Search Results (2,477)

Background/Objectives: Home-based telemedicine requires patients to perform technical tasks independently, whereas assisted public health center (PHC)-based telemedicine transfers some of these tasks to on-site personnel. This study describes model-specific perceptions and estimates the difference in intention to use between the two scenarios among relatively digitally capable, community-dwelling older adults. Methods: A cross-sectional, fixed-order, scenario-based online survey was completed by 300 adults aged 65 years or older in South Korea. Home-based barriers and PHC-based facilitators were analyzed as non-equivalent descriptive domains. The primary paired comparison used three conceptually matched intention items. Internal consistency, exploratory factor evidence, 95% confidence intervals (CIs), Pearson and Spearman correlations, and multivariable linear regressions with HC3 robust standard errors were reported. Results: The seven-item home-based barrier score was 2.80 (SD 0.76; 95% CI 2.71–2.89), and the seven-item PHC facilitator score was 3.58 (SD 0.58; 95% CI 3.52–3.65). Intention scores were 3.91 (SD 0.64) for home-based and 3.88 (SD 0.66) for PHC-based telemedicine. The paired mean difference (PHC minus home) was −0.030 (95% CI −0.107 to 0.047; p = 0.441; Cohen’s dz = −0.045, bootstrap 95% CI −0.155 to 0.071). Preferences were home-based 42.7% (95% CI 37.2–48.3%), PHC-based 41.3% (95% CI 35.9–47.0%), and unsure 16.0% (95% CI 12.3–20.6%). After adjustment, digital literacy remained positively associated with both intention outcomes. Conclusions: No statistically detectable difference in intention to use was observed between the two hypothetical scenarios; this finding does not establish equivalence. The item-level results generate a hypothesis that staff-supported PHC delivery may be useful for some older adults, but actual uptake, effectiveness, accessibility, and equity require evaluation in real-world studies that include less digitally capable and more vulnerable populations. Full article

Background: Diabetes mellitus is a major public health concern in Saudi Arabia, affecting approximately 18.3% of adults. Although over 95% of people in the Qassim region own smartphones, limited information exists regarding how and why patients with diabetes utilize digital health technologies. Objective: This study employed an extended Technology Acceptance Model (TAM) incorporating trust, privacy concerns, and self-efficacy to investigate the factors influencing digital health technology adoption among patients with diabetes in Qassim Unaizah, Saudi Arabia. Methods: A cross-sectional study was conducted from November 2025 to January 2026 following institutional review board approval. The quantitative phase utilized a structured survey (n = 203) measuring TAM constructs via validated 5-point Likert scales. Descriptive statistics, Pearson correlations, and one-way ANOVA were performed. Qualitative themes were derived from open ended responses to contextualize quantitative findings. Results: Most participants were male (62.6%), with a mean age of 47.2 years (SD ± 13.1). Smartphone ownership was nearly universal (99.5%), and 82.8% used blood glucose tracking applications. All TAM constructs exhibited significant positive correlations with behavioural intention (p < 0.001): attitude (r = 0.450), perceived usefulness (r = 0.438), self-efficacy (r = 0.394), trust (r = 0.379), ease of use (r = 0.340), and privacy concern (r = 0.309). Mean scores indicated strong acceptance: perceived usefulness (4.31, SD ± 0.39), behavioural intention (4.21, SD ± 0.44), and attitude (4.17, SD ± 0.42). Daily usage was reported by 63.1% of participants, 81.8% expressed satisfaction, and 63.1% reported that digital tools greatly improved their diabetes management. Privacy concerns were notably low (mean 1.70, SD ± 0.89, reverse-coded; Cronbach’s α = 0.921). Supplementary qualitative content analysis of optional open-ended comments (n = 40 respondents) identified six recurring topics: clinical utility, digital literacy, trust, data security awareness, patient empowerment, and social support. Conclusions: Patients with diabetes in Qassim Unaizah demonstrate substantial digital health adoption, predominantly driven by perceived usefulness, positive attitudes, and self-efficacy. The extended TAM effectively explains adoption within this Saudi Arabian context. Findings support interventions emphasizing clinical benefits, user friendly design, and trust building to optimize digital health utilization in diabetes care. Full article

