Message frame–tailoring based on the need for autonomy is a promising strategy to improve the effectiveness of digital health communication interventions. An example of a digital health communication intervention is Personal Advice in Stopping smoking (PAS), a web-based content-tailored smoking cessation program. PAS was effective in improving cessation success rates, but its effect sizes were small and disappeared after 6 months. Therefore, investigating whether message frame–tailoring based on the individual’s need for autonomy might improve effect rates is worthwhile. However, to our knowledge, this has not been studied previously.To investigate whether adding message frame–tailoring based on the need for autonomy increases the effectiveness of content-tailored interventions, the PAS program was redesigned to incorporate message frame–tailoring also. This paper described the process of redesigning the PAS program to include message frame–tailoring, providing smokers with autonomy-supportive or controlling message frames—depending on their individual need for autonomy. Therefore, we aimed to extend framing theory, tailoring theory, and self-determination theory.Extension of the framing theory, tailoring theory, and self-determination theory by redesigning the PAS program to include message frame–tailoring was conducted in close collaboration with scientific and nonscientific smoking cessation experts (n=10), smokers (n=816), and communication science students (n=19). Various methods were used to redesign the PAS program to include message frame–tailoring with optimal usability: usability testing, think-aloud methodology, heuristic evaluations, and a web-based experiment.The most autonomy-supportive and controlling message frames were identified, the cutoff point for the need for autonomy to distinguish between people with high and those with low need for autonomy was determined, and the usability was optimized.This resulted in a redesigned digital health communication intervention that included message frame–tailoring and had optimal usability. A detailed description of the redesigning process of the PAS program is provided.Netherlands Trial Register NL6512 (NRT6700); https://www.trialregister.nl/trial/6512 In 2018, a total of 22.4% of the adult Dutch population indicated to be occasional smokers -6.Computer tailoring refers to an automated communication strategy intended to reach every individual with tailored messages by adapting these messages to the individual’s unique characteristics and his or her behavioral and motivational state ,7,8. GenGiven its theoretical grounding, the PAS program starts with a baseline assessment consisting of questions on sociodemographic characteristics, smoking behavior, and addiction level, but, then, continues to ask questions about the respondent’s intention to quit smoking, attitude, social influence, self-efficacy beliefs, and action and coping planning on how to stop smoking and prevent the relapse of smoking . Then, twhat information is presented , is tailoring how this information is presented, which is known as message frame–tailoring [An investigation of the effects of PAS among Dutch smokers indicated a significant effect on smoking abstinence, reported 6 weeks after the initiation of participation in the program. However, 6 months after participation initiation, significant intervention effects could no longer be found . In otheailoring .need for autonomy, a theoretical concept derived from self-determination theory (SDT) [Message frame–tailoring refers to an integration of the message frame theory  and theory (SDT) . Tailoriry (SDT) . To be ary (SDT) . In SDT,ry (SDT) . Howeverry (SDT) ,27. To mry (SDT) .could, might, and would. Controlling language is defined as “a vocalization to pressure a person to behave (or think or feel) a particular way” [must, should, and ought. Choice is operationalized as offering participants the option to receive additional information about a certain topic [In our operationalization, message frame–tailoring based on the need for autonomy consists of 2 components: language  and choice  ,29. Autolar way”  and can lar way” . Examplein topic . Tailoriin topic ,26,27,32in topic .To investigate whether adding message frame–tailoring based on the need for autonomy increases the effectiveness of content-tailored interventions, the PAS program  was redeThe process of redesigning the original PAS program to incorporate message frame–tailoring consisted of four steps: (1) the feedback messages were rewritten in an autonomy-supportive and a controlling manner and a first pilot test was conducted, (2) the message frames were integrated into the program and a second pilot test was conducted, (3) a web-based experiment with a 2×2 between-participants design with a control condition was conducted, and (4) message frame–tailoring was integrated into the program and a usability test was conducted. An overview of the steps is presented in The study was registered in the Netherlands Trial Register (NL6512/NRT-6700).t test (2-tailed) using SPSS (IBM Corp), and the qualitative comments were inspected to identify relevant comments regarding language use.To tailor message frames based on the need for autonomy, the message frames needed to be developed. The feedback messages of the original PAS program were rewritten using autonomy-supportive and controlling language strategies. To test whether the language strategies were perceived as such, a pilot test was conducted among communication science students. After consenting to participate, students were randomly assigned to either evaluate the autonomy-supportive or controlling messages. The students received a questionnaire with 5 messages to be reviewed using a 5-point response scale, ranging from very autonomy-supportive to very controlling . StudentP<.001) than the controlling messages , which means that participants detected the language manipulation as intended. However, based on participants’ comments and inspection of the differences