Aim:To develop and describe a simple, culturally appropriate, evidence-based lifestyle intervention tool and administration protocol for stable NCD outpatients.Methods:A multidisciplinary team synthesized global (WHO) and national (ICMR-NIN) guidelines, behaviour-change principles (COM-B, Health Belief Model, self-efficacy), and patient/provider feedback to create a one-page bilingual handout containing 21 evidence-based recommendations classified using a traffic-light system (red: avoid; green: consume safely; yellow: lifestyle actions). A structured 7-step protocol was designed for administration by nurses/dietitians, physicians, and yoga instructors, incorporating motivational interviewing, lifestyle scoring (0-21), goal setting, practical demonstration, and follow-up.Results:The "Health Building Lifestyle Guideline" and protocol were successfully piloted in an integrative health clinic serving industrial workers. Patients and providers reported high acceptability, improved comprehension, and enthusiasm for the visual traffic-light format, numeric lifestyle score, and team-based reinforcement.Conclusion:This novel, low-cost, replicable traffic-light lifestyle guideline with a structured 7-step delivery protocol effectively bridges the knowledge-practice gap and empowers NCD outpatients to adopt and sustain healthier behaviours. Wider implementation and formal outcome evaluation are recommended.

Abstract Social and behavior change communication (SBCC) is a core public health strategy not just for interventions designed to prevent, control, and treat disease but also for addressing the social determinants of health. Quality SBCC interventions are based on some common design, implementation, and evaluation best practices. The evidence base for using SBCC for sexual and reproductive health (SRH) includes, among other programs, family planning, maternal and neonatal health, and HIV/AIDS. Three global SBCC interventions—one on each of these topics—are presented as exemplars of best practices in public health communication programs designed to improve individual health behaviors and enable social change. These SBCC programs employed cross-cutting approaches covering different levels of the social-ecological model while tackling multiple related health issues. While emphasizing individual roles and responsibilities, recognizing the importance of the cultural, social, and political context within which individuals live and work allowed these interventions to address social and gender norms. All three were theory-based and evidence-driven. They applied constructs from social and behavior change (SBC) theories to model causal pathways and stages or steps of behavior and community-level change. In addition, they relied on comprehensive, mixed-methods research throughout the project cycle. Other best practices included intersectoral collaboration and steps to ensure scale-up and sustainability.

Despite efforts to promote inclusivity in schools, ethnic bullying is a pervasive issue. Recent studies have highlighted the potential of empathy and cultural self efficacy within cross-cultural friendships to mitigate ethnic bullying. Violence prevention programs in the United States rely on didactic approaches and few include embodied approaches. Our goal was to examine the impact of dance/movement therapy (DMT) on empathy, peer relationships, and cultural self-efficacy among racially/ethnically diverse groups of middle school students using a mixed methods research design. Quantitative data did not demonstrate significant change in empathy, peer relationships, and cultural self-efficacy. Qualitative data described an increase in participants’ emotional intelligence including empathy, cultural self-efficacy, and positive cross-cultural relationships. Additional research is needed to determine the definitive impact of DMT on these outcomes.

BackgroundCommunity engagement is key in health communication interventions that seek to incorporate community voices in their planning and implementation. Understanding what approaches and strategies are currently being used can help tailor programs in different social and cultural contexts. This review explores needs-based and strengths-based approaches and consensus and conflict strategies in community-based global health communications programs. Our objective is to examine the current state of the field, outline lessons learned, and identify gaps in existing programming to help guide future interventions.MethodsPubMed and Web of Science were searched for articles published between 2010 and 2023. Studies were included if they described a community-based health communication intervention and an ongoing or completed implementation. Interventions were coded then categorized according to their level of community engagement and as single, hybrid, or complex, depending upon the number of approaches and strategies used.ResultsThe search yielded 678 results and 42 were included in the final review and analysis. A vast majority 34 (81.0%) interventions utilized a needs-based approach and 24 (57.1%) utilized a strengths-based approach. Consensus as a strategy was utilized in 38 (90.5%) of the manuscripts and 9 (21.4%) implemented a conflict strategy. Interventions that combined approaches and strategies were more likely to leverage a higher level of community engagement.ConclusionThese results showcase the complicated nature of global health communication program planning and implementation. There is a lack of interventions that use conflict as a strategy to empower communities to act on their own behalf, even when at odds with existing power structures. Complex interventions that include all approaches and strategies demonstrate the potential for global health communication interventions to be at the cutting edge of public health practice.

