Search Results (1,212)

Justice has received more and more attention in the management of tourist destinations, but its function in cultural heritage situations is still insufficiently investigated. This research investigates the supportive attitudes of the residents towards the Intangible Cultural Heritage (ICH)-related festivals by using an integrated framework including the perceived justice, festival identity and perceived economic benefits. A quantitative study was conducted based on 552 returned valid questionnaires. After reliability and validity tests, structural equation modeling, bootstrap mediation analysis, and multi-group structural equation modeling were employed to test the research hypotheses. The results indicate that all three aspects of the perceived justice have a positive effect on the festival identity of the residents, which consequently enhances their support for the development of the festival. These findings broaden the justice-based views in tourism research and offer useful suggestions for promoting fair and community-supported festival tourism development. Full article

Large-scale participatory budgeting (PB) lacks a mechanism for reconciling divergent resident preferences before project selection. Conventional consensus feedback mechanisms are difficult to deploy in this setting because anonymous ballots provide no direct basis for tailoring feedback, while resident-by-resident adjustment is computationally infeasible at population scale. We therefore develop a trust incentive-driven consensus feedback mechanism that transforms ballots into structural and behavioral signals. We apply fuzzy c-means (FCM) to identify overlapping preference groups and use the resulting memberships to construct group-mediated proxy trust, while using supported project costs to infer residents’ risk attitudes. These signals are incorporated into an extended interactive trust function (E-ITF) and a bounded consensus model that generates differentiated trust incentives and resident-specific adjustment bounds. Then, we develop the trust incentive-driven bounded consensus (TIBC) algorithm, which identifies selected inconsistent residents as a batch, determines bounded adjustment coefficients, and iteratively updates preferences, proxy trust, and resident weights. Finally, we evaluate the proposed mechanism using a real municipal PB case. TIBC algorithm reaches the common consensus target in two iterations, while maintaining subgroup consensus balance. These findings provide decision makers with a transparent and scalable way to incorporate consensus feedback into anonymous PB without requiring observed interpersonal trust data. Full article

Objectives: To assess the knowledge, attitudes, and intended practices (KAP) of pulmonary tuberculosis (PTB) patients regarding the disease and home-based treatment. Methods: A cross-sectional study was conducted at the authors’ hospital from 1 September 2024 to 28 February 2025, using a self-designed KAP questionnaire. Differences in KAP scores across demographic subgroups were analyzed, and the associations among knowledge, attitude, and practice were examined. Results: A total of 509 valid responses were included (effective rate: 90.73%). Participants were predominantly male (56.6%) and rural residents (68.0%). Their mean (SD) knowledge, attitude, and intended practice scores were 26.20 (2.90) (possible range: 15–30), 32.09 (4.14) (possible range: 9–45), and 35.89 (5.57) (possible range: 8–40), respectively. Correlation analysis showed significant but relatively weak positive correlations between knowledge and attitude (r = 0.257, p < 0.001), knowledge and intended practice (r = 0.136, p = 0.002), and attitude and intended practice (r = 0.251, p < 0.001). Multivariate logistic regression revealed that knowledge score (OR = 1.098, p = 0.007) and attitude score (OR = 1.094, p < 0.001) were independently associated with better intended practice. Living in rural areas (OR = 0.633, p = 0.043) and being government/enterprise/public institution staff (OR = 0.386, p = 0.004) were independently associated with lower intended practice scores. Conclusions: These findings highlight that higher levels of knowledge among PTB patients are positively associated with more favorable attitudes and better anticipated self-management practices. These associative findings generate the hypothesis that targeted educational interventions, especially among populations with lower education levels or non-urban backgrounds, might improve expected home-based treatment adherence, which warrants validation in future longitudinal studies. Full article

