Search Results (2,449)

Background/Objectives: The postpartum period involves profound bodily, psychological, and relational changes that may challenge women’s well-being and couple functioning, yet the role of flows of compassion and positive body image in postpartum couple satisfaction remains largely unexplored. The present study examined whether body appreciation mediated the associations between different flows of compassion (self-compassion, compassion toward others, and compassion from others) and couple satisfaction in postpartum women. Methods: A total of 230 Italian postpartum women who had given birth in the previous six months (Mage = 33.65, SD = 4.43) completed online self-report measures assessing self-compassion, compassion toward others, compassion from others, body appreciation, and couple satisfaction. Direct and indirect associations among compassion flows, body appreciation, and couple satisfaction were examined using path analysis, controlling for breastfeeding status. Results: Self-compassion and compassion from others were positively associated with body appreciation, which in turn was positively associated with couple satisfaction; compassion from others also showed a direct positive association with couple satisfaction, and significant indirect effects of self-compassion and compassion from others on couple satisfaction through body appreciation were observed. Conclusions: Body appreciation may represent a key psychological mechanism through which compassion-based processes support relational well-being in the postpartum period. This study is the first to examine the mediating role of body appreciation in the relationship between compassion flows and couple satisfaction in postpartum women. Integrating compassion flows with positive body image advances understanding of how intrapersonal and interpersonal emotional resources contribute to couple satisfaction following childbirth and informs interventions aimed at supporting postpartum adjustment. Full article

Background/Objectives: The role of middle nurse managers is characterized by high levels of responsibility and complex relationships, which can generate significant stress and put their mental health at risk. A mixed-methods study was carried out to measure distress and work-related factors among Italian middle nurse managers and to explore their experiences in order to identify critical issues and possible actions for improvement. Methods: The study was conducted between October 2019 and January 2020. Results: In the quantitative phase, 65 middle nurse managers completed validated questionnaires on distress, perceived health, working environment, job satisfaction, and emotional workload. Although most participants reported feeling healthy, nearly 30% experienced distress ranging from mild to severe. These findings informed the qualitative phase, in which 10 middle nurse managers were interviewed to further explore the lived experiences. Qualitative analysis identified four main themes: (1) sources of stress at work; (2) the importance of personal and organizational support for middle nurse managers; (3) copingstrategies; (4) actions for change to improve work activities. All themes were further divided into sub-themes. Middle nurse managers report experiencing difficulties in their work, adopting strategies to adapt to everyday challenges, and expressing a need for support to improve the management of their work teams. Conclusions: The findings suggest that, despite generally positive well-being indicators, a substantial subgroup of middle nurse managers experience distress related to organizational constraints. Practical implications include strengthening organizational support, reducing excessive workload, and addressing staffing issues to better sustain middle nurse managers’ well-being. Full article

Background: In 2022, we adapted the World Health Organization Digital Adaptation Kit (DAK) for antenatal care (ANC) into the BornFyne digital health platform. Because ANC services in many facilities relied on fragmented paper-based guidance, the DAK represented the first exposure for many providers to a structured, comprehensive ANC guideline framework integrated into a digital system. Understanding providers’ motivation, capabilities, and readiness to adopt guideline-driven digital care was essential to inform implementation strategies. We therefore conducted a workshop to explore healthcare providers’ expectations, perceived challenges, and readiness to integrate a comprehensive digital ANC system into routine practice. Methods: A prospective mixed-methods pre–post implementation pilot workshop was conducted between June and August 2023 across four districts. The 5-h workshop targeted ANC providers and included exposure to the WHO ANC DAK and demonstration of its integration into the BornFyne platform. Survey tools assessed perceived knowledge, attitudes, perceived behavioural control, intention, and social norms using Likert scales. Constructs were mapped to the COM-B framework. Paired student’s t-tests assessed pre–post changes (p < 0.05), and Cohen’s d estimated effect sizes. Qualitative responses were thematically analysed. Results: Nineteen participants, including doctors, nurses, midwives, and data managers from public, private, and faith-based facilities, completed the surveys. Most participants were women (90%). Following the workshop, perceived knowledge of behaviour change and digital guideline use significantly increased (t(19) = 3.22, p = 0.004, d = 0.78). Although no statistically significant changes were observed in attitudes, perceived behavioural control, intentions, or social norms, descriptive trends suggested improved confidence and openness toward digital ANC systems. Qualitative findings identified increased knowledge as the most important outcome, with 80% of participants emphasizing its role in strengthening capability. Participants also reported greater confidence in integrating digital tools into routine care but highlighted contextual and motivational barriers as ongoing challenges. Acceptability was high: 90% expressed satisfaction, and all participants rated the workshop as useful, relevant, engaging, and worth their time. Conclusions: The workshop improved providers’ perceived knowledge and demonstrated high acceptability of DAK-aligned digital ANC systems. While changes in attitudes and behavioural control were not statistically significant, the findings support the feasibility of behaviour change-based digital ANC interventions. Addressing contextual and motivational barriers will be essential for sustained adoption in resource-limited settings. Full article

