Dementia is under-diagnosed in primary care. Timely diagnosis and care management improve outcomes for patients and caregivers. This research evaluated the effectiveness of a nationwide Continuing Medical Education (CME) program to enhance dementia-related awareness, practice, knowledge and confidence of general practitioners (GPs) in Australia.Data were collected from self-report surveys by GPs who participated in an accredited CME program face-to-face or online; program evaluations from GPs; and process evaluations from workshop facilitators. CME participants completed surveys at one or more time-points  between 2015 and 2017. Paired samples t-test was used to determine difference in mean outcome scores  between time-points. Multivariable regression analyses were used to investigate associations between respondent characteristics and key variables. Qualitative feedback was analysed thematically.Mpost-pre = 0.9, p <  0.0005), practice-related items , knowledge , confidence . Significant increases were seen in all four outcomes for GPs who completed these surveys at both pre- and follow-up time-points. Male participants and those who had practised for five or more years showed greater change in knowledge and confidence. Age, years in practice, and education delivery method significantly predicted post-program knowledge and confidence. Most respondents who completed additional program evaluations (> 90%) rated the training as relevant to their practice. These participants, and facilitators who completed process evaluations, suggested adding more content addressing patient capacity and legal issues, locality-specific specialist and support services, case studies and videos to illustrate concepts.Of 1352 GPs who completed a survey at one or more time-points , mean scores increased between pre-CME and post-program for awareness (The sustainability of change in key elements relating to health professionals’ dementia awareness, knowledge and confidence indicated that dementia CME programs may contribute to improving capacity to provide timely dementia diagnosis and management in general practice. Low follow-up response rates warrant cautious interpretation of results. Dementia CME should be adopted in other contexts and updated as more research becomes available. Dementia (Major Neurocognitive Disorder) is a syndrome characterised by deterioration in memory, problem-solving and behaviour resulting in reduced functional ability in daily activities . DementiGeneral practitioners (GPs) are the customary first point of contact for people with dementia and their caregivers. They play a pivotal role in symptom recognition, assessment and referral  and are The timely diagnosis of dementia in primary care requires GPs to be able to differentiate normal ageing from dementia , 28. DifContinuing Medical Education (CME) are ongoing education and retraining programs for licensed medical professionals incorporating clinical guidelines and best research evidence to foster demonstrated changes in the performance, knowledge, skills, actions and attitudes of practicing professionals , 43. CMEThe Supporting GPs and Practice Nurses in the Timely Diagnosis of Dementia project was commissioned by Dementia Australia  . The proDementia: 14 Essentials of assessment and care planning” [Dementia: 14 Essentials of management” [In accordance with RACGP guidelines, the CME program comprised a minimum of 6 hours of thematically-linked structured educational content, including at least two-thirds interactive or experiential content (such as case studies and discussion) and three to five learning outcomes , 45. Thelanning”  and  categories  .Participants who attended face-to-face sessions completed paper-based pre- and post-program surveys. Participants who engaged with the education online began the CME with the pre-program survey and exited the CME with the post-program survey. All participants who provided an email address for follow-up received: 1) an emailed invitation to take part in the follow-up survey containing a link to the survey on SurveyMonkey; 2) an emailed reminder after 7 days; 3) an emailed reminder after 14 days.Program evaluation feedback forms required for CME point allocation were collected online and by the event organizer at GPCE events; research team members collected required forms from GPs attending small group workshops. GPs evaluated the CME program by rating the extent to which their learning needs were met  and the extent to which the program was relevant to their practice . GPs were also given the option to provide summative feedback about the program and recommendations for improving the program.All process evaluation data was collected between June and July 2017. Workshop facilitators received an emailed invitation to take part in the process evaluation. A copy of the questionnaire was attached to the emailed invitations. Facilitators were offered the choice of responding by completing and returning the questionnaire by email or by answering the questions over the phone with a research assistant. Workshop facilitators evaluated the program implementation process by answering open-ended questions regarding barriers and enablers to workshop delivery, aspects of the program format and workshop organization, and how to improve future workshop delivery. Questionnaire items are noted in Additional File Survey response rates were calculated as the number of returned questionnaires divided by the total number of individuals who enrolled in the CME program. Descriptive statistics were used to analyse participant demographic characteristics. Due to small numbers in Outer Regional and Remote and Very Remote categories, Inner and Outer Regional were combined and recoded as “Regional” and Very Remote was coded with “Remote” for analyses. Chi-squared tests were used to compare characteristics of participating GPs with characteristics of GPs in Australia generally , and to A composite index was calculated to represent participant level of awareness and current practice in managing care at each time point. Each composite index was based on a participant’s average response to survey items within each of the two categories (awareness and practice) and adjusted for missing values by dividing the total score by the total number of responses. Additionally, an overall average score was calculated for each item for awareness and for current practice. Mean scores were also calculated for knowledge and confidence, respectively, at each time point.Immediate training effects were calculated for individual items for all respondents using the average difference between pre- and post- CME program scores. Subgroup analysis was used to explore potential variability in the effects of face-to-face and online delivery methods. Paired t-tests were used to compare the mean scores of six to nine month follow-up and pre-CME program from the subset of participants who completed surveys at all three time points in order to examine longitudinal effects of the program on the GPs’ overall awareness, practice, confidence and knowledge, respectively.Pre- CME program scores were dichotomised for awareness  and practice . Logistic regression was performed controlling for participant characteristics  and program delivery method (online and face-to-face) to assess the factors significantly associated with: 1) the likelihood that GPs would endorse that they were aware, as opposed to unaware, of dementia diagnosis and management topics, and; 2) the likelihood that GPs would endorse that they applied recommended diagnosis and management actions in practice more than half the time, as opposed to less than half the time, prior to engaging in the CME program. Linear regression was performed, and the same variables were controlled in order to assess the impact of GP characteristics on knowledge and confidence at pre- and post-program.The analysis of qualitative data synthesised and summarised both GP and facilitator comments and recommendations for improving the CME program. Examples of both GP and facilitator feedback were coded thematically, and results summarised in a narrative manner.n = 2342) engaged online rather than face-to-face. Of the 44% of GPs (n = 1732) who enrolled for the full 40 CME point program, 83% completed all required activities .Of 3923 unique GPs who participated in the educational program between July 2015 and July 2017 , just over 33% (n = 1303) responded at baseline, 51.4% (n = 2017) responded at post-program, and 3.5% (n = 