The Body, the Mind, and the Spirit: Including the Spiritual Domain in Mental Health Care.

This article supports the expansion of Engel's (Science (AAAS) 196(4286):129-136, 1977) biopsychosocial model into a biopsychosocial-spiritual model, as Sulmasy (The Gerontologist 42(5):24-33, 2002) and others have suggested. It utilizes case studies to describe five areas of clinical work within mental health (religious grandiosity, depression and grief, demoralization and suicidality, moral injury, and opioid use disorder) with emerging evidence for the inclusion of the spiritual domain in addition to the biological, psychological, and social. For each clinical area, an underutilization of the spiritual domain is compared with a more developed and integrated use. An argument is made for continuing to develop, understand, and utilize a biopsychosocial-spiritual model in mental health.

A Comparative Study of Urban Park Preferences in China and The Netherlands.

Urban parks play an important role in tackling several urban challenges such as air pollution, urban heat, physical inactivity, social isolation, and stress. In order to fully seize the benefits of urban parks, it is important that they are attractive for various groups of residents. While several studies have investigated residents' preferences for urban park attributes, most of them have focused on a single geographical context. This study aimed to investigate differences in park preferences, specifically between Dutch and Chinese park users. We collected data in the Netherlands and China using an online stated choice experiment with videos of virtual parks. The data were analyzed with a random parameter mixed logit model to identify differences in preferences for park attributes between Chinese and Dutch citizens, controlling for personal characteristics. Although the results showed a general preference for parks with many trees, several differences were found between the Dutch and Chinese respondents. These differences concerned vegetation (composition of trees and flowers), the presence of benches and play facilities, and could probably be explained by differences in park use, values of nature, and landscape preferences. The findings of this study can be used as design guidelines by urban planners and landscape designers to design attractive and inclusive parks for different target groups.

Objective and Perceived Traffic Safety for Children: A Systematic Literature Review of Traffic and Built Environment Characteristics Related to Safe Travel.

The literature on children's active transportation has shown the influence of the built environment characteristics on walking and crashes. Various reviews have examined those two questions. One influence on walking is the perception of traffic safety. However, it is not clear how, or even if, the built environment affects such perceptions. This research aims to understand which traffic and built environment characteristics influence objective and subjective/perceived traffic safety for children based on the analysis of previous studies in the field. Two types of research were used: the first examines the association between traffic and built environment characteristics and child pedestrian and/or cyclist collisions/injuries; the second relates to the perception of safety by parents and children for active transportation and, where studied, its relationship with built environment characteristics. A systematic review was conducted using five electronic databases. The total number of articles retrieved was reduced to 38 following the eligibility criteria and quality assessment, where 25 articles relate to injuries among children and 13 articles pertain to perception of safety. The results showed that high traffic volume and high vehicle speed are the main reasons children and parents feel unsafe when children use active travel, which matches the main findings on objective safety. Few articles on perception of safety related to the objective built environment were found. However, consistent findings exist. The presence of sidewalk was related to the safety of children. The presence of a crossing guard was positively related to perceived safety but was associated with higher rates of injuries among children. Intersection density was related to unsafe perceptions but was not statistically associated with objective traffic safety. Additionally, population density was found to be positively related to injuries among children, but not to perception of safety. The results help policy strategy to enhance the safety of children when using active transport modes.

Evaluating the Impact of Adaptive Personalized Goal Setting on Engagement Levels of Government Staff With a Gamified mHealth Tool: Results From a 2-Month Randomized Controlled Trial.

