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Community-based mobile health (mHealth) services are increasingly used to support chronic disease management in underserved rural populations facing workforce shortages, geographic isolation, and rapid aging. South Korea entered a super-aged society in December 2024, intensifying pressures in rural regions where multiple mHealth programs are embedded within primary care and public health systems. However, evidence on sustained use in real-world settings remains limited. This study aimed to explore user experiences and acceptance of community-based mHealth services in an underserved rural area of South Korea and identify facilitators and barriers to sustained engagement, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2). A convergent mixed methods design was used, with qualitative and quantitative data collected in parallel, analyzed separately, and integrated at the interpretation stage. Overall, 24 participants with ≥6 months of experience using 1 of 4 publicly funded mHealth services in Pyeongchang County, Gangwon State, were purposively recruited. Semistructured interviews guided by the UTAUT2 were analyzed using directed content analysis, combining deductive and inductive coding. Structured questionnaires assessing usability and behavioral intention were analyzed using descriptive statistics. Findings were integrated through joint interpretation. Participants had a mean age of 71.3 (SD 9.2) years, and 70.8% (17/24) were female; hypertension (18/24, 75%) and hyperlipidemia (15/24, 58.3%) were the most common. Perceived difficulty was low (mean 2.54, SD 2.06, on a 0-10 scale), intention for continued use was high (23/24, 95.8%), and recommendation intention was unanimous (24/24, 100%). Willingness to pay was reported by 79.2% (19/24), most commonly KRW 1000-5000 (US $1-3) per month. Qualitative findings identified performance expectancy, social influence, facilitating conditions, and habit as the most salient determinants of sustained use. Real-time monitoring enhanced health awareness, motivated dietary modification, and increased physical activity. Public health center nurses served as human-in-the-loop facilitators, providing continuous training, troubleshooting, and emotional support, while family and peers reinforced engagement. Habit formation emerged as a central mechanism, with 91.7% (22/24) integrating mHealth use into routines anchored to waking, exercise, and bedtime. Effort expectancy barriers among older participants were mitigated through nurse-led training, and hedonic motivation was driven by intrinsic satisfaction and peer interaction. Integrated analysis showed convergence for ease of use and behavioral intention, and partial divergence for willingness to pay. Community-based mHealth services were successfully integrated into daily life and supported chronic disease self-management among older adults in an underserved rural setting. Sustained engagement was driven by perceived health benefits, continuous human support, and habit formation rather than technology features alone, underscoring the importance of relationship-centered, human-in-the-loop implementation models. Strengthening intuitive design, hands-on onboarding, multidisciplinary primary care teams, and stable financing will be essential for equitable digital health adoption in rural and aging communities.

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.

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.

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.

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.

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.

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.

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.

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.

Uptake of evidence-based medication for opioid use disorder (MOUD), including buprenorphine-naloxone, remains low despite the expanding US opioid crisis. This study examined participants' and staff perceptions of adopting and delivering buprenorphine-naloxone on a mobile unit providing integrated MOUD and HIV services for people with opioid use disorder who inject drugs in the HPTN 094 INTEGRA trial. We conducted semi-structured interviews with people with opioid use disorder who inject drugs in the intervention or control arm (n&#x2009;=&#x2009;77) and mobile unit staff (n&#x2009;=&#x2009;38) of HPTN 094 as part of an embedded qualitative implementation science evaluation across five US cities: Houston, Los Angeles, New York City, Philadelphia and Washington, DC. Interviews were transcribed and analysed using a pragmatic inductive and deductive thematic approach. Fear of precipitated withdrawal was a primary factor shaping perceptions of buprenorphine and other MOUD formulations. This fear was heightened by the widespread presence of fentanyl in the unregulated drug supply. Participants' MOUD preferences were influenced by their treatment goals and by misperceptions of the role of naloxone in buprenorphine and the risk of precipitated withdrawal. Additional barriers included stigma towards MOUD and infrastructure constraints that complicated buprenorphine-naloxone inductions on a mobile unit. Even with facilitated access, perceptions of evidence-based MOUD were strongly shaped by fear of precipitated withdrawal. Aligning MOUD formulations with the treatment goals of people who inject drugs, along with expanding flexibility in MOUD access, delivery and induction practices across formulations, may improve uptake of these life-saving treatments.