138) responded at follow-up  of GPs who responded at baseline were 45 years of age or younger, 51.2% (n = 670) were women, 68.6% (n = 882) practised full-time and 19.2% (n = 259) were GP registrars. Over 36% (n = 451) practised in regional and remote areas. The majority of GP respondents  attended the program face-to-face  and less than 35 years of age  compared to that reported nationally , and lower proportions of GPs working in major cities  and remote areas , compared to the national workforce.A higher proportion of GP participants were female  = 13.48, p < 0.0005, with a higher proportion of males engaging online  compared with females . Practice location was associated with choice of program delivery method x2  = 44.12, p < 0.0005. Compared to GPs practising in regional and remote areas, those practising in major cities were more likely to engage with the program online than face-to-face , knowledge , and confidence . Sensitivity analyses indicated that registrars had slightly lower scores compared to GPs pre- CME program; scores increased significantly for both registrars and GPs between pre- and post-program  of the GP respondents were 55 years of age or older, over half  had been in practice more than 20 years, and nearly 90% had engaged face-to-face. These GPs reported higher mean scores at six to nine months follow-up than reported pre- CME program in all four outcomes  = 48.58, p < 0.0005 and distinguished between respondents who were aware and those who were unaware of key dementia diagnosis and management topics prior to engaging in CME. Although the model correctly classified 78.3% of cases, it explained only 4% (Cox and Snell R-square) to 6.1% (Nagelkerke R-squared) of the variance in awareness and thus indicated that participant characteristics had little association with prior awareness of topic areas. The model for practice was significant x2  = 58.69, p < 0.0005, correctly classified 53.3% of cases and explained 5 to 6.4% of the variance in practice.Results of logistic regression of GP characteristics on pre- CME program awareness and practice are provided in Additional file OR = 1.84), than were GPs with fewer than 5 years’ experience.At the pre- CME program stage, face-to-face participants were 2.15 times more likely than online participants to report awareness of key elements in the diagnosis and management of patients with dementia, and 1.5 times more likely to report that they incorporated recommended diagnosis and management actions in practice more often than not. GPs who had practised 11 to 15 years were twice as likely to endorse both awareness of topics and use of diagnosis and management methods in usual practice than were GPs with fewer than 5 years’ experience, controlling for other factors in the model. GPs with more than 20 years’ experience were similarly more likely to endorse actions in practice  = 7.75, p < 0.0005. The total variance in confidence scores explained by the model as a whole was 8.6% (Adjusted R Square), F  = 10.45, p < 0.0005. Participants’ sex and years of practice experience contributed significantly to the model. Male participants had slightly higher self-rated pre- CME program knowledge and confidence scores compared with female participants. Having up to 5 years of practice experience was associated with lower self-rated knowledge and confidence scores than having more than 5 years’ practice experience, controlling for other variables.Results of linear regression of GP characteristics on pre- CME program knowledge and confidence scores are provided in Additional file F  = 11.02, p < 0.0005 and for confidence was 14.9%, F  = 14.50, p < 0.0005. Program delivery method, age and years of practice experience contributed significantly to the models for post-program knowledge and confidence scores. Face-to-face delivery was associated with slightly lower self-rated knowledge and confidence scores than online delivery. Compared to being less than 35 years of age and having fewer than five years practice experience (respectively), being at least 45 years of age and having between 5- and 20-years practice experience were associated with higher self-rated knowledge and confidence scores at post-program.Results of linear regression of GP characteristics on post-program knowledge and confidence scores are provided in Additional file n = 1005) returned a program evaluation survey. Most GPs (86.9%) felt that their learning needs were entirely met and that the program was entirely (91.9%) relevant to their practice. Examples of GP feedback are detailed in Additional file Over a quarter of GPs (Most GPs 6.9% feltEight workshop facilitators (53.3%) completed a process evaluation survey. Examples of facilitator responses are detailed in Additional file GPs who participated in the survey evaluation of this accredited dementia-focused CME program indicated that their awareness, use of tools and management strategies in practice, and knowledge and confidence in diagnosing and managing dementia in practice, increased following participation in the CME. The program reached approximately 11% of the nation’s GPs during the study period. Participants were generally aware of most topics covered in the CME prior to participation in the program, but some GPs were unaware of key areas such as the difference between MCI and dementia, the cumulative anticholinergic effect of medications, and legal issues involved in care and management of dementia. Results for participants who were followed across all three time-points indicated that significant improvements were maintained with little decline at six to nine months post- CME program. The declining trend in follow-up survey highlights the importance of offering continuous training and keeping participants abreast of the most up-to-date knowledge and evidence. Outcomes of this evaluation informed tailoring of the educational material and delivery methods of the CME program  as it continued to provide dementia-focused education through the triennium ending in 2019, and were a first step toward measuring impact.Online modules attracted the most professionals. Online education allowed GPs to proceed at their own pace and GPs completing modules online may have taken more time with the materials. Concurrently, results add to existing evidence that many GPs clearly remain interested in attending face-to-face training with colleagues , 48. GenSurvey respondents who engaged in the face-to-face program included GPs who attended large GPCE and / or small group workshops. Professional conferences such as GPCE attract large numbers and are more suited to delivering short educational sessions and less-intensive CME programs. However, large numbers limit individualised interaction with participants and shorter sessions may allow less time for participants to absorb and reflect on materials. Small group workshops and/or online modules provide greater scope for delivering interactive, time-intensive programs. These differences may account in part for better outcomes for GPs who completed the program online.GP characteristics had little practical association with awareness and current practice prior to the CME program and no association with their post-program outcomes. However, age and number of years in practice influenced self-reporting of knowledge and confidence. GPs with five or more years in practice reported more knowledge and confidence prior to the program than did their less experienced colleagues. GPs 45 years and older and those with between 5- and 20-years’ experience reported more knowledge and confidence after completing the CME than did their younger colleagues and those with fewer years in practice. Results are consistent with previous studies reporting that older, more experienced GPs feel more confident and knowledgeable than their younger counterparts regarding dementia-related care .Six-hundred and fifty-seven GP registrars engaged in the program. Although all GPs reported better outcomes after participating in the CME program, registrars rated their own knowledge and confidence as below average going into workshops and just above average afterwards. Registrars having had less time in practice were less likely to have accumulated dementia-related case-knowledge compared with their more experienced colleagues. Registrars also participated in the shorter, overview workshop rather than the longer, 40-point CME workshop and this may have contributed in part to observed differences in age and experience effects. However, in