Lay beliefs about the preventability of major health conditions

Seroprevalence of COVID-19 and associated factors in a medical institution in Pakistan

Objective

This study investigates the association of preventive measures with coronavirus disease (COVID-19) seropositivity.

Methods

This cross-sectional study was conducted at the Combined Military Hospital Kharian Medical College, Pakistan, in September 2020. A total of 442 participants from three different strata (faculty, students, and administration/technical staff) were enrolled using a convenient sampling technique. A rapid antibody testing method was used to detect antibodies. The Ichroma™ COVID-19 Ab test is an in vitro diagnostic device that helps in the rapid identification of COVID-19 by measuring the levels of IgG and IgM antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the blood. An automated fluorescent immunoassay system (AFIAS-6), with a clinical sensitivity of 95.8% and specificity of 96.7%, was used for qualitative analysis. A self-administered questionnaire was used to collect data, and data analysis was performed using SPSS version 25.

Results

In total, 442 participants were included in the study: 40 (9%) faculty members, 299 (67%) students, and 103 (23.3%) administrative/technical staff. As many as 14.9% of the participants were symptomatic; 32.4% always used masks, and 14% never wore masks. Furthermore, 69.7% of participants frequently washed their hands for 20 s, and 75.6% were aware of social distancing. A total of 16.96% of participants tested positive for IgG antibodies. Moreover, most of the administration/technical staff who tested positive for IgG were asymptomatic (68.42%). A significant association (p < 0.001) was found between following the safety guidelines (wearing masks, handwashing, and social distancing) and the occurrence of COVID-19.

Conclusion

This study showed a higher seroprevalence rate than other studies as it was conducted toward the end of the first wave of the COVID-19 pandemic. However, we are still far from achieving herd immunity. Furthermore, strict compliance with preventive measures is the only way to ensure safety until an effective vaccine is developed.

Preferred level of categorization as strategy to manage chronic illness-related identity among individuals with type 1 versus type 2 diabetes

The present investigation examined social identification management among individuals affected by chronic illness. Because diabetes is a chronic medical condition that consists of a broad superordinate group with two nested subgroups of differing relative status (type 1 versus type 2), it is well-suited to an examination of positive identity management strategies used by individuals with chronic illness. A cross-sectional survey was conducted on individuals with diabetes (N = 399) to assess diabetes-related identity. Results indicated that individuals with type 1 diabetes reported greater identity centrality and greater preference for subgroup self-categorization ("individual affected by type 1 diabetes") over superordinate group categorization ("individual affected by diabetes") than did individuals with type 2 diabetes. The relationship between diabetes type and preferred categorization level was moderated by perceived intractability of their condition and perceived stigmatization of the lower status subgroup (i.e., type 2), suggesting that categorization level functions to maintain a positive self-concept. Further, categorization level moderated the negative relationship between identity centrality and feelings of depression and anger, suggesting that self-categorization might function to protect against self-concept threat. The present findings highlight the roles of group status, group boundary permeability, and perceived stigma on identity management strategies used by individuals with a chronic illness.

Public knowledge of chronic kidney disease evaluated using a validated questionnaire: a cross-sectional study

Background

Screening programs may help to address the burden of chronic kidney disease (CKD) in Australia. Public awareness is an important determinant of the uptake of screening programs. However, data on the public knowledge of CKD in Australia is lacking. The aim of this study was to develop a validated questionnaire and assess the Australian public knowledge of CKD.

Methods

A CKD knowledge questionnaire was developed after reviewing the literature and discussions with nephrology experts. Content validity was performed by nephrologists (n = 3), renal nurses (n = 3) and research personnel (n = 4). The questionnaire was piloted in 121 public participants. Next, discriminant validation was performed by recruiting two additional groups of participants: final year undergraduate pharmacy students (n = 28) and nephrologists (n = 27). Reliability of the questionnaire was assessed by calculating Cronbach’s alpha. Next, a cross-sectional survey of the Australian public (n = 943) was conducted by using the validated questionnaire. It was administered using an online Omnibus survey. Quota sampling was used for participant selection and to ensure that the final sample would match the key characteristics of the Australian population. Finally, a standard multiple regression analysis was performed to identify predictors of the public knowledge.