Coercive control is a complex behavioural phenomenon where severity, frequency and patterns need to be examined collectively. However, approaches to measuring coercive control to date have demonstrated limited understanding of these patterns of behaviour by a partner or ex-partner that reflect an individual woman's experience. The aim of this study was to develop a holistic contemporary valid self-report measure of coercive control by partners. Standard instrument development, with academic and lived experience feedback and psychometric testing, using secondary data analysis, to develop the Coercive-Composite Abuse Scale (C-CAS). Australian survey of women: feedback from experts. Data for scale development from 854 adult women in Australia, where items assessed 5-year and 12-month abuse frequency. Feedback from five survivors and eight expert researchers. Scale reliability and validity; robustness of subscales; association with fear of a partner. Developed from existing scales and informed by academic and lived-experience expertise, the C-CAS factor analysis revealed a four-factor structure accounting for 57% of variance - Psychological Control (13 items, &#x3b1;=0.928), Sexual and Reproductive Coercion (6 items, &#x3b1;=0.887), Severe Coercive Control (8 items, &#x3b1;=0.820) and Technology-Facilitated Threats (3 items, &#x3b1;=0.754), showing excellent internal consistency. Evidence of the scale's face, content and construct validity was demonstrated, with further testing needed to confirm these findings. The factors combined into four key patterns- three of combined abuse and psychological control, which were experienced alone by some women. Our hypotheses asserting distinct patterns of abuse types for individuals, with severe combined patterns eliciting greater fear of a partner/ex-partner, were confirmed. The C-CAS, a self-report measure of coercive control experiences among women, has demonstrated initial reliability and validity and is suitable for use in population or clinical studies. Additional validation with diverse samples is required.

People with severe mental illness (SMI) are twice as likely to develop Type 2 diabetes (T2D) compared with people without SMI and have poorer outcomes from T2D. Research evaluating self-management interventions for T2D consistently excludes individuals with SMI, therefore existing offers fail to address the specific needs of this population. The DIAMONDS programme (Diabetes and Mental Illness, Improving Outcomes and Self-management) developed a bespoke supported self-management programme for people with coexisting SMI and T2D. As part of a mixed-methods feasibility study we collected and analysed qualitative data to explore the acceptability of the DIAMONDS intervention. Semi-structured interviews were conducted with 12 service user participants with SMI and T2D, and 10 DIAMONDS Coaches who delivered the intervention. Interviews were informed by the theoretical framework of acceptability and were thematically analysed. Four overarching themes were identified, these included: Recognising and addressing a need-highlighting the importance of the intervention in the context of current gaps in care; 'It's all about person-centred, essentially, isn't it?'-emphasising the role of flexible, individualised delivery in acceptability; Utility of different intervention components-describing how different components were used; Tangible change and beneficial effects- improvements in behaviour and health, including smoking cessation. The DIAMONDS intervention was acceptable for people with SMI and T2D and for DIAMONDS Coaches who were delivering it. A person-centred approach enabled engagement and self-reported behaviour change, but participants needed differing levels of support for behaviour change. These findings informed refinements to the intervention, which will be evaluated in a definitive trial.

