Structural Factors Affecting Health Examination Behavioral Intention

Chinese undergraduates' mental health help-seeking behavior: the health belief model

The detection rate of mental health problems among undergraduates has recently risen significantly. However, undergraduates underutilize mental health services; approximately a third only of undergraduates in need of treatment use school counseling resources. Based on a social psychological theoretical framework, the health belief model, factors of undergraduates' willingness to seek help when dealing with psychological problems were investigated. A cross-sectional online questionnaire and a snowball sampling method with 446 undergraduates investigated perceived susceptibility, perceived severity, perceived behavioral benefits, perceived barriers, self-efficacy, and cues to action to understand how students' mental health-seeking behaviors are affected. We found that perceived susceptibility (p < 0.01), perceived severity (p < 0.01), perceived benefits (p < 0.01), perceived barriers (p < 0.01), self-efficacy (p < 0.01), and cues to action (p < 0.01) significantly correlated with behavioral intention. Encouragement or counseling from others would be more likely to motivate undergraduates to seek mental health help. In addition, we used a bias-corrected Bootstrap approach to test the significance of the mediating effect, the mediation effect of cues to action between undergraduates' perceived susceptibility and mental health help-seeking behavior was utterly significant [mediation effect value of 0.077, with an SE value of 0.027 and a 95% CI (0.028, 0.133)]. It demonstrated that those who perceived themselves to be at high risk of developing a mental illness and who had received encouragement or counseling to seek mental health help were more likely to be motivated to seek mental health help. Multiple regression analyses indicated that self-efficacy (Z = 5.425, p < 0.01) and cues to action (Z = 6.673, p < 0.01) independently influenced behavioral intentions. Encouragement or counseling from others would be more likely to motivate undergraduates to seek mental health help.

Utilisation of the health belief model to study the behavioural intentions relating to obesity management among university students: a cross-sectional study

BACKGROUND

Overweight and obesity are excessive fat accumulations linked with many health problems, including heart diseases, type 2 diabetes and cancer. Multiple studies have demonstrated that beliefs about overweight, obesity and self-efficacy play essential roles in the success of interventions for obesity management.

OBJECTIVES

This study aimed to identify the perceptions of university students of overweight and obesity using the health belief model (HBM) and to analyse their association with the body mass index (BMI) categories of the students.

DESIGN

A cross-sectional questionnaire-based study and a multistage sampling technique were used to ensure the recruitment of students from selected colleges of Jazan University-Saudi Arabia.

SETTING

Six colleges of Jazan University were randomly selected to ensure equal representation of health sciences, sciences and humanities colleges.

PARTICIPANTS

A total of 579 students completed an online survey between January and April 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were demographic characteristics and HBM constructs. Secondary outcome measures were behavioural intentions relating to obesity management.

RESULTS

This study demonstrated that gender and self-reported family history of obesity were significantly correlated with the BMI categories of the students (p <0.001). Students in the underweight category showed the highest mean score for perceived severity (3.62 ±0.08). Perceived self-efficacy in exercise and diet was significantly associated with BMI categories, with adjusted ORs of 2.82 (2.10 to 3.79) and 1.51 (1.09 to 2.09), respectively. Perceived barriers to healthy eating and regular physical activity were significantly related to the behavioural intentions of obesity management. Multivariate logistic regression showed that perceived severity, perceived cues to action, perceived barriers and self-efficacy in dieting and exercise were significant predictors of behavioural intentions for the management of obesity.

CONCLUSION

This study underscores the need for tailored health promotion strategies that consider the perceptions and beliefs of people about the management of obesity.

Multilevel structural equation modeling of willingness-to-pay for fatality risk reduction: perspectives of driver and district levels

Road accidents remain a serious problem and directly affect drivers. Therefore, the perspectives of drivers are important in improving road safety. The objectives of this study are to empirically examine damage due to road accidents using the willingness-to-pay (WTP) approach and to analyze the factors that influence WTP at the driver and district levels. This study obtained data on WTP derived from car drivers across Thailand, which covers 96 districts. The value of statistical life was 824,344 USD per fatality (2,296 million USD annually). The results of Multilevel Structural Equation Modeling revealed a statistically important insight. At the driver level, the Health Belief Model and sociodemographic exert influence on the intention to pay. The demographic factor that has the greatest influence on perceived risk and leads to a high intention to pay is the working age group (γ = 0.826). However, when considering the HBM, perceived susceptibility (γ = 0.901) emerges as the most valuable factor influencing drivers' concerns about road accidents. On the other hand, district-level factors have a negative influence on the intention to pay for road safety measures. Among these factors, the law enforcement (γ = -0.555) practices implemented by local authorities have the most significant impact on drivers' perspectives and intentions regarding WTP. This finding can be used as a guideline for budget allocation and policy recommendation for policymakers in improving road safety according to the area contexts.

Educational attainment affects the diagnostic time in type 2 diabetes mellitus and the mortality risk of those enrolled in the diabetes pay-for-performance program

Most patients are diagnosed as having diabetes only after experiencing diabetes complications. Educational attainment might have a positive relationship with diabetes prognosis. The diabetes pay-for-performance (P4P) program-providing comprehensive, continuous medical care-has improved diabetes prognosis in Taiwan. This retrospective cohort study investigated how educational attainment affects the presence of diabetes complications at diabetes diagnosis and mortality risk in patients with diabetes enrolled in the P4P program. From the National Health Insurance Research Database, we identified patients aged >45 years who had received a new diagnosis of type 2 diabetes during 2002-2015; they were followed up until the end of 2017. We next used logistic regression analysis to explore whether the patients with different educational attainments had varied diabetic complication risks at diabetes diagnosis. The Cox proportional hazard model was employed to examine the association of different educational attainments in people with diabetes with mortality risk after their enrollment in the P4P program. The results indicated that as educational attainment increased, the risk of diabetes complications at type 2 diabetes diagnosis decreased gradually. When type 2 diabetes with different educational attainments joined the P4P program, high school education had the highest effect on reducing mortality risk; however, those with ≤ 6th grade education had the lowest impact.