Wool is often regarded as a low-value by-product of Alpine sheep farming, despite its potential to convey the ecosystem services (ESs) generated by these systems. This study examines how awareness and perception of these services are associated with consumer attitudes towards locally produced wool in the Lanzo Valleys in Northwestern Italy. A convenience sample of 400 adults familiar with the study area completed an online questionnaire. Principal Component Analysis identified two orientations towards wool products—Sustainability Orientation and Product-Value Orientation—which together explained 69.33% of the variance. A TwoStep Cluster Analysis based on the component scores identified four profiles within the study sample: Sustainability-sensitive (22%), Disinterested (14.25%), Eco-aesthetic (36%), and Aesthetically aware (27.75%). Sustainability-oriented respondents attributed greater importance to ES related to biodiversity, native-breed conservation and animal welfare, whereas aesthetic and experiential attributes represented an additional, distinct dimension of product evaluation. Residence status was not significantly associated with cluster membership. Given the non-probabilistic sampling design, these profiles should be interpreted as exploratory attitudinal patterns. The findings may inform differentiated communication and wool-valorisation strategies linking environmental, cultural, aesthetic and functional values. Full article

This study was conducted to examine the perceptions and attitudes of final-year veterinary students regarding the Official Minimum Fee Schedule established for veterinarians in Türkiye, within a multidimensional framework. The research was conducted with a total of 216 final-year students enrolled in veterinary faculties in Türkiye. Data were collected using a questionnaire consisting of Likert-type items. The construct validity of the scale was assessed using Exploratory Factor Analysis (EFA), and its reliability was measured using Cronbach’s alpha coefficients. The study found that the majority of students considered providing services below the official minimum fee schedule to be ethically inappropriate and reported that professional organizations play an important regulatory and supervisory role in this regard. In terms of demographic variables, no statistically significant differences were found in factor scores based on gender, income level, university, level of education, or internship experience. However, significant differences were identified in the dimensions of regulatory–deontological attitudes and price transparency based on place of residence. In conclusion, attitudes toward the minimum fee schedule in veterinary medicine are shaped not only by legal knowledge but also by ethical values, professional socialization processes, and institutional norms. These findings highlight the importance of addressing fee policies in veterinary education together with their ethical and professional dimensions, as well as strengthening the awareness-raising role of professional organizations. Full article

Background/Objectives: Primary health care (PHC) utilization in rural communities may depend not only on service availability but also on residents’ knowledge of available services, beliefs about service providers, and expectations regarding the value of care. This analytical cross-sectional study examined factors associated with PHC utilization among adults in the catchment areas of subdistrict health promoting hospitals (SHPHs) in Roi Et Province, Northeastern Thailand. Methods: Using multistage sampling, 10 districts, 20 subdistricts, and 20 villages were selected, followed by convenience recruitment of eligible adults within the sampled villages. A total of 461 participants completed a structured questionnaire assessing sociodemographic characteristics, perception, attitudes, expectations, and PHC utilization. Content validity was supported by Index of Item–Objective Congruence values of 0.67 to 1.00, and Cronbach’s alpha coefficients ranged from 0.97 to 0.98. Data were analyzed using descriptive statistics, correlation analysis, and multivariable linear regression. Results: Participants were predominantly female (65.08%), with a mean age of 49.90 years (SD = 15.23). Using predefined equal-width score intervals, perception was classified as moderate (M = 3.59, SD = 0.36), attitudes as positive (M = 3.91, SD = 0.50), expectations as high (M = 4.18, SD = 0.47), and PHC utilization as high (M = 4.13, SD = 0.53). Relatively higher expectation (β = 0.388, p < 0.001), attitude (β = 0.279, p < 0.001), and perception scores (β = 0.149, p < 0.001) were independently associated with greater overall PHC utilization. The adjusted analysis included 446 participants and explained 46.8% of the variance in PHC utilization (R² = 0.468; adjusted R² = 0.453; overall model p < 0.001). Conclusions: These findings identify residents’ service-related knowledge, beliefs, and anticipated value as factors associated with PHC utilization and as potential areas for further evaluation in communication and service-improvement initiatives. However, causal direction cannot be established, and the findings should not be generalized beyond the sampled communities in Roi Et Province without further research. Full article

