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Nursing students are the future workforce, and their readiness to use digital health tools is important. Previous studies have focused on knowledge and attitudes; however, they have not examined the wide range of digital health literacy levels that may influence nursing students' attitudes toward using telehealth in clinical settings. This study aimed to determine the relationship between nursing students' digital health literacy and their attitudes toward telehealth use in practice. A cross-sectional design was used. The sample consisted of undergraduate nursing students enrolled in a Bachelor of Nursing program at a selected Saudi Arabian university. The online survey used 2 scales: the Digital Health Care Literacy Scale and the Nurses' Attitudes Toward Use of a Telehealth Scale. A total of 273 students participated (mean age 21.3, SD 1.9 years). Most of the nursing students demonstrated a high digital health literacy level (n=184, 67.4%; mean Digital Health Care Literacy Scale score 11.9 out of 15, SD 3.1). Digital health literacy was a significant predictor of positive attitudes toward telehealth use in practice (adjusted odds ratio 1.48, 95% CI 1.28-1.71; P<.001). Male students were significantly less likely to report positive attitudes than female students (adjusted odds ratio 0.62, 95% CI 0.39-0.97; P=.03). However, academic year, telehealth workshops, and informatics courses were not significantly associated with positive attitudes toward telehealth use in practice. Higher levels of literacy appear to correlate with more positive attitudes toward telehealth use in practice. However, current formal education and workshops had no apparent influence on digital health literacy. This suggests a potential need for strengthening digital training and development in nursing education. This may enhance telehealth readiness and support future digital health care delivery.

This study aimed to review the scientific literature on the effects of cancer treatment-related oral complications on the quality of life and well-being of children surviving cancer. This study updates a previous review, from 2012, evaluating the oral health related quality of life and well-being of childhood cancer survivors and exploring the extent to which children's perspectives are considered in research. We used a scoping review methodology informed by established frameworks: Arksey and O'Malley, Levac et al. and the Joanna Briggs Institute. Articles were retrieved from five electronic databases (MEDLINE/PubMed, Scopus, Embase, Web of Science, and PsychInfo) using a predefined search strategy. Screening and study selection were performed independently by two reviewers using Rayyan software (QCRI), with a third reviewer resolving disagreements. Reporting followed the PRISMA-ScR guidelines. Inclusion criteria included articles focused on the impact of oral complications on the quality of life and well-being of child cancer survivors (aged 0-17 years at the time of diagnosis), written in English or French, and published from 2012-2025. Exclusion criteria included articles involving non-childhood cancers, and with non-specific disease categories. The protocol for this review was published in PLOS ONE (https://doi.org/10.1371/journal.pone.0290364). 79 articles were included in this scoping review. The majority of studies had quantitative designs. In contrast to the original review, a substantial number of studies (47) reported children-reported symptoms and completed assessment tools rather than relying solely on their parents and health care providers to provide this information. Furthermore, since the original review, reporting of oral health-related quality of life (OHRQoL) measures has increased, however they were reported in a limited number of studies. Our review suggests that there is growing implementation of patient-reported outcomes and subjective measures of OHRQoL in assessing oral complications in pediatric cancer patients. Future studies should incorporate qualitative approaches to capture children's or parents' perspectives on cancer therapy, thereby complementing quantitative findings and providing a more comprehensive understanding of the multifaceted impact of oral complications on children's quality of life.

Antimicrobial resistance is a growing public health concern in India. It is driven largely by the misuse and overuse of antibiotics. This qualitative study aimed to examine how the Training and Communication (T and C) package influenced antibiotic prescribing practices of healthcare providers and prescription adherence among patients and caregivers at Civil Hospital, Manimajra, Chandigarh. A grounded theory approach was applied to qualitative data collected at baseline and endline. Purposive sampling was used to conduct focus group discussions and in-depth interviews with healthcare workers, patients, and caregivers. The topic guides were developed with reference to the capacity, opportunity, motivation-behavior framework. Data were transcribed, translated, manually coded, and thematically analyzed to identify drivers and barriers to prescription adherence before and after the intervention. Drivers of, and barriers to, prescription adherence included patient characteristics, doctor's workload, patient's knowledge about antibiotic uses, expectations for cheaper medicines, and the attitude of healthcare providers before the intervention. Based on these findings, a T and C package was developed for healthcare providers and patient communication. The use of rapid diagnostic tests and prescription communication helped in early diagnosis and increased patient's adherence to the prescribed medicine after the intervention. Patients in the intervention arm reported supportive engagement with the healthcare professionals. The affordability of medicine was a major barrier to prescription adherence across arms, pre- and postintervention. Training of service providers and communication with patients were important for ensuring prescription adherence and optimal use of antibiotics. The affordability of medicines was the biggest challenge.

