Essential Service Products as Channels for COVID-19 Awareness and Behavior Change: A Narrative Review

Coronavirus disease 2019 (COVID-19) is here to stay. Nonpharmacological interventions such as hand hygiene, social distancing, and respiratory hygiene have remained the mainstay to curb the spread of the virus, and these are sustainable. To understand the information, education, and communication (IEC) efforts undertaken during previous pandemics and successful behavior change strategies that may be applicable to ongoing COVID-19 pandemic, we conducted a narrative review of articles using PubMed search on September 11, 2022. The results highlighted that reinforced IEC is the need of the hour in efforts against COVID-19 pandemic. The communication strategy during a pandemic should be of three stages aligned to the objectives of building a basic understanding and knowledge in the target population: building an awareness of the threat; personal actions to minimize the impact; and reinforcing the need for appropriate actions to minimize disease transmission, in that order. An innovative strategy of displaying IEC on the daily essential products can result in a sustainable solution that might result in a “felt need” in the community to follow COVID-19 appropriate behavior. A broad base of stakeholders' engagement with civil bodies, nongovernmental organizations, private sectors with well-defined responsibilities and accountability would offer an enabling environment for these efforts in ultimately curbing the COVID-19 pandemic.

Mechanisms of self-control on health behavior change / 中华行为医学与脑科学杂志

Self-control brings important effects on the process and maintenance of health behavior change in individuals, but its mechanism is unclear.Healthy behavior change could be divided into goal-oriented behavior initiation stage, combating habit rejection stage, and habit acquisition and maintenance stage.Established theories of health behavior change mainly focus on the conflict between the goal-directed behavior initiation phase and habitual behavior.It is also indicated that disgust is the key mechanism to restrain the implementation of goal-oriented behavior, but ignore the mechanisms in the action implementation and new behavior acquisition phases.In fact, goal-directed and habitual behaviors work together to ensure that individuals adapt efficiently to their environment.However, when goal-oriented behavior becomes habitual, old habit and new goal-oriented behavior begin to compete, causing conflicts and aversion.The core phase of self-control functioning is just in the confrontation with habit rejection phase.On the one hand, self-control directly assists individual goal-directed behavior habituation through conflict sense adaptation.On the other hand, intensive management and stimulus control indirectly assist goal-directed behavior habituation through the relief of conflict sense.Further exploration of the theory and clinical practice of self-control affecting healthy behavior change is needed in the future.

The application of integrated theory of health behavior change: a review / 中国实用护理杂志

This paper reviewed the progress and application of the integration theory of health behavior change, so as to provide a theoretical basis for improving the health literacy of Chinese residents, changing bad behavior and obtaining health outcomes. At the same time, it provides an implementable theoretical basis for the guidance model of health education, in order to provide theoretical suggestions for patients to change bad behavior and residents to strengthen health behavior.

Promotion of Toilet Construction and Usage in Rural Tamil Nadu: A Mixed-Methods Evaluation Study

Background: Open defecation is the leading cause for malnutrition and diarrhoeal deaths in low- and middle-income countries. The negative public health impacts of open defecation could be neutralized by toilet usage. However, the usage of improved sanitation facilities is unsatisfactory in rural India. Objectives: The study was carried out to find the psycho?social barriers among households for not having toilets and for not using the owned toilets and to develop and find out the effect of Behaviour Change Communication (BCC) strategy on toilet construction and usage. Methods: A community?based Embedded Experimental Mixed Methods study was undertaken in the four field practice villages of Urban Health Training Centre, Villupuram. For baseline and end?line surveys, 422 independent sample households who were not having or not using the toilets were selected by Simple Random Sampling. After IEC clearance, interviews and direct observation of the toilets were undertaken. Context?specific multi?faceted BCC strategy was employed through community participation. The data were analyzed in SPSS software. Chi?square test was used to determine the significance of difference and effect size was calculated to estimate the size of the difference between the baseline and end-line data. Results: Toilet ownership and utilization improved by 21.3% and 23.3% points, respectively. There was a significant reduction in households’ perceived psychosocial barriers in toilet adoption. Conclusion: Our intervention demonstrated considerable improvements in both toilet construction and usage surpassing the psycho-social barriers. Future sanitation promotion interventions should focus more on community participation and the key messages should be reinforced multiple times using different channels.