Objective: This study investigates the relationship between social media use and consumer purchase intentions or out-of-home food choices in the Polish gastronomic market, focusing specifically on variations across generations. Methodology: Data were collected between May and July 2024 through a diagnostic survey using the Computer-Assisted Web Interviewing (CAWI) technique (N = 1099). Respondents were recruited via a non-probability quota sampling approach based on strict demographic inclusion criteria. To test the research hypotheses regarding generational variations in market behaviour, a multivariate discriminant function analysis was performed using Statistica 13.1 PL. A preliminary pilot study (N = 30) confirmed the initial questionnaire readability and overall consistency (Cronbach’s alpha = 0.87), while subscales were treated independently during the main analysis. Results: Multivariate models were found to be highly significant, revealing clear differences between age groups. The youngest cohort (aged 18–35) relies heavily on Instagram and TikTok, showing distinct patterns regarding visual triggers such as “instagrammable” aesthetics, digital validation, and menu uniqueness alongside weight loss claims. Conversely, seniors (aged 61 and older) lean unexpectedly towards X. This older segment displays pragmatic, utility-driven motives, searching for detailed textual data about ingredients and the health-promoting properties of food. General product quality and calorie control were identified as universal factors that do not vary by generation. Conclusions and Managerial Implications: The digital transformation of the Polish restaurant industry does not follow a single path. Social media is closely linked to modern customer journeys, with physical dining spots frequently serving as spaces for socialisation. Consequently, restaurant operators should move away from mass communication and adopt a selective omnichannel strategy, where message formats shift from visual appeal to factual, nutrition-oriented text that is tailored to the digital literacy and dietary needs of each generation. Full article

Background/Objectives: Children now spend a substantial part of daily life in digital environments, and their digital, media, and information literacies shape their online safety, social-emotional development, and mental health, making these competencies a concern for child public health and preventive paediatric care. This study applies a Synthetic Knowledge Synthesis (SKS) to map how digital, media, and information literacies (hereafter digital literacies) among children have evolved, comparing neurotypical and neurodivergent children. SKS is a semi-automated approach that combines descriptive bibliometrics, keyword co-occurrence mapping, and qualitative content analysis to map an entire research field or topic. Methods: We treat digital literacies as relevant to children’s health, well-being, and safe online participation, and we analyse Scopus-indexed literature from 1996 to 2025 using descriptive bibliometrics, keyword co-occurrence mapping, and qualitative content analysis. Results: The mapping shows strong growth in general digital-literacy scholarship alongside a small but persistent body of work on a “double digital divide” affecting children with autism spectrum disorder (ASD), ADHD, and dyslexia. The two bodies of work differ in emphasis: the general literature foregrounds social integration and critical agency, while research on neurodivergent children foregrounds inclusive pedagogy, implicit learning, and multimodal expression. It also shifts from general digital-safety awareness toward protective mediations for vulnerabilities such as social-emotional decoding differences and impulsivity, which bear on children’s online safety and mental health. Because bibliometric mapping reveals where research is concentrated rather than what works in practice, the synthesis points to evidence gaps rather than proven methods. Conclusions: On this basis, we argue for an integrated public-health and socio-educational framework that complements universal literacy standards with adaptive, assistive safety nets, so that all children can take part in digital life safely and on equal terms. Full article

