Search Results (473)

Background/Objectives: Breast cancer is the most prevalent malignancy among women worldwide and a major public health concern. Early detection through screening methods such as breast self-examination, clinical breast examination, and mammography is associated with improved prognosis and reduced mortality. However, adherence to screening recommendations remains suboptimal and is influenced by multiple sociodemographic and psychosocial factors. Aims: This study aimed to assess women’s knowledge, attitudes, and practices regarding breast cancer screening and to identify factors associated with preventive behavior. Methods: A cross-sectional study was conducted using a structured self-administered questionnaire. The sample consisted of 1233 women from the general population. Data collected included sociodemographic characteristics, awareness of screening methods, attitudes toward prevention, and screening practices. Statistical analysis involved descriptive measures and multivariate regression models to identify predictors of knowledge and attitudes. Results: High levels of awareness were observed, with 96.5% reporting knowledge of breast self-examination, 94.5% clinical examination, and 95.0% mammography. Despite this, a gap between knowledge and practice was evident. Although 79.5% reported knowing how to perform breast self-examination, only 22.7% practiced it monthly, and 19.2% never performed it. Clinical examination within the past year was reported by 49.4%, while 13.3% had never undergone it. Among the women 45+ years old, 86% reported undergoing mammography every two years. Education, income, age, and place of residence were significantly associated with outcomes. Conclusions: A substantial gap exists between awareness and practice. Effective interventions should address behavioral, psychosocial, and structural barriers to improve screening uptake. Full article

Background/Objectives: Nutrition during childhood and adolescence is a key determinant of long-term health, influencing metabolic homeostasis, neurocognitive development, and immune system maturation. Globalization and technological advances have reshaped food production and consumption, increasing the availability of ultra-processed foods (UPF) of low nutritional quality. This study aimed to investigate the relationship between parental factors, namely food literacy, perceived barriers and enablers, dietary attitudes, and healthy eating behaviors, and the consumption of discretionary UPF among children and adolescents living in 5 Mediterranean countries. Methods: This cross-sectional study was based on a survey completed by 2011 parents of children and adolescents aged 6–17 years from 5 Mediterranean countries, who reported on their children’s dietary and lifestyle habits. Adherence to the Mediterranean diet was assessed through the KIDMED index. Parental food literacy was measured using the Short Food Literacy Questionnaire (SFLQ). Perceived barriers and enablers were assessed based on the Theory of Planned Behavior, and parents’ attitudes toward their child’s diet were evaluated using the Healthy-Eating Attitudes Questionnaire (HEAQ). Finally, the Theory of Internet Use Related to Health (TIUH) questionnaire was used to assess parents’ tendencies related to health information use online. Results: Higher perceived barriers and enablers were significantly associated with lower discretionary UPF consumption across all models. Parental food literacy (SFLQ) showed a positive association with discretionary UPF consumption, remaining significant in the fully adjusted model, although with reduced magnitude. Healthy-eating attitudes (HEAQ) were initially positively associated with discretionary UPF intake but lost statistical significance after full adjustment. Regarding health-related internet use (TIUH), the Health Information dimension showed a strong positive association with discretionary UPF consumption, while other dimensions (Consciousness and Beliefs) showed inconsistent and non-significant associations in the fully adjusted model. Conclusions: Children’s consumption of discretionary UPF is shaped by several interrelated factors, such as family environment, eating patterns, and parents’ perceptions, rather than solely by knowledge or attitudes. Full article

Background: Chemsex, or sexualized drug use, exists along a continuum ranging from non-problematic, consensual recreational practice across diverse populations to problematic behaviors linked with clinical vulnerabilities, substance dependence, or compulsive disorders. Within nursing practice, understanding this spectrum is essential to mitigate healthcare-related stigma. Objective: To map and synthesize evidence on stigma and attitudes among nurses regarding chemsex, identifying implications for practice and research. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were performed across PubMed/MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, and LILACS. Studies involving nurses or healthcare teams focused on stigma, attitudes, or related constructs in chemsex care were included. Data underwent descriptive and thematic synthesis. Results: Six studies met the inclusion criteria, showing substantial heterogeneity. Only one focused exclusively on nurses. Stigma and attitudes were rarely assessed explicitly, emerging instead as underlying factors influencing clinical practice, communication, and patient engagement. Key themes included the necessity for non-judgmental care, significant gaps in knowledge and training, variability in clinical practice, and the impact of organizational barriers. A schematic representation was developed to illustrate the interrelationships between stigma, knowledge, professional attitudes, and structural factors influencing healthcare practice. Conclusions: This review positions stigma as a central mechanism influencing nursing care in chemsex contexts. The findings underscore critical gaps in nursing-specific evidence and emphasize the need for targeted training, validated measurement tools, and integrated care models. Strengthening stigma-informed, patient-centered approaches is essential to improve care delivery and health outcomes for this population. Full article

