BACKGROUND: Air pollution poses a significant threat to global public health, contributing to high rates of mortality and morbidity. India, home to the world\'s largest population of children, is particularly affected. This study aims to identify effective strategies to mitigate the adverse health impacts of air pollution on this vulnerable group.
METHODS: The study utilized directed content analysis using a deductive approach and purposeful sampling to carry out in-depth interviews with researchers, academicians, paediatricians, public health experts, and climate change experts from different organizations in India. In total, 17 interviews were conducted over two months in March and April 2024 until data saturation was reached.
RESULTS:  A total of 29 subcategories were extracted. The main sub-categories include strategies for reducing indoor emissions and multisectoral emission reduction, strategies to reduce exposure at home, schools and transit, strategies for public awareness, effective communication, health sector communication and awareness, and raising awareness by frontline workers and educational institutions, strategies for capacity building of health sector and frontline stakeholders, strategies for building research and knowledge translation, strategies for vertical and horizontal collaboration, strategies for child-centric policies, school closure policies, fiscal policies, comprehensive policymaking, sectoral policymaking, advocacy in policymaking, strategies for monitoring, and strategies for mother and child health.
CONCLUSIONS: The results of this study indicate that mitigating the adverse health impacts of pollution for children would entail a multi-pronged approach encompassing effective communication and education strategies and awareness raising of important stakeholders such as health professionals, community, grassroots-level workers, parents, teachers and children. Such strategies could be useful to trigger the desired change in behaviour of all concerned. Also, there is a need for collaboration and partnership between various stakeholders and ministries as policy-making bodies. There is a need to build on the research and strengthen the monitoring and surveillance.

BACKGROUND: The implementation of youth care guidelines remains a complex process. Several evidence-based frameworks aid the identification and specification of implementation determinants and strategies. However, the influence of specific strategies on certain determinants remains unclear. Therefore, we need to clarify which active ingredients of strategies, known as behaviour change techniques (BCTs), elicit behaviour change and improve implementation outcomes. With this knowledge, we are able to formulate evidence-based implementation hypotheses. An implementation hypothesis details how determinants and in turn, implementation outcomes might be influenced by specific implementation strategies and their BCTs. We aimed to identify (1) determinants relevant to the implementation of youth care guidelines and (2) feasible and potentially effective implementation hypotheses.
METHODS: A four-round online modified Delphi study was conducted. In the first round, experts rated the implementation determinants based on their relevance. Next, experts formulated implementation hypotheses by connecting BCTs and implementation strategies to determinants and were asked to provide a rationale for their choices. In round three, the experts reconsidered and finalised their hypotheses based on an anonymous overview of all formulated hypotheses, including rationales. Finally, the experts rated the implementation hypotheses based on their potential effectiveness and feasibility.
RESULTS: Fourteen experts completed the first, second, and third rounds, with 11 completed the final round. Guideline promotion, mandatory education, presence of an implementation leader, poor management support, knowledge regarding guideline use, and a lack of communication skills were reported as most relevant determinants. In total, 46 hypotheses were formulated, ranging from 6 to 9 per determinant. For each determinant, we provide an overview of the implementation hypotheses that were most commonly deemed feasible and potentially effective.
CONCLUSIONS: This study offers valuable insights into youth care guideline implementation by systematically identifying relevant determinants and formulating hypotheses based on expert input. Determinants related to engagement and to knowledge and skills were found to be relevant to youth care guideline implementation. This study offers a set of hypotheses that could help organisations, policymakers, and professionals guide the implementation process of youth care guidelines to ultimately improve implementation outcomes. The effectiveness of these hypotheses in practice remains to be assessed.

BACKGROUND: It is common for women to explore and plan strategies to cope during labour. These strategies are usually focused on pain control and described as either pharmacological or non-pharmacological. As labour is an individual experience, each woman should be enabled to choose strategies that best suit them, and that reflect what they feel influences their sense of capacity to cope.
OBJECTIVE: By exploring women\'s intentions and choices of strategies, this study aimed to understand how coping strategies can better reflect women\'s individual needs and expectations.
METHODS: Fifty-six primiparous women were recruited from one tertiary hospital in Melbourne, Australia between February and May 2021. Data were collected via a survey in late pregnancy using open-ended questions. Content and thematic analyses were used to analyse responses.
RESULTS: Themes related to how women frame the intensity of labour, how they strive for a relationally safe environment and a need to be prepared and knowledgeable. Strategies chosen by women could be grouped into two categories: intrinsic and extrinsic. Intrinsic strategies could be self-generated by women (such as breathing techniques and movement), while extrinsic strategies required either equipment (such as a bath) or others to administer (such as epidural analgesia).
CONCLUSIONS: Women value having a range of intrinsic and extrinsic strategies that enable autonomy or require external support. This moves beyond the \'pharmacological and non-pharmacological\' categorisation of strategies, and we propose that reframing strategies as intrinsic and extrinsic could have a number of benefits on women\'s sense of autonomy and utilisation of strategies. The findings provide a foundation for more targeted research into how women can be supported to individualise and implement these coping strategies in labour.

