Search Results (32)

Background/Objectives: Drowning among children younger than five years remains a major public health problem in Thailand, particularly in residential water environments. Caregivers’ supervision and home safety practices play an important role in preventing childhood drowning. This study evaluated the association between participation in the Be SAFE Program, a community-based educational intervention developed using the Health Belief Model (HBM), and changes in caregivers’ health beliefs and self-reported drowning prevention behaviors. Methods: A quasi-experimental pretest–posttest control group study was conducted among 60 caregivers of children younger than five years recruited from two community settings in Ubon Ratchathani Province, Thailand. Participants were assigned to either an intervention group (n = 30) or a control group (n = 30). The intervention group participated in the HBM-based Be SAFE Program, whereas the control group received routine care. Outcomes included HBM constructs and self-reported drowning prevention behaviors. Baseline-adjusted analyses of covariance (ANCOVA) were performed to compare post-intervention outcomes between groups. Holm adjustment was applied to account for multiple comparisons. Results: After adjustment for baseline scores, caregivers in the intervention group demonstrated significantly greater improvements than those in the control group in perceived susceptibility, perceived severity, perceived benefits, cues to action, self-efficacy, and self-reported drowning prevention behaviors, together with significantly lower perceived barriers (all Holm-adjusted p < 0.05). Large effect sizes were observed across all measured outcomes. Conclusions: The findings suggest that the HBM-based Be SAFE Program was associated with greater short-term improvements in caregivers’ health beliefs and self-reported drowning prevention behaviors than routine care. These findings support the potential value of theory-based community educational programs for childhood drowning prevention while highlighting the need for larger multi-site studies with longer follow-up to confirm the program’s effectiveness and broader applicability. Full article

Background/Objectives: Depression is a common and consequential comorbidity among adults with diagnosed diabetes. Prior research has largely emphasized individual health behaviors, with less attention to emotional burden, social context, or theory-driven interpretation. The Multi-Theory Model (MTM) of Health Behavior Change offers an integrative framework for examining behavioral, emotional, and environmental correlates of health outcomes. This study applied MTM to examine correlates of lifetime diagnosed depression among U.S. adults with diagnosed diabetes. Methods: This cross-sectional study analyzed 2023 Behavioral Risk Factor Surveillance System (BRFSS) data from 19,967 adults with diagnosed diabetes, representing approximately 30 million U.S. adults after survey weighting. Lifetime diagnosed depression was assessed based on respondents reporting that a health professional had told them they had a depressive disorder, representing a lifetime history of depression rather than current depressive symptoms. Independent variables were organized into behavioral, emotional, and environmental domains consistent with MTM. Survey-weighted descriptive analyses, Rao–Scott χ² tests, and nested survey-weighted logistic regression models were conducted. Results: The weighted prevalence of lifetime diagnosed depression among adults with diagnosed diabetes was 24.3%. In the fully adjusted MTM-guided model, emotional and environmental domains showed the strongest associations with lifetime diagnosed depression. Frequent mental distress was associated with substantially higher odds of depression (adjusted odds ratio ≈ 10.4, p < 0.001). High social or economic stress and fair or poor self-rated health remained independently associated (p < 0.001). Behavioral factors, including physical activity, smoking, and body mass index, were attenuated after adjustment. Conclusions: Lifetime diagnosed depression among adults with diagnosed diabetes was more strongly associated with emotional burden and adverse social conditions than with health behavior alone, supporting the integration of distress screening and context-responsive interventions into diabetes care. Full article

South Asian Americans experience multifaceted sociocultural and acculturative stressors that influence mental well-being, yet few studies have applied contemporary behavioral theories to understand relaxation behaviors in this population. This cross-sectional study examined predictors of initiating and sustaining relaxation behaviors using the Multi-Theory Model (MTM) of health behavior change. A web-based survey of 271 South Asian adults incorporated the Perceived Stress Scale (PSS-10), MTM constructs, and sociodemographic characteristics. Reliability was high across MTM subscales (Cronbach’s α = 0.81–0.93). Structural equation modeling demonstrated acceptable fit (CFI > 0.90, TLI > 0.90, RMSEA < 0.08, SRMR < 0.08). Hierarchical regressions revealed that among participants practicing relaxation (n = 202), behavioral confidence significantly predicted initiation (β = 0.481, p < 0.001), followed by participatory dialogue (β = 0.194, p < 0.05) and changes in the physical environment (β = 0.242, p < 0.01). Emotional transformation strongly predicted sustenance (β = 0.395, p < 0.001), along with practice for change (β = 0.307, p < 0.05) and changes in the social environment (β = 0.210, p < 0.05). MTM constructs explained 69.8% of initiation variance and 70.4% of sustenance variance. Among non-practitioners, participatory dialogue predicted initiation (β ≈ 0.18–0.34, p < 0.05), and emotional transformation predicted sustenance (β = 0.570, p < 0.001). These findings underscore MTM’s strong predictive utility and support culturally tailored interventions enhancing confidence, emotional regulation, and social/environmental supports to promote relaxation behaviors in South Asian communities in the United States. Full article