Caring for patients with amyotrophic lateral sclerosis (ALS) involves demands that reduce caregivers' quality of life. Although caregiver burden and perceived social support was conceptualized as an independent correlate of quality of life rather than a factor operating primarily through caregiver burden. This study examined these associations within a stress-process framework in which perceived social support was conceptualized as an independent correlate rather than a buffering factor. This cross-sectional analytical study included 118 informal caregivers of patients with ALS. Primary stressors were defined as patient functional status (ALSFRS-R), caregiving duration, and communication difficulty. Caregiver burden (Zarit Burden Interview) was considered a secondary stressor. Physical and mental quality of life were assessed using the SF-12, and perceived social support was measured with the Multidimensional Scale of Perceived Social Support. Hierarchical regression analyses were performed to examine associations specified in the conceptual model while controlling for caregiver sociodemographic and socioeconomic variables. Additional mediation analyses were conducted to examine whether caregiver burden mediated the relationship between perceived social support and quality of life. Poorer patient functional status was significantly associated with higher caregiver burden, whereas communication difficulty showed a positive but non-significant association after adjustment for caregiver characteristics. Caregiver burden showed negative associations with both physical and mental quality of life. Perceived social support remained positively associated with quality of life after adjustment for caregiver burden and contributed additional explained variance in the models. Mediation analyses showed no evidence that caregiver burden mediated the association between perceived social support and either physical or mental quality of life. The findings are consistent with a stress-process framework in ALS caregiving, in which caregiver burden represents a central factor statistically associated with both caregiving stressors and quality of life, while perceived social support shows an independent association with quality of life. These findings suggest that both caregiver burden and perceived psychosocial resources may be relevant to caregiver well-being, although causal and intervention-related implications require further investigation. Caring for a person with amyotrophic lateral sclerosis (ALS) is physically and emotionally demanding, and many caregivers experience reduced quality of life. Previous studies have examined caregiver burden and social support separately, but it is not well understood how these factors work together to influence caregivers&#x2019; well-being. This study examines how disease-related challenges, caregiver burden, and perceived social support are connected, and how these factors jointly affect the physical and mental quality of life of ALS caregivers. The study tests a conceptual model proposing that caregiving challenges increase caregiver burden, which in turn affects quality of life, while perceived social support contributes directly to quality of life rather than simply reducing stress. Worse patient functioning and communication difficulties were linked to higher caregiver burden. Higher burden was associated with poorer physical and mental quality of life. Perceived social support remained positively related to quality of life even after accounting for caregiver burden. These findings suggest that improving social support and reducing caregiver burden are both important for maintaining quality of life among ALS caregivers.

Multiple long-term conditions (MLTC) are common in people with chronic kidney disease (CKD). This study examined the impact of MLTC on mortality, CKD progression, and health-related quality of life (HRQoL) in a referred CKD population. Adults with non-kidney replacement therapy (KRT)-dependent CKD (stages G1 to G5) were recruited to the prospective NURTuRE-CKD cohort across 16 UK nephrology centres. MLTC was defined as &#x2265;2 conditions (including CKD) and comorbidities categorised into 19 groups. Depression and anxiety were defined using the Hospital Anxiety and Depression Scale, and Cognitive impairment using the Six-item Cognitive Impairment Test. Outcomes were all-cause mortality, CKD progression (eGFR <15&#x2009;mL/min/1.73m2 or KRT), and HRQoL (EQ-5D-5L, at two time points). Participants with eGFR < 15 at baseline were excluded from progression analyses. All 2996 participants had comorbidities at baseline, and therefore MLTC. Mean age was 62.7 (SD &#xb1; 14.7) years, mean eGFR 37.3&#x2009;mL/min/1.73m2 (SD &#xb1; 17.9), and 41% were female. Median baseline comorbidity count was 3 (IQR 2 to 5; range 1 to 19). The commonest baseline comorbidities were hypertension, pain, obesity, hyperuricaemia, diabetes, sarcopenia, and cardiovascular disease. Over a median 1.42&#x2009;years between baseline and first follow up, the most frequent new comorbidities were pain (285 people (14%)), anxiety and depression (226 (11%)), cognitive impairment (115 (6%)), obesity (98 (5%)), and anaemia (82 (4%)). Increasing comorbidity count was associated with higher mortality (adjusted hazard ratios (vs. 1 comorbidity): 1.37 (2), 1.45 (3), 1.54 (4), and 1.80 (&#x2265;5)), with statistical significance at &#x2265;4 comorbidities). Comorbidity number was not associated with CKD progression. Greater number and certain specific comorbidities were associated with worse HRQoL. Greater comorbidity burden was associated with mortality and worse HRQoL but not CKD progression in this cohort. CKD management should target prevention of additional conditions, prioritise holistic care and focus on MLTC as much as kidney protection. What is already known on this topic &#xa0;Having multiple long-term conditions is common among people with CKD.People with CKD commonly have worse health-related quality of life (HRQoL) than similar populations without CKD.HRQoL is affected by many factors among people with CKD and often worsens over time.What this study adds Accruing new comorbidities over time is common among people with non-kidney replacement therapy (KRT)-dependent CKD, particularly pain and mental health conditions.Having a greater number of comorbidities was associated with mortality, but not progression to kidney failure among people with CKD in this particular population and period of follow up.A greater number and a wider range of specific comorbidities were associated with worse longitudinal HRQoL among people with CKDHow this study might affect research, practice, or policy This research encourages holistic care of people with CKD with a focus on multiple long-term conditions being as important as kidney protection.Greater efforts are needed to address specific comorbidities, particularly pain, mental health conditions (anxiety and depression), cognitive impairment, obesity, sarcopenia, anaemia, and cardiovascular disease.This research supports preventative interventions that reduce the risk of developing new long-term conditions among people living with CKD.

