OBJECTIVE: The aim of this study was to explore the barriers and facilitators underlying the healthcare digital divide by using qualitative methodologies, integrated with the Capabilities, Opportunities, Motivations, and Behaviors (COM-B) as well as the Behavior Change Wheel (BCW) theoretical frameworks.
METHODS: To conduct a thorough analysis, semi-structured，in-depth interviews were orchestrated among a cohort of older patients who had experiences with digital healthcare systems. Data were meticulously analyzed via Colaizzi\'s seven-step methodological procedure.
RESULTS: Nine barriers were elucidated, including physical limitation, inadequate training and support, self-imposed denial, failure to rebuild the digital healthcare environment, equipment constraints, deficits in communication and feedback, skepticism regarding data accuracy and validity, sense of social deprivation, and network information boycott. Conversely, eleven facilitators were identified, encompassing peer modeling, availability of training and support, reconstructive efforts toward the digital healthcare environment, mandatory usage, familial influence, media impact, scientific publicity and education, enhancement of self-efficacy, sense of social participation, perceived convenience, and access to healthful information.
CONCLUSIONS: Based on the COM-B and BCW models, healthcare organizations may be able to improve their digital healthcare support systems (capabilities), technical design, network speed, and equipment configuration (opportunities), as well as focus on \"human-computer integration,\" the parallel existence of digital technology and humanistic care, and taking into account the issues of information security, accuracy, and human rights equality (motivation) while benefiting the patients, in order to bridge the healthcare digital divide for the older adults.

Illegal poaching and overexploitation for the international pet trade are among the greatest threats to freshwater turtles in Southeast Asia. Expanding consumer research in China is crucial to filling knowledge gaps about the scale and structure of illegal trade and developing audience-targeted and relevant interventions that may reduce demand for illegal turtles as pets. We applied mixed methods to provide a detailed understanding of the consumer side of the illegal pet turtle trade in China. We conducted 30 interviews with key stakeholders and online surveys (n = 2456) of turtle keepers via community forums. From these, we identified 3 core consumer groups based on their prior turtle-keeping experience, species exposure, and potential for future purchases. We conducted a thematic qualitative analysis of concepts related to the capability, opportunity, motivation, and behavior (COM-B) model to determine the factors influencing the illegal pet turtle trade and to identify barriers to illegal purchases. Specifically, we identified purchasers\' capabilities, opportunities, and motivations in the context of legality, enforcement risk, captive breeding, and impacts on wild population. We developed consumer journey maps (i.e., visual representations of customer\'s experiences throughout their buying journey) for core consumer groups. These maps illustrate the sequential behaviors and processes that consumers undertake when purchasing turtles, from initial exposure to sourcing, keeping, and providing a new home. Key factors influencing illegal purchases included convenient purchase channels, misguided cognition and motivations for pet keeping, and weak law enforcement. Effective interventions included messages focusing on shifting cognition and beliefs, increasing legal risk perception, and emphasizing stringent law enforcement, primarily delivered through online channels. Our results underscore the necessity for adaptable, audience-tailored interventions to reduce consumer demand for illegal wildlife products. The mixed-methods approach, combining quantitative and qualitative data, provided a comprehensive understanding of the target behavior and can inform the development of effective intervention strategies.
