Xiang Cong Tham

Introduction Middle-aged adults with chronic conditions including diabetes, hyperlipidaemia and hypertension are at higher risk for cognitive decline. However, there is a lack of a targeted solution for this population. This study aims to develop a digital solution for salutogenic brain health targeting this population, assess its clinical effectiveness and evaluate the implementation in primary care settings by local champions, that is, nurses. Methods and analysis A type-I hybrid effectiveness-implementation design with a sequential multiple-assignment randomised trial will be adopted. 160 adults aged 40–64 years old with chronic conditions hypertension, hyperlipidaemia and type-II diabetes will be recruited from three National University Polyclinics in Singapore. They will be randomised using block randomisation to either the intervention group (‘Digital solution for Salutogenic Brain health’ programme) or the waitlist control group. Cognitive tests, clinical measures, questionnaires and interviews will be used to evaluate outcome measures. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework and the Capability, Opportunity, Motivation and Behaviour model will be employed to evaluate clinical effectiveness and implementation strategies. Ethics and dissemination This study has been reviewed and approved by the National Healthcare Group Domain Specific Review Board (NHG DSRB) in Singapore (NHG DSRB Reference Number: 2023/00620 (25 June 2024)). Data will be analysed by study team members and findings will be published in peer-reviewed journals. Trial registration number NCT06582316.

Background: A poor diet contributes substantially to the development of noncommunicable diseases. In Singapore, it is recommended to consume at least 2 servings of fruits and vegetables daily to reduce the risk of developing noncommunicable diseases. However, the adherence rate among young adults is low. The COVID-19 pandemic has led to frequent users of mobile food delivery apps (MFDAs) adopting unhealthy eating habits, including high consumption of sugar-sweetened beverages, making it crucial to gain a deeper understanding of the underlying factors driving their use patterns. Objective: We aimed to examine the use patterns of MFDAs among young adults during the COVID-19 pandemic; investigate the association between MFDA use and sociodemographic factors, dietary factors, and BMI; identify the underlying reasons for the observed use patterns of MFDAs among users; and compare the influences of MFDA use between frequent and infrequent users. Methods: A sequential mixed methods design was used involving a web-based survey and in-depth interviews with a subset of respondents. Poisson regression and thematic analysis were used to analyze the quantitative and qualitative data, respectively. Results: The quantitative results revealed that 41.7% (150/360) of participants reported using MFDAs frequently, defined as at least once a week. Although not substantial, the study found that frequent users were less likely to consume 2 servings of vegetables per day and more likely to drink sugar-sweetened beverages. Nineteen individuals who had participated in the quantitative component were selected for and completed the interviews. Qualitative analysis identified 4 primary themes: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. Before making any purchase, MFDA users consider all these themes at the same time, with cost being the most important influential factor. A conceptual framework based on these themes was presented. Lack of culinary skills and COVID-19 restrictions were also found to influence frequent use. Conclusions: This study suggests that interventions should focus on promoting healthy dietary patterns in young adults who frequently use MFDAs. Teaching cooking skills, especially among young male individuals, and time management skills could be useful to reduce reliance on MFDAs. This study highlights the need for public health policies that make healthy food options more affordable and accessible. Given the unintended changes in behavior during the pandemic, such as reduced physical activity, sedentary behavior, and altered eating patterns, it is essential to consider behavior change in interventions aimed at promoting healthy lifestyles among young adults who frequently use MFDAs. Further research is needed to evaluate the effectiveness of interventions during COVID-19 restrictions and assess the impact of the post–COVID-19 new normal on dietary patterns and physical activity levels.

Informal caregivers are essential in supporting stroke survivors' recovery, but it is unclear whether community interventions can promote healthy eating behaviors and social participation among stroke survivors and their caregivers. The Train-Your-Brain (TYB) program's impact on adherence to national dietary guidelines and social participation among informal caregivers and stroke survivors were assessed in a quasi-experimental study. The TYB program had nine sessions, with one focusing on healthy lifestyle. Participants were prompted to discuss the topics covered, leading to social participation. Dietary habits were assessed using fruits and vegetables consumption questions, while social participation was measured using the Social Impact Measurement Framework. Mann-Whitney U-test and Wilcoxon Signed Rank Test were utilized to analyze the data. Eighteen informal caregivers and 27 stroke survivors participated in the program. Results showed a significant increase in fruit and vegetable intake and social participation in informal caregivers after the program, but there were no significant changes in stroke survivors. Informal caregivers play a crucial role in stroke survivors' lifestyle habits and in encouraging social connections with other stroke survivors. Thus, healthcare professionals should prioritize caregiver support and education to facilitate long-term dietary and social changes that can positively impact stroke survivor's recovery and quality of life.