The objective of the research was to test the relationship between restrictions and menstrual health and hygiene management (MHHM). A total of 2,212 adolescents in the structured questionnaire and 309 adolescent girls in the focus group discussions (FGDs) were selected using stratified random sampling in three districts of Uttar Pradesh. Overall, 96 per cent of the adolescent girls mentioned they faced some restriction in the structured questionnaire. Factors affecting adequate preparation of clean absorbent included having food restrictions and not having personal and structural restrictions. Factors affecting adequate storage of clean absorbent included not having social/religious restrictions and having structural restrictions. Factors affecting adequate frequency of changing included not having personal restrictions. Factors affecting adequate disposal included not having structural restrictions. The FGDs and structured questionnaire demonstrated that restrictions were ubiquitous, and adolescent girls followed restrictions because of personal and social beliefs, including considering menstruation impure. There was a blurry distinction between personal and social restrictions and most FGDs could not articulate actions to overcome social restrictions. These results highlight that restrictions matter and have a relationship with adequate MHHM. There is a need to combat restrictions using multifaceted approaches by designing programmes that are context specific.

AbstractEntertainment-education is a global theory-driven and evidence-based storytelling strategy that promotes social and behavioral change. A formal review of the peer-reviewed and grey literature, alongside consultations with program and industry experts, revealed several contemporary examples of entertainment-education and climate change. Late-night comedy, with the inclusion of climate change storylines within popular entertainment, is common in the Global North. In the Global South, climate adaptation and mitigation narratives are situated in formats portraying audiences’ lived experiences. Crosscutting trends relate to documentary storytelling, children’s programming, and future efforts. Recommendations include re-examining theories across the social–ecological model; placing entertainment front and center; including messaging on rewards; using positive language; linking climate change with other issues; and emphasizing formative, process, and impact evaluation. Entertainment-education may be a promising vehicle for climate change communication, but the strategy requires a multidisciplinary set of changemakers working collaboratively to create meaningful and relevant programs.

Participatory research can be used in conjunction with quantitative, other qualitative, and mixed methods research methods to collaboratively address priority global health issues that are greatly influenced by social norms. Social norms have been identified as key components of deeply held beliefs that perpetuate as well as change detrimental health practices. At all levels of global health research, from program development to monitoring and evaluation, participatory tools can be used to honor the ethic of working with the target population, incorporating their needs, and engaging a community to improve health-related behaviors. This paper shows how to use two visually based participatory tools to impact social and behavior change around Female Genital Mutilation (FGM) and Menstrual Hygiene Management (MHM). Both FGM and MHM have been identified as critical to UNICEF’s Child Protection and to meeting the United Nations Global Sustainability Goals. We also outline how Social Network Mapping and 2x2 Tables were implemented to address complex social norms around FMG and MHM. The discussion then illustrates how they have been used within research and program development more broadly. These tools are valuable methods to understand and impact social and behavior change in a wide variety of public health issues.