Transitando desde las fases de cambio de comportamiento hacia el automanejo de personas con condiciones crónicas / Transiting from phases of behavior change to the self-management of people with chronic conditions

Introducción: A nivel mundial existe una constante preocupación debido a que cada día proliferan más personas con enfermedades crónicas. Para su abordaje, se han propuesto una serie de medidas que enfatizan el rol preponderante que tiene la persona en el logro del automanejo de su salud y enfermedad. El objetivo de este trabajo fue reflexionar acerca de elementos que favorecen el avance desde las etapas de cambio hacia el automanejo de personas con condiciones crónicas. Desarrollo: Para lograr el automanejo, resulta trascendental considerar en la atención a la persona con enfermedades crónicas, entre otros aspectos, el proceso de cambio de comportamiento y el grado de autoeficacia percibida. Asimismo, el personal profesional de la atención primaria de salud y enfermería requieren desarrollar habilidades específicas y de alta idoneidad para una atención integral, oportuna y continuada. Todos estos aspectos se interrelacionan para converger juntos en un plan de atención de salud colaborativo, consensuado y centrado en la persona. Conclusión: Para favorecer el avance del automanejo existen elementos tanto de la persona con enfermedad crónica como de la profesional que se articulan. Entre estas personas se dan relaciones de bidireccionalidad, que han de ser vistas como un proceso funcional continuo y no como elementos discretos en el cuidado en salud.

Introdução: Em todo o mundo existe uma preocupação constante, pois a cada dia proliferam mais pessoas com doenças crônicas. Para sua abordagem, foi proposta uma série de medidas que enfatizam o papel preponderante que a pessoa tem na realização do autogerenciamento de sua saúde e doença. O objetivo deste trabalho foi refletir sobre elementos que favorecem a passagem das etapas de mudança para a autogestão de pessoas com condições crônicas. Desenvolvimento: A fim de alcançar a autogestão, é crucial considerar, entre outros aspectos, o processo de mudança de comportamento e o grau de auto-eficácia percebido no cuidado da pessoa cronicamente doente. Do mesmo modo, os profissionais de cuidados de saúde primários e de enfermagem precisam desenvolver competências específicas e altamente qualificadas para cuidados abrangentes, atempados e contínuos. Todos estes aspectos se inter-relacionam para convergir em um plano de cuidados de saúde colaborativo, consensual e centrado na pessoa. Conclusão: Para favorecer o avanço da autogestão, há elementos tanto da pessoa quanto do profissional que se articulam, existindo relações bidirecionais entre eles, que devem ser vistos como um processo funcional contínuo e não como elementos discretos no cuidado à saúde.

Introduction: There is worldwide constant concern because of the increasing number of people with chronic diseases every day. When it comes to approaching this situation, a series of measures have been proposed to emphasize the preponderant role that the people have has in achieving the self-management of their health and disease. The objective of this work was to reflect on the elements that favor progress from the stages of change towards self-management in people with chronic conditions. Development: To achieve self-management, it is essential to consider - among other aspects - the process of behavioral change and the degree of perceived self-efficacy in the care of chronically ill people. Likewise, primary healthcare and nursing professionals need to develop specific and highly suitable skills for comprehensive, timely, and continuous care. All these aspects interrelate to converge together in a collaborative, consensual, and person-centered healthcare plan. Conclusion: To favor the advancement of self-management, there are elements that both the person and the professional need to articulate, for instance, the existing bidirectional relationships between them must be seen as a continuous functional process and not as discrete elements in healthcare.

Laparoscopía de etapificación y citología peritoneal en cáncer gástrico: descripción de la técnica quirúrgica / Staging laparoscopy and peritoneal cytology in gastric cancer: technique description and review of the literature

Resumen Introducción: El cáncer gástrico continúa representando la más alta mortalidad por cáncer en hombres en Chile. En una revisión sistemática, evidenciaron que en el 59% de los pacientes que se catalogaron como M0 mediante diferentes estudios como TC, resonancia magnética y PET, se detectaron metástasis a la laparoscopia de etapificación. El objetivo de este estudio es describir la técnica quirúrgica de esta laparoscopía incluida la citología peritoneal y una revisión de la literatura en cuanto a sus indicaciones y posibilidad de cambio de conducta. Materiales y Método: Se realizó la búsqueda de artículos vía MED - LINE/PubMed (U.S.A. National Library of Medicine), Cochrane Library, Elsevier, SciELO; no se aplicó análisis estadístico, se incluyeron 23 referencias relacionadas al tema y materias afines internacionales y nacionales. El procedimiento que describiremos será la laparoscopia diagnóstica y la citología de líquido peritoneal para estudio anatomopatológico. Discusión y Conclusiones: La laparoscopía de etapificación, logra un cambio de conducta en un 20% aproximadamente de los casos, pero hacen faltan más estudios de validación de esta en los centros que tratan dicha enfermedad en el país.