BACKGROUND: With an increasing number of grandparents providing care to their grandchildren, calls have been made for these caregivers to be considered important stakeholders in encouraging children\'s engagement in health-promoting behaviors, such as physical activity. Understanding the perspectives of grandparents who provide care is crucial to informing efforts that aim to increase children\'s physical activity, yet little is understood about their perceptions of specific barriers and enablers to promoting children\'s physical activity and reducing screen time. The present study sought to explore these perceptions.
METHODS: Semi-structured focus groups and individual interviews were conducted with grandparents who reported providing care to a grandchild aged 3 to 14 years. A total of 20 grandparents were sampled (mean age = 67.8 years). Data were subjected to reflexive thematic analysis.
RESULTS: Key reported barriers to physical activity included (i) the effort (physical and logistical) and financial cost associated with organizing physical activities, (ii) grandparents\' age and mobility issues (e.g., due to injury or illness), (iii) caring for children of different ages (e.g., older children having different physical activity interests than younger children), and (iv) a local environment that is not conducive to physical activity (e.g., lack of appropriate facilities). Barriers to reducing screen time included (i) parents sending children to care with electronic devices and (ii) children\'s fear of missing out on social connection that occurs electronically. Strategies and enablers of physical activity included (i) integrating activity into caregiving routines (e.g., walking the dog), (ii) involving grandchildren in decision making (e.g., asking them in which physical activities they wish to engage), (iii) encouraging grandchildren to engage in activity with other children, and (iv) creating a physical and social environment that supports activity (e.g., owning play equipment). A common strategy for reducing screen time was the creation of a home environment that is not conducive to this activity (e.g., removing electronic devices from view).
CONCLUSIONS: Findings suggest that grandparents may benefit from resources that assist them to identify activities that are inexpensive and require minimal effort to organize. Activities that account for grandparents\' age and health status, as well as any environmental barriers, are likely to be well-received.

BACKGROUND: Behavior change techniques (BCTs) are considered as active components of implementation strategies, influencing determinants and, ultimately, implementation performance. In our previous Delphi study, experts formulated \'implementation hypotheses\', detailing how specific combinations of BCTs and strategies (referred to as BCT-strategy combinations) might influence determinants and guideline implementation within youth care. For example, educational meetings providing instructions on guideline use were hypothesized to enhance practitioners\' knowledge and, consequently, guideline implementation. However, these hypotheses have not been verified in practice yet.
METHODS: We conducted a cross-sectional study involving practitioners and management professionals from youth (health)care organizations. Using questionnaires, we obtained data on the presence of BCT-strategy combinations and their perceived influence on determinants and implementation performance. Chi-squared tests and regression analyses were employed to determine the influence of specific BCT-strategy combinations on determinants and implementation performance.
RESULTS: Our analyses included data from 104 practitioners and 34 management professionals. Most of the management professionals indicated that the BCT-strategy combinations positively influenced or had the potential to influence their implementation performance. At the practitioner level, half of the combinations were perceived to have a positive influence on determinants and implementation performance. Furthermore, practitioners who reported the absence of BCT-strategy combinations were more skeptical about their potential influence on determinants and implementation performance.
CONCLUSIONS: Several BCT-strategy combinations were perceived to improve or potentially improve implementation performance of both practitioners and management professionals. In the development and evaluation of implementation efforts, we advocate for clearly describing the implementation effort\'s objective and using frameworks that detail the BCTs inducing behavior change, the strategy employed, and the processes driving the observed changes. Understanding these interconnected processes is important in designing targeted, evidence-based behavior change interventions. This understanding optimizes resource allocation and contributes to the overall success of implementation efforts in youth care.

UNASSIGNED: Retention of study participants in observational studies is essential to maintaining the representativeness of the population, minimizing selection bias, and assuring sufficient statistical power. The aim of this report is to describe the structures and strategies used to retain participants in The Environmental Determinants of Diabetes in the Young (TEDDY) Study, an observational study of children at increased genetic risk for type 1 diabetes followed in an intense protocol with frequent clinic visits from birth until age 15.
UNASSIGNED: A systematic review of methodologies used to retain research subjects identified four domains: barrier reduction strategies; community building strategies; follow-up/reminder strategies; and tracing strategies. Independent reviewers categorized the retention strategies implemented by the TEDDY Study into each of these domains. Strategies not fitting into any of these categories were placed into a fifth category unique to TEDDY.
UNASSIGNED: TEDDY identified over one hundred retention strategies used during the 15 years of follow-up; most could be categorized in these domains. Those unique to TEDDY included (1) study organization and structures to support retention; (2) efforts to meet the changing developmental needs of the TEDDY population, (3) implementation of efforts to address protocol challenges in real-time; and (4) employment of a re-engagement protocol for those who had dropped out of the study.
UNASSIGNED: Pediatric cohort studies should include strategies, structures, and resources addressing retention at the study\'s initiation. It is recommended that child and parent engagement in addition to the developmental needs of the child be an integrated focus of all strategies. Putting mechanisms in place to address protocol and retention challenges in real time would facilitate effectively addressing challenges as they arise.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT00279318.

