Search Results (759)

Background: Spiritual wellbeing is increasingly recognised as a key area of complex oncology and palliative care, but evidence from Eastern Europe is still limited. Understanding how spiritual well-being and religiosity are related to psychological distress and quality of life can inform holistic support interventions in cancer patients. Objective: To describe spiritual well-being, religiosity, anxiety, depression, and quality of life in a Romanian cancer cohort, and to examine associations between spiritual well-being and psychological distress. Methods: A cross-sectional study was carried out in 124 cancer-stricken adults at a regional cancer centre in Romania. Participants completed FACIT-Sp-12 (spiritual well-being), RCI-10 (religious belief), HADS (depression), and EQT QLQ-C30 (QoL). Multivariable linear regression was used to determine independent predictors of outcomes in patients. Results: Participants had a median age of 65 years (53–71) and 70 (56%) patients had metastatic disease. Religious involvement was high and spirituality related to disease was commonly reinforced, with 66 (53%). There were twice as many cases of clinical depression symptoms (28%) as anxiety symptoms (14%). A median QoL score of 51 (IQR: 37–64 points) was revealed by descriptive analysis of the EORTC QLQ-C30. In adjusted multivariable models, spiritual well-being was significantly and independently associated with lower anxiety (β = −0.25, p = 0.030) and depression (β = −0.29, p = 0.013), with models accounting for 11.5% and 10.8% of variance, respectively. Global quality of life was best explained by the model (R² = 26.4%), with independent contributions from impaired ECOG performance status (β = −0.27, p = 0.006) and depressive symptoms (β = −0.22, p = 0.014), whereas religious commitment showed no independent association with any primary outcome. Conclusions: In this Romanian cohort, spiritual well-being, not religious adherence, remained independently associated with lower anxiety and depression, suggesting that spiritual well-being is associated with better psychological health among cancer patients. Religious affiliation has not been shown to be independent of any outcome, a difference with direct implications for the screening of spiritual care. Global quality of life, on the other hand, was independently associated with both physical functional status (ECOG) and depressive symptom burden, rather than with spiritual or religious factors, underlining that both functional decline and psychological distress remain central to cancer-related quality of life. Full article

Background: Black communities in England experience health inequalities rooted in structural racism, socioeconomic deprivation, and systemic exclusion from health systems that fail to address their specific needs. Digital health technologies offer potential for reducing these disparities, yet the existing evidence reveals an absence of culturally appropriate digital interventions designed with and for Black communities in England. Objective: To synthesise evidence on the structural and cultural determinants of health inequality affecting Black people in England and examine the potential of health apps for delivering culturally appropriate health promotion. Methods: This is a purposive, critical narrative literature review, not a systematic review; it does not aim for exhaustive or fully reproducible search coverage but for a structured, purposive synthesis of the evidence base relevant to four thematic domains. Purposive sampling was used to identify literature across the PubMed/MEDLINE, PsycINFO, Google Scholar, and policy databases. Findings were thematically synthesised around four domains: structural determinants of health inequality; cultural diversity and representation within Black communities; digital inclusion and health app access; and theoretical frameworks for culturally appropriate intervention design. Findings: Three intertwined problems underpin the absence of culturally appropriate digital health tools for Black communities: structural exclusion from health systems; methodological shortcomings of aggregating heterogeneous populations under broad ethnic labels such as BAME; and the systematic exclusion of Black people from digital health design processes. We propose a multi-layered theoretical framework combining the Health Belief Model, Beattie’s community development paradigm, and McCurdie’s user-centred design principles to guide the co-design of a culturally appropriate health promotion app. Conclusions: A culturally appropriate health promotion app for Black communities in England appears to be a promising and potentially feasible direction, provided it is developed through authentic community partnership and grounded in theories that account for structural determinants of health; this conclusion is conceptual, and no user research, prototype testing, or feasibility study has yet been undertaken to confirm it. These are identified as necessary next steps rather than results already achieved. Full article