Nature-based education, characterized by authentic contexts and experiential learning, has increasingly been recognized as a potentially effective educational approach for fostering sustainable development literacy among university students. This study aimed to examine the influence of nature-based education on university students’ sustainable development behavior. It further investigated the sequential mediating roles of sustainability knowledge and attitudes. A cross-sectional self-administered questionnaire survey was conducted among 1248 university students across 21 prefecture-level cities in China. Data were analyzed using SPSS (Version 28.0) and SmartPLS (Version 4.0). Partial least squares structural equation modeling (PLS-SEM) was employed to test the hypothesized model and assess the relationships among latent constructs. The results indicated that nature-based education was positively associated with sustainability knowledge (β = 0.337, p < 0.001) and, to a lesser extent, sustainability attitudes (β = 0.106, p < 0.01), but had no significant direct effect on sustainable development behavior. Instead, sustainability attitudes mediated the knowledge–behavior relationship, while sustainability knowledge and attitudes jointly formed a significant sequential mediation pathway. Full article

Background: Herpes zoster (HZ), commonly known as shingles, and post-herpetic neuralgia (PHN) represent growing public health concerns, particularly among older adults. Despite the established efficacy of the herpes zoster vaccine (HZV), global uptake remains suboptimal. Objectives: This scoping review maps evidence from Saudi Arabia evaluating the baseline knowledge, awareness, attitudes, acceptance, hesitancy, and clinical uptake of the HZV among general adults, high-risk populations, and healthcare workers (HCWs). Methods: The JBI and PRISMA-ScR methodological frameworks were strictly adhered to during mapping. Eligible sources included peer-reviewed, observational cross-sectional studies conducted in Saudi Arabia and published in English between 2022 and 2026. The search was conducted across PubMed, Scopus, Web of Science, and Google Scholar. Data were systematically extracted and charted using a standardized digital piloting framework to capture study characteristics (author, year, and region), sample sizes, target populations, knowledge percentages, actual vaccine uptake rates, and self-reported barriers. Results: Out of 25 retrieved records, 19 unique primary studies were mapped. Public knowledge of HZ complications and vaccine eligibility criteria was consistently low to moderate, falling below 50% across most cohorts. Conversely, while verbal willingness to receive the vaccine was highly favorable (ranging from 60% to 75%), a profound “intention–behavior gap” was observed, with actual clinical uptake being below 10%. Key barriers included a lack of public health campaigns, safety concerns regarding reactogenicity, online misinformation, and a lack of proactive provider communication. For HCWs, barriers included unclear local guidelines and a lack of workplace mandates. Ultimately, a proactive physician recommendation was identified as the single most powerful clinical facilitator, increasing vaccine acceptance by over 80% across all cohorts. Conclusions: While the shingles vaccine is now distributed completely free across Saudi Arabia, high public willingness has not translated into actual vaccination rates (10%) due to low public awareness of disease severity. Free vaccine availability alone is insufficient; primary care systems must shift from a passive delivery model to an active, provider-driven framework to successfully close this gap Full article

Crisis management has evolved from a reactive organizational function into a strategic capability grounded in organizational learning, knowledge-based processes, and behavioral alignment, thereby enhancing institutional resilience in volatile environments. This study examines how organizational and financial determinants contribute to crisis management success in the United Arab Emirates (UAE). It integrates crisis management culture as a learning-oriented mediating capability. It incorporates a Theory of Planned Behavior (TPB)-based behavioral extension to explain how attitude, subjective norms, and perceived behavioral control shape intention toward crisis-related compliance. Using SPSS regression analysis and Partial Least Squares Structural Equation Modeling (PLS-SEM), the findings indicate that policies, procedures, and financial stability exert significant positive effects on crisis management success, whereas trained human resources show no direct significant impact. Crisis management culture emerges as a key mediating mechanism that enables knowledge integration, supports organizational learning processes, and translates structural preparedness into coordinated action. The TPB-based extension further shows that attitude, subjective norms, and perceived behavioral control significantly predict intention, and that intention is positively associated with crisis management success. The results suggest that effective crisis governance depends not only on formal structures and financial resources but also on learning-oriented cultures and behavioral mechanisms that transform institutional knowledge into coordinated crisis responses. Full article