a similar recent evaluation of dementia education, GP registrars self-reported pre-workshop levels of dementia knowledge were comparable to those of their more experienced supervisors .Few GPs chose to continue research participation at six to nine months' follow-up. Participants were not asked about their motivation for participating. Age and practice experience appeared to influence longitudinal participation rates, as did CME program engagement method. Greater practice experience and possibly greater experience in dementia-related care may have made some GPs more receptive to the longer research commitment. GPs who interacted with colleagues face-to-face in group workshops may have been more willing to contribute to the CME research than were GPs who completed CME independently online.Participant and facilitator feedback suggested that more tailored information on local services was desired. GPs emphasised the importance of involving local health care professionals who could provide local knowledge, as well as including caregivers of people living with dementia. As described previously , 53, CMEWorkshop facilitators noted geographical distance and small numbers of practising health professionals as barriers to conducting workshops in some regional and remote areas. Facilitators noted that some attendees in regional and remote venues had their first face-to-face professional contact with a geriatrician or specialist at the workshop. Australia’s population is concentrated primarily in major metropolitan areas along the country’s east and south-east coast and the south-west coast . Lack ofParticipants and facilitators flagged the need for more education addressing assessment of client capacity, legal issues and guidelines related to dementia and end of life issues, pharmacological management, and social impact for the client and family. These ongoing needs for training, education and specific guidelines to clinicians are widely acknowledged in the medical and legal community , 61. PhaThis study has several strengths. It is the first study to investigate the effectiveness of a nation-wide accredited dementia-focused CME program in Australia designed to enhance GP awareness, practice, knowledge and confidence in delivering timely diagnosis and management of dementia in general practice. Delivery and evaluation of the education program involved collaboration with multiple stakeholders including a national dementia advocacy organisation, a government-funded consortium of dementia education providers, private industry providers of medical education, and national medical professional accreditation organisations. The evaluation attracted a substantial, heterogeneous sample of GPs including a significant proportion of GPs practicing in regional areas.The research ascertained GP self-appraisals of awareness, practice, knowledge and confidence regarding dementia-related topics. It synthesised data from self-evaluations, program evaluations, and process evaluations to identify current gaps in GP awareness, to track program effectiveness in improving self-reported capacity, and to identify areas for improving future training.Limitations of this study include absence of a control group, use of a purpose-designed survey, participant self-selection, low survey response rates relative to the number of program participants, and use of self-report data. While participant self-selection could have introduced bias, the sample represented over 10% of Australian GPs. The study employed a one-group pretest-posttest design. It is possible that completing surveys prior to engaging in the education could have raised participants’ awareness of specific topics and therefore altered how they approached the education as well as their responses on the posttest.Scales exist to measure GP dementia knowledge and awareness , 63, 64.The CME evaluation included self-report of current practice and intended practice, but it did not measure planned practice change –67 usingLow response rates are not uncommon in survey research with GPs and study response rates were similar to those reported elsewhere , 70, 71.Survey participants self-selected and may have been more motivated than other GPs. Survey participants were generally younger than the national GP profile; GPs over 45 were under-represented. Follow-up response rates were low and comparison of GPs who submitted surveys at all three time-points with GPs who submitted surveys only at pre-, or at pre- and post- CME program indicated that longitudinal results primarily represented outcomes for face-to-face workshop attendees with greater practice experience. Longitudinal outcomes for online participants and GPs with less time in practice and registrars are not well represented. However, whilst acknowledging that there were differences between GPs who completed surveys at all three time-points and the majority who did not, results for completers and others were similar.Although GP self-report provides insights into how GPs perceive their own abilities and educational needs, physician self-assessment is less accurate compared to external observations of competence . FurtherDementia-focused education is useful and relevant for GPs of varied experience levels. Most GPs had general awareness of dementia topics which improved further following education. Registrars had less knowledge and confidence in dementia-related assessment and management and may benefit from greater exposure to dementia education.The CME program met GPs’ educational needs in both face-to-face and online formats. Time-poor GPs may prefer less background theory and more applied, practical information delivered in condensed formats such as reference sheets, webpages and video clips. The development of online learning modules provided a readily accessible free resource for GP self-directed CME training. The modules are now offered as an ongoing dementia training resource . Online Meeting perceived educational needs and increases in self-rated indices of key outcomes may or may not translate to measurable improvements in practice. In order to address parameters influencing GP intention and implementation of practice change consistent with course objectives, future CME development and evaluation should involve a theory-based practice change approach with data triangulation to validate and enhance interpretation. In order to determine the sustained effectiveness of the CME program and identify emerging GP educational needs, future research should examine diagnosis rates and accuracy and adherence to clinical guidelines , gauge cGPs have a pivotal role in dementia recognition, assessment and referral, and are well-situated to provide continuing care co-ordination and support for patients. The scale of GP engagement showed that dementia CME programs, delivered both face-to-face and online, are relevant to GPs. The sustainability of self-reported change in key elements relating to dementia awareness, knowledge and confidence by health professionals taking part in this program showed that dementia CME programs may contribute to improving capacity to provide timely dementia diagnosis and management in general practice. Dementia-focused CME programs should be continued and updated as more research becomes available. Future research should measure outcomes in practice.Additional file 1. Figure S1. Flowchart of survey response rates in a convenience sample of GPs engaged in dementia-focused CME.Additional file 2. Table S1. Comparison of GP characteristics with national average.Additional file 3. Table S2. Use of CME program delivery method by age and practice location .Additional file 4. Table S3. Mean score change for subset of GPs who submitted surveys at each of two time-points.Additional file 5. Table S4. Logistic regression of General Practitioner characteristics on pre-CME program awareness and practice.Additional file 6. Table S5. Linear regression of General Practitioner characteristics on pre-CME program knowledge and confidence.Additional file 7. Table S6. Linear regression of General Practitioner characteristics on post-CME program knowledge and confidence.Additional file 8. Table S7. Exemplars of General Practitioner suggestions for improving future dementia-focused Continuing Medical Education programs.Additional file 9. Table S8. Continuing Medical Education workshop facilitators’ responses to process evaluation survey questions.Additional file 10. Completed SURGE (SUrvey Reporting GuidelinE) checklist.


