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Cevheroğlu S, Büyükyılmaz F. Anxiety and Health Literacy Levels of Patients Undergoing Colonoscopy. Gastroenterol Nurs 2024; 47:11-18. [PMID: 37935448 DOI: 10.1097/sga.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/23/2023] [Indexed: 11/09/2023] Open
Abstract
This descriptive, correlational study was conducted to determine the anxiety and health literacy levels of patients undergoing colonoscopy and the variables affecting them. The study population consisted of individuals who presented for colonoscopy to the endoscopy department of a state hospital. The sample consisted of 160 individuals who met the inclusion criteria. Three data collection tools (Identifying Information Form, State-Trait Anxiety Inventory, and Health Literacy Scale) were used to determine anxiety and health literacy levels. Findings show that the state-trait anxiety of individuals who would undergo colonoscopy for the first time was moderate, and their health literacy scores were inadequate, problematic, and weak. There was a positive and significant relationship between patients' anxiety and health literacy levels. Variables such as age, gender, marital status, education level, employment status, disease-related symptoms, a family history of cancer, and fear of colonoscopy influenced anxiety and health literacy. Based on these findings, we recommend that individuals' anxiety and health literacy status be determined before a colonoscopy procedure to improve gastroenterology nurses' management of these patients.
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Affiliation(s)
- Seda Cevheroğlu
- Seda Cevheroğlu, PhD, BSN, is Senior Instructor, Nursing Department, Health Sciences Faculty, Eastern Mediterranean University, Famagusta, North Cyprus, Turkey
- Funda Büyükyılmaz, PhD, BSN, is Professor, Fundamentals of Nursing Department, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Funda Büyükyılmaz
- Seda Cevheroğlu, PhD, BSN, is Senior Instructor, Nursing Department, Health Sciences Faculty, Eastern Mediterranean University, Famagusta, North Cyprus, Turkey
- Funda Büyükyılmaz, PhD, BSN, is Professor, Fundamentals of Nursing Department, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Ran N. Study of impacts of education, open-access medical publishing, and internet on women's health in China. Health Care Women Int 2023; 44:1273-1289. [PMID: 35819913 DOI: 10.1080/07399332.2022.2096888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
The researchers' aim to quantitatively study the impacts of education, health expenditure, Internet, mobile phone, and open-access articles in medical science on women's health in China. We found that there are very strong significant negative correlations between the data of women's mortality rates and female school enrollment (p≪0.01), whereas there are strong significant negative correlations for open-access papers in eight disciplines of medical science, individuals using the Internet, and mobile cellular subscriptions (p≪0.01). The first principal component explains 96.8%, 96.6%, and 99.6% of the variation in the mortality rate of female infants (p = 0.002 < 0.01), females under-5 (p = 0.003 < 0.01), and female adults (p = 0.002 < 0.01), respectively. There is a similar relationship between open-access medical papers and women's health. The above results could be helpful to interdisciplinary audiences (patients, practitioners, and policymakers) to develop strategies for the effective implementation of knowledge on women's health (how to disseminate knowledge more effectively in the whole society).
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Affiliation(s)
- Na Ran
- Library, University of Science and Technology Beijing, Beijing, P. R. China
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Wang Z, Zhou C, Zhang L, Shen J, Mo M, He Y, Zheng Y. Predictors of cancer screening behavior of the working population in China based on the information-motivation-behavioral skills model. Front Public Health 2023; 11:1112172. [PMID: 37575100 PMCID: PMC10412821 DOI: 10.3389/fpubh.2023.1112172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Background The cancer screening rate in the working population is very low in China. Information-motivation-behavioral skills (IMB) model has been applied to elucidate screening behavior for various chronic diseases but has not been investigated in analyzing cancer screening behavior. This study aimed to examine factors influencing cancer screening behavior and their linkages based on the IMB model. Methods A cross-sectional study was conducted in Shanghai, China from August to October 2021. Data were obtained through an anonymous questionnaire. Predictive relationships between variables in the IMB model and cancer screening behavior were evaluated. Structural equation modeling (SEM) was constructed to demonstrate the utility of the IMB model. Results Among the 556 participants included in the analysis, 34.4% of participants had ever done a cancer screening. The construct validation analysis supported that the measure items included were acceptable. SEM found that knowledge of cancer warning signs and symptoms (β = 0.563, p < 0.001) and cancer screening behavioral skills (β = 0.264, p = 0.003) were related to participation in cancer screening, whereas cancer screening motivation was not directly influenced the participation in cancer screening (β = - 0.075, p = 0.372). Conclusion The cancer screening rate was found to be lower than expected in the working population. The IMB model could be used to make decisions in implementing behavioral interventions to participate in cancer screening among the Chinese working population. Enhancing the knowledge of cancer warning signs and symptoms and strengthening behavioral skills should be focused on to improve participation in cancer screening.