Examining the Impact of Service Quality on Passengers' Intentions to Utilize Rail Transport in the Post-Pandemic Era: An Integrated Approach of SERVQUAL and Health Belief Model

The COVID-19 pandemic has significantly disrupted railway transportation in developing countries, resulting in reduced passenger demand and economic activity. As a result of the pandemic effect, there is an increased focus on health and safety among potential passengers. To address this issue, the present study aimed to investigate the fundamental factors that contribute to railway transportation service quality (SERVQUAL) and the intention to use intercity train services in Thailand using the health belief model (HBM), with 1600 passenger participants using structural equation modeling (SEM). The findings demonstrated that train operators' service standards remain vital to passengers, and the HBM had a statistically significant impact on shaping passengers' intentions to use train services after an epidemic. These results can inform rail agencies and health authorities when developing policies and strategies to prioritize both business and passenger safety on intercity trains.

Exploration of COVID-19 Pandemic Prevention Behaviors among Healthcare Workers

Since the outbreak of COVID-19, the pandemic has become an important topic of global public health. To reduce the rapid spread of the pandemic, compliance with preventive behaviors has become one of the important guidelines from the World Health Organization (WHO). Healthcare workers stand on the frontline for pandemic prevention, and preventive behaviors are essential measures to protect their health and safety. The purpose of this study was to propose an integrative model that explained and predicted COVID-19 preventive behaviors among healthcare workers. The study integrated workplace safety climate and the health belief model (HBM) to verify the impact of workplace safety climate and health belief factors on the safety attitude, safety compliance, and safety satisfaction of healthcare workers performing COVID-19 pandemic prevention behaviors. A cross-sectional study was conducted from March to August 2021 with a self-administered online questionnaire. The sample of the study was drawn from healthcare workers of a famous medical institution in Taipei City as research subjects. After collecting 273 valid questionnaires and verifying them through the analysis of structural equation modeling (SEM), the findings revealed that workplace safety climate had an impact on health belief factors, and then health belief factors had impacts on safety attitudes. In addition, safety attitude affected safety compliance, while safety compliance further affected safety satisfaction. The study showed that workplace safety climate can strengthen healthcare workers' health beliefs and further affect their safety attitudes, safety compliance, and safety satisfaction. The study attempted to propose a model of healthcare workers' pandemic prevention behaviors as a reference for medical facility administrators in real practice.

Understanding the adoption of the mask-supply information platforms during the COVID-19

Since late 2019, coronavirus disease 2019 (COVID-19) has led to a significant increase in the demand for medical resources. To publish data on face mask supplies, the Taiwanese government collaborated with program developers to construct a mask-supply information transitional platform (MITP). To comprehend the adoption of MITP, the study proposes a research model that integrates the health behavior model (HBM) and IS/IT continuance model for examining the factors affecting intention to use an MITP. Survey data collected from 524 respondents indicated that (1) intention to use an MITP is directly influenced by perceived threat of COVID-19 and beliefs toward using the MITP; (2) cues to action directly influence the perceived threat of COVID-19; and (3) perceived ease of use of MITP is a significant determinant of perceived usefulness of MITP. These results provide practical guidelines for health authorities and government to develop health information systems and strategies to control pandemics.

Role of Perception, Health Beliefs, and Health Knowledge in Intentions to Receive Health Checkups among Young Adults in Korea

Regular health checkups allow early treatment when problems occur and prevent disease progression, but the rate of health checkups among young adults is low. This study aimed to investigate the factors affecting the intentions to receive health checkups among young adults in their 20s in Korea. The study design was a descriptive cross-sectional study and examined their intentions to receive health checkups, their health beliefs (perceived sensitivity, perceived severity, perceived benefit, perceived barrier, cue to action, self-efficacy), their attitude toward health checkups, and their knowledge of health checkups. The participants were 252 adults in their 20s in South Korea who were eligible for national health checkups. The intentions to receive check-ups model identified five variables, including sex, perceived sensitivity, cue to action, self-efficacy, and attitudes toward health checkups, were as significant influencing factors for the intentions to receive health checkups with 51.0% explanatory power (F = 53.18, p < 0.001). Different approaches must be adopted according to past experiences with health checkups when attempting to improve the intentions to receive health checkups in young adults.

How older adults’ health beliefs affect intention to perform COVID-19 self-examination: A reasoned action approach

BACKGROUND: COVID-19 self-examination is a significant part of the national recovery plan against the virus. Although it is easier to perform COVID-19 self-examination (CSE), only a small percentage of people prefer it. There are no precise statistics on CSE in Malaysia, but informal data from news agencies imply low CSE. Lack of awareness and conflicting information about the reliability of CSE results may have raised concerns about CSE’s efficacy and effectiveness. OBJECTIVE: This study investigates how Malaysian older adults’ health beliefs influence their intention to perform CSE. The study developed a framework combining illness threats (ITH), perceived barriers (PBA), medical motivations (MMO), and control over illness (COI) from the Health Belief Model (HBM) with the Reasoned-Action Approach’s attitude (ATT), perceived control (PCO), and intention (INT). METHODS: Structural Equation Modelling (SEM) analyses were conducted with AMOS 26 software to determine the influence of HBM on older adults’ attitude, perceived control, and intention. The study collected 200 data for the pilot study and 400 data for hypotheses testing. RESULTS: ITH, MMO, and COI have positive effects, whilst PBA affects ATT negatively. ITH and COI positively impact PCO, and PCO has a greater significant effect on INT than ATT. CONCLUSION: Given the HBM’s role in influencing older adults’ intention to perform COVID-19 self-examination, providing different levels of care and emphasising the perception of knowledge of illness are especially beneficial. Several recommendations are made to ensure that CSE remains relevant for older adults’ well-being, although COVID-19’s impact has become more stabilised.

