The Activities of the Slovenian Strategic Council for Nutrition 2023/24 to Improve the Health of the Slovenian Population and the Sustainability of Food: A Narrative Review.

The health status of individuals in Slovenia across age groups is a matter of concern, as current unsustainable lifestyle choices are already leading to various chronic noncommunicable diseases (NCDs). Outdated national dietary guidelines, their inconsistent implementation, and a lack of structural changes represent obstacles to promoting healthy and sustainable nutrition. Limited access to and rising prices of healthy, sustainable foods, in addition to the high availability of low-priced, highly processed foods, increase the risk of NCDs. The lack of systematic health monitoring and early disease detection poses a challenge. Global and local environmental issues, resistance, and/or the inability to adopt healthier diets hinder individuals from changing their nutritional behaviours. In this narrative review, we provide an overview of the current situation in Slovenia as well as planned activities initiated by the Slovenian government and the Prime Minister's Strategic Council for Nutrition, aiming to make progress in supporting healthy and sustainable nutrition, limiting food waste, and increasing the availability of healthier foods for all. Improving the sustainability of the Slovenian food system can contribute to several Sustainable Development Goals (SDGs), ensuring Slovenia's commitment to internationally agreed-upon targets. This could lead Slovenia to take a role as a pilot country in testing and implementing the necessary systemic changes, which could be further applied in other countries.

From Dimensions, Levels and Domains to Context-specific Conceptualizations of Health Literacy.

Health literacy refers to skills and knowledge that enable individuals to navigate health-related information environments, to function in healthcare systems, and to practice behaviors that lead to better health outcomes. Accordingly, health literacy is one of the major preoccupations of public health scholars, policies, and strategies. However, it is a complex, multidimensional, and dynamic concept that incorporates different kinds of health-related skills and knowledge. This editorial briefly presents dimensions, levels, and domains of health literacy and discusses a growing need to acknowledge health literacy as a context-specific concept that includes various forms with context-specific conceptualizations. More specifically, it focuses on three health literacy forms that are gaining attention, namely e-health literacy, vaccine literacy, and mental health literacy. By emphasizing the importance of health literacy research for this journal and in general this editorial calls for increasing engagement in this field and invites further contributions on the topic.

Water Wins, Communication Matters: School-Based Intervention to Reduce Intake of Sugar-Sweetened Beverages and Increase Intake of Water.

We compared three interventions designed for reducing the consumption of sugar-sweetened beverages (SSBs) aimed at decreasing the risk of overweight and obesity among children. We included three experimental (n = 508) and one control school (n = 164) in Slovenia (672 children; 10-16 years) to evaluate interventions that influence behaviour change via environmental (E), communication (C), or combined (i.e., double) environmental and communication approaches (EC) compared to no intervention (NOI). Data of children from the 'intervention' and 'non-intervention' schools were compared before and after the interventions. The quantity of water consumed (average, mL/day) by children increased in the C and EC schools, while it decreased in the E and NOI schools. Children in the C and EC schools consumed less beverages with sugar (SSBs + fruit juices), and sweet beverages (beverages with: sugar, low-calorie and/or noncaloric sweeteners) but consumed more juices. The awareness about the health risks of SSB consumption improved among children of the 'combined intervention' EC school and was significantly different from the awareness among children of other schools (p = 0.03). A communication intervention in the school environment has more potential to reduce the intake of SSBs than a sole environmental intervention, but optimum results can be obtained when combined with environmental changes.

An Examination of Retailers' Compliance with the Minimum Legal Drinking (purchasing) Age Law in Slovenia: A Quasi-experimental Intervention Study.

INTRODUCTION: Alcohol consumption among young people is strongly related to alcohol availability. The minimum legal drinking (purchasing) age (MLDA) is a legal measure that regulates alcohol availability to minors in Slovenia. This study examines (1) retailers' compliance with the MLDA law in Slovenia and (2) the effectiveness of two interventions directed at cashiers in off-premise stores. METHODS: The study uses a non-randomized quasi-experimental design to evaluate the effectiveness of (1) a communication intervention directed at off-premise store managers, and (2) an intervention by the Slovene Market Inspectorate. The first intervention focused on informing cashiers about MLDA's importance and their role as gatekeepers of young people's health, while the second involved law enforcement. Using the mystery shopping protocol, we conducted two waves of purchase attempts with decoy underage shoppers pre- and post-intervention in 97 off-premise stores. We collected data on the shopping process at the point of sale and conducted 40 semistructured interviews with cashiers to evaluate the barriers and incentives regarding MLDA compliance. RESULTS: Retailers' initial noncompliance rate with MLDA in off-premise stores was high, but improved significantly after the law enforcement intervention. We identified a significant correlation between the cashiers' ID requests and the refusal of alcohol sales, but cashiers' ID requests remained low. Qualitative findings reveal that cashiers experience several issues when handling MLDA in practice. CONCLUSION: Noncompliance with MLDA persisted even after the law enforcement intervention, revealing the need for policy makers to introduce new strategies for MLDA enforcement, such as revocable alcohol licenses for off-premise stores.