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Affiliation(s)
- Zezhou Wang
- Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Changming Zhou
- Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li Zhang
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Jie Shen
- Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Miao Mo
- Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yulian He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Ying Zheng
- Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Artificial Intelligence Technology for Tumor Diseases, Shanghai, China
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Shamseddine A, Chehade L, Al Mahmasani L, Charafeddine M. Colorectal Cancer Screening in the Middle East: What, Why, Who, When, and How? Am Soc Clin Oncol Educ Book 2023; 43:e390520. [PMID: 37163709 DOI: 10.1200/edbk_390520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The incidence of colorectal cancer (CRC) in the Middle East is increasing, especially among those younger than 50 years. Risk factors including obesity, sedentary lifestyle, and dietary changes are associated with the epidemiologic shift and are a result of socioeconomic changes happening in the region. Worldwide, CRC screening is associated with decreased incidence and mortality of CRC, but screening uptake is still low in the Middle East because of cultural barriers and lack of awareness; in addition, most countries do not have national screening programs. Knowledge of CRC screening and participation rates vary among different countries, but overall they are low. Both primary and secondary prevention approaches are needed in the Middle East, and cost-effectiveness is important in choosing screening modalities. Although colonoscopy is considered the most robust screening method, stool-based testing may be an acceptable screening strategy in resource-limited settings, and focusing on high-risk individuals such as those with hereditary CRC might be the most cost-effective strategy. In addition to financial limitations in many countries in the Middle East, human displacement places an extra toll on cancer control strategies in the region.
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Affiliation(s)
- Ali Shamseddine
- Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Laudy Chehade
- Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Layal Al Mahmasani
- Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Maya Charafeddine
- Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
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Gu J, Jia S, Chao H, Chen T, Wu X. Predictive factors based on the health belief model on cancer screening behaviour in first degree relatives of patients with Lynch syndrome-associated colorectal cancer. Int J Nurs Sci 2023; 10:251-257. [PMID: 37128484 PMCID: PMC10148252 DOI: 10.1016/j.ijnss.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/09/2023] [Accepted: 03/19/2023] [Indexed: 05/03/2023] Open
Abstract
Objectives This study aimed to investigate colorectal cancer-related knowledge, health beliefs, and screening behaviour in first-degree relatives (FDRs) of patients with Lynch syndrome-associated colorectal cancer (CRC) and explore the predictive factors of screening behaviour based on a health belief model. Methods This cross-sectional study was conducted in the colorectal department of a Class A tertiary hospital in Guangzhou from December 2017 to December 2019. A total of 265 FDRs of 96 patients with Lynch syndrome-related CRC were selected. The study was conducted in the colorectal department of a tertiary cancer centre in Guangzhou. The demographic questionnaire, the simplified CRC knowledge questionnaire, and the Champion's Health Belief Model Scale were used for evaluation. Data were analyzed using statistical description, between-group comparisons, and binary logistic regression. Results A total of 160 (60.4%), 61 (23.0%), and 44 (16.6%) of the participants had high, medium, and low levels of knowledge about CRC, respectively; the average overall score of health belief was 121.36 ± 13.02. Sixty-one participants (23.0%) underwent Lynch syndrome-associated cancer screening. The predictive factors of screening behaviour included sex (male), age (older), married status (married), multiple primary cancers of the index patients, and high levels of knowledge and health beliefs (P < 0.05). Conclusions The knowledge and health beliefs of cancer and cancer screening in FDRs of patients with Lynch syndrome-associated CRC should be improved. Both knowledge and beliefs are critical in promoting their cancer screening behaviour. Interventions should focus on health education and enhance health beliefs of the FDRs for better screening behaviour.
