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The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs).

The analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors.

Interpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically.

The study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality.

Contextual to the recognition of the complex interplay between health and behavioral aspects, integrated behavioral health (IBH) has emerged. Although this model is becoming popular in the Western world, its presence in the global context is not promising. This paper aims to explore the need for IBH in India and address its barriers to implementation and possible solutions.

We analyzed the case of IBH and its potential implications for India using the current evidence base, authors' reflections and experience of implementing similar programs.

This paper identifies contextual factors, including increased instances of non-communicable diseases and psychosocial and cultural determinants of health, that necessitate the implementation of IBH programs in India. The key features of different IBH models and their applicability are outlined. The current status of IBH and potential challenges in implementation in India in terms of human resources and other factors are delineated. We also discuss the potential models for implementing IBH in India.

Integrating behavioral health in primary care is considered an effective and sustainable model to promote health and well-being across various target populations. Towards this end, this paper is the first to discuss the contextual factors of IBH in India. It is a significant addition to the knowledge base on IBH and its possible implementation barriers and strategies in low- and middle-income countries.

This study aims to evaluate the impact of the proposed CARICOM Octagon “High In” Warning Label (OWL), against four alternative Front-of-Package Nutrition Labels (FOPNLs): US “Facts Up Front” (FUF), UK Multi-Traffic Light (MTL), Mexican OWL and the Brazilian Magnifying Glass “High In” Warning Label, on respondents’ purchase intentions, perception of healthiness and understanding of nutritional information across and within food products.

In an online randomized control experiment, adults from eight CARICOM countries (n = 948) were randomly assigned to a control and four treatment FOPNL groups. Respondents were tasked to choose between four categories of mock products with three variations in healthfulness across and within products.

No statistically significant difference (p > 0.05) was found across FOPNL groups compared to the OWL on outcomes of purchase intentions and perception of healthfulness. Regarding the understanding of nutritional information, FUF performed the best, as participants were 1.76 times (p = 0.03) and 3.23 times (p = 0.00) more likely to correctly identify the products with the highest and lowest amount of sugar, respectively. Results were similar for products with the lowest sodium (odds ratio [OR] = 2.25, p = 0.00) and highest saturated fats (OR = 2.11, p = 0.00).

Some limitations of this study include the use of an online platform to conduct the experiment. Though this was the most cost-effective method of execution and presented many benefits, there were limitations to using this approach. Firstly, this approach may not entirely replicate the real world in store purchasing settings. Although online grocery shopping is becoming increasingly popular, in the Caribbean, most grocery purchases are made in stores. Furthermore, online surveys are more likely to lead to samples with higher educational and income levels than the average population (Bethlehem, 2010). The skewedness observed was not unique to this study and was common with similar published studies (Franco-Arellano et al., 2020; Packer et al., 2021; Talati et al., 2018). Nevertheless, all respondents were randomly assigned to groups, and it was confirmed that there were no systematic differences in the education and income levels of participants across the FOPNL groups.

Some CARICOM policy makers advocate for the use of “High In” warning labels to limit the intake of nutrients of concern (NOCs) and to encourage healthier eating habits among consumers. However, regional private sector stakeholders have expressed concern about the lack of sufficient research undertaken at a regional level, to inform the effectiveness of this model within CARICOM, and some have also expressed a preference for the use of other interpretative and reductive FOPNLs, already in use in the Region. The results of this study reveal that while interpretative FOPNLs like the Draft CARICOM Regional Standard, DCRS5 (OWL) can assist consumers in making healthier purchase decisions, it was outperformed by the MTL on perception of healthiness and by the FUF on the understanding of nutrient information. It was also noted that the DCRS5 (OWL) was more effective when choosing across products with distinct nutritional differences but performed poorly in assisting respondents with making healthy purchasing decisions when all the products contained NOCs above the relevant thresholds. This study’s findings highlight that the existing FOPNL schemes can be further enhanced for improved outcomes. This can be achieved by using a hybrid approach which includes both reductive and interpretative elements to allow for comparison across and within food products. The literature also suggests the use of colour and combining positive as well as negative elements to encourage ease of interpretation, improved understanding and healthier food choices.

A properly designed FOPNL can support consumers in making healthier food choices; however, it must be accompanied by measures to raise consumer awareness and increase the health literacy of the population to cause shifts in preferences and behavioural patterns over time. This must also be coupled with policies to make healthy food choices more affordable to the general population.

The results of this study revealed that FUF and MTL performed the best in assisting participants to correctly identify between products with the highest or lowest NOCs at the 5% significant level, and that the OWL performed poorly in assisting participants with making healthy purchasing decisions when all the products contained NOCs above the relevant thresholds.

This chapter provides a comprehensive exploration of the pivotal role of family planning in advancing sustainable development goals (SDGs). It elucidates the intrinsic connection between family planning and sustainable development, scrutinizes the harmonization of family planning initiatives with SDG targets and indicators, gleans insights from global approaches, and identifies formidable challenges, with a particular focus on marginalized communities. This chapter culminates with a set of substantial recommendations aimed at surmounting these challenges and propelling SDG attainment through the prism of family planning.

The inflammatory potential of diet may play a role in the regulation of low-grade chronic inflammation derived from obesity. This study aims to investigate the relationship between the dietary inflammatory index (DII) and anthropometric indicators of adiposity among Turkish adults.