BACKGROUND: Although the health benefits of physical activity are well established, it remains challenging for people to adopt a more active lifestyle. Mobile health (mHealth) interventions can be effective tools to promote physical activity and reduce sedentary behavior. Promising results have been obtained by using gamification techniques as behavior change strategies, especially when they were tailored toward an individual's preferences and goals; yet, it remains unclear how goals could be personalized to effectively promote health behaviors. OBJECTIVE: In this study, we aim to evaluate the impact of personalized goal setting in the context of gamified mHealth interventions. We hypothesize that interventions suggesting health goals that are tailored based on end users' (self-reported) current and desired capabilities will be more engaging than interventions with generic goals. METHODS: The study was designed as a 2-arm randomized intervention trial. Participants were recruited among staff members of 7 governmental organizations. They participated in an 8-week digital health promotion campaign that was especially designed to promote walks, bike rides, and sports sessions. Using an mHealth app, participants could track their performance on two social leaderboards: a leaderboard displaying the individual scores of participants and a leaderboard displaying the average scores per organizational department. The mHealth app also provided a news feed that showed when other participants had scored points. Points could be collected by performing any of the 6 assigned tasks (eg, walk for at least 2000 m). The level of complexity of 3 of these 6 tasks was updated every 2 weeks by changing either the suggested task intensity or the suggested frequency of the task. The 2 intervention arms-with participants randomly assigned-consisted of a personalized treatment that tailored the complexity parameters based on participants' self-reported capabilities and goals and a control treatment where the complexity parameters were set generically based on national guidelines. Measures were collected from the mHealth app as well as from intake and posttest surveys and analyzed using hierarchical linear models. RESULTS: The results indicated that engagement with the program inevitably dropped over time. However, engagement was higher for participants who had set themselves a goal in the intake survey. The impact of personalization was especially observed for frequency parameters because the personalization of sports session frequency did foster higher engagement levels, especially when participants set a goal to improve their capabilities. In addition, the personalization of suggested ride duration had a positive effect on self-perceived biking performance. CONCLUSIONS: Personalization seems particularly promising for promoting the frequency of physical activity (eg, promoting the number of suggested sports sessions per week), as opposed to the intensity of the physical activity (eg, distance or duration). Replications and variations of our study setup are critical for consolidating and explaining (or refuting) these effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT05264155; https://clinicaltrials.gov/ct2/show/NCT05264155.

Public perceptions of physical and virtual water in China.

Ensuring access to water is one of the United Nations' Sustainable Development Goals. Water demand management, which has emerged as an important approach to secure water supply, should be underpinned by a good understanding of how the public perceive their use of water. In this study, we investigated public perceptions of physical and virtual water in China through online surveys using the multi-level regression models (two-level models). Based on 3262 responses, we found that overall, participants underestimated water uses and differences between water uses (daily potable water of an adult, shower, toilet flushing, etc.). Most participants did not possess the knowledge of virtual water embedded in their daily consumed products. Individuals showed rather different perceptions in water use, which were affected by gender, age, education, resource and environmental attitude, water saving behaviors, water price and residential water source. In combination with previous findings in the United States, we concluded that despite different natural water endowment and socio-economic and cultural conditions, underestimation of water use is commonly shared by Chinese and Americans. This highlights a need of strengthening public knowledge of water use. The results are useful in informing policies to enhance the public's awareness of water use towards improved water demand management.

Preadolescent Students' Engagement With an mHealth Intervention Fostering Social Comparison for Health Behavior Change: Crossover Experimental Study.

BACKGROUND: Contemporary mobile health (mHealth) interventions use various behavior change techniques to promote healthier lifestyles. Social comparison is one of the techniques that is consensually agreed to be effective in engaging the general population in mHealth interventions. However, it is unclear how this strategy can be best used to engage preadolescents. Nevertheless, this strategy has great potential for this target audience, as they are particularly developing their social skills. OBJECTIVE: This study aims to evaluate how social comparison drives preadolescents' engagement with an mHealth app. METHODS: We designed a 12-week crossover experiment in which we studied 3 approaches to implementing behavior change via social comparison. This study was hosted in a school environment to leverage naturally existing social structures among preadolescents. During the experiment, students and teachers used an mHealth tool that awarded points for performing healthy activities. Participants could read their aggregated scores on a leaderboard and compare their performance with others. In particular, these leaderboards were tweaked to implement 3 approaches of the social comparison technique. The first approach focused on intragroup comparison (ie, students and teachers competing against each other to obtain the most points), whereas the other two approaches focused on intergroup comparison (ie, classes of students and their mentoring teachers collaborating to compete against other classes). Additionally, in the third approach, the performance of teachers was highlighted to further increase students' engagement through teachers' natural exemplary function. To obtain our results, we used linear modeling techniques to analyze the dropout rates and engagement levels for the different approaches. In such analyses, we also considered individual participant traits. RESULTS: Our sample included 313 participants-290 students (92.7%) and 23 teachers (7.3%). It was found that student engagement levels dropped over time and declined during holidays. However, students seemed to monitor the intergroup competitions more closely than the intragroup competitions, as they, on average, checked the mHealth app more often when they were engaged in team-based comparisons. Students, on average, performed the most unique activities when they were engaged in the second intergroup setting, perhaps because their teachers were most active in this setting. Moreover, teachers seemed to play an important role in engaging their students, as their relationship with their students influenced the engagement of the students. CONCLUSIONS: When using social comparison to engage preadolescents with an mHealth tool, an intergroup setting, rather than an intragroup competition, motivated them to engage with the app but did not necessarily motivate them to perform more activities. It seems that the number of unique activities that preadolescents perform depends on the activeness of a role model. Moreover, this effect is amplified by preadolescents' perceptions of closeness to that role model.