Background/Objectives: Dental caries remains one of the most prevalent and preventable childhood diseases worldwide. Despite universal access to free dental care in Saudi Arabia, preventable oral diseases remain common, highlighting persistent gaps in oral health literacy and preventive behaviours among children. Male students consistently demonstrate poorer oral health knowledge and practices than their female counterparts, yet they remain understudied. This study aimed to assess oral health knowledge, attitudes, and practices (KAP) among male primary school students in Al Lith city, Saudi Arabia, and to identify their associated sociodemographic determinants. Methods: A school-based analytical cross-sectional study was conducted during the 2023–2024 academic year in Al Lith city, Makkah Province, Saudi Arabia. A total of 430 male students aged 10–13 years from grades five and six were recruited via multistage cluster sampling from 8 randomly selected schools. A validated, interviewer-administered, Arabic-language questionnaire assessed knowledge (18 items), attitudes (12 Likert-scale items), and practices (12 items) related to oral health, alongside sociodemographic data. The study was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Data were analysed using IBM SPSS Statistics version 27. Descriptive statistics and multivariable logistic regression were performed. Results: Of the 430 participants, 83.3% were aged 11–12 years, 89.8% were Saudi nationals, and 89.1% resided in intact, two-parent households. Knowledge deficits were widespread: only 8.4% correctly identified the recommended timing of sweet consumption, 20.2% understood dental plaque, and 28.6% recognised the protective role of fluoride. Attitudes were generally positive, with 80.1% agreeing that teeth should be brushed twice daily and 71.6% endorsing regular dental visits; however, 60.3% held that dental attendance was necessary only when pain was present. Substantial practice gaps were also evident: only 33.3% brushed for the recommended two minutes, and 12.6% had never visited a dentist. In multivariable analysis, low household income was independently associated with better oral health knowledge (adjusted odds ratio [AOR] = 2.22; 95% confidence interval [CI]: 1.04–4.74; p = 0.039), divorced parental status was independently associated with positive oral health attitudes (AOR = 5.40; 95% CI: 1.28–22.79; p = 0.022), and older age was independently associated with poorer oral health practices (AOR = 0.72; 95% CI: 0.55–0.93; p = 0.014). Conclusions: Male primary school students in Al Lith demonstrated generally positive oral health attitudes but significant deficits in knowledge and preventive practices. Comprehensive, school-based oral health promotion programmes that address key misconceptions, actively engage parents, and integrate culturally accepted practices—such as miswak use—with evidence-based preventive guidance are needed. Full article

Background: Genetic diseases pose a significant public health issue in Saudi Arabia, driven by relatively high prevalence and factors such as consanguineous marriage. Increasing public awareness and understanding are crucial to improving prevention, early detection, and the use of genetic healthcare services. This study aimed to evaluate residents’ knowledge, attitudes, and awareness of genetic diseases in the Qassim region. Methods: A web-based cross-sectional survey was conducted from March to May 2024 among Qassim residents, using an online questionnaire shared via multiple social media platforms. The survey assessed knowledge of genetic diseases, awareness of preventive measures and screening programs, and familiarity with genetic healthcare services. Descriptive statistics summarised the results, and binary logistic regression was conducted to identify factors independently associated with good awareness of genetic testing. Results: Of the 398 participants, about 66% knew about common genetic diseases in Saudi Arabia, while 92% recognised consanguineous marriage as a key cause of genetic disorders. Most respondents correctly identified that genetic diseases are not transmitted through infection (93%). Support for expanding premarital, prenatal, and newborn screening programs was high at 93%, 88.9%, and 90.7%, respectively. Nonetheless, only 38.7% were aware of specialised genetic laboratories and counselling services, and just 4.4% had consulted a genetic counsellor. Social media was the primary source of genetic information (36%). Despite limited awareness of available services, 94% supported establishing a regional genetic testing lab, and 71% were willing to participate in future genetic research. Multivariate analysis identified that marital status is the only variable significantly associated with genetics testing awareness status [aOR = 2.34; 95% CI (1.08–5.08); p = 0.030]. Conclusions: Participants demonstrated generally good knowledge of genetic diseases and positive attitudes towards preventive genetic screening programmes. However, awareness of and utilisation of specialised genetic healthcare services, including genetic counselling and genetic testing laboratories, remained limited. These findings underscore the need to enhance public education, expand genetic counselling, and improve access to specialised services to advance genomic medicine in Saudi Arabia. However, the predominance of younger participants and students may limit the generalisability of the findings to the broader Qassim population. Full article