The study sample consisted of 833 young adults (mean age = 23 ± 5.2 years). The inflammatory potential of the diet was evaluated with a DII. Data on dietary intake were collected by a single 24-h dietary recall, and DII was estimated from 25 dietary components. Also, the Mediterranean diet (Med-Diet) adherence screener was applied using the 14-item assessment tool.

The proinflammatory diet was statistically associated with young (p < 0.001), singles (p < 0.001), high school degree (p = 0.011), students (p < 0.001), not working or unemployed (p < 0.001), eating outside (p = 0.016) and lower adherence to a Med-Diet (p = 0.027). There was a statistically significant positive relationship between the DII score and body weight (BW), waist circumference and waist-to-height ratio (WHtR) (r = 0.107; p = 0.002, r = 0.092; p = 0.008, r = 0.115; p = 0.001, respectively). Besides, there was a statistically significant negative relationship between MED score and BW, WHtR and neck circumference (r = −0.101; p = 0.004, r = −0.084; p = 0.016, r = −0.175; p = 0.000, respectively).

To the best of the authors’ knowledge, this was the first Turkish study to assess the association between the anthropometric indicators of obesity and DII or adherence to Med-Diet in young adults. Lower DII scores and higher adherence to Med-Diet are related to the better status of anthropometric indicators of adiposity.

The purpose of this paper is to ascertain if practising healthy lifestyles improves the technical efficiency of farms in Kwara state, Nigeria. In theory, all deviations from the optimum level of output are due to random effects and inefficiency of producers in which their health plays a key part and is dependent on the kind of lifestyle practiced whether healthy or unhealthy.

Cross-sectional data were employed through a three-staged sampling technique to pick 320 arable crop farmers across the state using a well-defined questionnaire. Data analysis was carried out using descriptive statistics, healthy lifestyles index (HLI), stochastic production frontier (SPF) and propensity score matching (PSM).

First, the analysis showed that about one-third of the sampled arable crop farmers practised healthy lifestyles. Second, the average technical efficiency of arable crop production for farmers who practised a healthy lifestyle was 0.893, and the level of technical inefficiency of the farms was determined by health-related lifestyle status, number of day's illness and educational level. Third, technical efficiency was improved by 0.00431067 for farms whose farmers practised a healthy lifestyle.

Rather than seeing that technical efficiencies of farms are attributed to farm characteristics, inputs used and socioeconomic characteristics alone, the findings suggest that technical inefficiencies of arable crop farmers were also due to the kind of lifestyle practised, which was evidenced in the increased efficiency for farmers who practised healthy lifestyle.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0353

One of the major goals of sustainable development is creating employment opportunity among all. Despite its largest demographic dividends, the whole world faces challenges in employment generation among youth. The growing number of unemployed youths is one of the important problems faced by developed as well-developing countries. Youth unemployment is the situation of young people who are looking for a job but cannot find a job in the age between 15 and 24. Mismatch between education and employability resulted in high unemployment rates among the youth. A key research question is that how we can bridge the gap and equip the youth for job field. Although eminent economists, newspapers, international statistical bodies continuously put fingers towards this vulnerability, research work in this field is really scant. On this backdrop, this chapter wants to explore the intensity of youth unemployment in India; keeping in mind, India has the largest youth population in the world. Based on data sources from World Development Indicators, the chapter studies the time series since globalisation to COVID periods. This chapter also tries to search the macroeconomic variables related anyway to the youth unemployment rate. As research methodology, we use vector autoregressive (VAR) Granger causality test. Based on our results, the author has concluded that human development index in India and GDP both ways causes each other. And youth unemployment rate in India causes HDI. However, our econometric investigations can be useful to better assessment of youth unemployment in India from liberalisation to pandemic. At the end of this chapter, some final considerations and policy implications on youth labour market dynamics are analysed and discussed.

This study examined the determinants of mobile health (M-Health) application, adoption, usage and discontinuation among corporate workers diagnosed with hypertension and diabetes in Ghana.

The diffusion innovation and reasoned action theories were employed using an exploratory design. Three hundred corporate workers diagnosed with diabetes and hypertension from three health facilities for the past six months were sampled for the study using a multi-stage sampling technique and administered questionnaires. Descriptive statistics and logistic regression tools were employed in the analysis of data.

The study found a significant number of factors influencing m-health applications adoption, usage and discontinuity. These factors include nature and demand of job, perceived advantage, compatibility, complexity, triability, aesthetics and trust. Aesthetics emerged as the strongest predictive factor for the adoption, usage and discontinuity of use among diabetic and hypertensive corporate workers. With the adoption of M-Health applications, compatibility, as well as nature and demand of job, were significant predictors. With the usage of M-Health applications, complexity, triability, aesthetics and trust were significant predictors. Moreover, perceived advantage, compatibility, complexity and triability influenced significantly the choice to discontinue using M-Health applications. The study concluded that M-Health application functionalities play a valuable role in patients’ intention to adopt, use and discontinue the use of an M-Health application in Ghana.

This exploratory study offers in-depth insight into how major M-Health application features affect its adoption, usage and discontinuity, providing crucial information for future research and the improvement of chronic condition healthcare delivery.