Editorial for the Special Issue on "Experiencing the City: The Relation between Urban Design and People's Well-Being".

Urbanization brings major challenges with regard to livability and the health and quality of life of citizens [...].

Pilot Evaluation of the Impact of Lottery-Based Incentives on Engagement Levels of Male Low SES Vocational Students With an mHealth App.

In general, individuals with lower socioeconomic status (SES) are less physically active and adhere to poorer diets than higher SES individuals. To promote healthier lifestyles in lower SES populations, we hosted a digital health promotion program among male vocational students at a school in The Netherlands. In a pilot study, we evaluated whether this target audience could be engaged with an mHealth app using lottery-based incentives that trigger feelings of anticipated regret. Especially, we studied the social and interpersonal aspects of regret lotteries in a within-subject experimental design. In this design, subjects either participated in a social variant (i.e., with students competing against their peers for a chance at a regret lottery), or an individual variant (i.e., with subjects solely individually engaged in a lottery). Additionally, we studied the impact of different payout schedules in a between-subject experimental design. In this design, participants were assigned to either a short-term, low-value payout schedule, or a long-term, high-value payout schedule. From a population of 72 male students, only half voluntarily participated in our 10-week program. From interviews, we learned that the main reason for neglecting the program was not related to the lottery-based incentives, nor to the prizes that were awarded. Instead, non-enrolled subjects did not join the program, because their peers were not joining. Paradoxically, it was suggested that students withheld their active participation until a larger portion of the sample was actively participating. From the subjects that enrolled in the program (N = 36, males, between 15 and 25 years of age), we found that a large proportion stopped interacting with the program over time (e.g., after roughly 4 weeks). Our results also indicated that students performed significantly more health-related activities when assigned to the social regret lottery, as opposed to the individual variant. This result was supported by interview responses from active participants: They mainly participated to compete against their peers, and not so much for the prizes. Hence, from this study, we obtained initial evidence on the impact of social and competitive aspects in lottery-based incentives to stimulate engagement levels in lower SES students with an mHealth app.

Where do People Interact in High-rise Apartment Buildings? Exploring the Influence of Personal and Neighborhood Characteristics.

Early studies conclude that high-rise apartment buildings present challenges for people's quality of life, resulting in social isolation, social annoyance and anonymity for residents. Nevertheless, empirical research into factors supporting social interaction in high-rise apartment buildings is still scarce. This study aims to investigate how often and where people in high-rise neighborhoods interact, and how this is affected by personal and neighborhoods characteristics. A mixture of both quantitative and qualitative methods was used including social interaction diaries and questionnaires among 274 residents, in-depth interviews with 45 residents and objective measurement of the physical environments in four high-rise apartment buildings for low in-income people in Hanoi, Vietnam. Results demonstrate that social interaction is influenced by a number of personal and neighborhood characteristics. Furthermore, most social interactions-also gathering and accompanying playing children-take place in the circulation areas of the apartment buildings. However, the use of these spaces for different purposes of interaction is found to have negative impact on people's privacy, the feeling of safety and cleanliness of the shared spaces. The findings of this study provide information for planners and designers on how to design and improve high-rise apartment buildings that support social interaction.

How Does Walkability Change Behavior? A Comparison between Different Age Groups in the Netherlands.

Empirical research provides evidence that, in neighborhoods with higher walkability, individuals make more walking trips. However, it is not clear what the exact nature is of the relationships between neighborhood walkability and walking trips, since a higher walking frequency can be explained in different ways. This study examined whether the extra walking trips in better walkable neighborhoods are related primarily to trip generation, destination choice, or transport mode choice and whether this is the same for different age groups. A neighborhood fixed effects regression analysis was conducted in a first step to obtain a walkability measure for each neighborhood in the Netherlands including systematic as well as unobserved effects. Subsequently, the estimated fixed effects were used as walkability data for a path analysis based on a causal model to test the hypotheses stated. The results of the path analysis show direct relationships of neighborhood walkability with trip generation, destination choice, and transport mode choice, after controlling for the mutual relationships between the activity and trip variables. Comparing different age groups (i.e., children, adults, and elderly), the differences found mostly concerned the relationship between neighborhood walkability and trip generation. We concluded therefore that conditions for walkability are not the same for all age groups.