The integration of complementary sensing modalities provides a basis for accurate crack identification in advanced aircraft structures. In this context, PZT transducers are sensitive to incipient damage through guided-wave interrogation, whereas strain gauges capture quasi-static deformation. Prevailing fusion paradigms, however, encounter an interpretability–adaptability dilemma. Model-based approaches lack robustness to sensor degradation, while data-driven attention methods sacrifice transparency. To resolve this trade-off, an Evidence-guided Attention Neural Network (EANN) is proposed. Its central methodological contribution lies in repositioning Dempster–Shafer (D-S) evidence theory from a terminal fusion operator to an upstream credibility feature extraction module. Evidence-derived credibility features, comprising belief entropy, inter-source similarity, and Kalman-filtered residuals, drive the attention weight optimization and endow the learned channel weights with physically interpretable evidential meaning. Ablation experiments confirm that the observed improvement arises from the interaction between the evidence-guided credibility representation and adaptive attention weighting, with neither component sufficient on its own. The framework fuses quasi-static strain measurements with active piezoelectric guided-wave interrogation, which offers high sensitivity to incipient damage but remains vulnerable to channel degradation. Experiments on aluminum tensile plates and trapezoidal wing skin specimens show that EANN maintains identification accuracy under simulated sensor anomalies and partial failures by attenuating compromised channels without explicit fault detection, providing an uncertainty-aware fusion framework for online structural health monitoring of aerospace structures. Full article

Background/Objectives: This study examines the continued use of smart healthcare applications among older adults by integrating the Health Belief Model (HBM) with the Unified Theory of Acceptance and Use of Technology (UTAUT). Perceived health threat and health management self-efficacy were considered health-related antecedents, while technology anxiety was examined as a moderator. Methods: Data were collected from 224 South Korean adults aged 60 years or older with prior experience using smart healthcare applications. Confirmatory factor analysis and structural equation modeling were used to assess the measurement and structural models. Indirect effects were tested using 5000 bootstrap resamples, and moderation was examined through hierarchical regression and simple slope analysis. Results: Perceived health threat was positively associated with performance expectancy but not with effort expectancy. Health management self-efficacy was positively associated with both performance and effort expectancy. Performance expectancy, effort expectancy, social influence, and facilitating conditions were all positively associated with behavioral intention, which showed the strongest relationship with actual use behavior. Technology anxiety significantly weakened the relationship between social influence and behavioral intention, whereas its moderating effects on performance expectancy and effort expectancy were not significant. Conclusions: The findings provide an integrated explanation of continued smart healthcare application use among older adults by linking health-related beliefs, UTAUT factors, and technology anxiety. Sustained use may be promoted by strengthening self-efficacy, improving usability, and reducing technology-related anxiety through accessible design and appropriate support. Full article

Introduction: As seasonal influenza vaccination coverage among healthcare workers (HCWs) in Serbia remains suboptimal, we aimed to identify HCW beliefs associated with their intention to receive seasonal influenza vaccine (“vaccination intention”) in the season 2024/2025. Methods: In a cross-sectional survey conducted in 2024, healthcare institutions were selected from a national registry, using multi-stage sampling stratified by geographical region and healthcare level. All consenting HCWs present on the survey day self-completed questionnaires. Five dichotomised Health Belief Model constructs were assessed: perceived susceptibility to influenza, perceived disease severity, perceived vaccination benefits, perceived physical and psychological barriers, and perceived cues for action (recommendation by another HCW, someone close, or a supervisor). The association of vaccination intention (yes/no/undecided) with Health Belief Model constructs, demographic and occupational factors were assessed using multinomial logistic regression. Results: Of 1919 respondents, 30% declared positive vaccination intention, 52.5% no intention, and 17.5% were undecided. Compared with no intention, positive vaccination intention was associated with perceived self-benefit (aOR = 6.22, CI = 3.49–11.08), perceived patient benefit (aOR = 2.26, CI = 1.48–3.45), perceived susceptibility (aOR = 3.26, CI = 2.19–4.86), and perceived vaccine safety (aOR = 2.95, CI = 1.93–4.50). Participants were more likely to be undecided than reject vaccination if they experienced higher perceived susceptibility (aOR = 2.93, CI = 1.89–4.54), perceived influenza as severe (aOR = 2.04, CI = 1.30–3.21), perceived patient benefits (aOR = 1.77, CI = 1.14–2.74), or recalled receiving a recommendation from another HCW (aOR = 2.63, CI = 1.17–5.85). Conclusions: HCWs’ positive vaccination intention was associated with beliefs relevant for personal health and patient benefits. The undecided group showed a distinct pattern of beliefs warranting their separate analysis and specific approaches. Full article