Introduction: Gastric cancer continues to represent the highest mortality from cancer in men in Chile. In a systematic review, they showed that 59% of the patients who were classified as M0 by different studies such as CT, magnetic resonance imaging and PET, metastases were detected at staging laparoscopy. The objective of this study is to describe the surgical technique of staging laparoscopy including peritoneal cytology and a review of the literature regarding its indications and the possibility of behavior change. Materials and Method: Articles were searched via MEDLINE/PubMed (U.S.A. National Library of Medicine), Cochrane Library, Elsevier, SciELO, no statistical analysis was applied, 23 references related to the topic and related international and national subjects were included. The procedure to be described will be diagnostic laparoscopy and peritoneal fluid cytology for pathological study. Discussion and Conclusions: Staging laparoscopy achieve a change in behavior in approximately 20% of the cases, but more validation studies are needed in the centers that treat this disease in the country.

Promoting healthy lifestyles in Brazil: design and method of "VAMOS Program" in public health system / Promoção de estilos de vida saudáveis no Brasil: design e método do "Programa VAMOS" no sistema público de saúde

The "Programa Vida Ativa Melhorando a Saúde ­ VAMOS" (Active Life Improving Health) is a community intervention with a behavioral approach. It uses educational strategies to assist health professionals in support the population about the importance of adherence and maintenance of healthy lifestyles. This descriptive study shows the design and method of the VAMOS Program version 2.0. The intervention is for adults and older adults' users of Brazilian public health and aims to motivate them to adopt an active and healthy lifestyle regarding physical activity and eating. The program follows an intervention design that considers the dimensions of the RE-AIM framework. The VAMOS Program version 2.0 has the potential to be offered as a health promotion tool in the Brazilian public health system by using available resources and accessible and healthy behavioral strategies

O "Programa Vida Ativa Melhorando a Saúde ­ VAMOS" é uma intervenção comunitária com abordagem comportamental. Utiliza estratégias educativas para auxiliar os profissionais de saúde a orientar a população sobre a importância da adesão e manutenção de estilos de vida saudáveis. Este estudo descritivo apresenta o design e método do Programa VAMOS, versão 2.0. A intervenção é voltada para adultos e idosos usuários da saúde pública brasileira e visa motivá-los a adotarem um estilo de vida ativo e saudável no que diz respeito à atividade física e à alimentação. O programa segue um design de intervenção que considera as dimensões da ferramenta RE-AIM. O Programa VAMOS, versão 2.0, tem potencial para ser oferecido como ferramenta de promoção da saúde no sistema público de saúde brasileiro por meio da utilização de recursos disponíveis e acessíveis e estratégias comportamentais saudáveis

Changes in body weight and health behaviors of overweight children during the COVID-19 pandemic / Mudanças na massa corporal e em comportamentos de saúde de crianças com excesso de peso durante a pandemia da COVID-19

The aim of this study was to describe the perception of parents of overweight children about the effects of the period of social distancing due to COVID-19 on body weight (BW ), level of physical activity (PA), time spent in sedentary behavior (SB) and their children's eating habits and sleep. Parents of 47 overweight children (11.1 ± 1.33 years) were interviewed by telephone. Questions about the perception regarding BW and the four behaviors related to the health of their children during the period of social distancing were asked. The increase in BW was perceived by 61.7% of children and for almost all of them (93.6%) reductions in PA levels were reported, with 72.4% reducing participation in vigorous PA. An increase in time using smartphones, tablets, and microcomputers was observed in 65.9% of children. Favorable changes were noted in relation to quality (34.1%) and daily sleep time (51.1%). Favorable changes in the consumption of fruits (36.2%) and soft drinks (21.2%) and unfavorable changes in the consumption of vegetables (19.1%) and sweets and snacks (26.2%) were also reported. Four and a half months after the start of the social distancing measures due to the COVID-19 pandemic, overweight children increased the BW and changed the levels of PA and SB in an unfavorable way according to their parents. On the other hand, they started sleeping more and with higher quality and consuming more fruits and less soft drinks