The health behaviors of young adults lag behind those of other age groups, and active health management is needed to improve health behaviors and prevent chronic diseases. In addition, developing good lifestyle habits earlier in life could reduce the risk of metabolic syndrome (MetS) later on.The aim of this study is to investigate the effects of the e-Motivate4Change program, for which health apps and wearable devices were selected based on user needs. The program was developed for the prevention and management of MetS in young adults.This experimental study used a nonequivalent control group. In total, 59 students from 2 universities in Daegu, Korea participated in the study . Data were collected over 4 months, from June 1 to September 30, 2018. The experimental group received a 12-week e-Motivate4Change program intervention, and the control group received MetS education and booklets without the e-Motivate4Change program intervention.t=3.86; P<.001) and self-efficacy  than did the control group. Concerning BMI, there were significant effects by group  and for the group × time interaction . Concerning cholesterol, there were significant main effects for group  and time .After the program, the experimental group had significantly higher scores for health-related lifestyle (The e-Motivate4Change program effectively improved participants’ health-related lifestyle scores and self-efficacy, and significantly reduced their BMI and cholesterol levels. The program can be used to identify and prevent MetS among young adults. Chronic disease is a significant factor of disability as well as a major cause of death for nearly 60% of the global population . MetabolThe World Health Organization (WHO) reported that the incidence rate of chronic disease is not only related to social and economic factors but also to individuals’ eating habits and physical activities such as drinking and smoking . SedentaThe incidence rate of MetS is notably high among children and adolescents in the United States . FurtherSeveral studies have analyzed the relationship between the incidence rate of MetS and its risk factors such as smoking, drinking, physical activity, depression, and environmental and demographic factors . MoreovePrevious studies on MetS intervention programs examined ubiquitous health  nutrition education that focused on increasing fruit and vegetable intake  and commWith the rapid development of information and smart technology, the demand for mobile health , which uses mobile technology such as health apps to prevent disease and improve health, has increased ,25. CurrWearable devices are a key subfield of mHealth. Wearable devices can constantly and easily monitor one’s physical activity, and they can provide tailored feedback through synchronized apps . AccordiHowever, there are some problems with mHealth. First, there is a lack of entertaining aspects that can motivate sustained use. Second, the system that directly delivers the information and professional health care guidelines is incomplete . Other rSelf-efficacy is closely related to how well a person can control and perform specific activities under certain situations. Based on previous studies, health-related self-efficacy is a key motivator for one to continue physical activity;  thus, itTherefore, this study aims to improve on existing intervention programs by actively using wearable devices and mobile apps and increasing entertaining factors and motivation. To support sustained health activity, we developed a tailored program based on the specific needs of young adults to increase their self-efficacy and general health-related QOL.The specific goal of our study is to develop a program (e-Motivate4Change) using health apps and wearable devices selected based on user's needs, and analyze its impact on MetS prevention among young people. In addition, we sought to determine the program’s effect on participants’ health-related lifestyle, self-efficacy, and QOL.This experimental study used a nonequivalent control group and pre- and post-test design. The experimental group completed a presurvey, the e-Motivate4Change program intervention, and three postsurveys. The control group received a pamphlet on MetS and completed three postsurveys. Data were collected over 4 months, from June 1 to September 30, 2018.The questionnaire consisted of general characteristics, healthy lifestyle promotion, self-efficacy, and QOL. To collect physiological indicators, we measured participants’ BMI, blood pressure, blood sugar, and cholesterol level. The general flow of the study is shown in Nursing students from Daegu University and Keimyung University who volunteered to participate and met the criteria were recruited. G*power (Version 3.1.7) was used to calculate the appropriate sample size with an effect size of 0.50, a significance level of .05, and a qualification level of 80%. The program indicated that at least 27 participants were required.Anticipating a dropout rate of 20%, we recruited 60 participants (30 for each group) . During Participants were allocated to either the experimental or control group and the questionnaires were distributed. To measure healthy lifestyle promotion, we used Kang’s modified version  of Walke2 are “normal,” while a BMI from 25.0 to 29.9 kg/m2 indicates “slightly overweight,” and a BMI over 30.0 kg/m2 indicates “obese” [After completion, participants’ height, weight, body composition, blood pressure, blood sugar level, and cholesterol level were measured . BMI was “obese” .Participants were not provided with any written results of their body measurements since participants could freely check their status through the program. Additionally, the case report form, which is the electronic document of individuals’ information as stated in the research design, provided the necessary data to the team. All participants were thoroughly educated on how to complete the case report form.The e-Motivate4Change program was implemented for 10 minutes with the experimental group to increase their knowledge about MetS and promote health-related activities. Participants could also ask questions. In addition, 5 minutes were allowed for questions and answers. The control group was not provided with the e-Motivate4Change program; they only received a pamphlet. After the e-Motivate4Change program, the experimental group were asked to complete the questionnaire on healthy lifestyle promotion, QOL, and self-efficacy. We then measured their BMI, blood sugar level, cholesterol, and blood pressure again. Participants also completed an online satisfaction survey using a separate site on the e-Motivate4Change app. The control group completed the same surveys and health measurements.When participants entered their personal information, the e-Motivate4Change program generated and delivered tailored information and feedback. Such an interaction aimed to increase users’ interest and self-efficacy. The e-Motivate4Change program framework is shown in To develop an effective intervention program for young adults with a risk of MetS, we surveyed and analyzed users’ demands, which could be used as foundational data for the development of further prevention and intervention programs that use mobile health. According to the needs analysis of professional program developers N=40), nearly half had previously used health apps. The need for tailored prescription for individual users was rated the highest. Furthermore, 13.9% of the sample had used smart health bands. The most requested functions included a record of calorie consumption (88.9%), followed by a pedometer function, analysis of sleeping patterns, and a waterproof device [, nearly We required a mobile app for data collection, a back-end server for storage, a server for real-time data analysis, a prediction server, and a message push server for a long-run comprehensive platform. To make exercise an entertaining factor, gamification was necessary. Therefore, we motivated users through the most foundational flow of gamification: mission, point, rewards . After uThe e-Motivate4Change program was developed based on three modules . The firOn the first page, participants could see a brief description about MetS, as well as a description of the program, types of MetS, and its risk factors. We also provided participants with links to websites (including YouTube) that provided information about effective dance moves for preventing MetS. Users could self-diagnosis their health status at the login page and check their risk of MetS as well as their body image. Risks of MetS were categorized into diet, disease, and lifestyle factors. Once the users answered a quick survey, the program provided scores on diet, disease, and lifestyle, indicating users’ risk of MetS as “fair,” “warning,” or “danger.”Users were also asked to enter their basic health status, which provided an appropriate avatar with the same body image as the user (based on height and weight). There were five types of male and female avatars based on users’ risk of MetS, and the avatar was designed to change as users’ health status changed. Moreover, users could choose their preferred health management method . The program reflected the needs of the users and recommended customized apps and wearable devices. The recommended algorithm is shown in Concerning users’ health management, we sought the advice of two professional clinical nurses who worked at the national health care company, “Meta Health.” We regularly examined users’ health information such as weight, obesity rate, body fat, and fasting cholesterol to provide individualized health prescriptions, which included detailed descriptions regarding physical activity, diet, and sleep management.The community category consisted of a social networking service, questions, and games and quizzes for entertaining factors. Health rankings and a free bulletin board represented the community function. First, users could view their real-time health ranking information, which was determined by points (“mileage”) gained from active participation in the program, such as writing on the bulletin or participating in a quiz. Users received mileage for getting the correct answer on a health quiz as well as writing and replying on the bulletin. To encourage participation and motivate the users, the users could check their real-time mileage rankings as well as their rewards. The program also included a “real-life alarm service” so that users could look at their avatars as their risk of MetS changed. Group messaging through a social network