Texting while driving (TWD) is a leading cause of distracted driving-related crashes, especially among college students. This study applied the Multi-Theory Model (MTM) of health behavior change to predict initiation and sustenance of refraining from TWD among university students. A cross-sectional survey was conducted among 164 students from a Southwestern U.S. public university using a 49-item validated MTM-based questionnaire. Structural equation modeling and hierarchical multiple regression analyses were employed to assess reliability, construct validity, and predictors of behavioral initiation and sustenance. Cronbach’s alpha coefficients ranged from 0.71 to 0.93, indicating strong reliability. The MTM demonstrated good fit (CFI = 0.950, RMSEA = 0.057 for initiation; CFI = 0.992, RMSEA = 0.039 for sustenance). Behavioral confidence (β = 0.30, p < 0.001) significantly predicted initiation, explaining 51.5% of the variance, while emotional transformation (β = 0.41, p < 0.001) and practice for change (β = 0.27, p = 0.0105) predicted sustenance, accounting for 61.5% of the variance. The MTM effectively explained both initiation and sustenance of refraining from TWD among college students. Interventions aimed specifically at reducing texting while driving should prioritize strengthening behavioral confidence for initiating change and supporting emotional transformation and practice-for-change strategies to sustain long-term abstinence from TWD. MTM-based approaches hold strong potential for designing theory-driven, culturally relevant distracted driving prevention programs. Full article

Background: Gambling behaviors among college students are a growing public health concern, with problem gambling rates significantly higher in this population than in the general public. Aim: This study outlines the protocol for a randomized controlled trial (RCT) evaluating the efficacy of RESPONSIBLEPLAY^©, a Multi-theory Model (MTM)-based intervention designed to promote responsible gambling behaviors. Proposed Methods: The intervention integrates six MTM constructs—participatory dialogue, behavioral confidence, changes in the physical environment, emotional transformation, practice for change, and changes in the social environment—to address the initiation and sustenance of behavior change. College students aged 21 and older, scoring 3 or higher on the Problem Gambling Severity Index (PGSI), will be randomly assigned to either the MTM-based intervention group or a traditional knowledge-based intervention group. The participants will complete surveys assessing PGSI and MTM constructs at pre-test, post-test, and eight-week follow-up. This study aims to provide evidence for the efficacy of theory-driven intervention compared to a knowledge-based approach. Conclusions: If successful, this protocol will establish a robust framework for mitigating gambling-related harm in vulnerable college populations, paving the way for scalable, evidence-based interventions in diverse settings. The findings will contribute to the development of public health strategies that integrate theoretical constructs with practical applications to address high-risk behaviors. Full article