O objetivo deste estudo foi descrever a percepção de pais de crianças com excesso de peso sobre os efeitos do período de distanciamento social devido à COVID-19 na massa corporal (MC) no nível de atividade física (AF), no tempo em comportamento sedentário (CS) e nos hábitos alimentares e de sono de seus filhos/as. Pais de 47 crianças (11,1 ± 1,33 anos) com excesso de peso foram entrevistados por ligação telefônica. Questões sobre a percepção em relação à MC e aos quatro comportamentos relacionados à saúde de seus filhos/as durante o período de distanciamento social foram realizadas. O aumento de MC foi percebido para 61,7% das crianças e para quase todas elas (93,6%) reduções nos níveis de AF foram relatadas, tendo 72,4% reduzido a participação em AF vigorosas. Aumento no tempo utilizando smartphone, tablet e microcomputador foram percebidos em 65,9% das crianças. Modificações favoráveis foram percebidas em relação à qualidade (34,1%) e ao tempo diário (51,1%) de sono. Modificações favoráveis relativas ao consumo de frutas (36,2%) e de refrigerantes (21,2%) e desfavoráveis para o consumo de verduras e legumes (19,1%) e de doces e salgadinhos (26,2%) também foram relatadas. Após quatro meses e meio do início das medidas de distanciamento social devido à pandemia da COVID-19, de acordo com a percepção de seus pais, crianças com excesso de peso aumentaram a MC e modificaram de forma desfavorável os níveis de AF e CS. Por outro lado, passaram a dormir mais e com maior qualidade e a consumir mais frutas e menos refrigerantes

Avaliação da efetividade do "vamos" no contexto do programa academia da saúde: um estudo qualitativo / Evaluating the effectiveness of program vamos in the context of program academy of health: a qualitative study / Evaluación de la efectividad del "vamos" en el contexto del programa academia de la salud: un estudio cualitativo

Resumo: O objetivo deste estudo foi avaliar a efetividade do Vida Ativa Melhorando a Saúde (VAMOS) a partir da percepção dos usuários do Programa Academia da Saúde (PAS) de Belo Horizonte. Foi realizado um estudo qualitativo com participantes do GI (Grupo Intervenção) de um ensaio controlado e randomizado em dois polos do PAS. O GI participou das atividades do PAS e, adicionalmente, de um programa de mudança de comportamento (VAMOS) durante 12 semanas. A efetividade foi avaliada por meio de relatos em três grupos focais realizados com 32 participantes do GI (61 anos, ± 7,07) utilizando o roteiro baseado nas dimensões do modelo RE-AIM. A partir da análise de conteúdo foram identificados benefícios em quatro categorias: atividade física, alimentação, peso corporal e qualidade de vida. Pela percepção dos participantes, concluiu-se que o VAMOS trouxe benefícios nos marcadores do programa e que a metodologia utilizada foi efetiva para atingir os resultados.

Abstract: This study evaluates the effectiveness of program VAMOS (Active Life Improving Health) based on the perception of the Health Academy Program (PAS) users in Belo Horizonte. A qualitative study was conducted with participants of a randomized clinical trial in two PAS units. The IG (Intervention Group) participated in PAS activities and a behavioral change program (VAMOS) for 12 weeks. Effectiveness was evaluated through reports on three focus groups with 32 IG participants (aged 61 ± 7.07) using the script based on the dimensions of the RE-AIM framework. Through content analysis, benefits were identified in four categories: physical activity, food intake, body weight, and quality of life. Participants' perception reflected benefits in the program markers. Therefore, the methodology used proved to be effective in achieving the VAMOS goals.

Resumen: El objetivo de este estudio fue evaluar la efectividad del "Vida Activa Mejorando la Salud" (VAMOS) desde la percepción de los usuarios del Programa Academia de la Salud (PAS) de Belo Horizonte. El estudio fue cualitativo, con participantes del GI (Grupo Intervención) en un ensayo controlado aleatorio en dos polos del PAS. El GI participó en las actividades del PAS y en un programa de cambio de comportamiento (VAMOS) durante 12 semanas. La efectividad se evaluó a través de relatos en tres grupos focales realizados con 32 participantes del GI (61 años, ± 7,07) utilizando el guión basado en el modelo RE-AIM. A partir del análisis de contenido, se identificaron beneficios en cuatro categorías: actividad física, alimentación, peso corporal y calidad de vida. A partir de la percepción de los participantes, se concluyó que el VAMOS trajo beneficios en los marcadores del programa y que la metodología utilizada fue efectiva para alcanzar los resultados.

Knowledge, attitude and behaviour towards seasonal influenza: a community based study in rural Vadodara

