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Clinical social franchising is a rapidly growing delivery model in private healthcare markets in low- and middle-income countries. Despite this growth, little is known about providers' perceptions of the benefits and challenges of social franchising or cli

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Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Unlabelled: There is currently no German version of the Oxford hip score. Therefore we sought to cross-culturally adapt and validate the Oxford hip score for use with German-speaking patients (OHS-D) with osteoarthritis of the hip using a forward-backward translation procedure. We then assessed the new score in 105 consecutive patients (mean age, 63.4 years; 48 women) undergoing THA. We specifically determined: the number of fully completed questionnaires, reliability, concurrent validity by correlation with the WOMAC, Harris hip score, and SF-12, and distribution of floor and ceiling effects. We received 96.6% fully completed questionnaires. An intraclass correlation coefficient of 0.90 and Cronbach's alpha of 0.87 suggested the OHS-D was reliable. Correlation coefficients between the OHS-D and the WOMAC total score, pain subscale, stiffness subscale, and physical function subscale were 0.82, 0.70, 0.68, and 0.82, respectively. OHS-D correlated with the Harris hip score (r = 0.63) and the physical component scale of the SF-12 (r = 0.58). We observed no ceiling or floor effects. The OHS-D appeared a reliable and valid measurement tool for assessing pain and disability with German-speaking patients with hip osteoarthritis.Level Of Evidence: Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

This study investigated the relation of gender role self-concept (G-SC) to cardiovascular and emotional reactions to an ecologically relevant stressor in a sample of graduating male and female university students. Thirty-seven men and 37 women completed the Personal Attribute Questionnaire and worked on four tasks designed to reflect common features of a job interview. Blood pressure and heart rate were measured at baseline, during, and after each task; subjective stress was measured at baseline and after each task. Subjective and objective stress scores were averaged across tasks and analyzed by sex and G-SC (i.e., instrumentality, expressiveness). Results indicated that women as a group demonstrated greater emotional reactivity, but did not differ in their physiological reactions when compared to men. Regardless of sex, participants' instrumentality scores contributed significantly to the variation in subjective stress response: those scoring high on instrumentality reported less stress, but evidenced greater blood pressure reactivity than those scoring low on instrumentality. These results suggest that gender roles, particularly an instrumental self-concept, may play an important role in both subjective and objective reactions to an ecologically relevant stressor. [ABSTRACT FROM AUTHOR]

Background: Sexual and reproductive empowerment (SRE) is an important determinant of women's and girls' health yet measuring it is complex due to cultural and domain-specific variations. This study describes the process of adapting an SRE scale consisting of four domains (self-efficacy; future orientation; social support; and safety) and testing its psychometric properties among Arabic speaking adolescent girls in Lebanon., Methods: An SRE scale developed in a Western context was adapted in four steps: (1) reviewing the scale and selecting culturally appropriate domains for translation to standard Arabic; (2) conducting cognitive interviews with 30 11-17-year-old adolescent girls in Lebanon; (3) administering the scale to 339 refugee adolescent girls who participated in an early marriage intervention; and (4) conducting confirmatory factor analysis (CFA) on the data to assess the scale's psychometric properties., Results: The original model for the 13-item, four-domain adapted scale demonstrated poor fit in CFA. After iteratively removing two items, scale properties were improved, albeit were not optimal. The validity and reliability results for the self-efficacy domain were acceptable. Cognitive interview data revealed that Arab adolescent girls understood self-efficacy in relational terms, recognizing that autonomous decision-making is not necessarily favored but is influenced by parents and family., Conclusions: This study presents an effort to customize an SRE scale for use in studies on the health of adolescent girls in an Arab cultural context. Findings from cognitive interviews highlight the importance of taking into consideration relationality in adolescent sexual and reproductive decision-making. The self-efficacy domain in the adapted scale demonstrates acceptable psychometric properties and is recommended for use in health studies to capture SRE., (© 2024. The Author(s).)