Consumer acceptance of autonomous delivery robots for last-mile delivery: Technological and health perspectives

The unprecedented outbreak of the novel coronavirus has led to a great shift toward online retailing and accelerated the need for contactless delivery. This study investigates how technological and health belief factors influence consumer acceptance of autonomous delivery robots (ADRs). Anchored in four behavioral theories [i.e., technology acceptance model, health belief model, perceived value (VAL) theory and trust theory], a synthesized model is developed. A total of 500 valid responses were collected through an online questionnaire in Singapore, and structural equation modeling was conducted to examine the responses. The results revealed that perceived ease of use (EOU), perceived usefulness (UFN), perceived susceptibility (SUS), perceived severity (SEV), self-efficacy (SEL) and cues to action (CUE) have a positive and significant influence on consumers' perceptions of the value of ADRs. The total effect analysis also showed that perceived VAL strongly affects consumer acceptance of ADRs. Academically, this study introduces both technological and health belief factors to explain consumer acceptance of ADRs. It also provides recommendations for policymakers and autonomous delivery robot developers on policy formulation, public communication, product design and infrastructure development.

Reliable Information from Health Professionals Encourages Urban Japanese Mothers’ Continued Participation in Health Checkups

We examined mothers’ health information sources and their relationships with continued participation in health checkups among urban Japanese mothers. Participants were 152 mothers below 40 years old with one or more children under 12 years old. We collected data at a children’s festival in Tokyo in 2019. A self-administered questionnaire was used to collect information regarding health checkups, trusted sources of information regarding mother’s health, and anthropological variables. Continued participation in health checkups was defined as participating in health checkups almost every year during the past five years. Logistic regression analysis was used to adjust for health insurance, mothers’ age, number of children, and current medical history. the sources of mothers’ health information trusted by over 20% of mothers in the two groups were “family”, “friends”, “Web/SNS”, and “healthcare professionals.” However, continued participation in health checkups was significantly associated with only the source of health information from “healthcare professionals” (odds ratio: 2.8 [95% confidence interval: 1.26–6.31], p = 0.01). These findings suggest that reliable information from health professionals encourages urban Japanese mothers’ continued participation in health checkups among Japanese mothers under 40 years old who have children under 12 years of age.

COVID-19 and Pro-environmental Behaviour at Destinations Amongst International Travellers

This paper investigates the COVID-19 pandemic, and its impact on pro-environmental behaviour of individuals travelling internationally for leisure and recreational purposes. The aim of this manuscript is to investigate a conceptual framework created through the examination of current existing literature in the field of tourism science. The conceptual framework, consisting of certain constructs of the health belief model (HBM), and the theory of planned behaviour (TPB), is applied and tested using a partial least-squares-structural equation modelling (PLS-SEM). Data were collected from participants who have travelled internationally before and during the outbreak of the COVID-19 pandemic, and those who plan to travel post-COVID-19 pandemic. Results revealed that the conceptual framework tested positively against existing theory, highlighting the key influencing factors in which COVID-19 is likely to have on future pro-environmental behaviour of individuals travelling internationally for leisure and recreational purposes. Moreover, perceived safety threat and outcome expectations have a positive impact on attitude; attitude has a positive impact on behavioural intentions; subjective norm has a positive impact on behavioural intentions, and perceived behavioural control has a positive impact on behavioural intentions. The study results identify practical and theoretical implications for global and travel companies and organisations, presenting opportunities to adjust environmental policies and procedures accordingly, whilst identifying the most effective marketing and management strategies to rebuild a collapsed global travel industry.

Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics

Background

Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Although a number of CRC screening tests have been established as being effective for CRC prevention and early detection, rates of CRC screening test completion in the US population remain suboptimal, especially among the uninsured, recent immigrants and Hispanics. In this study, we used a structural equation modelling approach to identify factors influencing screening test completion in a successful CRC screening program that was implemented in an uninsured Hispanic population. This information will enhance our understanding of influences on CRC screening among historically underscreened populations.

Methods

We used generalized structural equation models (SEM) utilizing participant reported information collected through a series of surveys. We identified direct and indirect pathways through which cofactors, CRC knowledge and individual Health Belief Model constructs (perceived benefits, barriers, susceptibility, fatalism and self-efficacy) and a latent psychosocial health construct mediated screening in an effective prospective randomized CRC screening intervention that was tailored for uninsured Hispanic Americans.

Results

Seven hundred twenty-three participants were eligible for inclusion; mean age was 56 years, 79.7% were female, and 98.9% were Hispanic. The total intervention effect was comparable in both models, with both having a direct and indirect effect on screening completion (n = 715, Model 1: RC = 2.46 [95% CI: 2.20, 2.71, p < 0.001]; n = 699, Model 2 RC =2.45, [95% CI: 2.18, 2.72, p < 0.001]. In Model 1, 32% of the overall effect was mediated by the latent psychosocial health construct (RC = 0.79, p < 0.001) that was in turn mainly influenced by self-efficacy, perceived benefits and fatalism. In Model 2, the most important individual mediators were self-efficacy (RC = 0.24, p = 0.013), and fatalism (RC = 0.07, p = 0.033).

Conclusion

This study contributes to our understanding of mediators of CRC screening and suggests that targeting self-efficacy, perceived benefits and fatalism could maximize the effectiveness of CRC screening interventions particularly in Hispanic populations.