Background: Seasonal influenza, though contagious, is preventable, provided the community and its people are aware of its mode of transmission and basic steps of prevention.Methods: This was a cross-sectional descriptive study conducted in the rural field practice area of a Medical College Baroda in the month of February 2019, when the seasonal influenza cases were at its peak. A house to house survey was carried out to enquire about the knowledge, attitude, behavior related to seasonal influenza and its source of information. The structured questionnaire was based on the information, education and communication material displayed by the Health Department for the General Public. Respondents between the age of 15-60 years were interviewed after informed consent. Data-entry and analysis was done in Epi-Data software.Results: Out of 633 respondents, two-thirds of the respondents (427, 67.5%) were aware about seasonal influenza (swine flu). They were aware about common symptoms of flu such as cough, running nose and fever (43.8%, 43% and 41.4% respectively). Majority of those who knew about the flu were aware of it being preventable (59%); 37% knew it could be prevented by using a handkerchief, while 30% were aware about avoiding crowded places. Source of information was television (33%), followed by health care provider (14%) and newspaper (12%).Conclusions: Two-thirds of the respondents in the rural area were aware about seasonal influenza as a disease; majority of them knew that it could be prevented. The source of information was mainly media and health care providers. Attempts to improve the dissemination of information and behavior change communication is the way forward

Mudança de comportamento e cessação de uso de tabaco em mulheres: Uma experiência com treinamento de Agentes Comunitárias de Saúde / Behavior change and cessation of tobacco use in women: an experience with Community Health Workers' training

O conhecimento sobre mudança de comportamento constitui importante ferramenta para auxiliar profissionais de saúde a otimizar a eficácia das intervenções com pacientes. Apesar das evidências sobre a efetividade das atuações em saúde de Agentes Comunitários de Saúde (ACS), esses ainda não estão diretamente envolvidos nos programas de cessação de uso de tabaco. Os objetivos deste estudo foram desenvolver e avaliar uma capacitação de ACS para servirem de apoio a mulheres no processo de cessação. A capacitação foi elaborada em colaboração com ACS, pacientes e profissionais de saúde e enfocou no controle do tabaco e habilidades de mudança do comportamento. Foram aplicados pré e pós-teste para avaliar o conhecimento sobre tabaco e mudança de comportamento e percepção sobre habilidades e confiança para promover tais mudanças, sendo os dados analisados por meio do teste T pareado. Os resultados indicaram aquisição de conhecimento e melhora na percepção de habilidades e confiança para auxiliar mulheres no processo de cessação (N = 80; p < 0,05). Esses dados confirmam que treinamento com enfoque em mudança de comportamento pode ser útil para ampliar o envolvimento de ACS com intervenções na cessação e, dada a generalidade das habilidades propostas na capacitação, essas podem ser úteis para outras intervenções em saúde.

Knowledge about behavior change is an important tool to help health professionals optimize the effectiveness of interventions with patients. Despite evidence of the effectiveness of Community Health Workers (CHWs) participation in delivery of health interventions, there is still no direct participation in tobacco cessation programs. This study aimed to develop and evaluate a CHWs' training to provide support to women in the process of tobacco cessation. Training was built in collaboration with CHWs, patients, health professionals and focused on tobacco control and behavior change skills. Pre and post-test were applied to assess knowledge regarding tobacco and behavior change, and perception of skills and confidence to promote behavior change. These data were analyzed using Paired Sample T-Test. The results showed knowledge acquisition and improvement of the perceived skills and confidence to help women in tobacco cessation process (N=80; p<0,05). These data confirm that training with a focus on behavior change can be useful in increasing CHWs' involvement with cessation interventions and that, given the generality of the skills we focused on for this study, they might be also useful for other health interventions.

Empower parents, enable breastfeeding: a behavioral change communication exercise conducted at a community health centre of Haryana

In India, only 41.6% of the children are breastfed within 1 hour and 54.9% of the children are exclusively breastfed till 6 months. In order to promote breastfeeding, the first week of August is being observed as World Breastfeeding week. We organized a brainstorming session followed by an Interactive, audio-visual health education event on breastfeeding for the pregnant women and their household members at a Community Health Centre (CHC) in Haryana, during that week. A behavior change communication (BCC) session was held on 1st August 2019 at the Antenatal clinic of the CHC. Target population was the pregnant, lactating mothers and their household members. Needs assessment was done to assess their current knowledge, attitude and needs about the breastfeeding and breast milk, by interacting with them and posing questions. Based on the above needs assessment exercise, we delivered a health education session. The household members were enlightened about their role in breastfeeding. The behavior change communication exercise, tailored to local population and conducted by us would have improved the knowledge, attitude of the pregnant women and their family members towards breastfeeding, and in turn will improve the practice in near future. The exercise is replicable in other settings, by tailoring it according to the local needs.