Background: Medication non-adherence remains a major challenge in psychiatric care, yet its prediction often relies on clinical and sociodemographic characteristics, while giving comparatively limited attention to modifiable psychological–cognitive factors. Integrating mental health literacy and medication-related beliefs with explainable machine learning approaches may provide a more informative framework for understanding and predicting adherence. Objective: This study examined the association of mental health literacy and medication-related beliefs with psychotropic medication adherence and evaluated their explanatory and predictive values using conventional statistical modeling, machine learning, explainable artificial intelligence, and structural path analysis. Methods: A cross-sectional study was conducted with 225 psychiatric patients. Medication adherence; mental health literacy; and beliefs about medication necessity, concerns, harm, and overuse were assessed using self-report measures, including a MARS-derived eight-item adherence measure. Associations were examined using Spearman correlations, hierarchical regression with robust inference, and a secondary observed-variable path representation of multivariable associations with 5000 bootstrap resamples. The Elastic Net, Random Forest, and Gradient Boosting models were evaluated using repeated five-fold cross-validation. Shapley Additive exPlanations (SHAP) were used to interpret the best-performing model. Results: Greater adherence was associated with higher mental health literacy (ρ = 0.361) and stronger necessity beliefs (ρ = 0.353), whereas concern (ρ = −0.474), perceived harm (ρ = −0.528), and overuse beliefs (ρ = −0.284) were negatively associated with adherence (all p < 0.001). The psychological–cognitive model explained 40.0% of the variance in the primary eight-item adherence composite. The integrated Random Forest achieved the best out-of-sample performance (R² = 0.402, MAE = 0.958, RMSE = 1.299; n = 208), although the improvement over the psychological–cognitive Random Forest (R² = 0.375) was modest. SHAP identified perceived harm and medication concerns as leading predictors. Conclusions: Medication adherence in psychiatric patients was more strongly characterized by psycho-cognitive factors than by sociodemographic and clinical characteristics alone. Mental health literacy, necessity beliefs, medication concerns, and perceived harm may represent particularly informative targets for individualized adherence assessments and future intervention development. Prospective external validation is required before clinical implementation. Full article

Background/Objectives: Celiac disease (CD) is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals with higher prevalence among first-degree relatives. Despite its hereditary risk, little is known about how parents with at least one child with CD perceive this risk in unaffected children. This study examined parental perceptions and dietary practices regarding CD prevention in unaffected children. Methods: A cross-sectional mixed-methods study was conducted in Greek parents using an online questionnaire for the quantitative component and semi-structured interviews for the qualitative. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression analysis, while qualitative data were analyzed using framework analysis. Results: Although parents demonstrated high awareness of genetic risk, this was not translated into preventive dietary modifications. Belief in the role of diet as a preventive CD strategy emerged as the only significant predictor of dietary change. Diet was widely recognized as important for overall health or as a therapeutic regimen for children living with CD; however, it was not perceived as a preventive strategy for CD. Reported family barriers to adopting a healthy diet included financial constraints and limited guidance, whereas advice from healthcare professionals emerged as a key facilitator of dietary change. Conclusions: Although parents recognize the genetic risk of CD, they rarely implement dietary changes as CD preventive behavior for their unaffected children. These findings highlight the potential value of clearer dietary guidance and targeted professional support for families with children with CD and unaffected siblings. Full article