Conflict-affected women and girls living in protracted forced displacement settings are vulnerable to sexually transmitted infections (STIs). Yet, little is known about the risk factors for and lived experiences of STIs in complex humanitarian settings, particularly in the Middle East and North Africa, where STIs have long been understudied. This qualitative study adapts the social ecological model to characterize the multi-level risks for and lived experiences of STIs among Syrian refugee women resettled in an urban refugee camp in Beirut, Lebanon. Adopting a community-based sampling strategy, community health workers, who were refugee women from the camp, recruited and conducted in-depth interviews (IDIs) with 30 adult Syrian refugee women. Data were analyzed using an interpretative phenomenological approach and thematically organized according to the levels of the social ecological model. We identified a confluence of individual, interpersonal, community-based, and societal vulnerabilities to STIs, including extreme poverty and insecurity, patriarchal gender norms, stigma, sexual exploitation and trafficking, poor healthcare accessibility, intimate partner violence, including marital rape, transactional sex, sexual harassment, social isolation, and internalized stigma. Participants described experiencing bothersome symptoms and sequelae of advanced and untreated STIs in the setting of limited access to health services and challenges with engaging their partners in STI treatment, largely due to STI stigma. These novel findings suggest dynamic, interrelated social and health disparities across all social ecological levels influencing refugee women's sexual health, including their risk of STIs. Comprehensive, multi-sectorial interventions, which transcend traditional public health methods and which adopt a sexual well-being approach, are urgently needed to address systemic and intrapersonal violence against refugee women, examine and mitigate the burden of STIs, and ensure sexual justice and health equity in this protracted forced displacement setting., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fahme et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Individuals with cancer are recommended to engage in regular physical activity (PA) even during cancer therapy. The aim of this study was to explore how patient-reported physician PA counseling influences their PA intention and behavior in addition to psycho-cognitive determinants derived from the theory of planned behavior (TPB). A longitudinal study during cancer treatment was conducted among N = 115 patients with breast, prostate, or colorectal cancer (M age  = 58.0, SD = 11.5; 55.7% female). The median time since diagnosis was 2 months, and 19.1% were diagnosed with metastases. Participants provided information on PA counseling by their physicians and on psycho-cognitive variables of the TPB at three measurement points. Additionally, they wore accelerometers for seven days at baseline and three months later. Nearly half of participants (48%) reported basic PA counseling and 30% reported in-depth PA counseling. Patients in poorer health and with lower education reported significantly less in-depth counseling. In addition to patient self-efficacy in performing PA, only in-depth physician PA counseling, but not basic physician counseling, predicted intention for PA four weeks later. Patients' PA three months after baseline was predicted by patients' PA at baseline and their intention for PA. Overall, the PA level at baseline was identified as the most important predictor of PA three months later. Nevertheless, physicians seem to have the ability to increase their cancer patients' intention for PA by in-depth counseling., (© 2023. The Author(s).)

Background and Objectives: Subjective age, that is, how old people feel in relation to their chronological age, has mostly been investigated from a macro-longitudinal, lifespan point of view and in relation to major developmental outcomes. Recent evidence also shows considerable intraindividual variations in micro-longitudinal studies as well as relations to everyday psychological correlates such as stress or affect, but findings on the interplay with physical activity or sleep as behavioral factors and environmental factors such as weather conditions are scarce., Research Design and Methods: We examined data from 80 recently retired individuals aged 59-76 years ( M  = 67.03 years, 59% women) observed across 21 days. Daily diary-based assessments of subjective age, stress, affect, and sleep quality alongside physical activity measurement via Fitbit (steps, moderate-to-vigorous physical activity) and daily hours of sunshine were collected and analyzed using multilevel modeling., Results: Forty-four percent of the overall variance in subjective age was due to intraindividual variation, demonstrating considerable fluctuation. Affect explained the largest share in day-to-day fluctuations of subjective age, followed by stress and steps, whereas sunshine duration explained the largest share of variance in interindividual differences., Discussion and Implications: In our daily diary design, subjective age was most strongly related to self-reported affect as a psychological correlate. We, however, also found clear associations with objective data on daily steps and weather. Hence, our study contributes to contextualizing and understanding variations in subjective age in everyday life., Competing Interests: None., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Sleep problems and stress are common among students and are associated with negative effects on academic performance as well as mental and physical health risks, but studies exploring mediating factors between stress and sleep on a daily basis are scarce. This study aimed to investigate the relationship of daily stress, Bedtime procrastination (BP) (i.e., postponing bedtime without external reasons), and sleep outcomes controlling for trait factors such as self-control. N = 96 students at a German university (M = 22.2 years, SD = 4.0) wore a sleep-tracking wearable (Fitbit Charge HR) for two weeks to assess sleep duration and to calculate the gap between the intended time to go to sleep and the objectively measured time of falling asleep. Stress, intended time to go to sleep, and sleep quality were assessed via daily diaries. Established questionnaires were used to measure trait self-control, trait BP, and smartphone addiction. Multilevel analyses indicated that more stress experienced during the day was associated with more BP (b = 2.32, p = 0.008), shorter sleep duration (b = -3.46, p = 0.003), and lower sleep quality (b = 1.03, p = 0.005) after controlling for several trait factors. The association of daily stress with sleep outcomes (quality and duration) was partly mediated by BP. Our findings indicate that BP might be one factor that contributes to stress-linked decreases in sleep duration and quality. Potential reasons for stress-related later time to fall asleep-like higher physiological arousal or stress-related worries-should be investigated in future studies., (© 2023 The Authors. Stress and Health published by John Wiley & Sons Ltd.)

