchange chats by session was 399; 70% of chat time was occupied by the players. Twenty players attended all four sessions. Immediate norms, representations, and intentions were evaluated in 39 players and showed small differences between groups. Conclusion: Delivering and evaluating a smoking prevention intervention in an online game is feasible. In the targeted online community game, the intervention was attractive and allowed the delivery of innovative interventions to audiences with diverse social profiles. Long-term effects, sustainability, and evaluation methodology are discussed.

Introduction: Gathered within the context of the French “Service Sanitaire des Etudiants en Santé” (SSES), the leaders of a local prevention project and the coordinators of the said device have joined forces to propose a course dedicated to media education. Sharing their target population: middle school students, the aim was to put health students in a position to disseminate prevention interventions integrating the potential influence of digital media, in the region’s middle schools., Objective: The present study proposes to evaluate the integration of this media education module into the local SSES., Method: Using the referentialization model developed by G. Figari, we study the relevance of the plan, by combining and comparing the context of the creation of the media education module (MEM) and the strategies of integration into the SESS. The integration mechanism analyzed in the light of the effects produced allows us to address the effectiveness of the tool. Finally, the usefulness and efficiency of the implementation of the module are evaluated by relating the final product to the initial objectives., Results: This study results in a description of the reality of the newly established local system. The cooperation between the SSES team and professionals competent in prevention and health promotion is both a source of opportunities and difficulties&#8230.

Introduction: Sexual health is a major issue for young people, and there is a need to promote it. Sexual health promotion messages may be included in Netflix series that are widely watched by young people, with important emotional dimensions in scenarios., Objective: The aim of this study is to investigate the explicit sexual health promotion messages integrated in Netflix series popular among young people, and to describe them and how they are delivered., Methods: We selected two types of Netflix series, aimed at young people: (1) series whose synopsis is mainly about sexual health and (2) all-subject series. We extracted data from 65 episodes of 6 of the most-watched Netflix series. We used a data extraction grid on EpiData. We analysed sexual health themes and sexual health promotion messages. We described the series and listed all the sexual health and other health themes discussed. For each promotion message, we described scene contents and extracted dialogues., Results: We found 62 promotion messages in the 6 analysed series. The two series that highlight sexual health in their synopsis account for 81% (n=50/62) of these identified promotion messages. Messages mainly focus on sexual harassment and violence (19%), on sexually transmitted infections protection (18%) and on contraception (15%). Messages are mainly delivered as verbal information, and mostly feature 16-18 years old characters in school. Analysis highlighted four main points concerning scenarios in these series: (1) there are different ways to deliver sexual health promotion messages; (2) there is depiction of negative value judgements and gender norms; (3) some information may be incomplete or misleading and (4) risky behaviours are represented., Conclusion: Netflix series incorporate diverse sexual health promotion messages for young people. Further research could assess how these messages are perceived and whether they increase the knowledge, skills and positive health behaviours of young people., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Falls affects one of three people after 65 years old, and it can lead to serious consequences. Scientific evidence point out that physical exercise is the most efficient way to prevent falls among older adults. Objective: The main objective of this study is to determine if a social marketing program can increase the attendance rate of people aged 60 and over at group balance workshops. Methods: This quasi-experimental multicenter study is being conducted in three French Regions (Loire, Haute-Loire and Rhône) over a period of 18 months. The Social Marketing Campaign will be done in three ways. Firstly, a Communication Campaign will take place in the two Test Areas but not in the Control Area. Secondly, flyers have been designed to be distributed by local partners. Finally, conferences for older people will be organized in the areas of intervention in order to reach the target audience for the program. The study will include people aged 60 and older who want to participate in the Balance Program. Results: The Crédit Agricole Loire/Haute-Loire Foundation funded the study and the Jean Monnet University of Saint-Etienne reviewed it. The Ethics Committee of the University Teaching Hospital of Saint-Etienne approved and peer-reviewed it on September 6, 2019, under Reference Number IRBN622019/CHUSTE. Conclusion: The results of this first study will demonstrate whether or not social marketing for promoting group balance workshops in the elderly will increase their attendanceship in adapted physical activity sessions, especially those that prevent falls. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04136938, identifier NCT04136938., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Goethals, Barth, Hupin, Chapoton, Guyot, Celarier, Roche, Gallopel-Morvan and Bongue.)

