Search Results (133)

Mental health conditions affect many young people in sub-Saharan Africa (SSA), where stigma is high and access to care is limited. Digital tools accessible on basic mobile phones offer a scalable way to promote mental health, but evidence on their effectiveness in SSA is limited. This study evaluated the reach, feasibility, acceptability, and knowledge outcomes of Digital MindSKILLZ, an interactive voice response (IVR) mental health intervention implemented in the Democratic Republic of Congo, Ghana, Nigeria, Rwanda, Uganda, and Zambia. Over seven months, 700,138 people called the platform, and 425,395 (61%) listened to at least one message. Of these users, 63.6% were under 25 and 68.3% were from rural areas. The three content branches—mental health information, mental health skills, and soccer quizzes—were accessed by 36.5%, 46.4%, and 50.9% of users, respectively. Among users who accessed the mental health branch of the intervention, the mean number of messages completed was 7.6 out of 18 messages. In a follow-up survey, 91% of users understood the content, 85% would recommend the intervention, and 38% found the mental health content most helpful. Average knowledge scores were 62%, with lower scores on common disorders and stigma. The intervention showed strong reach and acceptability, but content and implementation improvements are needed to boost engagement and retention. Full article

Background/Objectives: Health literacy plays a fundamental role in adolescents’ health-related decisions and behaviors. The aim of our study was to assess the level of health literacy among 16–17-year-old students in Southern Hungary and to examine the associations between sociodemographic characteristics and health behaviors. Methods: This cross-sectional quantitative study was conducted in the autumn of 2024 in Baranya and Somogy counties. A total of 133 students completed a self-administered questionnaire including sociodemographic variables and health behaviors. Health literacy was measured using the validated HELMA-H instrument. Statistical analysis included chi-square tests, t-tests, and ANOVA (p < 0.05). Results: Overall, 62.7% of the students demonstrated adequate, while 37.3% demonstrated inadequate levels of health literacy. No significant association was found between overall health literacy and sociodemographic variables; however, partial associations were observed on specific subscales. Boys reported better access to health information (p = 0.037), while children of mothers with higher educational attainment scored better in comprehension (p = 0.042) and appraisal (p = 0.036). In the case of the numeracy subscale, children of mothers with the lowest educational level showed significantly better results (p = 0.006). Students with higher health literacy levels were less likely to smoke or consume caffeine; however, a reverse trend was observed regarding alcohol consumption. Physical activity showed a positive association with healthier behaviors (p < 0.05). Discussion: The use of digital technologies, interactive learning strategies, and the involvement of family members—especially mothers—may support the development of health-conscious decision-making in adolescents. Consequently, health education programs should focus not only on knowledge transfer but also on fostering critical thinking and decision-making skills. Full article

Indigenous people possess unique health literacy issues and challenges with preventing infectious diseases. This research assessed the baseline knowledge and misinformation in the Semai indigenous subgroup in Perak state, Malaysia, and the impact of a culturally adapted health education intervention. A single-group pre-test/post-test design was used with 156 participants ranging from 7 to 69 years old, predominantly children. The survey addressed key issues of head lice, intestinal parasites, tuberculosis (TB), handwashing, and germ transmission. An interactive, multi-station health education session in the local language produced a significant increase in overall knowledge (mean score increased from 3.17 to 3.83 out of 5, p < 0.0001), with the largest increase among the adult group aged 31–50 years. This was most notable for handwashing knowledge, which had the greatest increase, and misconceptions about intestinal worms and head lice remained. Differences in outcome by age suggest the need for targeted educational strategies, particularly for teenagers and elderly individuals who achieved less gain. The results support the effectiveness of culturally tailored, community-based health education in promoting the awareness of disease among indigenous communities. The drawbacks are convenience sampling, the child dominance of the sample, and the short-term follow-up. Future emphasis should be placed on long-term, community-based intervention using culturally tailored content and digital media. Full article

