Association between health-related behaviors and obstructive sleep apnea among Korean adults.

We aimed to investigate the association between health-related behaviors and obstructive sleep apnea (OSA) among Korean adults. A cross-sectional design using national open data was employed. Data from 8,096 adults aged 40 years and above who participated in the Korea National Health and Nutrition Examination Survey between 2019 and 2021 were analyzed. The participants' OSA risk level was assessed using the STOP-Bang questionnaire. A logistic regression analysis was performed to investigate the association between health-related behaviors and high risk for OSA. The association between health-related behaviors and OSA risk remained significant for former smokers (OR = 1.643) and high-risk drinking (OR = 1.365), after adjusting for variables that showed significant differences in general and metabolic characteristics. Implementing lifestyle modifications is crucial for mitigating the health and societal impact of OSA. Understanding and addressing modifiable risk factors, including high-risk drinking and smoking, should be prioritized in nursing intervention. Nursing interventions are critical for preventing and managing OSA among Korean adults. Prioritizing high-risk behaviors through cessation programs and education is essential. Vulnerability of individuals living alone must be addressed through community outreach and support services. Emphasizing routine screenings for pre-hypertension and pre-diabetes, promoting balanced nutrition, and encouraging physical activity are crucial.

Effect of patient-centered self-management intervention on glycemic control, self-efficacy, and self-care behaviors in South Asian adults with type 2 diabetes mellitus: A multicenter randomized controlled trial.

BACKGROUND: This study aimed to test the efficacy of patient-centered self-management intervention (PACE-SMI) to improve HbA1c, self-efficacy, and self-care behaviors in adults with type 2 diabetes mellitus (T2DM). METHODS: In this multicenter, parallel two-arm randomized controlled trial, 612 adults with T2DM and HbA1c ≥ 7% were enrolled and assigned to the control group (n = 310) and the intervention group (n = 302) using stratified permuted block randomization. The control group received usual care, whereas the intervention group received usual care plus nurse-led, theory-driven, culturally tailored PACE-SMI, comprising eight weekly sessions of individualized education, counseling, behavioral training, and home visit. Outcomes were assessed at baseline, postintervention, and 3 months follow-up. RESULTS: Data at 3 months were provided by 583 participants (control: n = 295, intervention: n = 288). Per-protocol analysis showed that the intervention group had a lower mean HbA1c (8.49% [standard deviation (SD), 1.58]) than the control group (8.74% [SD, 1.62]), with small yet statistically significant mean difference of 0.25% (95% confidence interval [CI], -0.01 to 0.51; Cohen's d = 0.16; p = 0.03). Self-efficacy and self-care behaviors significantly improved in the intervention group (116.89 [SD, 25.50] and 70.01 [SD, 17.97]) compared to the control group (75.43 [SD, 18.99] and 51.54 [SD, 12.04]), with mean differences of 41.48 (95% CI, 37.83-45.13; Cohen's d = 1.84; p < 0.0001) and 18.56 (95% CI, 16.08-21.04; Cohen's d = 1.22; p < 0.0001), respectively. Linear regression analysis indicated the effect of PACE-SMI on HbA1c was significantly mediated by improvements in self-efficacy and self-care behaviors (R2 = 0.232, p < 0.001). CONCLUSION: PACE-SMI led to modest but significant improvement in HbA1c and substantial enhancements in self-efficacy and self-care behaviors in adults with T2DM.

Impact of Five Types of Front-of-Package Nutrition Labels on Consumer Behavior among Young Adults: A Systematic Review.

The World Health Organization (WHO) recommends that governments promote and implement front-of-package (FoP) nutrition labels to prevent noncommunicable diseases. Recently, additional research has focused on various views on FoP label creation. However, few review studies have examined how different FoP labels affect young consumer behavior. Therefore, this study thoroughly analyzed the evidence on how FoP labels in five categories affect young consumer purchasing intention and behavior. We searched for keywords in the Web of Science, Scopus, and EBSCO databases and screened study samples according to inclusion and exclusion criteria. Fourteen studies that matched the criteria were included in this review. We discovered that numerous studies support the efficacy of the "graded indicators" category labels, with the "color-coded" and "positive logos" categories trailing closely behind. The effectiveness of the "warning" FoP label category is mixed on consumers' healthy purchasing behavior and intention. The numerical FoP labels were most commonly used to indicate ineffectiveness. Future studies should investigate the effects of FoP labels on various subpopulations and conduct thorough evaluations of the design elements of FoP labels. Also, they should offer evidence-based recommendations, supported by both quantitative and qualitative data, for regions that have not yet implemented FoP labeling systems.