Trillium Health Partners (THP) is a hospital network that serves the Mississauga region of Ontario, Canada, and sees nearly 1.7 million patient visits each year. THP is also a provider of highly specialized services to the region and a fully-fledged academic teaching center, with embedded research and innovation. Background/Objectives: Highly trained, skilled, and experienced nurses are foundational to THPs ability to meet the complex care needs of our patients across specialized programs. In 2024, 50% of the nursing workforce at THP was noted to have less than five years of experience. This generation of nurses are reporting high levels of burnout and are at greater risk of leaving the profession. The more experienced nurses are also facing burnout due to the continued pressures and demands in the workplace, having to manage an increasingly complex patient assignment, while providing mentorship to more novice nurses. Based on the existing literature and our collective experience at THP, we have developed the Transition to Independent Practice Support (TIPS) program, a multi-pronged approach to bolster support for our nursing workforce. The TIPS program at THP is designed to address knowledge gaps and enhance clinical competence among new and aspiring nurses. The primary aim of this study is to evaluate the efficacy of the TIPS program in facilitating the transition of novice nurses to independent and competent practitioners, utilizing the Kirkpatrick Model of Evaluation The specific objectives include (a) assessing participants’ reactions to the TIPS program; (b) measuring the increase in nurses’ knowledge and confidence following program participation; (c) evaluating changes in nurses’ behavior and practice post-program; and (d) determining the program’s impact on nurse retention and quality of patient care. Methods: Grounded in Meleis’s Transition Theory, the program combines webinars, simulations, clinical rounding, and mentorship to build resilience, decision-making, and confidence. Evaluative measures, based on the Kirkpatrick Model, assessed participant satisfaction, learning outcomes, behavior changes, and retention. Results: From September 2023 to March 2024, 388 interdisciplinary participants attended the program, including nursing students (56%), registered nurses (24%), registered practical nurses (14%), and aspiring nurses in other interprofessional roles (6%). Participants expressed high satisfaction with the program, achieving a mean reaction score of 4.80 (SD = 0.2921). Ninety-five percent found the sessions relevant, and 98% rated the facilitators as knowledgeable. Self-reported confidence significantly increased across all topics, with overall mean confidence scores rising from 2.94 to 4.52 (p < 0.0001, Cohen’s d = 3.01), demonstrating a strong impact on skill acquisition and application. Behavioral evaluations through simulations, competency checklists, and follow-up touchpoints confirmed improved clinical performance, with participants achieving 100% compliance to nursing skills during simulations and sustained confidence at three-month follow-ups. Since the program’s implementation, nursing turnover rates decreased from 9.52% to 7.7% by March 2024, with 100% of RNs, RPNs and IENs of TIPS participants retained within six months. Conclusions: This paper outlines the TIPS program and the diverse teaching and learning methodologies used in the design and program implementation to ultimately support the transition experience of the new gradate nurse into acute care. Preliminary outcomes are discussed including nursing retention rates, nurses’ knowledge, confidence, and skill levels. Full article

Colorectal cancer (CRC) ranks third in terms of global cancer prevalence and is the second most common cause of cancer-related mortality. Although CRC rates are decreasing in the United States, inequalities still exist despite the effectiveness of invasive screening methods, such as colonoscopy, flexible sigmoidoscopy, and computed tomography (CT) colonography in detecting colorectal cancer. Many current interventions promoting CRC screening do not utilize a modern theory-based approach, which has led to the low utilization of these screening methods. This cross-sectional study aims to address the lack of theory-based treatments for promoting visual CRC screening examinations by applying the multi-theory model (MTM) of health behavior change to explicate the health-related factors for individuals to seek visual colorectal cancer screening examinations for CRC screening. A 57-item validated questionnaire assessing MTM constructs and CRC screening was administered online. The survey questionnaire was administered to a sample of 640 adults from the United States. The participants were between the ages of 45 and 75 years. Hierarchical multiple regression was used to assess the relationship between MTM constructs with the initiation and sustenance of CRC screening behaviors. Out of the total participants in this nationwide sample, 71.4% (n = 457) reported that they had undergone a visual CRC screening examination. MTM subscales, specifically participatory dialogue, changes in the physical environment along with age, recommendation for CRC screening from a healthcare provider, and previous experience with colonoscopy, were found to be significant factors in predicting the initiation of visual CRC screening behavior. These factors accounted for 22% of the variation in initiation among this group (R² = 0.222, F = 3.521, p < 0.001). The MTM can be a valuable framework for designing educational media, information media, social media platforms, and clinical interventions to promote visual colorectal cancer screening examinations. Full article

The COVID-19 pandemic has severely impacted global tourism, raising the need for sustainable recovery strategies. This study examines how tourists’ confidence in tourism recovery (CTR) influences travel intentions across different pandemic phases—outbreak, stabilization, and conclusion. Positioned within the Theory of Planned Behavior (TPB), the research explores the mediating role of CTR in the relationships between attitude, subjective norms, perceived behavioral control, and travel intention. Using structural equation modeling (SEM), multi-group analysis (MGA), and Importance–Performance Matrix Analysis (IPMA), this study assesses changes in travel behavior during each pandemic phase. Data were collected through three surveys conducted in major Chinese cities between late 2022 and early 2023. The findings reveal that CTR significantly mediates the influence of behavioral factors on travel intention, especially during the stabilization and conclusion phases. The IPMA results highlight key areas for intervention, with CTR, perceived behavioral control, and subjective norms varying in importance across phases. This research underscores the need for adaptive and sustainable strategies to strengthen traveler confidence, offering practical insights for supporting long-term resilience and growth in the tourism industry during and beyond health-related crises. Full article

