Search Results (668)

Contemporary diabetes care is largely organised around one-to-one clinical consultations and the regulation of biomedical outcomes. While such approaches remain essential, they may be insufficient for addressing the social and behavioural aspects of chronic disease management. Based on this conceptual perspective, we propose the Friendly Neighbourhood Hospital as an approach to supporting peer contact and self-management, complementing clinical care. Drawing on affordance theory, social architecture, and urban social geography, we argue that hospital environments can shape participation, learning, and behavioural change through mechanisms including peer interaction, tacit knowledge, situated learning, and institutional trust. We illustrate this approach using five settings: communal cooking, movement and social interaction, public and cultural events, flexible access, and digital participation. These examples are illustrative and not evaluated interventions, and their anticipated effects, ranging from immediate participation and belonging to longer-term behavioural change, remain hypotheses for future testing. From this perspective, we do not advocate for replacing individual consultations but rather for repositioning them within a broader social and spatial context. Full article

Agricultural burning remains a persistent environmental challenge in many rural production systems. This study examines how and under what conditions rural transformation reshapes material dependence on and perceived social defensibility of agricultural burning. Using a qualitative multiple-case design, 30 semi-structured interviews were conducted in three rural communities in northern Thailand with farmers, village heads, residents and government officials. Data were analysed through within-case analysis and cross-case comparison. The findings identify three pathways through which rural transformation can weaken dependence on fire: functional replacement, functional removal and residue revaluation. Dependence nevertheless persists where labour scarcity, steep terrain and other production constraints limit workable alternatives. Practical substitutability therefore conditions whether production-system change reduces dependence on fire. Material dependence also becomes normatively consequential through perceived necessity. Where burning remains difficult to avoid, its harmful effects may be recognised while continued use remains perceived as socially defensible. Where necessity weakens, continued burning becomes harder to justify. These evaluations are interpreted as perceived social defensibility rather than community-wide normative consensus. The study contributes by identifying practical substitutability and perceived necessity as mechanisms linking rural production restructuring to material dependence and perceived social defensibility, explaining why material, behavioural and normative trajectories may align or diverge. Full article

Background/Objectives: Motivational interviewing (MI) is an established approach to addressing vaccine hesitancy, yet immediate changes following dedicated training for family physicians remain insufficiently documented in Romania. This study evaluated pre–post changes in physicians’ MI knowledge, self-reported communication behaviour, and self-perceived ability to counsel patients about vaccination, together with patient-level change following consultations delivered by trained physicians. Methods: This uncontrolled pre–post study used a voluntary, self-selected non-probability sample of 28 family physicians recruited through announcements distributed via county family medicine associations; participants completed paired assessments immediately before and after structured MI-based training. The three main physician-level outcomes were MI knowledge (MISI), corrected self-reported MI communication behaviour (MIBI), and self-perceived MI ability (SPMI). The linked component comprised 151 patients nested within 15 physicians. Patient changes were averaged within physician, and the physician-level mean patient composite change was used as the principal outcome of this component. Paired physician changes and physician-aggregated patient change were assessed using Wilcoxon tests, rank-biserial effect sizes, and bootstrap 95% confidence intervals (CIs), with Holm adjustment across the three physician outcomes. Results: Mean MISI increased by 39.80 percentage points (95% CI: 29.59–50.51), though the limited internal consistency of this seven-item composite requires item-level interpretation, and corrected MIBI by 0.44 points (95% CI: 0.20–0.68; r_rb = 0.75) and SPMI by 1.22 points (95% CI: 0.89–1.61; r_rb = 0.99); all Holm-adjusted p-values were <0.001. Across the 15 linked physicians, the mean patient composite change was 0.55 points (95% CI: 0.38–0.75; r_rb = 1.00; p < 0.001). No consistent association was observed between physician-level competency changes and mean patient change. Conclusions: Immediate post-training physician scores and post-consultation patient composite scores were higher. Controlled studies incorporating observed consultations and follow-up are required before causal or sustained effects can be inferred. Full article

