Search Results (10)

Background/Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have received widespread attention as effective obesity treatments. However, limited research has examined the perspectives of patients contemplating GLP-1RAs. This study explored perceptions, motivations, and barriers among individuals considering GLP-1RA therapy for obesity treatment, with the goal of informing patient-centered care and enhancing clinician engagement. Methods: Adults completed surveys and interviews between June and November 2025. In this pragmatic mixed-methods study, both survey and interview questions explored perceived benefits, barriers, and decision-making processes. Qualitative data, describing themes based on the Health Belief Model, were analyzed using Dedoose (version 9.0.107), and quantitative data were analyzed using SAS (version 9.4). Participant characteristics included marital status, income, educational attainment, employment status, insurance status, age, race/ethnicity, and sex. Anticipated length on GLP-1RA medication and selected self-reported health conditions (depression, anxiety, hypertension, heart disease, back pain, joint pain), reported physical activity level, and perceived weight loss competency were also recorded. Results: Among the 31 non-diabetic participants who were considering GLP-1RA medication for weight loss, cost emerged as the most significant barrier. Life course events, particularly (peri)menopause among women over 44, were commonly cited as contributors to weight gain. Participants expressed uncertainty about eligibility, long-term safety, and treatment expectations. Communication gaps were evident, as few participants initiated discussions and clinician outreach was rare, reflecting limited awareness and discomfort around the topic. Conclusions: Findings highlight that individuals considering GLP-1RA therapy face multifaceted emotional, financial, and informational barriers. Proactive, empathetic clinician engagement, through validation of prior efforts, clear communication of risks and benefits, and correction of misconceptions, can support informed decision-making and align treatment with patient goals. Full article

Background: Social media has emerged as a powerful communication tool for healthcare professionals, including nutritionists and dietitians, particularly since the COVID-19 pandemic. Evidence suggests that their online presence can enhance nutritional literacy and play a crucial role in countering misinformation. Objective: This systematic review aims to investigate how and why Registered Nutritionists and Dietitians (RNDs) use social media in their professional practice, focusing on benefits, challenges, and impact. Methods: A systematic literature search was conducted between 1 January 2019 and 28 February 2024, in PubMed, Scopus, Scholar, and SciELO databases using terms such as ‘nutritionist’, ‘dietitian’, and ‘social media’. Quality was assessed using the MMAT tool. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The included studies were analysed with respect to their content, professional practices, and patterns of social media use. Results: Of the 359 articles identified through the systematic search, 10 cross-sectional studies conducted using questionnaires were included in this review. Sample sizes ranged from 10 to 2542 participants across nine countries. Instagram and Twitter were the most frequently used platforms among RDNs, primarily for sharing evidence-based nutritional information, counselling content, and professional promotion. Reported usage ranged from 37.5% to 100%, with a marked increase during the COVID-19 pandemic, especially among younger professionals. Key enablers included enhanced communication, professional visibility, and cost-effective outreach, while main challenges involved limited digital literacy and difficulties replicating face-to-face counselling online. Although ethical concerns were reported, many RNDs maintained compliance with professional standards, particularly in regions with strict marketing regulations. Conclusions: This systematic review provides evidence that social media is a valuable tool for RNDs, particularly in the context of food and/or nutritional education. RNDs would benefit from training in content creation, knowledge dissemination and ethical digital communication. However, clearer guidelines from professional organisations are also recommended. Full article

