Search Results (431)

CareCoach seeks to enhance self-efficacy in family caregivers of people living with dementia and has been feasibility tested in a multicentre randomised controlled trial. The intervention offers two face-to-face sessions with a trained coach and access to an online platform with nine modules. This paper reports findings from an embedded qualitative process evaluation assessing implementation from the implementer’s (‘coach’s’) (n = 8) perspective using individual interviews and implementer group discussions. Qualitative data were transcribed verbatim, inductively coded and analysed using Normalisation Process Theory. Implementers demonstrated (1) ‘Coherence’ by seeking to understand how CareCoach compared to current practice, highlighting the importance of supporting coaches to differentiate and identify boundaries between their new ‘coach role’ and usual practice; (2) ‘Cognitive Participation’ by reviewing training and resources to understand their role own responsibilities and facilitate delivery of coaching sessions; group supervision and peer support were also emphasised; (3) ‘Collective Action’ through interactions with carers to deliver key behavioural aspects such as goal setting, problem solving, and providing feedback; and (4) ‘Reflexive Monitoring’ by appraising the intervention to gain useful insights that could facilitate refinement of CareCoach training and delivery. This study provides a theoretically informed understanding of the implementation of CareCoach for caregivers of people living with dementia and provides recommendations to enhance training for coaches, intervention delivery and carer engagement. Full article

Background/Objectives: Conventional ketogenic diets, although effective for weight loss, often contain high total and saturated fat intake, which leads to increased low-density lipoprotein cholesterol (LDL-C). Thus, the Healthy Ketogenic Diet (HKD) was developed to address these concerns. It emphasizes calorie restriction, limiting net carbohydrate intake to 50 g per day, prioritizing unsaturated fats, and reducing saturated fat intake. However, adherence to the HKD remains a challenge in urban, time-constrained environments. Therefore, this pilot randomized controlled trial aimed to investigate the effects of Healthy Ketogenic Diet Ready-To-Eat (HKD-RTE) meals (provided for the first month only) versus HKD alone on weight loss and metabolic parameters among overweight adults. Methods: Multi-ethnic Asian adults (n = 50) with a body mass index (BMI) ≥ 27.5 kg/m² were randomized into the HKD-RTE group (n = 24) and the HKD group (n = 26). Both groups followed the HKD for six months, with the HKD-RTE group receiving HKD-RTE meals during the first month. Five in-person workshops and mobile health coaching through the Nutritionist Buddy Keto app helped to facilitate dietary adherence. The primary outcome was the change in body weight at 6 months. Linear regression was performed on the change from baseline for each continuous outcome, adjusting for demographics and relevant covariates. Logistic regression was performed on binary weight loss ≥ 5%, adjusting for demographics and relevant covariates. Results: In the HKD group, participants’ adherence to the 50 g net carbohydrate target was 15 days, while that in the HKD-RTE group was 19 days over a period of 30 days. Participants’ adherence to calorie targets was 21 days in the HKD group and 23 days in the HKD-RTE. The average compliance with the HKD-RTE meals provided in the HKD-RTE group was 55%. The HKD-RTE group experienced a greater percentage weight loss at 1 month (−4.8 ± 3.0% vs. −1.8 ± 6.2%), although this was not statistically significant. This trend continued up to 6 months, with the HKD-RTE group showing a greater percentage weight reduction (−8.6 ± 6.8% vs. −3.9 ± 8.6%; p = 0.092). At 6 months, the HKD-RTE group had a greater reduction in total cholesterol (−0.54 ± 0.76 mmol/L vs. −0.05 ± 0.56 mmol/L; p = 0.283) and LDL-C (−0.43 ± 0.67 mmol/L vs. −0.03 ± 0.52 mmol/L; p = 0.374) compared to the HKD group. Additionally, the HKD-RTE group exhibited greater reductions in systolic blood pressure (−8.3 ± 9.7 mmHg vs. −5.3 ± 11.0 mmHg), diastolic blood pressure (−7.7 ± 8.8 mmHg vs. −2.0 ± 7.0 mmHg), and HbA1c (−0.3 ± 0.5% vs. −0.1 ± 0.4%) than the HKD group (not statistically significant for any). Conclusions: Both HKD-RTE and HKD led to weight loss and improved metabolic profiles. The HKD-RTE group tended to show more favorable outcomes. Short-term HKD-RTE meal provision may enhance initial weight loss, with sustained long-term effects. Full article