Background: Hypertension is a major contributor to cardiovascular morbidity and mortality globally, with particularly poor control in disadvantaged communities. Although awareness is generally high, sustaining lifestyle changes and treatment adherence remains difficult. This study examined socioeconomic, behavioural, and health system factors associated with hypertension management and explored the role of community-engaged health education in strengthening primary health care. Methods: A cross-sectional descriptive study was conducted among 107 adults with hypertension attending public primary health care facilities. Data were collected using structured questionnaires covering socioeconomic status, health system access, medication adherence, lifestyle practices, and knowledge and attitudes. Descriptive statistics summarized participant characteristics, while chi-square tests and multivariable logistic regression identified factors associated with clinic attendance, dietary adherence, lifestyle practices, and self-management. Results: Awareness of hypertension (86.9%) and trust in clinic care (91.6%) were high; however, a clear knowledge practice gap was evident. Although 79.4% acknowledged the importance of lifestyle changes, only 45.8% followed a hypertension-specific diet. Structural barriers included low income (39.3% earning <R3 000/month) and long distances to clinics (46.7% living ≥5 km away). Health worker advice strongly predicted dietary adherence (OR = 6.36, p = 0.001), lifestyle adherence (OR = 4.24, p = 0.006), and overall self-management (OR = 12.46, p = 0.024), whereas knowledge alone did not. Conclusions: Hypertension management is constrained more by structural and health system factors than by lack of awareness. Strengthening primary health care counselling and community-based health education may improve sustained lifestyle change and outcomes. Full article

Background/Objectives: Type 2 diabetes is a prevalent chronic disease that requires continuous self-management and adaptation by both individuals and their families. Health literacy is recognised as an important determinant of chronic disease management, influencing the ability to access, understand, and use health information. This study aimed to explore how family health literacy and family functioning were related to type 2 diabetes self-management across four family cases in the context of informal caregiving and to describe the changes observed following tailored family nursing interventions. Methods: An embedded mixed-methods multiple-case study was conducted with four families receiving care in a Portuguese primary healthcare unit. Qualitative data were obtained through structured family interviews guided by the Dynamic Model of Family Assessment and Intervention. Quantitative data were collected using family assessment instruments and the Diabetes Self-Care Activities Scale. Each family was analysed as an individual case, followed by cross-case comparison and integration of qualitative and quantitative findings. Results: Across the four cases, the ability to understand and translate diabetes-related information into family routines varied and was associated with differences in self-management practices. Within-case comparisons identified case-specific changes in family communication, mutual support, selected family nursing diagnoses, and some diabetes self-care behaviours. Medication adherence and blood glucose monitoring were more consistently maintained than dietary management, physical activity, and foot care. Conclusions: Family health literacy appeared to operate as a relational and context-dependent resource associated with how diabetes-related recommendations were negotiated and incorporated into daily family routines. Tailored family nursing interventions were followed by case-specific changes; however, the study design does not allow causal attribution. Full article

The COVID-19 pandemic lockdowns heavily impacted the stress levels of families worldwide. We examined parental stress levels regarding a variety of subtopics (including finances, schooling, and seeing extended family) in North Bay, Ontario, Canada. A mixed-method survey approach was used with a volunteer sample of 101 parents from the North Bay community. Included in the survey were 25 potential parental stressors, which parents were asked to rate in terms of their stressfulness, both during the COVID-19 lockdowns and post-pandemic. To accomplish this, participants were administered only one questionnaire, after the height of the pandemic was over, and asked to reflect on both the current time and on the time during the lockdown phase of the pandemic. General stress levels were higher after the lockdowns ended compared to during the lockdowns, indicated by 20 out of the 25 surveyed parental stressors. Four themes were identified in the qualitative data obtained from open-ended questions: ability to parent; requiring additional support; mental and physical well-being; and child-rearing. Specifically, in terms of the first theme, some parents felt that parenting had become more difficult, while others did not. With respect to theme two, many parents felt a need for support in a variety of areas, which relates to theme three, as supports were often desired to improve mental or physical well-being. The fourth theme highlighted the opportunity to spend more time at home with family and raise children according to parents’ own principles. Parents were also asked about changes in their behaviours, like gambling and alcohol use; gambling, in particular, increased during and after the pandemic compared to before. However, parents reported that the difficulty associated with continuing to parent as they did before the lockdowns was minimal, and that it did not change during or after the lockdowns. Finally, parents were asked about changes to their own mental and physical health; results were mixed, but approximately half of participants perceived positive changes in their well-being. Thus, compared to existing research, the current study provides a more comprehensive overview of stressors experienced by families in the wake of COVID-19 lockdowns. It also brings to light suggestions and recommendations from survey respondents to improve parents’ quality of life in post-COVID-19 North Bay, Ontario. Full article

