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Multiple long-term conditions and their association with quality of life and healthcare utilisation among adults in India: a cross-sectional analysis of WHO SAGE Waves 2 and 3

Tue, 11 Aug 2026 00:00:00 GMT

Title: Multiple long-term conditions and their association with quality of life and healthcare utilisation among adults in India: a cross-sectional analysis of WHO SAGE Waves 2 and 3 Authors: Banstola, Amrit; Ahmed, Sayem; Shenoy, M Swathi; Gupta, Priti; Kondal, Dimple; Bhagat, Radhika; Goenka, Shifalika; Khunti, Kamlesh; Prabhakaran, Dorairaj; Mohan, Sailesh; Pokhrel, Subhash Abstract: Objectives: To examine the prevalence and disease-combination patterns of multiple long-term conditions (MLTCs) among adults in India and their associations with quality of life and healthcare utilisation. Design: Cross-sectional analysis of two nationally representative survey waves. Setting: Community-based household survey conducted across six Indian states (Assam, Karnataka, Maharashtra, Rajasthan, Uttar Pradesh and West Bengal), part of the WHO Study on global AGEing and adult health. Participants: 9116 adults aged 18 years and older in Wave 2 (2015) and 7885 adults in Wave 3 (2019–2020). Primary and secondary outcome measures: Quality of life, assessed with the 8-item WHO Quality of Life scale (WHOQoL-8, range 0–100), was the primary outcome. Outpatient visits and hospitalisations in the preceding 12 months were the secondary outcomes. Associations with MLTC were estimated using Tobit regression for quality of life and Poisson regression for healthcare utilisation, adjusting for sociodemographic, socio-economic and behavioural factors. Results: MLTC prevalence rose from 19.2% to 24.4% between waves and was highest among adults aged 60 years and older, women, urban residents and the wealthiest quintile. Hypertension–cataracts, hypertension–arthritis and hypertension–diabetes were the most prevalent dyads. Depression–chronic obstructive pulmonary disease (COPD) and depression–stroke combinations had the poorest quality of life. Physical and functional domains declined most as MLTC increased, while the financial domain remained stable. Compared with adults without chronic conditions, WHOQoL-8 scores fell in a stepwise pattern with one, two and three or more conditions (–2.6, –5.1 and –6.7 points in 2015; –3.3, –5.6 and –7.9 in 2019–2020; all p<0.001). The COPD–stroke combination had the highest outpatient use, and depression–angina the highest hospitalisation rate. Healthcare use rose incrementally with condition count (p<0.001). Conclusions: MLTC are rising in India and are associated with poorer quality of life and higher healthcare use. High-burden combinations, particularly depression–COPD, depression–stroke, COPD–stroke and depression–angina, warrant targeted interventions to improve quality of life and manage rising healthcare demands. Description: Data availability statement: Data may be obtained from a third party and are not publicly available. The SAGE India datasets underpinning this study are accessible from the International Institute for Population Sciences (IIPS) at: https://iipsindia.ac.in/content/SAGE-data. Access requires submission of a data-use request to IIPS and is subject to their terms and confidentiality conditions.; For the purposes of open access, the author has applied a Creative Commons Attribution (CC BY) Licence to any Accepted Author Manuscript version arising from this submission.

An international multi-stakeholder study on developing teacher capabilities and agency to implement and sustain physically active learning in schools