Artificial intelligence (AI)-powered mental health chatbots have evolved quickly as scalable means for psychological support, bringing novel solutions through natural language processing (NLP), mobile accessibility, and generative AI. This systematic literature review (SLR), following PRISMA 2020 guidelines, collates evidence from 25 published, peer-reviewed studies between 2020 and 2025 and reviews therapeutic techniques, cultural adaptation, technical design, system assessment, and ethics. Studies were extracted from seven academic databases, screened against specific inclusion criteria, and thematically analyzed. Cognitive behavioral therapy (CBT) was the most common therapeutic model, featured in 15 systems, frequently being used jointly with journaling, mindfulness, and behavioral activation, followed by emotion-based approaches, which were featured in seven systems. Innovative techniques like GPT-based emotional processing, multimodal interaction (e.g., AR/VR), and LSTM-SVM classification models (greater than 94% accuracy) showed increased conversation flexibility but missed long-term clinical validation. Cultural adaptability was varied, and effective localization was seen in systems like XiaoE, okBot, and Luda Lee, while Western-oriented systems had restricted contextual adaptability. Accessibility and inclusivity are still major challenges, especially within low-resource settings, since digital literacy, support for multiple languages, and infrastructure deficits are still challenges. Ethical aspects—data privacy, explainability, and crisis plans—were under-evidenced for most deployments. This review is different from previous ones since it focuses on cultural adaptability, ethics, and hybrid public health incorporation and proposes a comprehensive approach for deploying AI mental health chatbots safely, effectively, and inclusively. Central to this review, symmetry is emphasized as a fundamental idea incorporated into frameworks for cultural adaptation, decision-making processes, and therapeutic structures. In particular, symmetry ensures equal cultural responsiveness, balanced user–chatbot interactions, and ethically aligned AI systems, all of which enhance the efficacy and dependability of mental health services. Recognizing these benefits, the review further underscores the necessity for more rigorous academic research into the development, deployment, and evaluation of mental health chatbots and apps, particularly to address cultural sensitivity, ethical accountability, and long-term clinical outcomes. Full article

Objective: Although the negative effects of polypharmacy on older adults are well-documented, studies exploring its relationship with frailty and quality of life within the framework of community-based rehabilitation (CBR) remain scarce. In this context, the aim of this study was to compare frailty and quality of life levels between older adults with and without polypharmacy and to examine the relationship between these parameters from a CBR perspective. The ultimate purpose of this study was to determine the usefulness of CBR. Method: A total of 120 community-dwelling older adults (60 with polypharmacy, 60 without polypharmacy), aged 65–75 years (mean age = 68.18 ± 3.50), were included in a community-based assessment carried out under the coordination of Lokman Hekim University in Ankara, Turkey. The use of five to nine medications was taken as a reference for those with polypharmacy, and the use of less than two medications was taken as a reference for those without polypharmacy. The quality of life of the older adults in the study was assessed with the Nottingham Health Profile (NHP), and frailty was assessed with the Edmonton Frailty Scale (EFS). In line with CBR principles, the findings were interpreted with a focus on promoting community-wide strategies to support older adults. Results: The study found a statistically significant difference in NHP and EFS results between older adults with and without polypharmacy (p < 0.05). In addition, a statistically significant relationship was found between NHP and all subdomains of NHP and EFS (p < 0.05). Conclusion: Older adults with polypharmacy had higher levels of frailty and lower quality of life, and an increase in frailty was significantly associated with a decrease in quality of life in both groups. These findings highlight the importance of community-level preventive interventions to support healthy aging. Within the framework of CBR, strategies such as creating accessible physical activity areas at the neighborhood level; organizing informative seminars on frailty, quality of life, medication use and health literacy in collaboration with volunteer health professionals and local authorities; and creating volunteer support networks to increase social interaction can contribute to the control of these symptoms in older adults. Full article

The COVID-19 pandemic has amplified concerns about healthcare access, particularly among vulnerable populations. This study extends Andersen’s behavioral model to investigate how fear of high-risk locations, alongside predisposing, enabling, and need factors, shapes healthcare-seeking behavior in Penang, Malaysia. A survey of 211 individuals (58% response rate) was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). Results reveal that need factors—specifically self-rated health and chronic illness—strongly predict healthcare utilization. However, this relationship is moderated by fear of infection, leading some high-risk individuals to forgo care despite medical necessity. Enabling factors, including financial resources and access to public healthcare, showed limited influence, likely due to Malaysia’s universal healthcare system and growing use of telemedicine. Older adults maintained healthcare utilization among predisposing variables, while higher-educated individuals were more cautious, possibly due to heightened health literacy and trust in digital alternatives. Although fear influenced care-seeking behavior for minor ailments, it did not significantly deter individuals from accessing services for severe conditions. These findings underscore the nuanced interaction between psychosocial factors and institutional context in shaping healthcare decisions during health crises. Full article

