Search Results (2,010)

Urbanization increases pluvial flood risk by expanding impermeable surfaces, which is a trend likely to intensify with climate change. Permeable pavement (PePav) made from industrial byproducts, in accordance with circular economy principles, may improve soil permeability. Public acceptance remains a critical barrier to its implementation. Existing measures of willingness to accept (WtA) new technologies are inconsistent, limiting interdisciplinary collaboration. Therefore, a concise WtA scale was adapted from the Bogardus Social Distance Scale to assess acceptance of PePav at varying levels of proximity in residential contexts, from public flood-prone roads to private yards. The scale was evaluated across three studies: Study 1 (N = 195) and Study 2 (N = 187) utilized mixed student samples, while Study 3 (N = 625) involved a non-student sample. The 5-item solution, identified through factor analysis in Study 1, consistently demonstrated a unidimensional and cumulative structure and satisfactory reliability, even after the proposed PePav ingredient modification in subsequent studies. The scale correlated with recycling experience and professional background, indicating convergent validity, but not with flooding or informal construction experience, across all samples. Study 3 provided evidence of external validity by incorporating empirically well-established Theory of Planned Behavior (TPB) constructs and showing that WtA predicted PePav use beyond TPB variables and demographics. The scale also showed measurement invariance across sample type (student vs. general population) and different levels of construction experience. The constructed WtA scale is suitable for efficiently assessing professional and public acceptance of circular building materials and may have broad cross-disciplinary relevance. This enables timely, targeted interventions and informed policy decisions to advance sustainable technologies in the built environment, with substantial implications for education, professional policy, and sustainable engineering. Nevertheless, further validation is required. Full article

In Latin America, the double burden of malnutrition is the region’s single most important public health concern for the incoming decade. Latin America’s burden of disease has distinct features in comparison to high-income countries: nearly 20 percent of NCDs are diagnosed in people under 60 years of age in Latin America, whereas only about 13 percent of people under 60 years of age in North America and Europe are diagnosed with these diseases. We aimed to better understand decision-making processes, preferences, and norms around food choices to provide input for future programming and policy suggestions at national and regional levels. We included key informant interviews and focus group discussions with parents and adolescents from urban and rural communities in three regions in Colombia and in Mexico. Results showed that food choices considered to be affordable, acceptable, accessible, and aspirational are driven by environmental and social factors that influence individual cognitive decisions. Across the study groups, cognitive biases influenced food decision-making in relation to eating out, natural, homemade, and “moderation”. At the sociological level, conversations, and social influences at home and in communities were strong indicators of dietary practices, health beliefs, and body size attitudes. Full article

Authentic Digital Interaction (ADI) refers to citizens’ direct, secure, and independent engagement with e-government services without reliance on intermediaries. This systematic literature review applies ADI as an organizing lens to synthesize recent empirical evidence on determinants shaping citizen interaction with e-government. Following PRISMA, 178 peer-reviewed studies published between January 2020, and October 2025 were identified across five databases, and 43 met the inclusion criteria. Descriptive mapping and ADI-guided narrative synthesis were used to consolidate related determinants and interpret their associations and contextual conditions. The review identifies three dominant patterns: perceived usefulness and performance expectancy are most frequently associated with intention, use, and continuance; trust and confidence shape whether perceived benefits translate into engagement; and policy and governance condition service consistency and the effects of usability and accessibility. Theoretically, the review shows that ADI provides a useful lens for interpreting e-government research beyond adoption and satisfaction by emphasizing direct, trustworthy, inclusive, and independent citizen interaction. Practically, the findings suggest that public agencies should prioritize accessible design, transparent processes, visible safeguards, and supportive governance arrangements. However, no formal risk-of-bias assessment was conducted. In addition, the evidence base remains limited by the sparse examination of participation, value co-creation, autonomy, and empowerment, and the review protocol, although prepared in advance, was not registered. Full article