Health-Related Behaviors and Perceived Health Status According to Water and Sugar-Sweetened Beverage Intake in Korean Adolescents.

The objective of this study was to determine the relationship between water and sugar-sweetened beverage (SSB) intake, health behaviors, and self-perceived health status using data from the 2019 Korea Youth Risk Behavior Web-based Survey (KYRBS). The subjects included in this analysis were 57,302 Korean adolescents from the 7th to 12th grades. The intake patterns of water and SSBs were categorized into four groups: Group I, adequate water intake (≥4 cups/day) and low frequency of SSB intake (≤1-2 times/week); Group II, adequate water intake and high frequency of SSB intake; Group III, inadequate water intake (<4 cups/day) and low frequency of SSB intake; Group IV, inadequate water intake and high frequency of SSB intake (≥3 times/week). Complex sample analyses were used for considering strata, clusters, and weights for samples. Significant differences were observed in the distribution of sociodemographic characteristics between the water and SSB intake groups. As grade levels increased or if students were female, there was a significant increase in the proportion of students characterized by low water intake and high consumption of SSB. Adolescents with healthier beverage habits, characterized by adequate water intake and low frequency of SSB consumption (Group I), generally abstained from smoking and alcohol, were more physically active, and maintained a desirable diet, reporting a better perceived health status. In contrast, those with higher SSB consumption and inadequate water intake (Group IV) were more likely to perceive their health as poor, with higher rates of smoking and alcohol use, lower physical activity levels, and poorer dietary habits compared to Group I. In conclusion, adolescents with desirable beverage consumption habits differed by sex and grade and they reported positive health behaviors and better overall health status. This suggests that there is a need for more active education and intervention in schools and families, as well as increased efforts by adolescents to promote healthy beverage habits.

Long working hours and preventive oral health behaviors: a nationwide study in Korea (2007-2021).

BACKGROUND: This study explored the association between working hours and preventive oral health behaviors. METHODS: In total, 48,599 workers (22,992 females) were included from the Korea National Health and Nutrition Examination Survey (2007-2021). Weekly working hours were self-reported. The following three preventive oral health behaviors were set as outcomes: participation in annual dental check-ups; adherence to the recommended toothbrushing frequency (≥twice a day); and use of interdental cleaning devices. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression. RESULTS: In male workers, the adjusted OR (95% CI) of the association between working ≥55 h/week and each outcome was 0.84 (0.77-0.92) for dental check-ups, 0.82 (0.72-0.94) for toothbrushing ≥twice a day, and 0.83 (0.76-0.92) for utilization of interdental cleaning device when compared to 35-40 h/week. In female workers, the adjusted OR (95% CI) of the association between working ≥55 h/week and each outcome was 0.79 (0.70-0.89) for dental check-ups, 0.88 (0.70-1.11) for toothbrushing ≥twice a day, and 0.80 (0.71-0.90) for utilization of interdental cleaning device when compared to 35-40 h/week. Additionally, low socio-economic status, such as low educational attainment, low income level, and blue-collar occupations, were major risk factors associated with non-adherence to preventive oral health behaviors in both male and female workers. CONCLUSIONS: Our study suggests that individuals who work long hours are more likely to exhibit undesirable oral health behaviors.

Notes from the Field: Support for Wastewater Monitoring and Influence on Protective Behavioral Intentions Among Adults - United States, July 2024.

In 2020, during the COVID-19 pandemic, CDC established the National Wastewater Surveillance System and later expanded it to include mpox and influenza A data dashboards.† Wastewater utility partners have cited community health benefits as a motivating factor for participating in wastewater surveillance; a lack of public support for wastewater surveillance activities might lead utility partners to cease participation (1,2). However, little is known about public support for wastewater monitoring and its influence on protective health behaviors. As innovative surveillance strategies such as wastewater surveillance evolve, ethical considerations, including understanding public perceptions regarding support for these activities and potential risks to communities, are essential (3).