A television (TV) character's actions and the consequences of these actions in TV storylines can shape the audience's own behavioral intentions, especially if the audience identifies with that character. The current research examines how storylines depicting positive versus negative consequences of drinking affect youths' drinking intentions, and whether post-narrative intervention messages delivered by story characters alter these influences. Results indicate that a post-narrative intervention can correct drinking intentions shaped by a pro-alcohol storyline, but the effectiveness depends on the source: a peripheral character is more effective than the main character at delivering a corrective message. This research pinpoints the role of identification with the main character as a key driver of stories' influence and a key focus of health intervention efforts to correct these stories' potentially undesirable impact on vulnerable audiences.

Social networking sites (SNSs) are invested in heavily by marketers aiming to reach a growing number of consumers. Concerns regarding the influence of posts displayed on SNSs in relation to behaviour were raised, in particular the promotion of ill-health behaviour directed to adolescents who may be at risk from suggestible practices. Although adolescents tend to be critical towards traditional forms of advertising, little is known about their perception of influencing strategies developed online, especially where sponsor- and user-generated content coexist. This exploratory study aims to gather information directly from adolescents about their use of SNSs their awareness of the influence that SNS content may have, particularly when it comes to tobacco and alcohol messages. Ten focus groups were conducted with 39 adolescents (11-16 years old; 56.4% male). Qualitative analysis documents the differences associated with adolescents' favourite SNSs. The different parameters linked to each SNS and the expectation to find entertaining content and values associated with friendship may decrease adolescents' perception of potential risk for health associated with SNS use. Authors advocate for the development of educational programs based on eHealth literacy and the use of social marketing techniques to facilitate and motivate adolescents to develop their competences.

Background: European citizens are the largest alcohol users in the world with an average of 11 l of alcohol per individual per year being used. This consumption practice usually begins during adolescence. Youths' views of substances consumption are built upon socialization experiments from which television takes part. To prevent vulnerable people from media influence, some governments tend to adopt restrictive laws against alcohol marketing within the public space including TV programmes; others rely on the self-control of the alcohol and/or media industry. More than 22 years ago, France adopted a restrictive law made of measures aiming to regulate or prohibit advertising of alcoholic products, especially within media dedicated to minors., Methods: This study relies on a content analysis to identify the patterns and the frequencies of occurrences linked to alcohol within a sample of 14 TV series (8 French series and 6 American series) most watched by French teenagers. In total, 180 episodes have been analysed representing 111 h 24 min and 6 s of series coded., Results: Alcohol is depicted within 87.8% of the sample. French series statistically show more events related to alcohol when compared to the American series. In French series, alcohol, mainly wine, is associated with a familiar lifestyle context with primary characters., Conclusion: The restrictive law ongoing in France does not prevent popular TV programmes watched by minors to depict alcohol. Concerns should be raised about the impact of the values given to the substance integrated to main characters life within the media., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objective: Two studies were conducted to investigate the role of connectedness with music videos in affecting youths' beliefs about substances (alcohol and tobacco) embedded therein and the potential for a prevention message to limit the impact of these images., Method: The first study used cross-sectional data from a national sample of 1,023 adolescents (54.3% male) to evaluate the relationship between youths' consumption of music videos and their beliefs about the consequences of consuming alcohol and tobacco. A controlled experiment with 151 participants (57% male) then tested whether exposure to smoking in a video affects youths' smoking beliefs and the preventive potential of a pre-video warning., Results: Connectedness to music videos, not overall amount of viewing, is the main correlate of beliefs about the positive outcomes of consuming alcohol/tobacco. A single exposure to a music video with smoking images can increase beliefs that smoking leads to positive consequences, and connected viewers are especially receptive to these images. Alerting youths to the presence of substance messages in a video leads to differential results as a function of connectedness., Conclusions: Many youths spend hours every day watching music videos in which positive visuals about drinking and smoking abound. Rather than the quantity of viewing, it is the degree to which youths immerse themselves in these music videos that enhances their beliefs that smoking and drinking have positive consequences. Interventions that warn youths about the presence of substances in music videos can minimize their influence, but youths highly connected with the music video content are especially resistant to warnings.