was also provided so that the participants could actively engage in information sharing about their health status. Lastly, we included a user preference survey so that we could receive feedback on their experience with the program at the end of the study.t tests to determine if there were original differences in the dependent variable before the study. Subsequently, we used independent t tests to identify the effects of the program on participants’ healthy lifestyle promotion, self-efficacy, and QOL. A repeated-measures analysis of variance was conducted for participants’ physiological measurements .All data collected through the study were analyzed using SPSS Statistics . To compare the general characteristics between groups, we used numbers, percentages, means, and standard deviations. We conducted chi-squared tests and Fisher exact tests to analyze the differences between groups, and we used This study was approved by the heads of two universities in D city and by the Institutional Review Board of Keimyung University (number 40525-201704-HR-020-02). Participants were informed about the research purpose and methods, as well as their rights, including the right to cease participation at any point without penalty. All questionnaires were completed anonymously, and participants were told that the results would not be used for anything other than research purposes. Participation was voluntary, and all respondents provided written informed consent.In total, 59 students  participated in the study . Everyone agreed that lifestyle habits matter for the prevention of MetS. Further, 54.2% (26/48) answered that MetS was “a disease related to obesity and high cholesterol,” 75% (36/48) answered that MetS causes “adult disease,” 25% (12/48) answered that MetS results in “decreased physical strength and abnormal symptoms,” and 52.1% (25/48) answered that exercise matters the most for preventing MetS, followed by a better diet . No significant differences were found in the homogeneity test conducted between the experimental and control groups regarding general characteristics; thus, the two groups were homogeneous.We compared healthy lifestyle promotion, self-efficacy, and QOL between the two groups . After tt=3.86; P<.001) and self-efficacy  than the control group. With regard to BMI, there was a significant effect by group  and group × time interaction . Regarding cholesterol, significant main effects for group  and time  were confirmed.To the best of our knowledge, this study was the first of its kind in Korea. This study was conducted to investigate the effectiveness of the e-Motivate4Change program using mobile apps and wearable devices developed to prevent and manage MetS in young adults. In total, 59 people from 2 universities in Korea participated. . The experimental group received a 12-week e-Motivate4Change program intervention, and the control group received MetS training and brochures without the e-Motivate4Change intervention. After the intervention, the experimental group scored significantly higher for health-related lifestyle  and feedback based on users’ input. The program also used big data technology with gamification functions to entertain users, ultimately promoting a healthy lifestyle and educating users about MetS.Generally, MetS can be prevented through changing diet habits and lifestyle. However, it can be challenging to maintain regular physical activities and good diet habits at an individual level. Thus, by recommending appropriate mobile apps and wearable devices and encouraging their use, this study made it possible for the users to engage in sustained health management. The findings of this study align with those from previous studies that revealed the significance of health trackers and smart apps that are free of time and space limitations for a sustained increase in physical activities ,48. PrevTo find a solution, we developed a needs-based customized recommendation system. Some of the most important features of this program can be summarized as follows. First, the program provides individualized health management prescriptions for the prevention of MetS. Based on the medical paradigm shift from treatment to prevention and management owing to an increasing risk of chronic disease, effective prevention is largely changing the clinical health sectors, as is the fourth industrial revolution . Thus, tClinical nurses play a critical role in enhancing health; therefore, more effort is needed to expand the role of nurses and support their competency . ClinicaSecond, previously one-sided services may not include gamification and entertainment factors. Such improvement provides individualized services for the users, maintaining their high level of interest and their motivation, encouraging them to keep using the program. For sustained management of chronic diseases, including MetS, more user-centered content is necessary.The personalized service recommendation system proposed in this study provides appropriate dietary and physical activity recommendations to improve youth health to prevent MetS. The ranking system included in the program provides entertainment and motivation to encourage continued use of the program. Moreover, this study can be regarded as different from previous studies as the participants were aged <30 years, whereas the typical age range of MetS study participants is 40 to 60 years. However, this study had limitations. We used a portable body fat measurement device that may not be able to provide accurate and detailed data. At the same time, it was not possible to monitor the type, intensity, or length of physical activity. Subsequent studies should aim to achieve this. In addition, future studies could aim to recruit a participant group with a wider age range than this study. For example, future health intervention programs could include young working women and working mothers.Despite its limitations, this study is meaningful in that we tried to increase accessibility and usability through smartphone apps while also bringing about changes in the perceptions and health behaviors of young adults by providing individualized recommendations from professional clinical nurses . MoreoveIn conclusion, the e-Motivate4Change program was associated with increased physical activity, decreased BMI, lower cholesterol, and increased self-efficacy among experimental group participants, thus effectively promoting a health-related lifestyle. Moreover, by providing programs to prevent and manage MetS, the program informed further studies. Therefore, this study provides foundational data to design further preventive strategies for relevant chronic disorders .


It can be done by moderate hypofractionation (using 2.4 – 3.4 Gy) or by ultra-hypofractionation (at least 5 Gy per fraction)   - 3 .This phase 3 non-inferiority randomized trial is the first to report on the efficacy and side-effects on ultra-fractionation compared with conventional and has the PSA relapse and clinical failure as primary endpoint. The most relevant secondary endpoints were the overall survival and prostate cancer-specific survival and the median follow-up time was 5yr.The ultra-hypofractionation was non-inferior to the conventional fractionation (HR 1.002) and no significant differences were found in terms of relevant urinary or gastrointestinal toxicity.


Satellite thermal infrared remote sensing has received worldwide attention in the exploration for earthquake precursors; however, this method faces great controversy. Obtaining repeatable phenomena related to earthquakes is helpful to reduce this controversy. In this paper, a total of 15 or 17 years of Moderate-resolution Imaging Spectroradiometer (MODIS)/Aqua and MODIS/Terra satellite remote sensing land surface temperature (LST) products is selected to analyze the temperature changes before and after the Mw 7.9 earthquake in Nepal on 25 April 2015 and to explore possible thermal information associated with this earthquake. Major findings are given as follows: (1) from the time course, the temperature slowly cooled before the earthquake, reached a minimum at the time of the earthquake, and returned to normal after the earthquake. Since these changes were initiated before the earthquake, they may even have been precursors to the Nepal earthquake. (2) From the space distribution, the cooling areas correspond to the seismogenic structure during the earthquake. These cooling areas are distributed along the Himalayas and are approximately 1300 km long. The widths of the East and West sides are slightly different, with an average temperature decrease of 5.6 °C. For these cooling areas, the Western section is approximately 90 km wide and 500 km long; the East side is approximately 190 km wide and 800 km long. The Western side of the cooling strips appeared before the earthquake. In short, these kinds of spatial and temporal changes are tectonically related to the earthquake and may have been caused by the tectonic activity associated with the Nepal earthquake. This process began before the earthquake and therefore might even be potentially premonitory information associated with the Nepal earthquake.  