The Influence of Urban Park Attributes on User Preferences: Evaluation of Virtual Parks in an Online Stated-Choice Experiment.

Urban green areas, such as parks, are becoming increasingly important in densifying cities. Urban parks encourage physical and social activity, recreation and relaxation, and thus eventually promote people's well-being. The aim of the current study is to examine which urban park attributes influence the preferences of park users, in order to offer recommendations regarding how urban parks of quality can be designed. To elicit the preferences of park visitors we designed an online stated-choice experiment. Seven park attributes, in particular the number and composition of trees and the presence of benches, side paths, a playground, litter, and flowers, were manipulated in a virtual park. In an online stated-choice task, videos of these park alternatives were presented and the preferences of 697 participants were measured. It is found that especially the number of trees and the presence of flowerbeds, particularly with a diversity of flowers, influenced participants' preferences. The presence of many benches and a playground were valued as well, but to a lesser extent. The presence of litter was found to be less troublesome than expected. Alternatives with all trees placed in one cluster were disliked. Moreover, significant standard deviations were found for the presence of side paths, a playground, and the absence of litter, which indicates that preference heterogeneity for these attributes exist. In a latent class analysis, two groups were identified, namely a Nature-loving group, who mainly valued the trees and the flowers, and an Amenity-appreciating group, who valued almost all attributes. It can be concluded that natural elements and a variety of flower species are important in an urban park, while facilities are evaluated differently by different groups of people. These findings may support park designers and policymakers in decision-making. Moreover, it illustrates the usefulness of creating a virtual park in environmental preference research.

Loneliness and Life Satisfaction Explained by Public-Space Use and Mobility Patterns.

Previous research has shown that personal, neighborhood, and mobility characteristics could influence life satisfaction and loneliness of people and that exposure to public spaces, such as green spaces, may also affect the extent to which people feel lonely or satisfied with life. However, previous studies mainly focused on one of these effects, resulting in a lack of knowledge about the simultaneous effects of these characteristics on loneliness and life satisfaction. This study therefore aims to gain insights into how public-space use mediates the relations between personal, neighborhood, and mobility characteristics on the one hand and loneliness and life satisfaction on the other hand. Relationships were analyzed using a path analysis approach, based on a sample of 200 residents of three neighborhoods of the Dutch city 's-Hertogenbosch. The results showed that the influence of frequency of public-space use on life satisfaction and loneliness is limited. The effects of personal, neighborhood, and mobility characteristics on frequency of use of public space and on loneliness and life satisfaction were found to be significant. Age and activities of daily living (ADL) are significantly related to each other, and ADL was found to influence recreational and passive space use and loneliness and life satisfaction. Policymakers should, therefore, mainly focus on creating neighborhoods that are highly walkable and accessible, where green spaces and public-transport facilities are present, to promote physical activity among all residents.

A Multi-Level Path Analysis of the Relationships between the Momentary Experience Characteristics, Satisfaction with Urban Public Spaces, and Momentary- and Long-Term Subjective Wellbeing.

Previous research has shown that the urban environment could influence people's behavior and wellbeing. However, little is still known about how the objective and subjective measures of the momentary experience of urban public spaces could contribute to the satisfaction with the urban environment of cities, which eventually could influence the momentary and long-term subjective wellbeing (SWB) of citizens. Therefore, the aim of this research is to gain insight into how momentary experience and satisfaction with the urban public space could contribute to the SWB of citizens, and thereby control for personal, contextual characteristics. Relationships were simultaneously analyzed using a multi-level path analysis approach based on a sample of 1056 momentary experiences of urban public spaces reported by 161 citizens of the urban area Eindhoven, The Netherlands. The results showed that personality and personal characteristics are highly important for explaining long-term SWB and subsequently long-term SWB positively influences momentary SWB (the degree of feeling secure, comfortable, happy and annoyed) together with the momentary satisfaction of urban public space characteristics. In addition, contextual characteristics, such as time/day and distance to facilities are important for explaining people's momentary SWB. Policy makers and urban planners can use these results when developing policy and designing a healthy, attractive, livable and safe living environment for citizens.