This study examines how demographic and socioeconomic characteristics shape the aesthetic perception of building-integrated photovoltaics (BIPV) in apartment housing. A survey of 418 respondents was conducted using visual scenarios showing PV integrated into rooftops, facades, balconies, and windows. Data were analysed using descriptive statistics, Pearson correlations, one-way analysis of variance (ANOVA) with Scheffé post hoc tests, multiple regression, and thematic analysis of open-ended responses. The results indicate that aesthetic responses to BIPV are not uniform across user groups. Younger respondents, participants with higher educational attainment, and respondents working in energy or technical fields tended to be more receptive to certain forms of BIPV integration, while architecture and design professionals were generally more critical of visually dominant applications. Rooftop PV received the highest overall ratings, while façade- and balcony-integrated applications generated greater disagreement. The regression models explained only a limited share of the variance, indicating that demographic factors are associated with broad perception patterns but do not strongly predict individual aesthetic judgement. The study offers context-specific evidence for facade-sensitive design guidance, retrofit prioritisation, and targeted stakeholder engagement in Jordan, with only cautious relevance to comparable settings pending cross-cultural validation. Full article

Background/Aim: Cardiovascular disease (CVD) represents a relevant global public health challenge with dyslipidemia as a major modifiable cardiovascular risk factor (CVRF). Recent advances have introduced injectable lipid-lowering therapies (LLT). Their clinical effectiveness in real-world practice seems to depend not only on pharmacological efficacy but also on patients’ acceptance, adherence, and persistence, influenced directly by perceived barriers and facilitators. The main objective of this scoping review is to map the barriers and facilitators related to the use of novel injectable LLTs among adult patients with dyslipidemia or CVD. Methods: This review was conducted in accordance with JBI methodology and reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for scoping reviews (PRISMA-ScR); pre-registration on Open Science Framework (OSF) was performed. A search was conducted in MEDLINE from PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) from EBSCOhost, and Google Scholar up to June 2025. Eligible studies included qualitative, quantitative, mixed-methods, and review papers involving adult patients with dyslipidemia who reported experiences, perceptions or challenges related to the use of injectable LLT in any healthcare or community setting worldwide. Two reviewers independently screened studies, selected and extracted data. Results: Out of 665 records identified, 7 studies met the inclusion criteria. Patients’ adherence to injectable LLTs is shaped by psychological fears, prior negative experiences, and perceived efficacy. Satisfaction increases when patients feel supported and informed. Convenience, self-administration, and motivational meaning facilitate persistence. Organizational support and economic accessibility further influence uptake, highlighting that adherence depends on both patient experience and structural factors. Conclusions: Patient acceptance and persistence with injectable LLT depends on a complex interplay of emotional, clinical, organizational and economic factors, beyond pharmacological efficacy alone. Fear of injections, previous statin-related experiences, administrative complexity, and high costs remain major barriers, while shared decision-making, trust in healthcare providers, perceived efficacy, regimen convenience, and supportive structures act as strong facilitators. Addressing these challenges requires multidimensional and multidisciplinary strategies for policy makers and clinical managers. Full article

Despite strong policy support for prefabricated interior decoration systems (PIDSs) in China, residential consumer uptake remains limited. Existing research has focused primarily on adoption drivers or industry-side promotion; in contrast, in this study, Innovation Resistance Theory (IRT) is employed to investigate the functional and psychological barriers to consumer acceptance in the Chinese residential market. Utilizing data from 476 Chinese consumers, partial least squares structural equation modeling (PLS-SEM) is applied to test a hierarchical mediation framework. The results demonstrate that functional obstacles, specifically risk and usage barriers, do not exhibit a direct association with resistance intention; rather, a significant indirect effect via perceived value and image is observed. Notably, the tradition barrier emerged as the most dominant predictor of resistance, reflecting a deep-seated cultural path dependency on traditional masonry methods and a perceived loss of construction rituals that disrupts system adoption. Furthermore, multi-group analysis (MGA) reveals a paradox of experience: while uninitiated users are resistant based on abstract stereotypes, those with traditional renovation experience are driven by status quo bias, and early adopters of PIDSs are resistant due to negative disconfirmation regarding usage friction and functional inflexibility. These findings suggest that, to achieve system equilibrium, the industry must transition from an industry-centric narrative to one focused on premium quality and user-centric design. Practical implications include the need to de-stigmatize prefabrication as precision manufacturing and to align policy and market interventions more closely with the concerns of individual end-consumers in order to improve residential market acceptance. Full article