Background: As the COVID-19 pandemic evolves, challenges in frontline work continue to impose a significant psychological impact on nurses. However, there is a lack of data on how nurses fared compared to other health care workers in the Asia-Pacific region. Objective: This study aims to investigate (1) the psychological outcome characteristics of nurses in different Asia-Pacific countries and (2) psychological differences between nurses, doctors, and nonmedical health care workers. Methods: Exploratory data analysis and visualization were conducted on the data collected through surveys. A machine learning modeling approach was adopted to further discern the key psychological characteristics differentiating nurses from other health care workers. Decision tree–based machine learning models (Light Gradient Boosting Machine, GradientBoost, and RandomForest) were built to predict whether a set of psychological distress characteristics (ie, depression, anxiety, stress, intrusion, avoidance, and hyperarousal) belong to a nurse. Shapley Additive Explanation (SHAP) values were extracted to identify the prominent characteristics of each of these models. The common prominent characteristic among these models is akin to the most distinctive psychological characteristic that differentiates nurses from other health care workers. Results: Nurses had relatively higher percentages of having normal or unchanged psychological distress symptoms relative to other health care workers (n=233-260 [86.0%-95.9%] vs n=187-199 [74.8%-91.7%]). Among those without psychological symptoms, nurses constituted a higher proportion than doctors and nonmedical health care workers (n=194 [40.2%], n=142 [29.5%], and n=146 [30.3%], respectively). Nurses in Vietnam showed the highest level of depression, stress, intrusion, avoidance, and hyperarousal symptoms compared to those in Singapore, Malaysia, and Indonesia. Nurses in Singapore had the highest level of anxiety. In addition, nurses had the lowest level of stress, which is the most distinctive psychological outcome characteristic derived from machine learning models, compared to other health care workers. Data for India were excluded from the analysis due to the differing psychological response pattern observed in nurses in India. A large number of female nurses emigrating from South India could not have psychologically coped well without the support from family members while living alone in other states. Conclusions: Nurses were least psychologically affected compared to doctors and other health care workers. Different contexts, cultures, and points in the pandemic curve may have contributed to differing patterns of psychological outcomes amongst nurses in various Asia-Pacific countries. It is important that all health care workers practice self-care and render peer support to bolster psychological resilience for effective coping. In addition, this study also demonstrated the potential use of decision tree–based machine learning models and SHAP value plots in identifying contributing factors of sophisticated problems in the health care industry.

BACKGROUND A poor diet contributes substantially to the development of noncommunicable diseases. In Singapore, it is recommended to consume at least 2 servings of fruits and vegetables daily to reduce the risk of developing noncommunicable diseases. However, the adherence rate among young adults is low. The COVID-19 pandemic has led to frequent users of mobile food delivery apps (MFDAs) adopting unhealthy eating habits, including high consumption of sugar-sweetened beverages, making it crucial to gain a deeper understanding of the underlying factors driving their use patterns. OBJECTIVE We aimed to examine the use patterns of MFDAs among young adults during the COVID-19 pandemic; investigate the association between MFDA use and sociodemographic factors, dietary factors, and BMI; identify the underlying reasons for the observed use patterns of MFDAs among users; and compare the influences of MFDA use between frequent and infrequent users. METHODS A sequential mixed methods design was used involving a web-based survey and in-depth interviews with a subset of respondents. Poisson regression and thematic analysis were used to analyze the quantitative and qualitative data, respectively. RESULTS The quantitative results revealed that 41.7% (150/360) of participants reported using MFDAs frequently, defined as at least once a week. Although not substantial, the study found that frequent users were less likely to consume 2 servings of vegetables per day and more likely to drink sugar-sweetened beverages. Nineteen individuals who had participated in the quantitative component were selected for and completed the interviews. Qualitative analysis identified 4 primary themes: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. Before making any purchase, MFDA users consider all these themes at the same time, with cost being the most important influential factor. A conceptual framework based on these themes was presented. Lack of culinary skills and COVID-19 restrictions were also found to influence frequent use. CONCLUSIONS This study suggests that interventions should focus on promoting healthy dietary patterns in young adults who frequently use MFDAs. Teaching cooking skills, especially among young male individuals, and time management skills could be useful to reduce reliance on MFDAs. This study highlights the need for public health policies that make healthy food options more affordable and accessible. Given the unintended changes in behavior during the pandemic, such as reduced physical activity, sedentary behavior, and altered eating patterns, it is essential to consider behavior change in interventions aimed at promoting healthy lifestyles among young adults who frequently use MFDAs. Further research is needed to evaluate the effectiveness of interventions during COVID-19 restrictions and assess the impact of the post–COVID-19 new normal on dietary patterns and physical activity levels.