This study explores the multifaceted attitudes of high school students toward the use of artificial intelligence (AI) and large language models (LLMs) like ChatGPT in educational contexts. Drawing upon a tripartite model of attitudes, our research evaluates affective, cognitive, and behavioral dimensions to offer a nuanced understanding of students’ perceptions. The affective dimension assesses emotional responses to AI tools, the cognitive dimension examines beliefs about the utility and ethical considerations of AI, and the behavioral dimension evaluates actual usage patterns of AI technologies. Utilizing a newly developed survey instrument tailored for the educational context, data was collected from 93 high school students across different regions of Italy in the period that ranged from February 2024–March 2024. Exploratory factor analysis (EFA) was employed to explore the underlying structure of the survey instrument and identify underlying factors influencing AI acceptance. The analysis reveals three distinct factors—Mindful AI Learning, Embracing AI Effects, and LLM as Learning Companion, highlighting the complexity of students’ attitudes toward AI. Results indicate a cautious but optimistic reception of AI in education, offering crucial insights into Information Intelligence for enhanced learning and the design of personalized learning pathways. The study contributes to the literature by offering a novel scale to measure attitudes toward artificial intelligence, specifically focusing on both general AI and Generative AI large language models, such as ChatGPT. Moreover, it highlights the critical need for AI literacy, ethical digital learning frameworks, and robust institutional policies to bridge the digital divide. Consequently, this work is framed as a preliminary exploratory investigation. Ultimately, these findings advance our knowledge of transformative digital learning processes and inform future strategies for human–machine integration in educational systems. Full article

Background: Antimicrobial resistance (AMR) poses an escalating threat to global health, agriculture, and the environment, demanding urgent multisectoral action under the One Health framework. Despite global awareness efforts, understanding of AMR among the general population remains insufficient, particularly in low- and middle-income countries such as Brazil. This study aimed to evaluate the knowledge, attitudes, and perceptions (KAP) of the Brazilian population regarding AMR. Methods: An online questionnaire was distributed through social media platforms between April and August 2025, resulting in 945 valid responses after data cleaning. Quasi-Poisson models were applied to identify demographic predictors of KAP scores while logistic regression models were used to assess the association between KAP scores and antibiotic use-related practices. Results: Education level was the strongest predictor of higher KAP scores, whereas age and gender showed inconsistent influence. Only 40.3% of respondents correctly identified antibiotics among commonly used medicines, and 25.9% reported proper disposal of antibiotic packaging. More than half (54.2%) were willing to pay more for antibiotic-free products, although only 26.7% had ever noticed such labeling. Network analysis of open-ended responses indicated that concerns about potential health risks and AMR awareness were the primary motivators for purchasing antibiotic-free products. Conclusions: These findings reveal significant gaps in public understanding of antibiotic use and resistance in Brazil, emphasizing the urgent need for targeted educational initiatives, improved public communication, and behavioral interventions to support antimicrobial stewardship and sustainable antibiotic use. Full article

Background: Pressure injuries (PIs) remain a major and escalating global patient safety concern, affecting 12.8% of hospitalized patients worldwide and contributing to rising prevalence and mortality rates from 5.63 to 8.18 and 0.31 to 0.47 per 100,000 population, respectively. The economic burden of PIs is substantial, amounting to $26.8 billion annually in the United States and $9608 per patient in the Kingdom of Saudi Arabia (KSA). However, adherence toward pressure injury prevention (PIP) guidelines among registered nurses (RNs) remains critically inconsistent. Objectives: The aim of this study was to examine whether attitude and practice function as parallel mediators in the relationship between knowledge and adherence to PIP guidelines among RNs, adjusting for age and years of experience. This aim was addressed through three-fold objectives: to assess RNs’ knowledge, attitude, practice (KAP) and adherence to PIP guidelines, evaluate the direct knowledge–adherence relationship, and quantify the two mediated pathways. Methods: A cross-sectional mediation study recruited 166 RNs from 52 clinical units at Prince Sultan Military Medical City in Riyadh, KSA, using convenience sampling with data collected from 5 to 15 March 2026. Validated instruments assessed KAP and adherence to PIP guidelines. Pearson correlations, multiple linear regression, and parallel mediation (Hayes PROCESS macro, model 4; 5000 bootstrap resamples) were performed with age and years of experience as covariates. Results: Mean scores indicated low knowledge (7.31/25; 29.2%), negative attitude (28.20/52; 54.2%), poor practice (36.10/110; 32.8%), and low adherence (28.40/90; 31.6%). Regression explained 36.8% of the variance in adherence to PIP guidelines (Adjusted R² = 0.35), with knowledge (β = 0.22; p < 0.003), attitude (β = 0.30; p < 0.001), practice (β = 0.20; p = 0.006), and years of experience (β = 0.12; p = 0.04) emerging as significant predictors. Both attitude (unstandardized indirect effect = 0.40; 95% Boot CI [0.20, 0.64]) and practice (indirect effect = 0.30; [0.10, 0.60]) significantly mediated the knowledge–adherence relationship, while knowledge retained a significant direct effect (B = 0.70, p = 0.003), indicating partial mediation. Conclusions: This study was the first to employ a parallel mediation analysis to examine KAP as concurrent predictors of adherence toward PIP guidelines within a tertiary military healthcare setting in the KSA. The mediating roles of attitude and practice, together with the direct effect of knowledge, indicated that adherence to PIP guidelines is shaped by interconnected cognitive and behavioral mechanisms. Persistently low KAP levels and low adherence, along with the predictive influence of all KAP domains and RNs’ years of experience, underscored the urgent need for integrated interventions that strengthen KAP to improve adherence and prevent PIs. Full article