Health Belief Model and Determinants of Breast Self-Examination Performance

Objectives: This study aimed at performing a path analysis to assess the parameters of the health belief model concerning BSE. Methods: The present descriptive cross-sectional study at a health care center, affiliated with Islamic Azad University Tehran, Faculty of Medicine in the northwest of Tehran, Iran was conducted from May to June 2018. The champion’s HBM scale, breast cancer knowledge test was assessed in all participants. The SPSS-22 and Lisrel-8.8 software, using statistical path analysis, were used for analyzing the data. Results: Totally, 225 women took part in this study. The mean of the BSE performance was 0.53 ± 0.52. The score of BCKT had a significant difference between women, who performed and did not perform BSE (P = 0.001). The final model was a good fit for the data collection. As a result, self-effectiveness improved HBM parameters. Also, perceived barriers, knowledge, and educational level had an association with BSE. Conclusions: According to the results of this study, self-care behaviors could be increased by eliminating perceived barriers and increasing the level of education and as a result of women's knowledge.

Social Distancing, Health Concerns, and Digitally Empowered Consumption Behavior Under COVID-19: A Study on Livestream Shopping Technology

During the COVID-19 pandemic, livestream shopping has provided consumers with a way to maintain social distancing while offering an alternative to offline shopping. This study aims to understand the impact of COVID-19 and other public health crises on the behavioral intentions of consumers using livestream shopping technology. A theoretical model was designed that combines the health belief model, trust theory, and the theory of planned behavior. Empirical data were collected from 358 residents in China and then analyzed using structural equation modeling. The results showed that perceived susceptibility, perceived severity, perceived benefits, and perceived obstacles had a significant impact on consumer trust. Consumer trust in turn had a direct impact on behavioral intention and an indirect impact on behavioral intention via attitude. These research results have practical implications for livestream shopping merchants, platform decision-makers, and service designers.

Cruise transport service usage post COVID-19: The health belief model application

This study investigates the key psychological factors that influence customer's intention to use cruise services post COVID-19. A theoretical model grounded on consumer and health-driven theories (i.e. perceived value, perceived trust and health belief model) is developed. A survey questionnaire is designed and administered to 376 Chinese consumers. The theoretical model was tested via structural equation modelling. Results reveal that the constructs of the health belief model (i.e. perceived benefits, perceived health threat, self-efficacy and cues to action) have a significant effect on customers' perceived value towards cruise services. Perceived value then has direct and indirect effects on customers' cruise intention through perceived trust. This study enhances academic research by justifying customers' intention to use cruise services via consumer and health-belief viewpoints and provides implications for cruise management and policy formulation.

The psychology of cruise service usage post COVID-19: Health management and policy implications

The cruise industry has suffered a huge loss due to the suspension of cruise operations during the COVID-19 pandemic. As the industry is preparing for recovery, there is an urgent need for research on cruise consumers' psychology, in particular, the factors influencing their intention to use cruise services after the pandemic. This study employs theories, namely, the health belief model, trust theory and attitude theory, to investigate consumers' use intention for cruise services after the pandemic. An online survey was administered to consumers in China's tourism industry, where 376 responses were received. Subsequently, this study employs structural equation modelling to test its theoretical model consisting of hypotheses. The results show that consumers' trust is directly influenced by health belief constructs including perceived safety threat, outcome expectation, self-efficacy and cues to action. Next, trust exerts a direct impact on consumers' attitude and intention to use cruise services. Moreover, this study finds full and partial mediation effects. The findings provide a series of recommendations for cruise operators and policymakers in terms of marketing strategies, service design, public communication and health measures.

Panic buying during COVID-19: Survival psychology and needs perspectives in deprived environments

Panic buying (PB), a typical consumer behaviour induced by crisis, was observed worldwide in the face of COVID-19 pandemic. Drawing on Survival Psychology and Maslow's motivation theories, this study introduced a theoretical model to establish the factors affecting consumers' PB and investigate their interrelationships. An online survey was designed and administered to 508 respondents in Singapore. Then, structural equation modelling was implemented to study the survey data. The results indicated that the effects of several constructs namely, normative social influence, observational learning, perceived severity, and perceived scarcity, with mediation by control, impose significant influence on consumers' PB. Analysis of total effects showed that normative social influence has the strongest effect on PB. This is followed by perceived scarcity, control, social trust, observational learning, and perceived severity. Two diverse research paradigms centring on Survival Psychology and Maslow's motivation theories were integrated to offer a logical explanation of the motivation driving PB. By utilising a theory-driven approach, the current study has offered a unique approach to interpreting consumers' PB. Overall, this study enhances current research on consumers' PB, offers new insights into understanding the motivating factors behind consumers' PB, and implicates policies on tackling hoarding situations in the event of crisis such as the COVID-19 pandemic.

The effect of educational intervention based on health belief model and social support on testicular self-examination in sample of Iranian men

BACKGROUND

Testicular Self-Examination (TSE) causes earlier diagnosis of Testicular cancer (TC). Hence, all men aged between15 to 35 years should perform TSE every month. This study aims to survey the effect of educational intervention based on health belief model and social support on testicular self-examination in men aged between 15 to 35 years of Fasa City, Fars province, Iran.

METHODS

In this quasi-experimental study, 200 men (100 in the experimental group and 100 in the control group) in Fasa City, Fars, Iran, were conducted from June 2018 to August 2019. The educational intervention for the experimental group consisted of six training sessions (testicular cancer, its prevalence and types, its risk factors, symptoms, infected areas, diagnosis, side-effects and its severity, understanding about testicular self-examination and its importance, benefits, and barriers of self-examination and correct way of doing TSE were discussed, role of social support). A questionnaire consisting of demographic information, knowledge, HBM construct, and social support was used to measure testicular self-examination before, 3 months after the intervention, and 6 months later. Data were analyzed using SPSS-22 via chi-squared, independent samples t-test, Mann-Whitney, and repeated measures ANOVA at a significance level of 0.5.