Urban tree planting on single-family-home lots represents a critical yet underexplored component of municipal greening strategies. This study examines residents’ perceptions of tree planting in Westpointe, a diverse neighborhood in Salt Lake City, Utah, as part of the city’s Reimagine Nature Public Lands Master Plan development effort. Through a mixed-methods approach combining qualitative interviews (n = 24) and a tree signup initiative extended to 86 residents, with 51 participating, this research explores the complex interplay of demographic, economic, social, and infrastructure factors influencing residents’ willingness to plant trees on single-family-home lots. The findings reveal significant variations based on gender, with women expressing more positive environmental and aesthetic motivations, while men focused on practical concerns including maintenance and property damage. Age emerged as another critical factor, with older adults (65+) expressing concerns about long-term maintenance capabilities, while younger families (25–44) demonstrated future-oriented thinking about shade and property values. Property characteristics, particularly yard size, significantly influenced receptiveness, with owners of larger yards (>5000 sq ft) showing greater willingness compared to those with smaller properties, who cited space constraints. Additional barriers, i.e., maintenance, financial, and knowledge barriers, included irrigation costs, lack of horticultural knowledge, pest concerns, and proximity to underground utilities. Geographic analysis revealed that Spanish-speaking social networks were particularly effective in promoting tree planting. The study contributes to urban forestry literature by providing nuanced insights into single-family homeowners’ tree-planting decisions and offers targeted recommendations for municipal programs. These include gender-specific outreach strategies, age-appropriate support services, sliding-scale subsidy programs based on property size, and comprehensive education initiatives. The findings inform evidence-based approaches to increase urban canopy coverage through private property plantings, ultimately supporting climate resilience and environmental justice goals in diverse urban neighborhoods. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with rural populations experiencing higher prevalence and worse outcomes. This paper explores the transformative potential of nurse-led palliative care models in addressing the unique challenges faced by rural patients with COPD and their informal caregivers and synthesizes current evidence on nurse-led palliative care interventions, highlighting their impact on symptom management, advance care planning, and psychosocial support. Methods: This is a comprehensive synthesis of nurse-led palliative care programs, focusing on home-based care, telehealth, community outreach, and primary care integration. Results: Nurse-led interventions significantly improve patient satisfaction, reduce symptom burden, and enhance the likelihood of advance care planning discussions. Home-based care models and telehealth are particularly effective in rural settings, offering accessible and continuous support. Conclusions: Nurses have a critical role in bridging the palliative care gap for rural patients with COPD and their informal caregivers. Expanding nurse-led palliative care services can improve quality of life, reduce healthcare utilization, and promote health equity. Future research should focus on long-term outcomes, cost-effectiveness, and strategies for scaling nurse-led palliative care programs in rural contexts. Full article

As the climate continues to warm, and municipal leaders look for cost-effective and timely approaches to urban sustainability, one increasingly sought-out approach is the use of tree canopy to cool neighborhoods. Despite widespread efforts to expand tree canopy in cities, an overwhelming body of evidence suggests that urban green space is declining across the U.S., yet little is known about the factors that propel these changes. Understanding the institutional and governance systems can help identify the opportunities for slow consistent declines. Using social network analysis (SNA) metrics, we examined stakeholder roles in power structures and decision-making processes within Portland, Oregon’s urban forest management. Our results reveal a highly decentralized urban forestry network (density = 0.0079), with weak cohesion (5.4%) among 162 stakeholders. Moving forward, while network governance may face obstacles from conflicting interests among community and interagency groups, transforming governance models at all levels will require developing periodic, collaborative urban forestry management plans to address nature-based planning challenges. These planning documents should strongly emphasize not only the prioritization of tree equity-related ordinances but also the optimization of eco-literacy and awareness through virtual reality (VR) technology. As a novel approach, immersive simulations demonstrate practical potential for showcasing urban forestry benefits in network governance outreach and consensus-building. Full article

Purpose: To systematically review published cost-effectiveness analyses of Evidence-Based Interventions (EBIs) recommended by the United States Community Preventive Services Task Force (CPSTF) to increase breast and cervical cancer screening. Methods: We searched PubMed and Embase for prospective cost-effectiveness evaluations of EBIs for breast and cervical cancer screening since 1999. We reviewed studies according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and compared the incremental cost-effectiveness ratio (ICERs), defined as cost per additional woman screened, adjusted to 2021 USD, within and across EBIs by cancer type. Results: We identified eleven studies meeting our review criteria: nine were breast cancer-focused, one breast and cervical cancer combined, and one cervical only, which together reported twenty-four cost-effectiveness assessments of outreach programs spanning eight EBIs. One-on-one education programs were the most common EBI evaluated. The average ICER across breast cancer studies was USD 545 (standard deviation [SD] = USD 729.3), while that for cervical cancer studies was USD 197 (SD = 186.6. Provider reminder/recall systems for women already linked to formal care were the most cost-effective, with an average ICERs of USD 41.3 and USD 10.6 for breast and cervical cancer, respectively. Conclusions: Variability in ICERs across and within EBIs reflect the population studied, the specific EBI, and study settings, and was relatively high. ICER estimate uncertainty and the potential for program replicability in other settings and with other populations were not addressed. Given these limitations, using existing cost-effectiveness estimates to inform program funding allocations is not warranted at this time. Additional research is needed on outreach programs for cervical cancer and those which serve minority populations for either of the female cancer screens. Full article