Background: The increasing prevalence of dementia and mild cognitive impairment (MCI) among the elderly population is a global health issue. Information and Communication Technology (ICT)-based interventions hold promises for maintaining cognition, but their viability is affected by several challenges. Objectives: This study aimed to significantly assess the effectiveness of ICT-based cognitive and memory aid technology for individuals with MCI or dementia, identify adoption drivers, and develop an implementation model to inform practice. Methods: A PRISMA-based systematic literature review, with the protocol registered in PROSPERO (CRD420251051515), was conducted using seven electronic databases published between January 2015 and January 2025 following the PECOS framework. Random effects models were used for meta-analysis, and risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Results: A total of ten forms of ICT interventions that had proved effective to support older adults with MCI and dementia. Barriers to adoption included digital literacy differences, usability issues, privacy concerns, and the lack of caregiver support. Facilitators were individualized design, caregiver involvement, and culturally appropriate implementation. ICT-based interventions showed moderate improvements in cognitive outcomes (pooled Cohen’s d = 0.49, 95% CI: 0.14–1.03). A sensitivity analysis excluding high-risk studies yielded a comparable effect size (Cohen’s d = 0.50), indicating robust findings. However, trim-and-fill analysis suggested a slightly reduced corrected effect (Cohen’s d = 0.39, 95% CI: 0.28–0.49), reflecting potential small-study bias. Heterogeneity was moderate (I² = 46%) and increased to 55% after excluding high-risk studies. Subgroup analysis showed that tablet-based interventions tended to produce higher effect sizes. Conclusions: ICT-based interventions considerably enhance cognition status, autonomy, and social interaction in older adults with MCI and dementia. To ensure long-term scalability, future initiatives must prioritize user-centered design, caregiver education, equitable access to technology, accessible infrastructure and supportive policy frameworks. Full article

Background/Objectives: Vaccination rates in South Tyrol, Northern Italy, remain among the lowest in the country. This study investigated whether health literacy is associated with vaccine uptake in this multilingual region. Methods: A representative cross-sectional survey (n = 2090) was conducted using the validated European Health Literacy Survey Questionnaire (HLS-EU-Q16) to assess health literacy. Vaccine uptake was evaluated on a 4-point Likert scale and analysed by age group (18–54 years; ≥55 years). Associations were explored using ANCOVA and multivariate logistic regression models. Results: Among younger adults (18–54 years), higher health literacy was significantly associated with greater vaccine uptake, particularly when compared with individuals with missing health literacy data. Health literacy was not a significant predictor for vaccine uptake in the older age group (≥55 years). Instead, vaccine uptake correlated with trust in healthcare providers, the presence of chronic diseases, and educational level. Differences in health literacy were notable across language groups, but these did not interact with vaccination behaviour. Conclusions: Building trust and targeting individuals with lower educational attainment are key strategies for improving vaccination rates across language groups. Although health literacy plays a secondary role, efforts to enhance it, especially among the German-speaking population, are still warranted. Younger individuals with missing health literacy scores, often with a migration background and low trust in healthcare, should be prioritised in vaccination and health literacy campaigns. Full article

Background: This project focuses on the relevance of using a health literacy approach to educating children about obesity prevention. The Habits of Health and Habits of Mind© model was used to write Electronic Texts for Health Literacy© to encourage actions that support obesity prevention. Guided by the Integrative Theory of Behavioral Prediction, the design template for a new genre of digital texts called Electronic Texts for Health Literacy© emerges for exploring children’s frame of mind, health literacy skills, and behavioral intentions toward obesity prevention. Methods: Online materials from selected websites were strategically reviewed for improving obesity prevention and child health literacy. The digital resources were juxtaposed with the Electronic Texts for Health Literacy©, with the latter written by and for children. Discussion: Health educators who use a constructivist pedagogy can help students to write health literacy narratives about obesity prevention, then read and talk about their multimodal compositions to further the practice and development of their health literacy skills. Children with obesogenic body frames can also gain from cowriting visual–textual–gestural health narratives with their peers or health professionals. Co-constructed narratives can help children make deeper connections about their identity, frame of mind, and social agency. Summary: Although this untested resource is available as a new genre of digital text, health educators could nudge children toward developing a stronger frame of mind and behavioral intentions toward obesity prevention when they write health literacy narratives that focus on decision making, goal setting, and communication in the context of eating nutritious foods and participating in physical activities. Full article