The global shift toward an aging population presents significant challenges for healthcare systems. This is compounded by rising disability rates, fragmented care models that struggle to meet complex needs, and a digital divide caused by the emergence of smart technologies. This work aims to evaluate how the digital divide affects the adoption, usability, and perceived benefits of smart home technologies designed to support activities of daily living and health monitoring. The influences of socioeconomic status and geographic location (urban versus rural) on the digital divide are considered. Four databases (Web of Science™, Scopus^®, PubMed^®, and IEEE Xplore^®) were searched between 2014 and 2026, resulting in 71 studies that examined older adults, smart home technologies for daily living or health monitoring, and factors related to the digital divide. Findings were synthesized using the Technology Acceptance Model, Van Dijk’s Digital Divide Framework, and Health Behavior Models. Three key barriers were identified—economic, technical, and social—which disproportionately affected vulnerable groups. Smart Home Health Technologies (SH2Techs) present adoption challenges distinct from standalone devices because they require integrated infrastructure and sustained engagement. Limited research addressing the usability of non-clinical SH2Techs has identified the need for co-design, simplified interfaces, targeted training, and policy reforms to support equitable aging in place. 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

Background: Food insecurity continues to pose a significant public health challenge in urban low-income communities, where limited resources and unstable food systems may negatively relate to children’s nutrition. Although prior studies have linked food insecurity with inadequate dietary intake, the role of coping strategies in this relationship remains insufficiently understood. This study investigated the associations between household food insecurity, coping strategies, and children’s dietary intake in densely populated urban areas of Surabaya, Indonesia. Methods: A cross-sectional study was conducted among 55 mother–child pairs in Simolawang and Bulak Banteng from September 2025 to February 2026. We used the Household Food Insecurity Access Scale (HFIAS) and the Short Food Literacy Questionnaire (SFLQ), and coping behaviors were assessed using the Reduced Coping Strategy Index (r-CSI). Children’s dietary intake was obtained through a Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ). Pearson correlation and multivariate regression analyses were applied to examine relationships among variables. Results: Most households were classified as food secure (61.82%), although varying degrees of food insecurity were observed. Household food insecurity was not significantly associated with children’s energy or macronutrient intake. In contrast, coping strategy scores were positively associated with household food insecurity (β = 0.26–0.27), indicating greater use of coping strategies among households experiencing greater food insecurity. Conclusions: Food insecurity was linked to increased coping behaviors but not directly to children’s macronutrient intake. Coping mechanisms may help sustain short-term intake but do not guarantee adequate nutrition. Interventions should address both food access and dietary quality in urban poor settings. Full article

Background/Objectives: Ageing populations face complex challenges, yet many older adults maintain well-being despite adversity. Understanding resilience offers critical direction for health promotion. This integrative review takes a conceptual and methodological approach to resilience in older adults, with clear implications for geriatric care. The review addresses: (1) how resilience is conceptualised and measured; (2) individual, social, and contextual factors linked to resilience; and (3) the effectiveness of interventions that aim to promote resilience. Methods: Following Whittemore and Knafl’s framework, a systematic search of six databases (PubMed, CINAHL, MEDLINE, Scopus, Web of Science, and Cochrane CENTRAL; 2016–2025) identified 42 empirical studies across 18 countries of diverse designs. Quality was assessed using the Mixed Methods Appraisal Tool, and thematic analysis identified five convergent themes. Results: Most studies explicitly defined resilience using trait-, process-, or outcome-based frameworks and employed validated instruments, most commonly the CD-RISC. Self-efficacy, spirituality, sense of coherence, and gratitude were consistently associated with resilience. Family relationships, social networks, and community participation were important relational correlates. Health status, education, economic security, and digital literacy were key contextual factors. Six longitudinal studies linked higher resilience to reduced mortality, slower cognitive decline, and attenuated frailty progression. Seven intervention studies, including five randomised controlled trials, supported physical activity, mindfulness, positive thinking training, Tai Chi, and technology-supported exercise as promising intervention modalities, though one web-based programme yielded null findings. Conclusions: Resilience in older adults is a multifaceted and potentially modifiable construct. Growing longitudinal evidence extends its relevance beyond psychological well-being to physical health outcomes, though cross-sectional designs predominate and limit causal inference. Measurement heterogeneity across more than twenty instruments underscores the need for international consensus and culturally valid tools. Larger longitudinal studies and adequately powered trials are needed to guide definitive practice and policy for ageing populations worldwide. Full article