Given South Korea’s acute land constraints and ambitious renewable energy targets, floating solar farms (FSFs) on multi-purpose dam reservoirs offer a sustainable land-sparing solution for advancing the water-energy nexus and climate adaptation. This study estimates households’ willingness to pay (WTP) for a tariff premium supporting FSFs on multi-purpose dam reservoirs—a bundled sustainability attribute encompassing land-sparing deployment, water-energy nexus synergies (90% evaporation reduction, hydropower complementarity), and avoided land-use conflicts—relative to equivalent electricity from land-based solar farms (LSFs). The valuation scenario explicitly frames FSFs as an integrated policy package, not an isolated engineering characteristic, with balanced disclosure of location-specific trade-offs. The study highlights the sustainability value of land-sparing water-energy nexus solutions in South Korea. The analysis draws on a nationwide contingent valuation survey of 1000 households conducted from mid-April to mid-May 2025. Employing the one-and-one-half-bound dichotomous choice format with a spike model to handle zero WTP responses, we estimate a mean tariff premium of KRW 26.8 (USc 1.9) per kWh—17% of the residential rate. This exceeds the current FSF-LSF levelized cost differential (KRW 19 per kWh), despite 49% zero bids largely from protest responses. Socioeconomic factors (education, income, female gender, metropolitan residence, policy awareness) significantly shape acceptance probabilities. These findings affirm meaningful support for FSF deployment, contributing to long-term sustainability by integrating renewable energy with water resource management and reducing land-use conflicts. They also inform sustainable energy transition policies by showing that consumers are willing to fund multifunctional infrastructure synergies. Full article

As a core decarbonization technology, the scaling up of Near-Zero Energy Building (NZEB) technologies under the “dual carbon” goal necessitates collaboration among governments, technology suppliers, and construction enterprises. However, high research and development (R&D) costs coupled with low market acceptance impede widespread adoption. This study develops a tripartite evolutionary game model to analyze strategic interactions among stakeholders. Using MATLAB 2022B simulations, we simulate the strategy sets for the government (subsidize/no subsidy), suppliers (R&D/no R&D), and enterprises (procure/no purchase). The results identify two Evolutionary Stable Strategies (ESS): a market-driven ESS (0, 1, 1) emerges when the green premium (Pm) exceeds the incremental cost (Cb); while a policy-driven ESS (1, 1, 1) requires government subsidies (S) to offset R&D gaps, specifically when $S>Cr/\alpha -Pmz$. These findings provide a theoretical basis for understanding the synergistic mechanisms underlying NZEB adoption and highlight the dynamic interplay between policy incentives and market forces. Full article

Introduction: Placental malaria increases the risk of adverse birth outcomes. Current preventive measures are undermined by poor coverage, growing resistance to chemo-preventive and therapeutic drugs, and vector eliminating insecticides. Candidate placental malaria (PM) vaccines (PAMVAC and PRIMVAC) have shown safety and immunogenicity in Phase I trials, but empirical evidence on their potential population-level value is lacking. This study modelled the expected cost-effectiveness of a PM vaccine administered before pregnancy. Methods: A decision-analytic model compared two strategies from the provider’s perspective: vaccinating women of childbearing age versus no vaccination. The model incorporated gravidity-specific risks of PM, neonatal mortality and the malaria attributable fractions from the literature. Since the efficacy of a PM vaccine for malaria prevention is unknown, we assumed a 40% efficacy and varied this estimate widely in sensitivity analyses. Primary outcomes were incremental cost-effectiveness ratios (ICERs) per perinatal disability adjusted life years (DALYs) averted. Baseline, best-case, and worst-case scenarios were analysed. One-way and probabilistic sensitivity analyses were used to assess parameter uncertainty. Cost-effectiveness was defined as an ICER below half of sub- Saharan Africa’s 2025 GDP per capita ($1556). Results: The vaccine was most cost-effective among primigravidae. Under baseline assumptions (40% efficacy; 30% uptake; $5 dose price), the ICER was $321 per perinatal DALY averted for primigravidae versus $4444 for multigravidae. Best-case assumptions further improved cost-effectiveness ($225 vs. $3148). Sensitivity analyses showed robust cost-effectiveness for primigravidae across all plausible parameter ranges, while ICERs in multigravidae were highly sensitive to programme costs and vaccine efficacy. Cost-effectiveness acceptability curves demonstrated that vaccination becomes favourable for primigravidae at relatively low willingness-to-pay thresholds. Conclusions: A placental malaria vaccine delivered before pregnancy has high potential to be cost-effective in endemic areas when targeted to protect primigravidae. These findings support prioritised deployment strategies and highlight the value of early economic modelling to inform vaccine development and policy planning. Full article