Enabling factors for behavior change among people with alcohol dependency: An exploratory study in a mental health-care facility

Background: Alcohol dependence has become a major public health problem with many implications on the lives of dependents and their families. Objectives: The objectives of this study is to ascertain the enabling factors to seek medical help and continue behavior change among alcohol dependents and to assess the perceptions of health-care providers regarding treatment-seeking behavior of alcohol dependents. Methods: The present study deployed the transtheoretical model (TTM) as a theoretical framework for analyzing the enabling factors to seek medical help and continue behavior change among alcohol dependents and to understand the perceptions of health-care providers dealing with alcohol dependents at a tertiary care psychiatry hospital in Guntur of Andhra Pradesh. In-depth interviews and desk review of hospital records were done. Respondents included treatment-seeking individuals for alcohol detoxification (action phase), patients attending follow-ups (maintenance phase), and mental health professionals at the study site. The study was conducted during August and September 2017. Qualitative analysis using thematic framework and MS EXCEL for quantitative data was used. Results: Themes and subthemes emerging out of analysis were fitted in stages of TTM of behavior change. In the process of behavior change, there were key supportive elements such as problem awareness (precontemplation), availability and accessibility of services (contemplation), appropriate treatment modality (action), and alcohol anonymous groups (maintenance), which sustained the progress of change and yielded effective outcomes. Conclusions: Alcoholism needs to be addressed holistically rather than focusing only on biological treatment.

Estimation of prevalence of risk factors for coronary artery disease in a rural population in Howrah, West Bengal

Background: Coronary artery disease (CAD) is a major cause of death globally in both developed and developing countries. Coronary artery disease which was once thought to be a disease of the urban population is now involving the rural community in an increased number. So a study of major coronary risk factors in rural communities will help to adopt various strategies particularly behavior change and communication relevant for these communities to prevent these risk factors and lower CAD related mortality and morbidity. Objective was to estimate rates of the various risk factors for CAD and identify the high-risk groups in the rural community.Methods: A community based cross sectional study was carried out in a rural area in the Howrah district of West Bengal. Four hundred and eighteen (418) persons (212 males and 206 females) were subjected to study using structured, pretested and predesigned schedule. Coronary artery disease risk factors were assessed. Statistical analysis was done with the help of statistical software, the SPSS 20.0 for windows.Results: The study observed that prevalence of tobacco use among the study population was the most significant risk factor (42.3%). The prevalence of other coronary risk factors ranged from 10-20%. Tobacco use, alcohol consumption and sedentary life style were significantly more amongst males. Whereas truncal obesity and systolic hypertension more among females.Conclusions: Various comprehensive strategies particularly behavior change and communication targeting these high risk population need to be emphasized to lower CAD related morbidity burden in the community.

Coaching nutricional y motivación para el cambio de conducta alimentaria / Nutritional coaching and motivation for change of eating behavior

RESUMEN La mayoría de las áreas del campo laboral del nutricionista, involucran en algún momento ya sea directa o indirectamente, estimular, guiar o inducir el cambio de conductas ligadas a la alimentación, proceso que se realiza a través de la enseñanza y el aprendizaje. Sin embargo, en la actualidad, esto se reduce en muchas ocasiones a la transmisión del conocimiento de manera unidireccional, donde la persona a cargo de realizar los cambios en realidad es un sujeto pasivo a cargo de seguir indicaciones. Por el contrario, el Coaching Nutricional (CN), es un proceso a través del cual la persona es totalmente activa en su cambio, identifica y vence sus obstáculos, crea el entorno adecuado, adopta una actitud y determinación necesarias para conseguir adaptar su alimentación, logrando a su vez mejorar otros aspectos de su persona y de su estilo de vida. En esto es clave evaluar el grado de motivación del sujeto, estableciendo estrategias específicas de acuerdo a los intereses y factores que motivan su cambio de conducta, de manera de favorecer la adherencia terapéutica y el cambio real de conductas en salud.

ABSTRACT Most of the areas of the nutritionist's labor field involve directly or indirectly stimulating, guiding or inducing the change of behaviors linked to food, a process that is carried out through teaching and learning. However, at present, this is often reduced to the transmission of knowledge in a unidirectional manner, where the person in charge of making the changes is actually a passive subject in charge of following directions. On the contrary, nutritional coaching is a process through which the person is active in their change, identifies and overcomes their obstacles, creates the appropriate environment, adopts the attitude and determination necessary to adapt their diet, and, in turn, improves other aspects of his/her person and lifestyle. Thus, it is key to evaluate the degree of motivation of the subject, establishing specific strategies according to the interests and factors that motivate their behavior change, in order to favor therapeutic adherence and a real change in health behaviors.