Background/Objectives: Lumbar puncture (LP) is an essential diagnostic and therapeutic procedure in neurological practice. Despite its clinical value, misconceptions and fear may influence its acceptance among the public. This study aimed to assess knowledge, attitudes, and misconceptions regarding LP among adults in Saudi Arabia and to examine associated sociodemographic factors. Methods: A cross-sectional study was conducted between June 2025 and January 2026 using a structured, self-administered online questionnaire adapted from a previously validated instrument. Adults aged ≥18 years residing in Saudi Arabia were recruited via convenience sampling through open social media channels, so the sample is self-selected rather than population-representative. Knowledge and attitude scores were categorized into defined levels, and multivariable regression analyses were performed to identify independent predictors. Results: A total of 1267 participants were included. Knowledge of LP was limited (mean 6.1 ± 3.9 of 18), with 905 (71%) scoring poor and only 362 (29%) demonstrating good knowledge; misconceptions about complications such as urinary incontinence and erectile dysfunction were common. Attitudes appeared favorable, with 1182 (93%) reaching the pre-specified 50% threshold, but this cut-off is lenient because an entirely neutral respondent scores 60% on a summed five-point scale, and only 692 (55%) agreed they would sign consent if their physician recommended LP. Knowledge and attitude were weakly but significantly related (r = 0.21, 95% CI 0.16 to 0.26; adjusted β = 0.25 per additional correct item, p < 0.001). Higher education, student status, healthcare occupation, and higher income predicted better knowledge, and male sex predicted lower knowledge (all p < 0.05), whereas sociodemographic factors were weakly associated with attitude. Conclusions: Among self-selected online respondents in Saudi Arabia, knowledge of lumbar puncture was limited while attitudes were comparatively favorable, and the two were weakly but positively related. Targeted educational interventions are warranted to address misconceptions, enhance public awareness, and support informed decision-making within the healthcare system. Full article

Cruise tourism is one of the fastest-growing segments of the global tourism industry, generating significant economic benefits while also creating challenges related to overtourism, congestion, environmental pressure, and residents’ quality of life. Understanding residents’ attitudes towards tourism is therefore essential for sustainable destination management. Although previous studies have examined the roles of place attachment and quality of life in shaping tourism attitudes, evidence from cruise destinations remains limited. This study investigates the influence of place attachment and quality of life on residents’ attitudes towards tourism in two contrasting European cruise destinations: Kotor (Montenegro) and Athens/Piraeus (Greece). Additionally, it aims to explore the link between place attachment and quality of life, which remains understudied in this context. The study also investigates whether destination moderates the effect between explored variables. To address this objective, Kotor and Athens/Piraeus were purposively selected as a maximum-variation pair. A quantitative survey was conducted among 319 local residents (157 from Kotor and 162 from Athens/Piraeus). The findings indicate that both place attachment and quality of life significantly influence residents’ attitudes towards tourism. Stronger place attachment was associated with more positive perceptions of social interaction with tourists and beneficial cultural impacts, but it also influenced residents’ attitudes indirectly through perceived quality of life. Moreover, place attachment was identified as a significant determinant across all five dimensions of residents’ quality of life. Furthermore, quality-of-life dimensions, particularly heritage and commercial development, socialisation and economic opportunities, and environmental conditions, emerged as significant predictors of tourism attitudes. Destination comparisons revealed overall consistency between both cruise tourism destinations, except for the link between place attachment and health and safety benefits, which was stronger among residents of Athens. The findings provide practical implications for sustainable tourism planning by highlighting the importance of incorporating residents’ perceptions into destination management. Full article