Alone in a Time of Pandemic: Solo-Living Women Coping With Physical Isolation.

For people in single households, living alone has become literal and absolute during the social-distancing measures related to COVID-19 and can lead to decreased health and wellbeing. In this article, we examine how solo-living women think, feel, make sense of, and practice COVID-19-related social-distancing measures and, consequently, physical isolation. During lockdown, we interviewed 23 solo-living women between the ages of 25 and 69 years living in Slovenia. We present three levels of responses to social-distancing measures: cognitive, affective, and behavioral. We identified dissonances between these levels of responses, and we learned that affective responses play a significant role in shaping one's orientation toward and respect for the social-distancing measures.

Systematic Literature Review of Interventions for Promoting Postmortem Organ Donation From Social Marketing Perspective.

INTRODUCTION: This systematic review examines the factors that make some interventions promoting postmortem organ donation more successful and more likely to change behaviors than others. We analyzed the effectiveness of different types of interventions for promoting postmortem organ donation against the criteria identified by previous research in other health-related areas as the most important for designing effective behavior change programs. We observed a correlation between the use of social marketing benchmarks and the reported success of intervention goals. METHODS: We conducted a systematic review of all articles describing interventions promoting postmortem organ donation published in scientific journals between January 2008 and November 2018. We analyzed these articles against the 7 social marketing benchmark criteria using a coding questioner. FINDINGS: The analysis revealed a correlation between the use of social marketing benchmark criteria in an intervention's design and the success of the intervention. Interventions that employed 6 or 7 criteria reported successful achievement of all intervention objectives. We observed a decrease in success rates when fewer than 6 social marketing benchmark criteria were included in the intervention design. DISCUSSION: The findings suggest that a social marketing approach may prove useful to efforts to promote postmortem organ donation. More social marketing benchmark criteria should be included in the design and implementation of interventions promoting postmortem organ donation.

Reluctance and Willingness for Organ Donation After Death Among the Slovene General Population.

INTRODUCTION: The paper presents the findings of the first large-scale survey on post-mortem organ donation among the general Slovenian population. It focuses on the reported donation willingness, the barriers to joining the register of organ donors and the position towards consent to donate organs of deceased relatives. METHODS: A face-to-face survey was conducted on a probability sample of 1,076 Slovenian residents between October and December 2017. The performed analyses included estimations of means and proportions for target variables, an evaluation of between-group differences and a partial proportional odds model to study the relations between organ donation willingness and socio-demographic characteristics. RESULTS: The mean reported willingness to donate one's own organs after death was 3.77 on a 5-point scale, with less than a third of respondents claiming to be certainly willing. Only 6% of those at least tentatively willing to donate organs were certain to join the register of organ donors in the future. The most frequently reported barriers to registration were unfamiliarity with the procedure and a lack of considering it beforehand. The reported willingness to donate organs of a deceased relative strongly depended on the knowledge of the relative's wishes, yet 80% of the respondents did not discuss their wishes with any family members. CONCLUSIONS: The findings confirm the gap between the reported donation willingness and joining the register of donors. Future post-mortem organ donation strategies need to consider socio-demographic and attitudinal factors of donation willingness and help stimulate the communication about organ donation wishes between family members.

Ill Literates or Illiterates? Investigating the eHealth Literacy of Users of Online Health Communities.

BACKGROUND: Electronic health (eHealth) literacy is an important skill that allows patients to navigate intelligibly through the vast, often misleading Web-based world. Although eHealth literacy has been investigated in general and specific demographic populations, it has not yet been analyzed on users of online health communities (OHCs). Evidence shows that OHCs are important Web 2.0 applications for patients for managing their health, but at the same time, warnings have been expressed regarding the quality and relevance of shared information. No studies exist that investigate levels of eHealth literacy among users of OHCs and differences in eHealth literacy between different types of users. OBJECTIVE: The study aimed to investigate eHealth literacy across different types of users of OHCs based on a revised and extended eHealth literacy scale (eHEALS). METHODS: The study was based on a cross-sectional Web survey on a simple random sample of 15,000 registered users of the most popular general OHC in Slovenia. The final sample comprised 644 users of the studied OHC. An extended eHEALS (eHEALS-E) was tested with factor analytical procedures, whereas user types were identified with a hierarchical clustering algorithm. The research question was analyzed with analysis of variance (ANOVA) procedure and pairwise comparison tests. RESULTS: Factor analysis of the revised and extended eHEALS revealed six dimensions: awareness of sources, recognizing quality and meaning, understanding information, perceived efficiency, validating information, and being smart on the Net. The factor solution demonstrates a good fit to the data (root mean square error of approximation [RMSEA]=.059). The most developed dimension of eHEALS-E is awareness of different Internet sources (mean=3.98, standard deviation [SD]=0.61), whereas the least developed is understanding information (mean=3.11, SD=0.75). Clustering resulted in four user types: active help-seekers (48.3%, 311/644), lurkers (31.8%, 205/644), core relational users (16.9%, 109/644), and low-engaged users (3%, 19/644). Analysis of the research question showed statistically significant differences among user types across all six dimensions of eHEALS-E. Most notably, core relational users performed worse than lurkers on the validating information dimension (P=.01) and worse than active help-seekers on the being smart on the Net dimension (P=.05). Active help-seekers have the highest scores in all dimensions of the eHEALS-E, whereas low-engaged users have statistically significantly lower scores on all dimensions of the eHEALS-E in comparison with the other groups. CONCLUSIONS: Those who are looking for advice and support in OHCs by making queries are well equipped with eHealth literacy skills to filter potential misinformation and detect bad advice. However, core relational users (who produce the most content in OHCs) have less-developed skills for cross-validating the information obtained and navigating successfully through the perils of the online world. Site managers should monitor their activity to avoid the spread of misinformation that might lead to unhealthy practices.