Resilience among older adults with multimorbidity using the Connor-Davidson scale in the Canadian Longitudinal Study on Aging: health behaviour, socio-economic, and social support predictors.

OBJECTIVE: Multimorbidity is recognized as a serious health condition faced by a majority of older adults. Research investigating adaptive responses to multimorbidity, termed multimorbidity resilience, has been growing. This paper examines protective and risk factors, with a focus on health behaviours, socio-economic resources, and social support using an established measure of resilience (Connor-Davidson Resilience Scale) among older adults, focusing on older persons with two or more concurrent chronic conditions. METHODS: Using Baseline (2011-2015), Follow-up One (2015-2018), and Follow-up Two (2018-2021) data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we tested hypotheses using 13,064 participants aged 65 years and older, who completed all waves and reported two or more of 27 chronic conditions, for the full sample of multimorbid individuals and three multimorbidity clusters: Cardiovascular/Metabolic, Musculoskeletal, and Mental Health. Associations between protective and risk factors and resilience were examined using linear regression to model the Connor-Davidson resilience scale, adjusting for illness context and social determinants of health. RESULTS: Among all multimorbid individuals, the strongest associations with resilience were found for higher self-rated health, greater sleep satisfaction, better appetite, higher household income, more relatives and friends, being overweight (compared to normal weight), fewer housing problems, and fewer skipped meals. Weaker associations were found for non-smokers, less alcohol consumption, less pain, sedentary behaviour, being non-married (compared to married), and among Canadian born (compared to foreign). The analyses for the three multimorbidity clusters were largely replicated for the three multimorbidity clusters, but with some nuances depending on the cluster. DISCUSSION: This research provides confirmatory evidence for several protective and risk factors affecting the ability to cope and recover from multimorbidity adversity among older adults. There are consistent patterns for the multimorbidity disease clusters, but some distinct relationships arise that are worthy of attention. The implications of the findings for modifiable health behaviours and socio-economic factors are discussed for their public health and clinical relevance.

Associations between social support and proactive health behaviours among Chinese adolescents: the mediating role of self-efficacy and peer relationships.

BACKGROUND: Proactive health behaviours are crucial for enhancing adolescent health. However, there is limited evidence on the potential pathways through which social support influences adolescents' proactive health behaviours. This cross-sectional study aimed to examine the relationships between social support, self-efficacy, peer relationships and proactive health behaviours in Chinese adolescents. METHODS: From October to December 2023, we recruited 6075 adolescents from Shandong Province, China. They completed self-report questionnaires on social support, self-efficacy, peer relationships and proactive health behaviours. RESULTS: Linear regression analysis indicated that social support was positively associated with proactive health behaviours among adolescents (ß = 0.571, 95% CI = 0.542, 0.600). Further mediation analyses revealed that self-efficacy (ß = 0.085, 95% CI = 0.069,0.101) and peer relationships (ß = 0.156, 95% CI = 0.136,0.177) mediated this relationship. CONCLUSIONS: Increased social support was associated with better proactive health behaviours in Chinese adolescents. Additionally, higher self-efficacy and positive peer relationships enhanced this association. Our findings emphasised the significance of providing supportive environments at home and at school to promote proactive health behaviours in adolescents.

Association between personality, lifestyle behaviors, and cardiovascular diseases in type 2 diabetes mellitus: a population-based cohort study of UK Biobank data.