Drowsy driving among college students is a critical public health issue due to its significant impact on road safety. This cross-sectional study aimed to investigate the determinants of stopping drowsy driving behavior among college students using the multi-theory model (MTM) of health behavior change. Data for this study were collected from September to October 2023 via a 42-item psychometric valid, web-based survey disseminated via Qualtrics, involving 725 students from a large southwestern university. Nearly half of the participants (49.38%) reported drowsy driving in the past month. Hierarchical multiple regression analysis revealed that participatory dialogue (p = 0.0008) and behavioral confidence (p < 0.0001) significantly predicted the initiation of refraining from drowsy driving, with the final model explaining 36.4% of the variance. Similarly, emotional transformation (p < 0.0001) and practice for change (p = 0.0202) significantly predicted the sustenance of behavior change, with the final model accounting for 40.6% of the variance. These findings underscore the importance of targeted MTM-based interventions focusing on enhancing students’ awareness and confidence in managing drowsiness to mitigate drowsy driving, ultimately improving road safety and student well-being. Full article

There is a large disparity in Pre-exposure Prophylaxis (PrEP) utilization among communities of color compared to White Americans. There is also a lack of theory-based survey instruments to measure the underlying reasons for the disparity among communities of color. The purpose of this study was to create an instrument based on a qualitative approach involving community interviews. Semi-structured interviews guided by the Multi-theory Model (MTM) of health behavior change were performed in a sample of 12 members from communities of color. The analysis entailed a directed content analysis along the themes of MTM constructs to develop a survey instrument. The barriers to PrEP that emerged included the cost of PrEP, lack of protection from other sexually transmitted diseases, reduced trust between partners, and the stigma associated with PrEP. The perceived disadvantages included the potential cost of PrEP, partner mistrust when taking PrEP, discussion of sexual behaviors with a provider, and unclear process of acquiring the PrEP prescription. The results guided the development of a survey tool to further investigate aspects of cost, partner relations, stigma, reassurance of safety, and other factors. The tool can be used for future studies as part of guided interventions to increase PrEP uptake. Full article

Eating outside-of-home (EOH) is one of the main changes in lifestyle that occurred worldwide in the past few decades. Given that EOH behavior is influenced by individual and contextual factors, the utilization of a theory seems to be suitable in analyzing this health behavior. The fourth-generation theory multi-theory model (MTM) is designed exclusively for health behavior change at the individual and community levels. Therefore, the purpose of this analytical cross-sectional study was to investigate EOH behavior by using the MTM among a nationally representative sample in the United States (US). Data for this study were collected from April–May 2023 via a 61-item psychometric valid, web-based, structured survey disseminated via Qualtrics. Chi-square/Fisher’s exact tests were used to compare categorical data, whereas the independent-samples t-test was used to compare the mean scores of MTM constructs across groups. Pearson correlation analysis was performed for the intercorrelation matrix between the MTM constructs and hierarchical regression models were built to predict the variance in the initiation and sustenance by certain predictor variables beyond demographic characteristics. The p values in the multiple comparisons were calculated by using adjusted residuals. Among a total of 532 survey respondents, 397 (74.6%) indicated being engaged in EOH at least twice a week, whereas 135 (25.4%) reported not being engaged in EOH. People who were engaged in EOH were younger (mean age = 42.25 ± 17.78 years vs. 55.89 ± 19.43 years) African American, (15.9% vs. 6.7%, p = 0.01), single or never married, (34.0% vs. 23.0%, p = 0.02), had a graduate degree (9.6% vs. 3.7%, p = 0.03), and were employed (72.0% vs. 34.8%, p < 0.001) as opposed to those who reported not being engaged in eating outside the home. Among the MTM constructs of initiation, “behavioral confidence” and “changes in the physical environment” were the significant predictors of initiating a reduction in EOH behavior and explained 48% of the variance in initiation. Among the MTM constructs of sustenance, “emotional transformation” and “changes in the social environment” were the significant predictors of sustaining a reduction in EOH behavior and explained 50% of the variance in sustenance. This study highlights a need to design MTM-based educational interventions that promote in-home eating instead of frequent EOH for health, family bonding, economic, and other reasons. Full article