Background and Objectives: Psychological disorders are prevalent and distressing. Early treatment initiation can prevent adverse outcomes and reduce healthcare system impacts. Improving mental health literacy (MHL)—one’s knowledge regarding psychological disorders—and treatment-seeking attitudes (TSAs) is key in early treatment initiation. Examining the facets of dispositional mindfulness—the capacity to pay attention to present-moment experiences with acceptance—may offer more granular insights into understanding MHL and TSAs. This study examined (a) associations between mindfulness facets and MHL and TSAs, (b) facets’ prediction of MHL and TSAs beyond demographics, (c) moderation of the MHL–TSA relationship by mindfulness facets, and (d) mediation of mindfulness–TSA relationships via general self-efficacy (GSE). Methods: A community sample of 299 adults was recruited online (TurkPrime) and completed demographic questions and self-report measures: Five-Facet Mindfulness Questionnaire-15, Mental Health Literacy Scale, Mental Help-Seeking Attitudes Scale, and General Self-Efficacy Scale. Results: Describe, Non-Judgment, and Act with Awareness were modestly associated with MHL; all five facets correlated with TSAs. Hierarchical regressions controlling for demographics showed that Describe and Non-Reactivity predicted MHL, while Act with Awareness uniquely predicted TSAs. Non-Reactivity moderated the MHL–TSA relationship, with higher Non-Reactivity amplifying the relationship. GSE fully mediated relationships between Observe and Non-Judgment with TSAs, suggesting self-efficacy is a key mechanism of these facets. Conclusions: Interventions cultivating Non-Reactivity, Describe, and Act with Awareness may improve the translation of mental health knowledge into treatment-seeking behaviors. Future research should explore how mindfulness facets independently and interactively foster early intervention and treatment engagement. Full article

Background/Objectives: Although nursing complexity and health literacy (HL) are critical determinants of patient outcomes, their combined impact on mortality, hospital re-admissions, and emergency department (ED) visits remains poorly understood. This study aims to measure nursing complexity and HL in hospitalized patients, examine their interaction, and analyze their impacts on mortality, hospital re-admissions, and ED visits over a one-year follow-up period. Methods: Adult patients from two hospital centers were enrolled, excluding those with stays under two days or cognitive impairments. Data were collected at baseline to assess nursing complexity (measured according to the number of nursing diagnoses assigned to patients within 24 h from hospital admission) and HL (assessed using the Single-Item Literacy Screener, SILS). Patients were followed during a 12-month follow-up period to track mortality, hospital re-admissions, and ED visits. Latent class analysis classified patients into distinct nursing complexity and HL profiles. Survival analyses and Cox proportional hazard models were used to evaluate the relationships between variables. Results: At baseline, among the 2667 enrolled patients, 55.9% were classified as having high nursing complexity, and 32% had inadequate HL. High nursing complexity was associated with lower HL (r = 0.384; p < 0.001). During follow-up, 387 patients (14.5%) were lost. Of the remaining sample, mortality occurred in 8.3% of the patients, hospital re-admissions in 27.2%, and ED visits in 16.8%. Nursing complexity was significantly associated with higher mortality (HR: 1.84, adjusted HR: 1.81), but not with hospital re-admissions or ED visits. The patients with inadequate HL (32%) had increased risks of mortality (HR: 11.21, adjusted HR: 7.75), hospital re-admissions (HR: 3.61, adjusted HR: 3.58), and ED visits (HR: 20.78, adjusted HR: 14.45). The patients with both high nursing complexity and inadequate HL had the highest mortality risk and the lowest 12-month survival rate (75%; 95% CI: 71.1–79.1%; p < 0.001). Conclusions: This study demonstrates that both high nursing complexity and inadequate HL independently and jointly contribute to adverse patient outcomes. Interventions targeting HL and supporting patients with high nursing complexity could reduce risks, enhance care, and improve patient survival. While these findings underscore the critical role of both factors in patient outcomes, the limitations include this study’s single-country setting and reliance on a single-item HL measure. Future research should validate these findings in broader healthcare contexts and integrate multidimensional HL assessments for a more comprehensive evaluation. Full article

Introduction: WELLfed is a community-based adult education programme focused on improving food literacy, with a stated aim to “nourish communities through food and connections”, in a low-income community in Aotearoa New Zealand. Adult learners are taught food preparation and cooking skills in weekly interactive sessions. Here, we describe two pilot phases of a three-phase evaluation. Methods: Our overall aim is to evaluate the effectiveness of the WELLfed programme. Phase 1, in keeping with the co-design approach of WELLfed, co-designed outcome measures through five focus groups (n = 20) involving a wide range of stakeholders. Phase 2 developed and refined a survey based on these co-designed measures. The survey was administered to WELLfed learners at baseline (n = 15) and again towards the end of their programme (follow-up n = 12). Wilcoxon rank sum tests of significance were performed, restricted to participants with both baseline and follow-up data. Results: Five domains of importance identified in Phase 1 were as follows: (i) engagement support, (ii) food knowledge and skills, (iii) personal development, (iv) relationship transformation, and (v) community flourishing. Phase 2 findings include increased comfort level at engagement (p = 0.063). Food knowledge and preparation skills improved on a range of factors. All metrics of self-confidence and self-efficacy increased, with the greatest change being the ability to find support in times of crisis. Self-reported excellent or very good health increased (p = 0.050). Fewer people reported food running out due to a lack of money (p = 0.016) or eating less because of a lack of money (p = 0.008). Conclusions: The pilot study shows the effectiveness of the WELLfed programme for improving food knowledge and skills, reducing food insecurity, and improving health outcomes. Further research with a larger sample size is required to confirm these pilot results. Full article