Following the Dobbs v Jackson Women's Health Organization decision, states with abortion bans have experienced increased maternal morbidity and mortality. However, the associations of these restrictions with abortion-adjacent care-medical care directly affected by or overlapping with abortion, such as management of early pregnancy loss (EPL), ectopic pregnancy, and other pregnancy complications-are not well described. To examine how state-level abortion bans are associated with abortion-adjacent clinical care among physicians from different medical specialties. This qualitative study was conducted between May 13, 2024, and May 23, 2025, using purposive and snowball sampling. Participants included physicians from emergency medicine, family medicine, and obstetrics and gynecology specialties practicing in 9 states with total abortion bans. Semistructured interviews were conducted via videoconference and analyzed using an inductive thematic approach with dual independent coding. Medical practice in a state with an abortion ban. Participant-reported experiences with clinical decision-making, care delivery, counseling practices, and professional responsibilities in the context of abortion bans. A total of 40 physicians (18 in obstetrics and gynecology, 8 in family medicine, and 14 in emergency medicine) across 9 states participated, 30 (75.0%) of whom were female. Mean (SD) length of time in practice was 7.9 (6.1) years. Six major themes emerged: (1) delays in care and deviations from standard practice for EPL, ectopic pregnancy, molar pregnancy, preterm prelabor rupture of membranes, and maternal comorbidities; (2) ambiguity and fear among physicians; (3) loss of patient autonomy and shared decision-making; (4) erosion of trust in the patient-physician relationship; (5) placement of physicians into new gatekeeping roles; and (6) increased health care system burdens. Physicians described requiring additional confirmatory testing, seeking institutional approval even for emergent life-saving interventions, and being forced to determine which patients were sick enough to receive medically indicated care. In this qualitative study of the consequences of abortion bans across multiple medical specialties, abortion bans were associated with disrupted clinical care far beyond what is traditionally categorized as abortion, with treatment delays that endanger patients, undermined patient autonomy and physician-patient trust, and with new gatekeeping roles for physicians. These restrictions shifted medical decision-making from clinical judgment and patient values toward legal risk mitigation, with potential long-term consequences including exacerbation of health care inequities and compromised ability to provide safe and effective care for pregnant patients.

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.

This article explores how thinking in terms of neurodiversity can help clinicians take mental distress seriously without unnecessarily medicalizing normal variation. Rather than searching for a disorder label, the focus shifts to a profile of sensitivities and talents, always understood in relation to context. The article shows where the categorical DSM model falls short in everyday clinical practice, particularly due to comorbidity, heterogeneity, and a tendency to overlook strengths. As an alternative, a simple dimensional framework with seven developmental dimensions is presented. This framework provides clinicians with a practical language to work with patients, parents, schools, or employers in understanding where a person struggles and where they thrive. Two clinical vignettes illustrate how this approach can lead to more concrete contextual adaptations, less pressure to label, and a more cautious and goal-oriented use of medication. The core message is that neurodivergence is best understood as a dynamic state of dysregulation in a specific context rather than as a fixed identity trait.

Current studies have explained only a small proportion of variance in hearing aid (HA) uptake and use. This novel study applied theoretical frameworks of human behaviour to develop surveys to identify further barriers and enablers that could be addressed with behavioural interventions. Data on hearing healthcare decisions/behaviours and/or acceptability of interventions was extracted from an ongoing systematic review of barriers and enablers to uptake and use of hearing interventions conducted by some of the authors. Two surveys, one each for HA users and non-users, were administered primarily online. Respondents were 38 adult HA users and 48 non-users in Australia with diagnosed hearing loss recruited across three metropolitan/rural audiology clinics. Survey responses yielded 5 barriers and 7 enablers not previously identified. Barriers included other health concerns being more important, and lack of knowledge about HAs and trust in service providers. Enablers included the input of others, and the beliefs that HAs are easy to manage and that HAs would make people feel good about themselves. Applying behavioural frameworks to identify barriers and enablers to hearing aid uptake and use resulted in identification of influences not previously reported. These should be addressed with behavioural interventions.

The COVID-19 pandemic disrupted physical activity behaviors and worsened mental health worldwide. This study synthesized observational evidence on relationships between physical activity and depression, anxiety, and stress in adults during COVID-19. A systematic review and multilevel random-effects meta-analysis (PROSPERO CRD42023491651) of observational studies published January 2020-May 2023 included 38 studies with 140,915 adults using validated measures. Physical activity showed significant inverse associations with depression (r&#x2009;=&#x2009;-0.18; p&#x2009;<&#x2009;0.001) and stress (r&#x2009;=&#x2009;-0.14; p&#x2009;=&#x2009;0.043), but not anxiety (p&#x2009;=&#x2009;0.340). Heterogeneity was substantial. Findings suggest physical activity can serve as a low-risk adjunct to mitigate depressive symptoms and perceived stress during public health crises, though interpretation should be cautious given observational design and high heterogeneity. Clinically, brief assessment and promotion of regular physical activity-tailored to context and delivered in-person or remotely-may support psychological well-being, while anxiety may require combined approaches during emergencies.