Background: Non-communicable disease (NCD) emergencies, including hypoglycaemia, stroke, acute coronary syndrome, and hypertensive crisis, call for prompt action by households and communities. The psychosocial mechanisms associated with emergency management behavior in rural Thailand, however, are not well understood. Objectives: The study pursued three objectives. It described levels of NCD emergency management behavior and the characteristics of emergency events reported during the preceding six months. It examined associations linking knowledge, Health Belief Model (HBM) constructs, social support, participation, self-efficacy, and emergency management behavior. Then, it identified the constructs with the strongest relations to behavior, along with an indirect pathway operating through self-efficacy, via structural equation modelling. Methods: A cross-sectional study analyzed data from 1321 community adults in Sisaket Province, Thailand, drawn from an initial 1407 records after excluding 86 with age below 21 years, incomplete data on SEM variables, or invalid disease-status coding. A structured, interviewer-administered questionnaire measured knowledge of NCD emergencies, HBM constructs, social support, family and community participation, self-efficacy, and emergency management behavior. Covariance-based SEM with item parcels and maximum-likelihood estimation was conducted; knowledge was treated as an observed variable. Results: Mean age was 58.0 years (SD = 14.3); 15.5% reported a recent emergency event. Knowledge was moderate-to-low (mean = 5.79/10; KR-20 = 0.440). Model fit was acceptable (CFI = 0.980; RMSEA = 0.047; SRMR = 0.049). Discriminant validity was supported by the Fornell–Larcker criterion for all constructs. Participation was strongly associated with self-efficacy (β = 0.858) and with emergency management behavior (β = 0.433); self-efficacy was also associated with emergency management behavior (β = 0.354). Participation had the largest total effect on behavior (0.737), combining a direct effect (0.433) and an indirect, self-efficacy-related effect (0.304). All structural-path variance inflation factors (VIF) were below 5.0 except participation behavior (VIF = 6.19), which remained below the more permissive threshold of 10.0. Conclusions: NCD emergency management behavior in this rural community was most strongly associated with family and community participation and with self-efficacy. Because the design was cross-sectional, these findings indicate association rather than confirmed causal or mediating pathways. Programmes should combine scenario-based knowledge with participatory practice, family role preparation, rehearsal of emergency-service (1669) activation, and confidence-building activities. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly embedded in menstrual and reproductive health applications, yet little is known about how women in conservative, rapidly digitizing regions evaluate AI-enabled menstrual tracking tools. This study investigates how perceived cultural fit and data privacy concerns are associated with women’s openness to AI-enabled menstrual tracking in Gulf Cooperation Council (GCC) countries. Methods: We conducted an online cross-sectional survey using a convenience sample of adult women residing in GCC countries (n = 273), measuring openness to AI menstrual tools, perceptions of cultural fit (e.g., respect for religious and cultural norms, endorsement by trusted institutions, Arabic language, GCC-specific design), privacy concerns (e.g., worries about who can access menstrual health data), and key sociodemographic characteristics and smartphone use. Results: Higher perceived cultural-contextual fit was strongly and positively associated with openness to AI-enabled menstrual tracking, whereas composite privacy concerns showed no statistically significant association once cultural fit and sociodemographic factors were controlled. Item-level analyses indicated that beliefs about cultural sensitivity and GCC-specific design were the most robust predictors of openness, while concerns about data access, authority endorsement, and language accessibility played a limited role. Homemakers reported higher openness than employed women. Conclusions: Overall, the findings suggest that, in this sample and model, GCC women’s openness to AI-enabled menstrual tracking was more strongly associated with perceived cultural alignment and local design than with the measured privacy-concern construct, highlighting the importance of culturally grounded, trust-building design and communication strategies for AI-based women’s health applications. Full article

