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Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study

Li J 1 , Fong DYT 1 , Lok KYW 1 , Wong JYH 2 , Ho MM 1 , Choi EPH 1 Show all authors , Pandian V 3 , Davidson PM 4 , Duan W 5 , Tarrant M 6 , Lee JJ 1 , Lin CC 1 , Akingbade O 7 , Alabdulwahhab KM 8 , Ahmad MS 9 , Alboraie M 10 , Alzahrani MA 11 , Bilimale AS 12 , Boonpatcharanon S 13 , Byiringiro S 3 , Hasan MKC 14 , Schettini LC 15 , Corzo W 16 , De Leon JM 17 , De Leon AS 17 , Deek H 18 , Efficace F 19 , El Nayal MA 20 , El-Raey F 21 , Ensaldo-Carrasco E 22 , Escotorin P 23 , Fadodun OA 24 , Fawole IO 25 , Goh YS 26 , Irawan D 27 , Khan NE 28 , Koirala B 3 , Krishna A 29 , Kwok C 30 , Le TT 31 , Leal DG 32 , Lezana-Fernández MÁ 33 , Manirambona E 34 , Mantoani LC 35 , Meneses-González F 33 , Mohamed IE 36 , Mukeshimana M 37 , Nguyen CTM 31 , Nguyen HTT 31 , Nguyen KT 31 , Nguyen ST 31 , Nurumal MS 14 , Nzabonimana A 38 , Omer NAMA 39 , Ogungbe O 3 , Poon ACY 40 , Reséndiz-Rodriguez A 41 , Puang-Ngern B 13 , Sagun CG 17 , Shaik RA 9 , Shankar NG 42 , Sommer K 19 , Toro E 32 , Tran HTH 31 , Urgel EL 17 , Uwiringiyimana E 34 , Vanichbuncha T 13 , Youssef N 43

Affiliations 

  • 1 School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
  • 2 School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China
  • 3 School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
  • 4 Vice-Chancellor and Principal, University of Wollongong, Wollongong, Australia
  • 5 Department of Social Work, East China University of Science and Technology, Shanghai, China
  • 6 School of Nursing, The University of British Columbia, Kelowna British Columbia, Canada
  • 7 The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
  • 8 College of Medicine, Maimaah University, Al Majmaah, Saudi Arabia
  • 9 Department of Family & Community Medicine, College of Medicine, Majmaah University, Majmaah, Saudi Arabia
  • 10 Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
  • 11 Department of Urology, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
  • 12 School of Public Health, JSS Medical College, JSS AHER, Mysuru, India
  • 13 Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
  • 14 Kulliyyah of Nursing, International Islamic University, Kuantan, Malaysia
  • 15 Italian Association against Leukemia, Lymphoma and Myeloma (AIL), Rome, Italy
  • 16 Diálogos Guatemala, Guatemala, Guatemala
  • 17 School of Nursing, Centro Escolar University, Manila, Philippines
  • 18 Nursing Department, Faculty of Health Science, Beirut Arab University, Lebanon
  • 19 Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
  • 20 Department of Psychology, Beirut Arab University, Lebanon
  • 21 Department of hepatogastroenterology and infectious diseases, Damietta faculty of medicine, Al-Azher University, Egypt
  • 22 Ergonomics Research Center (ECR), University of Guadalajara, Jalisco, Mexico
  • 23 Laboratory of Applied Prosocial Research, Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Spain
  • 24 Faculty of Health Sciences, University of Lethbridge, Alberta, Canada
  • 25 Faculty of Nursing, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
  • 26 Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
  • 27 School of Nursing, Wijaya Husada Health Institute, Bogor, Indonesia
  • 28 Department of Optometry, University of Kwazulu-Natal, Durban, South Africa
  • 29 Ecove, Ghaziabad, India
  • 30 School of Nursing, Paramedicine and Health Care Science, Charles Sturt University, New South Wales, Australia
  • 31 Nam Dinh University of Nursing, Nam Dinh, Vietnam
  • 32 Pontificia Universidad Católica de Valparaíso, School of Social Work, Valparaíso, Chile
  • 33 Research Department, National Commission for Medical Arbitration, Mexico, Mexico
  • 34 College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
  • 35 Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
  • 36 Pharmacology and Toxicology Department, Faculty of Pharmacy, Benghazi University, Libya
  • 37 School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
  • 38 Center for Language Enhancement, College of Arts and Social Sciences, University of Rwanda, Huye, Rwanda
  • 39 Faculty of Medicine, Alzaiem Alazhari University, Khartoum North, Sudan
  • 40 Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao
  • 41 National Autonomous University of Mexico, Mexico
  • 42 Mental Health and Learning division, Wrexham Maelor Hospital, Wrexham, United Kingdom
  • 43 Medical-surgical Nursing Department, Faculty of Nursing, Cairo University, Egypt
J Glob Health, 2023 Oct 20;13:04125.
PMID: 37861130 DOI: 10.7189/jogh.13.04125

Abstract

BACKGROUND: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences.

METHODS: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic.

RESULTS: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction).

CONCLUSIONS: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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