Uso de las percepciones del consumidor para guiar las intervenciones de cambio conductual enfocadas en el mercado ilegal de tortugas en China Resumen La caza furtiva y la sobreexplotación por el comercio internacional de mascotas son algunas de las mayores amenazas para las tortugas de agua dulce del sudeste asiático. Es esencial conocer más sobre los consumidores en China para llenar los vacíos en el conocimiento sobre la escala y la estructura del comercio ilegal y desarrollar intervenciones pertinentes y dirigidas al público que puedan reducir la demanda de tortugas como mascotas ilegales. Aplicamos métodos mixtos para conocer en detalle la percepción del consumidor del comercio ilegal de tortugas como mascotas en China. Realizamos 30 entrevistas a actores clave y encuestas en línea (n=2456) a cuidadores de tortugas a través de foros comunitarios. A partir de ellas, identificamos tres grupos principales de consumidores en función de su experiencia previa en la cría de tortugas, su exposición a las especies y su potencial para futuras compras. Realizamos un análisis cualitativo temático de conceptos relacionados con el modelo de capacidad, oportunidad, motivación y comportamiento (COM‐B) para determinar los factores que influyen en el comercio ilegal de tortugas e identificar las barreras para las compras ilegales. En concreto, identificamos las capacidades, oportunidades y motivaciones de los compradores en el contexto de la legalidad, el riesgo de aplicación de la ley, la cría en cautiverio y el impacto sobre la población silvestre. Elaboramos mapas de viaje del consumidor (representaciones visuales de las experiencias del cliente a lo largo de su compra) para los principales grupos de consumidores. Estos mapas ilustran los comportamientos y procesos secuenciales que llevan a cabo los consumidores cuando compran tortugas, desde la exposición inicial hasta la adquisición, el mantenimiento y la asignación de un nuevo hogar. Entre los factores clave que influyen en las compras ilegales se encuentran la conveniencia de los canales de compra, los conocimientos y motivaciones erróneos para mantener mascotas y la debilidad de la aplicación de la ley. Las intervenciones eficaces incluyeron mensajes centrados en cambiar los conocimientos y las creencias, aumentar la percepción del riesgo legal y hacer hincapié en la aplicación rigurosa de la ley, principalmente a través de canales virtuales. Nuestros resultados destacan la necesidad de intervenciones adaptables y adaptadas al público para reducir la demanda de productos ilegales de fauna silvestre por parte de los consumidores. El enfoque de métodos mixtos, que combina datos cuantitativos y cualitativos, proporcionó una comprensión exhaustiva del comportamiento objetivo y puede servir de base para el desarrollo de estrategias de intervención eficaces.
非法偷猎和国际宠物贸易的过度开发是东南亚淡水龟面临的最大威胁之一。扩大在中国的消费者研究对于填补非法贸易规模和结构的知识空白、开发针对特定受众的相关干预措施以减少对非法宠物龟的需求至关重要。本研究应用了定量、定性的混合方法, 以详细了解中国非法宠物龟贸易的消费端特征, 从而制定有效的、有针对性的干预措施以减少消费需求并保护濒危龟类物种, 我们的研究强调了干预措施设计过程中循证的重要性, 以便能够传达与消费者产生共鸣的信息。我们针对关键利益相关方进行了30次访谈, 并通过社区论坛对宠物龟饲养者进行线上问卷调研(n = 2456)。我们根据对宠物龟的饲养经验、触及方式和未来购买潜力, 识别出三类核心消费者群体。我们进行了基于能力、机会、动机和行为(COM‐B)模型的主题定性分析, 以了解影响非法宠物龟贸易的因素。此分析旨在识别减少购买非法宠物龟行为的障碍。具体而言, 我们在了解消费者对于目标龟种的合法性、违法风险、人工繁殖现状和影响野生种群的认知背景下, 确定了购买者的能力、机会和动机。我们为核心消费者群体制定了消费过程地图, 这些地图将消费者从初次接触、购买、饲养到重新安置的顺序行为和过程进行可视化。我们的结果揭示了影响消费者非法购买的关键因素, 包括便捷的购买渠道、错误的饲养动机和认知及薄弱的执法效果。有效的干预措施包括聚焦于转变动机和认知、增加法律风险感知并强调严格执法, 并通过线上渠道传递干预信息。我们的研究强调了为减少对非法野生动物产品的消费需求, 制定具有适应性的、针对特定受众的干预措施的必要性, 同时, 结合定量、定性研究的混合方法提供了对目标行为的全面理解, 并为制定有效干预策略提供了依据。 利用消费者的见解制定针对中国消费者的非法宠物龟贸易的行为改变干预措施.

BACKGROUND: There is a paucity of theory-informed physical activity research with adults with intellectual disabilities. This study aimed to address this by synthesising existing literature and applying the COM-B model to understand capabilities, opportunities and motivations.
METHODS: A qualitative evidence synthesis was conducted and reported in accordance with PRISMA guidelines and the ENTREQ. Three databases were systematically searched up to and including February 2022. Qualitative research relating to the physical activity of adults with intellectual disabilities were included. Thematic synthesis was conducted with themes mapped onto the COM-B model.
