Introduction: This study evaluates the usability, accessibility, and ergonomic design of six widely used Iranian mobile banking applications for older adults (aged 60 and above) to enhance digital inclusion and promote healthy aging through improved financial access. Methods: An explanatory sequential mixed-methods approach was utilized, integrating quantitative usability testing with the System Usability Scale (SUS) and qualitative heuristic evaluation using the Smartphone's Usability Heuristics (SMASH) framework. Five HumanComputer Interaction (HCI) experts evaluated the applications in a controlled lab setting, while 1,200 older adults from diverse backgrounds participated in usability testing and semi-structured interviews. Statistical analysis involved ANOVA with post hoc Least Significant Difference (LSD) tests to compare SUS scores across applications and age groups, complemented by thematic analysis of qualitative data. Results: Heuristic evaluation identified 135 usability issues, with error prevention (mean severity: 2.27) and visibility of system status (mean severity: 2.22) being the most critical. SUS scores varied significantly (F(5, 1194) = 42.36, P < 0.001), ranging from 27.50 (SD = 7.18) for Bank E to 59.02 (SD = 7.94) for Bank A. Younger older adults (60-63 years) reported higher SUS scores (M = 54.2) than those aged 72-75 (M = 45.3, P < 0.001). Qualitative findings highlighted cultural mismatches and cognitive overload as key barriers. Conclusion: Poor usability in mobile banking apps widens the digital divide for older adults, hindering financial independence. Tailored designs with simplified interfaces, cultural relevance, and enhanced error prevention can improve digital health literacy, support equitable access and promote mental and social well-being among aging populations.
Background: The COVID-19 pandemic has imposed substantial psychological pressure on healthcare workers (HCWs), largely due to fear of infection. Understanding the factors associated with this fear is essential for designing effective health promotion interventions. This study aimed to identify determinants of fear of COVID-19 infection among HCWs in Qom Province, Iran. Methods: This cross-sectional study was conducted in 2022 among 385 healthcare workers, including physicians, dentists, nurses, and health specialists. Data were collected using the standard S19-HCPS questionnaire. Fear of COVID-19 infection was considered the primary outcome measure. Data were analyzed using SPSS software, and multiple linear regression analysis was applied to identify significant predictors. Results: Approximately 50% of participants were male. Multiple linear regression analysis indicated that protective behaviors (β=−0.087, P=0.015), attitude toward COVID-19 (β=−0.118, P<0.001), perceived health policies (β=−0.773, P<0.001), and desire to provide patient care (β=−0.114, P<0.001) were significant predictors of fear of COVID-19 infection. These variables collectively explained 66.1% of the variance in fear scores. Conclusion: Fear of COVID-19 infection remains a significant concern among healthcare workers and may adversely affect their well-being and professional performance. Strengthening supportive health policies, promoting protective behaviors, and addressing attitudinal factors should be prioritized to reduce infection-related fear and enhance mental well-being among HCWs during ongoing and future public health emergencies.
Introduction: Theories of the policy process provide structured ways to understand, navigate and influence political landscapes using evidence-based approaches. While influencing policy is a core function of the health promotion discipline, little is known about how practitioners engage with these theories. This study aims to address this gap by examining health promotion practitioners’ awareness, understanding, and application of theories of the policy process in practice, and factors influencing health promotion practitioners’ engagement in policy processes. Methods: A thematic qualitative study was used to explore perspectives and experiences of health promotion practitioners practicing in Queensland, Australia using online, semi-structured interviews. Data were analysed with NVivo software using a reflexive thematic analysis to identify key themes. Results: Four key themes were generated; 1) health promotion practitioners understand policy process complexity but have limited awareness of theories of the policy process, 2) health promotion practitioners implicitly apply constructs of theories of the policy process in their practice, 3) organisational context shapes the extent to which health promotion practitioners’ are positioned to engage in policy processes, and 4) industry-level factors influence health promotion practitioners’ engagement in policy processes. Conclusion: Opportunities exist for health promotion practitioners to more explicitly draw from theories of the policy process to inform their practice in influencing healthy public policy for population health and equity outcomes. Stronger inclusion of theories of the policy process within tertiary education and professional development, including formalising industry accreditation, may support strengthening and maintaining practitioner skills to meet industry core competencies.