Geographic digital twins (GDT) are increasingly used as place-based platforms to support monitoring of environmental and social processes underpinning social innovations. This research addresses a specific methodological gap: whether a modular GDT architecture can sustain consistent deployment across five distinct European Transition Coastal Labs (TCLs). Three bottlenecks shaped the research: baseline datasets were held by different organisations and were rarely maintained as a shared reference; real-time sensor observations were managed within IoT systems separate from contextual GIS layers; and participatory inputs remained disconnected from mapped evidence. EmpowerCoast was designed and deployed within the Horizon Europe EmpowerUs project across Connemara (Ireland), Træna (Norway), Cap de Creus (Spain), Limassol (Cyprus) and Åland Islands (Finland). The platform implements a modular, OGC-compliant full-stack architecture integrating spatial storage, microservices, RESTful APIs, 3D visualisation and vendor cloud IoT ingestion. Four deployed proof-of-concepts are reported: near-real-time solar irradiance monitoring in Connemara, near-real-time chlorophyll-a monitoring in Træna, participatory storytelling and citizen science across all five TCLs, and ingestion of harmonised EMODnet habitat layers for Cap de Creus and the Åland Islands. Analysis of the deployed codebase, within a single consortium deployment, shows that consistency was located in exchange format, delivery protocol and structural pattern rather than in shared instances: sensor observations from two unrelated commercial ecosystems, differing in authentication, payload schema and measured parameter, produced structurally identical platform behaviour. By demonstrating that architectural consistency survives vendor, domain and jurisdictional heterogeneity, the UN Ocean Decade endorsed EmpowerCoast platform enables coastal communities across Europe’s Arctic, Atlantic, Mediterranean and Baltic shores to observe and interpret environmental changes through a shared spatial infrastructure. Full article

Healthcare waste mismanagement persists because the organisational and communicative dynamics driving erroneous practices remain largely unaddressed, particularly in high-turnover clinical units that concentrate the highest volumes of hazardous waste and operational pressure. Existing training interventions typically address motivational, analytical, or operational dimensions in isolation, lacking a systemic and adaptive framework. This study designs and theoretically validates Maieutic-H, a multilevel training ecosystem integrating narrative and gamified motivational strategies, Video-Based Interaction Analysis of communicative practices, and an AI-driven support system employing an interpretable Random Forest classifier to prioritise corrective actions, embedded within a six-phase adaptive cycle with longitudinal monitoring at one, six, and twelve months. Theoretical validation through comparison with eleven programmes from the literature identifies three recurring, sub-optimal configurations—single-component, parallel-component, and quasi-integrated interventions—none of which combines data-driven prioritisation with interactional analysis to surface operational blind spots. Preliminary qualitative validation against expert interviews showed 93% concordance between operator-perceived priorities and model-generated relevance scores, informing an adaptive recalibration ($\alpha =0.70$) that weights field-derived evidence over the simulated training baseline. The Maieutic-H model offers a scalable, theoretically grounded framework for sustainable behavioural change and regulatory compliance in complex clinical environments, aligning interpretable machine learning with healthcare process engineering. This manuscript presents a model development and theoretical validation study. Evidence on effectiveness will require empirical testing of the full Maieutic-H pathway in hospital pilot studies. Full article

Background/Objectives: Health literacy is a critical determinant of health, closely linked to behaviours, outcomes, and broader social determinants. Given that young people navigate distinct social contexts and health-related challenges compared to adults, understanding how to support their health literacy development during this important period is essential for lifelong wellbeing. This study aimed to explore the perceptions of academics and community-based practitioners regarding the concept of health literacy in young people and the importance of supporting its development. Methods: Semi-structured interviews were conducted with 30 participants (academics n = 17, health and wellbeing practitioners n = 9, policy/research n = 4) based across Europe and Australasia, with experience in youth health literacy. Data were analysed using reflexive thematic analysis. Results: Three key themes were identified: (i) Building lifelong health agency: From early foundations to transitional autonomy; (ii) Navigating novel health changes; and (iii) Structural inequities and intergenerational barriers in health literacy. Conclusions: Participants emphasised that youth health literacy interventions should move beyond didactic, individual-level information delivery toward fostering critical digital competencies and addressing structural barriers through participatory co-design with young people. Full article

