Search Results (874)

Teachers’ socio-emotional competencies are increasingly recognized as essential for professional well-being, adaptive teaching, and effective participation in digitally transforming educational systems. However, valid and culturally appropriate instruments for assessing these competencies among teachers remain limited, particularly in multilingual and underrepresented educational contexts. This study aimed to adapt the Behavioral, Emotional, and Social Skills Inventory (BESSI) for teachers in Kazakhstan and to examine its preliminary psychometric properties and socio-emotional competency profiles. The instrument was translated and culturally adapted into Kazakh and Russian using a TRAPD-based (Translation, Review, Adjudication, Pretesting, and Documentation) procedure involving translation, review, adjudication, pretesting, and documentation. Data were collected from 1458 school teachers across Kazakhstan representing different subject areas and language groups. After data-quality screening, the final analytic sample included 918 valid observations. Reliability analyses demonstrated excellent total-scale internal consistency (Cronbach’s α = 0.92; McDonald’s ω = 0.94), while domain-level reliability ranged from moderate to acceptable (α = 0.60–0.76; ω = 0.73–0.81). Exploratory factor analysis suggested an empirical eight-factor structure rather than a direct replication of the original BESSI framework, indicating that socio-emotional competencies may be organized differently in teacher populations. Model-based clustering identified four exploratory teacher profiles reflecting different configurations of self-management, emotional regulation, interpersonal, and innovation-related competencies. The profiles differed not only in overall competency levels but also in specific patterns of strengths and developmental needs. The findings provide preliminary evidence supporting the use of the adapted BESSI as a promising research and diagnostic instrument for assessing teachers’ socio-emotional competencies in Kazakhstan. At the same time, the results indicate the need for further confirmatory validation, measurement invariance testing, and external validity evidence before broader application. Full article

Background/Objectives: Routine depression screening is recommended in primary care, yet depression may remain underdetected among Filipino American patients. Provider-level factors, including culturally responsive preparation, communication challenges, workflow constraints, and attitudes toward mental health screening, may influence opportunities for early identification and referral. This exploratory cross-sectional study examined provider perspectives on barriers to depression screening and mental health discussions with Filipino American patients using the Capability, Opportunity, Motivation, and Behavior (COM-B) framework as an implementation-informed organizing lens. Methods: A cross-sectional survey was conducted among healthcare providers (N = 81) with experience caring for Filipino American patients in the United States. Survey items assessed provider confidence, perceived adequacy of mental health training, cultural and communication barriers, perceived stigma-related concerns, comfort discussing mental health, and interest in additional culturally responsive resources. Items from the adapted Attitudes Toward Assisting Filipino American Patients with Mental Health Symptoms (ATFA) scale and one item from the Mental Illness Clinicians’ Attitudes scale were conceptually mapped to the COM-B domains. Descriptive statistics, internal consistency estimates, and nonparametric tests were used to summarize findings and explore differences by provider characteristics. Results: Most providers recognized that Filipino cultural beliefs and customs may influence mental health help-seeking and symptom expression. Although many providers reported confidence identifying mental health symptoms, fewer reported adequate training to assess mental health concerns among Filipino American patients. Communication barriers, stigma-related concerns, and interest in additional culturally tailored resources were commonly reported. COM-B domain scores were not significantly associated with provider role or years of clinical experience. Providers who identified as Filipino reported greater perceived capability and opportunity related to initiating mental health discussions compared with non-Filipino providers. Conclusions: Findings suggest that provider motivation to address mental health concerns may be present, while capability- and opportunity-related barriers, including culturally responsive training, communication support, workflow integration, and referral resources, may remain important targets for future implementation efforts. Because this exploratory study used a modest convenience sample and an adapted measure that requires further psychometric validation, the findings should be interpreted with caution. Larger studies using validated instruments are needed to examine further provider-level determinants of culturally responsive depression screening among Filipino American patients. Full article