Background: Antimicrobial resistance (AMR) remains a major global public health threat, largely driven by inappropriate antibiotic use. Smart health technologies (SHTs), including mobile health applications and digital stewardship tools, offer promising opportunities to improve antibiotic use and strengthen antimicrobial stewardship. This study assessed public knowledge, practices, and stated acceptance of selected SHTs related to antibiotic use and AMR management among adults residing in Saudi Arabia. Methods: A cross-sectional online survey was conducted among adults residing in Saudi Arabia between November 2025 and January 2026 using a structured questionnaire assessing knowledge and practices related to antibiotic use, awareness of SHTs, perceived barriers, and acceptance of digital health technologies. Descriptive and inferential statistical analyses were performed. Results: A total of 434 consenting participants were included in the final analysis. Participants demonstrated gaps in knowledge of antibiotic use and AMR, while misconceptions and inappropriate practices remained common, including lifetime non-prescription antibiotic use (37.8%) and sharing antibiotics (31.3%). Awareness of SHTs was limited, with only 30.4% aware of antibiotic-related mobile health applications. Despite limited awareness, 61.8% were willing to use medication-reminder applications and 87.3% preferred electronic prescriptions. The mean acceptance score was 4.39 ± 0.66/5, and 79.7% had high stated acceptance. In an exploratory adjusted analysis, female respondents had higher odds of meeting the predefined high-acceptance threshold (AOR = 1.88, 95% CI: 1.04–3.40); however, this finding should be interpreted cautiously because the overall regression model was not statistically significant and showed modest discrimination. Perceived barriers were not independently associated with acceptance. Conclusions: Despite gaps in knowledge and persistent inappropriate antibiotic-use practices, the surveyed online respondents demonstrated favorable stated attitudes toward selected smart health technologies. These findings should not be interpreted as evidence of actual adoption or national implementation readiness. Further nationally representative and prospective studies are required before broader implementation can be recommended. Full article

Urban forest parks (UFPs) are important recreational green spaces within the urban built environment, contributing to urban residents’ subjective vitality and well-being. Understanding how the motivations of visitors to urban forest parks translate into positive psychological experiences is crucial for promoting urban residents’ physical and mental health. This study concentrated on the motives for visiting UFPs in Fuzhou, China, and developed a conceptual framework of “motivation–attitude–visit frequency–experience” to explore the pathways through which two dimensions of motivation influence leisure experience. Data were obtained from the responses of 573 visitors (242 males, 331 females) by using on-site intercept sampling, and online and on-site questionnaire survey at seven UFPs across the city. Serial mediation analysis was used to test the proposed relationships. The results showed that both extrinsic and intrinsic motivation positively predicted visit attitudes (β = 0.297, p < 0.001; β = 0.309, p < 0.001); only intrinsic motivation had a significant positive impact on visit frequency (β = 0.147, p = 0.031), and both visit attitudes and visit frequency positively predicted leisure experiences (β = 0.371, p < 0.001; β = 0.402, p < 0.001). Extrinsic motivation was entirely mediated by attitude, forming an indirect path to leisure experiences, whereas intrinsic motivation influenced experiences through both direct paths and indirect paths. The findings reveal the important role of attitude in linking visitors’ motivations with urban forest park use and experiential outcomes. Decision-makers should consider visitors’ motivational orientations and psychological responses in the planning, design, and management of urban forest parks to promote more meaningful and sustainable engagement with urban nature. With complexities of cities, more attention needs to be given to the use of longitudinal studies in future research to obtain comparable findings and further generalizations. Full article