INTRODUCTION: Various strategies aim to better assess risks and refine prevention for patients with type 2 diabetes mellitus (T2DM), who vary in cardiovascular disease (CVD) risk. However, the prognostic value of personality and its association with lifestyle factors remain elusive. RESEARCH DESIGN AND METHODS: We identified 8794 patients with T2DM from the UK Biobank database between 2006 and 2010 and followed them up until the end of 2021. We assessed personality traits using the Big Five proxies derived from UK Biobank data: sociability, warmth, diligence, curiosity, and nervousness. Healthy lifestyle behaviors were determined from information about obesity, smoking status, and physical activity. The primary outcome was a composite of incident CVD, including myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), and heart failure (HF). RESULTS: During a median follow-up of 13.6 years, a total of 2110 patients experienced CVDs. Among personality traits, diligence was significantly associated with a reduced risk of primary and secondary outcomes. The adjusted HRs with 95% CIs were: composite CVD, 0.93 (0.89-0.97); MI 0.90 (0.82-1.00); IS 0.83 (0.74-0.94); AF 0.92 (0.85-0.98); HF 0.84 (0.76-0.91). Healthy lifestyle behaviors significantly reduced the risk of composite CVDs in groups with high and low diligence. The findings of a structural equation model showed that diligence directly affected the risk of the primary outcome or indirectly by modifying lifestyle behaviors. CONCLUSION: This study revealed which personality traits can influence CVD risk during T2DM and how patients might benefit from adopting healthy lifestyle behaviors in relation to personality.

Health-promoting lifestyle behaviors and its association with sociodemographic characteristics in hospital clinical staff.

Objective: The aim of this study was to determine hospital clinical staff' health-promoting lifestyle behaviors, and explore associations between nurse demographic factors and lifestyle behaviors. Methods: This cross-sectional investigation focused on the clinical personnel employed at hospitals associated with Baqiyatullah University. A sample of 341 clinical staff of hospitals was collected using convenience sampling. In this study, the questionnaire of Health Promoting Lifestyle Profile II (HPLP-II) was used to assess health-promoting behaviors. Results: In the present study, the mean HPLP score was 131 ± 23. The score of health-promoting behaviors was significantly higher in the nursing major (p = 0.029). Also, a difference was found between the major and the subscales of health responsibility (p = 0.000), stress management (p = 0.004), physical activity (p = 0.004) and nutrition (p = 0.001). The score of health responsibility, stress management, physical activity and nutrition subscales was higher in nursing. There was a significant relationship between education and stress management (p = 0.033) and physical activity subscales (p = 0.001). The physical activity score was also higher in individuals with master's and doctoral degrees, and the stress management score was higher in participants with master's degrees. Based on the findings presented herein, age (p = 0.001) and gender (p = 0.016) were associated with the nutrition subscale, and the nutrition score was higher in the age group of over 30 years and in women. Additionally, a significant relationship was observed between marriage and the subscales of spiritual growth (p = 0.013) and nutrition (p = 0.024), and the score of spiritual growth, and nutrition was higher in married people. There was a significant relationship between job and health responsibility (p = 0.013) and nutrition (p = 0.022), and the score of health responsibility and nutrition score was found to be higher in nurses. Conclusion: Health-promoting behaviors of hospital employees are at an average level and are related to the educational levels of the employees, so these behaviors are more in nurses, while this relationship was not present in physicians. These findings may be helpful in providing recommendations for developing healthy lifestyle programs for clinical staff aimed at promoting health behaviors.

Positive Impact of UV Photography on Individual Sun Protection: A Swiss Feasibility Study.

Objectives: This study evaluates the feasibility and impact of conveying personalized sun protection message supported by a UV photograph of the face in Switzerland. Methods: 440 adults from 14 private and public sites associated with high sun exposure received a skin cancer prevention intervention composed of a facial UV-filtered photograph and individual counselling by a trained registered nurse. Pre-/post intervention surveys assessed sun protection of participants, their skin cancer risk and reasons for behavioural change. Results: The range of facial UV spots' count per individual was very broad (0-590) and mainly determined by phototype, followed by age. Three months after the intervention, 61% of participants positively changed their sun protection habit both during leisure and at work. Use of all sun protection means increased. No factor could be specifically associated to that propension for change. The individualized message was perceived as the main motivation for change. Conclusion: Personalized sun protection messages supported by a facial UV photograph led to significant favourable behavioural change in a highly sun-exposed population of adults.

Subgroup Behaviors and Factors Influencing Compliance With COVID-19 Preventive Measures Among Undergraduate Students in Southern Thailand.

