Migrant populations encounter barriers to healthy lifestyles, increasing their risk for non-communicable diseases (NCDs). A randomized controlled trial with two groups and repeated measures was carried out in four factories in Bangkok to evaluate the effectiveness of a Social Cognitive Theory-Based Self-Efficacy Intervention with LINE Follow-Up on self-efficacy, health promoting behaviours (HPBs), and body mass index (BMI). Sixty registered Myanmar migrants were randomly divided into an experimental group (n = 30) and a control group (n = 30). Measurements were taken at the baseline, Week 3, and Week 8. Data analysis was conducted using a two-way mixed repeated measures MANOVA with a significance level of α = 0.01. The results revealed a significant interaction effect between time and group for all dependent variables [F (6,53) = 11.84, P < .001, ηp2 = 0.57], indicating a significant difference in the trajectory of the three dependent variables between the intervention and control groups. The intervention group showed significantly greater improvements in HPBs [F (2,116) = 5.309, P = .006, ηp2 = 0.08] and BMI [F(1.711,99.232) = 34.846, P < .001, ηp2 = 0.375] compared to the control group over the 8-week period. A Self-Efficacy Intervention with LINE Follow-Up led to significant improvements in self-efficacy, HPBs, and BMI trajectory among Myanmar migrants. The smartphone-based LINE Official Account is a low-cost and practical tool for health promotion that reinforces self-efficacy through verbal persuasion and motivation, and it facilitates sustained HPBs that can influence BMI by continuous and accessible follow-up. This digital health strategy shows promise for enhancing health outcomes in this population and could potentially contribute to a healthier workforce and decreased burden of NCDs in the long term. Contribution to Health Promotion This paper outlines the strategies for supporting the implementation of a Social Cognitive Theory-Based Self-Efficacy Intervention with LINE Follow-Up.Stakeholder engagement is emphasized as crucial for the success of the programme, based on SCT.If the effectiveness of the intervention on HPBs is confirmed, the findings could inform nationwide programmes for migrants, potentially reducing NCDs and healthcare costs.From a health economic standpoint, this study contributes to promoting a healthy workforce in Thailand. The systematic approach used to develop the self-efficacy strategy can be applied to different contexts and interventions.
This study conducted a systematic review and meta-analysis to examine the effect of social support interventions on improving self-efficacy in patients with diabetes. A literature search was performed using Medline, CINAHL, Cochrane Library, and Embase for studies published between January 2014 and December 2023. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes and 95% confidence intervals were calculated using R software. This systematic review and meta-analysis followed the PRISMA guidelines. From 5543 records, this research included six randomized controlled trials involving 1030 adult patients with diabetes. Social support interventions were effective in improving self-efficacy (Standardized Mean Difference = 1.33, 95% CI: 0.48-2.18) with high heterogeneity (I2 = 95%), demonstrating that social support can significantly enhance self-efficacy. This study demonstrates the impact of social support interventions on self-efficacy among diabetes patients. The findings of this systematic review strongly advocate for the prioritization and expansion of social support interventions in diabetes care, underscoring the urgent need for continued and enhanced research in this critical area (PROSPERO registration number: CRD42024566185).
Early childhood education centres are key settings for fostering self-regulation skills related to food through responsive feeding environments. The CELEBRATE Feeding coaching intervention aimed to support early childhood educators in implementing these practices across eight centres in two Canadian provinces. Using the RE-AIM framework, quantitative and qualitative data from coaching logs, pre- and post-intervention surveys, observations, interviews, and a 6-month post-intervention survey were analysed as part of the process evaluation. The intervention reached a diverse range of educators and children, resulting in improvements in responsive feeding behaviours, with observation scores significantly increasing (38.2-45.8 on a 63-point scale, P < .001) from baseline to post-intervention. Interviewed centre staff (n = 37) reported engaging more frequently in responsive feeding practices and observed positive changes in children's food intake and independence. Most surveyed educators (>90%) found the 6-month duration and monthly visits appropriate, with strong support from their coach. Educators valued expert guidance and practical resources and felt motivated and capable in adopting responsive feeding practices. Challenges included communication, scheduling barriers, and educator turnover. Follow-up data indicated that all centres continued key practices, though some barriers remained. Overall, the intervention had a positive impact, though addressing logistical barriers is crucial for long-term sustainability.