Opioid misuse continues to be a major public health issue in the United States. Older adults (≥65) are at particular risk of harm from opioids due to changes in opioid pharmacokinetics with age; however, healthcare professionals lack training and confidence in addressing opioid harm reduction strategies in this population. Therefore, the purpose of this study was to improve healthcare professional knowledge and beliefs regarding opioid harm reduction strategies amongst older adults. An 8 h interprofessional conference was conducted 1 May 2025 to educate healthcare providers about opioid misuse prevention strategies for older adults. This study utilized a quasi-experimental one-group pretest–posttest design to assess changes in healthcare professional knowledge and beliefs before and after the conference. Healthcare professionals in the U.S. were recruited to participate in the conference via email listservs with national reach, predominantly concentrated in Alabama. Data were collected at pre- and post-conference via an anonymous online survey informed by the Theory of Planned Behavior and Health Belief Model. Primary outcome measures included: (1) knowledge of opioid use and misuse in older adults (5 items); (2) prescribing and dispensing attitudes surrounding opioids and medications for opioid use disorder (MOUD) (5 items); (3) perceived susceptibility to harm from opioids (4 items); and (4) perceived barriers to opioid harm reduction in older adults (17-items). Constructs were measured using multiple-choice questions (knowledge) and Likert-type scales (1 = strongly disagree, 5 = strongly agree). Secondarily, intention to join a Microsoft Teams working group for ongoing collaboration was assessed through a single categorical (Yes/No/Unsure) multiple-choice question at post-conference. Data were analyzed using descriptive statistics, and differences in mean knowledge, attitudes, susceptibility, and barriers scale scores from pre- to post-conference were analyzed using Wilcoxon signed-rank tests (alpha = 0.05). Of N = 75 survey respondents, the majority were White (86.7%), female (74.7%), 50 years of age on average, and employed as pharmacists (68%). Overall, mean (SD) knowledge (83.73% [19.92] versus 90.67% [12.45]; p = 0.011) and perceived susceptibility (3.82 [0.63] versus 4.03 [0.63]; p = 0.002) increased from pre- to post-conference, while perceived barriers decreased (2.71 [0.54] versus 2.54 [0.58]; p = 0.001). Despite an upward trend, there was no statistically significant change in the mean prescribing and dispensing attitudes from baseline to post-conference. Additionally, 34.7% intended to join the Microsoft Teams working group at post-conference. Findings support the utility of interprofessional educational interventions to increase healthcare provider knowledge and beliefs regarding opioid harm reduction strategies amongst older adults. Full article

The voluntary carbon market (VCM) has emerged as a promising mechanism for climate mitigation; however, farmer participation in developing countries remains limited. This study combines the Theory of Planned Behavior (TPB) and the Capability–Opportunity–Motivation–Behavior (COM-B) framework to investigate factors associated with Thai farmers’ intention and self-reported stage of participation in VCM. Data were collected through face-to-face interviews with 240 farmers across multiple crop systems in Thailand and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The model explained substantial variance in intention and behavior (R² = 0.610 and 0.555, respectively), although PLS-Predict indicated limited predictive performance. Perceived behavioral control (PBC) showed the strongest positive association with reported participation behavior (β = 0.493, p < 0.001), followed by intention (β = 0.343, p < 0.001). Access to extension and technical support (AES) was positively associated with intention (β = 0.624, p < 0.001) and PBC (β = 0.338, p < 0.001). Knowledge was positively associated with PBC (β = 0.324, p < 0.001) but negatively associated with intention (β = −0.106, p = 0.045). No significant association was observed between attitude and intention; however, subjective norms were negatively associated with intention (β = −0.336, p < 0.001). Indirect associations through intention and PBC were also observed. Overall, the findings suggest that capability-, opportunity-, and trust-related factors are associated with farmers’ reported participation in VCM and may inform the design of future policies and support programs. Although the model demonstrated useful explanatory capability, its predictive performance was limited, indicating that the findings should be interpreted primarily as explanatory rather than predictive. Full article