Results

The median CKD knowledge scores of the public, students and nephrologists were 12, 19 and 23 (maximum score of 24), respectively, with statistically significant differences in the scores across the three groups (p < 0.001; Kruskal-Wallis test). The Cronbach’s alpha was 0.88 (95% CI: 0.86–0.91), indicating that the questionnaire had good internal consistency. In the cross-sectional survey of the Australian public, the participants’ mean (SD) age was 47.6 (±16.6) years and 51.2% were female. The mean (SD) knowledge score was 10.3 (± 5.0). The multivariate analysis showed that participants with a higher level of education; with a family history of kidney failure; with a personal history of diabetes; and currently or previously living in a relationship had significantly higher knowledge scores.

Conclusion

The Australian public knowledge of CKD was relatively poor. Improving public knowledge may assist in increasing early detection and subsequent management of CKD in Australia.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5301-4) contains supplementary material, which is available to authorized users.

Precision in Setting Cancer Prevention Priorities: Synthesis of Data, Literature, and Expert Opinion

Cancer will continue to be a leading cause of ill health and death unless we can capitalize on the potential for 30-40% of these cancers to be prevented. In this light, cancer prevention represents an enormous opportunity for public health, potentially saving much of the pain, anguish, and cost associated with treating cancer. However, there is a challenge for governments, and the wider community, in prioritizing cancer prevention activities, especially given increasing financial constraints. This paper describes a method for identifying cancer prevention priorities. This method synthesizes detailed cancer statistics, expert opinion, and the published literature for the priority setting process. The process contains four steps: assessing the impact of cancer types; identifying cancers with the greatest impact; considering opportunities for prevention; and combining information on impact and preventability. The strength of our approach is that it is straightforward, transparent and reproducible for other settings. Applying this method in Western Australia produced a priority list of seven adult cancers which were identified as having not only the biggest impact on the community but also the best opportunities for prevention. Work conducted in an additional project phase went on to present data on these priority cancers to a public consultation and develop an agenda for action in cancer prevention.

The behavioural constellation of deprivation: Causes and consequences

Socioeconomic differences in behaviour are pervasive and well documented, but their causes are not yet well understood. Here, we make the case that a cluster of behaviours is associated with lower socioeconomic status (SES), which we call “the behavioural constellation of deprivation.” We propose that the relatively limited control associated with lower SES curtails the extent to which people can expect to realise deferred rewards, leading to more present-oriented behaviour in a range of domains. We illustrate this idea using the specific factor of extrinsic mortality risk, an important factor in evolutionary theoretical models. We emphasise the idea that the present-oriented behaviours of the constellation are a contextually appropriate response to structural and ecological factors rather than a pathology or a failure of willpower. We highlight some principles from evolutionary theoretical models that can deepen our understanding of how socioeconomic inequalities can become amplified and embedded. These principles are that (1) small initial disparities can lead to larger eventual inequalities, (2) feedback loops can embed early-life circumstances, (3) constraints can breed further constraints, and (4) feedback loops can operate over generations. We discuss some of the mechanisms by which SES may influence behaviour. We then review how the contextually appropriate response perspective that we have outlined fits with other findings about control and temporal discounting. Finally, we discuss the implications of this interpretation for research and policy.

The Interactive Domain Model of Best Practices in Health Promotion: Developing and Implementing a Best Practices Approach to Health Promotion

This paper discusses issues associated with taking a best practices approach to health promotion including determining factors, implementation, and implications for practitioners and policy makers. We suggest that health promotion effectiveness will be increased through adoption of a systematic and critically reflective approach to practice—one which considers all major factors affecting practice and is consciously guided by health promotion values and goals, theories and beliefs, evidence, and understanding of the environment. To help practitioners develop and implement best practices, we outline our Inter-active Domain Model of Best Practices in Health Promotion, the IDM Operational Framework, and a set of best practices criteria. The conceptual model, framework, and criteria are based on three domains (i.e., underpinnings, understanding of the environment, and practice) and related subdomains, all of which interact with each other within the context of the immediate and broader environments.

Genetics and primary care: where are we headed?

