Objective:To investigate the relationship between rapidly changing emotional states and simultaneously measured heart rate variability (HRV). Methods:Eighty-two healthy subjects underwent a mood induction procedure while ECG recordings were made. The subjects were asked to look at an image for 30 s and then instructed to visualize the image again with closed eyes for 1 min. RR intervals were calculated as the time between two adjacent R-peaks. HRV was calculated by taking the square root of the mean absolute differences between RR intervals for each 10-s segment. This value was then logarithmically transformed. Results:Following a series of validation analyses, the relationship between mood changes and HRV was assessed. A first positively loaded image corresponded with higher levels of HRV compared to a first negatively loaded image. For the second image of opposite emotional valence, no reversal of HRV could be demonstrated. In contrast, the HRV level measured during the first image continued during the visualization phase of the second image. Conclusion:This study provides evidence that experimentally manipulated mood covaries with HRV. However, when mood states change rapidly, the relationship with HRV is not detectable. Several post-hoc explanations are provided. Possible implications for clinical practice are discussed.
Background: Prolonged mechanical ventilation (PMV) imposes emotional, physical, and social burdens on family caregivers, yet limited research focuses on their subjective well-being (SWB). This study aimed to explore the factors associated with SWB among family caregivers of hospitalized PMV patients, guided by the Self-Regulation Model. Methods: A total of 134 family caregivers completed questionnaires assessing SWB, illness representations, sense of coherence, and perceived social support. Results: Path analysis revealed that positive illness representations—such as perceptions of shorter illness duration and effective treatment control—enhanced SWB through higher sense of coherence and perceived social support. Conversely, negative representations, including severe perceived consequences and heightened emotional responses, adversely affected SWB. Symptom burden and illness understanding were not significantly linked to coping resources or SWB. Conclusions: Although we offer a mediation model with cross-sectional data, the findings underscore the role of coping resources as mediators in the relationships between illness representations and SWB. Future longitudinal research is recommended to further support the mediation model suggested in our study. Interventions fostering adaptive illness representations and bolstering coping resources, such as sense of coherence and social support, are recommended to alleviate caregiver burden and improve well-being. These insights offer practical guidance for healthcare providers in supporting caregivers and enhancing outcomes for both patients and families.
Background:Despite extensive evidence of the negative impacts of stigma on sex worker wellbeing, less research explores the link between stigma and reduced access to health care. This paper explores sex work stigma and its association with reduced access to health care among sex workers in Australia. Methods:Sex workers (n = 689) were recruited through sex worker organisations to complete an online survey measuring experiences of stigma and discrimination generally and in health care, including experiences of stigmatising practices known to affect sex workers (e.g. inappropriate comments, offers of unnecessary sexual health checks), as well as reduced access to health care due to stigma. Analyses explored associations between stigma and reduced access to care, controlling for socio-demographic variables, connection to the sex worker community, personal wellbeing, and social support. Results:Most sex workers had experienced stigma in the previous year, with 97% reporting experiencing any stigma and 88% experiencing negative treatment by health workers. Common stigmatising practices experienced by sex workers were inappropriate comments from health workers (70%), health workers diagnosing sex work as the problem (65%), suggestions/advice to leave sex work (65%), and offers of unnecessary sexual health checks (55%). Sex workers reported engaging in strategies to avoid experiencing stigma in health care, including not disclosing their sex work (93%) and looking for alternative health services (91%). Sex workers who had lower personal wellbeing, lower social support, experienced poor treatment from health workers, had greater connection to the sex worker community, and who were older in age reported greater reductions in their health care access due to stigma. Conclusions:Sex workers in Australia face considerable stigma, particularly in health care, which may have significant impacts on their access to care. This study has important implications for informing stigma reduction initiatives targeted at health workers who provide care to sex workers.