Research and development of Maritime Autonomous Surface Ships (MASS) has surged in recent years. However, questions remain regarding the safety of interactions between MASS and conventionally crewed ships in mixed-traffic environments, particularly during collision avoidance. Although the critical role of MASS technology is widely recognised, few studies have explored how these interactions may affect the behaviour of the conventional ship’s Officer of the Watch (OOW). The primary aim of this paper is to explore the challenges and complexities of mixed-traffic interaction from the perspective of the conventional OOW as an active participant in collision avoidance. A collision-avoidance framework is presented as an analytical lens linking situational awareness, motion prediction, mental models, conflict detection, conflict resolution, and manoeuvre execution. This framework is used to examine challenges related to communication, COLREG interpretation, uncertainty surrounding MASS capabilities and operations, knowledge and training, and trust. We argue that these factors may influence how OOWs interpret MASS behaviour and determine whether, when, and how to intervene. To address this research gap, key research questions are formulated, and a scenario-driven methodological approach using Full Mission Bridge Simulators (FMBS) is proposed to investigate changes in OOW behaviour and decision-making during mixed-traffic encounters. Full article

Background/Objectives: Despite recommendations to exercise, many individuals living with and beyond cancer do not achieve or sustain recommended physical activity levels because access to structured exercise support remains limited. We evaluated the real-world delivery of a scalable, community-based exercise model designed to address this gap. Methods: We conducted a hybrid effectiveness–implementation study of a 12-week supervised exercise intervention delivered in community settings across Alberta, Canada (in person or virtual). The primary outcome was the proportion of participants meeting physical activity guidelines at one year. Secondary outcomes included physical fitness and patient-reported outcomes. Results: Among 2570 participants, completion (90.6%) and attendance (77.1%) were high. At one year, the proportion meeting physical activity guidelines increased from 24.1% to 38.9% (p < 0.001), exceeding the prespecified target. At 12 weeks, participants demonstrated clinically meaningful gains in physical fitness, including sit-to-stand performance (+2.8 repetitions; 95% CI, 2.6, 3.9) and six-minute walk distance (+39.9 m; 95% CI, 36.9, 42.8), along with improvements in patient-reported outcomes. Improvements in fatigue and quality of life were smaller among participants receiving chemotherapy. Adverse events were rare (0.5%), with all serious events occurring among participants receiving active cancer treatment. Conclusions: This study demonstrates that structured supervision and behavioural support can be delivered through scalable, community-based models integrated with cancer care and may help patients achieve and sustain recommended physical activity levels. These findings support the translation of established exercise evidence into real-world models of care while highlighting the need for additional strategies to support long-term behaviour change. Full article

Background: Falls among older adults are linked to central nervous system deterioration and executive function deficits. Objectives: This study evaluates the feasibility of a gamified EEG-based neurofeedback intervention combined with adaptive working-memory training, targeting neural processes associated with attentional inhibition and working memory in older adults, and characterises, as exploratory secondary outcomes, the oscillatory and functional measures that change over the training period. Methods: Twenty healthy older adults ($65.0\pm 3.3$ years) completed a 24-session longitudinal training programme. The intervention combined real-time alpha-band neurofeedback (NF), targeting left-frontal alpha activity associated with inhibitory control, with an adaptive N-back task engaging theta-band working memory processes. Behavioural outcomes included the Colour Trail Making Test A and B (CTMT-A/B), the Berg Balance Scale short form (BBS-3P), and the four-item Dynamic Gait Index (DGI-4). EEG was recorded at the Early, Middle, and Later stages to characterise training-related neural and behavioural changes. Results: The programme proved highly deliverable: adherence was 100% across all 24 sessions, no session was terminated early, and no severe adverse events occurred. Participants acquired control of the trained signal, with left-frontal alpha power rising across training at the neurofeedback target site, and frontal theta increased bilaterally under adaptive working memory load, consistent with the reduced hemispheric asymmetry characteristic of this age group. Scores changed in the direction of improvement on all four behavioural measures; however, functional changes were small, and cognitive changes cannot be separated from repeated-testing effects. Of sixteen candidate EEG–behaviour associations, four showed moderate-to-large participant-level coefficients and were retained as candidate associations: right-frontal alpha with balance ($r=-0.64$) and with gait adaptability ($r=-0.48$), and bilateral frontal theta with processing speed ($r=-0.53$ and $-0.51$). Several associations that appeared strong when observations were pooled across stages did not survive participant-level modelling, indicating that repeated-measures methods are needed in this literature. All associations are exploratory, uncorrected for multiplicity, and reported with effect sizes and confidence intervals. Conclusions: The gamified neurofeedback and working-memory training programme was feasible, well tolerated, and fully adhered to in a supervised experimental setting by community-dwelling older adults and was accompanied by measurable modulation of the targeted frontal rhythms. This study delivers a shortlist of candidate EEG features, with the effect-size estimates needed to power a confirmatory trial. Because the design is single-arm, both functional scales approached ceiling, and the same test forms were repeated at each stage, practice effects cannot be separated from intervention effects, and these associations are hypothesis-generating; a sham-controlled trial in a fall-prone population is the appropriate next step. Full article