Impact of Social Processes in Online Health Communities on Patient Empowerment in Relationship With the Physician: Emergence of Functional and Dysfunctional Empowerment.

BACKGROUND: Substantial research demonstrates the importance of online health communities (OHCs) for patient empowerment, although the impact on the patient-physician relationship is understudied. Patient empowerment also occurs in relationship with the physician, but studies of OHCs mostly disregard this. The question also remains about the nature and consequences of this empowerment, as it might be based on the limited validity of some information in OHCs. OBJECTIVE: The main purpose of this study was to examine the impact of social processes in OHCs (information exchange with users and health professional moderators, social support, finding meaning, and self-expressing) on functional and dysfunctional patient empowerment in relationship with the physician (PERP). This impact was investigated by taking into account moderating role of eHealth literacy and physician's paternalism. METHOD: An email list-based Web survey on a simple random sample of 25,000 registered users of the most popular general OHC in Slovenia was conducted. A total of 1572 respondents completed the survey. The analyses were conducted on a subsample of 591 regular users, who had visited a physician at least once in the past 2 years. To estimate the impact of social processes in OHC on functional and dysfunctional PERP, we performed a series of hierarchical regression analyses. To determine the moderating role of eHealth literacy and the perceived physician characteristics, interactions were included in the regression analyses. RESULTS: The mean age of the respondents in the sample was 37.6 years (SD 10.3) and 83.3% were females. Factor analyses of the PERP revealed a five-factor structure with acceptable fit (root-mean-square error of approximation =.06). Most important results are that functional self-efficacy is positively predicted by information exchange with health professional moderators (beta=.12, P=.02), information exchange with users (beta=.12, P=.05), and giving social support (beta=.13, P=.02), but negatively predicted with receiving social support (beta=-.21, P<.001). Functional control is also predicted by information exchange with health professional moderators (beta=.16, P=.005). Dysfunctional control and competence are inhibited by information exchanges with health professionals (beta=-.12, P=.03), whereas dysfunctional self-efficacy is inhibited by self-expressing (beta=-.12, P=.05). The process of finding meaning likely leads to the development of dysfunctional competences and control if the physician is perceived to be paternalistic (beta=.14, P=.03). Under the condition of high eHealth literacy, the process of finding meaning will inhibit the development of dysfunctional competences and control (beta=-.17, P=.01). CONCLUSIONS: Social processes in OHCs do not have a uniform impact on PERP. This impact is moderated by eHealth literacy and physician paternalism. Exchanging information with health professional moderators in OHCs is the most important factor for stimulating functional PERP as well as diminishing dysfunctional PERP. Social support in OHCs plays an ambiguous role, often making patients behave in a strategic, uncooperative way toward physicians.

Exploring the benefits and challenges of health professionals' participation in online health communities: Emergence of (dis)empowerment processes and outcomes.

BACKGROUND: Various online applications and service has led to the development of online health communities (OHCs), which in addition to the peer-to-peer communication offer patients and other users also interaction with health professionals. While the benefits and challenges of patients and other users' participation in OHCs have been extensively studied, a thorough examination of how health professionals as moderators (i.e., those who provide clinical expertise to patients and other users in OHCs) experience participation in OHCs is lacking. OBJECTIVE: The aim of this study is to explore the main benefits and challenges of health professional moderators' participation in the OHCs. METHODS: The study undertakes an exploratory qualitative study, with in-depth semi-structured interviews with health professional moderators (n=7) participating in the largest OHC in Slovenia, Med.Over.Net. The data was analysed using inductive thematic analysis approach and principles of grounded theory. RESULTS: Four themes of health professional moderators' experiences were identified: (a) benefits of addressing OHC users' health-related needs, (b) challenges of addressing OHC users' health-related needs, (c) health professional moderators' benefits, and (d) health professional moderators' challenges. CONCLUSIONS: This small study demonstrates that health professional participating in OHCs as moderators perceive themselves as facilitators of patients and other OHC's users empowering processes and outcomes, in which OHC's users improve their health literacy, develop skills, expand their social support, and gain other important resources necessary when dealing with health-related issues. Health professional moderator's role, however, also involves several duties, responsibilities and limitations that are often experienced as difficulties in providing patients and other users with adequate counselling and online medical service. OHCs also represent an important terrain for personal and professional empowerment of health professional moderators, although the presence of disempowering processes also needs to be noted.