Previous studies have suggested that the intrauterine system increases the risk of depression, particularly in adolescents. However, these studies relied on national registry data collected at a time when medical guidelines discouraged adolescent use of this contraceptive method. As a result, the adolescents who appeared in these registries represented an atypical group who had this contraceptive prescribed against medical recommendations. Consequently, unknown or unmeasured participant characteristics may have introduced confounding variables and influenced conclusions. Although prescription guidelines for intrauterine systems now include adolescents, selective prescribing may persist. If so, it could affect future studies on hormonal contraceptives, even though the decision is clinically sound. We thus aimed to explore current contraceptive prescription practices, investigating user characteristics, policies, and contextual factors that might influence prescribing the intrauterine system rather than other hormonal contraceptive products, or vice versa. We conducted focus group interviews with 23 healthcare professionals employed at six health centers in Norway, prescribing hormonal contraceptive drugs to adolescent women. We used thematic analysis to identify factors that can influence which products are recommended and requested. Our analysis generated three themes: "Old conceptions die hard" describes skepticism among family doctors and mothers regarding adolescent use of the intrauterine system, "Particular promotion of the intrauterine system to "vulnerable" adolescents" outlines the practice of healthcare professionals recommending this contraceptive method to individuals identified as vulnerable, and "What tips the scale: Pros, peeves and other people" discusses influences on adolescents' contraceptive choice. This exploratory study suggests that both prescription practices and personal preferences influence choice of contraceptive product, and that it is not arbitrary who has the intrauterine device inserted. Future quantitative research should incorporate the factors identified in this exploration, to minimize their confounding effects when aiming to draw causal conclusions on the effects of the intrauterine system on mental health. The intrauterine system is an effective, easy-to-use hormonal contraceptive method. However, some have raised concerns that it can cause symptoms of depression in adolescents. We believe these concerns to be misguided, as they stem from studies on teenage users conducted at a time when medical guidelines advised against this contraceptive method in adolescents. Consequently, the teenagers included in these studies may already have had medical or mental health conditions that led clinicians to prescribe the intrauterine system despite the guidelines. These underlying conditions may also explain the later development of depressive symptoms, which may then have been incorrectly attributed to using the intrauterine system. Recommendations for the intrauterine system now include adolescent women, but if different contraceptives are still selectively prescribed, the conclusions we draw when researching these drugs and mental health could be affected.We therefore explored current prescription practices, interviewing healthcare professionals at health centers for adolescents. We aimed to identify factors that could influence which type of contraception adolescent women prefer and what healthcare professionals prefer to prescribe.Our informants said that several factors can still influence who has the intrauterine system prescribed. Most notably, specific individual characteristics were described as leading to some adolescents being viewed as “vulnerable”. For these adolescents the healthcare professionals reported making additional efforts to recommend the intrauterine system over other types of contraception, because of its effectiveness and user friendliness.This study highlights the need for assessing background factors when researching the relationship between hormonal contraceptives and mental health.
Disparities in health outcomes have been associated with inequitable access to health literacy and services. Additionally, reduced health literacy may lead to an unhealthy lifestyle, causing a decrease in quality of life and social inequities. Advancing health literacy is vital in educational organizations to curb gaps in social inequities. Adapting strategies to promote health literacy is essential for advancing equitable and effective educational organizations. Therefore, policies and interventions should aim to address any barriers that threaten inequities in the educational organization. This scoping review aims to explore how advancing health literacy strategies within the school organization can promote health equity. A scoping review of current literature was conducted using Arksey and O'Malley's framework and reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Articles were identified using ERIC (Education Resources Information Center), PUBMED (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature), and ProQuest Education Database. Included articles were restricted to the English language and the last twelve years to capture the most recent literature. Thirty-seven interventions to advance health literacy in educational settings were identified, with most published between 2020 and 2025 (28/37). Twenty-nine targeted elementary to secondary school students, while fewer focused on teachers, counselors, school personnel, or university students. Most were individual-level interventions aimed at improving student health literacy, while organizational approaches emphasized staff development and whole-school practices. Strategies included peer-led programs, curriculum-embedded teacher-led interventions, digital tools, staff-focused training, and whole-school models. Mental health literacy predominated, though oral health, infectious disease, pain, emergency preparedness, and WaSH literacy were also addressed. All studies reported improved health literacy-related outcomes. Evidence indicates that educational institutions may advance health literacy through curriculum-based, digital, peer-led, and whole-organization strategies. Integrating these approaches into policies and practice may promote equity, improve student and staff outcomes, and position schools and universities as important settings for health promotion and future intervention research.