Impact of Professional Nutrition Education on Dietary Behavior and Body Mass Index Status of Senior Clinical Nutrition Students and Dieticians in Saudi Arabia

Background: Dieticians are uniquely qualified to providenutrition education that can promote healthy lifestyles, reducethe burden of diet related chronic diseases, and improve thequality of life among population.Objectives: To evaluate the effectiveness of professionalnutrition education on changing dietary habits and achievementof normal BMI.Methodology: A cross sectional study. Subjects weregraduates from clinical nutrition departments and otherdepartments of Saudi Universities (n=225). Using internetstructured questionnaire focusing on dietary habits before andafter college education, physical activity and weight changes totest the impact of education on food habits both on the subjectand his/her surrounding environment (family and friends).Results: Increase consumption of fruits, vegetables, darkgreen vegetables, whole grain cereals, dairy products, andwater and increase physical activities, in addition to decreaseconsumption of soda, artificial canned juices, energy drinks,solid fat, added sugar, saturated fat and salt were clear amonggraduates of clinical nutrition departments in comparison toother graduates.Conclusion: Professional nutrition education positively impactfood choices and healthy food habits. This impact is extendedto their families and friends.

Letter to the Editor: The development of knights cabin cancer retreats: a community program to engage cancer survivors' proactive health behaviors

Purpose: Cancer survivors often lack the knowledge and skills to return to positive health behaviors following a cancer diagnosis. The use of retreats may be an ideal environment for cancer survivors to learn about health behaviours while receiving social support from other survivors. Methods: Knights Cabin Cancer Retreats was created as a charitable organization in 2014 and is at no cost to participants or their supporters. Elements of the retreat include guided hikes, yoga, classes on nutrition, stress, mindfulness and sleep management techniques, all with a focus on the evidence based theories of behavioral change. Results: Ten retreats have been hosted across Canada to date with 137 cancer survivors and their supporters. Survivors reported that their top learning outcomes from the retreat were physical activity/nutrition and behavioral change/habit development. Conclusion: Knight's Cabin Cancer retreats are unique in their programming with a format of health education that allows for emotional support and engagement with other cancer survivors in a therapeutically natural environment.

O Modelo Transteórico para Auxiliar Adolescentes Obesos a Modificar Estilo de Vida / El Modelo Transteórico para Ayudar Adolescentes con Sobrepeso y Obesidad a Cambiar su Estilo de Vida / The Transtheoretical Model to Assist Lifestyle Modification in Adolescents with Overweight and Obesity

Resumo O número de adolescentes com sobrepeso e obesidade quadriplicou nos últimos trinta anos, gerando possível redução na sobrevida. O tratamento não medicamentoso está relacionado à mudança de estilo de vida, visando a redução de peso. O presente relato de experiência visa descrever uma intervenção interdisciplinar grupal baseada no Modelo Transteórico de Mudança (MTT) para motivar adolescentes com sobrepeso e obesidade a modificar o estilo de vida, avaliar a motivação para a modificação de diferentes comportamentos relacionados à saúde, e explanar estratégias que facilitam a evolução nos estágios de mudança. Participaram deste estudo 13 jovens, com idade média de 16,32 anos (DP = 1,21), sendo cinco do sexo masculino e oito do feminino. Este relato procura apresentar a forma que os processos de mudança podem contribuir no aumento da motivação para mudança do estilo de vida. Ao final da intervenção o grupo apresentou aumento na motivação para praticar exercício físico e regular hábitos alimentares, e perda média de peso.

Resumen El número de adolescentes con sobrepeso y obesidad cuadruplicó en los últimos treinta años y las consecuencias de esa condición pueden llegar a ser la reducción de la sobrevida. El tratamiento sin medicinas se hace por medio del cambio de estilo de vida enfocado a la reducción de peso. El informe expone una intervención interdisciplinar en grupo basada en el Modelo Transteórico (MTT) para motivar adolescentes con sobrepeso y obesidad a modificar su estilo de vida, evaluar su motivación para la modificación de comportamientos relacionados a la salud, y explicar estrategias que facilitan la evolución en las etapas de cambio. En este estudio participaron 13 jóvenes, con edad mediana = 16,32 (DE = 1,21), cinco del sexo masculino y ocho del femenino. Este informe busca demonstrar la forma que los procesos de cambio pueden estimular el aumento de motivación para el cambio del estilo de vida. Al final de la intervención el grupo presentó aumento de la motivación para practicar ejercicio físico regularmente y mejorar hábitos alimenticios, y perdida media del peso inicial.

Abstract The prevalence of overweight and obesity in adolescents has quadrupled over the last 30 years, with significant consequences for life expectancy. The main non-pharmacological intervention for these conditions is lifestyle modification. This experience report describes an interdisciplinary intervention based on the Transtheoretical Model (TTM), delivered to a group of obese adolescents with the aim of increasing motivation for lifestyle modification, evaluating motivation to change health-related behaviors, and discuss techniques to facilitate the evolution through the stages of change. The study involved thirteen participants with a mean age of 16.32 years (SD = 1.21), of whom five were male and a eight, female. The purpose of this report is to describe how the processes for change can increase motivation for lifestyle change in this population. At the end of the intervention, participants showed increased motivation to exercise regularly and improve eating habits, as well as a mean overall weight loss.