RESULTS

The mean age of the men was 27.26 ± 3.16 years in the experimental group and 27.39 ± 3.12 years in the control group. Three months after the intervention and 6 months after the intervention, the experimental group showed a significant increase in knowledge, perceived susceptibility, perceived severity, perceived benefits, self-efficacy, cues to action, social support, and testicular self-examination performance compared to the control group.

CONCLUSION

This study showed the effectiveness of the intervention based on the HBM constructs and social support in the adoption of testicular self-examination in 3 and 6 months post-intervention in men aged between 15 to 35 years. Hence, these models can act as a framework for designing and implementing educational interventions for testicular self-examination.

Antibiotic stewardship knowledge and belief differences among healthcare professionals in hospitals: A survey study

BACKGROUND

Collaborative practice in healthcare has been recommended to improve the quality of antimicrobial stewardship interventions, a behavioral change in antimicrobial use. Insufficient knowledge regarding antibiotic resistance, the fear of complications from infections, and how providers perceive antibiotic use and resistance are likely to influence prescribing behavior. This study's objective was to identify the knowledge and belief healthcare professionals' differences about antibiotic stewardship.

METHODS

This cross-sectional survey study of three hospitals in the East Java province, Indonesia utilized a 43-item questionnaire to assess antimicrobial stewardship knowledge and belief. There were 12 knowledge questions (total possible score: 12) and 31 belief questions (total possible score: 155). The Kuder Richardson 20 (KR-20) and Cronbach alpha values of the questionnaire were 0.54 and 0.92, respectively.

RESULTS

Out of the 257 respondents, 19% (48/257) had a low scores of knowledge, and 39% (101/257) had low scores on belief about antibiotic stewardship (101/257). Most midwives had a low scores on knowledge (25/61) and low scores on belief (46/61). Respondents with high scores on belief were 17% (10/59) physicians, 15% (4/27) pharmacists, 8% (5/65) nurses, and 3% (2/61) midwives.

CONCLUSION

Among healthcare professionals, knowledge and belief differences concerning antibiotic stewardship vary widely. These differences will affect their capability, behavior, and contribution to the healthcare team collaboration and performance. Further studies are needed to evaluate the correlation between the level of inter-professional collaboration and the quality of the antibiotic stewardship implementation.

Use of Salt-Restriction Spoons and Its Associations with Urinary Sodium and Potassium in the Zhejiang Province of China: Results of a Population-Based Survey

In China, a major source of sodium is salt added during cooking. In this context, use of a salt-restriction spoon (SRS) has been promoted in public health campaigns and by health care providers. To describe use of and factors associated with SRS use, knowledge of correct use, and actual correct use. This study is a population-based, representative survey of 7512 residents, aged 18 to 69 years, of China's Zhejiang Province. The survey, which was conducted in 2017 using a multistage random sampling strategy, collected demographic information, SRS use, and physical measurements; a 24-h urine collection was obtained from 1,496 of the participants. The mean age of the participants was 44.8 years, 50.1% were females, and over 1/3 (35.3%) were classified as hypertensive. Mean 24-h urinary sodium and potassium excretions were 167.3(72.2) mmol/24 h and 38.2(18.2) mmol/24 h, respectively. Only 12.0% (899/7512) of participants once used or were currently using SRS; of the 899 users, 73.4% knew how to use the SRS correctly, and just 46.5% actually used it correctly. SRS use was more commonly associated with behavioral factors rather than socio-demographic factors. Initiation of SRS use by health care providers was associated with correct technical knowledge of SRS. Lower sodium-to-potassium ratio was associated with SRS use, while SRS use was not associated with urinary sodium and potassium excretion. Use of SRS was uncommon in Zhejiang Province of China. Given that a common source of sodium in China is salt added during cooking, use of SRS is an appealing strategy, ideally as part of a multi-component campaign.

The Determinants of Panic Buying during COVID-19

The COVID-19 pandemic has seen an unmatched level of panic buying globally, a type of herd behavior whereby consumers buy an uncommonly huge amount of products because of a perception of scarcity. Drawing on the health belief model, perceived scarcity, and anticipated regret theories, this paper formulated a theoretical model that linked the determinants of panic buying and analyzed their interrelationships. Subsequently, data were collated from 508 consumers through an online survey questionnaire in Singapore that was conducted during the early stage of the pandemic, before the onset of the circuit breaker in April 2020. Next, an analysis of the results was done through structural equation modeling. It showed that the effect of the health belief model dimensions (i.e., perceived susceptibility, perceived severity, outcome expectation, cues to action, and self-efficacy) on panic buying is partially mediated by the consumers' perceived scarcity of products. Furthermore, the effect of perceived scarcity on panic buying is partially mediated by consumers' anticipation of regret. This paper expands on the current theoretical understanding of panic buying behavior, giving insights into the possible measures and solutions that policymakers and relevant stakeholders can uptake to manage panic buying in future a pandemic or health crisis.

A path analytic model of health beliefs on the behavioral adoption of breast self-examination

BACKGROUND

In Malaysia, breast cancer accounted for 34.1% of all female cancer cases with women presenting breast cancer at late stages. Breast cancer has a higher five-year survival rate if detected early. An increase of approximately 30% in the five-year survival rate is indicated if breast cancer is detected at stage III compared to stage IV. Thus, survival rate of breast cancer can be increased by creating awareness and encouraging breast cancer screening amongst women. Breast self-examination (BSE) is highly recommended for breast cancer screening due to its simplicity with no incurred cost. The Health Belief Model is used in this study to explain and predict the adoptive behavior of BSE amongst women in Kuantan, Pahang.