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Affiliation(s)
- Jiaojiao Gu
- The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shumin Jia
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Huaxiang Chao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tinglan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaodan Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Corresponding author.
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Carter-Bawa L, Schofield E, Atkinson TM, Ostroff JS. Development and psychometric evaluation of the Spanish version of the lung cancer screening health belief scale. Eur J Cancer Care (Engl) 2022; 31:e13707. [PMID: 36109851 PMCID: PMC10074415 DOI: 10.1111/ecc.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to describe the translation and psychometric testing of the Lung Cancer Screening Health Belief Scale (LCSHBS) into Spanish. METHODS The English version of the LCSHBS was professionally translated in accordance with best practices in the translation of patient-reported outcome tools. The independent certified professional translator completed a forward translation of the LCSHBS from English to Spanish, followed by a review of the translated questionnaire by a certified Memorial Sloan Kettering Cancer Center Spanish-English bicultural expert, who reviewed the scale for accuracy. RESULTS Initial testing of the scales is valid and reliable, and supports the Spanish version of the LCSHBS (LCSHBS-S). Internal consistency reliability of the scales was supported with Cronbach's ranging from 0.81 to 0.96. Construct validity was established with confirmatory factor analysis and testing for differences between individuals who have and have not screened in theoretically proposed directions. These newly translated scales can help investigators expand this research into the large Spanish-speaking lung screening-eligible population as they develop and test critical behavioural interventions to increase lung cancer screening in the at-risk population. CONCLUSIONS Development of effective interventions to enhance shared decision-making about lung cancer screening between patients and providers must first identify factors influencing the individual's screening participation. Future efforts facilitating patient-provider conversations are better informed by understanding the perspective of the individual making the decision.
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Affiliation(s)
- Lisa Carter-Bawa
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Schofield
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Thomas M Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Xu HF, Gu XF, Wang XH, Wang WJ, Du LB, Duan SX, Liu Y, Zhang X, Zhao YQ, Ma L, Liu YY, Huang JX, Cao J, Fan YP, Li L, Feng CY, Lian XM, Du JC, Zhang JG, Yu YQ, Qiao YL. Knowledge and awareness of colorectal cancer risk factors, screening, and associated factors in advanced colorectal cancer patients: a multicenter cross-sectional study in China. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:354. [PMID: 35433933 PMCID: PMC9011206 DOI: 10.21037/atm-22-1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/18/2022] [Indexed: 11/06/2022]
Abstract
Background Colorectal cancer (CRC) is the 3rd most common malignancy globally, and its disease burden is increasing rapidly in China. But CRC patients' knowledge and awareness of CRC have not yet been examined, which could facilitate the identification of targeted population from public for intervention. Methods A nationwide multicenter cross-sectional survey was conducted in 19 tertiary hospitals (10 cancer hospitals and 9 general hospitals) from March 2020 to March 2021 in China. During study period, all Stage III and IV CRC patients were invited to complete a semi-structured survey that had been designed to collect information about their socio-demographic characteristics, and knowledge and awareness of CRC risk factors and screening. A multivariate logistic regression model was used to identify factors associated with their knowledge and awareness. Results In total, 4,589 advanced CRC patients were enrolled in this study, of whom, 46.2% were from tertiary cancer hospitals, and 59.5% were male. Patients had a mean age of 60.1±11.6 years. Before diagnosis, 65.1% of the patients had no related knowledge of the CRC risk factors, and 84.9% were unaware of the CRC screening-related information. Only 30.4% of patients had actively sought to acquire CRC-related knowledge before diagnosis. The 3 most common knowledge sources were relatives or friends who had been diagnosed with CRC (13.2%), popular science television/broadcast shows (12.9%), and community publicity and education (9.6%). Generally, knowledge and awareness were positively associated with better education level [odds ratios (ORs) ranged from 1.49 to 2.54, P<0.001], annual household income ranged from 50,000 Chinese Yuan (CNY) to 100,000 CNY (OR =1.32, P<0.001), being manual laborer (OR =1.25, P<0.001) and being white-collar worker (OR =1.47, P<0.001). Conclusions Advanced CRC patients' knowledge and awareness of CRC were severely limited before diagnosis. Thus, those who had limited knowledge and awareness should has a priority for intervention.