Background: Vaccine hesitancy (VH) is a complex global public health threat requiring validated tools for its assessment globally. This study aimed to evaluate an extended adult Vaccine Hesitancy Scale (aVHS) among Greek-speaking adults. Methods: This study evaluated a newly developed extended version of a widely used aVHS, incorporating five additional items on long-term safety, risk–benefit evaluation, vaccine-related harm, scientific credibility, and perceived alternatives, on a cross-sectional sample of 491 adults in Greece and Cyprus. Cross-cultural adaptation of the extended aVHS involved translation, back-translation, and pilot testing. Structural validity was assessed using parallel analysis, exploratory factor analysis (EFA), and reliability using Cronbach’s α and McDonald’s ω. Criterion validity was assessed against focus-group classification using ROC analysis in 68 participants. Results: A one-factor EFA solution appeared the most parsimonious, showing strong loadings for the original and extended aVHS (0.67–0.86 and 0.65–0.87), with similar explained variance (60.31% and 60.06%). The one-factor solution was confirmed by parallel analysis for both scales. Internal consistency was excellent, and slightly higher for the extended than the original aVHS (α = 0.95; ω = 0.95 vs. α = 0.92; ω = 0.93). The five newly added items performed strongly, with item–rest correlations of 0.69–0.85 and loadings of 0.72–0.87. Criterion validity was excellent, with a slightly higher AUC (0.991 vs. 0.981) and numerically higher classification performance for the extended than the original aVHS. Conclusions: The extended aVHS is a psychometrically coherent tool that improves the performance of the original scale among Greek-speaking individuals. This scale may enhance VH surveillance, aiding targeted vaccination communication strategies. Full article

Background and Objectives: Periodontal diseases are highly prevalent worldwide and have been associated with impaired oral health-related quality of life (OHRQoL). However, the strength and direction of this association remain inconsistent, particularly when sociodemographic and behavioural factors are considered. The aim of this study was to evaluate the independent association between periodontal status and OHRQoL in Bulgarian adults attending a university dental clinic, while accounting for sociodemographic factors and sleep quality, which was included as a clinically relevant behavioural determinant of oral health-related quality of life. Materials and Methods: This cross-sectional study included 504 adult participants (≥18 years) who underwent comprehensive periodontal examination and completed validated questionnaires. OHRQoL was assessed using the culturally adapted Bulgarian version of the Oral Health Impact Profile (OHIP-14), and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Due to the skewed distribution of OHIP-14 scores, the outcome was dichotomized at the sample median. Multivariable logistic regression analysis was performed to assess independent associations, adjusting for age, sex, education, financial status, place of residence, and sleep quality. Results: Periodontal status, sex, and sleep quality were independently associated with impaired OHRQoL. Females demonstrated lower odds of impaired OHRQoL compared to males (OR = 0.636; 95% CI: 0.428–0.924; p = 0.025). Poor sleep quality was associated with increased odds of impaired OHRQoL (OR = 1.554; 95% CI: 1.041–2.321; p = 0.031). Periodontitis was significantly associated with impaired OHRQoL (OR = 3.526; 95% CI: 2.073–5.998; p < 0.001), reflecting a complex relationship between clinical periodontal status and subjective health perception. Conclusions: OHRQoL is influenced by a multifactorial framework integrating periodontal status, behavioural factors, and sociodemographic characteristics. These findings highlight the importance of incorporating patient-reported outcomes into periodontal assessment and support a biopsychosocial approach to oral health research. Full article

Background/Objectives: Accurate assessment of dietary behaviors is essential for understanding their impact on health and guiding nutritional policies. Given the escalating prevalence of noncommunicable diseases in the MENA region, the availability of culturally adapted and psychometrically validated Arabic-language instruments is essential for accurate health assessment. This systematic review aims to identify and evaluate studies that have translated, adapted, or validated dietary behavior measurement instruments into Arabic. Methods: Following the PRISMA guidelines and registered in PROSPERO (CRD420251157552), a search was conducted in PubMed, Scopus, and Web of Science. Studies including the validation, translation, or adaptation of instruments into Arabic among Arabic-speaking populations were included. Methodological quality was assessed using the COSMIN checklist. Results: Thirty-two studies were included, published between 2006 and 2025, primarily in Lebanon (n = 14) and Saudi Arabia (n = 6). The instruments measured various concepts: dietary intake, diet quality, eating disorders, etc. While internal consistency and structural validity were frequently assessed with adequate methodological quality, content validity, measurement error, and responsiveness were either under-reported or failed to meet COSMIN standards. Conclusions: Despite an increasing volume of publications, the methodological quality of Arabic instrument validation remains heterogeneous, with significant gaps in the assessment of longitudinal properties. Efforts are needed to improve the rigor of adaptation processes and to evaluate key properties such as responsiveness in order to ensure reliable tools for research and clinical practice in the MENA region. Full article

