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Introduction HIV self‐testing (HIVST) in outpatient departments (OPD) is a promising strategy for HIV testing in Malawi, given high OPD patient volumes and substantial wait times. To evaluate the relative cost and expected impact of facility‐based HIVST (FB‐HIVST) at OPDs in Malawi for increasing HIV status awareness, we conducted an economic evaluation of an HIVST cluster‐randomized controlled trial. Methods A cluster‐randomized trial was conducted at 15 sites in Malawi from September 2017 to February 2018 with three arms: 1) Standard provider‐initiated‐testing‐and‐counselling (PITC); 2) Optimized PITC (additional provider training and job‐aids) and 3) FB‐HIVST (HIVST demonstration, distribution and kit use in OPD, private kit interpretation and optional HIV counselling). The total production cost per newly identified positive and per person newly initiated on ART were calculated by study arm. These were calculated as the total cost of testing everyone divided by the number of newly identified positives; and the total cost of testing everyone divided by the number of those initiated on ART. Cost‐outcomes were calculated under three cost scenarios: (1) full study costs, (2) routine implementation costs and (3) routine implementation + reduced cost for HIVST kits. Results The average cost per person newly diagnosed in the full study cost scenario was$101, $ 156 and$189, and cost per person initiated on ART was $ 121,$156 and $ 279 for Standard PITC, Optimized PITC and FB‐HIVST respectively. In the routine implementation cost scenario, the average cost per person newly diagnosed was reduced to$83, and $ 93, and cost per person initiated on ART to$83, and $ 137 for Optimized PITC and FB‐HIVST respectively. In the negotiated HIVST cost scenario, the average cost per person newly diagnosed was reduced to$55 and cost per person newly initiated on ART reduced to $ 81 in the FB‐HIVST arm. Conclusions While the cost per new ART initiation through FB‐HIVST was higher than Standard PITC, FB‐HIVST could become cost‐saving compared to PITC if the cost of kits is reduced or if treatment linkage rate were increased in the FB‐HIVST arm. For high volume OPDs, HIVST may increase facility capacity and increase the number of newly diagnosed positives.

Background This longitudinal study aimed to develop a nine-item Brief Self-Assessed Wisdom Scale (BSAWS) derived from the original 40-item Self-Assessed Wisdom Scale (SAWS). Methods The psychometric properties of the shortened scale were evaluated based on a sample of 157 older adults. The factor structure and dimensionality of the original SAWS were examined using confirmatory factor analysis. Subsequent explorative factor analysis of the BSAWS supported the construct validity of the shortened scale. Results The internal consistency, convergent validity and construct validity of the shortened scale were also evaluated and the results indicated that the BSAWS possesses good psychometric properties and is comparable with the full version. Conclusions This scale refinement may help researchers and practitioners conduct epistemological surveys or clinical research related to wisdom.

Background Breast cancer is a global health issue and a leading cause of death among women. Early detection through increased awareness and knowledge on breast cancer and breast cancer screening is thus crucial. The aim of the present study was to assess the effect of an educational intervention program on breast cancer knowledge and the practice of breast self-examination among young female students of a university in Bangladesh. Methods A quasi-experimental (pre-post) study design was conducted at Jahangirnagar University in Bangladesh. Educational information on breast cancer and breast self-examination (BSE), demonstration of BSE procedure and leaflets were distributed among 400 female students after obtaining written informed consent. The stepwise procedures of BSE performance were demonstrated with images. Pre-intervention and 15 days post-intervention assessments were conducted to assess the changes in knowledge on breast cancer and practices of BSE. Mc-Nemar’s tests and paired sampled t -tests were performed to investigate the differences between pre- and post-test stages. Results A total of 400 female university students aged 18-26 years were included in the sample. Significant changes were found in knowledge and awareness about breast cancer and BSE practices after the educational intervention. The significant differences were measured in the mean scores of pre-test vs. post-test: breast cancer symptoms (2.99 ± 1.05 vs. 6.35 ± 1.15; p  < 0.001), risk factors (3.35 ± 1.19 vs. 7.56 ± 1.04; p  < 0.001), treatment (1.79 ± 0.90 vs. 4.63 ± 0.84; p  < 0.001), prevention (3.82 ± 1.32 vs. 7.14 ± 1.03; p  < 0.001), screening of breast cancer (1.82 ± 0.55 vs. 3.98 ± 0.71; p  < 0.001) and process of BSE (1.57 ± 1.86 vs. 3.94 ± 0.93; p  < 0.001). Likewise, a significant percentage of change in BSE practices was obtained between pre-test and post-test (21.3% vs. 33.8%; p  < 0.001). Conclusions Study findings confirm that the study population had inadequate awareness and knowledge at baseline which was improved significantly after educational intervention. A nationwide roll-out with community-based interventions is recommended for the female population in both rural and urban areas.