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Affiliation(s)
- Hui-Fang Xu
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Xiao-Fen Gu
- Department of Student Affairs, Affiliated Tumor Hospital, Xinjiang Medical University, Ürümqi, China
| | - Xiao-Hui Wang
- Department of Public Health, Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Wen-Jun Wang
- School of Nursing, Jining Medical University, Jining, China
| | - Ling-Bin Du
- Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Shuang-Xia Duan
- Department of Preventive Health, Xinxiang Central Hospital, Xinxiang, China
| | - Yin Liu
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Xi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yu-Qian Zhao
- Center for Cancer Prevention Research, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Ma
- Public Health School, Dalian Medical University, Dalian, China
| | - Yun-Yong Liu
- Liaoning Office for Cancer Control and Research, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Juan-Xiu Huang
- Department of Gastroenterology, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Ji Cao
- Department of Cancer Prevention and Control Office, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan-Ping Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Li
- Department of Clinical Research, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Chang-Yan Feng
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Xue-Mei Lian
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Jing-Chang Du
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Jian-Gong Zhang
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Yan-Qin Yu
- The Clinical Epidemiology of Research Center, Department of Public Health and Preventive Medicine, Baotou Medical College, Baotou, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China.,Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Could a Behavioral Model Explain Adherence to Second-Level Colonoscopy for Colon Cancer Screening? Results of a Cross-Sectional Study of the Palermo Province Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052782. [PMID: 35270473 PMCID: PMC8910366 DOI: 10.3390/ijerph19052782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/04/2022]
Abstract
According to Italian Essential Levels of Assistance (ELA), a colonoscopy is strongly recommended after a positive fecal occult blood test (FOBT) due to its effectiveness in early colorectal cancer detection. Despite the evidence, the Palermo province population (Italy), after a positive FOBT, have a lower colonoscopy adherence compared to Italian standards. This cross-sectional study analyzed patients’ perceptions of colonoscopy procedures to understand the reasons for non-adherence. Patients with a positive FOBT who did not undergo a colonoscopy within the national organized screening program were administered a telephone interview based on the Health Belief Model (HBM) questionnaire. The number of non-compliant patients with a colonoscopy after a positive FOBT were 182, of which 45 (25.7%) patients had undergone a colonoscopy in another healthcare setting. Among the HBM items, in a multivariate analysis only perceived benefits were significantly associated with colonoscopy adherence (aOR = 6.7, p = 0.03). Health promotion interventions should focus on the importance of the benefits of colorectal screening adherence to prevent colorectal cancer, implementing health communication by healthcare workers that have closer contacts with people, as general practitioners.
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Lau J, Lim TZ, Jianlin Wong G, Tan KK. The health belief model and colorectal cancer screening in the general population: A systematic review. Prev Med Rep 2020; 20:101223. [PMID: 33088680 PMCID: PMC7567954 DOI: 10.1016/j.pmedr.2020.101223] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022] Open
Abstract
Colorectal cancer screening saves lives and is cost-effective. It allows early detection of the pathology, and enables earlier medical intervention. Despite clinical practice guidelines promoting screening for average risk individuals, uptake remains suboptimal in many populations. Few studies have examined how sociobehavioural factors influence screening uptake in the context of behaviour change theories such as the health belief model. This systematic review therefore examines how the health belief model’s constructs are associated with colorectal cancer screening. Four databases were systematically searched from inception to September 2019. Quantitative observational studies that used the health belief model to examine colorectal screening history, intention or behaviour were included. A total of 30 studies met the criteria for review; all were of cross-sectional design. Perceived susceptibility, benefits and cues to action were directly associated with screening history or intention. Perceived barriers inversely associated with screening history or intention. The studies included also found other modifying factors including sociodemographic and cultural norms. Self-report of screening history, intention or behaviour, convenience sampling and lack of temporality among factors were common limitations across studies. The health belief model’s associations with colorectal cancer screening uptake was consistent with preventive health behaviours in general. Future studies should examine how theory-based behavioural interventions can be tailored to account for the influence of socioecological factors.
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Affiliation(s)
- Jerrald Lau
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tian-Zhi Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gretel Jianlin Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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