BACKGROUND: The implementation of hospital accreditation standards in healthcare systems in Yemen that ensure safe and high-quality healthcare services is hampered by specific challenges. Therefore, this study was purposed to explore the challenges and strategies for applying hospital accreditation standards among healthcare professionals in Yemen.
METHODS: A qualitative, phenomenological design was adopted to conduct this study. Semi-structured interviews were used to collect data during the period from January 1, 2022, to February 28, 2022.
RESULTS: Based on the content analysis, the study outcomes and lack of (i) funding, (ii) competent human resources, (iii) optimal infrastructure, and (iv) equipment and supplies deter the implementation of hospital accreditation standards. Also, this study highlighted the cultural and social barriers limiting the effectiveness of hospital accreditation standards, the need for increased investment in healthcare infrastructure and human resources, and cultural sensitivity training for healthcare professionals to enhance the implementation of and compliance with hospital accreditation standards.
CONCLUSIONS:  Policymakers should engage global corporations and development partners for technical assistance and capacity building that support the local application of hospital accreditation standards.

BACKGROUND: The primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced-based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e. physical inactivity, poor diet, harmful alcohol use, and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such, this review will provide important evidence to advance the field of sustainability research.
METHODS: This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team, data screening and extraction will be performed in duplicate, strategies will be coded using an adapted sustainability-explicit taxonomy, and evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or programme within any of the eligible settings will be included. Article screening, data extraction, risk of bias, and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random-effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include the following: time period, single or multi-strategy, type of setting, and type of intervention. Differences between sub-groups will be statistically compared.
CONCLUSIONS: This will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners.
BACKGROUND: PROSPERO CRD42022352333.

School closures in March 2020 due to the COVID-19 pandemic precipitated losses of critical student resources as physical, mental, emotional, and social needs escalated. Identifying the challenges, strategies, and changes in school nurse (SN) practice in Massachusetts during this pandemic is fundamental to understanding how to manage future anticipated pandemics while protecting children, communities, and SNs. The purpose of this mixed-methods descriptive study in the second year of the global pandemic was to (a) listen to SN voices through a novel online survey including the prompts of challenges, strategies, and practice changes and (b) describe the SN experience of COVID-19 response in Massachusetts schools, including identification of intent to leave school nursing. Responses were analyzed using descriptive qualitative analysis (n  =  73). The prompts each elicited subthemes that coalesced to a cohesive theme: Finding one\'s way required the support of others to pave untraversed roads.

BACKGROUND: Maintenance rates of exclusive breastfeeding (EBF) worldwide are low, thus, one of the objectives of the summary of policies on breastfeeding (BF) in world nutrition goals for 2025 are that at least 50% of infants under six months of age receive EBF that year. The Objective of this study is to document the rates of EBF in children born in San Ignacio University Hospital (HUSI) and identify factors associated with maintenance.
OBJECTIVE: To document the percentages of EBF in those that were born at HUSI and identify factors associated to their maintenance.
METHODS: This is a study of cases and controls in an analytic, retrospective cohort that took children born alive between January 2016 and January 2019 at HUSI located in the city of Bogotá, Colombia.
RESULTS: Receiving information about BF at HUSI was able to maintain EBF up until 4 mo (OR = 1.65; 95%CI: 1.02-2.66). The presence of gynecologic and obstetric comorbidities (OR = 0.32; 95%CI: 0.12-0.83), having mastitis (OR = 0.56; 95%CI: 0.33-0.94), and receiving information from mass media (OR = 0.52; 95%CI: 0.31-0.84) are factors associated with not maintaining EBF.
CONCLUSIONS: Receiving education at a Women- and Child-Friendly Institution was the only significant factor to achieve EBF until 4 mo, with a frequency greater than the one reported in the country, which matches multiple studies where counseling and individualized support on BF achieve this purpose. Knowledge about BF and early detection of obstetric/gynecologic complications must be strengthened among the healthcare staff in charge of mothers during post-partum. Additionally, strategies must be promoted to continue BF such as creating milk banks with the objective of increasing BF rates even when mothers return to work.