REDE D+, a social prescribing (SP) program, offers a complementary approach to traditional T2DM management by connecting people to community activities designed to support them in self-care behaviors and health literacy (HL). This study aims to assess the feasibility of a pilot study by evaluating recruitment, adherence and retention rates among people with T2DM, health professionals (nurses), community stakeholders, while exploring preliminary results in improvements on self-care behaviors and HL. This 12-week non-randomized pilot cohort study, conducted in primary and community healthcare settings in accordance with the guidelines of the Medical Research Council, involved a personalized assessment during a diabetes nursing consultation, followed by the prescription of community-based activities. Subsequently, a social prescriber nurse acts as a liaison between the two settings through structured follow-up, ensuring the continuity of the prescribed community-based activities. Primary outcomes were feasibility (recruitment, adherence, and retention rates). The secondary outcomes included anthropometric values [weight, body mass index (BMI), and abdominal perimeter], clinical values [glycated hemoglobin A1c (HbA1c)], measures of self-care, HL, diabetes knowledge, quality of life, and wellbeing. Descriptive and exploratory inferential analyses were conducted to examine preliminary patterns. Magnitude of effect was estimated via Cohen's d, allowing for a standardized assessment of improvements across the secondary outcomes. The REDE D+ program revealed an 87.8% recruitment rate across the three participant groups, a 90% retention rate, and a good level of adherence to group community-based activities (94.4%). The secondary results suggest a small effect size of the SP intervention on weight, BMI, abdominal circumference, and HbA1c, and some improvements in HL and self-care behavior with a medium effect. The indicators related to physical activity and quality of life were the domains that showed the most statistically significant effects. The REDE D+ program has proven to be feasible, yielding positive results in terms of recruitment, retention, and adherence among people with T2DM. Preliminary secondary results suggest that has the potential to support the improvement of self-care behaviors and promote HL. However, future research is needed to evaluate its effectiveness and cost-effectiveness in large-scale studies.

Multiple sclerosis (MS) frequently leads to mobility impairment, fatigue and a significant decline in health-related quality of life (QoL). Home-based assistive technology, such as robotic exoskeletons, offers a promising solution to enhance independent mobility and increase the intensity of motor training. Long-term functional and quality of life benefits of light lower-limb exoskeleton home use have yet to be determined. The primary objective of this study is to determine the efficacy of an 8-week period, home-based use of a robotic exoskeleton in improving QoL in individuals with MS, compared with a no-device control period. This is a multicentre, randomised, controlled and single-blinded cross-over trial. A total of 28 patients with confirmed MS (Expanded Disability Status Scale (EDSS) score 5.0-7.0)&#x2009;will be recruited across three rehabilitation centres. Participants will be randomly assigned to two 8-week phases: intervention (daily home-based exoskeleton use) or control (physical activity advice), separated by an 8-week wash-out period. The primary outcome is the change in the MS Quality of Life assessed by the Functional Assessment of Multiple Sclerosis (FAMS) physical composite score from baseline to the end of each phase. Secondary outcomes include changes in walking performance (2-minute Walk, 10 M Walk, Timed Up-and-Go, Four Square Step Test and Sit-to-Stand Test), fatigue severity (Fatigue Severity Scale and Fatigue Impact Measurement Scale (EMIF)-MS), and strength capacity (Manual Muscle Testing, Tardieu scale), self-confidence (Rosenberg), anxiety and depression (Hospital Anxiety and Depression Scale), satisfaction to use (Technical Aid Satisfaction Scale) and intention to use (Unified Theory of Acceptance and Use of Technology). This study was registered on ClinicalTrials.gov on 1 February 2024 (Trial registration number: NCT05835622 https://clinicaltrials.gov/ct2/show/NCT05835622). Patient recruitment is currently underway and is anticipated to be completed by January 2026. Primary endpoint data collection is expected to be completed in June 2026.This study protocol describes a rigorous trial designed to provide high-level evidence on the impact of a home-based robotic exoskeleton on QoL in individuals with MS. By determining intervention effectiveness, the results will provide clinical guidelines, potentially facilitating the widespread adoption of home-based assistive robotics to substantially improve the independence and overall QoL for patients with MS. NCT05835622.