Empirical analysis of career cognition and development expectation of family doctors in Changning district , Shanghai / 中华医院管理杂志

Objective Under the linkage reform of family doctor service and medical insurance payment ,to study the family doctors′ career cognitive and expectations in order to improve the endogenous power of the family doctor system development ,and push forward the reform with sustainable effects .Methods All the family doctors in Changning were surveyed. There were 154 family doctors surveyed in the first phase of 2013 ,and 143 in the second phase of 2016 .The data were subject to descriptive statistics .Results About 80％ of the family doctors had a clear understanding of the family doctor system in 2016 ,with the proportion of family doctors clearly understanding their duties risen from 55.26％ (84/152)in 2013 to 61.27％ (87/142)in 2016 .Self-assessment of their work value and professional reputation were more positive significantly .70％ of them believed their social status as above average. The proportion of family doctors who were very confident/confident" in the development of community health services and family doctor system increased from 31.72％ (46/145) to 47.20％ (59/125)and from 31.72％ (46/145)to 52.42％ (65/124)respectively .Conclusions The occupational cognition and career expectations of family doctors in Changning district have been significantly improved ,which can guide their behavior towards reform objectives and propel the family doctor system progress smoothly .

Who is saying what on Twitter: An analysis of messages with references to HIV and HIV risk behavior / Quién dice qué en Twitter: Mensajes con referencia a VIH y conducta de riesgo de VIH

Abstract: This research aimed to determine the nature of social media discussions about HIV. With the goal of conducting a descriptive analysis, we collected almost 1,000 tweets posted February to September 2015. The sample of tweets included keywords related to HIV or behavioral risk factors (e.g., sex, drug use) and was coded for content (e.g., HIV), behavior change strategies, and message source. Seven percent of tweets concerned HIV/AIDS, which were often referred to as jokes or insults. The majority of tweets coded as behavior change attempts involved attitude change strategies. The majority of the tweets (80%) came from private users (vs. organizations). Different types of sources employed different types of behavior change strategies: For instance, private users, compared to experts or organizations, included more strategies to decrease detrimental attitudes (29% versus 6%, p < .001), and also more strategies to counter myths and misinformation (6% versus 1%, p = .008). In summary, tweets related to HIV/AIDS and associated risk factors frequently use the terms in jokes and insults, come largely from private users, and entail attitudinal and informational strategies. Online health campaigns with clear calls to action and corrections of misinformation may make important contributions to social media conversations about HIV/AIDS.

Resumen: Esta investigación tuvo el objetivo de caracterizar las discusiones sobre VIH en los medios sociales. Con el objetivo de realizar un análisis descriptivo, recogimos alrededor de mil tweets entre febrero y septiembre del 2015. Estos tweets fueron seleccionados si incluían palabras claves relacionadas con el VIH o con factores de riesgo conductual tales como sexo o uso de drogas. Cuatro codificadores clasificaron los tweets en función del contenido (e.g., el VIH como enfermedad, referido a un producto o servicio), la estrategia de cambio conductual (cambio conductual, llamada a la acción, o corrección de mitos), y la fuente del mensaje (e.g., usuarios privados, expertos, empresas comerciales). La mayoría de los tweets (80%) provenía de usuarios privados en lugar de institucionales. El 7% de los tweets se refería estrictamente al VIH u otras infecciones de transmisión sexual, frecuentemente utilizando esos términos como bromas o insultos, tales como escribir que una experiencia displacentera "me dio SIDA". La mayoría de los intentos de cambio conductual incluía estrategias de reducción de actitudes negativas. Fuentes de distintos tipos empleaban estrategias de cambio conductual de distintos tipos. Por ejemplo, usuarios privados (comparados con expertos, organizaciones comerciales, y otras organizaciones, tal como periódicos y ONGs), publicaban más mensajes clasificados como estrategias de promoción de actitudes negativas (29% versus 6%, p < .001), y tenían más correcciones de mitos (6% versus 1%, p = .008). En resumen, los tweets que mencionan el VIH o factores de riesgo de VIH utilizan los términos en bromas e insultos con gran frecuencia, provienen mayormente de usuarios privados, e incluyen estrategias de cambio de actitud. Las campañas de Internet con llamadas claras a la acción y con correcciones de mitos pueden hacer contribuciones importantes a las conversaciones sobre VIH en los medios sociales.