To adapt an existing educational resource highlighting the link between betel nut use and oral cancer to improve its relevance for culturally and linguistically diverse (CALD) communities in Victoria, Australia. This study employed a qualitative design, involving semi-structured interviews with 14 individuals from CALD communities residing in Victoria. A review of an existing resource (developed in New South Wales) was facilitated to seek feedback about content, language, relevance, appearance, and dissemination strategies. The collected data was analysed thematically via content analysis. The data analysis highlighted suggestions to refine the resource around simplified language, culturally relevant visuals, prioritization of oral cancer symptoms, and the inclusion of guidance on reducing betel nut use. Community centres and culturally significant venues were identified as effective dissemination channels. These study findings informed the adaptation process and led to a tailored resource for Victorian CALD populations. Cultural adaptation and community engagement are essential for enhancing the impact of public health materials. This study underscores the importance of culturally tailored public health interventions in multicultural nations like Australia. The traditional approach may fail to resonate with CALD populations; however, well-adapted educational materials can improve understanding and encourage effective risk communication in multicultural settings.
Conversational artificial intelligence (AI) is increasingly being used in healthcare to encourage behavioral modification, information dissemination, and patient engagement. However, its effectiveness depends on high-quality, domain-specific training data. General-purpose datasets are often inadequate in terms of clinical specificity and dialog coherence, particularly in sensitive domains like smoking cessation. This study introduces a curated question-and-answer dataset comprising 3000 Q&A pairs from reputable health resources, including expert-authored guidelines and cessation programs. Each entry is annotated with metadata reflecting informational intent, action-oriented content, and user engagement signals, supporting both single-turn and multi-turn conversational modeling. A compact generative language model, Chat Generative Pre-trained Transformer 4o-mini (ChatGPT-4o-mini), was fine-tuned using this dataset and compared against the pretrained base model using BLEU, ROUGE-L, and BERTScore metrics, assessing syntactic accuracy, lexical coverage, and semantic alignment. The fine-tuned model demonstrated improved response clarity, conversational coherence, and adherence to evidence-based content. This study emphasizes methodological benchmarking and model performance rather than behavioral or clinical outcomes, isolating the model-optimization layer to assess how curated, domain-specific training data influence response quality under controlled conditions. By contributing a reproducible pipeline for dataset construction and evaluation, this work supports safe and effective conversational agents in healthcare contexts and promotes responsible AI practices in digital health applications. Statement of significance The success of large language model (LLM)-based conversational agents depends on access to high-quality, domain-specific training data. However, such data is typically absent from models trained on general web corpora. Smoking cessation, as a behavior-change domain with substantial clinical burden and health disparities, requires emotionally attuned and evidence-based messaging to be effective. Rather than introducing a new smoking cessation intervention, this study contributes a reproducible methodological framework for evaluating how curated, evidence-based datasets influence LLM behavior in health education contexts. By isolating the dataset-to-model performance relationship, this work provides a technical foundation that complements prior user-centered intervention studies and supports responsible development of conversational AI systems prior to behavioral deployment. This study contributes a rigorously curated dataset drawn from evidence-based sources, annotated with metadata for motivational framing, tone, and dialogue intent. In parallel, we present a methodology for fine-tuning LLMs and evaluating performance in both single-turn and multi-turn conversational settings.
Through intersectionality theory, this study examines how gender and geographical location interact to shape adolescents' access to health education in centralized systems, using sex education in Chinese vocational high schools as an illustrative case. Drawing on data from 3167 adolescents across regions with varying development levels, we demonstrate how educational institutions reproduce gender hierarchies and geographical inequalities through differential access to sex education. Students in economically developed regions and urban areas show significantly higher odds of receiving sex education, with particularly pronounced effects for girls in developed regions. Gender emerges as the primary determinant of exposure to specific content, with girls consistently showing higher chances of being taught topics like pregnancy, contraception, and sexual behavior. These findings suggest two intersecting forms of disadvantage. Resource-wise, boys in less developed regions appear most likely to be excluded from sustained provision. Norm-wise, girls may be more harmed by how sex education is framed through gendered expectations that treat sexual and reproductive health as primarily their responsibility rather than a shared concern. Together, these patterns illustrate how intersecting dimensions of advantage and disadvantage, alongside underlying patriarchal assumptions, create systematic disparities that reinforce both gender and geographical inequalities.