Background: Malaria is a significant public health challenge in the Democratic Republic of the Congo. In conflict-affected areas, access to quality-assured ACTs is restricted by chronic stockouts and circulation of substandard and falsified antimalarials. This study investigates perceptions and social acceptability of Artemisia annua herbal tea in the Kalima Health Zone. Methods: Distinct from the prior provider-arm cross-sectional survey of the same program in the Kalima Health Zone which sampled only biomedical healthcare workers (n = 337), this exploratory qualitative study adopted a socio-anthropological design across three stakeholder strata (community users, biomedical providers, opinion leaders). Maximum-variation purposive sampling recruited 30 informants across five health areas (11 end-users, 11 providers, 8 opinion leaders). Sample-size adequacy was assessed against Malterud’s information power framework; data collection continued until operational thematic saturation. Hybrid inductive–deductive thematic content analysis followed COREQ reporting. Results: End-users demonstrated high willingness, driven by accessibility, perceived three-day recovery, and avoidance of unreliable ACTs. Biomedical providers voiced intense posological anxieties over uncalibrated raw biomass and sub-therapeutic dosing. Behavioral patterns were shaped by socio-religious norms and digitally mediated religious discourse. A unanimous demand for industrial galenic transformation of raw biomass into calibrated tablets emerged across all groups. Conclusions: This study does not validate the clinical efficacy, safety, posological adequacy, or resistance-attenuation potential of Artemisia annua herbal tea. It documents a transversal household-level consensus, across the three strata and five health areas, that Artemisia annua herbal tea adoption responds to documented double ACT supply chain failure. A unanimous demand for industrial galenic transformation emerged across all stakeholder groups. Full article

Individuals with lower-limb mobility impairment often experience fear of falling and difficulty coordinating with caregivers during transfer tasks. Therefore, safe, stable, and easy-to-operate collaborative transfer assistive equipment is urgently needed. This study proposes a Health Belief Model-driven design method for transfer assistive equipment, aiming to translate users’ risk perceptions and behavioral needs into implementable structural design strategies. First, transfer-related behavioral characteristics were analyzed according to the six constructs of the Health Belief Model. Second, the KJ method was used to classify original user requirements and establish a hierarchical requirement model, while the Fuzzy Analytic Hierarchy Process was applied to calculate requirement weights. Third, Quality Function Deployment and the House of Quality were used to transform user requirements into technical characteristics, through which four key technical contradictions were identified: anti-tipping stability versus lightweight design, status feedback versus process simplification, assistance and effort reduction versus lightweight design, and support-bearing capacity versus human–machine adaptability. Finally, structural optimization strategies were generated using TRIZ, and the proposed concept was preliminarily assessed through JACK digital human simulation and multi-stakeholder assessment at the conceptual design stage. The multi-stakeholder assessment further indicated that the proposed concept responded to requirements related to fall risk mitigation, injury protection, and perceived benefits, while adaptability for small-sized users, distal lower-limb support, and status-feedback mechanisms require further optimization. This study provides a traceable design process for incorporating users’ psychological and behavioral factors into structural innovation for assistive devices, thereby offering a methodological reference for the design of transfer assistive equipment. Full article

Extra virgin olive oil (EVOO) is a key component of the Mediterranean diet and a functional food whose health properties are mainly attributed to phenolic compounds. Despite the availability of EFSA-approved health claims, consumers often rely on heuristic cues that may not correspond to scientifically recognized quality indicators. A cross-sectional online survey involving 516 Italian consumers was conducted to investigate consumption patterns, health-related beliefs, territorial identity, and sensory quality perception. Descriptive analyses, regional comparisons, and a multivariable logistic regression model predicting sensory misperception were performed. Most respondents reported frequent EVOO consumption and willingness to pay a premium for certified products. Territorial identity, trust in local producers, and origin-related cues emerged as important dimensions of quality perception. Although respondents generally recognized the health relevance of antioxidants and unsaturated fatty acids, misconceptions regarding sensory indicators were common. Specifically, 41% of respondents associated sweetness with EVOO quality, whereas bitterness and pungency were less frequently recognized. Greater perceived knowledge of EVOO health properties was associated with a lower likelihood of identifying sweetness as an indicator of EVOO quality. Overall, consumer evaluation of EVOO reflected the interaction of informational, symbolic, and experiential dimensions, highlighting the potential relevance of communication strategies and sensory education initiatives whose effectiveness should be evaluated in future research. Full article