Background: Sexual Assault Care Centres (SACCs) in Belgium provide integrated medical and psychological care, a forensic examination and the option to report to the police to victims of sexual assault (SA). Understanding victims’ acceptability of these services is essential for improving SACC’s effectiveness and informing policy. Methods: In-depth interviews were conducted with 19 victims and 14 support persons to explore victims’ experiences with SACCs. The victims represented diverse characteristics (gender, age, SACC site and police reporting status). Data were analysed using thematic framework analysis, guided by Sekhon’s “Theoretical Framework of Acceptability”. Results: Participants viewed SACCs as a highly acceptable integrated model of specialised care for victims of recent SA. They expressed strong appreciation for the care provided at the SACC and its set-up (affective attitude), and they identified key professional qualities of SACC professionals (ethicality). Participants demonstrated good understanding of the functioning of the SACCs (intervention coherence). The model was perceived as effective in providing medical care, mental health support, and facilitating police reporting, though gaps were noted in linking victims with other actors in the criminal justice system (perceived effectiveness). Organisational strengths included the holistic, long-term, proactive, affordable and accessible nature of the care offered (perceived effectiveness, burden and opportunity cost). Victims faced challenges in linking to, engaging with and remaining in care due to distress post-SA, with support persons playing a crucial role in helping them navigate these challenges (self-efficacy). Conclusions: The study highlights the acceptability of an integrated, multidisciplinary approach to specialised SA care. Key elements include embedded psychological support, the option for forensic examination without mandatory reporting, and the possibility of police reporting at the SACC. These findings may inform the development of specialised SA services in other settings. Full article

This study provides an in-depth examination of the association between sustainable agricultural practices and economic sustainability among small-scale farmers in the canton of Ambato, Ecuador, with attention to gender differences in the adoption of specific practices. The study used a cross-sectional quantitative design and structural equation modeling (SEM) based on data from 150 farmers. The results demonstrate that intention to adopt sustainable practices was positively associated with economic sustainability (β = 0.96), and perceived benefits also showed a positive relationship with economic sustainability (β = 0.29). Conversely, agricultural practices showed a negative direct structural coefficient with economic sustainability (β = −0.29), thereby suggesting that the short-term costs of implementation may reduce immediate economic returns in resource-constrained contexts. Descriptive results indicated differences in the adoption of specific practices by sex, especially in crop rotation, biological pest control, and efficient irrigation, although the evidence for gender differences in economic sustainability was mainly descriptive rather than inferential. The model showed acceptable fit (CFI = 0.934, TLI = 0.917, RMSEA = 0.065). Overall, these findings contribute empirical evidence from an Andean agricultural context and suggest that training, technical support, and transition-cost reduction policies are necessary to strengthen the economic viability of sustainable agriculture. Full article

Background: Although pre-exposure prophylaxis (PrEP) has demonstrated strong clinical efficacy in preventing HIV infection among men who have sex with men (MSM), real-world utilization remains suboptimal. In South Korea, MSM constitute a major population within the domestic HIV epidemic; however, PrEP uptake has not increased pro-portionally to awareness. This discrepancy has been conceptualized as the “awareness–uptake gap,” reflecting multi-level barriers beyond individual knowledge. Purpose: This integrative review aimed to compare PrEP awareness, acceptance, and utilization among MSM populations in South Korea and international settings, and to identify structural, institutional, and psychosocial determinants contributing to the awaness, uptake gap. The study further sought to derive practical implications for nursing practice and health policy. Methods: An integrative literature review was conducted following Whittemore and Knafl’s five-step methodology and reported in line with PRISMA guidance. Electronic searches were performed in PubMed, Google Scholar, RISS, ScienceON, and DBpia for peer-reviewed studies published between 2015 and 2025 in English or Korean. The final search was completed on 31 January 2026. A total of 5952 records were identified, and 187 studies met the inclusion criteria after screening and duplicate removal. Quality appraisal was conducted using AXIS, Newcastle-Ottawa Scale, RoB 2.0, CASP, and MMAT according to study design, and the findings were synthesized within an environmental–structural–individual framework. Results: The included studies consistently showed that awareness of PrEP exceeded actual uptake. Across settings, the awareness–uptake gap was shaped by policy environment, service accessibility, stigma, privacy concerns, economic burden, institutional complexity, and provider preparedness. Comparative evidence from China, Thailand, Belgium and France, Brazil, and West Africa further suggested that awareness alone did not ensure uptake when service pathways were fragmented, culturally unsafe, or poorly understood. Conclusions: Closing the awareness–uptake gap requires integrated policy and practice strategies that extend beyond cost reduction. Strengthening confidentiality systems, simplifying service pathways, and enhancing provider competency—particularly through nurse-centered PrEP navigation and counseling models—may support more sustainable PrEP expansion among MSM populations in global settings. Full article