Little is known about how older migrants maintain their health, despite health promotion's emphasis on strengthening everyday capacities for well-being. Older Indian migrants are one of Australia's fastest-growing ageing populations, yet existing research has focused predominantly on barriers, disease management and service access. As a result, the health-promoting strategies older migrants already use remain largely invisible in policy and practice. This study addresses this gap by exploring the practices that older Indian migrants in Melbourne employ to maintain their health. A qualitative study was conducted using semi-structured individual and focus group interviews with 55 India-born adults aged 50+ (32 temporary and 23 permanent migrants) living in Melbourne, Australia. Interviews were undertaken in English, Hindi and Punjabi. Participants identified interconnected practices underpinning everyday health maintenance, including reliance on home remedies; culturally familiar yet adaptive dietary and physical activity routines, including walking; domestic labour and group activities. Community and family networks facilitated motivation and support, while gendered household roles constrained women's capacity for rest and engagement in structured physical activity. This study found that older Indian migrants sustain health through home remedies, culturally embedded dietary routines, physical activity and a strong social network. These practices reflect a strengths-based orientation to well-being, drawing on intergenerational knowledge and community support to maintain health in later life. Health-promotion strategies should work with, rather than replace, the culturally grounded practices older Indian migrants already use. Culturally considerate, family-centred health advice; intergenerational activities and digital media partnerships may enhance healthy ageing.
In the context of rapid information technology development and widespread internet-based healthcare, electronic health literacy (eHL) is essential for health promotion and disease prevention. As prospective nurses, nursing students require sufficient eHL to retrieve, evaluate, and apply digital health information in clinical practice and health education. However, evidence regarding the heterogeneity and influencing factors of eHL among nursing interns in China remains limited. This multicenter cross-sectional study recruited 1,191 nursing interns from six hospitals in Anhui Province using convenience cluster sampling. Data were collected from October to December 2025. Latent profile analysis, multivariate logistic regression, and Spearman's rank correlation were applied. Three distinct latent classes of eHL were identified: low eHL (28.89%), medium eHL (45.42%), and high eHL (25.69%). The overall mean eHL score among the interns was 77.57 (SD = 14.68). Multivariate logistic regression analysis indicated that, compared with those in the low eHL group, nursing students with higher educational levels, higher health information literacy, and fewer weekly episodes of staying up late were more likely to be classified into the medium and high eHL groups (p < 0.05). Furthermore, Spearman's rank correlation analysis revealed that eHL was positively correlated with health information literacy (p < 0.05). Electronic health literacy among nursing students remains at a moderate level. Universities should strengthen systematic health literacy education, guide students to access reputable health websites, and recommend reliable health information resources. Hospitals may establish health consultation centers or virtual platforms to assist nursing students in identifying and evaluating online health information and addressing their practical health needs.
Medical students face elevated health risks due to academic stress and a sedentary lifestyle. Given the geographical and ethnic diversity of Southwest China, it is particularly important to understand the factors associated with physical fitness and bone health in this population. However, evidence regarding the physical fitness and bone health of medical students in this region remains limited. This cross-sectional study included 334 medical students (99 males and 235 females; aged 17-24 years) from Southwest China, comprising both Han and ethnic minority students. Body mass index (BMI) was calculated, a composite physical fitness index (PFI) was derived from six standardized fitness tests, and calcaneal bone mineral density (BMD) was assessed using quantitative ultrasound. Gender-stratified analyses, partial correlations adjusted for age and BMI, and multiple regression models were performed. Male students showed higher prevalences of overweight/obesity (18.18% vs. 5.96%) and osteopenia (6.06% vs. 2.98%) than females. A nonlinear association was observed between BMI and physical fitness, with normal-weight students demonstrating the highest PFI. No significant differences were observed between Han and ethnic minority students in physical fitness or bone health indicators. Muscle strength emerged as the strongest predictor of BMD, with bent-leg sit-ups predicting BMD in females (B = 0.290, p = 0.020) and pull-ups predicting BMD in males (B = 0.543, p = 0.014). Physical fitness and bone health differed according to sex and BMI status among medical students in Southwest China. Muscle strength was identified as the most important modifiable factor associated with BMD. These findings support the development of sex-specific and culturally appropriate health promotion strategies to improve musculoskeletal health among ethnically diverse university populations.