Introduction Smoking cessation is a central component of disease management in chronic obstructive pulmonary disease (COPD). Hospitalisation provides an opportunity to initiate smoking cessation support. The present study aimed to explore how patients with COPD perceived the usefulness of smoking cessation support in the context of hospitalisation.Methods Patients receiving smoking cessation support during hospitalisation at the Department of Medicine, Lillebaelt Hospital, Denmark, were invited to semi-structured interviews via telephone one week after discharge. Interviews were transcribed verbatim and analysed inductively using qualitative content analysis.Results Eight patients with COPD (mean age 73 years) were interviewed between January and March 2024. Patients described how their acute respiratory symptoms, the smoke-free environment and the easy access to pharmacological smoking cessation treatment during hospitalisation made smoking both impractical and unreasonable. A respectful, non-judgmental approach to smoking cessation support was emphasised as central to its perceived usefulness and acceptance. One week after discharge, seven patients remained abstinent and reported increased confidence in managing cravings with practical strategies and pharmacological smoking cessation treatment. However, many expressed uncertainty regarding long-term maintenance.Conclusions Hospital-initiated smoking cessation support was perceived as timely and useful by patients with COPD. The combination of the hospital context and a respectful, person-centred approach facilitated early cessation. However, sustained abstinence after discharge was perceived to be challenging.
Background Image schemas are simple mental structures that are formed from the body’s interaction with the physical environment. One of the leading theories in this area is the one proposed by Mark Johnson. The aim of this study was to identify, classify, and quantify image schemas employed by psychotherapists during cognitive-behavioral therapy sessions with patients diagnosed with Generalized Anxiety Disorder and to explore the conceptual organization of therapeutic discourse through Johnson’s image schema framework.Methods This study employed a qualitative cognitive discourse analysis approach, supplemented by descriptive statistical methods. Data collection was done through audio recording of psychotherapy sessions of 16 patients with generalized anxiety disorder based on cognitive-behavioral therapy approach. The sampling method was purposive. Then, the conversations of the treatment process have been investigated based on the frequency and types of image schemas used in the discourse.Results A total of 2,057 cognitive schemas were identified throughout the therapeutic conversations. Among these, 1017 schemas with an average of 49.44% related to types of force schemas, 557 schemas with an average of 27.08% related to types of path schemas, and 483 schemas with an average of 23.48% related to types of containment schemas. A chi-square goodness of fit test and pairwise Z-tests for proportions were conducted to assess whether these differences were statistically significant. The results showed that force schemas were used significantly more than other types.Conclusions The results of this study suggest that integrating Johnson’s theory of image schemas with cognitive-behavioral therapy may offer a complementary conceptual framework for understanding how anxious patients might reframe their negative thoughts and underlying mental models.
Background:Adjustment disorder (AjD) is defined in ICD-11 by core symptoms of preoccupation and failure to adapt in response to a clearly identifiable stressor. Disorder-specific instruments, including the self-report questionnaire Adjustment Disorder - New Module 20 (ADNM-20) and the Composite International Diagnostic Interview - Module Adjustment Disorder (CIDI-AD), have been developed to operationalize these core features. However, it remains unclear to how consistently triggering events are identified across different assessment approaches. The present study aimed to identify the most frequent triggering events associated with AjD symptoms in psychosomatic rehabilitation and to examine the concordance of stressor identification across assessment approaches. Method:The ADNM-20 was administered to a clinical sample of psychosomatic inpatients (N = 2063). The CIDI-AD interview was conducted with a random subsample (n = 373) on the same day or the following day. Stressor categories (work, own illness, family, illness/death in family, other) were coded to enable comparison of stressor categories across instruments. Results:Work-related problems were the most common triggers in both instruments, followed by own illness. Approximately half of the participants (≈ 49%) reported different primary stressors in the questionnaire and the interview. On average, participants reported nine stressors in the ADNM-20 (range 1-19 events) and five stressors in the CIDI-AD (range 1-19 events), indicating that many individuals in psychosomatic rehabilitation experience multiple concurrent stressors. Conclusion:The findings indicate that stressor identification varies substantially across assessment methods in psychosomatic rehabilitation settings. The frequent occurrence of multiple, overlapping stressors suggests that AjD-related symptoms may not always be attributable to a single dominant event. These results underscore the importance of considering cumulative stress exposure in AjD assessment and highlight the need for future research to clarify how the ICD-11 single-stressor assumption applies in populations with concurrent stressors.