For a period of time in the past, it had been strongly claimed by some researchers that earthquakes are unpredictable catastrophes, based on the pervasive hypothesis that the Earth’s crust is in a state of perpetual self-organized criticality in which any small earthquake may cascade into a large event ,2. The vAmong many methods for exploring the premonitory signals before an earthquake, satellite thermal infrared remote sensing has received worldwide attention in the exploration of earthquake precursors ,6,7. ManA strong earthquake shook Nepal on 25 April 2015, with a moment magnitude of Mw 7.9 and an initial rupture depth of approximately 12–15 km . The epiSince the Eocene, the Indian Plate and the Eurasian Plate have collided along a plate boundary of approximately 2500 km to form the Himalayan orogenic belt. The cumulative crustal shortening is approximately 2000–3000 km . The colOn 25 April 2015, the Mw 7.9 earthquake in Nepal occurred in the Southern foothills of the Himalayas. The epicenter of the mainshock was at 84.708 °E, 28.147 °N, and the initial rupture depth was approximately 12–15 km [According to the seismic wave inversion results , the cosainshock . These vainshock . Considering that the main fault zones in the vicinity of the epicenter a are neaIn addition, the range of the study area has an impact on the regional average value, which influences the magnitude of the anomalous changes. The larger the area is, the smaller the amplitude of the anomaly; the smaller the area is, the larger the amplitude of the anomaly. However, the selection of the size of the study area should not affect the changing trend of abnormality. In addition, if this abnormality actually exists, the same results should be obtained from different satellite data. In this paper, two completely independent observations of satellite data are used for comparative studies to verify the reliability of the thermal anomaly information.The information received by the satellites is mainly surface thermal radiation that has been modified by the atmosphere. There are many uncertainties in the direct use of satellite imagery to analyze crustal activity. Atmospheric correction is one of the basic tasks. Land surface temperature, which contributes to surface thermal radiation, can be obtained from satellite remote sensing thermal infrared data after processing, including the atmospheric correction. The data used in this paper are well-known international LST products ,40,41. TThe LST products selected in this paper are data from the V5 version of the MODIS/Terra and MODIS/Aqua satellites covering March 2000 or July 2002 to February 2016, which are obtained according to the day/night surface temperature inversion algorithm . These products have a spatial resolution of 0.05 degrees, a time resolution of 8 days, and an accuracy of 1.0 K .The change in LST is mainly driven by periodic solar radiation, which provides a periodic heat flux. For the Earth, the Sun is a stable periodic heat source, mainly causing daily and annual changes. The solar-synchronous polar-orbiting satellites, such as Terra and Aqua, pass over the same place only twice in one day, and the daily cycle changes are not observed. In simple terms, there are the following terms:Among these terms, The annual variation residual In fact, the annual variation residual Among these terms, Now, Equation (3) can be written as:In other words, obtaining thermal information related to crustal activity (such as earthquakes) is possible only by extracting the local temperature From the spatial scale, there are obvious differences in the influence of atmospheric circulation and local factors on LST: the spatial scale of the atmospheric circulation is relatively larger, and the spatial scales of local factors are relatively smaller, especially the linear characteristics of the fault zone, which has obvious one-dimensional features. Thus, Equation (3) can be solved by a two-dimensional spatial analysis method, such as wavelet analysis. Then, Data processing is roughly divided into two categories: time-based and space-based processes. First, for each location The basic data processing flow is briefly described as follows:(1) Determine (2) Obtain t theory  is used obtained .(3) Calculate (4) Obtain t method  is used To avoid the border effect in the spatial decomposition, the spatial scales involved in the above four steps of data processing are larger than those in (5) Calculate the variations in thermal information with time, based on dy areas , the spaAccording to the above procedure, the LST data from the MODIS/Terra and MODIS/Aqua satellites are processed separately. Here, the MODIS/Aqua results are taken as an example for analysis. The MODIS/Terra results are given in the discussion section. In addition, considering that yzed see . Here, w(A) Analysis of standard deviationAs shown in (B) Analyses of moving averageFurther, as shown in After smoothing, the temperature fluctuation is between –4.6 and 2.02 °C; the standard deviation is significantly reduced to between 0.37 and 0.95 °C. Similarly, the maximum standard deviation of the five areas is 0.95 °C, which is taken as the reference value, denoted as SRefStd. The lines in In short, from the time process, there was significant cooling before the earthquake, and the temperature reached the lowest value during the earthquake and returned to normal after the earthquake. The variation range was more than twice the SRefStd, and the change in area 4 reached −4.60 °C, even more than 4 times the SRefStd. That is, in study areas 3 and 4, a change in temperature more than the normal background occurred before the earthquake.(C) Frequency distributionAccording to the previous analysis, the abnormal change in area 4 is the most obvious b4, while pattern a,b; (ii)ribution c. That iIn comparing the spatial distributions of local temperature occurred a. That iFurther, there is still another important phenomenon: from the perspective of seismic location, the epicenter of the Nepal earthquake is approximately 40 kilometers away from the cooling strip b. In facIn summary, a significant cooling zone is found in the local temperature field As shown in Although both S1 and S2 are cooling events, there is a significant difference in duration from the normal background to the minimum point. The duration of S1 lies within the range of the duration of weather events. The magnitude of S1 is more than twice the standard deviation b4; howevAs for S2, the temperature decrease lasted for nearly a year, and can hardly be interpreted as an event associated with meteorological changes. Particularly, the temperature reached a minimum value when the earthquake occurred and quickly increased back to normal background after the earthquake. This trend of change largely coincided with the occurrence of the earthquake, which implies that the change was related to the earthquake.The results from the MODIS/Aqua satellite are given above. For comparative analysis, we also calculated the LST data from the MODIS/Terra satellite. The calculation process is consistent with that for the Aqua satellite, and the results are given in Among the above-mentioned results for the Aqua satellite, study area 4 is located in the main cooling zone, and In summary, for both the temporal process before and after the earthquake and the spatial distribution, the results obtained from the Terra satellite are basically consistent with those from the Aqua satellite. The data from different satellites yield the same results, which indicate that the cooling phenomenon is independent of satellites. In other words, the phenomenon is repeatable and reliable.There are several mechanisms that cause thermal infrared anomalies , mainly The cooling phenomenon found in this paper was also found in another thrusting-type earthquake, namely the Wenchuan Mw7.9 earthquake, which occurred in Longmenshan thrust faults located at the Eastern boundary of the Qinghai-Tibet Plateau . AdditioAccording to theoretical and experimental studies, temperature has a sensitive response to stress changes, and the temperature decreases when the extensional stress enhances ,49,50,51Since the physical model is insufficient, if certain information from the process of thermal information change can be found, such information can be helpful to further understand the phenomenon. The following assumption seems to be plausible: for an earthquake-related signal, if there is an abnormality before the earthquake, the peak should be reached at the time of occurrence of this earthquake and should weaken after the earthquake. The factors that influence LST are extremely complicated; in particular, meteorological changes occur rapidly. Thermal information related to earthquakes might be overwhelmed by complex meteorological effects. In general, the coseismic response should be a relatively certain piece of information that may be used as a basis for determining whether other information is related to an earthquake.Through the above analysis, during the Nepal earthquake, a cooling strip corresponding to the seismogenic structure was found. In particular, from the temporal perspective, the temperature slowly decreased before the earthquake, reached a minimum at the time of occurrence of the earthquake, and returned to a normal level after the earthquake. This sequence indicates that this spatial and temporal change is closely related to the earthquake and may have been caused by the tectonic activity associated with the Nepal earthquake. In addition, as mentioned above, the variation range of this signal was more than twice the maximum standard deviation among study areas . MeanwhiIn this paper, a total of 15 or 17 years of MODIS/Aqua and MODIS/Terra satellite remote sensing LST products from 2002 or 2000 to 2016 was selected to analyze the temperature change before and after the Mw 7.9 earthquake in Nepal on 25 April 2015 and to explore possible thermal information related to earthquakes. A set of “physical” methods was used to analyze the effects of non-seismic factors such as solar radiation and atmospheric circulation. The results from the two satellites are listed below:(1) From the time course, there was significant cooling before the earthquake in study areas 3 and 4, which reached the lowest values during the earthquake and returned to normal after the earthquake. The variation range was more than twice the maximum standard deviation among study areas, and even more than 4 times the maximum standard deviation among study areas. That is, in study areas 3 and 4, there occurred changes in temperature greater than normal backgrounds before the earthquake. This cooling peaked at the time of the earthquake and returned to normal after the earthquake. This sequence indicates that changes closely related to the earthquake over time may have been due to tectonic activity associated with the Nepal earthquake. Considering that these changes occurred before the earthquake, they may even have been precursors to the Nepal earthquake.(2) From the spatial distribution, there were cooling strips corresponding to the seismogenic structure during the earthquake. These coseismic cooling strips were distributed along the Himalayas and were approximately 1300 km long. The widths of the East and West sides were slightly different, with an average temperature decrease of 5.6 °C. The Western section (AB) was approximately 90 km wide and approximately 500 km long; the East side (BC) was approximately 190 km wide and 800 km long. The Western side of the cooling strips appeared before the earthquake.(3) From the relationship between the stress change and the temperature response, if possible, the above temperature change process might indicate that there was a progression in which the crustal stress gradually decreased before the earthquake, which is consistent with the coseismic stress drop of this thrust-type earthquake.