Mental contrasting with implementation intentions (MCII) has been successfully applied to improve health-related behaviors (e.g. exercise). We explored its effectiveness to improve sleep outcomes beyond effects of sleep hygiene (SH) information, and investigated associations with stress. Eighty university employees (mean age: 29.6, SD = 4.5) were randomized to either a MCII + SH or a SH-only condition. During a baseline-week and a post-intervention week, sleep duration (Fitbit Alta and self-report), sleep quality, and stress were assessed daily and saliva was collected to assess the cortisol awakening response (CAR). In total, self-reported sleep quality and duration increased, but there was no meaningful condition*week interaction for sleep parameters or CAR. Higher average stress was associated with shorter sleep duration and lower sleep quality. Within-person, days with higher stress were followed by nights with lower sleep quality. Despite overall improvements, effects of MCII were not confirmed. MCII might be less effective to improve behaviors which are less controllable.

Street-based sexual harassment is a prevalent but understudied form of gender-based violence that restricts women's access to public spaces. Drawing on adaptations of the ecological model that identify the root causes of gender-based violence in patriarchy, in this study, we explore the causes of street harassment in informal areas of Greater Cairo. Our analysis is based on qualitative interviews and focus groups with male and female youth aged 13-29 years, parents of youth and community leaders in two informal areas. We supplement the qualitative data with descriptive analysis of a representative, 2016 survey of youth in informal areas of Cairo that measured experiences with and attitudes toward harassment. Harassment was prevalent in the study areas, and respondents tended to place the blame for harassment at the individual level of the ecological model, particularly women's behavior. However, there were also community- and societal-level factors that contributed to the prevalence of harassment. Patriarchal norms and stigmatization of women who are harassed reinforced victim-blaming, such that most young women were afraid to report experiences of harassment due to social censure. In this context, educational or awareness raising interventions are unlikely to be effective in combating harassment, which is widely acknowledged to be a problem. Rather, interventions are needed along the different levels of the ecological model to target peer group and community norms that encourage harassment, address harassment in schools and strengthen reporting mechanisms., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: The substitution of an in-study control population with a historical control (HC) population is considered a viable option for reducing the necessary recruitment of control patients. However, it is necessary to evaluate whether this method is applicable to studies on indications targeting endometriosis-associated pelvic pain (EAPP). This study aims to evaluate the potential bias in the results of an EAPP study with an HC arm., Methods: For this case study, we re-evaluated data from a randomised, placebo-controlled trial using dienogest daily to treat EAPP with an HC arm based on data from a second randomised, placebo-controlled trial in the same indication. Propensity Score (PS) matching was used to match between the treatment and HC arm on all baseline variables. To evaluate the effect of matching on the introduced bias, we evaluated efficacy parameters with the full treatment and control group, as well as the matched group., Results: The difference between means (placebo minus treatment) in change in pain, as measured on the Visual Analogue Scale from baseline to end of treatment, deviates in the comparison treatment/pool of HC (7.15 (0.22 to 14.08)) from the overall in-study group (reference: 11.89 (6.06 to 17.73)). After PS matching on the baseline variables, the difference between means (11.79 (4.09 to 19.5)) is close to the reference., Conclusions: Using HC with PS matching has proven to be useful in the setting of treating EAPP, while emphasis must be given to the selection mechanism and the underlying assumptions. This case study has shown that