MATERIALS AND METHODS

This study employed a multi-stage sampling method using a simple proportion formula at 5% type 1 error, p < 0.05 and absolute error at 2% which resulted in a sample of 520 participants. The data for the study was obtained using a validated bilingual self-constructed questionnaire and the model constructed using Mplus software.

RESULTS

Perceived severity, benefits and barriers were found to significantly influence the behavioral adoption of BSE. Married women aged from 45 to 55 years and knowledge were found to significantly moderate the relationship between perceived benefits and behavioral adoption of BSE. Further, self-efficacy was found as the core construct that mediates the relationship between married women aged 45 to 55 years and the behavioral adoption of BSE.

CONCLUSION

Self-efficacy is found in the study to influence the behavioral adoption of BSE. This is undeniable as self-efficacy can promote confidence in initiating and maintenance of behavioral change if the perceived change is beneficial at an acceptable cost.

Factors influencing intention to follow the “stay at home” policy during the COVID-19 pandemic

Purpose

This research seeks to simultaneously test the effect of attitude towards the behavior of following the “Stay at Home” policy, subjective norm, perceived behavioral control, perceived susceptibility and perceived severity on people's intention to follow the “Stay at Home” policy during COVID-19 pandemic.

Design/methodology/approach

The data were collected through an online survey with 148 respondents in the Greater Area of Jakarta, Indonesia. The data were then analyzed using multiple regressions.

Findings

The findings show that attitude towards the behavior, subjective norm and perceived behavioral control positively and significantly affect intention to follow “Stay at Home” during the COVID-19 pandemic. However, perceived susceptibility and perceived severity of COVID-19 do not significantly influence the intention to follow “Stay at Home” during the COVID-19 pandemic.

Research limitations/implications

This research was limited to the Greater Area of Jakarta, Indonesia. Furthermore, sampling was done through convenience sampling. Therefore, future research should be conducted in a different context to test the generalization of this research's findings.

Practical implications

To encourage citizens' adherence to the stay-at-home policy during the COVID-19 pandemic, they must be directed to have positive attitudes toward the policy. Financial and non-financial supports are critical to ensure citizens' ability to sufficiently observe the policy sufficiently. Another important aspect is the influence of leaders and public figures to consistently call for obedience consistently.

Originality/value

This is the first research that studies citizens' behavior related to the “Stay at Home” policy requisitioned by the government to hinder the spread of COVID-19.

Application of the Health Belief Model Educational Program to Reduce the Tendency of Cesarean Birth

BACKGROUND

Pregnant women are an important population in all health systems and they are responsible for making decisions about their delivery mode.

OBJECTIVE

This study aimed to investigate the effects of an educational intervention based on the Health Belief Model (HBM) to reduce the tendency of cesarean section among pregnant women.

METHOD

This field trial was conducted in Mashhad, Iran. 180 primigravida women who had a healthy and uncomplicated pregnancy with 28–32 weeks of gestational age were recruited in the study by the cluster sampling method and randomly allocated to intervention (90 women) and control (90 women) groups. A 6-hour workshop that was designed based on the HBM about delivery modes was conducted for the intervention group. The control group did not receive any intervention. All the participants filled out demographic and reproductive characteristics, knowledge about mode of delivery, and the HBM constructs questionnaires at the beginning of the study and 1 month after the intervention. Analyses were carried out using SPSS 16 software. The level of significance was set at p less than .05.

RESULTS

There was no significant difference between the two groups in terms of knowledge about delivery modes and constructs of the HBM as well as selected delivery mode before the intervention (p > .05), but the results showed a significant difference between the two groups in the mentioned variables 1 month after the intervention (p < .0001). Also, the change of score between 1 month after and before the intervention had a significant difference between the two groups in terms of knowledge about delivery modes (p < .0001) and constructs of the HBM (p < .0001). The two groups were significantly different in terms of selected delivery mode and more participants opted for normal vaginal delivery in the intervention group (p = .025).

CONCLUSIONS

The overall results showed that instruction of delivery modes based on the HBM can lead to more selection of normal delivery by pregnant women. Therefore, it is recommended that this model be used in educational programs during pregnancy.

Social change and birth cohort decrease in social support for older adults in China: A cross-temporal meta-analysis, 1994-2018

Social support not only plays an important role in the physical and mental health of the elderly people but also constitutes an essential resource for healthy ageing. With the rapid economic and social development during the last 40 years in China, the acceleration of urbanisation, and the disintegration of traditional extended families, the social support that Chinese older adults receive may be declining, leading to deterioration in quality of life for the rapidly ageing population. Cross-temporal meta-analysis was employed to investigate changes in older Chinese adults' social support from 1994 to 2018. One hundred and thirty-six studies (N = 82,722; age ≥ 60) that used the social support rating scale (SSRS) were analysed. Additionally, social support scores were correlated with social indicators to explore the relationship between social support and the environment of social development. Results show that social support scores decreased by 5.09 and 0.73 standard deviations over the past 24 years. Correlation with social indicators suggests that a decrease in social connectedness and an increase in economic imbalance may be responsible for the reduction in social support.

Examining Users' Adoption of Precision Medicine: The Moderating Role of Medical Technical Knowledge

Precision medical technologies have received a great deal of attention, but promoting such technologies remains a problem for enterprises and medical institutions. Adopting the unified theory of acceptance and use of technology (UTAUT) model and the health belief model (HBM), this study investigated the key factors affecting users' willingness to adopt precision medicine (PM) in terms of technical factors and external stimuli. Based on 415 questionnaires, performance expectancy, price value, social influence, and perceived threat of disease were found to significantly increase users willingness to adopt PM; meanwhile, privacy risks had the opposite effect. Knowledge about PM was found to strengthen the positive effect of performance expectancy, price value, social influence, and perceived threat of disease on willingness to adopt PM and weaken the negative effect of privacy risk. This study demonstrates the successful application of UTAUT to the medical field while also providing guidance for the promotion of PM.