Background Adolescent girls' right to achieve menstrual health and hygiene management (MHHM) healthfully is yet to be realized. One reason is the lack of practical guidance on the procurement, use, and disposal of menstrual products. This study defined interpersonal practical guidance (IPG) as face-to-face communication and mediated practical guidance (MPG) as social and behavior change communication (SBCC) intervention-driven communications through print and media materials. We examine the impact of these two delivery mechanisms of practical guidance on adolescent MHHM knowledge, attitudes, and practices (KAP) following an SBCC intervention in India. Objectives To understand how IPG and SBCC-driven MPG independently influence adolescent girls’ KAP on the procurement, use, and disposal of menstrual products and whether those who receive both IPG and MPG have better KAP related to the procurement, use, and disposal of menstrual cloth or sanitary pads than those who receive only one form of practical guidance or none at all. Methods Adolescent girls' questionnaire responses from GARIMA's case-comparison evaluation were analyzed using Stata/SE 17 ( n = 2,384). Girls were matched on sociodemographic and socioeconomic variables. χ 2 analysis examined relationships between sociodemographic, practical guidance, and KAP variables. Multivariate logistic regression assessed associations between practical guidance and KAP variables. Results There are significant associations between adolescent girls' KAP depending on whether they received IPG, SBCC-driven MPG, or both. IPG and MPG delivered together has greater odds of predicting correct menstrual management KAP than when delivered separately. These effects were most notable for adolescent girls' knowledge and practices related to using and disposing of menstrual hygiene products. Conclusion There is urgent need to create positive, sustainable changes to address menstrual health and hygiene management. This study introduces an innovative approach that utilizes interpersonal and mediated communication as mechanisms to deliver practical guidance on menstrual management. Future interventions should implement and evaluate to better understand the role of practical guidance in ensuring all women and girls are prepared to confidently manage their menstrual health.

Violence against children (VAC) is a pervasive, global issue with both short- and long-term health, social, and economic consequences. This systematic review sought to identify best practices for designing and implementing social and behavior change communication (SBCC) programs targeting VAC in and around schools. Combinations of key search terms within five domains were entered into four databases: PubMed Central, Google Scholar, Sociological Abstracts, and EBSCOhost. Results were screened according to the inclusion and exclusion criteria. Namely, articles had to be published in English, be published after March 2014, focus on VAC in and around schools, focus on children, and use SBCC approaches. The searches produced 892,271 results. Of these, 63,183 were screened and 54 articles were selected. These articles were combined with 16 articles, gathered from a previous systematic review using the same databases and search domains conducted by the same research team, for a total of 70 articles. Articles were quantitatively analyzed using a coding guide in STATA and qualitatively analyzed using Nvivo. Results showed that most programs addressed bullying, were implemented in high-income countries, and included children aged 10 and older. Best practices in program design were using theory, conducting formative research, and involving program beneficiaries. Best practices in implementation were combining whole-school and targeted approaches, including special and hidden populations, involving secondary and tertiary audiences, using nonclassroom settings, using peer leader/mentor and cascade training models, and conducting process monitoring. Implications and avenues for future planning and implementation of SBCC interventions to address VAC in and around schools are discussed.

Despite legislation outlawing child marriage in Kyrgyzstan in 2017, the practice continues today. Early marriage is driven by social norms around religion, honor, financial stability, and restrictive gender roles. Participatory research activities were implemented with 12 adolescents in Kyrgyzstan Osh and the rural town of Chuy. Activities explored the perceptions of male and female youth around early marriage, gender norms, the consequences and benefits of marriage, and their autonomy in deciding who and when to wed. Responses from adolescents in the study were analyzed for themes by gender to reveal patterns in social norms around early marriage in Kyrgyzstan. Data showed that adolescents overwhelmingly did not support early marriage and expressed anxiety, shame, or concern about this topic. Interventions to prevent early marriage in Kyrgyzstan should advocate for girls’ education and career opportunities and raise family and community awareness about the harms of child marriage.

