The Promotion and Development of Community Health for Personal Health: Theories and Applications

This study aimed to examine the physical activity and exercise status of stroke patients in the community after discharge and the need for community-based exercises. This study included 100 community-dwelling patients with stroke in South Korea. The survey investigated the self-assessment of health status and physical activity, demand for community-based exercise after discharge, quality of life, and social participation. Overall, 96% of the respondents recognized the need to exercise, and two-thirds exercised. The third who did not exercise cited disability (29%), lack of facilities (22%), and health concerns (13%); only 21% of participants had ever used a community exercise facility, and their satisfaction with the facility was low. The main reasons for not using community exercise facilities were concerns about accidents during exercise and accessibility issues. Among real-world community stroke patients, those who exercised regularly had higher EuroQol-5D and reintegration to normal living indices than those who did not exercise (p < 0.05). Although community-dwelling stroke patients were highly aware of the need for physical activity and exercise, few engaged in adequate exercise. This lack of engagement is directly linked to identifiable personal and socio-structural barriers. Addressing these barriers will improve the quality of life and social participation of patients with stroke. Full article

Nutrition promotion programs may have varying effects and influence health disparities. SuperShelf promotes healthy choices in food pantries through inventory changes and nudge implementation (e.g., choice architecture). This secondary analysis of the SuperShelf cluster-randomized trial assessed whether the effect of SuperShelf on client diet quality differed by equity characteristics. English-, Spanish-, or Somali-speaking adult clients from 11 food pantries in Minnesota were included (N = 193). We measured change in diet quality by the Healthy Eating Index 2015 (HEI-2015; maximum score 100) using up to two 24 h dietary recalls from pre-intervention and post-intervention periods. We used linear mixed-effects models to determine whether the effect of SuperShelf on diet quality varied by self-reported gender, race/ethnicity, education, and employment status. In separate adjusted models, the interactions of SuperShelf and gender, education, or employment status were not significant. The interaction of SuperShelf and race/ethnicity was significant (p-interaction = 0.008), but pairwise comparisons in diet quality were non-significant in all racial/ethnic subgroups. SuperShelf did not have differential effects on diet quality by gender, race/ethnicity, education, or employment status, suggesting it does not worsen dietary disparities among food pantry clients, though more subgroup analyses are needed to explore potential racial/ethnic disparities in this context. Full article

The association between younger age and poorer mental health during the COVID-19 pandemic has been documented. Whether these changes were associated with a change in antidepressant (AD) use is not well understood. This study aimed to estimate the impact of the COVID-19 pandemic on AD use by young adults in the ASL TO4 Regione Piemonte (Italy). The impact of the pandemic on the weekly prevalence of AD users was assessed using interrupted time-series analysis with autoregressive integrated moving average models. A total of 1071 subjects (18–22 years with ≥1 AD dispensation) were included in the study. The observed prevalence was lower than the predicted value for several weeks after the introduction of the lockdown. However, it was consistently higher than the predicted values from week 134. The maximum difference between observed and predicted values (25 subjects per 10,000 young adults) was found at week 170. Changes in AD use were observed in both genders and were more pronounced for selective serotonin reuptake inhibitors. In conclusion, the impact of the COVID-19 pandemic on the mental health of young adults is likely to be significant in the coming years, which may place a future burden on pharmaceutical public health and community health. Full article

In response to the distinctive healthcare requirements of independent, healthy, community-dwelling older adults in Japan and other developed countries with aging populations, the current study examined the differences in factors associated with self-rated health (SRH) between the following two age groups: young–old (65–74) and old–old (75 and above). Age-stratified analysis was used to provide a comprehensive understanding of the unique health challenges faced by these demographic segments and to inform the development of targeted interventions and health policies to improve their well-being. The results of a cross-sectional study of 846 older adults in Yokohama, Japan, who completed self-administered questionnaires, revealed that high SRH was consistently linked with the low prevalence of concurrent medical issues in both age groups (<75 and ≥75) (β: −0.323, p < 0.001 in the <75 group; β: −0.232, p < 0.001 in the ≥75 group) and increased subjective well-being (β: 0.357, p < 0.001 in the <75 group; β: 0.244, p < 0.001 in the ≥75 group). Within the ≥75 age group, higher SRH was associated with more favorable economic status (β: 0.164, p < 0.001) and increased engagement in social activities (β: 0.117, p = 0.008), even after adjusting for age, sex, and economic status. These findings may inform the development of targeted interventions and policies to enhance the well-being of this growing population in Japan and other developed countries. Full article