Introduction:Depression and occupational burnout are prevalent mental health challenges in working-age populations and are linked to adverse health behaviors, with these concerns particularly relevant among individuals with obesity. Although prior research suggests associations with eating behaviors and physical activity, most studies rely on cross-sectional designs, leaving the temporal and potentially bidirectional relationships between mental health and health behaviors unclear. Methods:This longitudinal study examined bidirectional associations between depressive and burnout symptoms, eating behavior, and physical activity among occupational health clients with obesity (N = 110; BMI 30-40 kg/m2) participating in a 12-month behavioral intervention. At baseline, the mean age was 50.8 years and mean BMI 34.2 kg/m2; 17% were male and most were white-collar workers. Assessments at baseline, 6, and 12 months included depression (BDI-21), burnout (BBI-15), eating competence (ecSI 2.0), dietary behaviors (TFEQ-R18), and physical activity (BHPAQ). A random-intercept cross-lagged panel model (RI-CLPM) was used to examine within-person longitudinal associations. Results:Higher depressive symptoms predicted subsequent decreases in eating competence and increases in emotional eating, although the depression-emotional eating association was derived from a traditional CLPM rather than an RI-CLPM model due to convergence issues. Elevated burnout symptoms predicted subsequent increases in emotional eating and decreases in physical activity. In addition, emotional eating predicted later burnout symptoms. No longitudinal associations were observed between depression and physical activity, or between depression or burnout and uncontrolled eating. Discussion:Elevated depressive and burnout symptoms may predispose individuals to less healthy behaviors, potentially limiting the effectiveness of health interventions. These findings highlight the interplay between mental health, eating, and physical activity, suggesting that addressing psychological distress in behavior change programs may improve outcomes for individuals with elevated depression and burnout. Clinical trials:gov NCT04785586; RR2-10.1016/j.conctc.2020.100638.
Background:The Patient Roles and Responsibilities Scale (PRRS) measures the impact of cancer and treatment on 'real world' functioning such as caregiving and financial responsibilities. It was developed and validated in advanced cancer but with the intention to be sufficiently generic and appropriate for use in all cancers and stages. Here we further investigate the psychometric performance of the PPRS when completed by people three years after cancer diagnosis, treated with curative intent. Methods:This is a secondary analysis of data collected during the HORIZONS Programme, a prospective longitudinal cohort study of the impact of cancer and treatment on everyday life. Data analysed were from the 36-month timepoint and included the PRRS alongside the Work and Social Adjustment Scale, the Quality of Life in Adult Cancer Survivors and the EORTC QLQ-C30. Internal consistency was assessed using Cronbach's alpha, criterion and convergent validity through correlation with other quality-of-life measures, and construct validity using confirmatory factor analysis (CFA). Results:Data from 1077 participants (453 breast, 388 gynaecological, 236 non-Hodgkin lymphoma) were included in the analysis. Cronbach's alpha was 0.91 for the PRRS-16 and 0.69-0.92 for the subscales. The measure showed the predicted pattern of correlation with validation measures r = |0.58-0.82|. All CFA goodness-of-fit criteria were met, indicating an acceptable fit for the three-factor model, though correlations between factors were stronger than expected. Conclusion:This study provides further evidence of the reliability and validity of the PRRS and its performance and appropriateness for use in cancer groups other than those previously validated.
Introduction:Physical activity (PA) is known to mitigate risk for cardiovascular disease (CVD) and improve overall well-being, though many women do not meet national PA guidelines. Menstrual-related symptoms and related biopsychosocial fluctuations may be a key, but often overlooked, determinant of daily PA behavior. Traditional methods of assessment are limited in their ability to capture such dynamic experiences within-person. Methods:Using a 45-day intensive assessment protocol, Project PACE is designed to overcome the limitations of existing approaches, to examine temporal associations between menstrual symptoms, PA, and related experiences (e.g. sleep) among insufficiently active women with at least one CVD risk marker. Participants (N = 60) will self-report menstrual symptoms, PA, PA-related cognitions, and other daily health behaviors twice per day via electronic surveys, and wear a Fitbit Inspire device for continuous assessment of PA and sleep. Primary analyses will use multilevel models to examine within-person associations between daily menstrual cycle symptoms and PA behavior, while exploratory analyses will examine potential mechanisms and sources of heterogeneity in these associations. Results:We hypothesize that (1) PA behavior, menstrual experiences, and cognitive PA determinants (e.g. motivation, intentions, self-efficacy) will be highly variable within-person, reflecting low stability across days, and (2) on days when participants experience more intense symptoms relative to their typical levels, they will report lower motivation, intentions, and self-efficacy for PA. Discussion:The goal of this study is to clarify these associations among women ages 18-50. This information will be useful for informing improvements to personalized and adaptive PA interventions for women.