Factors influencing weight management behavior among college students: An application of the Health Belief Model

BACKGROUND

Overweight and obesity have become a significant public health concern in both developing and developed countries. Due to the health implications of weight-reduction behaviors, it is important to explore the factors that predict their occurrence. Therefore, the present study was performed to examine factors affecting the behavioral intention of weight management as well as assess the predictive power of the Health Belief Model (HBM) for body mass index (BMI).

METHODS

This cross-sectional study was conducted among 336 female students recruited from dormitories of Tabriz University of Medical Sciences, using quota sampling technique. Data were collected by a structured questionnaire in seven parts (including perceived severity, perceived susceptibility, perceived benefit, perceived barrier, cue to action, self-efficacy in dieting and physical activity, and behavioral intention of weight management), based on the HBM. Structural equation modeling (SEM) was conducted to identify the relationship between HBM constructs and behavioral intention of weight management. Linear regression model was performed to test the ability of the HBM to predict students' BMIs.

RESULTS

Higher level of perceived threats (sum of perceived susceptibility and severity) (β = 0.41, P<0.001), perceived benefits (β = 0.19, P = 0.009), self-efficacy in exercise (β = 0.17, P = 0.001), and self-efficacy in dieting (β = 0.16, P = 0.025) scales was significantly related to greater behavioral intention of weight management. Moreover, perceived threat mediated the relationships between perceived cue to action, perceived benefits, self-efficacy in exercise, and weight management practices. The fit indices of the SEM model seemed acceptable. The final regression model explained approximately 40% of variance in BMI (P<0.001). Additionally, perceived severity, barrier, and self-efficacy in dietary life were the significant variables to predict students' BMIs.

CONCLUSIONS

These findings suggest that health education programs based on the HBM needs to be integrated in preventive health programs and health interventions strategies to ensure adherence and well-being of the participants.

Pay-for-performance programmes reduce stroke risks in patients with type 2 diabetes: a national cohort study

OBJECTIVES

A pay-for-performance (P4P) programme is a management strategy that encourages healthcare providers to deliver high quality of care. In Taiwan, the P4P programme has been implemented for diabetes, and certified diabetes physicians voluntarily enrol patients with diabetes into the P4P programme. The objectives of this study were to compare the risk of stroke and its related factors in patients with type 2 diabetes who were enrolled in a P4P programme compared with those who were not.

STUDY DESIGN

This study is a natural experiment in Taiwan. A retrospective cohort investigation was conducted from 2002 to 2013, which included 459 726 patients with type 2 diabetes, who were grouped according to P4P enrolment status following a propensity score matching process.

METHODS

We reviewed patients ≥45 years of age newly diagnosed with type 2 diabetes mellitus (DM) from the National Health Insurance Research Database in Taiwan. A Cox proportional hazards model was used to compare the relative risk of stroke between patients with type 2 DM enrolled in the P4P programme and those who were not enrolled.

RESULTS

Compared with the patients not enrolled, there was a significantly lower stroke risk in P4P participants (HR=0.97, 95% CI 0.95 to 0.99). Although a significantly lower risk of haemorrhagic stroke was observed (HR=0.87, 95% CI 0.82 to 0.93) in P4P participants, no statistically significant difference for the risk of ischaemic stroke between P4P and non-P4P patients (HR=0.99, 95% CI 0.97 to 1.02) was found. Following stratification analysis, a significantly reduced stroke risk was observed in male patients with type 2 diabetes, but not in women.

CONCLUSIONS

Participants in Taiwan's Diabetes P4P programme displayed a significantly reduced stroke risk, especially haemorrhagic stroke. We recommend the continual promotion of this programme to the general public and to physicians.

Psychological factors associated with protected sex among indirect female sex workers in Denpasar, Bali, Indonesia

A cross-sectional study was conducted among indirect FSWs (a type of FSWs who provide sex services under the cover of entertainment or recreational enterprises) in Denpasar, Bali from August to October 2017 to investigate factors associated with protected sex with clients using the Health Belief Model (HBM) framework. The protected sex as a dependent variable was identified through self-reported consistency in using condoms with clients in the last month. Independent variables consisted of six HBM constructs and three main groups of modifying factors (personal, sex work, and interventional factors). Binary logistic regression was employed to identify the determinants. The prevalence of protected sex with clients in last month was 50.17% (95%CI = 41.50-80.83). Indirect FSWs were more likely to use condoms consistently if they completed senior high school or higher. Meanwhile, those working in a karaoke lounge, bar, or café were less likely to have protected sex than those in a massage parlour, spa, or beauty salon. Based on HBM, an increase of one-score of these following constructs increased likelihood of protected sex: perceived susceptibility, self-efficacy, and cues to action. Low protected sex among indirect FSWs indicates the need for public health interventions at individual, interpersonal, and institutional level.

Osteoporosis preventive behaviors in adolescent girls: the educational program based on BASNEF model

Osteoporosis is a progressive and preventable metabolic disease. This study aimed to assess the short-term effect of the educational program based on the Beliefs, Attitude, Subjective Norms, Enabling Factors (BASNEF) model on the osteoporosis preventive behaviors in adolescent girls. It was found that the BASNEF model improved the osteoporosis preventive behaviors in adolescent girls.

PURPOSE

Osteoporosis is a progressive and preventable metabolic disease. This study aimed to investigate the short-term effect of the education program based on the BASNEF model on the osteoporosis preventive behaviors in adolescent girls.