National Key R&D Program of China is 2018YFF0300603. The correct number for Training Program for Young Top Talents in Beijing-affiliated Universities is CIT&TCD201504085. The correct number for National Natural Science Foundation of China is 31800935.There is an error in the Funding statement. The correct number for National Key R&D Program of China, Training Program for Young Top Talents in Beijing-affiliated Universities, and National Natural Science Foundation of China. The corrected funding statement appears below.In addition, there is an error in the Funding statement. The correct Names for the Funder are The study described in this report was funded by National Key R&D Program of China (2018YFF0300603), Training Program for Young Top Talents in Beijing-affiliated Universities (CIT&TCD201504085), and National Natural Science Foundation of China (31800935).The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


N = 130; experimental group = 69; control group = 61). The Qhubekela Phambili program, which is based on the JOBS program, was adapted for the South African context and was implemented over six 4-h sessions. Data collection took place pre- and post-intervention. One-way repeated measures multivariate analysis of variance was used to analyze the data. Those who had undergone the intervention showed statistically significantly higher levels of job-search self-efficacy and self-esteem. This study makes a novel contribution to the literature on the JOBS program, particularly regarding developing countries. This study showed that in a context characterized by poverty and a lack of support for the unemployed, the program also delivered promising results. It confirms previous findings that the JOBS program is suitable in a variety of labor market and economic conditions.No validated intervention that specifically addresses the psychosocial needs of unemployed people exists in the South African context. This study intends to evaluate an evidence-based job-search program, called the JOBS intervention, that is aimed at the self-efficacy, amotivation, and self-esteem related to participants searching for jobs. A quasi-experimental research design was used. Convenient samples were taken of unemployed individuals from two low-income communities ( Unemployment has various adverse consequences for people, such as decreased self-esteem, a loss of personal control, and patterns of reduced (or no) job-search efforts, when unemployed for prolonged periods . ConsideLabor market interventions generally focus on job creation, subsidized employment opportunities, and providing the unemployed with resources and services, such as vocational training and employment services . While tPreviously conducted research agrees on the fact that unemployment should be seen within a social, more humane context and not solely as an economic burden . The latEven though South Africa has one of the highest unemployment rates in the world  programsIn general, the aim of JOBS program is to prevent deterioration of mental health and promotion of (re)employment . These iGuiding behavior. Facilitators have the responsibility to demonstrate effective and positive behavior to participants. They provide participants with specific positive feedback and steer them away from any ineffective or negative actions or feedback.Social support. Fragile participants are put at ease by creating a supportive environment that encourages unconditional acceptance by facilitators and other participants , as opposed to didactic passive methods . At the same time, two control groups were asked to complete the research questionnaire. The intervention program was executed over 2 weeks and included four experimental groups and four control groups. Both groups (intervention and control) were asked to complete a pre-test survey on the first day of the program and a post-test survey on the last day of the program . The attendance and dropout of participants are reported in The characteristics of the participants are displayed in A questionnaire to determine the biographical characteristics of the participants was used. Characteristics such as gender, age, race, level of education, and duration of unemployment were asked in this questionnaire.The job-search self-efficacy measure was developed in earlier investigations of the JOBS program . It consThe self-regulation questionnaire job-searching scale  was usedThe Rosenberg self-esteem scale  was utilParticipants’ experience and perception of the program were measured to indicate the intervention’s integrity and strength. The measure consisted of six multi-item indices, rated on a five-point scale. The following aspects of the intervention were included: Trainer support was measured with five items and group support with five items. The facilitators and other group participants were rated on their warmth, expertise, and helpfulness . Both active learning and job-search skills were answered on a frequency scale that varied from 1 = not at all to 5 = a great deal and were measured with five items. Example items are “During the workshop, to what extent do you feel that you could share your experiences?” (active learning) and “During the workshop, to what extent do you feel that the trainers and other group members helped you to identify possible job opportunities?” (job-search skills). An example item of inoculation against setbacks is “Do you anticipate difficulties and setbacks during your job-search?” which was answered from 1 = very few to 5 = very much and measured with three items. Learning experience ranged from 1  to 5 (improved to a very great extent). It was measured with seven items . The reliability of these scales ranged from 0.66 to 0.91.SPSS version 25.0 was used to analyze the data . The valn = 61) were also invited to undergo the training to ensure that all participants benefit equally. This training took place 1 week after the experimental groups had undergone their training.Ethical clearance was obtained from the Humanities and Health Research Ethics Committee . Based on these ethical considerations, much attention and effort were paid to ensure a program that is as accessible and resourceful as possible for the participants. The program was presented at a venue at the university. Participants were transported by bus from townships to the university and back. The Flemish Interuniversity Board, the funding agency for the project, paid the costs of the transport. The venue provided for a conducive atmosphere that promotes capacity building. Furthermore, participants received food parcels on each day of the workshop, a gift voucher, and an attendance certificate. An Unemployment Research Advisory Board (URAB) was established to advise the researchers on the development and implementation of the program in the two townships. Lastly, participants from the control groups (n = 130), at baseline, differed from participants who randomly dropped out of the program (n = 17). A significant difference between the level of amotivation of the two conditions and the dropout group was found . Those in the condition groups scored lower levels of amotivation , compared to those who dropped out . There were no significant differences between conditions for gender , race , education , or duration of unemployment . Participants who dropped out of the program were excluded from further the analyses due to the lack of data at Time 1.To ensure acceptable validity and reliability of the program, previous JOBS studies used two types of measures, namely testing the integrity of randomization, and the strength of the program . The firF = 0.11; p < 0.74; partial η2 < 0.01], age , race , education , or, duration of unemployment . Given the absence of significant a priori differences between the two conditions there is no need to control for any variables at baseline (Time 0), when testing the effectiveness of the intervention.To test for random sampling between the experimental and control groups, MANOVA was conducted. Baseline scores of the condition groups’ demographic variables, job-search self-efficacy, amotivation and self-esteem were compared. Supporting the successfulness of the random assignment, there were no significant differences