Mon, 27 Jul 2026 00:00:00 GMT

Title: An international multi-stakeholder study on developing teacher capabilities and agency to implement and sustain physically active learning in schools Authors: Daly-Smith, Andy; Mandelid, Mathias Brekke; Morris, Jade; Norris, Emma; Kallio, Jouni; Tjomsland, Hege Eikeland; Archbold, Victoria; Tammelin, Tujia; Singh, Amika; Silva, Paula; von Seelen, Jesper; Pesce, Caterina; Salmon, Jo; Bartholomew, John; Resaland, Geir Kåre Abstract: Background: Despite growing acceptance of integrating physically active learning (PAL) into schools, challenges remain regarding sustaining the results obtained in controlled experiments beyond the formal program. This study addresses this gap by exploring how in-service teacher training can be structured to support the sustained implementation of PAL.Methods: We adopted an international multi-stakeholder perspective and recruited teachers (n = 6), teacher educators (n = 6), and researchers (n = 6) to participate in online semi-structured interviews. All 18 stakeholders were recruited based on their expertise in PAL. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis.Results: We identified two overarching themes: (A) the process of gradual growth and (B) building a whole-school PAL culture. The first theme illustrates teachers’ gradual PAL growth through i) onboarding, ii) starting simple, and iii) building towards advanced practice. The second theme revolves around building a whole-school PAL culture and encompasses the process of sustaining PAL through (i) school and national policy and (ii) developing a PAL culture.Conclusions: Based on these themes, we developed a conceptual framework as a visual representation of the results structured around the phases of onboarding, starting simple, advanced practice, and building a whole-school PAL culture. The framework indicates that PAL teacher training is a comprehensive process that occurs in a synergistic relationship between teachers’ individual and collective agency to implement and sustain PAL in schools. This study and the proposed conceptual framework may help advance the implementation and sustainability of future PAL initiatives. However, the framework represents an interpretative synthesis of stakeholder perspectives and requires further empirical testing across educational contexts. Description: Data availability statement: The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Health-conscious programme for appropriate use of smart devices: abridged secondary publication

Sun, 01 Feb 2026 00:00:00 GMT

Title: Health-conscious programme for appropriate use of smart devices: abridged secondary publication Authors: Tsang, SMH; Cheing, GLY; Lam, AKC; Siu, AMH; Pang, PCK; Yip, KC; Jensen, M Abstract: Key Messages: 1. There is a high prevalence of self-reported musculoskeletal, visual, and psychosocial symptoms among adolescents with excessive use of electronic devices. 2. A moderate association was found between electronic device use and these symptoms. 3. The degree of slumped spinal posture during electronic device use was correlated with the severity and frequency of self-reported musculoskeletal symptoms. 4. Vergence facility and accommodative facility were correlated with the severity and frequency of self-reported eye symptoms and the Ocular Surface Disease Index, respectively. 5. Frequent breaks, physical activity, and focused-group programmes help reduce the negative impacts associated with excessive or problematic use of electronic devices.

Validation of the UCSD Performance-Based Skills Assessment (UPSA) for functional evaluation of people with severe mental illness in Hong Kong

Sat, 11 Jul 2026 00:00:00 GMT

Title: Validation of the UCSD Performance-Based Skills Assessment (UPSA) for functional evaluation of people with severe mental illness in Hong Kong Authors: Chen, Clement; Leung, Kelvin PY; Mok, Cycbie CM; Siu, Andrew MH Abstract: Background/hypothesis: This study aims to translate and adapt the University of California San Diego Performance-Based Skills Assessment Extended Range (UPSA-2-ER) to Chinese for assessing independent living skills of people with severe mental illness in Hong Kong. Study design: An expert panel was conducted to evaluate the translation, content validity, and cultural relevance. The UPSA-2ER (HK) was administered to 30 Hong Kong Chinese with severe mental illness (SMI) to examine the inter-rater reliability and 210 more to examine the internal consistency, structural validity and predictive validity. Sixty-six participants also completed the Chinese Functional Needs Assessment (CFNA) for concurrent validity. Study results: Good content validity was established with modifications of items to address cultural relevance. Both inter-rater reliability (ICC ranged from 0.98 to 0.99) and internal consistency (Cronbach's α = 0.97) of total score were excellent, while internal consistency of sub-domains ranged from fair to excellent (Cronbach's α ranged from 0.76 to 0.96). In Rasch analysis, raw variance explained by measures ≥40% was interpreted as good in terms of unidimensionality (Sumintono & Widhiarso, 2015), study results provided modest evidence that the UPSA-2ER(HK) has a unidimensional structure, as the variance explained by the items was 43.5% and the unexplained variance in the 1st contrast was 4.4%. Classification & regression tree analysis showed that the UPSA-2ER(HK) correctly classified 78.5% of the 210 participants into their residential status of independent living, halfway house or long stay care home. For concurrent validity, the UPSA-2ER(HK) demonstrated high correlation with the local golden standard, CFNA (r = 0.82). Conclusions: The results showed that the instrument has satisfactory psychometric properties for assessing capacity to perform community living tasks. Description: Data availability: Data will be made available on request.