While workplace health promotion has traditionally emphasized risk reduction, knowledge about the extent to which interventions incorporate health-promoting resources such as Sense of Coherence, Participation, Goal-Setting, Variability, and Empowerment is fragmented. This scoping review examined how these salutogenic principles are operationalized in behavioral workplace health promotion programs focused on primary prevention. A systematic search across five databases identified 128 intervention studies published between 2014 and 2024. Each program was assessed using a Salutogenesis-Score (0-5) reflecting the number of salutogenic principles integrated into its design and delivery. Overall, the incorporation of salutogenic principles was moderate. Empowerment, Variability, and Sense of Coherence were most frequently represented, whereas Participation and Goal-Setting appeared considerably less often. For instance, tailored interventions that included individualized counseling or self-management tools achieved high scores, with multi-component programs showing the strongest overall alignment. Although many programs contain elements that support health-promoting behavior, their potential to fully activate salutogenic mechanisms remains underused. Strengthening participatory approaches and personalized goal-setting may enhance employee agency, adaptability, and long-term engagement, thereby fostering more sustainable and empowering workplace health promotion.
Males, who disproportionately account for 83% of oropharyngeal cancer cases, are underrepresented in health promotion research, including human papillomavirus (HPV) vaccination studies. The initial exclusion of males in HPV vaccine research, policies, and interventions has negatively affected male vaccine uptake. Furthermore, stigma, a well-documented barrier to healthcare engagement, has been overlooked in HPV vaccination behaviors. This study aimed to provide a more contextualized understanding of HPV vaccine disparities among adult males by applying the Health Stigma and Discrimination Framework (HSDF) to examine how stigma is produced, enacted, and sustained across social systems, which may impact male vaccine uptake. This qualitative study analyzed previously collected data from virtual group interviews conducted in 2021 with a convenience sample of 13 vaccine-eligible males aged 18-35 residing in El Paso, Texas, United States. Participants completed a demographic survey and participated in semi-structured discussions about their knowledge, attitudes, and experiences with HPV and vaccination. Data were analyzed by employing the Critical Discourse Analysis (CDA) method and the Health Stigma and Discrimination Framework (HSDF) to guide the methodological and analytical processes, helping to map stigma processes and mechanisms across individual, interpersonal, and structural levels to identify multi-level influences on male HPV vaccine behavior. Analysis identified four overarching themes reflecting the discursive construction of stigma processes and mechanisms, spanning proximal to distal levels of influence. At the individual level, (1) male sexual health and manhood reflects how internalized sex-specific beliefs and masculine norms fostered shame and discomfort around male sexual health, often framing males as unaffected by HPV rather than vulnerable or in need of vaccination. At the interpersonal level, (2) cultural and familial forces captures how discourses of intergenerational silence, religious morality, and sexual health taboos perpetuated stigma processes and mechanisms, constraining open discussion about HPV and vaccination. At the systemic level, (3) structural barriers to vaccination reflects how policy environments, institutional practices, and health system norms perpetuate systemic-level obstacles restricting vaccine access. Finally, at the multi-level, (4) stigma resistance reflects counter-narratives that highlight affirming, peer-informed, perspectives and reframed male vaccination as legitimate and necessary. Findings provide an in-depth examination of how stigma processes and mechanisms-rooted in masculine norms, sexual health taboos, intergenerational silence, misinformation, and institutional exclusion-shape HPV vaccination access, beliefs, and behaviors among vaccine-eligible adult males. In contrast, participants expressed resistance to these stigmatizing narratives by reframing male vaccination as a necessary and achievable health behavior when supported by peer-informed, culturally resonant messaging. These findings highlight the need for multi-level interventions that replace stigmatizing discourses and practices with affirming male narratives in HPV and broader sexual and reproductive health prevention efforts.