Introduction: Falls are a significant cause of injury and reduced quality of life among older adults in Thailand, particularly in rural areas with limited access to preventive care. While several fall prevention programs exist, few are tailored to the caregiver's role in supporting older adults at home, particularly caregivers in rural settings. This study aimed to develop and evaluate a mobile application for fall prevention among older adults in rural Thailand using a research and development (R&D) approach. Methods: The five-step R&D process (April 2022-December 2023) included a needs assessment, followed by co-design workshops with caregivers, prototype development and small-group testing, pilot testing for usability and satisfaction, and implementation and evaluation. Through this structured, caregiver-centered process, the application KANLOM was developed. A onegroup pretest-posttest study was conducted with thirty caregivers. Outcomes (knowledge, attitudes, and behaviors) were analyzed using descriptive statistics and paired t-tests. Results: After using the KANLOM application, caregivers demonstrated statistically significant improvements in knowledge (mean difference = 1.07, 95% CI: 0.12-2.00, P= 0.028), attitudes (mean difference = 0.13, 95% CI: 0.07-0.23, P < 0.001), and fall prevention behaviors (mean difference = 0.16, 95% CI: 0.08-0.24, P < 0.001). Overall satisfaction with the development and use of the application was high (mean = 2.80 out of 3.00), especially in content usefulness, visual appeal, and practical applicability. Conclusion: The KANLOM mobile application improved caregivers' ability to assess and prevent fall risks. Its participatory, offline design supports use in low-resource settings, empowers caregivers to take an active role in fall prevention, promotes community participation and health equity, and provides important implications for future research and policy.
Introduction: The study and conceptualization of self-care have a longstanding history. However, a clear conceptualization of self-care remains contested due to the plurality of perspectives and diversity of definitions, particularly when considering the general population regardless of pathology. Our literature review aimed to better understand how to conceptualize self-care for the general population, drawing on existing scientific literature on self-care theory and conceptualization. Methods: We followed The Cochrane Collaboration’s and PRISMA-P Group’s methodological guidelines for the conceptualization, analysis, and reporting of literature reviews. Results: Our results reaffirmed the varied and evolving interpretations of self-care and provided insights into conceptualizing and promoting self-care among the general population. The analysis, based on three main criteria (definitions, antecedents, and consequences), highlighted a continuous renewal of the self-care concept across various disciplines and demographic groups. For the general population, self-care is fundamentally intentional and purpose-driven, encompassing a wide spectrum of purposes from health management to enhancing overall well-being. This multifaceted concept integrates actions, abilities, and socio-cognitive processes and emphasizes the importance of understanding the multiple antecedents of self-care to develop effective policies and interventions that enhance well-being and quality of life across diverse groups. Conclusion: From our perspective, the conceptualization of self-care for the general population benefits from a systemic, ecological view. Moreover, promoting self-care outcomes, such as autonomy, independence, and self-efficacy, can yield benefits, including improved health and well-being for the general population. We advocate for a multi-tiered approach to self-care promotion, implemented through schools, workplaces, and broader community contexts, to maximize benefits across society.
Introduction: Home accidents are a major global health concern for children under five. This study aimed to determine the prevalence of home accidents and to identify the predictors of mothers’ preventive behaviors based on the Health Belief Model (HBM) in Yazd, Iran. Methods: This cross-sectional study was conducted in 2023 on 200 mothers with children under five years, selected via multi-stage cluster sampling from five comprehensive health centers in Yazd. A researcher-made questionnaire based on HBM, including locus of control, was used for data collection. Its validity and reliability were confirmed (CVR>0.75, CVI>0.79, Cronbach’s alpha>0.68). Data were analyzed using SPSS-21 with independent t-tests, ANOVA, Pearson correlation, and linear regression, considering the design effect. Results: Totally, of 212 studied children, 163 (76.9%, 95% CI: 71.2-82.6) had experienced at least one home accident. The most common accidents were cuts (39.6%), falls (33.0%), and burns (30.7%). Accident occurrence was significantly associated with older child age (mean difference: 8.25 months, 95% CI: 3.38-13.12, P=0.005) and higher household income (P=0.008). Mothers of children without accidents had significantly higher self-efficacy (mean difference: 5.49, 95% CI: 1.48-9.50, P=0.018), lower perceived barriers (mean difference: -5.92, 95% CI: -10.84 to -1.00, P=0.027), and higher preventive behavior scores (mean difference: 1.78, 95% CI: 0.72-2.84, P=0.017). Linear regression showed that perceived barriers (β=-0.297, P<0.001), perceived benefits (β=0.250, P<0.001), powerful others locus of control (β=-0.226, P<0.001), and chance locus of control (β=-0.156, P=0.019) were significant predictors, explaining 35.8% of the variance in preventive behaviors. Conclusion: The HBM was found to be an effective framework for explaining maternal preventive behaviors. Interventions should focus on reducing perceived barriers, enhancing perceived benefits, and modifying external locus of control beliefs to prevent home accidents in children.