Background: Mobile health interventions offer a potential solution to adherence challenges, yet evidence regarding their collective efficacy in schizophrenia spectrum disorders has not been formally synthesized. This systematic review evaluates the impact of mobile health (mHealth) interventions on medication adherence as a primary outcome and on daily functioning and psychotic symptoms as secondary outcomes in individuals with schizophrenia spectrum disorders. Methods: Using the Population, Intervention, Comparison, Outcome (PICO) framework, a systematic search was conducted across multiple databases to identify relevant randomized controlled trials (RCTs) evaluating mHealth strategies for medication adherence in adults with schizophrenia spectrum disorders. The PubMed, CINAHL, PsycINFO, EMBASE, and JBI databases were searched from inception until 24 February 2026, using combinations of search terms such as “Schizo” OR “Psychos” AND “mHealth” OR “Digital Health” AND “Medication Adherence”. Data extraction was conducted using a standardized data extraction table and narratively synthesized. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, ensuring structured and comprehensive reporting of the findings. Results: Fourteen randomized controlled trials (RCTs) with 1717 participants were included in this review. Four studies evaluated text messaging interventions, four employed phone call interventions, three used electronic medication monitoring systems, and three used mobile applications. Nine of the fourteen studies reported statistically significant improvements in medication adherence. For secondary outcomes, the results were highly inconsistent: only three studies demonstrated significant reductions in psychotic symptoms, and none showed benefits for daily functioning. While various theoretical frameworks, such as the Health Belief Model and Cognitive Behavioral Therapy and intervention modalities, were utilized, the overall evidence was limited by high clinical heterogeneity and a lack of robust long-term data. Conclusions: mHealth interventions, particularly text messaging and mobile applications, demonstrate clear potential to improve medication adherence in individuals with schizophrenia spectrum disorders. Given the high heterogeneity and lack of long-term evidence, future research should prioritize standardized outcome measurements, rigorous designs, and extended follow-up periods to confirm clinical utility. Full article

Background: Given the rising global prevalence of dementia and its complex etiology, involving genetic and environmental risk factors, the aim of the present exploratory study was to investigate how offspring of individuals with dementia perceive genetic risk and the role of diet in dementia prevention. Methods: A mixed-methods study was conducted in Greece. Overall, 118 offspring completed an online questionnaire assessing demographics, risk perceptions, and dietary beliefs and practices in dementia risk reduction. Additionally, 22 semi-structured interviews explored dietary beliefs, practices, and influencing factors using framework analysis. Results: Most participants (76.3%) recognized diet’s role in dementia prevention, while 52.5% perceived offspring as having increased genetic risk; 40.7% reported making dietary changes to reduce disease risk. Healthcare professional consultation was the factor most strongly associated with dietary modification (OR = 26.61, 95% CI 7.47–94.76, p < 0.001). Qualitative findings showed that, while dementia was viewed as severe, personal susceptibility was often perceived as uncertain or distant. Key barriers, facilitators, and the role of self-efficacy in adopting healthier dietary practices were also explored. Conclusions: Our findings identify personalized dietary counselling and risk communication as priorities for evaluation in future intervention studies, aimed at supporting the implementation of dietary modifications and reducing the gap between knowledge and behavior in dementia risk reduction. Full article

In higher education, there is growing recognition that mental health support should be responsive to students’ lived experiences, educational contexts, and disciplinary norms. For instance, engineering students report high levels of distress and underutilize professional mental health services when compared to students in other disciplines, reflecting a culture that normalizes excessive workload, self-reliance, and academic rigor. Therefore, this case study examined the impact of a 15-min contextualized, classroom-based mental health presentation tailored to undergraduate engineering students at a large Southeastern U.S. university. Grounded in the Integrated Behavioral Model of Mental Health Help-Seeking, the presentation integrated findings from the literature on engineering culture and its influence on student well-being. Across two years, the presentation was delivered to nearly 4500 engineering students, reaching an average of 82% of enrolled engineering students. The study evaluated this impact by comparing presentation and non-presentation groups among students who completed surveys in Spring 2023 (n = 431) and Spring 2024 (n = 132). The presentation group showed significant improvements in perceived and objective knowledge of mental health and help-seeking resources, whereas help-seeking beliefs, mechanisms, and intention did not significantly change, likely due to the deeply culturally ingrained nature of these constructs. These findings underscore the value of contextualized approaches to mental health promotion and provide support for scalable, classroom-embedded presentations and other interventions within engineering education and higher education more broadly. Full article