Since first sequencing the human genome in 2003, emerging genetic/genomic technologies have ushered in a revolutionary era of medicine that purports to bridge molecular biology and clinical care. The field of translational medicine is charged with mediating this revolution. Sequencing innovations are far outpacing guidelines intended to ease their practice-based applications, including in primary care. As a result, genomic medicine’s full integration in primary care settings especially, has been slow to materialize. Researchers and clinicians alike face substantial challenges in navigating contentious ethical issues raised in translation and implementation, namely preserving the spirit of whole-person approaches to care; maintaining respect for persons and communities; and translating genetic risk into clinical actionability. This commentary therefore explores practical barriers to, and ethical implications of, incorporating genomic technologies in the primary care sector. These ethical challenges are both philosophical and infrastructural. From a primary care perspective, the commentary further reviews the ethical, legal and social implications of the Center for Disease Control’s proposed model for assessing the validity and utility of genomic testing and family health history applications. Lastly, the authors provide recommendations for future translational initiatives that aim to maximize the capacities of genomic medicine, without compromising primary care philosophies and foundations of practice.

The contribution of three components of nutrition knowledge to socio-economic differences in food purchasing choices

OBJECTIVES

To assess socio-economic differences in three components of nutrition knowledge, i.e. knowledge of (i) the relationship between diet and disease, (ii) the nutrient content of foods and (iii) dietary guideline recommendations; furthermore, to determine if socio-economic differences in nutrition knowledge contribute to inequalities in food purchasing choices.

DESIGN

The cross-sectional study considered household food purchasing, nutrition knowledge, socio-economic and demographic information. Household food purchasing choices were summarised by three indices, based on self-reported purchasing of sixteen groceries, nineteen fruits and twenty-one vegetables. Socio-economic position (SEP) was measured by household income and education. Associations between SEP, nutrition knowledge and food purchasing were examined using general linear models adjusted for age, gender, household type and household size.

SETTING

Brisbane, Australia in 2000.

SUBJECTS

Main household food shoppers (n 1003, response rate 66·4 %), located in fifty small areas (Census Collectors Districts).

RESULTS

Shoppers in households of low SEP made food purchasing choices that were less consistent with dietary guideline recommendations: they were more likely to purchase grocery foods comparatively higher in salt, sugar and fat, and lower in fibre, and they purchased a narrower range of fruits and vegetables. Those of higher SEP had greater nutrition knowledge and this factor attenuated most associations between SEP and food purchasing choices. Among nutrition knowledge factors, knowledge of the relationship between diet and disease made the greatest and most consistent contribution to explaining socio-economic differences in food purchasing.

CONCLUSIONS

Addressing inequalities in nutrition knowledge is likely to reduce socio-economic differences in compliance with dietary guidelines. Improving knowledge of the relationship between diet and disease appears to be a particularly relevant focus for health promotion aimed to reduce socio-economic differences in diet and related health inequalities.

Community understanding of the preventability of major health conditions as a measure of health literacy

OBJECTIVE

To examine health literacy in a rural community by measuring the understanding of the preventable nature of six major health conditions.

DESIGN

Cross-sectional population survey.

SETTING

New housing areas of Strathfieldsaye, Victoria.

PARTICIPANTS

A total of 197 adults aged 18 years or older.

MAIN OUTCOME MEASURES

Perceived preventability of skin cancer, lung cancer, cervical cancer, high blood pressure, heart attack and diabetes.

RESULTS

Skin cancer was the only condition which most people perceived as being all or mostly preventable (50.3%). Lung cancer was perceived to be all or mostly preventable by 35.5% of respondents, high blood pressure by 34.0%, cervical cancer by 27.4%, diabetes by 25.4% and heart attack by only 14.7%.

CONCLUSIONS

This study shows that there is a lack of understanding of the preventability of these health conditions. Efforts need to be directed towards improving the public's knowledge of disease prevention and to ensure that health promotion programs reach populations with the most need.

Does HPV vaccination affect women's attitudes to cervical cancer screening and safe sexual behaviour?