Background/Objectives: Pakistan has one of the highest burdens of adolescent anaemia in South Asia. A Weekly Iron-Folic Acid Supplementation (WIFAS) program for school-going adolescent girls aged 10–19 years was piloted in the Lodhran District, Punjab, Pakistan. Methods: A quantitative cross-sectional study was conducted among 750 girls, selected by multi-stage random cluster sampling from 50 public schools across Lodhran; qualitative data were generated through in-depth interviews and focus group discussions with 327 stakeholders. Quantitative data were analyzed using a chi-square test in SPSS. Qualitative data were analyzed in NVIVO using thematic analysis based on the Socio-Ecological Model, enabling environment and institutional systems, community engagement, behavior change and adolescent empowerment and agency. Coding was guided by overarching research questions of acceptability, feasibility and impact. Cases of anaemia averted were estimated using program data and outcome modeling. Qualitative findings were triangulated with quantitative results. Results: The program reached 30,506 girls and was estimated to have averted 5659 cases of anaemia. WIFAS coverage increased from 0% to 100%, with a high level of adherence (80%). Knowledge about anaemia, its signs/symptoms and preventative measures increased significantly at endline. Dietary practices showed positive changes, with significant increase in girls never skipping a meal. Stakeholders attributed success to the creation of an enabling environment through institutional alignment and multisectoral collaboration, culturally adapted, adolescent-friendly materials, and robust community mobilization that proactively addressed socio-cultural barriers. Conclusions: The school-based WIFAS program for reducing anaemia among adolescent girls was feasible and acceptable in a context where few nutrition services are available to girls. Full article

Background/Objectives: Adolescent pregnancy remains a global public health challenge associated with adverse outcomes for both mothers and newborns. This study aimed to use two instruments and several multivariate techniques to identify a minimal set of variables that reproduces the instrument-based classification of adolescent pregnancy risk, while remaining parsimonious with the original instruments. Methods: A cross-sectional, quantitative methodological study was conducted among Colombian schoolgirls, comprising 160 adolescents in the face-validity phase and 319 in the risk-estimation and modeling phase. The IRENE and REND instruments, originally developed to assess the risk of adolescent pregnancy, underwent cultural adaptation, face validity and content validity. Subsequently, the instruments were administered to estimate the risk. Finally, Factor Analysis and Categorical Principal Component Analysis were applied as exploratory dimensionality reduction techniques to identify the most relevant variables for retention, thereby preserving the parsimony of the original versions. Results: Overall, 80.3% of participants were classified as not at risk, while the remainder were classified as at risk by one or both instruments. The results suggest that variables such as who the adolescent lives with, the age at which the adolescent had their first complete sexual intercourse, and how the adolescent would respond to an unplanned pregnancy are factors associated with the instrument-based risk classification. Subsequently, dimensionality reduction and logistic regression analyses identified a small subset of variables that can be used to reproduce the instrument-based classification of adolescent pregnancy risk. Conclusions: The reduced set of variables reproduced the instrument-based risk classification with high internal accuracy. Because the predictors and the outcome derive from the same instruments, these findings reflect internal reproduction of the instrument classification rather than prediction of an observed pregnancy, and they require external validation. Overall, the reduced and optimized set of variables from the IRENE and REND instruments offers a parsimonious approach that reproduces the instrument-based risk classification and that may support rapid screening once validated in independent adolescent samples. The main limitations are the use of a single institution, the non-probabilistic convenience sample, and the absence of an observed pregnancy outcome. Full article