Background:Test anxiety (TA) is common among medical students and may adversely affect mental well-being and academic performance. However, existing instruments such as the Test Anxiety Inventory (TAI) predominantly quantify the severity and manifestations of anxiety (outcomes) rather than identifying modifiable, intervention-relevant antecedents (predictors). This study aimed to develop and validate the Test Anxiety Predictors Inventory (TAPI) to support concurrent identification of at-risk students and to inform domain-specific, targeted interventions in resource-constrained medical training settings. Methods:A cross-sectional census survey was conducted at Can Tho University of Medicine and Pharmacy (Dec 2024-Mar 2025; 382/389 valid responses, 98.2%). A 30-item pool was piloted in 71 students, then refined through iterative EFA (3 rounds; ML extraction, Direct Oblimin) and CFA (ML and DWLS estimators). Internal consistency, convergent and discriminant validity, correlation with TAI, and concurrent classification performance (multivariable logistic regression; ROC-AUC) were assessed. Because census sampling yielded one dataset, EFA/CFA reflect internal testing pending external validation; 'prediction' denotes concurrent classification, not temporal forecasting. Results:TA prevalence (TAI ≥ 48) was 67.0% (95% CI 62.15-71.54). The final 14-item TAPI loaded on three factors-EAS (7), AMF (4), SRP (3)-explaining 77.99% of variance (KMO = 0.935). The correlated three-factor CFA showed good fit (CFI = 0.957; RMSEA = 0.083). The second-order DWLS model showed excellent fit but produced a Heywood warning with negative latent variance for EAS; the correlated three-factor model is therefore the more defensible representation. Reliability was high (α/ω = 0.89-0.95; CR = 0.92-0.96; AVE = 0.74-0.82; HTMT < 0.85). TAPI-TAI correlation was r = 0.576; classification model AUC = 0.804, sensitivity = 0.938, specificity = 0.452. Conclusions:TAPI shows promising internal structure and concurrent classification performance. High sensitivity supports first-stage screening, while modest specificity indicates it should complement, not replace, formal diagnostic procedures.
Introduction:Breastfeeding is a key early-life primary prevention behavior; yet, despite consistent recommendations and recent improvements, exclusive breastfeeding rates remain well below target levels. This preregistered longitudinal randomized controlled trial (RCT) tested the effectiveness of two resource-efficient digital communication interventions. Methods:Women in the 36th week of pregnancy (N = 467) were randomly assigned to one of six conditions in a 2 × 3 between-participants design. The first intervention consisted of informational messages targeting components of the extended Theory of Planned Behavior (TPB). The second intervention was a drip communication campaign delivered via mobile phone messages: participants in the tips condition received messages aimed at increasing practical breastfeeding knowledge and skills, whereas participants in the implementation intentions condition were additionally prompted to formulate specific if-then plans. Control groups received messages related to healthy eating and physical activity. Participants were followed up until 5 months postpartum. Results:The TPB-based intervention exerted indirect effects on both full and any breastfeeding duration by increasing breastfeeding self-efficacy and perceived behavioral control, which in turn enhanced exclusive breastfeeding intentions. For full breastfeeding only, the intention-behavior relationship-and thus the indirect effect of the TPB intervention-was strengthened by both the tips and implementation intentions interventions. Higher levels of self-objectification indirectly reduced breastfeeding duration through weaker identification as a breastfeeding mother and lower intentions. Discussion:Delivering simple, resource-efficient digital communication interventions that empower mothers and support the translation of intentions into sustained behavior represents a scalable strategy to promote exclusive breastfeeding.