Introduction: A lack of rigorous, objective measurement of health promotion (HP) in sports clubs has been identified. This study developed and validated content of an observational tool for sports managers to evaluate HP within their clubs. Methods: First, a rapid literature review identified sports club HP observational tools and their development process. Second, a 3-round Delphi study gathered feedback from 69 sports stakeholders to design a checklist. Round 1 created items and observation areas; Round 2 obtained feedback, item suggestions and reformulations; Round 3 structured items into a checklist and rated them on three indicators. Third, experts categorized items into health determinants from the health promoting sports club (HPSC) model and drafted a user’s guide. Results: The rapid review yielded 11 studies, including tools for injury surveillance, coaching behaviours, alcohol management, referee-athlete interaction and motivation, but none directed at HP. The Delphi study round 1 included 18 respondents formulating 24 items organized into: Locker room, Website, Cafeteria & Food Offerings and Facilities & Surroundings. Round 2 included 31 respondents validating 43 items and reformulating ‘Locker room’ into ‘Locker and Restrooms’. Round 3 included 21 respondents validating 36 items separated into the four areas. Five researchers categorized items into Economic (n=5), Environmental (n=16), Organizational (n=17) and Social (n=9) health determinants. The HPSC Observational Tool includes a user’s guide, a checklist including scoring methods and recommendations. Conclusion: This study provides an innovative observational tool for sports managers to assess their club’s HP. Sports managers can directly evaluate specific areas and follow recommendations for improvement.
Background: The gut microbiota significantly influences mental health through the gut-brain axis, modulating mood, cognition, and emotional regulation. While probiotics and prebiotics have been widely studied for their psychobiotic effects, postbiotics—metabolic byproducts of probiotics—represent an underexplored area with potential therapeutic applications. Understanding the role of postbiotics in mental health disorders, such as depression, psychosis, and mania, could lead to novel treatment strategies. This review examines the psychobiotic potential of postbiotics and their mechanisms of action. Methods: A systematic literature review was conducted to evaluate the effects of postbiotics on mental health conditions. We searched PubMed, Medline, EMBASE, and the Cochrane Library for English-language articles published between January 1, 2015, and January 1, 2025, using keywords such as "postbiotic," "paraprobiotic," "depression," "anxiety," and "psychosis." A manual search supplemented the electronic search to ensure comprehensive coverage. Studies focusing on postbiotic effects on mood regulation, neuroinflammation, and neurotransmitter modulation were included. Results: Postbiotics demonstrate promising psychobiotic effects in depression, psychosis, and mania. They modulate neurotransmitter levels, including serotonin and gamma-aminobutyric acid (GABA), and reduce neuroinflammation, contributing to improved mood and cognitive function. Additionally, postbiotics influence the hypothalamic-pituitary-adrenal (HPA) axis, enhancing stress response and emotional regulation. These findings suggest that postbiotics may serve as effective therapeutic agents for mental health disorders. Conclusion: Postbiotics offer significant potential as novel interventions for mental health conditions, with mechanisms involving neurotransmitter modulation and neuroinflammation reduction. Further empirical research is needed to elucidate their clinical applications and optimize therapeutic protocols. This review highlights the importance of postbiotics in advancing innovative strategies to improve mental health outcomes and well-being.
This study examines life expectancy in Asian Muslim-majority countries from a comparative perspective, with a particular focus on the role of socioeconomic and health-related determinants. Using secondary data from the World Bank and other international databases across countries which are categorized by income levels. The findings reveal substantial disparities among countries, where high-income Gulf nations such as Qatar, the United Arab Emirates, and Kuwait exhibit higher life expectancy, lower mortality, and improved child health outcomes, primarily due to advanced healthcare systems and economic prosperity. In contrast, low-income and conflict-affected countries such as Afghanistan, Yemen, and Pakistan experience lower life expectancy, higher mortality, and elevated fertility rates, driven by poverty, political instability, and limited access to healthcare services. Middle-income countries demonstrate transitional patterns with gradual improvements in health indicators. Overall, the study highlights a strong association between economic status and life expectancy, emphasizing the need for targeted health policies, improved healthcare access, and socioeconomic development to reduce disparities across the region. These findings provide important insights for policymakers aiming to enhance population health and promote equitable development in Asian Muslim-majority countries.
