Objective: Given the low levels of physical activity (PA) among U.S. college students, the use of exergaming as a supplement to traditional exercise may promote higher levels of motivation and PA. Therefore, this study’s purpose was to examine the effect of two different exergames on college students’ situational interest (SI), self-efficacy (SE), and equilibrium change (EQC) compared to traditional treadmill walking. Methods: Sixty college students (30 female; M_age = 23.6 ± 4.1 years; M_BMI = 23.9 ± 4.0 kg/m²) participated in three separate 20 min exercise sessions: (1) Xbox 360 Kinect Just Dance; (2) Xbox 360 Kinect Reflex Ridge; and (3) traditional treadmill walking at 4.0 mph. Participants’ SI, SE, and EQC were measured after each session using a series of validated surveys. Results: A mixed model analysis of covariance (ANCOVA) with repeated measures evaluated mean differences between exercise sessions for all outcomes. Significant main effects were observed between the three exercise sessions (all p < 0.01). Specifically, Just Dance and Reflex Ridge sessions yielded significantly higher SI scores than treadmill exercise, F (10, 49) = 54.61, p < 0.01, η² = 0.92. In addition, participants experienced significantly lower EQC in Reflex Ridge than in treadmill exercise, F (2, 58) = 4.26, p = 0.02, η² = 0.13. No differences were identified for SE. Conclusion: The integration of exergaming into traditional exercise routines may help to promote higher levels of SI but not SE amongst college students. RR exergaming also demonstrated low EQC as compared to traditional exercise. Experimental study designs are warranted to provide additional evidence on the efficacy of exergaming.

Objectives: Poor training of non-physician healthcare workers (especially community nurses) could hinder the successful integration of cardiovascular disease (CVD) management into HIV chronic care in primary healthcare facilities in low- and middle-income countries. To address this limitation, we included a holistic training programme with a robust module for both practice facilitators and community nurses as part of the formative stages of the managing hypertension among people living with HIV: an integrated model (MAP-IT), which is a study that is evaluating the effectiveness of practice facilitation on the integration of a task-strengthening strategy for hypertension control (TASSH) into primary healthcare centres in Akwa Ibom State of Nigeria. Methods: Between June and November 2021, 3 didactic training workshops were conducted using a training module which is based on the simplified Nigerian Hypertension Protocol for primary care and the World Health Organization (WHO) heart package. Knowledge acquired by the participants was assessed using anonymized pre- and post-training assessments in the first two workshops. Participants’ view of the training was assessed using a comprehensive course evaluation questionnaire. Results: A total of 92 community nurses and six practice facilitators were trained in the workshops on managing hypertension in persons living with HIV. Mean pre- and post-test scores improved from 11.9(3.4) to 15.9(2.9); p < 0.001 in the first workshop, and from 15.4(0.9) to 16.4 (1.4); p < 0.001 in the second workshop. The methodology used in the training, understanding of the MAP-IT study programme, and the level of engagement was highly rated by the participants with LIKERT scores of 3.2/4.0, 3.2/4.0, and 3.1/4.0 respectively. Conclusion: Our training methodology, which involved the train-the-trainer model to deliver simplified HIV and HTN care guidelines, showed improvement in the knowledge of managing hypertension in persons living with HIV and was highly rated by participants.

Objectives: To identify stakeholder perceived challenges and facilitators for implementing a clean fuel and clean stove intervention to reduce household air pollution and hypertension in Lagos, Nigeria. Design: Qualitative study guided by the Exploration and Preparation phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, using focus group discussions and in-depth semi-structured interviews with inductive and deductive thematic analysis. Setting: Peri-urban communities across the five administrative divisions of Lagos State, Nigeria. Participants: 128 stakeholders from 32 communities, including community, religious, market and youth leaders, primary healthcare staff, and household decision makers. Approximately half were female. Interventions: This was a pre-implementation needs assessment that included demonstrations of the clean stove and fuel. Primary and secondary outcome measures: Thematic domains describing barriers and enablers to adoption and implementation, mapped to EPIS inner, outer, and bridging factors. Results: Stakeholders reported barriers that included stove stacking, upfront stove cost, concerns about long-term fuel price and availability, equipment durability and maintenance, safety, mistrust of new technology, and uncertainty about stove performance for dishes requiring high heat and long cooking times. Reported facilitators included payment flexibility and subsidies, opportunities to test the stove, perceived benefits of cleaner and faster cooking with less soot, endorsement by community leaders, and interest in local retail and distribution to improve access. Conclusions: Implementation planning for clean fuel and clean stove programmes should address affordability, reliable fuel supply chains, durability and service, culturally relevant cooking needs, and trust building through community leadership. These findings inform adaptation strategies for scale-up in similar low-resource settings. Trial registration number: NCT05048147 .