Passenger satisfaction is a key component of sustainable urban mobility, influencing public transport use, customer loyalty, and the attractiveness of railway systems. However, evidence from Latin American commuter rail services remains limited. This study evaluates the satisfaction of frequent users of the Limache–Puerto railway service operated by EFE Valparaíso in Greater Valparaíso, Chile, based on measurements conducted between 2024 and 2025. Using 400 surveys administered on station platforms and onboard trains, the analysis assessed overall satisfaction, Net Promoter Score (NPS), and experience attributes related to safety, predictability, cleanliness, information provision, comfort, and crowding. A repeated cross-sectional quantitative design with quota sampling was employed to compare successive measurement waves. Results indicate that passengers highly value the service’s speed and efficiency. Although NPS experienced a temporary decline during 2025, the final measurement remained comparable to the 2024 baseline. Key concerns included perceived platform safety, peak-hour crowding, onboard environmental conditions (temperature and odors), and service frequency in critical segments. Mentions of informal vendors decreased, whereas concerns regarding criminal incidents and passenger flow difficulties increased. The findings highlight the need for targeted interventions in safety, crowding management, environmental quality, and communication during disruptions. This pilot operational monitoring study proposes a practical framework for evaluating passenger satisfaction and NPS through repeated measurements, providing evidence to support service management and sustainable railway planning. Full article

This study presents the design, development, and evaluation of iSign, an Android-based educational mobile application developed to support sign language learning among deaf and hard-of-hearing individuals in rural communities. The project was conducted using a research and development (R&D) approach guided by the ADDIE instructional design framework. A preliminary needs assessment, based on municipal records and field validation, revealed limited access to structured sign language education and assistive learning resources in selected barangays of Odiongan, Romblon. The iSign application was designed as a user-centered and accessible mobile learning tool incorporating alphabet learning (A–Z), number recognition (0–9), a dictionary containing 160 commonly used vocabulary words with definitions and corresponding sign language video demonstrations, and multimedia content such as nursery rhyme songs interpreted in sign language. The system was developed using Android Studio and structured to support offline accessibility to accommodate low-connectivity environments. The application was evaluated in terms of functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. Twenty-one community participants and four information technology experts assessed the system using a five-point Likert scale. The overall weighted mean rating of 4.0 (“Agree”) indicates that the developed application met acceptable software quality standards and user satisfaction levels. The findings demonstrate that iSign is a functional and accessible mobile learning application that can serve as a supplementary tool for sign language education in underserved communities. Full article

This study examines NPC dialogue mechanisms as an independent design factor in task-oriented digital games. Although generative NPCs are often discussed in relation to narrative richness, conversational naturalness, and social presence, limited controlled evidence exists on whether dialogue mechanisms themselves affect player outcomes when task information is held constant. To address this gap, the study combined a formative user study with a single-factor between-subject experiment using a controlled game prototype. The LLM-NPC and Script NPC conditions shared identical task goals, scene structure, completion criteria, predefined fact set, and task-stage prompting boundaries. The experimental contrast was therefore framed as a comparison between a script-based branching dialogue interface and a boundary-controlled LLM-based adaptive dialogue interface, rather than as a comparison involving unequal task information. The results showed that, under controlled information boundaries, LLM-NPCs significantly improved task efficiency, as reflected in shorter completion time, fewer NPC inquiries, and fewer incorrect searches. For immersion, the overall multivariate effect was not statistically significant, and no confirmatory evidence of an LLM-NPC advantage in immersion was found. For satisfaction, the LLM-NPC condition showed significantly higher total satisfaction, which was specified as the primary satisfaction endpoint. Secondary affective and overall evaluative satisfaction outcomes showed consistent uncorrected differences in the same direction. These findings suggest that, under the implemented factual and procedural controls, the value of LLM-NPCs in this task-oriented setting is less likely to lie in providing more information than in reorganizing predefined task facts in a more context-sensitive and player-adaptive manner. Boundary-controlled adaptive dialogue may therefore provide a useful design perspective for future task-oriented NPC systems. Full article