even for studies which are very similar in design, heterogeneity and between-study variations are present. With the use of an HC arm, it was possible to reproduce similar results than in the original study, while the PS matching improved the comparability considerably. For the main endpoint, PS matching could reproduce the original study results., Trial Registration Number: NCT00225199, NCT00185341., Competing Interests: Competing interests: All authors were employees of Bayer AG during the project period. None of the authors have a relevant competing interest to declare., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The pathways through which the COVID-19 pandemic has impacted population mental health are potentially gendered. Little research has explored these pathways in low- and middle-income country contexts, such as in the Middle East and North Africa (MENA) region, where socioeconomic roles are highly gendered. To address this gap, we examine the relationships between pandemic-related socioeconomic changes and subjective wellbeing in the MENA region. Our core hypothesis is that the COVID-19 pandemic affected men and women's subjective wellbeing differently in part because these effects were mediated by gendered socioeconomic roles. We exploit multiple waves of longitudinal, nationally-representative phone survey data across Egypt, Jordan, Morocco, Sudan, and Tunisia. The data were collected between November 2020 and August 2021 and include 32,296 observations of 20,256 unique individuals. Mental health is measured through the WHO-5 subjective wellbeing scale. Our key independent variables capture pandemic-related employment loss, income loss, experience of limitations on food access, enrollment of children in alternative schooling modalities, and receipt of formal and informal transfers. We find significantly worse subjective wellbeing for women in Egypt and Morocco during the pandemic, but not the three other countries. There were negative associations between employment and income loss during the pandemic and subjective wellbeing, but not gender-differentiated ones. In contrast, high levels of limitations on food access were associated with worse mental health for men than women. Receipt of transfers generally did not have any association with subjective wellbeing. Further research is needed into how social assistance programs implemented in response to pandemics may be designed so as to address the negative mental health consequences of such events., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sieverding et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Insufficient sleep is common among teachers and is associated with diverse health risks. This study aimed to predict intention and sleep duration by applying the Theory of Planned Behavior (TPB) and to examine the effectiveness of an implementation-intention intervention to improve sleep duration and quality., Method: Sixty-nine teachers (M = 36.8 years, SD = 10.4) were assigned to an active control group (CG) or intervention group (IG). At baseline, TPB variables were assessed and participants of the IG received instructions to develop implementation intentions to reach the goal of sleeping 8 h on average. During a 3-week intervention period, all participants wore an activity tracker (Fitbit Charge HR) to measure sleep duration and kept diaries to assess sleep quality, physical activity, and stress. After 1 month, a 1-week follow-up, including a booster for the IG, was conducted., Results: Forty-two percent of variance in sleep duration were explained by control variables, past behavior, perceived behavioral control, and intention. Mixed ANOVAS with baseline covariates found a large main effect with longer sleep duration in the IG. A time x group interaction suggested that only the IG slept significantly longer in the follow-up period compared to the intervention period. For sleep quality, a medium-sized main effect for study group was found and a time x group interaction indicated higher sleep quality in the IG for week 3 and the follow-up., Conclusion: The TPB was effective in predicting sleep intention and duration. Implementation intentions accompanied by daily monitoring and a booster appear to be promising for improving sleep., (© 2022. The Author(s).)