There is considerable interest in collaborating with social media influencers to promote health messages, but little evidence demonstrating how this might be done in organizations with few resources or experience. We tested the feasibility and cost of partnering with social media nano- and micro-influencers to promote colorectal cancer (CRC) screening messages. We identified 16 US influencers through an online influencer marketing campaign platform. To test if influencers would create theory-consistent content, we provided them with recommended CRC screening information and guidelines for including one of four message strategies (threat, efficacy, threat and efficacy, information only). Influencers created and posted one video promoting CRC screening on their Instagram Reels and Stories, June-July, 2025. Engagement metrics were collected 1 month after posting. The videos were viewed 89 764 times (M = 5610, SD = 5545), and cost $0.13 per view. They did not elicit resistance; comments were 96% positive, 4% neutral, 0% negative, and engagement rates were high (mean = 7.9%). Influencers were largely able to follow written guidance for including theory-based content in their posts. In light of the rise in social media use, including among middle-aged and older adults, partnerships between public health organizations and social media influencers could expand health message reach.
Cannabis is commonly smoked and often co-used with tobacco, yet evidence on interventions to reduce smoking harms for people who use cannabis is limited. We systematically reviewed evidence on the efficacy and effectiveness of health education interventions (aiming to increase health literacy, knowledge, or motivation) in reducing cannabis smoking and tobacco smoking among people using cannabis. We searched five databases (inception-February 2025) for quantitative evaluations of health education interventions targeting cannabis use and reporting cannabis and/or tobacco smoking among people who use cannabis. Evidence from 32 studies was synthesized narratively, with risk of bias assessed using design-appropriate tools. Samples ranged from 15 to 10 781 participants, predominantly adolescents and young adults. Half evaluated interventions to prevent uptake, mostly school-based programmes, which showed mixed impact in reducing cannabis smoking. Half promoted quitting/reduction and provided some evidence that motivational interventions reduced cannabis smoking. Tobacco outcomes were rarely assessed (k = 7) and largely null; risk of bias was high throughout. Overall, school-based preventive programmes showed mixed effects, while motivational interventions more consistently reduced cannabis but not tobacco smoking. Even modest effects may benefit public health, highlighting the need to clarify effective components, delivery settings, and to standardize measures for routes of administration and co-use.
Tuberculosis (TB) health education campaigns often struggle to motivate at-risk populations by employing one-size-fits-all fear appeals without considering how structural barriers shape audiences' ability to respond. Drawing on the Extended Parallel Processing Model (EPPM), this study tested how varying levels of threat and efficacy in TB messages influence information-seeking intentions, with perceived barriers as a moderator. In a 2 (threat: low versus high) × 2 (efficacy: low versus high) between-subject experiment with 225 Chinese participants, results revealed that high-threat messages increased participants' TB information-seeking intentions compared with low-threat messages. In addition, low-barrier individuals responded best to high-threat, high-efficacy messages; moderate-barrier individuals were motivated by high-threat messages even with low efficacy messages. These findings demonstrate that accounting for structural barriers extends the EPPM framework and provide health educators with a practical framework for audience segmentation and message tailoring.
Effective heatstroke prevention depends not only on access to information but also on whether online health materials support understanding and actionable decision-making. However, evidence comparing the quality and presentation of online heatstroke information across countries remains limited. We conducted a quantitative content analysis of 120 publicly available heatstroke-related webpages from Japan, the United States, the United Kingdom, and Australia (30 per country), with one World Health Organization webpage included as a reference. Readability, information volume, credibility, and information presentation were assessed using established metrics, including the Patient Education Materials Assessment Tool for Print Materials. Cross-country comparisons and sensitivity analyses focusing on webpages targeting the general public were performed. UK webpages showed higher readability, whereas Japanese webpages more frequently incorporated visual aids and tools that facilitate preventive actions, resulting in higher understandability and actionability scores. However, actionability did not reach adequate levels in any country. Online heatstroke information differs substantially across countries. While readability improves accessibility, greater integration of visual and action-supporting design elements is needed to better promote preventive action.