This study examines the impact of microfinance on the social performance of local households in the Kassena Nankana East District of northern Ghana. The study’s primary objective was to measure the average effect of the common social performance framework’s core indicators (outreach and products and services) on beneficiaries. Because the social performance management framework is an institutional-based evaluation, it is silent on changes in the service users’ lives. This study modified the common social performance management framework to treat outreach and products and services as independent variables, with changes in the lives of service users as the only output or result. We narrowed these indicators to outreach and mobile banking, and under products and services, we concentrated on nonfinancial products and services because, in microfinance, nonfinancial services lack the needed attention. This study employed the propensity score matching (PSM) method to measure the average treatment effect of the independent variables (outreach, mobile banking, and training) by using data from 341 client households. In the absence of a random assignment of treatment conditions, we placed client households who received these three treatments in a treatment group and those who did not receive such treatments in a control group. We further used the PSM method to match observations of households in the treatment group (households who have access to mobile banks, MFI outreach, and training) with those in the control group (households without access to those) by creating the conditions of an experiment where the treatment elements are randomly assigned to avoid any possible bias. The results showed that outreach significantly decreased loan disbursement time. Conversely, outreach was not significant in relation to delayed loan disbursement time. Mobile banking was statistically significant for increased income, business expansion, timely loan disbursement, and high cost of loans. On the contrary, mobile banking was significantly negative in relation to delayed loan disbursement time. Training showed a significant correlation with women’s empowerment, household decision making, and political and community participation. Regarding the impact of training on the use of a loan, the value of loans for consumption was negative, whereas for production it was positive. Despite the general acceptance of the common framework to measure microfinance social performance, there is still little work to prove the relationship between the framework’s output variables and changes in the lives of the service users. This paper is the first to provide empirical evidence on the impact of outreach and training on change variables. The implication of this paper is that nonfinancial services are equally crucial to delivering change for microfinance service users. Therefore, policymakers must find ways to incorporate essential nonfinancial products and services as bundle packages with credit. Additionally, mobile banking has a high potential for addressing challenges with remote outreach and adverse selection, which is a primary obstacle preventing many poor people from accessing credit. Full article

Utility-sponsored residential energy reduction programs have seen rapid advancement in the Unites States (US) over the past decade. These programs have particularly emphasized investments in energy efficient appliances and enveloped improvements. They have generally required co-investment by residents and, as a result, have mostly reached medium to high-income residents, with low income residences, in effect, supporting the utility investments through higher energy costs. Additionally, utility initiatives directed toward behavior-based energy reduction have reached residences with more advanced technologies, such as smart meters and smart Wi-Fi thermostats linked to phone apps, technologies generally not present in low-income residences. This research seeks to inform development of behavior-based energy reduction programs aimed specifically at low-income residences, premised on peer-to-peer energy education and support. It focuses on the design and implementation of a pilot program for 84 low-income residences in a medium-sized Midwestern US urban neighborhood, followed by measurement of realized energy savings and assessment of program outcomes through surveys of resident participants and interviews with program implementers. Only 21 residences provided an initial response to outreach. Of these, only 11 participated, and of these, energy savings were, in general, modest. However, evidence based upon other research and qualitative data obtained from program implementers and participants is presented in this study for the development of an improved design. The improved design emphasizes grassroots community co-design of the program and community engagement through program implementation to transform energy consumption and behaviors and find energy justice for vulnerable communities. Full article

The actions of residents in the wildland–urban interface can influence the private and social costs of wildfire. Wildfire programs that encourage residents to take action are often delivered without evidence of effects on behavior. Research from the field of behavioral science shows that simple, often low-cost changes to program design and delivery can influence socially desirable behaviors. In this research report, we highlight how behavioral science and experimental design may advance efforts to increase wildfire risk mitigation on private property. We offer an example in which we tested changes in outreach messaging on property owners’ interest in wildfire risk information. In partnership with a regional wildfire organization, we mailed 4564 letters directing property owners to visit personalized wildfire risk webpages. By tracking visitation, we observed that 590 letter recipients (12%) sought information about their wildfire risk and response varied by community. This research–practice collaboration has three benefits: innovation in outreach, evidence of innovation through experimental design, and real impacts on interest in wildfire mitigation among property owners. Future collaborations may inform behavioral and evidence-based programs to better serve residents and the public interest as the risks from wildfires are projected to grow. Full article

The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select, a community-based health promotion program previously shown to improve functional health, physical activity, nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach, personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained, as well as health outcomes, such as healthy days, weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days, physical activity and nutrition-related outcomes among participants, this study supports the use of Texercise Select as an intervention with substantial health and cost benefits. Full article