University hospital employees face role-specific stressors that can impair mental well-being and work-related vitality. While worksite health promotion programs show potential for improving mental well-being by targeting lifestyle behaviors, most target single professions or hospital subunits, and evidence for mental well-being and work-related vitality remains mixed. Mobile apps offer unique advantages for delivering such worksite health promotion programs hospital-wide. However, accessible interventions tailored to a diverse workforce are lacking. This study aimed to investigate the feasibility of an app-based worksite health promotion program (the Recharge360 program [The Recharge Company]) targeting multiple lifestyle behaviors, including a team-based competition element, for improving mental well-being and work-related vitality of hospital employees over a 5-month follow-up period by evaluating two objectives: (1) the implementation process of the program, and (2) the preliminary effects of the program on mental well-being and work-related vitality. We included 532 employees (mean age 43, SD 12 y; n=482, 91% women; n=480, 90% highly educated) from a university hospital in Amsterdam, the Netherlands. The study had a single-arm, longitudinal pretest-posttest design lasting 5 months, during which employees participated in the 5-day Recharge360 program (Recharge week) 3 times-in weeks 1, 9, and 17. At baseline (T0) and after each Recharge week (T1-T3), we assessed mental well-being, work ability, need for recovery, and task performance. The process was evaluated by assessing recruitment, attrition, and survey completion rates, and the degree of participation. Preliminary effects were evaluated by linear mixed model regression analyses to assess changes in mental well-being and work-related vitality between baseline and follow-up. Recruitment appeared feasible, but attrition rates were high (up to 70% in the final Recharge week), and the degree of participation decreased over time. We showed statistically significant, albeit small, increases in well-being at T3 (unstandardized β coefficient=2.08, 95% CI 0.33-3.84), with progressively larger improvements in the analyses among those who started at least 1, 2, and all 3 Recharge weeks (unstandardized β coefficient=3.27, 95% CI 1.09-5.45). Results for work-related vitality were mixed. The need for recovery remained unchanged, task performance increased slightly at T3 (unstandardized β coefficient=0.16, 95% CI 0.07-0.24). Work ability showed a small, but statistically significant, decline across follow-up (unstandardized β coefficient=-0.46, 95% CI -0.64 to -0.29). This app-based worksite health promotion program might be feasible to implement in a university hospital setting and shows potential to slightly improve mental well-being, but primarily for a selective group of highly educated, health-conscious women. While these findings support further investigation in a randomized controlled trial in similar university hospital settings, they also highlight the need for more participatory study designs to improve the tailoring of program components and engagement of underrepresented groups, as well as for a supportive culture and population-based approaches at the organizational level.
Malnutrition accounts for nearly one-third of child deaths globally and continues to be a major concern in India. Despite economic progress, undernutrition remains prevalent, with one-third of children underweight and over two-thirds anemic. Within India, marginalized groups such as the Koraga tribe face greater risks due to poverty, limited healthcare access and cultural barriers that compound child health challenges. Understanding maternal perceptions is crucial to effectively address these challenges. In-depth interviews were conducted with Koraga tribal mothers of children aged 5-10 years. Participants were selected using criterion-based purposive sampling to ensure representation across different age groups and household contexts. Interviews were audio-recorded in local languages (Tulu and Kannada), transcribed verbatim, translated into English and analysed inductively using thematic analysis with NVivo software (version 14). Twenty Koraga tribal mothers were interviewed between October 2023- March 2024. Thematic analysis revealed five major themes: evolving perceptions of health and wellbeing; nutrition beliefs and practices; hygiene and health promotion; traditional healing with modern care and barriers and community solutions. These findings highlighted key challenges such as limited healthcare access, poverty and educational constraints, while also capturing community-driven strategies including reliance on health workers and government food-schemes. Maternal perceptions, shaped by cultural norms and socioeconomic constraints, play a critical role in influencing health and child nutrition in the Koraga community. The findings highlight the need for policy measures that integrate culturally informed nutrition education with strengthened frontline health services, alongside community-based programs involving women's self-help groups to improve health outcomes in marginalised tribal populations.