Loneliness of Older Adults: Social Network and the Living Environment.

The social participation and integration of older adults are important aspects of healthy aging. However, in general, older adults have smaller social networks than their younger counterparts due to changes in their life cycle stage, such as retirement or age-related losses, along with a declining health and increasing mobility limitations. Consequently, with increasing age, an increasing proportion of older people experience feelings of loneliness and social isolation. Previous studies that have analyzed the relationships between loneliness, social networks, and the living environment have often been based on bivariate relationships or included only a limited number of variables. Therefore, the aim of this study was to analyze multiple relationships in a more comprehensive framework. Data were collected using a survey among 182 adults aged 65 years and over in the Netherlands. A Bayesian belief network (BBN) modeling approach was used that derives all direct and indirect relationships between the variables. The results showed that feelings of loneliness are directly related to satisfaction with one's social network and neighborhood attachment and are indirectly related to perceived safety and satisfaction with local amenities and services. This knowledge is relevant to urban planners and policy makers who focus on creating livable and healthy social neighborhoods for the aging population.

Evaluation of the impact of extrinsic rewards on user engagement in a health promotion context.

Despite the many mHealth solutions available, it remains unclear what their success factors are. Specifically, there has been controversy on the effectiveness of extrinsic rewards. This study evaluates two design elements of an mHealth solution - i.e., social proof and tangible rewards - and their impact on user engagement. During a four-week campaign, a sample of 143 university staff members engaged in a health promotion campaign. Participants were randomly distributed over one of three treatment groups. It was found that the introduction of a sufficiently meaningful, unexpected, and customized extrinsic reward can engage participants significantly more in a health promotion context.

Measurement properties of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ): a study based on Classical Test Theory.

PURPOSE: The construct validity, test-retest reliability, and measurement error of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) were examined. Additionally, the influence of administration-method on reliability and measurement error was investigated. METHOD: 112 Dutch adult MS-patients from an academic- and a residential care-facility participated. Questionnaires were administered on paper, online or as interview, and patients performed several performance tests. Construct validity was assessed by testing pre-defined hypotheses. Reliability was assessed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurements (SEMs) and Smallest Detectable Changes (SDCs). RESULTS: For construct validity (N = 105) 9 of 13 hypotheses were confirmed (69%). As expected, the AMSQ showed moderate to strong relationships with the instruments measuring similar constructs. The test-retest reliability coefficient was 0.96 (95% Confidence Interval 0.94-0.97); SEM was 6.3 (6.3% of scale range); SDC was 17.5 (on a sale from 0 to 100). Different administration-methods showed good reliability (ICC 0.88-0.94) and small standard errors (SEM 5.6-7.2). CONCLUSION: The AMSQ shows satisfying results for validity and excellent reliability; allowing for proper use in research. Due to a large SDC value, caution is needed when using the AMSQ in individual patient care. Further research should determine whether the SDC is smaller than the minimal important change. Implications for Rehabilitation The Arm Function in Multiple Sclerosis Questionnaire (AMSQ) measures activity limitations due to hand and arm functioning in patients with Multiple Sclerosis (MS). Results of this study confirm adequate validity and reliability of the AMSQ in patient with MS. The equivalence of scores from online, paper or interview administration is supported. A change score of ≥18 points on the scale of the AMSQ (on a scale 0-100) needs to occur to be certain a change beyond measurement error has occurred in an individual patient.

Locations that Support Social Activity Participation of the Aging Population.

Social activities are an important aspect of health and quality of life of the aging population. They are key elements in the prevention of loneliness. In order to create living environments that stimulate older adults to engage in social activities, more insight is needed in the social activity patterns of the aging population. This study therefore analyzes the heterogeneity in older adults' preferences for different social activity location types and the relationship between these preferences and personal and mobility characteristics. This is done using a latent class multinomial logit model based on two-day diary data collected in 2014 in Noord-Limburg in the Netherlands among 213 respondents aged 65 or over. The results show that three latent classes can be identified among the respondents who recorded social activities in the diary: a group that mainly socializes at home, a group that mainly socializes at a community center and a group that is more likely to socialize at public 'third' places. The respondents who did not record any interactions during the two days, are considered as a separate segment. Relationships between segment membership and personal and mobility characteristics were tested using cross-tabulations with chi-square tests and analyses of variance. The results suggest that both personal and mobility characteristics play an important role in social activity patterns of older adults.