Background Medication adherence is a vital element in the management of chronic diseases such as asthma, yet nonadherence remains a persistent challenge, particularly in regions with suboptimal health literacy (HL) levels. In the Middle East, where asthma prevalence is substantial, the association between asthma-related numeracy and adherence behaviors has not been sufficiently studied. This study aimed to assess the association between asthma-related numeracy, as one aspect of health literacy, and adherence to prescribed treatments among adult asthmatic patients. Methods A cross-sectional survey was administered to 400 adults with physician-diagnosed asthma attending a pulmonary clinic at a major Jordanian hospital. Asthma-related numeracy was measured using the Arabic Asthma Numeracy Questionnaire (Ar-ANQ), while adherence was assessed with the MARS-5 scale, with total scores >= 24 classified as high adherence. Asthma control was assessed using four symptom-control items. Logistic regression models estimated the odds of high adherence after adjustment for sociodemographic, medication, clinical, and numeracy-related variables. Results A total of 45.3% of the patients were classified as having high adherence. Higher Ar-ANQ scores were significantly associated with higher odds of high adherence (OR = 2.924, 95% CI: 2.249-3.801, p < 0.001). Low income (OR = 0.289, p = 0.001) and older age (OR = 0.966, p = 0.021) were significantly associated with lower odds of high adherence, while lower educational attainment showed a borderline association (OR = 0.518, p = 0.067). Conclusion Inadequate asthma-related numeracy was associated with lower adherence in Jordanian adults. Addressing disparities tied to age and income, while using numeracy-sensitive communication, may support medication adherence and asthma management.
BackgroundWeight stigma - bias, prejudice, and discrimination based on weight - affects engagement in physical health behaviours in Western populations. Effects on individuals from South Asia, particularly India, are less well understood.ObjectiveThis study examined whether weight stigma is associated with young Indian adults' engagement in physical health behaviours and explored potential moderators and mediators.Methods781 adults (18-26 years) completed an online survey. Multiple regression analyses assessed whether experienced (EWS), anticipated (AWS), and internalised (IWS) weight stigma is associated with engagement in physical health behaviours while controlling for self-reported BMI, gender, age, and income, whether effects were mediated by stress and self-esteem, and moderated by perceived weight status and BMI.ResultsEWS, AWS and IWS were significantly associated with greater engagement in unhealthy and extremely unhealthy weight control behaviours, alcohol consumption, and binge eating with and without loss of control. EWS was also associated with greater cigarette use. AWS and EWS were associated with lower physical activity. While stress more consistently mediated the relationship between weight stigma and health behaviour, self-esteem emerged as a novel mediator. Perceived weight status was a more consistent moderator than BMI.DiscussionThis is the first study to provide evidence that weight stigma is associated with greater engagement in unhealthy behaviours and less engagement in healthy behaviours in young Indian adults. Mediation by stress supports COBWEBS and the Weight-Based Social Identity Threat Model, while self-esteem emerged as a novel mediator. These findings offer insights into mechanisms linking weight stigma to physical health behaviours and the impacts of weight stigma within a non-Western setting.
Background The occurrence of depressive symptoms among adolescents presents a significant public health challenge. However, little is known about the influence of lifestyle changes on depressive symptoms among adolescents after the cancellation of the zero-COVID policy in China. This study aims to examine the associations between clusters of lifestyle behaviors and depressive symptoms among Chinese adolescents during and after the zero-COVID policy period.Methods A school-based 2-year longitudinal study was conducted from September 2022 to October 2023 in Ningbo, Zhejiang Province, China. Depressive symptoms were assessed using the 20-item Center for Epidemiological Studies Depression Scale. Two-step cluster analysis was used to identify clusters based on adolescents' levels of moderate-to-vigorous physical activities, screen-based sedentary time, sleep duration, and consumption of sugar-sweetened beverages and deep-fried food in each period. A binary generalized linear model (GLM) regression was used to estimate and examine associations between lifestyle clusters and depressive symptoms.Results A total of 2705 adolescents aged between 10 and 19 years were included in the analysis. The prevalence of depressive symptoms in the zero-COVID policy period was lower than that in the post-zero-COVID policy period (20.00% vs. 25.21%, p < 0.01). Five lifestyle clusters were recognized in each time period.Conclusions In general, unhealthy lifestyle clusters were associated with a higher likelihood of depressive symptoms, with the association being stronger and more significant in the post-zero-COVID policy period. Effective interventions for adolescents' lifestyle behaviors, such as health education programs, are needed to reduce long-term negative effects on their mental health in the post-pandemic period and potential future pandemics.