Background: Despite significant advancements in diabetes care, many individuals with type 2 diabetes (T2D) do not receive optimal care and treatment. Digital interventions promoting behavioral changes have shown promising long-term results in supporting healthier lifestyles but are not implemented in most healthcare offerings, maybe due to lack of general practice support and collaboration. This study evaluates the efficacy of the Digital, Individualized, and Collaborative Treatment of T2D in General Practice Based on Decision Aid (DICTA), a randomized controlled trial integrating a patient-centered smartphone application for lifestyle support in conjunction with a clinical decision support (CDS) tool to assist general practitioners (GPs) in optimizing antidiabetic treatment. Methods: The present randomized controlled trial aims to recruit 400 individuals with T2D from approximately 70 GP clinics (GPCs) in Denmark. The GPCs will be cluster-randomized in a 2:3 ratio to intervention or control groups. The intervention group will receive one year of individualized eHealth lifestyle coaching via a smartphone application, guided by patient-reported outcomes (PROs). Alongside this, the GPCs will have access to the CDS tool to optimize pharmacological decision-making through electronic health records. The control group will receive usual care for one year, followed by the same intervention in the second year. Results: The primary outcome is the one-year change in estimated ten-year cardiovascular risk, assessed by SCORE2-Diabetes calculated from age, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol, age at diabetes diagnosis, HbA1c, and eGFR. Conclusions: If effective, DICTA could offer a scalable, digital-first approach for improving T2D management in primary care by combining patient-centered lifestyle coaching with real-time pharmacological clinical decision support. Full article

Since the start of the energy crisis in 2020, the Dutch government has introduced various programmes aimed at alleviating energy poverty among low-income households. This research examines the effects of three specific interventions—energy coaching, home renovations, and white goods schemes—on a range of energy poverty-related aspects, including living comfort, physical and mental health, energy costs, financial concerns, social connection, neighbourhood involvement, and sustainable behaviour. While previous studies have mostly investigated these interventions in isolation, this research offers a comparative analysis to explore how their impacts differ and how they may complement one another. This research, comparing an intervention group and control, shows that energy coaches, renovations, and white goods schemes each have positive effects on various aspects of energy poverty. However, the nature and magnitude of these effects differ by type of support measure. Renovations are the most effective overall, significantly improving living comfort, physical health, and reducing energy costs. White goods schemes primarily reduce moisture and mould in dwellings and have a notable positive impact on mental health. Energy coaches contribute to improved living comfort, lower energy costs, and uniquely enhance community involvement. The complementary nature of these interventions highlights the potential added value of integrated or combined approaches to tackling energy poverty. Full article

Background/Objectives: Injury prevention programs (IPPs) are evidence-based interventions that reduce musculoskeletal injuries in youth sports. Despite their proven benefits, the adoption of IPPs by coaches remains limited. This study aimed to evaluate the awareness, usage, and perceptions of IPPs among youth sports coaches in Poland and to identify factors associated with their implementation. Methods: A cross-sectional study was conducted using a web-based survey tailored to youth sports coaches in Poland. Coaches of athletes aged 9–17 were recruited through targeted outreach to clubs and professional networks. The survey assessed IPP awareness, implementation, perceptions, and sources of information. Statistical analyses included chi-square tests, non-parametric comparisons, Firth’s logistic regression, and cluster profiling. Results: Only 54.6% of coaches (59 out of 108) were aware of IPPs, and among them, just 47.5% reported using them. No significant associations were found between IPP use and demographic variables such as gender, sport, or place of residence. Coaches who were aware of IPPs were significantly younger than those who were unaware (p = 0.029). The information source was the strongest predictor of IPP implementation: coaches trained via formal courses were over 20 times more likely to use IPPs compared to those learning from peers (OR = 20.4, p < 0.001). While coaches generally perceived IPPs as beneficial for fitness and recovery, 28.6% expressed doubts about their effectiveness in reducing injury risk. Conclusions: Despite broadly positive beliefs, only 47.5% of coaches who were aware of IPPs reported using them. Formal training significantly enhances the likelihood of adoption. These findings emphasize the need for structured educational efforts and improved dissemination strategies to promote evidence-based injury prevention in youth sports settings. Full article