Background/Objectives: Workplace violence (WPV) is a major occupational health hazard and psychosocial safety concern in psychiatric nursing, yet evidence integrating exposure, worker well-being, and workforce stability within a single theory-informed model remains limited in Saudi Arabia. This study examined associations between WPV and proximal occupational outcomes (burnout, job satisfaction, and absenteeism) and distal outcomes (quality of life [QoL] and turnover intentions) among psychiatric nurses and tested burnout as a statistical mediator of the WPV–turnover intentions association. Methods: A multicentre cross-sectional census survey was conducted across three psychiatric facilities in northern Saudi Arabia between June and August 2025 (N = 171). Participants reported WPV exposure over the preceding 12 months using Arabic versions of standardised instruments, including validated Arabic versions where available and a forward–backward-translated WVSQ. Linear, negative binomial, and logistic regression models examined outcome associations and factors associated with WPV exposure; the PROCESS macro (Model 4, 5000 bootstrap resamples) tested statistical mediation. Results: Most nurses reported at least one WPV incident in the preceding 12 months, most commonly verbal abuse. Younger age, male sex, shorter psychiatric nursing experience, lower perceived staffing adequacy, and inadequate security were associated with higher WPV exposure. WPV exposure was associated with lower QoL across all WHOQOL-BREF domains, higher burnout, lower job satisfaction, higher absenteeism, and stronger turnover intentions. Burnout showed a partial statistical mediation pattern in the WPV–turnover intentions association. Because the study was not specifically powered for the indirect effect, the mediation result should be interpreted with caution. Conclusions: In this cross-sectional study, WPV was a pervasive occupational exposure among Saudi psychiatric nurses and was associated with poorer QoL and higher turnover intentions, with burnout showing a partial statistical mediation pattern. Multilevel prevention, safer staffing, and structured post-incident psychological support are needed to support psychiatric nurses’ well-being and workforce retention. Full article

Against the backdrop of population aging, the well-being of older adults with disabilities in daily life and its underlying mechanisms has increasingly become an important research topic. Using data from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS), this study focuses on 509 individuals aged 60 and above with disabilities. It incorporates informal social support, depression risk, and life satisfaction into a unified analytical framework, and employs ordered Logit models, binary Logit models, and the KHB decomposition method to examine their interrelationships and underlying mechanisms. The results show that: (1) informal social support is positively associated with the life satisfaction of older adults with disabilities; (2) informal social support is negatively associated with depression risk; and (3) depression risk is negatively associated with life satisfaction and plays a significant mediating role in the relationship between informal social support and life satisfaction, accounting for 23.25% of the total effect. From a daily life perspective, this study reveals that the well-being of older adults with disabilities is not solely derived from institutional resource provision, but is generated and sustained through ongoing social interactions and relational networks. The study therefore deepens our understanding of the everyday and relational dimensions of subjective well-being in later life. Full article

Community-based forest ecotourism is an important livelihood pathway for communities around protected forests, but household agritourism operators often face ecological regulations, seasonal demand and heterogeneous tourist expectations. These conditions increase information asymmetry and make service matching difficult. This study examines how two-way information disclosure affects business performance in community-based forest ecotourism. Drawing on social penetration theory, we test a chained mechanism linking two-way information disclosure to operational performance. Based on 780 valid questionnaires from agritourism operators and core family managers around Giant Panda National Park, China, this study measures information disclosure practices, service responsiveness, operator-side perceptions of tourist responses and self-reported business performance. The results show that seller- and buyer-side information disclosure significantly enhance perceived identification. Seller information disclosure has relatively stable effects on customer orientation, perceived quality and operational performance, whereas buyer information disclosure mainly works through perceived identification. Perceived quality, perceived value and satisfaction act as partial transmission channels. Heterogeneity analysis shows stronger effects among low-income and newly established operators. The findings provide micro-level evidence for reducing expectation mismatch and strengthening sustainable livelihood capacity in forest protected-area communities. Full article