Background/Objectives: Problematic internet use (PIU) is a growing behavioral health concern among school-aged children. Whether health literacy and health-promoting lifestyle beliefs are associated with PIU among gifted children—a developmentally distinct population—has, to the best of our knowledge, not been investigated. Methods: A cross-sectional correlational design was used with 118 gifted students (M = 13.80, SD = 2.06) attending a Science and Art Center (BİLSEM) in İzmir, Türkiye. Data were collected using the Problematic Internet Use Scale–Adolescent Form (PIUS-A; α = 0.92), the Health Literacy for School-Aged Children Scale (HLSAC; α = 0.87), and the Adolescent Health-Promoting Lifestyle Beliefs Scale (AHPLBS; α = 0.91) in a classroom setting under researcher supervision. A three-step hierarchical multiple linear regression was performed, with age, sex, daily sleep duration, daily screen time, and weekly physical activity entered as covariates in the first step. Results: Covariates explained 24.8% of the variance in PIU (p < 0.001), with daily screen time as the strongest predictor (β = 0.36). Health-promoting lifestyle beliefs added significant incremental variance (ΔR² = 0.063, p = 0.023); health beliefs were the only statistically significant belief predictor (β = −0.24, p = 0.036), with lower health belief scores associated with higher PIU. Health literacy domains did not add statistically significant incremental variance (ΔR² = 0.028, p = 0.495), and no individual domain was a statistically significant predictor. Conclusions: Within the constraints of a cross-sectional design, health beliefs appear to play a more prominent role than health literacy in the covariate-adjusted explanation of PIU among gifted school-aged children. School health nurses may prioritize interventions that strengthen internalized health beliefs alongside information-based education, contributing to more equitable, tailored school health services for this population. Full article

The increasing complexity of healthcare data ecosystems demands educational technologies capable of supporting data-intensive learning through advanced analytics, immersive interfaces, and learning analytics. This paper presents a cloud-based reference architecture and a prospective evaluation protocol for integrating Business Intelligence (BI), Extended Reality (XR), and learning analytics in health data science education. The proposed architecture is informed by a systematic literature review conducted according to the PRISMA 2020 guidelines, which screened 613 records retrieved from four databases and retained 56 studies for qualitative synthesis. The review indicates that, although BI and XR technologies have independently been associated with educational benefits, empirical evidence supporting integrated educational architectures combining BI, XR, and learning analytics remains limited, particularly in health data science education. Based on these findings, the paper specifies a layered reference architecture comprising a cloud analytics engine, an immersive visualization engine, an interoperability layer, and a learning analytics pipeline designed to support adaptive and AI-assisted educational services during subsequent implementation phases. The reference architecture is partially instantiated within the curricular unit Health Data Analysis and Visualization of the Digital Health programme at the Polytechnic University of Porto, where the BI and XR components are currently deployed and used within the course, while the interoperability middleware, learning analytics infrastructure, and AI-assisted services remain under development or are specified as architectural capabilities. To support future empirical validation, the paper also defines a comprehensive prospective evaluation protocol comprising predefined outcomes, established instruments with published psychometric properties, together with an expert-developed health data literacy assessment undergoing content validation, research hypotheses, power analysis, a statistical analysis plan, and ethical and data-governance provisions. The manuscript makes four principal research contributions: (i) a cloud-based reference architecture for BI–XR integration, (ii) a computational learning analytics pipeline specification, (iii) an interoperable system design for health data science education, and (iv) a prospective evaluation protocol to guide the future validation of the proposed reference architecture. Full article