Background: Obesity in adults is a growing health concern. The principal interventions used in obesity management are lifestyle-change interventions such as diet, exercise, and behavioral therapy. Although they are effective, current treatment options have not succeeded in halting the global rise in the prevalence of obesity or achieving sustained long-term weight maintenance at the population level. E-health and m-health are both integral components of digital health that focus on the use of technology to improve healthcare delivery and outcomes. The use of eHealth/mHealth might improve the management of some of these treatments. Several digital health interventions to manage obesity are currently in clinical trials. Objective: The aim of our systematic review is to evaluate whether digital health interventions (e-Health and m-Health) have effects on changes in anthropometric measures, such as weight, BMI, and waist circumference and behaviors such as energy intake, eating behaviors, and physical activity. Methods: A search was conducted for randomized controlled trials (RCTs) conducted through 4 October 2024 through three databases (Medline, Web of Science, and Scopus). Studies were included if they evaluated digital health interventions (e-Health and m-Health) compared to control groups in overweight or obese adults (BMI ≥ 25 kg/m²) and reported anthropometric or lifestyle behavioral outcomes. Study quality was assessed using the Cochrane Risk of Bias Tool (RoB 2). Meta-analyses were performed using random-effects or fixed-effects models as appropriate, with statistical significance set at p < 0.05. Results: Twenty-two RCTs involving diverse populations (obese adults, overweight individuals, postpartum women, patients with eating disorders) were included. Digital interventions included biofeedback devices, smartphone apps, e-coaching systems, web-based interventions, and mixed approaches. Only waist circumference showed a statistically significant reduction (WMD = −1.77 cm; 95% CI: −3.10 to −0.44; p = 0.009). No significant effects were observed for BMI (WMD = −0.43 kg/m²; p = 0.247), body weight (WMD = 0.42 kg; p = 0.341), or lifestyle behaviors, including physical activity (SMD = −0.01; p = 0.939) and eating behavior (SMD = −0.13; p = 0.341). Body-fat percentage showed a borderline-significant trend toward reduction (WMD = −0.79%; p = 0.068). High heterogeneity was observed across most outcomes (I² > 80%), indicating substantial variability between studies. Quality assessment revealed predominant judgments of “Some Concerns” and “High Risk” across the evaluated domains. Conclusions: Digital health interventions produce modest but significant benefits on waist circumference in overweight and obese adults, without significant effects on other anthropometric or behavioral parameters. The high heterogeneity observed underscores the need for more personalized approaches and future research focused on identifying the most effective components of digital interventions. Digital health interventions should be positioned as valuable adjuncts to, rather than replacements for, established obesity treatments. Their integration within comprehensive care models may enhance traditional interventions through continuous monitoring, real-time feedback, and improved accessibility, but interventions with proven efficacy such as behavioral counseling and clinical oversight should be maintained. Full article

Elite female tennis players are among those at high risk for developing the Female Athlete Triad (Triad), characterized by three interrelated conditions: energy deficiency/low energy availability, menstrual dysfunction, and low bone mineral density. From 1996 to 2022, the Women’s Tennis Association (WTA) developed and implemented prevention, education, and management plans for female athletes at risk for, or exhibiting symptoms of, the Triad. This article reviews the WTA Triad protocol, developed in 2018 and utilized through 2022, in collaboration with subject matter experts in the Women’s Health and Exercise Laboratory at The Pennsylvania State University. The WTA Triad protocol (1996–2022) includes prevention and management programs implemented by a multidisciplinary Performance Health Team to include screening for “red flags” during annual physicals or upon clinical presentation of a menstrual problem, bone disorder, or nutritional concern; targeted education for players, coaches, and other support team members with handouts and lectures on nutrition and body image to prevent energy deficiency; and a multidisciplinary protocol to guide treatment and return-to-play decisions. Other sport governing bodies can adopt similar multi-layered programs and practices for their athletes, coaches, and support teams to educate, screen, manage, and help to prevent the development of the Triad. Full article

Sedentary behavior at work is a major, and growing, public health concern. This field experiment investigates the effectiveness of behavioral nudges, specifically default settings on height-adjustable workstations (HAWS), in promoting stand-up working behavior. It also examines whether transparency and health coaching enhance these effects. The study was conducted in a Belgian governmental organization and included 149 employees across eight departments. Departments were randomly assigned to one of four conditions: a non-transparent default nudge (NTDN), a transparent default nudge (TDN), a classical health coaching intervention, or a hybrid intervention combining TDN and coaching. Over an eight-week intervention period, employee posture was recorded using fixed camera snapshots taken every 30 min. These data were used to calculate the stand-up ratio. The NTDN increased stand-up rates from 1.82% to 4.93%. The TDN more than doubled this effect, reaching 11.25%. The combination of TDN and coaching produced the highest increase, with stand-up rates rising to 18.80% (d = 9.85). Coaching alone showed no significant effect. Although behavior partially regressed after the interventions were removed, post-measurement stand-up ratios after a week remained higher than baseline. These findings suggest that transparent default nudges, especially when combined with low-threshold coaching, can meaningfully reduce sedentary behavior in everyday office environments. Full article