African American and rural-dwelling family caregivers of persons with newly diagnosed advanced cancer perform critical, time-intensive tasks and historically have had limited resources to support their role. To determine the effect of a lay coach-led, early palliative care telehealth intervention (Educate, Nurture, Advise, Before Life Ends [ENABLE] Cornerstone) for African American and rural-dwelling family caregivers of patients with advanced cancer on caregiver and patient outcomes at 24 weeks. This single-blind randomized clinical trial was conducted from January 2020 to May 2025 at outpatient oncology clinics at 2 large cancer centers in the Southeastern US. Participants were African American and rural-dwelling family caregivers aged 21 years or older self-identifying as an unpaid close friend or family member who is involved with the day-to-day medical care of a patient with advanced cancer. The intervention included 6 weekly, 20- to 60-minute psychosocial telephonic sessions facilitated by a trained lay coach plus monthly follow-up. Usual care consisted of mailed pamphlets outlining resources for families at each of the cancer centers. The primary outcome was caregiver distress (anxiety and depressive symptoms as measured by the Hospital Anxiety and Depression Scale [HADS]) at 24 weeks. Secondary outcomes were caregiver and patient quality of life (QOL; measured with the Patient-Reported Outcomes Measurement Information System Global Health Short Form), caregiver burden (Montgomery-Borgatta Caregiver Burden Scale), and patient distress (HADS). Outcomes were assessed using baseline-constrained linear mixed-effects models. A total of 222 family caregivers (mean [SD] age, 55.5 [14.7] years; 169 [76.1%] female; 114 [51.4%] African American; 101 White [45.5%]; 7 other race [3.2%]) and 165 patients (mean [SD] age, 60.7 [12.2] years; 98 [59.4%] female; 79 African American [47.9%]; 84 White [50.9%]; 2 other race [1.2%]) were randomized. At week 24, no relevant between-group differences were observed in caregiver HADS anxiety (mean [SE] baseline-adjusted difference, 0.23 [0.44]; Cohen d&#x2009;=&#x2009;0.05; 95% CI, -0.14 to 0.24; P&#x2009;=&#x2009;.60) or HADS depressive symptom scores (mean [SE] baseline-adjusted difference, 0.04 [0.41]; Cohen d&#x2009;=&#x2009;0.01; 95% CI, -0.19 to 0.21; P&#x2009;=&#x2009;.91). For all other outcomes, 24-week differences were of small magnitude and not statistically significant. Exploratory sensitivity analyses of caregivers distressed at baseline indicated improvements in caregiver anxiety (mean [SE] baseline-adjusted difference, -1.21 [0.53]; Cohen d&#x2009;=&#x2009;-0.38; 95% CI, -0.70 to -0.05) and patient mental health QOL (mean [SE] baseline-adjusted difference, 3.00 [1.37]; Cohen d&#x2009;=&#x2009;0.45; 95% CI, 0.04 to 0.86), but no statistically significant differences in caregiver burden (mean [SE] baseline-adjusted difference, -1.15 [0.69]; Cohen d&#x2009;=&#x2009;-0.32; 95% CI, -0.71 to 0.06) and patient depression (mean [SE] baseline-adjusted difference, -1.30 [0.71]; Cohen d&#x2009;=&#x2009;-0.37; 95% CI, -0.77 to 0.03). This randomized clinical trial of a telehealth intervention for African American and rural-dwelling caregivers of patients with advanced cancer found no differences in caregiver and patient outcomes at 24 weeks. However, an exploratory sensitivity analysis indicated potential improvements in caregiver anxiety and patient mental health QOL. ClinicalTrials.gov Identifier: NCT04318886.

This study aimed to explore the experiences of nurses and nurse managers when using the Unforeseen Situations of Staffing and Qualifications action Model (USSQM) and to describe their views on the further development needs of the USSQM. A descriptive qualitative study was employed. Nineteen (n&#x2009;=&#x2009;19) nurses and nurse managers from one department of a University Hospital in Finland were selected for semistructured focus-group interviews by purposive sampling. Data were collected from January to October 2025; the interview guide focused on participant's experiences of the use of USSQM. Data were analyzed using inductive content analysis. The analysis of the results revealed six themes: (1) Integration of the USSQM into clinical routine, (2) Providing decision-making support and practice clarity, (3) Strengthening the fundamentals of the USSQM, (4) Safeguarding nurse well-being and ethics, (5) Fostering communication and cooperation, (6) Utilization of digital solutions. Nurses and nurse managers described that USSQM was mainly used to assess workload status and manage patient flow. Participants described experiencing a tension between their strong professional ethics and the fundamental objectives of the USSQM. Consequently, they expressed that it was challenging to follow the reorganization and prioritization guidelines dictated by the model. The participants described the USSQM as a practical and usable action model for daily practice. However, future refinement of the USSQM must focus on integrating objective workload indicators to reduce subjectivity and utilizing digital solutions for automated data retrieval. Additionally, adequate information and support from organizational leadership should be ensured during the implementation process to facilitate the comprehensive use of the USSQM. Nurse managers especially experienced that USSQM gave them support in decision-making; therefore, nurse managers play an essential role in ensuring the implementation of the USSQM in the units. They serve as role models and support nurses in decision-making when tasks need to be reorganized or prioritized during periods of high workload.