Cochrane reviews provide high-quality evidence syntheses. To guide the production and dissemination of new Cochrane reviews, an evidence map based on the characteristics of existing reviews is necessary. This study is a scoping review that aimed to create an evidence map of Cochrane reviews on nutrition and physical activity (PA) in healthy and at-risk populations, describe stakeholder involvement in review production and assess the dissemination of these reviews. This scoping review follows a registered protocol and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA ScR) guideline. Eligible studies were Cochrane reviews on nutrition and PA for healthy and at-risk populations that were identified in the Cochrane Database of Systematic Reviews through to 22 January 2026 and selected independently by two researchers from 2043 search hits. Extracted data included bibliographic, population, and intervention or concept characteristics, information on stakeholder involvement in review production and open-access Altmetric data on the online and scientific attention towards Cochrane reviews. Data were processed into meaningful categories and synthesised using descriptive statistics. The included Cochrane reviews (n = 260) were published between 1999 and 2026. Review focus was on nutrition (n = 193, 74%), PA (n = 39, 15%), and nutrition + PA (n = 28, 11%). Most reviews included any populations by age and sex (n = 52, 20%) or specific populations by age (adults: n = 62, 24%; children: n = 54, 21%; and child-caregiver dyads: n = 50, 19%). The interventions or concepts were predominantly non-digital (n = 230, 88%), included mainly nutrition components (e.g. supplementation: n = 104, 40%; diet: n = 68, 26%), and were conducted in any unspecified settings (e.g. community, population; n = 226, 87%). The outcomes were mainly disease-related (e.g. disease prevention and risk factor reduction; n = 129, 50%) and reproductive (e.g. maternal and child health promotion; n = 56, 22%). There were less or no reviews with the following characteristics: (1) populations of older adults and males, (2) interventions or concepts with digital modality and with components targeting PA promotion, behaviour change, and other factors (e.g. policy), (3) specific settings (e.g. vulnerable, organisational), (4) outcomes targeting general health promotion and psychosocial (e.g. behavioural, cognitive, and mental) functioning. Involvement of various stakeholders (e.g. consumers, clinicians, and advisory boards) was reported in the production of 32% of Cochrane reviews. Online attention was highest for reviews with nutrition components (i.e. supplementation and diet) while scientific attention was highest for reviews with mixed components (i.e. PA and supplementation). New Cochrane reviews on nutrition and PA need to target specific populations (especially older adults and males) and settings, assess digital interventions or concepts, and focus on components and outcomes targeting physical and mental health promotion. Stakeholder involvement in review production and online and scientific attention could be further promoted to potentially improve review uptake in practice.
Ethiopia has one of the highest rates of undernutrition among children under five (U5) and women of reproductive age (WRA) globally, alongside rising overweight/obesity, particularly in urban areas. Poor diet is a shared driver of multiple forms of malnutrition. We used a participatory photography (Photovoice) approach to explore the lived experiences of WRA and their children U5 in adopting healthy diets across lower- and higher- socio-economic status (SES) groups in Addis Ababa. Women took photographs illustrating challenges to healthy diets, and five focus groups (n = 31 women) were conducted to discuss challenges and solutions, with separate sessions held for different SES groups. A hybrid thematic analysis, combining deductive and inductive approaches, identified themes/subthemes, with comparisons across SES groups. Financial and physical barriers to accessing healthy foods, time constraints and perceived poor food safety were major contributors to poor diets. In lower SES groups, women also reported limited knowledge about healthy diets, inadequate family support and poor home food environments. In higher SES groups, unhealthy food preferences coupled with easy access to and aggressive promotion of unhealthy foods were key challenges. Proposed government-level solutions included job creation, nutrition education, affordable healthy food, investment in household infrastructure, expanded childcare and restrictions on unhealthy food availability and promotion. Societal-level solutions included gender equality, strengthened community-based loan schemes and support for urban agriculture. These findings highlight that women recognise their needs and who should support them, and emphasise the importance of including women's voices in decision-making processes. Findings also underscore the need for integrated interventions targeting individual, food environment and socio-economic drivers to improve diets among women and children in urban Ethiopia.
To examine the clinical activity and workforce contribution of Advanced Nurse Practitioners (ANPs) working in general practice. Primary care systems internationally are experiencing increasing demand due to ageing populations, rising multimorbidity and workforce shortages. Advanced nursing practice has expanded globally as a strategy to strengthen service capacity, improve access and maintain quality outcomes. Although there is substantial evidence regarding patient outcomes associated with advanced practice roles, there is comparatively limited empirical data describing the day-to-day clinical activity of ANPs in primary care settings. This national cross-sectional descriptive study, conducted in Ireland and reported in accordance with the STROBE Statement, involved a 1-week activity capture of General Practice Advanced Nurse Practitioners (GP ANPs) and candidate ANPs (cANPs) working across general practice settings. Data collected included consultation type, prescribing activity, complexity of care and clinical outcomes. Data were analysed using descriptive statistics. Twenty GP ANPs/candidate ANPs recorded 1659 consultations, including 757 full episodes of care (45.6%). Practice spanned acute illness (adults and children), chronic disease management, women's health and preventive services. Medication optimisation activity included 503 medication reviews, 251 prescriptions issued and 59 medications deprescribed. About 15% of consultations were classified as complex and 14.8% involved multiple presenting complaints. Most consultations were independently managed. GP ANPs demonstrate broad clinical capability and contribute substantially to general practice capacity. The findings highlight the value of a holistic nursing approach, which is well suited to chronic disease management, health promotion, patient education and the management of multimorbidity, supporting access to care and strengthening primary care workforce capacity.