This perspective aims to 1) examine the WHA78’s contributions to health promotion, equity, and analyze their implications for reducing disparities, and 2) propose actionable strategies to navigate implementation challenges and emphasize global solidarity in the achievement of ‘health for all’. The WHA78 has prioritized social determinants, community empowerment, equitable health access, and climate-resilient health systems. Strengthening health systems and addressing equity can be further complemented by the Pandemic Treaty’s enforceable compliance mechanisms. Further, the WHA allocated 20% of pandemic-related products to the WHO to address the needs of low-income countries. Strengthening regional and international health cooperation through health diplomacy, promoting sustainable health systems, sharing digital infrastructure, and fostering local/regional pharmaceutical manufacturing are vital to turning WHA78’s commitments into equitable outcomes.
Health literacy (HL) is increasingly recognized not merely as an individual asset, but as a structural determinant of health equity and a critical governance instrument for sustainable health systems. While frameworks for "health literate organizations" are well-established in high-income contexts, low- and middle-income countries (LMICs) face similar systemic barriers—including centralized governance, fragile social trust, and resource constraints—that require distinct implementation roadmaps.In this perspective we argue that for health systems in the Middle East and North Africa (MENA) region to succeed, they must pivot from a didactic, education-centric paradigm toward an empowerment-oriented governance model. Accordingly, we articulate a multidimensional framework structured around five interdependent pillars: 1. structural reform and high-level advocacy, 2. mobilizing social capital and trust, 3. human resource empowerment, 4. primary health care transformation, and 5. sustainable financing. Drawing on global evidence—including WHO frameworks, the Ottawa Charter, and Health in All Policies—this paper proposes a multidimensional roadmap that institutionalizes HL as a core accountability mechanism within reginal health governance in the MENA region. This model offering a politically astute and transferable framework for LMICs seeking to embed health equity within the architecture of the state.
Central Asia faces mounting challenges from emerging infectious diseases, antimicrobial resistance, and food insecurity. This article examines regional cooperation in the One Health approach as a transformative strategy for strengthening regional health security through Regional Health Diplomacy (RHD). The Central Asia One Health Framework for Action represents a paradigmatic shift from fragmented national health strategies to an integrated regional approach. We argue that ‘RHD’ serves as the critical catalyst for implementing the One Health Framework. We call for the strategic implications to extend beyond health outcomes to encompass broader regional integration, establishing Central Asia as a pioneer in multi-sectoral health governance and a potential knowledge hub for One Health implementation.
Background: There is no study that simultaneously evaluates the relationship between lifestyle variables and the incidence of hypertension in the Iranian population. The aim of present study was to compare the incidence of hypertension across different lifestyle subgroups of the Azar cohort population identified via Latent Class Analysis. Methods: We used the data of 15,006 eligible participants across five follow-up periods. Seven observed variables were used to assess lifestyle behaviors as a latent variable. These indicators were smoking, substance abuse, alcohol consumption, secondhand smoke exposure, sleep quality, physical activity, and obesity. The analysis was performed in SAS 9.2 software. Results: Three-class and seven-class models were appropriate for females and males based on the indices for model selection and the interpretability of the model results, respectively. In females, 25.7%, 9% and 65.3% were at "low risk", "high risk" and "secondhand smoke exposure and poor sleep quality", respectively. In males, 13.3% and 3.6% were in the "smoker" and "high-risk" classes, respectively. In females and males (up to class 4), after adjusting for age and socioeconomic status, the prevalence and incidence of hypertension increased with the advancement of classes. Conclusion: Considering the characteristics of the identified classes and the occurrence of hypertension in each class, the main focus of lifestyle interventions can be placed on the most high-risk groups. Our findings suggest that poor physical activity, poor sleep quality, and obesity should be addressed as the main targets of lifestyle intervention strategies for preventing and controlling hypertension.
