Background:Public bus drivers experience prolonged sitting, irregular shifts, limited breaks, and disrupted meals and sleep, making the maintenance of a healthy lifestyle difficult. Although occupational health checkups identify health risks, little is known about the duration of maintenance of self-reported stages of behavior change or their association with physiological markers. Objective:This study examined the duration of maintenance of the self-reported stage of behavior change and its association with physiological markers and lifestyle behaviors among male bus drivers. Methods:This retrospective cohort study analyzed occupational health checkup data collected from male bus drivers at a passenger bus company in Japan between 2006 and 2023. The primary exposure was the self-reported behavior change stage, based on a standard questionnaire item used in the Specific Health Checkups questionnaire. For the duration analysis, each participant's longest continuous action or maintenance episode was identified, and the Kaplan-Meier analysis was used to estimate the retention time. For the outcome analyses, participants who maintained the action or maintenance stage for at least 1.5 years after time 0 were classified as the sustained group. Those who returned to the preaction or preparatory stage at 6 months or 1 year comprised the comparison group. Physiological markers were compared using analysis of covariance adjusted for baseline values, age, and medication use. Lifestyle items were analyzed using multivariable logistic regression. Results:The survival analysis dataset included 717 participants, of whom 566 (78.9%) returned to the preaction or preparatory stage, while 151 (21.1%) were right-censored. The mean age at the start of the maintenance episode was 47.2 (SD 7.0) years, and the median retention time was 362 (IQR 0-1087) days. Retention probabilities were 57.7% at 6 months, 44.1% at 1 year, 33.3% at 2 years, and 23.2% at 3 years. In the outcome analyses, the sustained and comparison groups included 249 and 468 participants, respectively. At baseline, waist circumference was lower in the sustained group (85.77 cm vs 87.54 cm; P=.02), whereas other markers and medication use did not differ significantly between groups. At 2 and 3 years, the sustained group had lower BMI, waist circumference, triglycerides, and higher high-density lipoprotein cholesterol levels. Glycated hemoglobin (HbA1c) levels were lower in the sustained group at 3 years (P=.02). The sustained group had higher odds of an exercise habit (1 year: odds ratio [OR] 3.40, 95% CI 2.24-5.16; 2 years: OR 8.90, 95% CI 5.26-15.07) and daily physical activity (1 year: OR 2.51, 95% CI 1.61-3.91; 2 years: OR 5.17, 95% CI 2.93-9.13), and lower odds of current smoking (1 year: OR 0.36, 95% CI 0.14-0.95; 3 years: OR 0.26, 95% CI 0.09-0.75). Conclusions:Maintenance of the self-reported behavior change stage often began in midlife but was difficult to sustain beyond 1 year. Long-term maintenance was associated with favorable physical activity-related lifestyle patterns, lower smoking prevalence, and more favorable metabolic profiles. Health guidance should evaluate not only numerical improvements but also sustained behaviors and the prevention of worsening under occupational constraints.
Background:Digital health technologies (DHTs), including mobile health (mHealth) apps and online medical records, are increasingly being used to support self-management and communication with health care professionals among the general population across the United States. However, few studies have explored whether cultural, privacy, and sociodemographic factors may influence DHT adoption among Vietnamese Americans specifically. Objective:This cross-sectional study aimed to explore DHT use, barriers to adoption, and their associations with social determinants, such as age, sex, social support, and mental health concerns, among Vietnamese Americans. Methods:Data were collected from a sample of Vietnamese American adults (n=304) through surveys assessing DHT engagement, confidence in medical record security, and social and psychological factors. Descriptive statistics and inferential analyses, including 2-tailed t tests and chi-square tests, were used to examine differences across demographic groups. Results:Many participants had engaged with mHealth tools (253/304, 83.2%), including using mobile devices for health tracking (185/302, 60.9%), and health care professional discussions (194/301, 64.5%). Online medical records were reported to be widely available (230/304, 75.7%), with a large proportion of the participants (182/227, 80.2%) accessing them at least once in the past year. Privacy concerns were a key barrier to using online medical records, with 40.5% (17/42) of nonusers citing security fears, and 26.6% (81/304) reporting withholding health information from health care professionals. The main reasons participants did not access online medical records (45/304, 14.8%) were that they preferred to speak to health care professionals directly (31/44, 70.5%) or did not perceive a need to access their online medical records (30/43, 69.8%). There were no statistically significant differences in sociodemographic characteristics between DHT users and nonusers. There were statistically significant differences in the levels of social support of participants who had varying levels of confidence in the security of their medical records (F2,301=10.19; P<.001; η²=0.063). A greater proportion of male participants reported distrust (ie, being "not confident" in the security of their medical records) than female participants (χ22=20.8; P<.001), indicating a significant association between sex and confidence level. Conclusions:While DHT adoption is high among Vietnamese Americans, privacy concerns remain a major barrier to full use of online medical records. Health care professionals and public health initiatives should focus on improving trust in medical record security, incorporating culturally tailored education on the benefits of digital health, and leveraging social media and mHealth tools to optimize patient engagement. Developing stronger family and community support may facilitate the adoption of DHTs.