Objective: To investigate clusters of students' COVID-19 preventive behaviors and their associated factors. Methods: We surveyed undergraduate students using an online questionnaire at a regional university in southern Thailand, between April and June 2022. Statistical analyses included latent class analysis and multinomial regression analysis. Results: Three latent classes were identified: moderately consistent practitioner (7.5%), high compliance overall (48.9%), and good compliance with routine safeguards (43.6%). Females tended to have high compliance overall (RRR 2.46 95% CI 1.23-4.94), and higher academic performance was associated with high compliance overall and good routine safeguards. Perceived threats from COVID-19 were associated with good compliance with routine safeguards (RRR 4.21 95% CI 1.70-10.45). Benefits of actions and clear cues to action were associated with high overall compliance (RRR 5.24 95% CI 2.13-12.90). Students who perceived feasibility were more likely to be moderately consistent practitioners. Conclusion: The common clusters of the students' preventive behaviors were high compliance overall and good compliance with routine preventions. Female, academic performance, perceived threats, and perceived benefits and cues to action were associated with compliance.

Sociodemographic Characteristics and Digital Behaviors Associated with the Use of Fitness and Diet Apps Among Adolescents.

BACKGROUND: Numerous health apps focusing on fitness, nutrition, and physical activity are available, yet many adolescents have never used them. The purpose of this study was to assess the prevalence of the use of fitness and diet apps and related socio-demographic factors and digital behaviors among high school students. Study Design: A cross-sectional study. METHODS: High school students were recruited from 4 out of 21 public high schools in Belgrade, Serbia. Participants filled out an anonymous questionnaire about socio-demographic characteristics and digital behaviors, along with the e-health literacy scale (eHEALS). Adjusted logistic regression was applied for data analysis using SPSS 20. RESULTS: Of the 702 students who completed the questionnaire, 670 used smartphones (95.4%; average age 16.5±1.2 years). The prevalence of fitness and diet app use among girls was 29.7% and 9.6%, as well as 17.3% and 3.6% among boys, respectively. Having higher family income, having better e-health literacy, browsing websites about fitness and diet, and using diet apps but not watching YouTube were associated with the use of fitness apps among girls. Being younger and browsing fitness websites and YouTube were associated with the use of fitness apps among boys. Being younger, browsing websites about diet, and using fitness apps were associated with the use of diet apps among girls. CONCLUSION: Based on the findings, girls used fitness and diet apps more often than boys. Practical demonstrations on how to utilize certain health apps could be an additional opportunity to support positive health behaviors among adolescents.

Modernizing behavioral parent training program for ADHD with mHealth strategies, telehealth groups, and health behavior curriculum: a randomized pilot trial.

OBJECTIVE: Parent behavior management training (BMT) is an evidence-based yet underutilized tool to treat children with ADHD and address related health disparities. This pilot study investigated the acceptability and feasibility of a novel, health behavior-, and technology-adapted BMT (LEAP) vs. standard BMT. METHODS: The weekly 9-session LEAP telemedicine group program is based on a standard BMT curriculum enhanced with strategies for supporting optimal child sleep, problematic media use (PMU), and physical activity, including wrist-worn activity trackers. Children ages 6-10 years with ADHD and their caregivers were randomized to LEAP or standard BMT. Acceptability and feasibility were tracked. Caregivers completed standardized measures, and children wore hip-worn accelerometers for 1 week at baseline, postintervention (10 weeks), and follow-up (20 weeks). RESULTS: 84 parent/child dyads were randomized to LEAP or standard BMT, with high and comparable acceptability and feasibility. Both treatment groups demonstrated decreased ADHD symptoms and improved executive functions postintervention (p < .0001), maintained at follow-up. Average accelerometer-measured MVPA decreased and sleep duration remained unchanged, while PMU and bedtime resistance improved for both groups. CONCLUSIONS: LEAP is highly feasible and acceptable, and yielded similar initial clinical and health behavior improvements to standard BMT. Innovative and targeted supports are needed to promote healthy behaviors in children with ADHD.

Determining the predictors of preventive behaviors adopted by pregnant women against COVID-19 based on the Health Belief Model constructs: a cross sectional study.