States with legalized non-medical cannabis require different warnings on packages and advertisements; yet, studies examining effects of textual warnings and different warning symbols on young adults' perceptions are limited. In 2024, US young adults ages 18-34 (n = 3 579) completed an online survey-based experiment using a 2 × 4 factorial design (textual warning: no, yes; warning symbol: none, leaf, THC, leaf + THC), then reported on 5 perception outcomes: addictiveness, harm, cautiousness, appeal, and interest. Multivariable regressions assessed these conditions and their interactions in relation to outcomes, overall and by past-month cannabis use status. Among participants without past-month use, the THC symbol (versus none) was associated with higher perceived addictiveness (B = 0.32, SE = 0.12), harm (B = 0.23, SE = 0.12), and cautiousness (B = 0.31, SE = 0.13); the textual warning was associated with greater appeal (B = 0.18, SE = 0.09). No effects were found among participants reporting cannabis use. An interaction between textual warning × leaf symbol on perceived harm (B = 0.35, SE = 0.18) indicated that exposure to both the textual warning and leaf symbol decreased perceived harm; exposure to only one (i.e. not together) increased perceived harm. Regulatory bodies must understand effects of different warning requirements, consider requiring the THC symbol, assess potential confusion of the leaf symbol, and explore warnings targeting different subgroups.
This single-site, pilot-scale randomized controlled study intended to evaluate the effects of a self-determination theory-informed (D6 gamification model-based) gamified breastfeeding counselling program on breastfeeding self-efficacy, breastfeeding success, and breast-related problems in postpartum participants. A pretest-posttest randomized controlled trial was conducted with 60 pregnant individuals recruited from a single university-affiliated private hospital in Türkiye, using a pilot-scale parallel group design. Participants were assigned to experimental (n = 30) and control (n = 30) groups by block randomization that was performed by an independent statistician. Due to the behavioural nature of the intervention, participant blinding was not feasible; however, outcome analyses were conducted by a blinded biostatistician. The intervention group received a digitally delivered gamified breastfeeding counselling program from gestational week 35 until week 2 postpartum, while the control group received routine prenatal and postnatal care. Data were obtained for validated measures of breastfeeding self-efficacy, breastfeeding success, and breast-related problems. Descriptive and inferential statistical analyses were conducted with SPSS 28.0 software. At week 2 postpartum, the mean breastfeeding self-efficacy scale-short form scores were significantly higher in the gamified counselling group than the control group (63.6 ± 6.2 versus 54.3 ± 8.4, P < .001, Cohen's d = 1.26). Breastfeeding performance also favoured the intervention group, with higher infant breastfeeding assessment tool scores (8.6 ± 1.1 versus 7.3 ± 1.4, P < .001) and LATCH breastfeeding assessment scores (9.3 ± 0.7 versus 8.4 ± 1.1, P = .002). Furthermore, breast fullness severity that was assessed using a dichotomous self-reported outcome (present/absent) checklist in which higher scores indicate more severe fullness, was lower in the intervention group than the control group (2.5 ± 1.1 versus 4.0 ± 1.2, P < .001). Gamified breastfeeding counselling was effective in enhancing breastfeeding self-efficacy and breastfeeding success and reduced common breast-related problems. These findings provide preliminary evidence supporting the feasibility and short-term benefits of integrating gamification-based strategies into breastfeeding education, warranting larger multicenter studies with extended follow-up.