Background: Fundamental movement skills (FMS)—including muscular strength, endurance, and mobility—are linked to better health-related quality of life and higher physical activity in children. Rural children often score lower on FMS tests than urban peers due to resource limitations rather than ability. Thus, increasing access to FMS activities in under-resourced rural areas is essential. The primary objective was to test the feasibility of Hoosier Strength in a rural middle school sample, and the secondary objective was to observe the preliminary changes in FMS-related outcomes pre- to post-intervention and at follow-up. The exploratory objective was to explore how participants responded to different coaches on the Hoosier Strength coaching team (i.e., gender, coaching style during activities). Methods: This study used a Hybrid Type 3 design to evaluate feasibility and FMS outcomes, integrating qualitative and quantitative data. The four-week intervention included a test group (n = 24; 14 females, 10 males; mean age: females 12.4 ± 0.5 years, males 12.7 ± 0.4 years) and a control group (n = 12; 8 females, 4 males; mean age: females 12.9 ± 0.3 years, males 12.7 ± 0.3 years). Data analysis included descriptive statistics for feasibility indicators (Acceptability of Intervention Measures [AIM], Intervention Appropriateness Measure [IAM], and Feasibility of Intervention Measure [FIM]), linear regression for mobility and muscular endurance changes, t-tests for psychological need satisfaction and frustration, and regression analysis for squat knowledge and post-intervention confidence. Results: (1) There was high feasibility across the 4-week Hoosier Strength intervention and at follow-up; (2) there were no statistically significant changes in squat performance; (3) participants’ confidence in their ability to squat at the end of the intervention was significantly predicted by their squat knowledge at baseline; and (4) participants prioritized leadership and team management over tactical analysis, highlighting a preference for coaches who foster teamwork. Conclusions: The findings offer a transparent approach for evaluating the feasibility and preliminary outcomes of the Hoosier Strength intervention in an under-resourced rural middle school, thereby encouraging further investigation into strength training interventions in rural schools. Full article

Objective: Protein supplements (PSs) are widely consumed by professional and non-professional athletes, yet research on non-athletic PS users’ perceptions, motivations, and health risk awareness is limited. This study aimed to investigate non-professional athletes’ PS patterns of use, motivations, and safety. Methods: A cross-sectional study was conducted using a constructed questionnaire reporting on PS usage trends, exercise habits, and demographic factors. Adult respondents were recruited from gyms, athletic organizations, amusement parks, and playing fields. Results: We received 1100 responses, and 327 were PS users. From the total of PS users, there was a prevalence of PS use in males [(203 (62%)]; adults in the age group of 25–34 [136 (42%)], p < 0.001; and participants with a normal BMI (189, 58%), p < 0.001. Following high-intensity fitness exercise sessions and engagement with more than two types of physical activity were associated with more than doubled odds of PS consumption (p < 0.001). The main reasons for PS intake were for muscle mass increase (35%) and recovery (18%), and protein powder was the most popular PS (279; 64%). The main channels of information for PS use were Web/social media (50, 40%) and coaches (54, 43.2%), while one out of two [35 (49%); p = 0.008] of those engaged in more than two types of physical exercise declared that PSs are good for health. Conclusion: The findings highlight demographic, behavioral, and informational factors shaping PS consumption in non-professional athletes. Despite the perceived benefits, reliance on non-expert sources and unregulated products raises concerns about consumer awareness and safety, while educational initiatives to promote evidence-based supplementation practices are deemed crucial. Full article

(1) Background: Adolescent health and well-being are associated with sports and physical education activities. Novel therapies for athletics training, sporting formations, and physical culture are important. In areas where sports facilities are scarce and not cost-effective, they can lead to poorer physical and mental well-being in adolescents. Emotions related to sports, somatic anxiety, worry, and concentration disruption aligned with task and ego orientation have been under-researched in Pakistan. (2) Methods: A sample of 830 adolescents between the ages of 14 and 19 years were recruited from Pakistan’s sports training center through purposive sampling. Sport-specific emotions, anxiety, task and ego orientation, and coaching athlete purpose (CAP) were measured. (3) Results: Regression analysis showed that different dimensions of sports anxiety (somatic trait anxiety, worry, and concentration disruption) have a significant effect on the task and ego orientation of sports education students. The Hayes process macro analysis shows that CAP significantly mediates between sports emotions and orientation. (4) Conclusions: It is important to introduce Rational Emotive Behavior Coaching and integrate ontological health and well-being for coaching in the sports field. Full article