South Asian immigrants in Southeast Queens County, New York City face healthcare, housing, and digital access challenges shaped by English proficiency. Despite community growth, data remains limited. This assessment examines English proficiency as a social determinant of health. A mixed-methods study was conducted across nine ZIP codes in Southeast Queens County, New York City. From August 1–October 31, 2023, the quantitative phase included a multilingual survey (English, Bengali, Hindi) that reached 395 South Asian participants, covering demographics, living conditions, food security, safety, mental health, and digital literacy. The qualitative phase (December 2023–March 2024), guided by IDEO’s Human-Centered Design, included five interviews and a focus group. Analysis revealed significant disparities between Limited English Proficiency (LEP, n = 288) and non-LEP (n = 107) individuals. LEP respondents reported more housing issues, especially pest infestations (91.1% vs. 82.4%, p = 0.042), and lower homeownership (19.1% vs. 34.6%, p = 0.031). Computer literacy was lower among LEP individuals (50.6% vs. 80.8%, p < 0.001), though internet access was high in both groups (87.0% for LEP vs. 91.4% for non-LEP, p = 0.24). Housing instability persisted, with a greater share of LEP participants renting (70.6% vs. 56.4%, p = 0.031). This assessment highlights how language proficiency shapes social determinants of health for South Asian immigrants in Southeast Queens County, New York City. LEP individuals faced more housing, food, safety, and digital literacy challenges, underscoring the need for language-accessible, culturally tailored services.

Introduction: In Africa, 75% of households are exposed to household air pollution (HAP), a key contributor to cardiovascular disease (CVD). In Nigeria, 90 million households rely on solid fuels for cooking, and 40% of adults have hypertension. Though clean fuel and clean stove (CF-CS) technologies can reduce HAP and CVD risk, their adoption in Africa remains limited. Methods and analysis: Using the Exploration, Preparation, Implementation and Sustainment framework, this cluster-randomised controlled trial evaluates the implementation and effectiveness of a community mobilisation (CM) strategy versus a self-directed condition (i.e., receipt of information on CF-CS use without CM) on adoption of CF-CS technologies and systolic blood pressure (SBP) reduction among 1248 adults from 624 households across 32 peri-urban communities in Lagos, Nigeria. The primary outcome is CF-CS adoption at 12 months; secondary outcomes are SBP reduction at 12 months and sustainability of CF-CS use at 24 months. Adoption is assessed via objective monitoring of stove usage with temperature-triggered iButton sensors. SBP is assessed in 2 adults per household using validated automated blood pressure monitor. Generalised linear mixed-effects regression models will be used to assess study outcomes, accounting for clustering at the level of the peri-urban communities (unit of randomisation) and households. To date, randomisation is completed, and a total of 1248 households have enrolled in the study. The final completion of the study is expected in June 2026. Ethics and dissemination: The study was approved by the Institutional Review Boards (IRB) of NYU Grossman School of Medicine (primary IRB of record; protocol ID: i21-00586; Version 6.0 approved on 4 June 2024), and Lagos State University Teaching Hospital (protocol ID: LREC 06/10/1621). Written consent was obtained from all participants. Findings will inform scalable and culturally appropriate strategies for reducing HAP and CVD risk in low-resource settings. Results will be disseminated through peer-reviewed publications, conference presentations and stakeholder engagements. Trial registration number: NCT05048147

Background: Implementation strategies are dynamic and multi-faceted, and may require adaptations to fit implementation contexts, especially in lower-and-middle income countries. We report the adaptations for an ongoing late-stage implementation science trial (R01HL147811) that integrates hypertension management into HIV care in Lagos, Nigeria – a country with a high dual-disease burden – through the Task Strengthening Strategy for Hypertension (TASSH) intervention and Practice Facilitation implementation strategy. Methods: FRAME (Framework for Reporting Adaptations and Modifications—Enhanced) modules were used to record adaptations to the intervention (i.e., TASSH) respectively, enhance participant recruitment and retention rates, and increase frequency of trainings. Data collection sources included (not limited to) patient records, nurses’ logs, and minutes of implementation review meetings. Data across these sources was coded retrospectively by trained research staff and triangulated during virtual meeting discussions. Once consensus was reached, data was mapped onto the relevant framework modules using Microsoft Excel. Results: We modified FRAME to include an additional component on ‘what was originally planned’ for the context of the adaptations. There were twelve adaptations identified during the implementation of the study. The adaptations characterized by using the frameworks included reordering recruitment start dates of study cohorts, providing patients incentives to attend follow-up visits, adding feeder sites to the study sites, and increasing the frequency of training to account for the high nurse turnover in the primary healthcare centers. Overall, 25% of the adaptations involved expanding the structure of the intervention and implementation strategies, and 33% involved adding new elements to the strategies. All adaptations occurred in the implementation phase of the trial. Conclusion: Based on our experiences, the characterization of the adaptations using FRAME demonstrates their combined applicability to an ongoing trial that can be tailored to fit the local context. Trial registration: ClinicalTrials.gov ( NCT04704336). Registered on 11 January 2021.