The duplication of chromosome 21, as evidenced in Down Syndrome (DS), has been linked to contraindications to health, such as chronotropic and respiratory incompetence, neuromuscular conditions, and impaired cognitive functioning. The purpose of this study was to examine the effects of eight weeks of prescribed exercise and/or cognitive training on the physical and cognitive health of adults with DS. Eighty-three participants (age 27.1 ± 8.0 years) across five continents participated. Physical fitness was assessed using a modified version of the six-minute walk test (6MWT), while cognitive and executive functions were assessed using the Corsi block test, the Sustained-Attention-To-Response Task (SART), and the Stroop task (STROOP). All were completed pre- and post-intervention. Participants were assigned to eight weeks of either exercise (EXE), 3 × 30 min of walking/jogging per week, cognitive training (COG) 6 × ~20 min per week, a combined group (COM), and a control group (CON) engaging in no intervention. 6MWT distance increased by 11.4% for EXE and 9.9% for COM (p < 0.05). For SART, there were positive significant interactions between the number of correct and incorrect responses from pre- to post-intervention when participants were asked to refrain from a response (NO-GO-trials) across all experimental groups (p < 0.05). There were positive significant interactions in the number of correct, incorrect, and timeout incompatible responses for STROOP in EXE, COG, and COM (p < 0.05). Walking generated a cognitive load attributed to heightened levels of vigilance and decision-making, suggesting that exercise should be adopted within the DS community to promote physical and cognitive well-being. Full article

The role of women in promoting the production and consumption of vegetables at a family level towards mitigating the risk of non-communicable diseases (NCDs) is crucial. Women not only select and prepare food items consumed by their families but care about the health issues of family members. As research examining this critical role of women is scant, we attempted to understand how women as agro-entrepreneurs can promote vegetables to enhance healthcare situations. A field study was conducted in a northeastern district of Bangladesh from January to June 2019, adopting qualitative–participatory approaches that involved interviews, focus groups, and workshops. The study revealed that women play a vital role in taking care of the health of the family members, while their role in planning the family diet is exclusive. However, they have limited decision-making authority in the production and consumption of vegetables, and their knowledge and perception of NCDs are limited. The results imply that with enhanced capacity of vegetable production and better knowledge of nutrition and NCDs, women can improve family dietary habits by increasing the consumption of vegetables. Therefore, building the agro-entrepreneurial capacities of women in terms of knowledge, skills, access to finance, and decision-making authority at the family level would be a significant interventional approach for increased production and consumption of vegetables. We argue that public health strategies and policies addressing NCDs should incorporate this family-centric approach by promoting agro-entrepreneurship by women who would promote the production and consumption of vegetables. Full article

Diabetes self-management or self-care activity related to diet, physical activity, and glucose monitoring, among other things, is recognized as important to effectively managing this condition. The aim of this study was to create an assessment tool for evaluating knowledge and self-management behavior in Type 2 Diabetes Mellitus (T2DM) for patients and their providers. The study utilized an online survey with a cross-sectional design of adults diagnosed with Type 2 diabetes. The survey consisted of 8 sections and a total of 56 questions, which were designed to measure the participants’ current knowledge and behavior regarding diabetes self-management. The total sample size was 306 participants, and the results revealed a significant association between performance on diabetes knowledge questions and self-management behavior (β = 0.46; 95% CI: 0.34, 0.58; p < 0.001). Furthermore, education had a significant impact on diabetes self-management behavior (β = 0.59; 95% CI: 0.14, 1.03; p = 0.01). Overall, the data indicated that participants who performed well on knowledge-based questions exhibited higher scores in desired diabetes management behaviors. Increasing awareness of this work in the diabetic community could facilitate the clinical encounters between diabetic patients and their healthcare providers, with an emphasis on each individual’s needs being taken into consideration. Full article

Stroke is one of the leading causes of disability and death worldwide, a severe medical condition for which new solutions for prevention, monitoring, and adequate treatment are needed. This paper proposes a SDM framework for the development of innovative and effective solutions based on artificial intelligence in the rehabilitation of stroke patients by empowering patients to make decisions about the use of devices and applications developed in the European project ALAMEDA. To develop a predictive tool for improving disability in stroke patients, key aspects of stroke patient data collection journeys, monitored health parameters, and specific variables covering motor, physical, emotional, cognitive, and sleep status are presented. The proposed SDM model involved the training and consultation of patients, medical staff, carers, and representatives under the name of the Local Community Group. Consultation with LCG members, consists of 11 representative people, physicians, nurses, patients and caregivers, which led to the definition of a methodological framework to investigate the key aspects of monitoring the patient data collection journey for the stroke pilot, and a specific questionnaire to collect stroke patient requirements and preferences. A set of general and specific guidelines specifying the principles by which patients decide to use wearable sensing devices and specific applications resulted from the analysis of the data collected using the questionnaire. The preferences and recommendations collected from LCG members have already been implemented in this stage of ALAMEDA system design and development. Full article