Though early intervention saves many lives worldwide, breast cancer remains a leading cause of cancer among women in Ethiopia. This study, therefore, aimed to evaluate community-based interventions promoting breast self-examination using the Health Belief Model. A cluster randomized controlled trial followed by a cross-sectional study lasting six months was used to evaluate the effectiveness of the community-based educational intervention on breast self-examination among reproductive-aged women in Ethiopia. A total of 810 participants were randomly assigned in a 1:1 ratio and assessed at baseline, three months, and six months post-intervention. A general linear model for repeated measures was used to examine the mean differences in study variables across time points. Non-parametric tests (Cochran's Q) were employed to analyze dichotomous variables related to breast self-examination practices. Path analysis was conducted to examine the interactions among the constructs of the Health Belief Model. A total of 810 reproductive-aged women participated in the study, yielding a 100% response rate at baseline. The mean age of participants was 33.2 ± 7.7 years in the intervention group and 33.5 ± 8.1 years in the control group. The proportion of women performing breast self-examinations increased from 33.3% at baseline to 59.9% at the end of the intervention. And the Comprehensive knowledge about breast self-examination rose from 11.7% to 69.1% over the same period. Perceived susceptibility, perceived severity, knowledge, and health motivations had a statistically significant mean difference between the intervention and control groups (p < 0.0001). We registered PACTR database (https://pactr.samrc.ac.za/): \"PACTR201802002902886\". The study found that there is a strong interplay between the likelihood of performing breast self-examination and perceived susceptibility, perceived severity, knowledge, and health motivations. Field specialists should figure out the problem related to perception and awareness through intensive health promotion interventions. Registered in the Pan African Clinical Trial Registry (www.pactr.org) database, and the unique identification number for the registry is PACTR201802002902886.

Breast cancer is a leading cause of cancer-related deaths worldwide, with most cases in Bangladesh diagnosed at advanced stages due to limited awareness and late detection. While breast self-examination (BSE) is a simple, cost-free method for early detection, its practice among adolescents remains poorly understood. This study aims to explore breast cancer knowledge, BSE practices, and barriers among adolescent girls in a semi-urban area, addressing a critical gap in early prevention efforts. A cross-sectional study was carried out with 384 adolescent girls from four renowned schools in a semi-urban area of Dhaka, Bangladesh. Participants were sampled at school from January to April 2025. Proportionate stratified random sampling was conducted to determine the study sample from each school. A validated semi-structured self-reported questionnaire was employed to collect data from participants during the survey period. Among the participants, only 45.3% had heard of BSE and just 4.6% reported ever practicing it. Overall, breast cancer knowledge was low, with a mean score of 9.49 out of 31 (30.6%). Regression analyses indicated that higher breast cancer knowledge scores were significantly associated with having a science academic background (β = 1.82, p < 0.01), higher family income (β = 1.14, p < 0.05), and prior BSE practice (β = 2.36, p < 0.001). A strong positive correlation was observed between overall knowledge and BSE practice (r = 0.54, p = 0.001). Students from the science section were significantly more likely to practice BSE than those from the humanities section (OR = 9.47, 95% CI: 1.21-73.89, p = 0.032). Participants who received BSE information from health workers were approximately nine times more likely to practice BSE than those who did not (OR = 9.62, 95% CI: 2.30-40.20, p = 0.002). The study demonstrates critically low levels of breast cancer knowledge and BSE practice among adolescent girls, with knowledge strongly influencing practice. These findings underscore the need for culturally appropriate, school-based educational interventions to improve awareness, promote early detection behaviors, and potentially reduce future breast cancer morbidity and mortality in Bangladesh.

We conducted a secondary thematic analysis of interview data from our wider qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews about their experiences of CHAnGE. Data relating to recruitment and participation were analysed inductively to identify themes, then a coding framework comprising the core constructs from self-determination theory-autonomy, competence and relatedness-was used to explore if and how this theory fit with and helped to explain our data. Recruitment presentations promoted the CHAnGE intervention well in terms of addressing value expectations of structured support, different forms of accountability, credibility, achievability and, for some, a potential to enhance social relationships. Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. These factors related strongly to self-determination concepts of autonomy, competence and relatedness, but the intervention's demonstrated potential to support self-determination needs could be conveyed more effectively.