Adolescent Syrian refugee girls living in Lebanon are vulnerable to poor sexual and reproductive health (SRH). Sociocultural norms, stigmatization, and limited educational opportunities in the context of forced displacement may impact adolescent girls' SRH. Little is known about how and where girls in this population access SRH information and services. This study aimed to: (1) assess knowledge of SRH topics among a population of adolescent Syrian refugee girls displaced in Lebanon, and (2) determine the association of schooling versus maternal SRH communication with SRH knowledge. A total of 418 11-17-year-old Syrian refugee girls displaced in the Beqaa region of Lebanon were recruited to participate in a cross-sectional survey. Bivariate logistic regression and ordinary least squares regression models were used to examine the associations between schooling, maternal SRH communication, and other covariates with SRH knowledge outcomes. Significant predictors (p<0.2) were included in multivariate analyses. The mean age of girls was 13.4 years. Approximately two thirds of our sample was enrolled in school, with enrollment rates dropping considerably around age 15. In bivariate and multivariate models, older age and participation in SRH programs were predictive of puberty knowledge. One in five girls enrolled in school had learned about menstruation in school, which was associated with higher puberty knowledge in bivariate models. Older age, current school enrollment, and reaching the 8th-11th grade were strongly associated with HIV knowledge. Schooling is more strongly associated with SRH knowledge among adolescent girls than is maternal communication. School-based SRH curricula should be administered on the basis of age and not grade, given significant age-for-grade heterogeneity in this population. Forced displacement and poverty are major barriers to education retention and may have long-term impacts on girls' health., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Fahme et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The goal of our study was to examine the intention to get vaccinated using predictors from the 5C Model of vaccination attitudes, the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM). Between August and November 2020, an online survey was delivered to 1428 participants in the UK and Germany (mean age = 40.6; 57% women), assessing socio-demographic and health factors, general vaccination attitudes, TBP and HBM variables, and COVID-19 vaccination intention. Vaccination intentions did not differ by country or survey period. Predictors of intention with the highest explanatory power in a relative weight analysis were confidence, collective responsibility (5C) perceived behavioral control, social norms, attitudes (especially negative affect & TPB cognitions), and perceived benefits (HBM). Women reported lower intention, although the effect size was small. Predictors from the TPB and HBM were effective to explain the intention to receive COVID-19 vaccines over and above socio-demographic variables, health-related factors and general vaccination attitudes. The results are interpreted in the context of current vaccination campaigns. Messages promoting sense of autonomy and control over the decision to get vaccinated, approval from significant others and reassurance that getting vaccinated will not be associated with fear or other negative feelings are important facilitators of vaccine uptake.

Parental communication during puberty can be a protective factor for adolescents. In Egypt, girls have poor access to sexual and reproductive health services and there is a lack of information on puberty in school curricula. Yet little is known about girls' other sources of information about puberty, including communication with mothers. We analysed 29 in-depth interviews with young mothers of girls in Greater Cairo to better understand mother-daughter communication about puberty. We examine respondents' motivations for communication with their daughters, the type of messages they provided or expected to provide, and barriers to mother-daughter communication, paying particular attention to intergenerational dynamics with respect to how women learn about puberty. We found that while mothers wanted to, and did, play a primary role in communicating with girls about puberty, discussions were constrained by lack of information and embarrassment. Mothers were more open to discussing some aspects of puberty, such as hygiene, than others. Conversations may also be delayed due to social norms about what is appropriate for girls to know and when. Messages were often fear-based and embedded in norms that stigmatised girls' sexuality. Programmes and interventions targeting mothers' knowledge and communication skills around puberty should be adapted and tested in the context of Egypt.

Objective: Evidence on the benefits of physical activity (PA) during cancer has caused a paradigm shift from people with cancer being advised to save energy (rest paradigm) to guidelines recommending them to engage in regular PA (activity paradigm). This study examined the rest and the activity paradigm among people with cancer based on the theory of planned behaviour (TPB)., Methods: A cross-sectional survey was completed by N = 1244 people (58% women; M = 59.95 years) with breast, prostate and colorectal cancer, including 15 items on rest and activity attitudes. To explain the intention to engage in PA, hierarchical regression analyses were calculated., Results: The two-dimensional structure of attitudes (rest and activity) was confirmed. The agreement with the activity paradigm (M = 4.11; SD = 0.78) was higher compared to the rest paradigm (M = 2.56; SD = 0.78, p < .001). The TPB was an appropriate model to explain the intention to engage in PA (R 2  = .59), showing that the activity paradigm, but not the rest paradigm, was significantly associated with participants' intention for PA., Conclusion: Results indicate that the paradigm shift has successfully reached attitudes of people with cancer. Interventions focusing on the benefits of PA rather than addressing rest cognitions promise higher effectiveness in affecting PA levels., Clinical Trial Registration Number: NCT02678832., (© 2022 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.)