Background/Objectives: Dental caries remains one of the most prevalent and preventable childhood diseases worldwide. Despite universal access to free dental care in Saudi Arabia, preventable oral diseases remain common, highlighting persistent gaps in oral health literacy and preventive behaviours among children. Male students consistently demonstrate poorer oral health knowledge and practices than their female counterparts, yet they remain understudied. This study aimed to assess oral health knowledge, attitudes, and practices (KAP) among male primary school students in Al Lith city, Saudi Arabia, and to identify their associated sociodemographic determinants. Methods: A school-based analytical cross-sectional study was conducted during the 2023–2024 academic year in Al Lith city, Makkah Province, Saudi Arabia. A total of 430 male students aged 10–13 years from grades five and six were recruited via multistage cluster sampling from 8 randomly selected schools. A validated, interviewer-administered, Arabic-language questionnaire assessed knowledge (18 items), attitudes (12 Likert-scale items), and practices (12 items) related to oral health, alongside sociodemographic data. The study was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Data were analysed using IBM SPSS Statistics version 27. Descriptive statistics and multivariable logistic regression were performed. Results: Of the 430 participants, 83.3% were aged 11–12 years, 89.8% were Saudi nationals, and 89.1% resided in intact, two-parent households. Knowledge deficits were widespread: only 8.4% correctly identified the recommended timing of sweet consumption, 20.2% understood dental plaque, and 28.6% recognised the protective role of fluoride. Attitudes were generally positive, with 80.1% agreeing that teeth should be brushed twice daily and 71.6% endorsing regular dental visits; however, 60.3% held that dental attendance was necessary only when pain was present. Substantial practice gaps were also evident: only 33.3% brushed for the recommended two minutes, and 12.6% had never visited a dentist. In multivariable analysis, low household income was independently associated with better oral health knowledge (adjusted odds ratio [AOR] = 2.22; 95% confidence interval [CI]: 1.04–4.74; p = 0.039), divorced parental status was independently associated with positive oral health attitudes (AOR = 5.40; 95% CI: 1.28–22.79; p = 0.022), and older age was independently associated with poorer oral health practices (AOR = 0.72; 95% CI: 0.55–0.93; p = 0.014). Conclusions: Male primary school students in Al Lith demonstrated generally positive oral health attitudes but significant deficits in knowledge and preventive practices. Comprehensive, school-based oral health promotion programmes that address key misconceptions, actively engage parents, and integrate culturally accepted practices—such as miswak use—with evidence-based preventive guidance are needed. Full article

Background: Postpartum depression (PPD) is an important maternal mental health concern. Knowledge, self-efficacy, and social support may be associated with the recognition and severity of depressive symptoms. This study assessed PPD knowledge among pregnant women/mothers and adults from the broader population in Saudi Arabia and examined the associations of self-efficacy and perceived social support with depressive-symptom scores in the maternal group. Methods: A cross-sectional online survey was conducted in Saudi Arabia from January to March 2021. Convenience and chain-referral sampling were implemented through WhatsApp. The analytical sample included 432 pregnant women/mothers aged ≥18 years and 275 broader-population participants. Arabic-language questionnaires assessed sociodemographic characteristics and PPD knowledge; the maternal-group questionnaire also assessed depressive symptoms, self-efficacy, and perceived social support. Descriptive statistics, Pearson correlations, linear regression, and one-way ANOVA were used. Results: Good PPD knowledge was observed in 73.8% of the maternal group and 77.5% of the broader-population group. Self-efficacy (r = −0.246, p < 0.001) and perceived social support (r = −0.197, p < 0.001) were negatively correlated with depressive-symptom scores. Both variables were statistically significant in the regression model; self-efficacy had the larger absolute standardized coefficient (β = −0.246) compared with perceived social support (β = −0.197). Depressive-symptom scores also differed across categories of age, family income, education, and previous PPD history. Conclusions: The study demonstrated a relatively good level of knowledge about postpartum depression among the surveyed participants. Higher perceived social support and self-efficacy were associated with better maternal mental health outcomes, highlighting their important role in the context of postpartum depression. These findings underscore the relevance of knowledge, social support, and self-efficacy in understanding postpartum mental health among the study population. Full article