The Human Papillomavirus (HPV) vaccine has the potential to greatly reduce the incidence of cervical cancer by protecting against HPV infections responsible for 70% of cervical cancer diagnoses. However, preliminary research has indicated that women vaccinated against HPV may be less likely to undergo cervical cancer screening and engage in safe sexual behaviour. The aim of the current study was to investigate whether vaccinated and unvaccinated women differ in their (i) knowledge of cervical screening guidelines, (ii) perceived vulnerability to cervical cancer, (iii) cervical screening intentions and uptake, and (iv) attitudes to and engagement in safe sexual behaviour. Participants were 193 female university students (119 vaccine recipients and 74 vaccine non-recipients) who completed online self-report questionnaires. Of all the assessed outcomes, attitudes to safe sexual behaviour were the only significant findings related to vaccination status (p<.001), such that vaccinated women held more positive attitudes to practicing safe sexual behaviour. Less than 5% of participants correctly identified screening guidelines. These findings do not support previous research concluding vaccination could have a detrimental impact on screening and sexual behaviour. Importantly, results highlight poor awareness of screening guidelines, poor levels of consistent condom use (50%) amongst those sexually active, and low uptake of screening (42%) amongst those eligible to be screened. Further research needs to specifically address young women's gaps in knowledge by developing initiatives promoting cervical screening.

How cardiac patients describe the role of their doctors in smoking cessation: a qualitative study

This article reports a qualitative study investigating patients' experiences of ongoing smoking or smoking cessation after hospitalisation for an acute coronary syndrome (myocardial infarction or unstable angina) and describes how study participants spoke about the role of their doctors in smoking cessation. We invited individuals who had been admitted to an Australian public hospital in 2005 with a discharge diagnosis of an acute cardiac syndrome and who were smokers at the time of their hospitalisation to participate. Participants underwent a semi-structured interview and ongoing smokers also completed a 'stages of change' questionnaire. In total, 35 participants were interviewed, including 14 who were no longer smoking at least 12 months after their admission and 21 who were. Findings gave insight into the ways that cardiac patients perceive smoking cessation advice from their doctors, the perceived stigma of smoking and how lay understandings about smoking and smoking cessation emphasise the role of choice and individual responsibility. Our findings also indicate considerable scope for GPs and other doctors to offer better smoking cessation support to patients with established cardiovascular disease, particularly after a period of hospitalisation when the majority are highly motivated to stop smoking.

Psychosocial determinants of socioeconomic inequalities in cancer screening participation: a conceptual framework

Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.

Findings from a community education needs assessment to facilitate the integration of genomic medicine into primary care

PURPOSE

To assess the lay public's knowledge of, and beliefs about, genetics and genetic testing to create an educational initiative that promotes acceptance and utilization of genomic medicine in primary health care.

METHODS

A telephone survey of English-speaking adults in Guilford County, North Carolina was conducted in 2006 to identify community members' educational needs regarding genetics and genetic testing.

RESULTS

Most respondents recognized the connection between family history and disease risk. A majority did not appear to know about: (1) basic principles of inheritance, (2) laws prohibiting genetic discrimination, and (3) the availability and limitations of genetic tests. About 25% thought that they could not reduce their risk if they have a genetic predisposition for disease. Knowledge level was affected by education, experience, age, and race.

CONCLUSION

If primary care providers use family history as a risk assessment tool, community education programs must address (1) the collection of family health history, (2) legislation regarding genetic nondiscrimination, (3) benefits and limitations of existing genetic tests, and (4) genetic determinism. Programs emphasizing practical, "how to" information can be targeted to individuals likely to collect family history information and address misperceptions about discrimination, testing, and determinism.

Use of and attitudes and knowledge about pap smears among women in Kuwait

OBJECTIVE

To estimate the lifetime prevalence of Pap smear among women in Kuwait and to assess their knowledge about and attitude toward Pap smears.

METHODS

This was a descriptive cross-sectional study using a multistage cluster sampling method. We interviewed 299 women attending polyclinics in Kuwait using a self-administered questionnaire. Factors related to history of having a Pap smear, knowledge level, and willingness to participate in a screening program were evaluated.