Background: Wearables provide new opportunities to promote physical activity also among older adults but data on effectiveness and user friendliness are rare., Objective: The effects of a comprehensive self-regulative intervention on moderate to vigorous physical activity (MVPA) and number of steps were examined using commercially available activity trackers. Acceptance regarding the devices was analysed in various domains., Methods: In this study 80 older adults (mean = 67.03 years, standard deviation = 3.97 years; 59% women) wore a Fitbit Charge HR for 21 days including a baseline, a postintervention and a follow-up week. The intervention comprised feedback, goal setting and planning and 50% of the participants were additionally randomized to a role model component. Social cognitive predictors based on the health action process approach (HAPA) and user experience were assessed via questionnaires., Results: The MVPA increased by an average of 19 min per week and steps by 1317 per day. An additional benefit of the role model component could be observed for MVPA. In the follow-up, the intervention effect was still significant for the number of steps, while MVPA dropped back to baseline. Multilevel models including HAPA variables explained small but significant amounts of variance in MVPA (8% within-person, 26% between-person) and steps (11% within-person, 12% between-person). User experience was rated as very high., Conclusion: Providing an intervention based on established behavior change techniques and self-monitoring via wearables seems to be effective for increasing physical activity among older adults. The HAPA variables seem to play a limited role to explain activity levels. Acceptance of wearables can be expected to be high., (© 2022. The Author(s).)

Background: A better understanding of the role of structural barriers for physical activity (PA) after a cancer diagnosis could help to increase PA among people with cancer. Thus, the present study aimed to identify determinants of structural barriers to PA in people with cancer and investigate the association between structural barriers and insufficient post-diagnosis PA, taking different PA change patterns into account., Methods: A total of 1299 people with breast, prostate, or colorectal cancer completed a questionnaire assessing their socio-demographic and medical characteristics, pre- and post-diagnosis PA, and perceived PA impediment by seven structural barriers. Regression analyses were used to investigate determinants of the perception of structural barriers and to examine the association between structural barriers and insufficient post-diagnosis PA, also with regard to different pre-diagnosis PA levels., Results: Overall 30-60% of participants indicated to feel impeded by structural barriers. The analyses revealed a younger age, higher BMI, lower educational level, no current work activity, co-morbidities, and lacking physicians' exercise counseling as significant determinants of the perception of structural barriers. Individuals reporting stronger impediments by structural barriers were significantly less likely to be meeting PA guidelines post-diagnosis, particularly those with sufficient pre-diagnosis PA levels., Conclusions: The study highlights the need for tailored PA programs for people with cancer as well as for more guidance and support in overcoming structural barriers to improve PA behavior. The study has been registered under NCT02678832 at clinicaltrials.gov on February 10 th 2016., (© 2021. The Author(s).)

Previous research has shown that structural barriers negatively influence the physical activity (PA) behavior of cancer patients, but underlying mechanisms are unclear. The aim of the current study was to explore the potential mediating role of social-cognitive factors, namely PA self-efficacy and PA intention in this context. A total of 856 cancer patients completed a questionnaire on sociodemographic and medical characteristics, pre- and post-diagnosis PA, PA self-efficacy, PA intention, and PA impediment by structural barriers. A serial mediation model was used to test whether the association between structural barriers and post-diagnosis PA was mediated by PA self-efficacy and/or PA intention, in the overall sample and in subsamples defined by individuals' pre-diagnosis PA. The results confirmed that structural barriers were not directly (95%CI [-0.45; 0.10]) but indirectly associated with post-diagnosis PA. Higher impediment by structural barriers decreased the likelihood of sufficient post-diagnosis PA via lower PA self-efficacy (95%CI [-0.25; -0.06]) and via the serial pathway of lower PA self-efficacy and lower PA intention (95%CI [-0.19; -0.05]). Investigating differences in these mediations by pre-diagnosis PA yielded significance only among previously active cancer patients. Both structural barriers and PA self-efficacy might hence be relevant target points for interventions aiming to improve PA behavior, especially among pre-diagnosis active cancer patients.