In the context of Health China 2030, the Chinese government endorses the unique advantages of traditional Chinese medicine (TCM) within the public health care system and promotes the inheritance and development of TCM culture. Emerging digital formats-such as online literature, online audiovisual media, and digital games-have become important vehicles for promoting TCM culture and public health education. Consequently, Chinese digital games have increasingly incorporated elements of TCM, serving as new media for communicating health knowledge and cultural values to a broad player population. This study examines how exposure to digital games containing TCM culture, supported by national health promotion policies, influences players' willingness to accept TCM treatment, thereby contributing to the broader goal of improving residents' health welfare. However, empirical research examining how such games influence players' willingness to accept TCM-based medical treatment remains limited. This study aims to investigate the key factors and mechanisms through which digital game use motivations shape players' intention to seek TCM treatment. Based on data collected through an online questionnaire survey of 460 Chinese digital game players, PLS-SEM was utilized to examine the core factors and relationships between gaming motivations, TCM cultural identity, health self-efficacy, and TCM treatment intention. The findings reveal that three types of game use motivations-hedonic, social, and knowledge-seeking-indirectly enhance players' willingness to accept TCM treatment by strengthening their health self-efficacy and identification with TCM culture. Additionally, players' distrust of the TCM healthcare system negatively moderates the association between gaming motivations and TCM treatment intention. This study demonstrates the potential of digital games as effective tools for integrating cultural transmission with public health communication. By improving players' TCM treatment intention, digital games containing TCM culture contribute to the public health objectives outlined in the Health China 2030 strategy. The results provide both theoretical grounding and practical guidance for government agencies and enterprises seeking to leverage digital games to promote TCM cultural inheritance and enhance public health education as part of health welfare improvements.
Breastfeeding is widely recognized as one of the most cost-effective public health interventions for improving maternal and child health outcomes. Nevertheless, breastfeeding indicators remain suboptimal worldwide despite strong international recommendations. In recent years, digital technologies have emerged as tools to support breastfeeding promotion, education, and continuity. However, the evidence on digital and multimedia breastfeeding interventions is heterogeneous and scattered across disciplines, limiting a comprehensive understanding of their scope and effectiveness. For the purposes of this review, "digital resources" refers broadly to digital platforms and technologies used to deliver breastfeeding-related information or support; "interactive multimedia tools" refers to resources integrating two or more media formats (e.g., text, audio, video, graphics) with user interaction; and "digital interventions" is used as an umbrella term encompassing both concepts. To systematically map and synthesize available evidence on digital resources and interactive multimedia tools used to promote and support breastfeeding, describing their characteristics, implementation contexts, target populations, reported outcomes, and limitations. A scoping review was conducted following the Arksey and O'Malley methodological framework and reported in accordance with PRISMA-ScR guidelines. The methodological approach was also aligned with selected recommendations from the Joanna Briggs Institute for scoping reviews. Searches were carried out in PubMed, the Virtual Health Library (VHL), Google Scholar, and the AI-powered tool Consensus between April 2023 and July 2024. Peer-reviewed publications in English and Spanish from the last 10 years addressing digital resources or interactive multimedia tools for breastfeeding promotion or support were included. Data were extracted and synthesized using a descriptive analytical approach. A total of 23 studies published between 2019 and 2024 were included. The review identified a range of digital interventions, including social media platforms, mobile health (mHealth) applications, web-based resources, educational videos, telemedicine services, and multimedia materials. Most studies targeted pregnant women and breastfeeding mothers, often in contexts of social or economic vulnerability. Overall, digital interventions were associated with increased breastfeeding knowledge, improved maternal self-efficacy, enhanced access to information and peer support, and favorable perceptions. However, evidence regarding breastfeeding duration and exclusivity was inconsistent, and substantial variability was observed in intervention design, implementation strategies, and outcome measurement. Studies from both high-income countries (HICs) and low- and middle-income countries (LMICs) were identified, with social media campaigns and low-cost mobile approaches appearing particularly relevant in resource-constrained contexts. Digital resources and interactive multimedia tools represent promising complementary strategies for breastfeeding promotion and support. This scoping review highlights both the potential benefits and the heterogeneity of existing digital interventions, emphasizing the need for standardized, theory-informed, and context-sensitive approaches to strengthen evidence-based practice and future research in digital breastfeeding support.