RESULTS

The lifetime prevalence of Pap smear was found to be 37% (95% CI 33-43). Forty-four percent of women in our study had a Pap smear only once in their lives. History of having at least one Pap smear was significantly related to such factors as age, total family income, marital status, history of cervical infection, and knowledge. The level of knowledge about cervical cancer varied among the participants. Forty-six percent of women were uncertain about the symptoms of cervical cancer. About half the women recognized cervical infection, smoking, and having multiple sexual partners as risk factors for cervical cancer; however, only 10% recognized early sexual intercourse as a risk factor. Willingness to participate in a future screening program varied significantly according to educational level, employment status, and total family income.

CONCLUSIONS

Although cervical cancer incidence and mortality are relatively low in Kuwait, they may be underreported in the absence of a screening program. Moreover, lifetime prevalence of having a Pap smear was found to be considerably lower in Kuwait compared with developed countries.

Fatalistic beliefs about cancer prevention and three prevention behaviors

BACKGROUND

A substantial proportion of US adults hold fatalistic beliefs about cancer prevention. Although evidence suggests that fatalistic beliefs discourage people from engaging in screening behaviors that can reduce their cancer risk, far less is known about associations between cancer fatalism and other prevention behaviors. We examined sociodemographic correlates of these beliefs and their associations with regular exercise, smoking, and fruit and vegetable consumption with a national sample of American adults.

METHODS

Data were analyzed from the first wave of the Health Information National Trends Survey (HINTS 2003). HINTS used random-digit dialing to complete phone interviews with adult Americans (N = 6,369).

RESULTS

Nearly half of respondents (47.1%) agreed that "It seems like almost everything causes cancer," 27.0% agreed that "There's not much people can do to lower their chances of getting cancer," and 71.5% agreed that "There are so many recommendations about preventing cancer, it's hard to know which ones to follow." These beliefs were stronger in subjects who were less educated but generally weaker among both African Americans and Hispanics relative to Whites. Fatalistic beliefs about cancer prevention were negatively associated with exercising weekly, not smoking, and eating five or more fruits and vegetables daily in multivariate analysis controlling for sociodemographic characteristics.

CONCLUSIONS

Americans who hold fatalistic beliefs about cancer prevention may be at greater risk of cancer because they are less likely to engage in various prevention behaviors. Results have notable implications for future cancer communication and education efforts.

Using the PRECEDE model to plan men's health programs in a managed care setting

Managed care organizations represent an important venue for delivering health promotion programs. However, most health plans do not employ public health strategies that match peoples' needs and preferences to effective behavior change techniques. This article focuses on the planning efforts by Blue Cross and Blue Shield of North Carolina (BCBSNC) to address the problem of underutilization of preventive health care services among adult male members--an issue that has received comparatively little attention in the health behavior arena. BCBSNC planners used the PRECEDE planning process to define issues relevant to the target population and determine appropriate intervention strategies. Increasing perceived susceptibility and severity to disease, perceived benefits of screening, physician recommendation for screening, and health knowledge/awareness emerged as intervention priorities. The PRECEDE planning process yielded important evidence-based information and strategies to address men's underuse of preventive services and led BCBSNC to adopt new systems for planning interventions to promote the health of its members.

Knowledge of cervical cancer and screening among women in east-central England

This study assesses the extent and accuracy of women's knowledge of cervical cancer, risk factors, and the efficacy of the national screening program. Data were obtained from a questionnaire survey of randomly selected women eligible for screening, drawn from a population in east-central England. The majority of women in the sample overestimated the current incidence of cervical cancer, both absolutely and relative to other cancers. Perceiving incidence to be high was associated with reporting worries about the disease. With respect to the screening process, 78.3% believe that the smear abnormality rate is higher than it actually is, and only 7.6% correctly appreciate that the abnormality rate is highest at younger ages. With respect to performance, 16.3% believed the smear test to be completely accurate, and more than half overestimated the likely number of cancer cases prevented by screening. While certain cervical cancer risk factors were correctly assigned by the majority of women, undue emphasis was placed on genetic influence, while the risks posed by human papillomavirus infection were unfamiliar to almost half of the sample. We conclude that women typically possess only a partial picture of risk factors and overestimate both the incidence of cervical cancer and the efficacy of screening.