Public spaces in Iraqi cities carry social memory, daily trade, and civic trust; therefore, post-conflict reconstruction must be evaluated through social performance as well as physical repair. This study develops a user-satisfaction framework for sustainable and resilient public space reconstruction in post-conflict Iraq. A convergent mixed-methods design was used, combining literature and site analysis with Likert-scale surveys of residents and experts in two public-commercial case studies: Eskan Bazaar and Najafi Street. The resident survey included 901 valid respondent records (Eskan Bazaar, n = 451; Najafi Street, n = 450), and the expert survey included 89 respondent records (Eskan Bazaar, n = 48; Najafi Street, n = 41). The analysis used weighted means, standard deviations, medians, percentage agreement, site comparison, and reliability testing. Cronbach’s Alpha showed acceptable to excellent internal consistency for the local surveys (0.79 and 0.91) and excellent internal consistency for the expert surveys (0.93 for both sites). Results show that Najafi Street scored higher than Eskan Bazaar across all local factors, especially cultural preservation (3.15 versus 2.71) and accessibility (2.57 versus 2.30), while accessibility remained the weakest local dimension in both cases. Expert results similarly favored Najafi Street, particularly for cultural preservation (3.28 versus 2.83) and accessibility (3.26 versus 2.94). The findings were translated into a five-pillar framework covering community engagement, cultural preservation, environmental stewardship, economic revitalization, and adaptive resilience. The framework is preliminarily validated through construct reliability, cross-case application, expert-local triangulation, and monitoring indicators, while future post-occupancy testing is recommended. Full article

Background/Objectives: Nutrition is essential in healthcare and rehabilitation, although the readiness of physiotherapists in Saudi Arabia to integrate nutritional assessment and counseling remains ambiguous. This study aimed to assess their knowledge of nutrition, lifestyle choices, and attitudes towards incorporating nutrition into practice. Methods: This cross-sectional study included 500 licensed physiotherapists practicing across Saudi Arabia and used a culturally adapted questionnaire derived from previously validated instruments. The survey assessed background characteristics, nutrition knowledge, nutritional lifestyle, and attitudes toward integrating nutrition into physical therapy. Descriptive statistics, analysis of variance, Pearson correlation, and multiple linear regression analyses were performed. Results: Participants demonstrated moderate nutrition knowledge (59.68 ± 17.25) and favorable nutritional lifestyles (20.67 ± 3.79), with positive attitudes toward integrating nutritional assessment and counseling into their practice (13.63 ± 4.64). A significant positive correlation was observed between nutritional lifestyle scores and nutrition integration scores (r = 0.29, p < 0.01). Because lower nutritional lifestyle scores indicate healthier lifestyles and lower integration scores reflect greater integration, participants with healthier nutritional lifestyles tend to show greater nutrition integration. Nutrition knowledge scores were negatively correlated with integration scores (r = −0.37, p < 0.01). Multiple linear regression analysis identified professional seniority, nutritional lifestyle, and nutrition knowledge as significant predictors of nutrition integration score, explaining 22.8% of the variance (F = 29.24, R² = 0.22, p = 0.001). Conclusions: Saudi physiotherapists showed positive attitudes toward integrating nutritional assessment and counseling into the practice, but their nutrition knowledge was moderate, with knowledge gaps. Nutrition integration correlated significantly with nutritional lifestyle scores, nutrition knowledge, and professional seniority. The findings indicate the need to improve nutrition-related competencies and interdisciplinary collaboration in rehabilitation practice. Full article

Indigenous crops are well adapted to marginal conditions and rich in nutrients, making them promising contributors to food and nutrition security in rural South African communities. This study evaluated the consumer acceptability and community perceptions of stiff pap composite dishes incorporating pumpkin leaves, Cucurbita pumpkin, and cream-fleshed sweet potato (CFSP) among 60 rural participants. Employing a cross-sectional design, sensory testing using a nine-point hedonic scale and focus group discussions (FGDs) were conducted across the uMkhanyakude and King Cetshwayo District Municipalities in KwaZulu-Natal, South Africa. All three composite dishes were well-liked overall. The CFSP-based dish achieved the highest overall acceptability (7.68) and was the most preferred (40%; n = 24), while the pumpkin-based dish was the least preferred (38%; n = 23). Significant differences in taste and color were observed across dishes (p < 0.05). Focus groups highlighted that familiarity, flavor balance, preparation methods, and cultural norms shaped willingness to adopt these dishes, with novel combinations eliciting both curiosity and hesitation. Cultural norms, family preferences, and the traditional significance of stiff pap shape acceptance pathways. The findings suggest that integrating indigenous crops into culturally familiar staples can promote dietary diversification and support smallholder farming systems, with culturally sensitive culinary guidance serving as the key enabler for broader adoption. These findings imply that embedding indigenous crops within culturally central staples offers a practical, consumer-driven entry point for sustainable food system transformation, simultaneously advancing dietary diversity, smallholder livelihoods, and the resilience of rural food systems. Full article