Hands-on continuous glucose monitoring (CGM) training is yet to be integrated intentionally into most pharmacy curricula. The objective of this study was to examine pharmacy students’ perceptions of receiving hands-on CGM training as part of their core therapeutics in diabetes. Anonymous, voluntary pre-post surveys were administered to two cohorts of 3rd-year pharmacy students from a public pharmacy school in Southern California. Pharmacy students from other class levels were excluded. The surveys, consisting of Likert scale and open-ended questions related to different aspects of CGM, were administered via a web-based learning management system. Descriptive analyses were utilized to summarize the data. In total, 84 (98%) and 79 (92%) students completed the pre- and post-activity surveys, respectively, with an average of 12.5 days of CGM wear. After receiving the CGM training, 94% of the students recommended the integration of hands-on CGM training into the PharmD curriculum. In addition, the number of students who felt confident coaching patients on CGM use more than doubled from 30% to 85%, with 73% reporting added benefits of improved personal health behaviors. In conclusion, pharmacy students’ perceptions of integrating hands-on CGM education as part of their core curriculum were largely positive with added benefits of self-care. Full article

As the US population ages, the number of prescriptions managed by patients and healthcare teams is increasing. Thus, discontinuing or reducing medications that are considered to pose more risks than benefits can be achieved through deprescribing. Despite increasing calls for a stronger focus on deprescribing in healthcare education, current discussions highlight the lack of training on this topic within healthcare curricula. This is a significant barrier to effectively implementing the deprescribing process. This study aimed to characterize healthcare professional students (HPSs)’s perspectives on deprescribing within an interprofessional healthcare team, particularly regarding the motivations and roles of these future practitioners. Methods: Focus groups were conducted with HPSs at the University of Tennessee Health Science Center. The data collection, guided by a conceptual model, took place over three months in 2022. Data analysis was performed using thematic analysis, during which themes were identified through inductive coding. Results: Participants (n = 36) represented various faculties, including medicine, pharmacy, health professions, nursing, and dentistry. Two themes emerged: (1) Healthcare Team Members’ Roles and Responsibilities (2) “Put Me in, Coach”: Patient Safety Motivates Deprescribing. Conclusion: Data from HPSs highlighted the importance of an interprofessional healthcare team approach to deprescribing. Based on these insights, educators and practitioners should focus on establishing strong interprofessional healthcare teams that privilege open communication. Teams should consider deprescribing as a patient safety concern, as this may galvanize the team and provide additional motivation for performing the necessary work of deprescribing. Full article

In the United States, at least one in three adults has prediabetes, a condition categorized by blood glucose levels higher than normal but not high enough to be classified as type 2 diabetes. The Centers for Disease Control and Prevention (CDC) recommends a modest weight loss of 5–7%, a reduction in A1C by 0.2%, and at least 150 min of physical activity per week to prevent or delay the onset of type 2 diabetes in individuals with prediabetes. Eat Smart, Move More, Prevent Diabetes (ESMMPD) is a CDC-recognized lifestyle-change program for individuals with prediabetes or at high risk of developing type 2 diabetes. ESMMPD consists of 26 lessons delivered over the course of a year by trained Lifestyle Coaches using Zoom^TM. Participants are taught strategies to implement health-promoting behaviors related to healthy eating, physical activity, and mindfulness into their daily lives. The core components of the program are planning, tracking, and living mindfully. The aim of this article is to provide insights into the development, delivery, and core components of the ESMMPD program for public health practitioners. Full article

The mental health struggles of university students have been the focus of a substantial amount of research worldwide. To tackle this, universities have developed initiatives to promote student wellbeing. Here, we highlight Time to Thrive (TTT), a co-designed online programme based on positive and coaching psychology and neuroscience literacy to support undergraduate students to thrive at university. This study examines the effectiveness of TTT on undergraduate student wellbeing and explores students’ subjective experiences as participants in TTT. A mixed-methods randomised controlled trial was conducted with an intervention group (n = 18) and a later access control group (n = 26) to verify the impact of TTT on psychological wellbeing, mental wellbeing, and resilience. Participants completed the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), the Flourishing Scale (FS), and the Brief Resilience Scale (BRS) pre-post intervention. Following programme completion, intervention group participants were interviewed about their experience with TTT (n = 5), and their reflections were analysed using Interpretative Phenomenological Analysis (IPA). Participation in TTT significantly improved psychological wellbeing in the intervention group, controlling for pre-TTT scores. Three themes were developed through IPA: the differing functions of TTT, the personal impact of TTT, and placing students who need it the most at the heart of TTT. These findings suggest that university-delivered initiatives can effectively foster undergraduates‘ wellbeing. Embedding TTT and relevant programmes within the curriculum may facilitate engagement and impact. Moreover, evidence sustaining their effectiveness may inform policy for broader application in higher education. Full article