Background: In an era of sedentary lifestyles and multifaceted health challenges, adopting health behavior (HB) is essential to address the health problems threatening the physical health of university students. This study aimed to explore the factors associated with HB among university students. The University Student Health Behavior Model (USHBM) was developed based on the theory of planned behavior and incorporated health consciousness (HC), health knowledge (HK), and risk perception (RP). Methods: Using a cross-sectional survey design, data were collected from 384 university students in China. Structural equation modeling was employed to evaluate the hypothesized relationships of the USHBM. Results: HK significantly and directly predicted behavioral intention (BI) (β = 0.421, p < 0.001). Perceived behavioral control (PBC) emerged as the strongest associated factor of BI (β = 0.417, p < 0.001). HC was significantly and positively related to attitude toward behavior (ATT) (β = 0.451, p < 0.001), subjective norm (SN) (β = 0.332, p < 0.001), and PBC (β = 0.357, p < 0.001). Furthermore, RP functioned as an associated factor of HB (β = 0.411, p < 0.001). Additionally, RP was significantly and positively associated with the adoption of HB. Conclusions: The findings provided an in-depth understanding of university students’ HB. According to the findings, practical implications for enhancing university students’ HB were discussed. Full article

Organizational commitment is crucial for employee retention and performance; however, little is known about how social and leadership resources translate into organizational commitment through routine learning behaviors. Based on the Conservation of Resources (COR) theory, this study explores how trust and leader’s vision of talent influence organizational commitment through three informal training formats: peer/supervisor coaching, knowledge sharing, and job rotation. Using data from the 2023 Korea Human Capital Enterprise Survey (N = 10,371), this study employs a generalized structural equation model that combines Bernoulli logit mediation equations with Gaussian identity outcome equations, along with the bootstrap method, to test the proposed mediation model. The results show that trust and leader’s vision of talent are positively correlated with organizational commitment, whereas knowledge sharing and job rotation significantly mediate these relationships. Peer/supervisor coaching shows no mediating effect. This study conceptualizes informal training as a mechanism through which workplace resources are implemented and translated into employee attitudes, thereby extending COR theory from resource acquisition and protection to resource utilization processes in everyday organizational contexts. The findings suggest that organizations should strengthen trust-based and development-oriented human resource practices to foster employee commitment. These implications extend beyond Korean firms to global HR practitioners seeking to build learning-supportive workplaces. Full article

This paper evaluated low environmental risk awareness related to the food industry among students in Romanian high schools offering food-related educational programs, within the framework of Sustainable Development Goal 4 (SDG4). The study used a questionnaire based on 349 self-reported answers and interviews conducted with an independent group of 20 students. Using an informed theory of planned behavior (TPB) model and a structural equation modeling (SEM) approach, the influence of knowledge, attitude, and subjective norms on low environmental risk awareness was tested in order to understand the potential of Romanian high school students to become responsible food citizens. Subjective norms and knowledge showed significant effects on self-reported low environmental risk awareness (p < 0.001), indicating the need for interventions to consolidate pro-environmental social norms and offset low environmental risk awareness in Romanian high schools with food-related educational programs. The interviews supported the dominant importance of subjective norms over the other variables in relation to low environmental risk awareness and in shaping future food citizens. Full article

This paper describes the development and design of Nutrition for Athletes: A Focus on Dietary Supplements, an online educational intervention created for varsity athletes at the University of Guelph. Guided by the Theory of Planned Behaviour (TPB), the program aimed to improve athletes’ nutrition and dietary supplement-related knowledge while modifying attitudes, subjective norms, perceived behavioral control, intentions, and behaviors associated with dietary supplement use. Formative research with the target population revealed widespread misconceptions, strong social influences, and high perceived benefits of supplement use, which highlighted the need for an intervention focused on reshaping underlying beliefs. The program covered topics related to sports nutrition, hydration, dietary supplements, and risks of supplement use, and was integrated into the university’s learning management system. Each unit was mapped onto relevant TPB constructs, with an emphasis on correcting inaccurate beliefs and promoting a food-first approach. The program’s effectiveness was evaluated through pre- and post-intervention questionnaires assessing knowledge and TPB constructs. This paper outlines the theoretical framework, development process, and content structure of the intervention, and presents a model that can be replicated in future educational programs. Full article