Background/Objectives: Measles remains a significant public health concern in Romania, with recurrent ongoing nationwide outbreaks despite the availability of the measles–mumps–rubella (MMR) vaccine. This study investigates the epidemiological, clinical, and sociocultural dimensions of measles among Romanian adults, with a particular focus on a vulnerable group, the Roma population. Methods: We conducted a retrospective cohort study using clinical data from a tertiary hospital in Bucharest, Romania. The study included adult patients hospitalized with measles between July 2023 and April 2024. In a subsequent phase, we carried out a cross-sectional survey among hospitalized measles patients to assess their perception and understanding of measles and the MMR vaccine, with particular attention to responses from Roma participants. Results: A retrospective investigation of 100 hospitalized adult patients with laboratory-confirmed diagnoses of measles demonstrated frequent complications such as hepatic involvement (85/100), pneumonia (68/100), and respiratory failure (21/100). Only 6/100 of patients were fully vaccinated. Rhabdomyolysis was significantly more common in unvaccinated individuals and women. No deaths were recorded, and no ICU admissions occurred. Among the hospitalized patients, 49 adults responded to a vaccine centered questionnaire. We report a notable vaccine hesitancy, particularly among the Roma respondents. Socioeconomic factors such as low income, limited education, and lack of health insurance were significantly associated with negative perceptions of the MMR vaccine. A statistically significant association was observed between Roma ethnicity and the belief that the MMR vaccine causes autism. Conclusions: These findings highlight the urgent need for targeted public health interventions with culturally adapted education campaigns to improve vaccination coverage and thereby protect vulnerable adult populations in Romania. Full article

Background/Objectives: Colorectal cancer (CRC) disproportionately affects Romania, where mortality exceeds the EU average and screening uptake remains low. Diet is among the most modifiable CRC risk factors, yet no validated instrument for assessing nutritional knowledge, attitudes, and practices (KAP) related to CRC prevention exists for the Romanian population. We developed and pilot-tested the EduNutriCRC questionnaire and characterised the corresponding nutritional KAP profile of Romanian adults. Methods: In a cross-sectional pilot study (April–May 2026), a convenience sample of 301 Romanian adults aged 18–74 years completed the 51-item self-administered questionnaire. The instrument was evaluated for internal consistency and dimensional structure (exploratory factor analysis), with non-parametric tests used for group comparisons. Results: The composite knowledge score (C1–C9; maximum 9) was 6.12 ± 2.25 with wide item-level variation. Internal consistency was acceptable, and the Attitudes subscale resolved into two factors (Motivation & Self-Efficacy and Perceived Barriers). Screening engagement was critically low (92.4% never tested; 81.7% unaware of the national programme). Although 64.1% expressed willingness to change their diet, 46.2% reported consuming processed meat at least weekly. Motivation & Self-Efficacy, but not the knowledge score, was inversely correlated with risk-food consumption (ρ = −0.39, p < 0.001). Conclusions: EduNutriCRC demonstrated acceptable psychometric properties at the pilot stage. The study identified prevalent nutritional misconceptions, a marked knowledge–behaviour gap, low screening awareness, and a structural mismatch between information sources used and those trusted. Attitudes and self-efficacy, rather than factual knowledge, were the more proximal correlates of dietary behaviour, supporting the development of self-efficacy-focused, culturally adapted educational interventions for CRC prevention in Romania, with EduNutriCRC serving as a baseline and monitoring instrument. Full article