METHODS

This randomized clinical trial was conducted on adolescent girls from January to August 2018 in an urban area of Iran. Subjects were 120 adolescent girls aged 13-14 years studying in the girls' high school that were randomly assigned to intervention and control groups. The data collection tool was the demographic questionnaire and the researcher-made questionnaire consisting of six domains based on the BASNEF model. Validity and reliability of the questionnaires were confirmed before data collections. The educational program was developed based on the BASNEF model in four sessions lasting from 30 to 45 min. Data was collected before, immediately and 1 month after the educational program and was analyzed via the SPSS software v.18.

RESULTS

No statistically significant differences were reported between the groups in terms of knowledge (p = 0.48), attitude (p = 0.94), subjective norms (p = 0.17), behavioral intention (p = 0.82), enabling factors (p = 0.62), and osteoporosis preventive behaviors (p = 0.32). Meanwhile, immediately and 1 month after the educational program, differences were reported between the two groups in knowledge (p < 0.001), attitude (p = 0.002, p < 0.001), subjective norms (p = 0.024, p = 0.001), behavioral intention (p < 0.001, p = 0.001), enabling factors (p < 0.001), and osteoporosis preventive behaviors (p < 0.001).

CONCLUSION

It is suggested that educational program based on the BASNEF model is used to strengthen the osteoporosis preventive behaviors among adolescent girls.

Factors Correlated with the Intention of Iron Tablet Consumption among Female Adolescents

Introduction: Anaemia in female adolescents tends to have a negative impact that is likely to later arise in pregnancy, labour and childbirth. The prevalence of iron deficiency anaemia in female adolescents in Indonesia is thirty percent. Indonesia runs an iron tablet program for female adolescents. However, with the running of the program, it is not clear what factors are correlated with the intention of iron tablet consumption among female adolescents. The purpose of this study was to analyse the factors correlated with the intention of iron tablet consumption among female adolescents.Methods: This research used a cross-sectional design. The sample consisted of 100 students in senior high school in Surabaya, chosen by proportional random sampling. The independent variables were parent income, knowledge, perceived susceptibility, perceived seriousness, perceived threats, perceived benefits, perceived barriers, and perceived self-efficacy. The dependent variable was female adolescent intention related to consuming iron tablets. The data was collected using a questionnaire and analysed by a chi square test with a level of significance α<0.05.Results: There was a significant correlation between perceived threat (p=0.02), perceived benefit (p=0.01), perceived barrier (p=0.02) and perceived self-efficacy (p=0.00) and female adolescent intention related to consuming iron tablets. There was no correlation between parental income, adolescent knowledge, perceived susceptibility, and perceived seriousness with the intention to consume iron tablets.Conclusion: From this research, it has been concluded that the factors related to the intention to consume iron tablets in female adolescents were perceived threat, perceived benefit, perceived barrier and perceived self-efficacy. Increasing the confidence of female adolescents in association with the importance of avoiding anaemia by consuming iron tablets is crucial so then they can maintain their health and prevent diseases due to anaemia later on.

Factors Related to Participation in Health Examinations for Japanese National Health Insurance: NIPPON DATA2010

BACKGROUND

This study investigated relationships among socioeconomic factors and participation in health examinations for Japanese National Health Insurance (NHI) using a representative Japanese population.

METHODS

We used the linkage database of NIPPON DATA2010 and Comprehensive Survey of Living Conditions 2010. Participants with NHI aged 40-74 years were included in the analysis. Prevalence ratios (PRs) for participation in health examinations in the past year were set as an outcome. Participant characteristics, including sex, age, socioeconomic factors (educational attainment, employment, equivalent household expenditure [EHE], house ownership, and marital status), laboratory measures, and lifestyle were included in an age-stratified modified Poisson regression analysis to examine relationships.

RESULTS

The number of study participants was 812, and 564 (69.5%) participated in health examinations in the past year. Among those aged 40-64 years, there was no significant PR for socioeconomic factors. Among those aged 65-74 years, high (≥13 years) educational attainment (adjusted PR, 1.22; 95% confidence interval [CI], 1.05-1.41) and house ownership (PR 1.40; 95% CI, 1.11-1.77) were positively associated with participation, while high (4th quartile) EHE (PR 0.84; 95% CI, 0.73-0.97) was negatively associated.

CONCLUSION

These results suggest that high educational attainment, house ownership, and low EHE were positive factors for participation in health examinations among those aged 65-74 years.

Predicator of Pregnant Women's Self-care Behavior against Air Pollution: An explanation based on the Extended Parallel Process Model (EPPM)

Introduction

Air pollution is one of the most important problems of metropolitan cities. The level of air pollution in the city of Ahvaz is so much higher than the standard level, that it can create risks, particularly for pregnant women in the area. The aim of the study was to examine the predictors of self-care behavior of pregnant women against air pollution according to Extended Parallel Process Model (EPPM) in Ahvaz.

Methods

In this cross-sectional study, 330 pregnant women who were referred to health care centers in western Ahvaz in 2015 were examined. The data collection tool was a reliable and valid researcher-made questionnaire consisting of three parts: The first part was demographic information, the second part according to the extended parallel process model, included perceived susceptibility, perceived severity, response efficacy, and self-efficacy. The third part examined self-care behavior. Then, the collected data was analyzed by using the software SPSS 16. Data analysis was done by using Spearman’s correlation coefficient and linear regression.

Results

The average age of study subjects was 26.07 ± 2.3 years, and most (45.5%) were in the second trimester of pregnancy. These findings showed that self-efficacy constructs (β = 0.41) and response efficacy (β= 0.15) have predictive power of self-care behavior (p < 0.05).

Conclusion

The findings showed that self-efficacy and response efficacy, are important factors to predict air pollution self-care behavior. Therefore, to develop a theory-based behavioral modification program for pregnant women, more emphasis on these constructs is recommended.