Background: In many countries, stigma surrounds menstruation, which impacts several Sustainable Development Goals, including good health, quality education, gender equality, and water and sanitation. Despite its relationship with several development issues, menstrual health and hygiene management among adolescents has until recently been ignored by practitioners and researchers. This paper is a systematic review of existing literature and argues that menstrual health and hygiene management is a human rights issue, cross-cutting through development domains of health, education, nutrition, child protection, and water, sanitation, and hygiene. Methods: Four coders independently screened PubMed, Academic OneFile, and Google Scholar to obtain articles using iterations of the key terms: menstrual health; adolescents; health outcomes; education; nutrition; water, sanitation, and hygiene; and child protection. English language primary studies in peer-reviewed or grey literature articles published after 2000, that mentioned adolescents, health or hygiene, and menstruation or menstrual were included. A 9-item scale was used to rate selected full-text articles as strong, moderate, or weak. Synthesis of the results were narrative and examined the relationships between menstrual health and hygiene management and the cross-cutting domains.Results: In total, 28,745 articles were screened, with 84 articles included in the full-text review and quality assessment. Nine articles were coded as “strong” (10.8%), 46 (55.4%) as “moderate,” and 28 (33.7%) as “weak.” More than 60% of the articles examined the relationship between menstrual health and hygiene management and health (37.3%) or water, sanitation, and hygiene (25.3%). Only 11 manuscripts examined menstrual health and hygiene management as a cross-cutting issue impacting more than one development domain.Conclusions: Access to adequate facilities and menstrual health and hygiene management resources are the most common relationships documented within literature. However, there is little focus on menstrual health and hygiene management in the context of other development domains, highlighting the fact that poor menstrual health and hygiene management has not been studied as a human rights issue, negatively impacting millions of girls. Using a cross-cutting, human rights framework to address inadequate menstrual health and hygiene management is fundamental to promoting menstrual health and hygiene management with dignity among girls and women across the globe.

Female Genital Mutilation (FGM) is a harmful practice with no benefits and considerable harm to girls and women who undergo it. In 2016, the United Nations Joint Program to Eliminate FGM, funded the development and subsequent validation of a monitoring and evaluation framework to understand the relationship between social norms and practicing FGM. Evidence on the framework was gathered through a pilot study in Ethiopia. This paper uses cross-sectional quantitative data from the pilot to operationalize the framework and determine what factors are associated with practicing FGM. A total of 554 and 481 participants answered the question “Have you undergone FGM?” and “Do you know a family member who has undergone FGM?” respectively. Overall, 65% of participants said they had undergone FGM and 32% said they knew someone in their family who had undergone FGM. Predictors of not undergoing FGM included most progressive attitudes vs. less progressive attitudes about FGM and relationship to identity [OR: 1.9 (95% CI: 1.1–3.3)]; region [Afar vs. Addis Ababa: OR: 0.09 (95% CI: 0.02–0.5); Southern Nations Nationalities and People's Regions vs. Addis Ababa: OR: 0.1 (95% CI: 0.05–0.3)], being 36 years old and above vs. 10–19 years (OR: 0.2 (95% CI: 0.1 to 0.7)) and being single, never married vs. married or engaged (OR: 2.8 (95% CI: 1.1–7.0)]. Predictors of knowing a family member who has not undergone FGM included: Higher knowledge vs. lower knowledge [OR: 0.3 (95% CI: 0.1–0.5)]; if the family expected you to abandon FGM, you had a greater odds of knowing a family member who had not undergone FGM [43.6 (95% CI: 2.7–687.8)]; coming from Southern Nations, Nationalities and People's Region was associated with a lower odds of knowing a family member who had not undergone FGM [0.3 (95% CI: 0.1–0.6)]. Being a female influential vs. female caregiver was associated with a higher odds of knowing a family member who had not undergone FGM [2.9 (95% CI: 1.01–5.2)]. This paper has allowed us to validate a theory and research based social norms framework, specifically examining how social and behavior change communication can be used as a mechanism for shifting norms around a given harmful practice. Now that this model has been developed and validated, it is likely to provide a foundation to study the direct and indirect impacts of social norms programming on changing harmful practices, such as FGM.

This study assessed both demographic and Social Ecological Model (SEM) variables associated with supporting the abandonment of female genital mutilation (FGM) in three regions of Ethiopia. Data were collected through structured quantitative questionnaires with study participants (n=1146), including adolescent girls, caregivers, social network contacts, and community influentials. Data were analyzed using the statistical software STATA/SE. Chi-square, binary logistic regression, and multivariate logistic regression were used to analyze the data. Results found the one significant association between support for FGM abandonment and demographic variables was having an education above secondary level (AOR=0.11, CI=0.01-0.92). For SEM variables, attitudes regarding identity (AOR=5.74, CI=1.42-23.11), expectation to abandon (AOR=56.88, CI=14.99-215.90), sanctions (AOR=23.00, CI=4.77-110.95), and social networks (AOR=4.61, CI=1.21-17.51) were found to be significant factors in supporting FGM abandonment. Programs should intervene on multiple levels of the SEM and focus on social norms to empower and mobilize communities toward the elimination of FGM.