Background: Maternal self-efficacy is a key determinant in managing behaviors linked to childhood obesity. This study investigated maternal self-efficacy in addressing childhood obesity-related behaviors in Zanjan, Iran. Methods: This cross-sectional study, conducted in 2023, investigated maternal self-efficacy among 458 mothers of children aged 6–12 years. Participants were selected via cluster sampling from five comprehensive health centers across the city. Data were collected using the validated Persian version of the Children’s Lifestyle Behavior Checklist, which assesses parental perceptions of obesity-related behaviors and self-efficacy in addressing them. Independent t-tests and multiple linear regression analyses were conducted using SPSS (version 23), with statistical significance set at P<0.05. Results: Most mothers (96.9%, 95% CI: 94.8% to 98.2%) reported difficulties in managing obesity-related behaviors, with 36.9% (95% CI: 32.4% to 41.6%) showing low self-efficacy, particularly for sedentary lifestyles. Significant differences in problem perception (P<0.001, 95% CI: –64.83 to –30.54) and self-efficacy (P<0.001, 95% CI: 14.51 to 27.66) were observed between mothers of normal-weight versus overweight/obese children. Regression analysis indicated that maternal education (β=0.202, 95% CI: 6.910 to 20.388, P=0.0001) and child BMI (β=-0.303, 95% CI: -3.343 to -1.812, P=0.0001) were key predictors of self-efficacy. Conclusion: Sedentary lifestyles were a major concern among mothers. They reported low confidence in managing obesity-related behaviors, underscoring the need for targeted interventions. Specifically, evidence-based educational programs are essential to enhance mothers’ capacity to regulate children’s screen time and promote healthy lifestyle behaviors.
Background: Pandemic management demands a multifaceted strategy that integrates disease transmission control, resource allocation, and effective public health interventions. This study explores how combining clinical decision-making frameworks (CDMFs) can improve decision-making and adaptive strategies during public health emergencies. The goal is to provide a synergistic approach that enhances the speed, effectiveness, and equity of pandemic responses. Methods: We conducted a review of literature published up to January 2025 to evaluate the contributions and limitations of these frameworks in pandemic preparedness and response. The review emphasizes how each framework supports adaptability, risk identification, and strategic planning, while also addressing challenges related to equity and data quality. Results: The SOAR framework fosters adaptability and creativity, while risk assessment provides a systematic method for threat identification and mitigation. Artificial intelligence (AI)-driven decision support system (DSS) leverage machine learning and predictive analytics to provide immediate insights and improve strategic planning, although issues of data quality and equity must be addressed. The DECIDE framework ensures comprehensive decision-making, balancing strategic planning with the urgency of a crisis. The review highlights the potential of AI to improve decision-making efficiency, while underscoring the need for careful oversight to maintain transparency and prevent the perpetuation of health inequalities. Conclusion: Integrating AI into CDMFs offers significant opportunities to improve future pandemic responses. Evolving these frameworks and incorporating AI-DSS, while carefully addressing ethical considerations and data quality, will lead to more scientifically sound, practical, and equitable solutions to global health problems, enhancing overall pandemic preparedness and resilience.
Health inequities in India encompass limited primary care access, dearth in healthcare personnel, especially in rural fragile geographies. A health system strengthening (HSS) approach through an innovative 3T-model can solve this ubiquitous problem. 3T includes- (i) Train rural youths (majorly women) as nationally certified & digitally literate Community Health Workers (CHWs) creating livelihood and women empowerment (ii) Technology: clinical algorithm driven software; easy-to-use affordable innovative diagnostic devices, screening tools (iii) Task-shifting: the software guides CHWs transmit structured, analysable, patient data to ‘remote’ doctors. CHWs addresses personnel shortage in health sector. Technology and task-shifting enable improved access to general and specialist doctors. Digital presence reduces doctors’ travel and time, enabling more consultations. The 3T-model addresses critical health inequities in India. Effective scaling can significantly improve access to affordable primary care and public health services for last-mile populations with potential to reduce gender disparities in access to essential healthcare.
Background: Health care taxation is one of the government’s income sources. In Iran, despite the high consumption of harmful products, there are limitations in healthcare taxation, which may be due to the high wall of distrust between the government and taxpayers. In this study, we aimed to identify and analyze the reasons for paying health care taxes in developed countries in comparison with Iran. Methods: In this scoping review, the data were collected among the evidence published from 2000 to 2022 in English and Persian. A search strategy was conducted to find all the evidence and resources published using the selected keywords across several databases. Finally, 129 articles were confirmed to be included in the review. Results: Taxes on harmful goods, including sin taxes value, added taxes, and green taxes were among the most important and sustainable resources to improve the health care system in each country. In Iran, despite the approval of various taxes on harmful goods and polluting industries for public health reasons, these policies have not yet been implemented. Conclusion: For Iran, we recommend strictly implementing the tax policies, with allocations tailored to local conditions, to reduce the financial burden on the Iranian healthcare system.