Breastfeeding promotion and support are essential for maternal and child health. This project aimed to improve breastfeeding promotion and support practices in an obstetrics ward of a specialized Romanian hospital. This project followed the JBI methodological model for best practice implementation. Data collection was carried out using an audit questionnaire with 11 evidence-based audit criteria. After the implementation of improvement strategies (education, updating protocols, promotional materials, development of a breastfeeding support group), a follow-up audit was conducted to measure any changes in compliance. The follow-up audit showed significant progress compared to the initial assessment, with six audit criteria obtaining 100% compliance. For the remaining four criteria, compliance ranged from 58% to 97%, indicating notable but uneven progress. The last criterion (rooming-in) increased only modestly (17% to 36%), marking a positive but slower improvement compared to the other areas evaluated. By implementing strategies aimed at changing current breastfeeding practices, involving nurses and midwives, and through sustained institutional support, the project objectives have been achieved. However, periodic implementation of improvement strategies is necessary to maintain the positive results achieved and to improve aspects of inadequate compliance. Moreover, to assess the sustainability of the results and to extend best practices to all wards and professional categories, future audits of clinical practice will be necessary. http://links.lww.com/IJEBH/A619.
Early childhood education and care (ECEC) centres are an ideal setting to promote key healthy eating and active living (HEAL) practices. Redesigning messages around such practices to be digital could help engage ECEC educators and assist with long-term implementation and reach. The aim of this study was to evaluate the potential impact of a HEAL-focused video initiative (Small Bites for Big Steps) on precursors to behaviour change including educators' self-efficacy, perceived behavioural control and behavioural intentions and the acceptability of the videos. A pilot randomised controlled trial was conducted with early childhood educators (56% aged 25-44 years, 98% female). Participants randomised to the intervention group received on average 3-4 weekly videos promoting HEAL practices, whilst participants in the control group maintained usual practice. Educators' self-efficacy, perceived behavioural control, and behavioural intention were assessed using questionnaires at baseline and post-intervention (9 weeks). Data were analysed using Mann Whitney U tests in SPSS and thematic analysis. Acceptability data were collected using questionnaires, focus groups, interviews, and Vimeo analytics. One hundred and six educators from 16 ECEC services were recruited. Exploratory efficacy analysis found significant improvements from baseline to post-intervention between groups for healthy eating/drinking perceived behavioural control. At post-intervention, there was a significant difference between intervention and control groups for healthy eating/drinking behavioural intention, physical activity behavioural intention, and overall behavioural intention. No significant between group differences were observed for changes in perceived behavioural control relating to physical activity or for any self-efficacy measures. Educators valued the content, length and approach of the videos. Limitations identified from the qualitative data included technical difficulties and cultural appropriateness. This video-based intervention positively influenced educators' perceived behavioural control and behavioural intentions, key precursors to behaviour change. The video suite was acceptable to educators. SO WHAT?: Redesigning HEAL messages into video resources may support ECEC educators to promote and implement these practices to young children and their families/carers.
Using evidence-based approaches grounded in science, public health professionals promote the well-being of individuals, families, and communities. Unfortunately, over the past year, the public health field and its science-based programs have been seriously threatened and undermined in the United States. The New York State Public Health Association (NYSPHA) recognized the toll federal actions were taking on the public health workforce and initiated the Express Yourself for Public Health discussion series as a safe space for the greater public health community to share fears and concerns and to better understand workforce needs. We hosted three rounds of this series in March, September, and December 2025. Each session was conducted via Zoom and lasted 1 hr, including a 5-min introduction, a 45-min facilitated discussion in breakout rooms, and a 10-min report out. In total, 160 individuals participated across 16 sessions. Participants spoke at length about the undermining of science, funding cuts, and misinformation/disinformation and the effect this has had on the authority of public health, employment security, and the future workforce. They shared ways they have navigated these challenges and offered suggestions for recruiting and retaining students in public health programs. Guided by our findings, we have initiated several career development opportunities including engaging members in new and existing topical, advocacy, and action-oriented workgroups; providing instruction in communications, advocacy, and leadership; revamping our mentorship program; and educating potential students on stacked certificate and dual degree programs. Similar organizations and associations should consider emulating our series to support their workforce during this time of uncertainty.