between conditions for gender . Equality of variance was assessed with utilizing Levene’s test, which uses the F-test, none of the variables’ were significant ; therefore the assumption of equality of variance is met.Fourthly, to test whether the variances of the differences between conditions are equal repeated measures MANOVA was used. Repeated measures MANOVA requires sphericity and Mauchly’s test evaluates if this holds. The sphericity assumption was met by our data because the repeated measure variables had only two levels. Finally, homogeneity of variance-covariance was tested with Box’s M test of equality of covariance homogeneity of variance. Box’s M (13.17) was not significant , by an independent grouping variable , a one-way repeated measures MANOVA was conducted.F = 8.16, p < 0.001, Wilk’s Λ = 0.84, partial η2 = 0.17]. This was a medium effect  and self-esteem . The F-test of amotivation was not statistically significant: F = 0.06, p >0.05. The plots in The results showed a statistically significant interaction effect between the experimental condition  and the combined dependent variables : [m effect  where 17F3, 12 = 8.16, FEG  = 13.56, p < 0.001, Wilk’s Λ = 0.61, partial η2 = 0.39); FCG  = 0.95, p > 0.5, Wilk’s Λ = 0.95).Next, we tested the effects of combined dependent variables  for the experimental group (EG) and control group (CG) separately. The following results were obtained: F = 18.62, p < 0.001, partial η2 = 0.22) and self-esteem . The F-test of amotivation was not statistically significant: F = 0.44, p > 0.05. The pairwise comparisons (of T0 and T1 scores) for the experimental and control groups are reported in F = 0.08, p > 0.05), amotivation , and SE .Univariate analyses in the experimental group showed that the effects of two dependent variables (job-search self-efficacy and self-esteem) were statistically significant: job-search self-efficacy . Consequently, hypothesis 3 was supported.To date, much research has been conducted on the psychological consequences of being unemployed. Yet, when it comes to practice, employability interventions seldom include crucial psychosocial aspects to assist the unemployed, particularly so in South Africa. One program addressing the gap in literature and practice is the JOBS intervention. Due to the encouraging results, several JOBS derivatives have been implemented globally , howeverPreliminary analyses were conducted to determine whether the Qhubekela Phambili program was valid and reliable. Two aspects, randomization of intervention conditions and strength and integrity of the program, were considered. Given that no significant differences were found between the experimental and control group at baseline, the integrity of randomization of the experimental and control groups was fully preserved. Also, the strength and integrity of the program was fully preserved, as the Qhubekela Phambili program adhered to the research-based principles of the JOBS program. An analysis of the working elements of the JOBS program revealed that a sense of mastery, comprising job-search self-efficacy, amotivation, and self-esteem, is one of the most predictive elements of positive outcomes in the JOBS program . TherefoThe first hypothesis, and also one of the most significant findings to emerge from this study, was that the Qhubekela Phambili intervention succeeded in increasing participants’ job-search self-efficacy levels. Experimental group participants scored significantly higher in job-search self-efficacy, compared to their control group counterparts. This finding is consistent with previous empirical studies reporting that the JOBS program can enhance participants’ job-search self-efficacy. Increases in job-search self-efficacy is a crucial finding, as it has previously been related to sustained job-search efforts, despite repeated disappointments .The second aim of the study was to determine whether participants would show lower levels of amotivation after the Qhubekela Phambili workshop. No significant changes in participants’ levels of amotivation were found. This finding may be somewhat concerning, as the only variable to differ significantly differ between the condition and dropout groups was amotivation. Possible explanations for this finding may be found in the literature. It has previously been noted that the adverse effects of unemployment on mental health are larger among the long-term unemployed than the short-term unemployed . BearingEarlier literature found that amotivation is negatively related to job-search efforts due to the jobseekers’ lack of motivation to persist . ConsideThe third hypothesis of this study was that participants would show higher levels of self-esteem after attending the program. Indeed, the program demonstrated the capability to increase participants’ self-esteem. As hypothesized, after taking part in the JOBS program, participants from the experimental group reported higher levels of self-esteem, compared to their control group. This finding is in line with previous research that suggests that the intervention provided the participants with the intended support to raise their self-esteem .Several limitations of this study need to be acknowledged. First, only self-report measures were used. While self-report measures are considered the most appropriate for assessing perceived behavioral constructs, efforts to study such constructs more objectively may yield significant findings. Second, it was not possible to investigate the measurement invariance of the measures of the three dependent variables in this study because of the small sample sizes . Future In social interventions, non-participation is a reality . In prevAnother potential weakness in this investigation may be the number of no-show (54%) and dropout (14%) participants. Those who participated in the first round of surveys and then did not return, reported significantly higher levels of amotivation, compared to participants in the experimental conditions. Though previous research has shown that the people who need the intervention the most were indeed the ones who participated  this is To be able to compare the findings of the current study with previous studies conducted on the JOBS program, similar dependent variables  were measured. However, given that the program was adjusted to also focus on entrepreneurship, an additional measure or an adapted version of the job-search self-efficacy questionnaire, not limited to job-search self-efficacy, but also determining a broader self-efficacy concept may have been valuable.According to A final limitation, particularly relevant to intervention studies in behavioral research, may be that much time has been spent with the experimental group, therefore, the results of this study can be attributed to the attention they received during the program. A comparative framework should be considered to provide an opportunity for the control group to receive equal attention .Unemployment is considered one of the South African government’s top priorities . AlthougThe present study contributed to existing literature to support the effectiveness of the JOBS program in a variety of contexts. Overall, the Qhubekela Phambili program provided evidence to demonstrate the programs’ ability to enhance the job-search self-efficacy and the self-esteem of participants. Contrary to expectations, the program did not succeed in decreasing the levels of amotivation experienced by participants, which may reveal another valuable finding. Since the amotivated believe that their actions will not yield desired outcomes  emphasishttps://repository.nwu.ac.za/handle/10394/33069, This manuscript has been released in a repository at The datasets generated for this study are available on request to the corresponding author.The studies involving human participants were reviewed and approved by the North-West University – Humanities and Health Research Ethics Committee . The participants provided their written informed consent to participate in this study.This publication was based on the Ph.D. thesis of RP. HD, SR, and AV were co-authors as well as supervisors of the project. RB made conceptual contributions to the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.