The Technology Acceptance Model (TAM) has been widely used to explain e-banking and digital technology adoption. Existing literature supports the robustness of its core relationships, but the magnitude of the effects varies considerably across studies, raising questions about their stability and generalizability in new contexts. Existing meta-analysis studies focus primarily on pooled effect sizes, providing limited insight into the temporal stability of relationships, their sensitivity to individual studies, and the extent to which observed heterogeneity reflects contextual variation. This study contributes by reinterpreting heterogeneity not as a problem to be reduced, but as a feature that defines the limits of generalizability. We advance the TAM literature by moving beyond average effects and rethinking empirical evidence through the joint lens of robustness, stability, and dispersion. We conduct a random-effects meta-analysis on 44 effect sizes (correlation coefficients) coming from 43 research papers indexed in Web of Science and Scopus. In addition to pooled correlations, the analysis employed cumulative meta-analysis, leave-one-out influence diagnostics, prediction intervals, and publication bias assessments to evaluate the evolution, consistency, and variability of TAM relationships across contexts. The findings show that core TAM relationships are consistently positive and stable at the aggregate level yet display substantial variation across empirical settings. While some relationships remain robust across contexts, others exhibit prediction intervals that include zero, indicating that their strength and even direction may depend on contextual conditions. As prior TAM meta-analyses have not systematically incorporated prediction intervals, this study provides new evidence to the extent to which TAM relationships generalize beyond average effects. The results further show that although TAM offers a reliable structural framework, interventions and policies based on its core relationships must be context-sensitive, because relying on average effects alone may lead to ineffective or inconsistent adoption outcomes. Full article

Driven by the global agenda of low-carbon urban development, local governments in China have implemented targeted policies requiring new energy vehicle adoption in the ride-hailing industry. This study focuses on a key issue in the development of sustainable smart public transportation systems: the factors affecting the acceptance of electric vehicles (EVs) in ride-hailing services among full-time and part-time drivers. Using 432 valid samples of ride-hailing drivers from Zhangzhou, a third-tier city in China, we compared the basic personal attributes of full-time and part-time drivers. Ordered logit models were developed to explore differences in factors influencing their acceptance of electric ride hailing (ER). Findings reveal: (1) Drivers’ perceived significance of EVs in green transportation is positively associated with their acceptance of ER. (2) Endurance mileage and charging efficiency have no significant effect on acceptance among drivers in underdeveloped cities. (3) Full-time drivers exhibit relatively low concern for subsidy policies, whereas part-time drivers express a pressing need for vehicle purchase subsidies and operational subsidies. (4) Overall, part-time drivers demonstrate higher acceptance of ER than full-time drivers. Based on these findings, this paper offers policy recommendations for governments to enhance ER acceptance among both driver groups. It is important to note that the present study utilizes survey data collected from Zhangzhou. The research conclusions should be treated with caution when applied to other cities, and further studies can be conducted in different regions to verify the results. Full article

Indonesia has identified clean hydrogen as one of the strategic initiatives for its energy transition, recognizing its potential as an energy carrier that can support the achievement of net zero emissions. To deepen the understanding of this emerging technology, this study assesses the readiness of green hydrogen development in Indonesia through a multi-stakeholder perspective combined with a technology readiness evaluation and insights from global developments. Based on stakeholder interviews across government, industry, academia, and energy institutions, this analysis identifies key enabling conditions and barriers for hydrogen deployment in the Indonesian context. This analysis indicates that the readiness level of green hydrogen technology in Indonesia has reached approximately technology readiness level (TRL) 5–TRL 6, suggesting that most initiatives remain at the pilot and demonstration stages. In addition, seven key factors influencing green hydrogen adoption were identified: infrastructure and technology, policy and regulation, finance, application sectors, public acceptance, standardization, and private sector participation. These results provide policy-relevant insights for accelerating hydrogen development and highlight priority areas for advancing Indonesia’s transition toward a low-carbon energy system. Full article