Midwifery empowerment is an important topic. The most widely used instrument to measure the perceived empowerment of midwives is the Perceptions of Empowerment in Midwifery Scale (PEMS), which has not been validated in Spain. The aim of this study was to translate and adapt the PEMS to the Spanish context. This research was carried out in two phases; Phase 1: Methodological study; translation, backtranslation and cross-cultural adaptation of the PEMS and pilot study on the target population (10 midwives) for evaluation of face validity. Phase 2: Cross-sectional observational study to obtain a sample for construct validation by Exploratory Factor Analysis and measurement of PEMS-e reliability. Additionally, an inferential analysis was carried out to study the possible association between several collected variables and PEMS-e subscale-scores. A total of 410 midwives from 18 Spanish regions participated in the study through an online questionnaire. An initial Spanish version of the PEMS scale was produced, demonstrating adequate face validity. A final model was produced for the PEMS-e, which included 17 items classified into two subscales (“Organizational support” and “Own skills and teamwork”) with fit indexes RMSEA = 0.062 (95%CI: 0.048–0.065) and AGFI = 0.985 (95%CI: 0.983–0.989) and Cronbach’s alpha 0.922 for the total scale. Results showed that one in four midwives had considered abandoning the profession in the last 6 months (p ≤ 0.001). This research suggests that Spanish midwives perceive their empowerment level as low. The PEMS-e is a valid tool with solid psychometric properties that can be used in future research to identify factors that contribute to increased empowerment among Spanish midwives and inform strategies to improve job satisfaction and retention in the profession. Full article

Designing an over-the-counter medication electronic health record (OTC-EHR) may help improve OTC usage. An online survey for the conceptual OTC-EHR design examined participant characteristics, attitudes towards obtaining user-shared OTC medication information, health-related application usage, and the inclination to share anonymized health information. Descriptive statistics, tests to assess statistical significance, and text mining were used to analyze the results. The findings revealed that Japanese consumers, particularly those with high eHealth literacy and women, possess relatively positive attitudes towards obtaining user-shared OTC medication information than those with low eHealth literacy (t (280.71) = −4.11, p < 0.001) and men (t (262.26) = −2.78, p = 0.006), respectively. Most consumers own smartphones but do not use health-related applications. A minority held positive attitudes about sharing anonymized health information. The perceived helpfulness of OTC-EHR was positively associated with the usage of health-related applications (χ² (4) = 18.35, p = 0.001) and attitude towards sharing anonymized health information (χ² (3) = 19.78, p < 0.001). The study findings contribute towards OTC-EHR’s design to enhance consumers’ self-medication and reduce risks, while the psychological barriers to sharing anonymized health information should be improved by increasing the OTC-EHR’s penetration rate and engaging in appropriate information design. Full article

Background. Black males accounted for 19.7% of all the new HIV diagnoses in Canada in 2020, yet Black people make up only 4.26% of the population. Persistent misconceptions about modes of HIV transmission need to be addressed to reduce the relatively high HIV prevalence among Black men. We described the HIV misconceptions held by some HBM in Ontario. We also identified the social determinants that are protective versus risk factors for HIV misconceptions among heterosexual Black men (HBM) in Ontario with a view to building evidence-based strategies for strengthening HIV prevention and stigma reduction among HBM and their communities in Ontario. Methods. We report quantitative findings of the weSpeak study carried out among HBM in four cities (Ottawa, Toronto, London, and Windsor) in Ontario. Sample size was 866 and sub-samples were: Ottawa (n = 210), Toronto (n = 343), London (n = 157), and Windsor (n = 156). Data were collected with survey questionnaire. The outcome variable, HIV misconception score ranging from 1 to 18, was measured by the number of statements on the HIV Knowledge Questionnaire with incorrect answers. We included three categories of independent variables in the analysis based on a stepwise and forward model selection approach. The variable categories include (i) sociodemographic background; (ii) personalised psychosocial attributes (levels of HIV misconceptions, negative condom attitude, age at sexual debut, and resilience); and (iii) socially ascribed psychosocial experiences (everyday discrimination and pro-community attitudes). After preliminary univariate and bivariate analyses, we used a hierarchical linear regression model (HLM) to predict levels of HIV misconceptions while controlling for the effect of the city of residence. Results. More than 50% of participants in all study sites were aged 20–49 years, married, and have undergone a college or university undergraduate education. Yet, a significant proportion (27.2%) held varying levels of misconceptions about HIV. In those with misconceptions, the two most common misconceptions were: (i) people are likely to get HIV by deep kissing, putting their tongue in their partner’s mouth, if their partner has HIV (40.1%); and (ii) taking a test for HIV one week after having sex will tell a person if she or he has HIV (31.6%). Discrimination (β = 0.23, p < 0.05, 95% CI = 0.01, 0.46), negative condom attitudes (β = 0.07, p < 0.05, 95% CI = 0.01, 0.12), and sexual debut at an older age (β = 0.06, p < 0.05, 95% CI = 0.01, 1) were associated with more HIV misconceptions. Being born in Canada (β = −0.96, p < 0.05, 95% CI = −1.8, −0.12), higher education (β = −0.37, p < 0.05, 95% CI = −0.52, −0.21), and being more resilient (β = −0.04, p < 0.05, 95% CI = −0.08, −0.01) were associated with fewer HIV misconceptions. Conclusion and recommendations. HIV misconceptions are still common, especially among HBM. These misconceptions are associated with structural and behavioural factors. We recommend structural and policy-driven interventions that promote more accessible and equity-driven healthcare, education, and social integration of HBM in Ontario. We also recommend building capacity for collective resilience and critical health and racial literacy as well as creating culturally safe spaces for intergenerational dialogues among HBM in their communities. Full article