Background: In developing countries, access to information, awareness, and availability of COVID-19 vaccines are key challenges. Somalia launched the COVID-19 vaccination in March 2021; however, the uptake of the vaccination is slow, which creates fear of further loss of life in the country unless intentional and organized campaigning and efforts are made to improve both the availability of the vaccine and its acceptance by the community. This study aimed to understand the current level of awareness, accessibility, trust, and hesitancy toward the COVID-19 vaccine among women in Somalia. Methods: To assess COVID-19 vaccine uptake, acceptance, community awareness, and hesitancy rates in Somalia, we carried out a cross-sectional mixed methods study in three regions of Somalia that were selected randomly out of the 18 regions of Somalia. A multi-theory model (MTM) was developed to identify correlated factors associated with the hesitancy or non-hesitancy toward COVID-19 vaccination among women of all ages (18 years and above). Results: A total of 999 eligible women (333 in each district) of 18–98 years old were interviewed in March 2022. About two-thirds (63.76%) of participants reported hesitancy about receiving the COVID-19 vaccine. The theory model initiation construct indicated that behavioral confidence in the vaccine (b = 0.476, p < 0.001), participatory dialogue (at b = 0.136, p < 0.004), and changes in the physical environment (b = 0.248, p = 0.015) were significantly associated with COVID-19 vaccine acceptance among women who were not hesitant to take the vaccine. Conclusions: The availability of COVID-19 vaccines may not translate into their uptake. The decision to get the vaccine was determined by multiple factors, including the perceived value of the vaccination, previous experience with the vaccine, perceived risk of infection, accessibility and affordability, and trust in the vaccine itself. Public health education programming and messaging must be developed to encourage vaccine uptake among women with varying levels of vaccine hesitancy. Full article

Colorectal cancer is the third most common cancer worldwide and is the second leading cause of cancer-associated deaths. While colorectal cancer is on the decline in the United States (US), disparities still exist, despite the non-invasive screening modalities, such as stool-based tests have shown themselves to be effective in the detection of colorectal cancer. Many of the existing stool-based test interventions lack the use of a contemporary theory-based approach. Given the paucity of theory-based interventions intended to promote stool-based tests, this cross-sectional study utilizes the multi-theory model (MTM) of health behavior change to explain the seeking of stool-based tests for colorectal cancer (CRC) screening. An online 57-item questionnaire with an established psychometric validity was used to collect responses from the US-based sample (n = 640) of adults aged 45–75 years old. The data were analyzed using bivariate and multivariate statistical methods. Structural equation modeling (SEM) was conducted to test the construct validity of the survey instrument. In this nationwide sample, 39.2% (n = 251) of participants reported having received some form of a stool-based test. Among the participants who did not undergo stool-based CRC screening, the MTM subscales, including “participatory dialogue”, “behavioral confidence”, and “changes in the social environment”, were significant predictors of initiating screening behavior and explained 48% of the variance in the initiation among this group (R² = 0.579, F = 5.916, p < 0.001; adjusted R² = 0.481). The MTM may be a useful framework with which to design educational, mass media, social media, and clinical interventions for the promotion of stool-based CRC screening among adults aged 45–75 years old. Full article

Gambling among college students can start as a pastime activity. However, this pastime can lead to problem gambling and pathological gambling. This cross-sectional study aimed to identify and explain the initiation and sustenance of quitting gambling among university students who had participated in gambling during the past month and those who had not using a novel fourth-generation multi-theory model (MTM) of health behavior change. Data were collected from a sample of 1474 university students at a large southwestern university in the U.S. between January 2023 and February 2023, utilizing a validated 39-item survey. The statistical analyses employed in this study encompassed descriptive statistics, independent samples t-tests, and hierarchical regression modeling. Among students who had engaged in gambling in the past month, the constructs of participatory dialogue (β = 0.052; p < 0.05), behavioral confidence (β = 0.073; p < 0.0001), changes in the physical environment (β = 0.040; p = 0.0137), and demographic variables accounted for 27.7% of the variance in the likelihood of initiating the behavior change. Furthermore, the constructs of emotional transformation (β = 0.104; p = 0.0003) and practice for change (β = 0.060; p = 0.0368), and demographic variables accounted for 22.6% of the variance in the likelihood of sustaining quitting gambling behavior. The Multi-Theory Model (MTM) can be employed to design interventions aimed at reducing problem gambling among college students. Full article

During college years, perceived stress is the top reported hindrance to well-being and academic success. Data on the acceptance and perceived benefits of yoga among college students are limited. A purposive sample of college students (n = 79) from a course centered on Vinyasa Yoga and Mindfulness Meditation were recruited. Comprehensive yoga journaling data were collected, and a directed content analysis along the constructs of the multi-theory model (MTM) of health behavior change was utilized. The advantages of yoga that emerged were improved physical performance, reduced perceived stress, acceptance of oneself, better well-being, and improved coping. The identified disadvantages were time commitment, lack of motivation, and other competing interests. Learning through small steps, modifications, and identifying multiple sources of confidence helped build behavioral confidence. Practicing at home or at a yoga studio was a common theme for support in the physical environment. Directing negative emotions into purposes was helpful in maintaining the yoga practice. Sustained commitment to the practice also helped maintain the regular performance of yoga. Finally, social support from family, friends, and instructors was vital for continued practice. The study has important ramifications for the development of survey tools for descriptive studies and designing behavior-change yoga interventions in this target population. Full article