This paper examines the relationship between exposure to a transmedia entertainment-education (EE) social and behavior change communication (SBCC) initiative with shifting child marriage-related social norms. Districts were selected purposively, whereas households were selected randomly. A total of 1102 households (n = 3905) with fathers, mothers, adolescent boys, and girls completed the baseline and endline survey. Logistic regression using panel data was conducted. There was a decline in the perceived prevalence of child marriage and dowry exchange within respondents' communities at endline. For injunctive norms, fathers reported significantly higher levels of disapproval for child marriage at endline. However, the reverse was true for mothers and adolescent girls. Almost all respondents had a significantly lower odds of identifying rewards/benefits and punishments/consequences associated with rejecting child marriage at endline. Most respondents with exposure to Icchedana were more likely to report the importance of injunctive norms or expectations of others on their behaviors, than those who were not exposed. Exposure to EE contributes to improved articulation of and shifts in social norms and engenders normative changes at the population level.

Despite its relationship with several development issues and sexual health, menstrual health and hygiene management among adolescents have until recently been ignored by practitioners and researchers. This paper is a systematic review of existing literature and argues that menstrual health and hygiene management is a human rights issue. 28,745 articles were screened, with 84 articles included in the full-text review and quality assessment. The results indicate that using a cross-cutting, human rights framework to address inadequate menstrual health and hygiene management is fundamental to promoting menstrual health and hygiene management with dignity among girls and women across the globe.

Vaccine hesitancy is a prevalent and ongoing issue. However, due to the COVID-19 pandemic, additional attention has been brought to the topic of vaccine hesitancy. Vaccine hesitancy is a threat to the population's health globally. This article aims to acquire insights from previous literature to determine what works to increase vaccine uptake and how we can apply this knowledge to increase COVID-19 vaccine uptake. Research has focused chiefly on childhood vaccination and the hesitancy of caregivers. After conducting an extensive literature review, we have created a conceptual model of indicators that influence vaccine uptake for health providers and caregivers, which can also be used for vaccine recipients. Overall, the reasons for vaccine hesitancy are complex; therefore, a multifaceted approach is needed to address it. Understanding the factors that affect vaccine hesitancy will aid in addressing hesitancy and, in turn, lead to an increase in vaccine uptake.

Excess dietary sodium contributes to the burden of chronic disease, including cardiovascular disease and stroke. Media-based health education campaigns are one strategy to raise awareness among populations at greater risk for stroke, including African Americans. During 2014–2015, the Philadelphia Department of Public Health conducted a health education campaign using radio, print news, and transit ads, to promote awareness of the link between dietary sodium, hypertension and stroke, and encourage reduced consumption of high sodium foods. Using a repeated cross-sectional design, street intercept surveys were conducted with ~400 Philadelphia residents representing the campaign's priority audience (African Americans ages 35–55) before and 6–13 weeks after the campaign, to evaluate both process (campaign exposure) and impact (recall of key health messages). Thirty percent of post-campaign respondents reported familiarity with one of the most engaging radio spots, and 17% provided accurate unaided recall of its key content, with greater recall among older respondents and frequent radio listeners. Forty-one percent of post-campaign respondents named stroke as a consequence of excess salt consumption, compared to only 17% of pre-campaign respondents, with greater awareness of the salt-stroke connection among those accurately recalling the radio spot from the campaign. Results suggest that priority populations for sodium reduction can be effectively reached through radio and transit campaigns. From a pragmatic perspective, street intercept surveys may offer one low resource strategy for evaluating public health education campaigns conducted by local health departments, especially among urban populations.