Background: Patients with end-stage kidney disease commonly develop hyperparathyroidism, which may impair muscle strength and physical function. Elevated parathyroid hormone (PTH) levels have been associated with weakness and poor Timed Up and Go (TUG) test performance. We hypothesized that elevated PTH at kidney transplantation would correlate with worse TUG performance and poorer post-transplant outcomes. Methods: We performed a retrospective cohort study of 226 kidney transplant recipients (2015–2023) at a single transplant center with documented TUG testing and PTH levels. Patients were divided into normal PTH (≤600 pg/mL, nPTH) and high PTH (>600 pg/mL, hPTH) groups. Demographics, clinical characteristics, and transplant outcomes, including graft and patient survival, were analyzed. Results: The hPTH group (n = 16) was younger than the nPTH group (41.8 vs. 55.4 years, p < 0.001) and more likely to have English as a second language (62.5% vs. 35.6%, p = 0.032). They also had lower estimated post-transplant survival scores (29.3 vs. 52.0, p = 0.003) and higher rates of hyperphosphatemia (18.8% vs. 4.3%, p = 0.044). TUG pass rates, acute rejection, delayed graft function, and patient survival were similar between groups. However, the hPTH group demonstrated shorter mean graft survival (6.6 vs. 7.7 years, p = 0.022). On multivariable Cox regression, elevated PTH at transplantation remained independently associated with graft failure (adjusted hazard ratio 20.6, 95% CI 1.91–222). Conclusions: Elevated PTH at transplant was associated with poorer graft survival despite similar rejection rates and patient survival. Although not directly measured in this study, high PTH may reflect increased medical complexity or adherence-related challenges. Full article

This article examines how gender shapes the framing, governance and lived experience of women’s health within a national health system, and what this reveals about translating gender equality commitments into social policy practice. Using a convergent mixed-methods design, the study combines analysis of national policy documents and parliamentary debates in Portugal (2014–2024) with interviews with key actors (n = 13) and an exploratory national survey of women (n = 268). Across policy and political arenas, women’s health is widely recognised within gender equality and rights-based discourse, yet remains weakly consolidated within mainstream health governance. Reproductive framings dominate, while life-course dimensions such as menopause, women’s mental health and health literacy are under-articulated and weakly operationalised. Actor perspectives emphasise prevention, health literacy, communication and continuity of care, pointing to diffuse ownership and limited accountability. Survey respondents’ accounts both reproduce and extend dominant framings, highlighting mental health, information needs, access barriers and the importance of accessible and trustworthy health information. Reported care experiences reveal a pattern of “respect without responsiveness”, where positive interpersonal treatment coexists with organisational and communicative shortcomings. The article conceptualises this as a governance paradox of recognition without consolidation and shows how policy silences shape not only what becomes actionable within gendered health systems but also the informational conditions that support informed engagement with health and care. The findings have implications for designing life-course-oriented, communication-sensitive and accountability-anchored approaches to women’s health governance. Full article

The digital transformation of healthcare systems increasingly depends on the successful adoption and use of digital health technologies (DHTs) by healthcare users. In this context, digital health literacy (DHL) has emerged as a key factor influencing the effective use of digital health applications. Despite growing interest in DHL, limited research has focused on identifying distinct user profiles in the context of digital health applications. This study aims to identify DHL profiles among users of digital health applications in the Slovenian healthcare system. Data were collected from 247 respondents using the eHealth Literacy and Use Scale (eHLUS), which captures three dimensions: Autonomous Use and Technical Access, Digital Health Engagement, and DHL. Hierarchical cluster analysis (Ward’s method, Euclidean distance) was applied to identify user groups. The analysis revealed four distinct DHL profiles: Digitally Empowered Users, Digitally Vulnerable Users, Passive Digital Users, and Motivated Developing Users. The findings indicate substantial heterogeneity among users in their use of digital health applications across the dimensions of DHL. This study represents one of the first applications of the eHLUS instrument outside its original context and contributes to a better understanding of user diversity within digital healthcare systems. The findings offer a foundation for the development of targeted educational interventions, the reduction in digital inequalities, and the design of user-centered digital health applications that support the ongoing digital transformation of healthcare systems. Full article