BACKGROUND: Pregnant women face great challenges during the coronavirus disease 2019(COVID-19) pandemic. The purpose of this study was to explain the main dimensions of adoption of self-care behaviors against COVID-19 based on the health belief model(HBM) in pregnant women. METHODS: This cross-sectional and analytical study was conducted in Iran, at the end of the third wave of the COVID-19 pandemic, between January and April 2021. Two hundred and thirty pregnant women who referred to Urmia health centers were selected using multi-stage random sampling. The data were collected using an online questionnaire including items that measured the participants' demographic characteristics, the knowledge questionnaire, the HBM items, and questions assessing the adoption of self-care behaviors against COVID-19. The data were analyzed using SPSS software version 20. Descriptive statistics, bivariate Pearson's correlation test, and multiple linear regression were used to analyze the data. RESULTS: The results of this study showed that the rate of self-care behaviors against COVID-19 in the pregnant women participating in the present study was not very favorable. It was also shown that among the constructs of the HBM, knowledge, self-efficacy, and perceived barriers were the most important predictors of adopting self-care behaviors with a variance of 24% change among the pregnant women. CONCLUSION: Knowledge, self-efficacy, and perceived barriers were found in this study as the strongest predictors of self-care behaviors among pregnant women. Thus, it is suggested to implement interventions commensurate with the results of this study.

Sun protection knowledge and behaviors of agricultural workers in Turkey: a cross-sectional study.

BACKGROUND: Agricultural workers are at risk of developing skin cancer due to prolonged exposure to the sun during their daily work. This study was conducted to determine sun protection knowledge and behaviours of agricultural workers in Turkey. METHODS: The cross-sectional study was conducted with 460 participants working in agriculture. The data were collected using a sociodemographic form, Skin Cancer and Sun Knowledge Scale and Sun Protection Behaviour Scale. The data were analysed using One Way ANOVA and Independent Samples t Test. RESULTS: Participants mean total score on the Skin Cancer and Sun Knowledge Scale was 15.24 ± 2.47 (max-min 0-25) and the mean total score on the Sun Protection Behaviour Scale was 24.10 ± 4.46 (max-min 8-40). Statistically significant disparities were observed between the SCBS, SPBS and their sub-divisions along with the working period, age, marital status, gender, level of education, income status, skin type and agricultural working status of the participants (p < .05). CONCLUSION: The study found that people working in the agriculture had inadequate sun protection behaviours and knowledge. Based on the study's results, it is proposed to create intervention programmes that specifically target single, male, middle-aged or older individuals with extended working hours and low levels of education and income.

Social environment, health cognition, and health behavior: how individuals with non-fixed employment end up with adverse health outcomes in China under the era of VUCA?-findings from PLS-SEM and fsQCA.

Objectives: This article studied the single-factor causal relationships between the social environment, health cognition, and health behavior of the individuals with non-fixed employment and their adverse health outcomes, as well as the complex causal relationships of multiple factors on these outcomes. Methods: Partial Least Squares Structural Equation Modeling (PLS-SEM) and Fuzzy-Set Qualitative Comparative Analysis (fsQCA) are employed. Data is collected from the results of an open questionnaire Psychology and Behavior Investigation of Chinese Residents 2021. Results: PLS-SEM analysis reveals that health risk behaviors and cognition play a mediating role in impact of the social environment on adverse health outcomes, indicating that individuals with non-fixed employment susceptible to adverse health outcomes. fsQCA analysis identifies that weak social support is a core condition leading to outcomes of depression and anxiety. There are shared configurations and causal pathways between the outcomes of physical health and depression. Conclusion: The study supports the social determinants theory of health and suggests that the fundamental reason for people being trapped in adverse health outcomes is the health inequality caused by social stratification, and the external shock of uncertainty in the era of VUCA (Volatility, Uncertainty, Complexity, and Ambiguity).

Translation, cross-cultural adaptation, and validation of a Gujarati version of a theory of planned behavior questionnaire that assesses walking treatment beliefs in people with intermittent claudication.