(1) Background: Each year, significant volumes of healthcare data are generated through both research and care. Since fundamental digital processes cannot function effectively without essential data competencies, the challenge lies in enhancing the quality of data management by establishing data literacy among professionals in outpatient healthcare and research. (2) Methods: Within the DIM.RUHR project (Data Competence Center for Interprofessional Use of Health Data in the Ruhr Metropolis), a didactic concept for interprofessional data literacy education is developed, structured as a learning objectives matrix. Initially conceived through a literature review, this concept has been continually developed through collaboration with interprofessional project partners. The study was conducted between February 2023 and June 2024. (3) Results: The foundational structure and content of the didactic concept are based on various scientific studies related to general data literacy and the outcomes of an interactive workshop with project partners. Eight distinct subject areas have been developed to encompass the data literacy required in healthcare professions: (1) Fundamentals and general concepts, (2) ethical, legal, and social considerations, (3) establishing a data culture, (4) acquiring data, (5) managing data, (6) analyzing data, (7) interpreting data, and (8) deriving actions. Within these, learners’ data literacy is assessed across the four competency areas: basic, intermediate, advanced, and highly specialized. (4) Conclusions: The learning objectives matrix is anticipated to serve as a solid foundation for the development of teaching and learning modules aimed at enhancing data literacy across healthcare professions, enabling them to effectively manage data processes while addressing the challenges associated with digital transformation. Full article

Background/Objectives: Access to healthy and affordable food remains a challenge for under-resourced communities due to uneven food distribution and the need for reliable transportation. This study developed and evaluated an interactive Geographic Information System (GIS)-based food asset map for a low-income community in Windham, Connecticut to improve awareness of food resources and expand opportunities for fresh food access. Methods: Using the human-centered design (HCD) framework and the Asset-Based Community Development (ABCD) model, the map integrates food locations, transportation routes, and assistance eligibility. Internal pilot testing (n = 8) identified usability issues, leading to updates such as mobile compatibility and user guides. Usability testing (n = 74) assessed navigation performance and user feedback through task-based evaluations and surveys. Categorical map usability, sociodemographic, diet, and health characteristics were tested for participants with food security (yes/no) or digital literacy (passed/failed). Results: Food-secure participants showed higher usability success than food-insecure individuals (p < 0.05), while those relying on food assistance faced greater challenges (p < 0.05). Individuals rating their diet as “very good/excellent” were most likely to pass the map usability testing (p < 0.05), whereas younger, college-educated, employed participants and those with vehicles trended toward passing (p < 0.1). Participants generally reported the map easy to navigate, especially those with food security. Conclusions: The asset map promotes food resource awareness and addresses barriers such as limited public transportation information. Additional efforts are needed to support food-insecure users in utilizing digital food access resources. This study contributes to initiatives to improve food access, digital inclusion, and community engagement in under-resourced communities. Full article

Background: School food literacy programs (e.g., home economics) are an opportunity to improve the dietary habits of teens. However, the literature suggests that girls and athletes have better food literacy, and it is not clear how school programs contribute to this inequality. To address this, we explored how gender and sport influenced teens’ perspectives of their school food literacy experiences and how they can be improved. Methods: Using semi-structured interviews and a Grounded Theory analysis, we generated a theoretical understanding of how to improve school food literacy programs for athletes and non-athletes of diverse genders. Thirty-three teens were recruited to balance sport participation (n = 18 athletes) and gender (n = 15 boys; n = 14 girls; n = 4 non-binary) based on data saturation. Results: Teens expressed four categories to improve school programs that aligned with principles of the Capability, Opportunity, Motivation and Behaviours (COM-B) Model of behaviour change. Programs should Provide a challenge (e.g., more advanced recipes), Make it fun (e.g., explore new cuisines in interactive ways) and Establish importance (e.g., health impacts). Practice is key for teens’ self-confidence and development of food skills (e.g., meal planning) as well. Boys emphasized Make it fun whereas girls and non-binary teens emphasized Establishing importance. Athletes valued Practice is key more than non-athletes. Conclusions: School programs should relay the importance of food literacy in fun and tailored ways to teens (e.g., meal planning among athletes). It may be especially salient for programs to tailor their activities and messaging, where possible, to appeal to diverse teens who play sports and those who do not. Full article