RESULTS: Twenty-five studies were included. Influences of physical activity were identified and mapped onto the COM-B model, which also included COM-B influences of social support provided by caregivers.
CONCLUSIONS: There are many complex influences of physical activity for adults with intellectual disabilities. Researchers should consider the influences contributing to caregivers\' capacity to support physical activity.

OBJECTIVE: To investigate the prevalence of physical inactivity in older adults living in nursing homes and explore the determinants of physical inactivity by using the Capability, Opportunity, Motivation-Behaviour model.
METHODS: A multisite, cross-sectional study was performed by convenience sampling and questionnaire survey.
METHODS: A total of 390 nursing home residents were recruited from three nursing homes in Southern China from May 2022 to April 2023. The participants completed a self-designed general information questionnaire, Physical Activity Scale for the Elderly, Self-Efficacy for Exercise Scale, Exercise Benefits Scale, Patient Health Questionnaire-9 and the Short Physical Performance Battery test. Descriptive statistics, univariate analysis, Spearman correlation analysis, and ordinal logistic regression were applied for data analysis.
RESULTS: The prevalence of physical inactivity among the nursing home residents reached 88.46%. Ordinal logistic regression results showed that exercise self-efficacy, perceived exercise benefits, physical function, availability of physical activity instruction, having depression, number of chronic diseases and living with spouse were the main influencing determinants of physical inactivity and explained 63.7% of the variance.
CONCLUSIONS: Physical inactivity was considerable in nursing home residents in China and influenced by complex factors. Tailored measures should be designed and implemented based on these factors to enhance physical activity while considering the uniqueness of Chinese culture.
UNASSIGNED: Healthcare professionals should enhance physical activity of residents by increasing benefits understanding, boosting self-efficacy, improving physical function, alleviating depression and integrating personalized physical activity guidance into routine care services. And more attention should be paid to the residents who had more chronic diseases or did not live with spouse.
CONCLUSIONS: Physical inactivity is a significant problem in nursing home residents. Understanding physical inactivity and its determinants enables the development of tailored interventions to enhance their physical activity level.
UNASSIGNED: This study was reported conforming to the STROBE statement.
UNASSIGNED: Nursing home residents who met the inclusion criteria were recruited.

OBJECTIVE: To identify factors associated with health behaviours among stroke survivors, through a multi-centre study.
METHODS: A sequential mixed methods design.
METHODS: In the quantitative research phase, a total of 350 participants were recruited through multi-stage sampling from December 2022 to June 2023. General information questionnaires, The Stroke Prevention Knowledge Questionnaire (SPKQ), Short Form Health Belief Model Scale (SF-HBMS), Health Promoting Lifestyle Profile (HPLPII), and the WHOQOL-BREF (World Health Organization Quality of Life Questionnaire, Brief Version) were distributed across five tertiary hospitals in Henan province, China. For the qualitative research component, semi-structured interviews were conducted to explore the barriers and facilitators of health behaviour. This study adheres to the GRAMMS guidelines.
RESULTS: A total of 315 participants (90.0%) completed the survey. Identified barriers to health behaviour included residing in rural areas, higher scores on the Charlson Comorbidity Index (CCI) and mRS, as well as lower scores on SPKQ, SF-HBMS and WHOQOL-BREF. Twenty-four individuals participated in qualitative interviews. Twenty-eight themes were identified and categorised by frequency, covering areas such as knowledge, skills, intentions, social influences, social/professional role and identity, environmental context and resources, beliefs about capabilities, beliefs about consequences and behavioural regulation. Both quantitative and qualitative data suggested that health behaviour among stroke survivors is at a moderate level, and the identified barrier factors can be mapped into the COM-B model (Capability, Opportunity, Motivation and Behaviour).
CONCLUSIONS: The study indicates that key barriers to health behaviour among stroke survivors align with the COM-B model. These identified factors should be carefully considered in the planning of future systematic interventions aimed at improving health behaviours among stroke survivors.
UNASSIGNED: Patients were invited to completed questionnaires in the study and semi-structured interviews. The investigators provided explanation of this study\' content, purpose and addressed issues during the data collection.