BACKGROUND: Walking as a treatment is recommended for people with intermittent claudication (IC), but participation tends to be poor. Walking treatment beliefs, as defined by the Theory of Planned Behaviour (TPB) are associated with walking behavior, so assessing and designing interventions targeting walking treatment beliefs are crucial. To assess walking treatment beliefs in people with IC in Gujarat, a translated, culturally adapted questionnaire that assesses the four TPB constructs (attitude, subjective normative beliefs, perceived behavioral control beliefs, and intention to walk) is required. AIM: To translate and cross-culturally assess the content validity and face validity of a Gujarati version of a TPB questionnaire that assesses walking treatment beliefs. MATERIALS AND METHODS: A forward-backward translation of the 12-item TPB questionnaire was applied using a standardized approach. The translated versions were compared with the original questionnaire, and ten experts, rated each item according to: clarity, semantic, appropriateness, and cultural relevance. Content Validity Index (CVI), item level content validity (I-CVI), Scale -content validity index (S-CVI/Ave), and universal agreement (UA) were computed to summarize the overall content validity of the questionnaire as well as a proportion of agreement with content experts. Face validity was assessed using a think-aloud approach with ten patients with IC. This cognitive interviewing approach (think-aloud approach) asked participants to describe their thoughts whilst completing the questionnaire. Responses were analyzed thematically. RESULTS: There was complete agreement between experts for 9/12 items (I-CVI=1.00), leading to an overall agreement (S-CVI/Ave) of 0.98. For face validation, at least 50% of the participants had no significant problems with any question in the questionnaire. Most problems participants encountered were straightforward, such as re-reading some questions or considering the questions carefully before answering. CONCLUSION: The Gujarati TPB questionnaire had excellent content validity and was comprehensible and answerable by the majority of our participants with IC and, therefore, had good face validity; this will enable walking treatment beliefs to be assessed in people with IC.

Effects of health-related dispositions on citizens' appraisals toward the COVID-19 pandemic and protective behavior.

In this study, health risk attitude and health locus of control were included as dispositional factors in the Protection Motivation Theory (PMT) to explain people's protective behavior in the context of COVID-19 pandemic. Empirical data involved two waves of data with a sample of 526 adults with full-time jobs from Beijing, China, and structural equation model results confirmed a partial successful extension of the PMT. Specifically, health risk attitude had a direct effect on citizens' protective behavior, but without an indirect effect mediated by threat appraisal toward the COVID-19 pandemic; health locus of control did not directly associate with citizens' protective behavior, but had an indirect effect on it fully via coping appraisal toward the COVID-19 pandemic. Thus, the PMT has been extended by adding a distal dispositional factor on the impact of coping appraisal on protective behavior. Implications for advancing the government's anti-epidemic strategy are discussed.

Effectiveness of NSW health get healthy telephone coaching in adults screened from general practices.

BACKGROUND: The effectiveness of the NSW Health "Get Healthy Information and Coaching Service®"(Get Healthy) to facilitate weight loss on a population scale has been documented, but this was based on self-reported measures. Our study aims to test the effectiveness of the Get Healthy Service on objectively measured weight, BMI, waist circumference, and changes in other health behaviours, including nutrition, physical activity and alcohol intake. METHODS: Men and women aged 40-70 years (n = 154) with pre-diabetes (5.7% < HbA1c < 6.5%) were referred from GP Practices to the Get Healthy Service, NSW Health. A subset (n = 98) participated in the "Zinc In Preventing the Progression of pre-Diabetes" (ZIPPeD) trial (ACTRN12618001120268). RESULTS: The self-reported outcomes showed a statistically significant improvement from baseline to 12 months in weight (mean 2.7 kg loss, p < 0.001), BMI (mean 1 unit reduction, p < 0.001), and waist circumference (mean 4.3 cm reduction, p < 0.001). However, in the objectively measured outcomes from ZIPPeD, the differences were more modest, with point estimates of 0.8 kg mean weight loss (p = 0.1), 0.4 unit reduction in BMI (p = 0.03), and 1.8 cm reduction in waist circumference (p = 0.04). Bland-Altman plots indicated that discrepancies were due to a small number of participants who dramatically underestimated their weight or BMI. There were minimal changes in nutrition, physical activity, and alcohol. CONCLUSIONS: The potential benefits of Get Healthy should be interpreted with caution as we have shown significant differences between self-reported and objectively measured values. More valid and objective evidence is needed to determine the program's effectiveness and cost-effectiveness.