Behavioral and social sciences theories and models: are they used in unintentional injury prevention research?

Behavioral and social sciences theories and models have the potential to enhance efforts to reduce unintentional injuries. The authors reviewed the published literature on behavioral and social science theory applications to unintentional injury problems to enumerate and categorize the ways different theories and models are used in injury prevention research. The authors conducted a systematic review to evaluate the published literature from 1980 to 2001 on behavioral and social science theory applications to unintentional injury prevention and control. Electronic database searches in PubMed and PsycINFO identified articles that combined behavioral and social sciences theories and models and injury causes. The authors identified some articles that examined behavioral and social science theories and models and unintentional injury topics, but found that several important theories have never been applied to unintentional injury prevention. Among the articles identified, the PRECEDE PROCEED Model was cited most frequently, followed by the Theory of Reasoned Action/Theory of Planned Behavior and Health Belief Model. When behavioral and social sciences theories and models were applied to unintentional injury topics, they were most frequently used to guide program design, implementation or develop evaluation measures; few examples of theory testing were found. Results suggest that the use of behavioral and social sciences theories and models in unintentional injury prevention research is only marginally represented in the mainstream, peer-reviewed literature. Both the fields of injury prevention and behavioral and social sciences could benefit from greater collaborative research to enhance behavioral approaches to injury control.

Public interest in genetic testing for susceptibility to heart disease and cancer: a population-based survey in the UK

BACKGROUND

Given the current concerns about the clinical validity of commercially marketed genetic tests for multifactorial diseases, there is a surprising dearth of information about what public demand might be for genetic tests for any complex diseases other than cancer. The aim of this study was to examine interest in genetic testing for the most common multifactorial disease, heart disease, and to compare it with interest in testing for cancer in a general population sample that had not received detailed information about genetic tests.

METHODS

Interest in genetic testing for heart disease susceptibility was surveyed and compared to interest in genetic testing for cancer susceptibility among a nationally representative sample of 1,960 British adults as part of the Office for National Statistics Omnibus survey.

RESULTS

Sixty-nine percent of respondents expressed interest in being tested for genetic susceptibility to heart disease. Men, people aged 45-60 years, those with less education, and those with a family history were most interested in genetic testing for heart disease. Sixty-four percent of respondents expressed interest in genetic testing for susceptibility to cancer, and gender, age, and education, but not family history, were associated with interest.

CONCLUSIONS

Interest in genetic testing for susceptibility to both heart disease and cancer was high, with the most educated individuals being the least interested in testing. Although the shift toward the 'expert patient' is actively encouraged and consistent with today's health policies, there is considerable and justifiable concern about some of the genetic tests for multifactorial diseases that are currently being marketed directly to the public. The high level of initial interest in the general public found in this study supports the need for a public education program around genetic testing for multifactorial diseases.

Public beliefs about the preventability of unintentional injury deaths

This report is based upon the results of a national random digit dialed telephone survey in which 943 adults were queried. Subjects reported the proportion of deaths due to motor vehicle crashes, falls, fires/burns, drowning and poisoning that they felt were preventable. On average, respondents believed that 56% of 'fatal accidents' were preventable; as were 62% of motor vehicle crash deaths, 53% of fall deaths, 67% of drownings, 62% of fire/burn fatalities and 70% of accidental poisonings. Logistic regression models predicting preventability beliefs differed according to the type of injury event in question, but socio-economic status and perceived alcohol involvement were positive predictors of beliefs related to all of the injuries under study. The ramifications of these findings and future research directions are discussed.

Assessing “Sun Know How”: comparing outdoor and indoor workers

The aim of this study was to compare knowledge of the “Sun Know How” campaign’s primary sun safety messages (i.e. covering up, seeking shade and applying sunscreen) between adults who work predominantly outdoors and adults who work predominantly indoors. A questionnaire survey was conducted amongst a purposive sample of local authority and National Health Service employees across four boroughs in the Northern and Yorkshire region (N = 273). While findings support the value of concentrating efforts and resources on outdoor workers, they also highlight the necessity for interventions which reflect and account for distinct needs, practical circumstances, and the developing evidence base.