To describe the emotions of nursing home (NH) residents associated with urinary incontinence (UI) from the point of view of healthcare professionals (HCPs). A phenomenological descriptive study. Seventeen HCPs caring for older people with UI for at least 6&#x2009;months participated across 9 NHs in the Osona county (Barcelona, Spain). Individual interviews were conducted using online videoconferencing and, with participant consent, each session was recorded. Data obtained were analysed with Colaizzi's 7-stage method, using descriptive phenomenology. In-depth thematic analysis was finalised by using ATLAS.ti 8.0. UI in NH residents triggers negative emotions including feelings of impotence, guilt, frustration, embarrassment, anger, discomfort, worry and insecurity. Alleviating factors include de-emphasising UI, implementing adaptations in NHs, and building a strong bond of trust between NH residents and HCPs. Conversely, resident conflicts and cognitive impairment worsen these negative emotions. HCPs perceive a wide range of negative emotions related to UI among NH residents, influenced by cognitive impairment and interpersonal conflicts. These emotions can be eased through appropriate person-centred strategies. There is a need to intentionally incorporate person-centred, emotionally attuned care strategies to reduce residents' distress and improve continence in NH. This study examined how UI generates negative emotions among NH residents from the perspective of HCPs. There is a spectrum of distressing emotions related to UI that are either mitigated or exacerbated by contextual and relational factors. These findings can inform caregiving approaches in NH by guiding more tailored and empathetic strategies to support residents living with UI. Consolidated criteria for reporting qualitative research. HCPs provided their perspectives on the emotions associated with UI in NH residents.

University lifestyle can have lasting effects on students' health, yet culturally validated instruments to examine health-promoting lifestyles are lacking in Mongolia. This study aimed to adapt the Health-Promoting Lifestyle Profile II (HPLP-II) and to assess the validity and reliability of its Mongolian version among students in Ulaanbaatar. A cross-sectional study was conducted with 827 undergraduate students from three universities in Ulaanbaatar, Mongolia. The instrument was translated from English into Mongolian using standard forward- and backward-translation procedures. The final version retained six dimensions and 51 items. Construct validity was assessed using confirmatory factor analysis for a six-component structure, and internal consistency was evaluated using Cronbach's &#x3b1; and McDonald's &#x3c9;. Confirmatory factor analysis indicated a good fit for the six-factor structure (&#x3c7; 2&#x202f;=&#x202f;14233.03; df&#x202f;=&#x202f;1,275; p&#x202f;<&#x202f;0.001; CFI&#x202f;=&#x202f;0.95, GFI&#x202f;=&#x202f;0.95, TLI&#x202f;=&#x202f;0.95, SRMR =&#x202f;0.065, and RMSEA&#x202f;=&#x202f;0.031). The overall HPLP-II demonstrated high internal consistency (&#x3c9;&#x202f;=&#x202f;0.92, &#x3b1;&#x202f;=&#x202f;0.91). However, the nutrition dimension exhibited the lowest reliability and factor loadings, suggesting revision for future studies. The Mongolian version of the HPLP-II demonstrated acceptable reliability and construct validity, supporting the use of a six-dimensional, 51-item instrument to assess health-promoting lifestyles among Mongolian university students. These findings provide a foundation for future health-promotion interventions in Mongolian university settings.

Children with life-limiting conditions and their families face profound existential and spiritual challenges throughout the paediatric palliative care (PPC) trajectory. While spiritual care (SC) is a recognised component of PPC, its continuity and quality across care settings remain underexplored. This study examined how SC can be organised and safeguarded across the PPC continuum, from the perspectives of parents, healthcare professionals, and spiritual care providers. An exploratory qualitative study was conducted using multidisciplinary peer consultation groups. Two groups met online in 2022-2023, discussing six PPC cases over seven sessions. Participants included spiritual care professionals, clinicians from hospital and home settings, and parents. Data sources included audio-recorded transcripts, structured case descriptions, and field notes. A modified QUAGOL approach was used for narrative-informed thematic analysis. Coding was supported with team discussions. Continuity of care (relational, informational, and managerial) informed interpretation as a sensitising framework. Two themes were identified: (1) challenges in ensuring continuity of spiritual care, including fragmented referrals, lack of coordination, and cultural disconnects; and (2) defining and delivering quality SC, emphasising relational consistency, cultural and linguistic fit, and interprofessional collaboration. Parents valued providers who "knew their story", while professionals stressed clearer referral pathways and role alignment. Gaps in coordination and information transfer constrained support across transitions. &#xa0;Continuity of spiritual care in PPC is not merely a logistical task but a relational and interpretive process. Embedding SC into proactive care planning and interprofessional practice may improve coordination, enhance cultural responsiveness, and support families throughout the illness trajectory. &#x2022; Spiritual care is an essential dimension of paediatric palliative care but is often fragmented across settings. Traditionally, SC has been hospital-centred. &#x2022; Families frequently lack consistent support during transitions between hospital, home, and community care. &#x2022; This study suggests that continuity in spiritual care relies on sustained relationships, cultural attunement, and clear coordination. &#x2022; Embedding spiritual care in proactive planning may support consistency and family-centred support throughout the illness trajectory.