Political skepticism and legislative threats like the One Big Beautiful Bill Act (OBBBA) currently shake the structures supporting public health. OBBBA seeks to de-professionalize our credentials by reducing federal loan caps from $50,000 to $20,500. It seems the fundamental necessity of our workforce remains undeniable despite these challenges. I address the anxiety of students and early-career professionals by contrasting this hostile political landscape with economic labor realities. I map the educational continuum, noting undergraduate public health degrees surpassed master's degrees in 2020. They now serve a student body that is over 55% people of color. I measure these trends against 2024 U.S. Bureau of Labor Statistics projections for five core disciplines: biostatistics, epidemiology, health policy, environmental health, and health promotion. Data indicate strong growth across the sector while governmental wages stagnate and loan forgiveness faces legislative peril. Roles like data scientists and medical services managers are projected to grow by 34% and 23%, respectively. Wage disparity is stark. Epidemiologists earn a median of $130,390 in scientific research compared with just $76,180 in local government. I argue market demand and the World Health Organization's projected global shortfall of 18 million health workers by 2030 validate our expertise. The narrative of de-professionalization likely poses a severe risk to health equity. Our labor is essential, whether we are investigating disease outbreaks or advocating for environmental justice. We must remain resilient and train to become the professionals our communities require to survive.
The use of community score cards (CSC) in collaboration with local organisations and the health sector is a novel approach to improving the performance of reproductive, maternal, newborn and child health (RMNCH) services. The goal of the New Partnership Initiative Expand (NPI) program was to increase the availability and demand for high-quality, high-impact RMNCH services in rural Ethiopia. An independent evaluation of the NPI program was completed in 2024 using a mixed-methods evaluation design. The CSC process engaged 355,220 community representatives and 1557 client councils. The quantitative data included routine service delivery data extracted from Ethiopia's District Health Information System, baseline versus end-of-project CSC standards of care, RMNCH indicators and measures of organisational capacity. The qualitative data included 69 in-depth interviews, 27 focus group discussions with 218 community participants, and interviews with local organisations, health officials, client councils and CSC administrators. The mean CSC scores and standard deviations were 47.2 ± 11% at baseline, 67 ± 6.6% at midterm and 72.3 ± 7.6% at endline. The RMNCH scores were 58% for contraceptive acceptance rate (CAR), 59% for antenatal care (ANC) and 76% for postnatal care (PNC) at baseline, and 71% for CAR, 65% for ANC and 80% for PNC at endline. Applying paired t- and Z-tests, we found a statistically significant difference in CSC and RMNCH scores over time (P < 0.000 in all cases). The self-reported indicators used to measure the organisational and technical capacity to conduct the CSC processes increased by 12%. The inclusion of local organisations in the CSC process led to increased measures of community engagement, positive perceptions of health system standards of care and improvements in organisational capacity. Health worker responsiveness and increased utilisation of RMNCH services also increased. We recommend efforts to further engage local organisations in the application of CSCs in low- and middle-income countries, and expansion by the Ministry of Health in Ethiopia.
The integration of a new standard for food safety in Australia signifies a notable step toward national unity in the adoption of Hazard Analysis and Critical Control Point (HACCP) principles and contemporary food safety management tools for the food service and retail sector. The standard introduces key measures, including certification of food safety supervisors, food safety training requirements for food handlers, and means for substantiating control of food safety hazards throughout key food handling processes. This study explored the experiences and perspectives of local regulators regarding the implementation and feasibility of the new standard. Data were collected via an online survey and semi-structured interviews with Environmental Health Practitioners across two Australian states. Findings reveal that implementation of the standard varied between states, largely shaped by the degree of support provided by respective state authorities. Six key barriers to effective implementation emerged from participant accounts. In response, five targeted recommendations are proposed, grounded in established health promotion principles. Until these challenges are adequately addressed, the standard risks remaining ineffectual, limiting its capacity to enhance public health outcomes. SO WHAT?: The key to effective implementation and realisation of Standard 3.2.2A as healthy public policy lies within the central tenets of public health theory and practice.