Small-scale fisheries are socio-ecological systems in which resource users interact with environmental conditions, fishing regulations, community initiatives, and institutional actors. Understanding how fishers perceive and report these interactions provides information on the social context of fisheries management, although such perceptions cannot substitute for independent assessments of ecological sustainability, behavioural compliance, or governance effectiveness. This study characterized fishers’ environmental perceptions, self-reported fishing practices, participation in environmental education and conservation activities, and perceptions of community and institutional involvement in fisheries management in Tecomate Lagoon, Guerrero, Mexico. A cross-sectional quantitative design was used, and structured questionnaires were administered to 120 active artisanal fishers selected through simple random sampling. Data were analyzed descriptively using frequencies and percentages. Respondents primarily associated the lagoon with economic (49.17%) and food-related (25.83%) functions. Declining water levels (60.00%) and reduced species abundance (40.00%) were the environmental changes reported by respondents. Regarding fishing practices, 94.17% stated that they complied with fishing regulations, and 100% reported releasing organisms below the minimum legal catch size. Environmental training was reported by 95.00% of respondents, while 94.17% reported participation in conservation-related activities. CONAPESCA (80.83%) and UAGro (19.17%) were identified as institutions involved in fisheries-related initiatives. These findings characterize the perceptions and self-reported experiences of surveyed fishers and should not be interpreted as evidence of ecological sustainability, actual behavioural compliance, educational effectiveness, or governance performance. The contribution of the study lies in systematically documenting the resource-user perspective as a component of the social dimension of the fishery. This information provides a descriptive baseline that can complement future ecological, behavioural, institutional, and longitudinal assessments of small-scale fisheries in coastal lagoon systems. Full article

Alzheimer’s disease is biologically defined by beta-amyloid and tau pathology, yet the mechanisms through which molecular and network alterations become expressed as the progressive loss of meaningful behaviour remain incompletely understood. This perspective proposes a neurocognitive framework in which apraxia provides a particularly informative clinical window onto the deterioration of functional integration. The model assigns a central organisational role to interhemispheric communication within distributed frontoparietal, temporal, language, memory, and default mode networks. It interprets recognised apraxic syndromes as clinically distinct disturbances that expose complementary requirements of meaningful action, including action knowledge, bodily configuration, sequencing, spatial organisation, object use, fine motor control, and interhemispheric transfer. The framework further examines whether partially convergent impairments of gesture, connected speech, autobiographical construction, and perspective coordination may reflect declining capacity to integrate specialised representations within coherent behaviour. Its original theoretical component proposes that conscious proprioceptive organisation contributes to maintaining body-centred reference frames through which heterogeneous information is coordinated during action and perspective transformation. Evidence for Alzheimer-related connectivity alterations and impairments of praxis, discourse, and autobiographical memory is reviewed separately from the proposed integrative mechanism, which requires direct testing. The framework predicts that longitudinal changes across these behavioural domains will covary with deterioration in interhemispheric and large-scale network connectivity and provide explanatory information beyond global cognitive severity and regional atrophy. Multimodal longitudinal studies combining molecular biomarkers, neuroimaging, apraxia assessment, connected-speech analysis, and autobiographical tasks are proposed to evaluate, delimit, or reject these predictions. Full article

Social media has become an important channel for information exchange during sudden disasters, with implications for both public-sector communication and corporate risk communication. However, limited research has examined how substantive message content and linguistic presentation jointly relate to online dissemination behaviour. This issue is also relevant to corporate risk management, as firms must respond to crises while managing stakeholder perceptions. Drawing on the Elaboration Likelihood Model (ELM) and Construal Level Theory (CLT), this study conceptualizes information richness and relevance as central-route cues, and specificity and interactive language as peripheral linguistic cues. User involvement is introduced as a motivational condition that may change the relative weight assigned to these cues. The empirical analysis uses 51,856 Weibo posts concerning the 2025 Tibet earthquake. OLS results show that all four message characteristics are positively associated with dissemination intensity, and that user involvement strengthens the associations of content-related cues while weakening those of linguistic cues. A supplementary negative binomial regression confirms the positive associations of information richness and interactive language, as well as the key interaction patterns, though the results for information relevance and specificity are less stable. These findings extend crisis communication research by showing that disaster-information dissemination is jointly associated with substantive content, linguistic presentation, and user involvement, and offer practical implications for organizations seeking to design clearer and more adaptive risk communication. Full article