Globally, Australia is ranked the fourth-top producer of e-waste. While Australian states and territories are increasingly recognising the e-waste problem and developing policies and regulations that deal with e-waste, huge amounts of e-waste still go undocumented. Currently, regional councils are concerned with the existing recycling practices owing to the escalating quantities of e-waste generated yearly. This paper examines the e-waste management practices of Victorian and Queensland regional councils, compares the current practices in managing e-waste, identifies the problems and challenges, and recommends innovative approaches to address e-waste collection and recycling practices in Australia. This study was conducted in regional Victoria and Queensland councils. A qualitative research method employing semi-structured interviews is adopted in this study. The study interviewed 49 employees of Victorian and Queensland regional councils. The findings of the study identified a number of areas that needs improvement in the management of e-waste such as: (a) lack of education and awareness about e-waste for the residents in the communities, (b) absence of knowledge about e-waste recycling (c) poor attitude towards e-waste recycling, (d) lack of sufficient funding; (e) limited number of e-waste recyclers to engage, (f) lack of specific policies and legislation on e-waste management (g) inability of the current National Television Computer Recycling Scheme (NTCRS) and mobile muster national product stewardship initiatives and schemes to cover all categories of e-waste. These results suggest that e-waste management practices in Victorian and Queensland Regional Councils need improvement. The findings of this study show that there are more similarities and fewer differences in how the Victorian and Queensland regional councils manage their e-waste. This study provides numerous practical and workable suggestions for addressing the e-waste management practices of regional councils in Australia. From a real-world scenario, this study will be useful to regional councils, environmentalists, and policymakers in identifying areas of improvement in e-waste management practices and developing impactful solutions. Full article

Environmental sustainability projects are essential for preserving natural resources and enhancing quality of life for present and future generations. This cross-sectional study examined Saudi residents’ knowledge and awareness of green projects, attitudes and perceptions toward them, personal environmental behavior and participation, and perceptions of institutional and societal roles. A questionnaire was administered to 1044 participants from various regions across Saudi Arabia. Descriptive statistics, including means and standard deviations, together with the Mann–Whitney U test, Kruskal–Wallis H test, and Dunn’s post hoc test, were used to answer the research questions and test the hypotheses. The findings indicated generally positive responses across the four dimensions; at the item level, most items fell within the agree range, while neutral ratings appeared mainly in items related to following green-project news, reviewing related policies, using low-emission transportation, and the perceived sufficiency of institutional communication. Significant differences were observed in the overall questionnaire and several dimensions according to gender, favoring females, and according to nationality, favoring Saudi participants. Regional differences were limited to the environmental behavior and personal participation dimension, whereas educational qualification did not produce significant differences. The absence of educational differences suggests that green-project awareness and behavior may be shaped not only by formal educational level, but also by national campaigns, media exposure, and shared public discourse. The study provides a countrywide empirical baseline for green-project awareness, attitudes, and environmental behaviors in Saudi Arabia and identifies areas for more targeted communication, regional engagement, and longitudinal research. Full article

Background: Informed consent is an essential ethical and legal process that safeguards patient autonomy, integrity, and rights in healthcare. Although it has traditionally been associated with medical practice, the expanding scope of nursing practice and increased professional autonomy require a clearer understanding of nurses’ roles in this process. Given nurses’ continuous and close contact with patients, examining their knowledge, attitudes, and practices regarding informed consent is essential to ensure ethical standards and patient safety. Objectives: This scoping review will map and synthesize the available evidence on the knowledge, attitudes, and practices of general nurses, specialist nurses, resident nurses, and nursing students in relation to informed consent. Methods: This review will follow the Joanna Briggs Institute methodology for scoping reviews and will be guided by the PRISMA-ScR extension. A comprehensive search strategy will be applied to MEDLINE, CINAHL, Web of Science, Scopus, and Cuidatge databases. Quantitative, qualitative, and mixed-methods studies addressing nurses’ knowledge, attitudes, and practices regarding informed consent will be included. Discussion papers, reflective articles, commentaries, letters to the editor, opinion articles, books, book chapters, gray literature, and literature reviews will be excluded. Study selection and data extraction will be performed systematically, and findings will be synthesized descriptively and presented through tables and narrative analysis. Conclusions: This protocol outlines a transparent and reproducible methodology for a scoping review. It will map evidence on nurses’ and nursing students’ knowledge, attitudes and practices regarding informed consent; it will summarize the existing evidence as well. This study was prospectively registered with the Open Science Framework (OSF) on 13 May 2026. Full article