This study aimed to evaluate the effect of the 'I Can Manage' an interactive web-based program that supports self-regulation under the leadership of nurses, application on self-management, fatigue and anxiety levels in individuals with Multiple Sclerosis (MS). This study is a parallel-group randomized controlled trial. Individuals with MS were randomly assigned to an intervention group (N = 38) and a control group (N = 38). The intervention group used 'I Can Manage' for eight weeks, while the control group did not receive any intervention. Data were collected using the Participant Identification Form, Multiple Sclerosis Self-Management Scale, Fatigue Severity Scale, State-Trait Anxiety Inventory, Program Usage Form, and Web Program Evaluation Form. The study was registered at ClinicalTrials database (NCT05393765). The time x group interaction for the self-management scores was significant and had a moderate effect size in favour of the intervention group (P < .01, pη2 = 0.114), whereas no significant changes were observed in the fatigue, state, and trait anxiety scores. A total of 86.8% of the participants used at least one feature of the program, and 93.9% found it easy to use and understand. 'I Can Manage' improved self-management in individuals with MS but did not lead to significant changes in fatigue or anxiety levels.
The aim of this study is to evaluate the effect of post-discharge education provided via tele-nursing on the quality of life and functional independence levels of elderly patients who have undergone surgery due to a hip fracture. This randomized controlled, pre-test/post-test, single-center experimental study included 30 patients in the intervention group and 30 in the control group, conducted between August and April 2023. The intervention consisted of three online video consultations, three telephone calls, and an educational booklet, while no intervention was applied to the control group. Data were collected using a Patient Identification Form, QoL scale, and FIM. Ethical approval, institutional permissions, and informed consent were obtained. In the intervention group, 56.7% of the patients were female, while 53.3% of the patients in the control group were female (P = .79). The average age in the intervention group was 75.80, compared to 75.87 in the control group (P = .97). After the education, the post-test scores of the vitality and mental health subscales of the QoL scale were higher in the intervention group than in the control group (P < .05). After the education, the intervention group had a higher total FIM score than the control group, mainly driven by improvements in self-care and transfer subscales (P < .05). Post-discharge education provided via tele-nursing to elderly patients undergoing surgery for hip fractures improves their quality of life and functional independence levels. Trial Registration: ClinicalTrials.gov, NCT06257615.
Childhood obesity remains a critical public health concern among Hispanic families in Mexico and the United States. Healthy Change, a brief peer-led programme delivered in childcare centres, was designed to increase mothers' awareness of child weight status and support healthier feeding practices. Embedded within a cluster randomized trial, this qualitative study examined experiences of Mexican and Mexican American mothers in the intervention arm. Four post-intervention focus groups were conducted at intervention sites (n = 25), and transcripts were analysed using inductive content analysis. Mothers reported favourable impressions, emphasizing practical advice, relatable peer facilitators, and a supportive group atmosphere. Many described initial shock or discomfort on learning that their child was overweight, followed by greater recognition of risk and intentional changes in family diet, routines, and opportunities for physical activity. Participants also identified needs for broader content, clearer communication, and some professional involvement to complement peer support. Family encouragement and involvement facilitated change, whereas competing schedules and communication gaps hindered participation. Findings suggest that peer-led programmes in childcare settings are feasible, acceptable, and capable of supporting healthier family lifestyles. Such interventions may offer a resource-efficient approach to strengthening maternal awareness and advancing early childhood obesity prevention in diverse communities.
Churches are promising partners for the delivery of cancer prevention and early detection interventions; few studies have examined pastors' views of offering these programs. This mixed methods study occurred in two phases: (i) pastors (n = 213) were surveyed to assess whether their church offered nine different cancer prevention/early detection programs and rated their perceived importance and feasibility of offering programs; (ii) a subsample of pastors (n = 17) participated in interviews. The Consolidated Framework for Implementation Research guided the development of the survey and the interview guide, and convergent parallel analysis was used to triangulate results. Of the nine programs, physical activity and healthy eating programs were most offered (47% and 40%, respectively). Perceived importance was low for most programs (mean = 2.38 out of 4), but perceived feasibility was moderately high (mean = 3.11 out of 4). The interviews identified prominent subthemes such as internal support, church characteristics, and pastor health interest that further described pastors' perceived importance of programs and factors that impeded program offerings. Perceived feasibility subthemes revealed that while pastors perceived programs to be feasible, many lacked the resources to deliver programs. Public health partnerships with churches can help mitigate resource limitations and improve sustainability of cancer screening and early detection programs.