Background Efficacious messaging campaigns are essential for increasing vaccine uptake, particularly in communities with low coverage and heightened hesitancy. A major barrier to equitable vaccination is the lack of culturally responsive messaging that reflects the values and experiences of underserved minoritized populations. Despite growing recognition of cultural responsiveness, few studies offer systematic, theory-informed approaches to message design, implementation, and validation. To address this gap, we propose a four-phase framework that explicitly centers culture and behavioral theory into vaccine messages, with the goal of improving relevance, resonance, and effectiveness among marginalized groups.Methods Grounded in a design science approach, the framework comprises four integrated phases across seven sequential steps. Phase 1 involves formative research comprising an environmental scan of public health messaging (Step 1) and a systematic review of message efficacy studies (Step 2), as well as focus groups assessing the cultural responsiveness of existing messages (Step 3). Phase 2 includes belief elicitation through open-ended surveys to identify key factors influencing vaccine decisions (Step 4). Phase 3 uses quantitative methods to examine belief-based correlates of vaccination hesitancy and intentions (Step 5). Phase 4 applies findings from earlier phases to develop culturally informed message prototypes, assessed for appropriateness through focus groups (Step 6) and evaluated in a feasibility trial using a pre-post design (Step 7).Conclusion This four-phase framework offers a rigorous, replicable approach for developing theory-driven, culturally tailored health messages. It is intended for future vaccine communication initiatives and can be adaptable to other health behavior contexts and diverse minoritized populations.
Background Resilience is critical to the health and well-being of last-mile adolescent girls and young women (AGYW) who work in artisanal and small-scale mining (ASM) communities. The COVID-19 pandemic exacerbated the health and economic challenges that AGYW in ASM communities experience. Despite a growing focus and discussion of adolescent resilience in the literature, there is a continued gap in information on the experience of last-mile or hard-to-reach adolescents, such as those in ASM communities, and their resilience. This paper aims to understand adolescent resilience in ASM communities in Uganda and Ghana and identify contributing factors.Methods This study employed quantitative analysis of survey responses from 1618 AGYW in Ugandan and Ghanaian ASM communities. Survey questions focused on resilience and were adapted from the Brief Resilience Scale (BRS). Responses were analyzed (descriptive, bivariate, logistics regression) using STATA and BRS scoring to indicate low and normal/high resilience.Results Across AGYW in both Ghana and Uganda, an average of 57% had a normal/high resilience score and 43% had a low resilience score. Variables that were significantly related to normal/high resilience (p value equal to or less than 0.05) included residence in Ghana, AGYW 18 years or above, completed secondary education, were migrants, were employed by their parents or other relatives, received fair payments, had savings, drank alcohol, did not experience physical violence or a combination of physical and sexual violence, and had monthly incomes higher than $70.Conclusions Findings correlate with existing literature on resilience amongst adolescents. Targeted resilience interventions with the AGYW in ASM have the potential to break cycles of vulnerability and should focus on savings and financial literacy, along with advocacy for mitigating sexual and gender-based violence and enhancing girls' rights to continue to build resilience. Long-term multi-stakeholder collaborations are key to building resilience within ASM communities.
Background Early childhood education and care (ECEC) teachers in Japan experience high levels of occupational stress, placing them at significant risk of burnout. While organizational support has been explored concerning burnout, limited research has examined the role of psychological safety as a mediating factor in this context.Objective This study investigated the mediating role of psychological safety in the relationship between occupational stress and burnout among ECEC teachers in Japan.Methods A longitudinal data survey was conducted in early May 2023 (Time 1) and late March 2024 (Time 2), with 500 participants completing both surveys. Measures included the Brief Job Stress Questionnaire (Time 1) and Japanese versions of the Burnout and Psychological Safety Scales (Time 2).Results Covariance structure analysis revealed that quantitative job overload had a direct positive association with only emotional exhaustion. Higher job control was associated with lower levels across all dimensions of burnout and was partially mediated by psychological safety. Supervisor support had a direct negative association with only reduced personal accomplishment, while having a significant indirect association with all burnout dimensions through psychological safety. The association of coworker support with burnout was fully mediated by psychological safety.Conclusion These findings underscore the critical role of psychological safety in the relationship between occupational stress and burnout. Notably, they suggest that interventions to enhance psychological safety may effectively prevent burnout among ECEC teachers.