Background Sedentary behaviour (SB) is a risk factor for chronic disease and premature mortality. While many individual studies have examined the reliability and validity of various self-report measures for assessing SB, it is not clear, in general, how self-reported SB (e.g., questionnaires, logs, ecological momentary assessments (EMAs)) compares to device measures (e.g., accelerometers, inclinometers). Objective The primary objective of this systematic review was to compare self-report versus device measures of SB in adults. Methods Six bibliographic databases were searched to identify all studies which included a comparable self-report and device measure of SB in adults. Risk of bias within and across studies was assessed. Results were synthesized using meta-analyses. Results The review included 185 unique studies. A total of 123 studies comprising 173 comparisons and data from 55,199 participants were used to examine general criterion validity. The average mean difference was -105.19 minutes/day (95% CI: -127.21, -83.17); self-report underestimated sedentary time by ~1.74 hours/day compared to device measures. Self-reported time spent sedentary at work was ~40 minutes higher than when assessed by devices. Single item measures performed more poorly than multi-item questionnaires, EMAs and logs/diaries. On average, when compared to inclinometers, multi-item questionnaires, EMAs and logs/diaries were not significantly different, but had substantial amount of variability (up to 6 hours/day within individual studies) with approximately half over-reporting and half under-reporting. A total of 54 studies provided an assessment of reliability of a self-report measure, on average the reliability was good (ICC = 0.66). Conclusions Evidence from this review suggests that single-item self-report measures generally underestimate sedentary time when compared to device measures. For accuracy, multi-item questionnaires, EMAs and logs/diaries with a shorter recall period should be encouraged above single item questions and longer recall periods if sedentary time is a primary outcome of study. Users should also be aware of the high degree of variability between and within tools. Studies should exert caution when comparing associations between different self-report and device measures with health outcomes. Systematic review registration PROSPERO CRD42019118755

The Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS) was designed to measure self-criticism (SC) through Inadequate Self (IS) and Hated Self (HS) factors, as well as self-reassurance (RS). However, its long and short forms have yet to be validated in the Spanish Population. The present study examines the psychometric properties of the short form (FSCRS-SF) and its clinical usefulness in a sample of 576 adult individuals, 77 with psychiatric disorders and 499 without. Non-clinical participants were split according to their previous experience with meditation (active meditators, n = 133; non-active meditators, n = 41; and non-meditators, n = 325) and differences between these subgroups were explored. Additionally, a subsample of 20 non-clinical participants took part in a mindfulness- and compassion- based intervention (MCBI) to assess the usefulness of the scale as an outcome measure. Results confirmed the original three-factorial structure, good internal consistency, acceptable test-retest reliability, and a pattern of correlations consistent with previous literature. Regarding differences between groups, the clinical subsample showed significant higher SC and lower RS levels than non-clinical participants and active meditators had significant lower IS and higher RS levels than non-meditators. Participants who participated in the MCBI showed significant RS improvement and a decrease in IS and HS levels. Moreover, a hierarchical multiple regression showed that RS made a significant predictive contribution to distress at three months' time. In conclusion, results show that the Spanish version of the FSCRS-SF is a reliable and valid measure of SC and RS in non-clinical populations and an adequate instrument to detect changes after MCBIs.

Background Breast cancer (BC) is the most commonly diagnosed cancer among women worldwide. This study aimed to explore the planned behavior of breast self-examination (BSE) and its predictors among women in Northern Iran. Methods A cross-sectional study was conducted among 240 women in Babol, Iran, from 2020 to 2022. Data were collected using BSE barriers, knowledge and practice of BSE, and the Theory of Planned Behavior (TPB) questionnaires. Data were analyzed using a linear regression model and Pearson’s correlation coefficient. Results The mean TPB construct score was 53.2 ± 3.9. The majority of women did not perform the BSE correctly (91.2%), and over half of the women lacked knowledge about BC and timely detection methods (54.6%). There was a significant positive correlation between attitude and “Do not know how to do it” ( r  = 0.160, P  = 0.01), and a negative correlation with the marriage age ( r = −0.210, P  = 0.001), while a significant negative correlation was found between behavioral intention and ‘‘fear of biopsy’’ as a barrier ( r = −0.130, P  = 0.05). Additionally, there was a significant positive correlation between the perceived behavioral control and ‘‘Fear of feeling pain during examination’’ as a barrier ( r  = 0.130, P  = 0.04). Multiple linear regression analysis revealed that the lack of training by health care providers (β = 0.16, P  = 0.02) and being afraid of finding a lump in the breast (β = 0.13, P  = 0.04) were positive predictors of TPB. Conversely, marriage age (β = −0.13, P  = 0.049) and attitude toward BSE (β = −0.19, P  = 0.005) were negative predictors of TPB construct. Additionally, “fear of feeling pain during examination” positively predicted perceived behavioral control (β = 0.13, P  = 0.05). Notably, the results showed BSE practice was able to positively predict behavior (β = 0.94, P  = 0.0001). Knowledge was positively associated with “afraid of finding a lump in the breast” (β = 0.13, P  = 0.04). Conclusions Low levels of knowledge about BC, BSE, symptoms, and risk factors point to the need for targeted planned behavior-based interventions.