Acne is a chronic skin condition that primarily affects adolescents and young adults but can persist into adulthood. It can have repercussions on physical and mental health, self-esteem, and body image. The increasing use of social media for health information and peer support offers an opportunity to explore real-life experiences with acne. This study aims to analyze social media messages from users in the United States and the United Kingdom using artificial intelligence to assess the impact of acne on quality of life (QoL), identify discussion topics, and explore unmet needs. The data were extracted from public platforms using a query containing the word "acne" between January 1 and December 31, 2024. Data cleaning and filtering were performed using natural language processing, machine learning methods, and algorithms. Biterm topic modeling was used to identify the main discussion topics, and QoL impact was assessed using a deep learning algorithm adapted from the EuroQol 5-Dimension Questionnaire or the 36-Item Short Form Health Survey. Unmet needs were identified through manual annotation using the saturation method. A total of 646,809 messages posted by 432,234 users were identified. The main topics included skincare routines and product recommendations (n=154,907, 23.9%), acne scars (n=135,643, 21%), and general treatment information (n=97,177, 15%). Engagement varied across topics and platforms. On Instagram, dietary and nutritional strategies (0.16%, SD 6.36%) showed the highest mean engagement, followed by skincare routines and product recommendations (0.11%, SD 4.81%). In general, engagement scores were higher in the United Kingdom compared to the United States across all topics. On TikTok, content about makeup and acne had the highest mean engagement score (3.03%, SD 92.65%). Overall, 52.9% (228,613/432,234) of the users expressed at least 1 QoL impact, most frequently related to signs and symptoms (175,604/228,613, 76.8%), social functioning (n=149,234, 65.3%), mental health (n=107,155, 46.9%), and cost (n=62,008, 27.1%). Of 3200 annotated messages, 582 contained unmet needs, including effective solutions for hormonal acne (111/582, 19.1%), clarity in identifying acne triggers (n=84, 14.4%), treatment guidance (n=68, 11.7%), and psychological support (n=68, 11.7%). This study revealed the significant physical, psychological, social, and financial impact of acne on QoL and identified several unmet needs. Given the growing role of social media, these findings highlight opportunities for dermatologists and health professionals to educate and engage with the acne community through digital platforms.

This study aimed to adapt the Mindful Eating Scale (MES) for use in China and to assess its psychometric properties among individuals who are overweight or obese. The MES was translated and back-translated following the modified Brislin translation model. After expert review and pretesting, the scale underwent cross-cultural adaptation. Study participants were recruited from individuals who are overweight or obese and admitted to the endocrinology outpatient department of a hospital in Hangzhou. The psychometric properties of the cross-culturally adapted MES were subsequently evaluated. A total of 221 questionnaires were distributed, of which 217 were returned, yielding a valid response rate of 98.19%. The cross-cultural adaptation of the MES consisted of 6 dimensions and 23 items. It demonstrated a Cronbach's &#x3b1; coefficient of 0.905, an item-total correlation reliability of 0.833, and a retest reliability of 0.915. The chi-square-to-degrees-of freedom ratio (&#x3c7;2 /df) was 1.954, the root mean square error of approximation (RMSEA) was 0.066, the goodness-of-fit index (GFI) was 0.862, the adjusted goodness-of-fit index (AGFI) was 0.818, the comparative fit index (CFI) was 0.964, and the Tucker-Lewis index (TLI) was 0.956. The cross-culturally adapted MES demonstrated satisfactory psychometric properties. However, because dietary habits vary across regions and this study was limited to a specific region of China, further research is needed to determine whether the MES is a suitable instrument for assessing mindful eating levels among Chinese individuals who are overweight or obese.