This study examines the quality of urban life (QoUL) in Ulaanbaatar by analyzing variations in overall life satisfaction across urban development types and identifying the sociodemographic, housing, mobility, and domain-specific factors associated with these differences. An integrated methodological framework combining questionnaire survey data and spatial information was utilized to analyze 529 valid responses collected from five urban development contexts: new development, redevelopment, land readjustment, urban sprawl, and other areas. The analysis employed descriptive statistics, comparative group analysis, and ordinal logistic regression models. Overall life satisfaction differed significantly across development types. The land readjustment areas reported the highest mean value of life satisfaction (3.64), followed by new development (3.53), urban sprawl (3.32), redevelopment (3.13), and other areas (2.97). In the pooled model, higher educational attainment was negatively associated with overall life satisfaction (OR = 0.30, p < 0.05), possibly reflecting higher expectations among better educated residents. In contrast, longer residential duration, particularly beyond 10 years, was positively associated with overall life satisfaction, indicating the importance of residential stability and place attachment. Household composition also emerged as relevant, with family-related responsibilities and child-supportive living conditions shaping how urban environments are experienced. Across development types, accessibility, environmental quality, and dwelling satisfaction were the most consistent predictors. These findings indicate that improving QoUL in Ulaanbaatar requires development-type-specific, people-centered policies that integrate housing, transport, environmental improvement, neighborhood services, and family-supportive interventions to support more sustainable and equitable urban development. Full article

Cultural sustainability at World Heritage Sites depends on whether heritage meanings remain publicly intelligible and experientially meaningful, not only on conservation outcomes or visitor management. Yet empirical evidence remains limited on how authorized heritage meanings are received, negotiated, and spatially anchored by visitors. This study examines the transformation of expert-informed authorized heritage meanings into visitor heritage identity at the Yungang Grottoes, China. Through thematic analysis of 20 semi-structured expert interviews, an expert-informed analytical framework was developed and consolidated into four case-specific identity dimensions: National, Ethnic, Cultural, and Place Identity. Based on 325 valid on-site questionnaires, the study combines Likert-scale measurement, open-ended response coding, and period-level cultural mapping. Results show that Cultural and National Identity were most strongly recognized, while Ethnic and Place Identity were more closely linked to interpretive mediation, prior knowledge, and embodied spatial experience. In cultural mapping responses, respondents most frequently anchored National Identity in Early Period caves, Ethnic and Cultural Identity in Middle Period caves, and Place Identity across more distributed landscape and atmospheric settings. Four Authorized Heritage Discourse–Visitor heritage identity relational patterns were identified: correspondence, partial alignment, negotiation, and divergence/extension. The findings offer a visitor-centered and spatially differentiated approach to evaluating sustainable heritage interpretation by extending conventional conservation-, management-, and satisfaction-oriented indicators toward visitor meaning-making, identity negotiation, and spatially situated interpretation. Full article

Sustainable tourism in oasis landscapes requires governance approaches that go beyond generic destination-growth models and standardized sustainability checklists. In living cultural landscapes such as Al-Ahsa Oasis, tourism development is inseparable from water systems, palm-grove agriculture, rural livelihoods, heritage values, climate stress, visitor behavior, and institutional accountability. This paper develops a governance framework for sustainable tourism in Al-Ahsa Oasis, Saudi Arabia, a UNESCO World Heritage cultural landscape. Methodologically, it is a conceptual framework-development study based on structured critical review and contextual synthesis. It critically interprets international sustainable tourism, heritage management, visitor management, and sustainable investment frameworks in relation to recent Al-Ahsa-specific evidence on rural tourism, resident satisfaction, farm-tourist behavior, rural lodges, land-cover change, and World Heritage governance. The study proposes a six-dimensional framework structured around cultural landscape stewardship, water-sensitive ecological governance, agricultural landscape continuity and rural accommodation regulation, community benefit and local enterprise, climate-responsive visitor management and interpretation, and monitoring and institutional accountability. These dimensions are treated as interdependent governance fields rather than separate checklist categories. The framework is further operationalized through an indicator and governance matrix linking suggested indicators, data sources, governance mechanisms, and responsible actors. The paper contributes by reframing sustainable oasis tourism as an adaptive governance problem rather than a technical exercise in applying predefined criteria. It provides an evidence-informed basis for planning, monitoring, stakeholder deliberation, policy refinement, and future empirical testing in Al-Ahsa and comparable arid cultural landscapes. Full article