Maternal mortality remains a major public health concern in Southeast Asian low- and middle-income countries, where disparities in maternal health persist. Digital health interventions have increasingly been used to support maternal health services; however, the maternal health outcomes reported in these interventions have not been systematically analyzed across the countries in this region. This scoping review aimed to map maternal health outcomes from digital health intervention studies conducted in Southeast Asian low- and middle-income countries and to describe the characteristics of the interventions and the contextual barriers and enablers that influence those outcomes. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and Joanna Briggs Institute guidance. PubMed, CINAHL, and Scopus were searched for English-language studies published between January 2005 and May 2025, with supplemental screening of Google Scholar and reference lists. Maternal health outcomes were mapped using a proximal-intermediate-distal framework, with proximal outcomes categorized into knowledge and psychobehavioral outcomes, and intermediate and distal outcomes defined as service utilization and biomedical measures. Contextual factors, including barriers and enablers, influencing implementation and outcome interpretation, were also extracted and synthesized. Data were charted and summarized descriptively. A total of 36 studies were included, with the majority (61%) conducted in Indonesia. Digital health interventions primarily used mobile applications or short message service-based messaging (78%) and focused on targeted client communication or personal health tracking. Most of the studies (94%) evaluated proximal outcomes, while fewer assessed intermediate or distal outcomes. The reported barriers included limited access to digital devices, low levels of digital literacy, and challenges with network connectivity, while factors that facilitated the success of the interventions included widespread access to mobile phones and the use of customized or personalized intervention strategies. Digital health interventions in Southeast Asian low- and middle-income countries have primarily focused on proximal maternal health outcomes. The limited evaluations of service utilization and biomedical outcomes underscore the need for future evaluations to examine outcomes beyond early, proximal measures.
Background:Chiang Mai Province, located in northern Thailand, is a well-known tourist destination. Its rural areas are characterized by mountainous and valley landscapes, where residents primarily engage in agricultural activities and maintain traditional ways of life rooted in Northern Thai culture. However, persons with disabilities in rural areas of Chiang Mai face significant challenges in enhancing their quality of life and well-being. Home adaptations and assistive products are essential for these individuals, as they facilitate daily activities and improve overall living conditions. To address the needs of persons with disabilities in these communities effectively, it is crucial to gather insights and perspectives that reflect their everyday experiences. Objective:This study aimed to explore the experiences of persons with disabilities, focusing on the needs and obstacles they encounter in accessing home adaptation and using assistive products. Methods:A qualitative approach was used for this study. Individual interviews were conducted with 11 persons with disabilities residing in rural communities of the Doilor Subdistrict in Chiang Mai, Thailand. The data were analyzed using thematic analysis. Results:Five themes emerged: (1) financial and personal burdens of home adaptations, (2) living with safety risks in the home environment, (3) the need for assistive products aligned with individual health conditions and contexts, (4) challenges in accessing mobility support and essential services, and (5) emotional impact and sociocultural support. Conclusions:The findings indicate that persons with disabilities in rural northern Thailand encounter multifaceted barriers to enhancing their mobility and adapting to their home environments. More effort is needed to enhance home modification support, integrate assistive products, and provide transportation accessibility that promotes community inclusion for persons with disabilities. This study highlights the influence of organizational priorities on community practice and the need for person-centered practice to ensure that modifications lead to meaningful outcomes valued by persons with disabilities in the future.
Background:Former homeless older adults represent a highly vulnerable population facing substantial community health challenges, including an elevated risk of sarcopenia due to compounded health and social disadvantages. Developing a context-specific management system is crucial for enhancing early detection, prevention, and care within supportive housing settings. Objective:This study aimed to develop and evaluate the feasibility of a sarcopenia management system for former homeless older adults in Thailand. Methods:mixed methods design was used, consisting of three phases: (1) development, (2) implementation, and (3) preliminary evaluation testing. The development phase engaged 18 stakeholders and 32 focus group participants (former homeless older adults and staff) through 2 rounds of consultation. The system was subsequently implemented and preliminarily evaluated for feasibility, perceived quality, perceived benefits, and user satisfaction. Results:Through qualitative methods and a systematic review, a context-specific sarcopenia management system was developed for former homeless older adults. The system comprised five core components screening, classification, management, follow-up, evaluation and was integrated into routine care processes involving multidisciplinary staff and homeless volunteers within a supportive housing setting. The system was subsequently implemented and preliminarily tested among 116 former homeless older adults living in a supportive housing facility in Thailand. Preliminary findings indicated good feasibility and acceptability of the system. The perceived quality of the system achieved a mean score of 2.6 (SD 0.48), while perceived benefits were rated at 3.8 (SD 0.40). Overall satisfaction with system use and implementation processes achieved mean scores of 2.8 (SD 0.41) and 2.72 (SD 0.79), respectively, indicating high user satisfaction. Conclusions:This study presents the first context-sensitive sarcopenia management system specifically developed for former homeless older adults in supportive housing in Thailand. The system was well accepted and shows promise for strengthening early detection, prevention, and management of sarcopenia in community-based housing settings.