Low health literacy, associated with poorer outcomes and higher costs for health systems and users, disproportionately affects older adults. In Portugal, 80.6% of individuals aged 65+&#x2009;have insufficient health literacy. This qualitative study employed a sequential triangulation design to examine television's role in mediating older adults' navigational health literacy (HL-NAV). We purposively sampled 112 episodes across seven programmes on four national channels over 13&#x2009;weeks and conducted focus groups with 22 older adults following curated TV screenings. Data were analysed using content and discourse analysis separately, then comparatively integrated across domains, guided by the HLS19-NAV framework. Findings reveal that televised health narratives are fragmented, biased, and predominantly promote individual responsibility and self-care, offering limited support for navigating the health system. These representations intersect with older adults' accounts, highlighting gaps and barriers to HL-NAV. Results underscore the need to integrate TV into national health literacy strategies and develop targeted media interventions.

College students are at heightened risk for mental health problems; yet, professional help-seeking remains low. Although digital mental health tools can improve accessibility and reduce stigma, many focus on isolated functions, such as self-screening, psychoeducation, or symptom management, and are not fully integrated with campus counseling services. Multidomain platforms that combine screening, mental health information, counseling access, and campus service navigation may support help-seeking in university settings; however, their acceptability and implementation value remain underexplored. This mixed methods study examined the refinement and preliminary evaluation of Fruto, a campus-integrated, multidomain app developed to support university students' help-seeking attitudes and counseling-related beliefs in a real-world counseling-center setting. Phase 1 used scenario-based prototype sessions to analyze students' interactions with the platform and inform refinement. Phase 2 assessed whether 8 weeks of Fruto use was associated with pre-post changes in attitudinal and counseling-related outcomes. We conducted a 2-phase, mixed methods study. Phase 1 involved vignette-based prototype sessions and semistructured interviews with 16 students to explore user experiences with an early version of Fruto. Scenario-based tasks facilitated feedback on the platform, and thematic analysis identified design implications that guided refinement. Phase 2 involved an 8-week single-group pre-post evaluation. A total of 109 students completed the baseline survey, and 70 provided follow-up responses. Surveys assessed help-seeking attitudes, counseling-related beliefs, and perceived app quality. Linear mixed effects models examined pre-post changes using all available data, and exploratory baseline-adjusted regressions examined the association between overall perceived app quality and postuse outcomes. Scenario-based prototype sessions elicited actionable feedback on how students might use Fruto in realistic help-seeking contexts. Qualitative findings identified 3 refinement priorities that informed subsequent app updates: trusted and identifiable content providers, seamless integration across app features, and relatable self-discovery content to lower psychological barriers to app use. Following these refinements, Phase 2 assessed 8-week pre-post changes using linear mixed effects models. Fruto use was associated with significant increases in positive help-seeking attitudes (B=0.884, SE 0.284, 95% CI 0.327-1.441; P=.002) and positive counseling expectations (B=1.585, SE 0.541, 95% CI 0.526-2.645; P=.003). No significant changes were observed in negative attitudes, negative counseling beliefs, or socially supportive beliefs. In exploratory baseline-adjusted regressions, overall perceived app quality was associated with positive counseling expectations, but not with positive help-seeking attitudes. Fruto shows promise as a campus-integrated, multidomain platform associated with more favorable help-seeking attitudes and counseling expectations among university students. These findings suggest that multidomain platforms may strengthen positive, approach-oriented beliefs toward professional support. Future studies with longer follow-up and objective usage or service-use data are needed to examine whether attitudinal changes translate into help-seeking behavior. Clinical Research Information Service KCT0010622; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=30274&search_page=L.

The rapid advancement of digital technologies, combined with the evolving complexity of health care environments, has introduced a new paradigm in nursing practice. Clinical nurses are now required not only to deliver safe and effective patient care but also to demonstrate competencies in digital literacy and innovation. Among these emerging competencies, digital leadership has become a critical attribute-enabling nurses to lead digital transformation, ensure patient safety, enhance care quality, and support system-level change within health care organizations. Despite its increasing relevance, there is a notable absence of validated measurement tools tailored to assess digital leadership in clinical practice. This study aimed to develop and psychometrically validate a Digital Leadership Scale for Clinical Nurses (DLS-CN) to systematically evaluate the digital leadership capabilities of nurses working in clinical settings. The scale development process followed a rigorous multistep procedure. Initial items were derived from previous qualitative research involving a literature review and in-depth interviews, complemented by an additional literature review conducted in this study. The content validity of 38 preliminary items was evaluated by 9 experts over 2 rounds. A pilot test was conducted with 30 nurses, followed by cognitive interviews with 5 nurses to refine item clarity and relevance. The final set of items was administered to 446 clinical nurses across various health care institutions. Data were randomly split for exploratory factor analysis and confirmatory factor analysis. Additional analyses were conducted to evaluate item discrimination, convergent validity, and internal consistency using IBM SPSS 25.0 and AMOS 23.0. The finalized DLS-CN consists of 29 items grouped under four domains: (1) ability to use digital technology, (2) digital safety management, (3) digital collaboration mindset, and (4) organizational influence. These 4 factors explained 56.9% of the total variance. The scale showed strong internal consistency (Cronbach &#x3b1;=0.95). Convergent validity was demonstrated through strong positive correlations with the Nursing Informatics Competency Scale (Pearson correlation coefficient r=0.82; P<.001) and the Self-Leadership Scale (Pearson correlation coefficient r=0.83; P<.001). The DLS-CN is a valid and reliable instrument for measuring digital leadership among clinical nurses. It offers a practical tool for educators, administrators, and researchers to assess and enhance digital leadership capabilities-ultimately supporting the digital transformation of health care systems.