Background: Plastic food-contact materials are increasingly recognised as a potential source of dietary exposure to endocrine-disrupting chemicals, particularly through packaged, canned, and ultra-processed foods. However, culturally adapted tools for estimating long-term exposure-related dietary behaviours in Latin American populations remain limited. This study aimed to develop and provide a preliminary evaluation of the Dietary Plastic Exposure Score for Mexican Populations (DPES-MX), and to characterise exposure-related dietary patterns in Mexican university students. Methods: A cross-sectional study was conducted in 152 university students from Querétaro, Mexico. Anthropometric, lifestyle, and dietary information were collected using standardised questionnaires and a culturally adapted food frequency questionnaire. The DPES-MX incorporated dietary and food-handling practices linked to potential migration of plastic-related compounds from food-contact materials, including canned foods, packaged beverages, takeaway foods, microwave heating in plastic containers, and convenience-oriented eating behaviours. Principal component analysis (PCA) and adjusted linear regression models were applied to explore associations between dietary patterns and DPES-MX scores. Results: Men showed slightly higher DPES-MX scores than women, although differences were not statistically significant. Women were more frequently classified within the low DPES-MX score category, and female sex was independently associated with lower DPES-MX scores in adjusted models. PCA identified a dietary component characterised by alcoholic beverages, snacks, sweets, sugar-sweetened beverages, and processed foods that was positively associated with higher DPES-MX scores (β = 0.81, p < 0.001). Conclusions: The DPES-MX could serve as a culturally adapted epidemiological tool for identifying dietary and behavioural practices linked to potential exposure to plastic-related food-contact materials in Mexican populations. Convenience-oriented dietary patterns appeared to be associated with higher DPES-MX scores. Full article

The Multidimensional Body–Self Relations Questionnaire (MBSRQ) is a premier body image assessment tool, yet its full 69-item version lacks psychometric validation and cross-gender measurement invariance testing within the Greek population. This study rigorously evaluated the structural validity, internal consistency reliability, and measurement invariance of the complete Greek MBSRQ using a large community sample of 1776 adults (899 men, 877 women). Construct validity was examined via multigroup Confirmatory Factor Analysis (CFA) utilizing the Diagonally Weighted Least Squares (DWLS) estimator to properly accommodate ordinal data. The original 10-factor model demonstrated an acceptable fit for women (CFI = 0.903, RMSEA = 0.086) but exhibited a visibly attenuated, marginal fit for the male subsample (CFI = 0.843, TLI = 0.835, RMSEA = 0.089). While the baseline configural invariance model fit fell below conventional thresholds, sequential constraints supported full scalar invariance (Delta-CFI = 0.004, Delta-RMSEA = 0.002). Significant gender differences emerged, with women reporting higher Appearance Orientation and Overweight Preoccupation. Subjective weight perception more adversely impacted female body satisfaction, whereas health evaluation operated completely independently of aesthetic domains. Consequently, the full Greek MBSRQ provides a reliable platform for cross-gender comparisons, though its structural validity requires qualified, highly cautious interpretation due to male-specific model fit limitations. Full article

Introduction: Work-related musculoskeletal disorders are common among nursing staff and may affect functionality, psychological well-being, and work performance. Brief, culturally adapted, and psychometrically sound instruments are needed to characterize musculoskeletal risk in occupational settings. This study aimed to translate, culturally adapt, and examine the structural validity and internal reliability of the abbreviated version of the Örebro Musculoskeletal Screening Questionnaire in Peruvian nurses with musculoskeletal symptoms. Methods: An instrumental, cross-sectional study was conducted with a sample of 170 Peruvian nurses. The Spanish-adapted version of the ÖMSQ-12S was administered. Descriptive statistics, corrected item-total correlations, confirmatory factor analysis using the robust maximum likelihood estimator, internal reliability through Cronbach’s alpha and composite reliability, convergent validity through average variance extracted, and discriminant validity using the Fornell–Larcker criterion were analyzed. Results: The original three-dimensional 12-item model showed inadequate fit: χ²(51) = 276.301, CFI = 0.713, TLI = 0.628, RMSEA = 0.161, and SRMR = 0.190. Due to low and divergent factor loadings, a refined 11-item, four-factor solution was evaluated: functionality/satisfaction, fear-avoidance, psychological aspects, and characteristics of the musculoskeletal problem. This model showed better fit: χ²(37) = 58.190, CFI = 0.971, TLI = 0.957, RMSEA = 0.058, and SRMR = 0.039. Reliability was adequate across all factors (α = 0.773–0.893; CR = 0.779–0.895). Convergent validity was acceptable in most dimensions, although discriminant validity was limited between psychological aspects and characteristics of the musculoskeletal problem. Conclusions: The ÖMSQ-11S showed preliminary evidence of structural validity and internal reliability in Peruvian nurses with musculoskeletal symptoms. However, its use as a predictive tool or universal occupational screening instrument requires further studies with longitudinal designs, more heterogeneous samples, and external clinical or occupational criteria. Full article