Implementing and evaluating interventions in humanitarian settings in low- and middle-income countries presents unique challenges that are little addressed in the implementation literature. We document the process of developing, implementing, and evaluating the Amenah pilot intervention that aimed to mitigate the drivers of early marriage in a Syrian refugee community in Lebanon. Adolescent girls' vulnerability to early marriage increases following displacement due to poverty, insecurity, and school disruptions. We delineate how, as a local research team, we triangulated evidence from the international literature and formative community research to make informed decisions during the intervention's design and implementation phases. The pilot was delivered to 203 Syrian refugee schoolgirls aged 11-14 years during the 2017-2018 academic year. It consisted of 16 structured, interactive sessions with girls and a set of facilitated meetings with the girls' mothers, both of which were implemented by trained female community workers from the Syrian refugee community. Process evaluation results showed that sociodemographic factors predicted attendance among mothers, but relationships with peers in the intervention were the only significant predictor of attendance among girls. The primary outcomes of the pilot were attitudinal measures related to education and marriage. Attitudes toward education were highly positive at baseline and did not change over the course of the intervention. There were no significant changes in girls' ideal age at marriage. Among girls aged 13 and older at endline, the mean self-reported expected age at marriage increased slightly from 20.2 to 20.8 years ( P <.05). Our results also suggest that girls may adjust their expected age at marriage downward as they become older and if they drop out of school. We reflect in the discussion on some of the challenges encountered and lessons learned for the benefit of researchers intending to conduct community-based interventions in displacement settings., (© Sieverding et al.)

Aim: We conducted a systematic review and meta-analysis to analyse gender differences in COVID-19 vaccination intentions., Subject and Methods: PubMed, Web of Science and PsycInfo were searched (November 2020 to January 2021) for studies reporting absolute frequencies of COVID-19 vaccination intentions by gender. Averaged odds ratios comparing vaccination intentions among men and women were computed. Descriptive analyses of the studies were reported., Results: Sixty studies were included in the review and data from 46 studies ( n  = 141,550) were available for meta-analysis. A majority (58%) of papers reported men to have higher intentions to get vaccinated against COVID-19. Meta-analytic calculations showed that significantly fewer women stated that they would get vaccinated than men, OR 1.41 (95% CI 1.28 to 1.55). This effect was evident in several countries, and the difference was bigger in samples of health care workers than in unspecified general population samples., Conclusion: This systematic review and meta-analysis found lower vaccination intentions among women than men. This difference is discussed in the light of recent data on actual vaccination rates in different countries., Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-021-01677-w., Competing Interests: Conflict of interestThe authors declare that there is no financial or non-financial conflict of interest., (© The Author(s) 2022.)

Objective: This study examined cancer patients' reporting on physicians' physical activity (PA) counseling, its associations with patients' PA, and comparisons of patients' and physicians' reports of the type(s) of PA counseling provided., Methods: Patients with breast, colorectal, or prostate cancer (n = 1206) participated in a nationwide cross-sectional study. Cancer patients' sociodemographic and treatment-related characteristics as well as self-reported PA levels (pre- and post-diagnosis) were assessed. PA counseling was queried according to the counseling steps of the 5As framework (Assess/Advise/Agree/Assist/Arrange). For a subsample (n = 135), matched patient-physician data were available., Results: Patient-reported PA counseling was categorized into "no counseling" (indicated by 20.8% of participants), "basic counseling" (Assess and/or Advise; 58.8%), and "in-depth counseling" (Agree, Assist, and/or Arrange; 20.4%). "In-depth counseling" was associated with an increase in PA levels pre- to post-diagnosis. This relationship was enhanced for patients with metastases. There were low agreements between patients' and physicians' reporting of PA counseling steps., Conclusion: In-depth PA counseling is rarely provided to cancer patients but seems to be required to affect PA levels. Patients often report receiving less intensive PA counseling than reported by their physician., Practice Implications: Physicians should be enabled to provide routine in-depth PA counseling to all patients with cancer., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)