Children undergoing cancer treatment face repeated, prolonged hospitalisations carrying substantial risks of psychological distress, social isolation, and impaired development. Volunteers offering structured non-medical activities are widely employed to complement professional psychosocial care in paediatric oncology settings, yet empirical evidence examining their role specifically—as distinct from professionally delivered psychosocial interventions—remains sparse. This narrative review, conducted in accordance with SANRA criteria and drawing on a structured search of PubMed, PsycINFO, and Google Scholar (2000–2025), supplemented by a targeted verification search in July 2026, synthesises the theoretical and preliminary empirical basis for volunteer involvement, critically evaluates associated clinical risks, and proposes evidence-informed recommendations for paediatric oncology clinical practice. Three theoretical frameworks provide the conceptual grounding for volunteer activities: developmental psychological models (Piaget; Erikson), stress and coping theory (Lazarus and Folkman), and the biopsychosocial model (Engel). Indirect empirical evidence—derived predominantly from professionally delivered interventions—supports short-term benefits of structured distraction, play, and social activities on procedural anxiety, pain experience, and sense of social inclusion; the sole study examining volunteer-facilitated activities specifically in paediatric oncology reported meaningful reductions in distress and high family satisfaction. Eight categories of clinical risk are identified, including physical and psychological overload, erosion of child autonomy, suppression of authentic emotional expression, and inadequate coordination with healthcare staff. Six practice recommendations are proposed, centred on a working definition of the volunteer role, mandatory pre-access training, genuine individualisation including cultural adaptation, multidisciplinary-team-led coordination, and structured programme evaluation. Volunteer involvement can meaningfully complement professional psychosocial care when delivered within a structured, supervised, and multidisciplinary-team-coordinated framework. The paediatric oncology team occupies a pivotal role in realising the potential benefits while safeguarding children from associated risks. Prospective research employing standardised volunteer programme definitions and validated child-reported outcome measures is urgently needed to build an evidence base commensurate with the clinical importance of this practice. Full article

The sleep monitoring terminal display (SMTD) designated for sleep cabins provides data visualizations of sleep profiles, yet poses challenges concerning visually informed interfaces. Given the scarcity of research on the SMTD interface, this study aims to evaluate the influence of SMTD-related factors, including stimulus areas of interest (AOIs), user experiences and tasks, on user visual perceptions while interacting with the SMTD system. Eye-tracking experimental contexts drawn from authentic settings are used to examine how the SMTD interfaces affect visual perceptions under varying tasks. Forty valid samples were collected, and pupil sizes (PSs), task performances, satisfaction, and usability were statistically compared and evaluated. The findings indicated that tasks had no significant effects, but user experiences and stimuli AOIs had significant main effects on PSs. In addition, task completion time ratio and tracking ratio between the two tasks varied; physical demand exceeded mental demand in task 1, whereas it was the opposite in task 2. The effectiveness of post-optimized interfaces was additionally substantiated through combining subjective ratings and objective metrics. The SMTD study provides novel insights for digital interface development and helps enhance users’ integrated visual perception. Full article

Cancer patient–informal caregiver dyads function as core collaborative units across the cancer trajectory from diagnosis to recovery. A central challenge for these dyads lies in managing illness uncertainty alongside the demands of dyadic coping, two interrelated factors that jointly shape long-term quality of life, psychological well-being, and disease adaptation. These two factors interact to shape their long-term quality of life, psychological well-being, and disease adaptation. Past studies have mostly examined dyadic coping and illness uncertainty separately. Employing a narrative review design, this study searched the PubMed database for literature published from 2021 to 2025, and synthesizes evidence on association pathways and moderating factors between dyadic coping and illness uncertainty among adult cancer patient–informal caregiver dyads. Existing research on dyadic coping has predominantly focused on the effects of interventions (e.g., enhanced spousal communication, joint exercise) on emotional health and relationship quality. Studies on illness uncertainty have largely examined its association with anxiety and depression, but have failed to provide a comprehensive understanding of the interactive pathways between the two constructs. This review addresses this gap by synthesizing evidence from three perspectives: interactive mechanisms, heterogeneous characteristics, and integrated intervention directions. Evidence from the reviewed literature suggests that illness uncertainty represents a critical antecedent of dyadic coping among cancer dyads. Illness uncertainty and dyadic coping share a bidirectional association, and this relationship is moderated by factors including cancer type, patient age, and cultural background. Most uncertainty management interventions effectively reduce illness uncertainty in specific populations. Synthesized evidence indicates that dyadic coping is a significant predictor of relationship satisfaction among couples coping with chronic illness. Interventions that are made for these couples need to include things like psychoeducation and skill-building parts that are about dyadic coping, so that they can improve the couples’ relationship satisfaction. Based on predominantly observational evidence with heterogeneous study designs, the authors propose that combining uncertainty management interventions with dyadic coping skills training represents a key direction for future clinical care optimization. This review provides evidence-based implications for developing targeted dyadic care strategies and advancing family-centered, full-course cancer care models. Full article