Background Vaccine hesitancy and public adherence to health measures remain critical challenges in Slovakia, where coverage of COVID-19 vaccination has been low, and parents’ decisions regarding vaccination of their children further illustrate variability in immunization uptake.Methods This study investigates how Slovak adults (N = 505) differ in their perceptions of vaccination, compliance with restrictions, and health literacy. Using Latent Class Analysis, we identified three distinct population segments that reflect both internationally recognized typologies and the unique sociocultural context of Slovakia.Results Our findings indicate that health literacy is an important characteristic distinguishing population segments with different vaccine-related beliefs and behaviours. Individuals with higher health literacy demonstrated greater confidence in vaccination and more autonomous, informed decision-making, whereas those with lower literacy relied more on external authority and restrictive measures.Conclusions These results highlight the importance of tailored public health communication strategies that prioritize clarity, accessibility, and credibility, alongside interventions that combine education and community engagement. By targeting health literacy, policymakers can potentially reduce vaccine hesitancy and foster sustainable trust in health systems. Future research should explore longitudinal and mixed-method approaches to examine causal mechanisms and the dynamic interplay of literacy, trust, and social influence over time.
Background Falls Management Exercise (FaME) programmes improve physical function and reduce falls rate and risk in older adults, but after completion exercise engagement declines, leading to loss of the health benefits gained. This study aimed to co-design an exercise maintenance intervention for older adults exiting FaME programmes, addressing the critical need to sustain physical activity benefits after programme completion.Methods A three-stage co-design process: Stage 1 involved community-based stakeholder consultations with older adults completing FaME and rehabilitation professionals (n = 16) to identify acceptable intervention components. Stage 2 consisted of professional stakeholder consultations (n = 11) to assess feasibility. In Stage 3, the Normalisation Process Theory guided development of implementation procedures with service-providers (n = 2). Data were analysed using descriptive statistics and thematic analysis.Results Community-based stakeholders identified core components: information on local physical activity opportunities (88%), motivational strategies (81%), follow-up group meetings (69%), and health education (63%). Professional stakeholders confirmed unanimous agreement for motivational strategies and health education. Concerns emerged regarding affordability of follow-up meetings for service-providers and equity of digital interventions. Follow-up phone calls, text message reminders, self-completed functional fitness assessments and exercise snacks in face-to-face sessions emerged as additional components.Conclusion KESS is a rigorous, co-designed, stakeholder informed intervention targeting exercise maintenance in older adults after FaME ends. KESS aims to prevent a decline in exercise adherence and consequent increasing risk of falling, observed in FaME programme attendees >6 months after programmes end if appropriate activity is not maintained. KESS is ready for feasibility and acceptability testing.
Purpose:Social participation and post-traumatic growth (PTG) both exert beneficial effects on well-being of patients receiving maintenance dialysis. However, the temporal directionality of their association has remained unexamined. This study aimed to examine the bidirectional, longitudinal relationship between PTG and social participation over 1-year period among patients receiving maintenance dialysis. Methods:Research data were collected from patients receiving dialysis treatment for over 3 months at two tertiary hospitals in China. A total of 193 participants completed the baseline survey, and 147 completed the second-wave survey. Self-reported questionnaires were delivered to assess their PTG and social participation. Cross-lagged analysis was used to examine the possible relationship between PTG and social participation. Results:After adjusting for confounding factors, a unidirectional linear relationship was observed: higher levels of PTG at baseline were associated with greater social participation over time (β = 0.290, 95% CI: 0.151-0.430, p < 0.001), whereas baseline social participation was not significantly associated with subsequent PTG. Conclusions:This study revealed low levels of social participation among patients receiving maintenance dialysis. Based on the cross-lagged analysis, PTG appears to play a contributing role in improving social participation over time.