Spinal muscular atrophy (SMA) imposes substantial physical and emotional burdens on families, particularly on primary caregivers. Although spiritual well-being has been linked to psychological resilience in chronic diseases, its relationship with caregiver burden, depressive symptoms, and quality of life in caregivers of children with SMA remains insufficiently studied. This study investigated these associations in parents of children with SMA. This cross-sectional online survey included 51 parents of children with genetically confirmed SMA (types I-III). Participants completed questionnaires including sociodemographic and clinical characteristics, the Spiritual Well-Being Scale, Zarit Burden Interview, Patient Health Questionnaire-9 (PHQ-9), and WHOQOL-8.Tr. Correlation and exploratory regression analyses were performed to examine relationships between study variables. The mean Spiritual Well-Being Scale, Zarit Burden Interview, Patient Health Questionnaire-9, and WHOQOL-8.Tr scores were 119.2&#x2005;&#xb1;&#x2005;15.5, 49.5&#x2005;&#xb1;&#x2005;12.8, 11.2&#x2005;&#xb1;&#x2005;5.0, and 25.4&#x2005;&#xb1;&#x2005;5.8, respectively. Spiritual well-being was negatively correlated with caregiver burden (r&#x2005;=&#x2005;-0.492, P&#x2005;<&#x2005;.001) and depressive symptoms (r&#x2005;=&#x2005;-0.380, P&#x2005;=&#x2005;.002), and positively correlated with quality of life (r&#x2005;=&#x2005;0.486, P&#x2005;<&#x2005;.001). Caregivers of children requiring medical devices had higher burden and depressive symptom scores and lower spiritual well-being scores (P&#x2005;<&#x2005;.05). Employment and higher income levels were associated with better quality of life and lower caregiver burden (P&#x2005;<&#x2005;.05). Caregivers using prayer as a coping strategy reported higher spiritual well-being scores (P&#x2005;=&#x2005;.007). In exploratory regression analyses, higher spiritual well-being scores were associated with lower caregiver burden and depressive symptoms and with higher quality-of-life scores. Higher spiritual well-being was associated with lower caregiver burden and depressive symptoms and with better quality of life among parents of children with SMA. Given the cross-sectional design and limited sample size, these findings should be interpreted cautiously. Further longitudinal and multicenter studies are needed to better clarify the role of spiritual well-being in caregiver outcomes among families affected by SMA.

Global population aging has precipitated an increased demand for professional geriatric care while facing a shortage of nursing personnel and inconsistent attitudes toward older adults care among nursing students. A systematic review and meta-analysis were conducted to examine nursing student's attitudes toward older adults care and the factors that influence these attitudes in order to optimize the education of geriatric nurses. This meta-analysis was reported following the PRISMA 2020 Checklist. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang data, VIP, and Chinese Biomedical Literature Service System were systematically searched from inception to July 4, 2024, to identify cross-sectional surveys reporting nursing student's attitudes toward older adults. Meta-analysis was performed using Stata 17.0 software after two researchers independently screened the literature, extracted information, and evaluated the risk of bias in the included studies. Subgroup and sensitivity analyses were performed to address heterogeneity. Funnel plots and Egger's test were used to assess the publication bias. Sixty-four studies of nursing student's attitudes toward geriatric care from 11 countries, 47 using KAOP 34-238 and 17 using KAOP 34-204, involved 19,933 and 4,399 nursing students, respectively. Fifty-six studies were assessed as being of high or moderate quality, while eight studies were classified as low quality. Regarding nursing students' attitudes toward older adults, the results of the meta-analysis showed that the KAOP 34-238 score was 146.41 (95% CI: 141.16-151.66, I 2&#x202f;=&#x202f;99.8%), and the KAOP 34-204 score was 130.95 (95% CI: 125.53-136.39, I 2&#x202f;=&#x202f;99.5%). Subgroup analyses of these predictor variables revealed that nursing students showed statistically significant differences in the following factors (p&#x202f;<&#x202f;0.05): gender, having lived with and caring for an older person, having taken a course in geriatric care, selecting nursing as their first choice, and student grade level. The attitude of nursing students toward older adults is generally positive. Future studies should be designed with higher quality to explore the relationship between attitudes toward older people and nursing students' willingness to work in geriatric care. CRD42022348244.