When engaging communities in vaccine promotion efforts, it is critical to understand who has availability and interest in participating, and how participants experience the process. Guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework, we evaluated an online codesign process with long-term care center staff to design coronavirus disease (COVID-19) booster promotion materials for their colleagues. Twenty-six staff joined codesign teams organized by self-identified race to culturally tailor materials during a cluster-randomized controlled trial with 40 centers in two US states. Data sources included surveys; interviews; screening, enrollment, and attendance data; fidelity assessment; codesigned materials; and focus groups. We report summary statistics and thematic analyses. We found that time constraints could impede enrollment. Most codesigners enjoyed collaborating and identified their individual contributions. Many linked having shared characteristics with their teammates (e.g. race, gender, age) to a feeling of connection. A few reported feeling motivated to engage in booster promotion. The process resulted in messages aligned with known psychological antecedents of vaccination. Considering recruitment challenges and limited participation of direct care staff, organizers should consider shorter codesign processes. Organizing teams based on shared characteristics could promote comfort. Community input should inform codesign structure and team composition to achieve optimum enrollment and engagement.
Public health campaigns on substance use and physical activity aid disease prevention. This review examines how process evaluations are conducted in substance use and physical activity campaigns, focusing on methodologies, theoretical frameworks, implementation quality, fidelity, reach, and delivery. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was conducted across PubMed, PsycINFO, Web of Science, Scopus, ProQuest, and Google Scholar from 1990 up to April 2025. Eligible studies included randomized controlled trials, quasi-experimental, and observational designs involving adult human participants and reporting process or implementation evaluation components. Twenty-one studies met inclusion criteria. A one-step forward citation analysis was performed using the bibliometrix package in R. Findings revealed that 62% of studies reported process evaluation components, with 52% employing mixed-method approaches. Commonly cited theoretical frameworks included the Transtheoretical Model, Theory of Planned Behaviour, and Social Cognitive Theory. Only 20% of studies explicitly defined process evaluation objectives, and few translated findings into actionable implementation adaptations. Bibliometric analysis indicated influence across 373 publications, primarily from the United States, Australia, and Canada. Overall, process evaluation in public health campaigns remain inconsistent. To enhance the quality and utility of such evaluations, greater theoretical integration, improved methodological transparency, and the use of standardized assessment tools are recommended.
This study examined the effect of midwife-led solution-focused approach (SFA) training provided to nulliparous pregnant women on their perception of childbirth as traumatic, self-efficacy regarding vaginal birth, and mode of birth. This randomized controlled trial was conducted with 80 pregnant women (experimental 40; control 40) who presented to a state hospital in Türkiye and were between 28 and 32 weeks of gestation. The experimental group received SFA training delivered by a midwife once a week for 4 weeks. Data were collected using the Descriptive Information Form, Traumatic Childbirth Perception, and Vaginal birth Self-efficacy Scales. Traumatic childbirth perception were significantly lower in the experimental group than control group (P < .001), representing a large effect size (η2 = 0.64). Vaginal birth self-efficacy were significantly higher in the experimental group (P < .001), indicating a medium effect size (η2 = 0.08). Although the vaginal birth rate was higher in the experimental group (32.5%) than control group (17.5%), the difference wasn't significant (P > .05); however, it reflected small effect size (Phi = 0.17). Midwife-led SFA training is effective in reducing traumatic childbirth perception and enhancing self-efficacy for vaginal birth, with tendency towards increased preference for vaginal birth. It is recommended that SFA training be more widely incorporated into obstetric care.
Risk perception is a critical psychological factor that motivates patients with type 2 diabetes (T2DM) to adopt preventive behaviours, and the relationship between health literacy and complication risk perception appears to be influenced by social interaction factors. This study aimed to examine the association between health literacy and complication risk perception, with a particular focus on the mediating roles of patient-provider communication and perceived social support. A total of 533 patients with T2DM were recruited from a tertiary hospital in China and completed questionnaires assessing demographic characteristics, health literacy, patient-provider communication, perceived social support, and complication risk perception. The results indicated that patient-provider communication and social support mediated the relationship between health literacy and complication risk perception. These findings suggest that fostering a positive communication environment and enhancing patients' perceived support from family, healthcare providers, and peers may improve their complication risk perception, thereby encouraging proactive preventive behaviours.