between messages that had high or low scores and those that had average scores, we further emphasized communication style (autonomy-supportive vs controlling). The main change consisted of emphasizing with signal words on the type of language style—autonomy-supportive or controlling—used at the beginning of each message .As the 5-point scale ranged from very autonomy-supportive (rating=1) to very controlling (rating=5), we expected lower scores for the autonomy-supportive messages than the controlling messages. Results showed significantly lower scores for the autonomy-supportive messages  to the feedback messages of the original PAS program resulted in four versions of the program: (1) autonomy-supportive language and no choice, (2) autonomy-supportive language and choice, (3) controlling language and no choice, and (4) controlling language and choice. Besides the 4 message frames, 1 control condition was added to the program, consisting of generic smoking cessation advice with a neutral message frame  and no content tailoring . Following is an example of a control message:When smokers are stressed, tensed, or dreary, they often find it difficult not to smoke. To help you with this, we give you a few tips. If you find yourself feeling emotional and wanting a cigarette, it’s good to do something else. You can take a walk: the outside air may do you good. Or you can exercise. This helps you to change your mind and reduces the desire for a cigarette.Examples of feedback messages for the 4 message frames are presented in The next step in the redesign process was conducting a second pilot test to investigate the intervention from experts’ and smokers’ perspectives. Totally, 5 experts  and 11 smokers  participated in the usability test and the subsequent interviews. The experts were working as professionals or researchers in the fields of health communication, public health, eHealth intervention development, and smoking cessation support. First, participants received a link to the website and were instructed to complete the program, while paying attention to the comprehensibility of the program and the feedback messages. Subsequently, a researcher interviewed the participants on the following topics: time taken to conduct the program; comprehensibility of instructions, questions, and answer categories; and awareness of the message frame used. Participants were rewarded with a shopping voucher worth €10 (US $11). During the usability tests and the interviews, the researcher took notes. Results were discussed within the research team to determine whether changes to the program were required to resolve issues mentioned in the feedback.The participants took between 20-60 minutes (average 35 minutes) to complete the program. As the introduction was perceived as very long, it was shortened. In addition, some questions seemed to be unclear; therefore, a brief instruction was added. Some questions needed to be reformulated . In addition, participants wished to receive the summary of feedback messages by email; thus, this option was added. The message frames were generally perceived as intended; therefore, no modifications were made regarding this aspect. After incorporating these changes, the PAS program with message frames was ready for use in the next step.To tailor message frames based on individuals’ need for autonomy, we had to identify (1) the most autonomy-supportive and the most controlling message frame based on participants’ perceived autonomy support and (2) the cutoff point to distinguish between people with high need for autonomy and those with low need for autonomy. Therefore, a web-based experiment with a 2×2  between-participants design with a control condition was conducted. An extensive description of the method and results of this experiment is provided elsewhere . HoweverParticipants’ need for autonomy was measured using the Health Causality Orientations Scale (HCOS), consisting of 4 vignettes, each of which contained 3 items that could be answered on a 5-point Likert scale  . The primust was salient in the advice and not appreciated. Furthermore, especially participants with high need for autonomy chose to receive more information when offered choice and wanted to choose a quit date themselves more often than participants with low need for autonomy.Results showed that participants’ perceived autonomy support was generally high . On the basis of the results, it was not possible to identify the most autonomy-supportive and the most controlling message frames. Therefore, we decided to follow SDT principles, according to which the provision of choice and the use of autonomy-supportive language enhances an individual’s autonomy . Additiomust used in their feedback messages. On the basis of these results, 3.8 was chosen as the cutoff point of the HCOS to distinguish between individuals with high need for autonomy and those with low need for autonomy.Regarding participants’ need for autonomy, the results also showed a high overall score . The Johnson-Neyman procedure was followed to identify the need for autonomy score at which the three-way interaction of the need for autonomy, language use, and provision of choice on perceived autonomy support changed from insignificant to significant, resulting in a range of 3.8 to 4.4. The qualitative data showed that participants with need for autonomy ≥3.8 more often made unappreciative comments about not being able to set a quit date themselves and about the word On the basis of the evaluative comments from participants, some changes were implemented. First, the participants perceived a period of 2 weeks to set a quit date as very soon. In the original PAS program, the quit date was set 4 weeks after participation initiation, but based on results that showed the importance of immediate action when a quit attempt was considered ,37, it wOn the basis of the results of the web-based experiment as described in the previous step, the PAS program was developed into a program with message frame–tailoring. The message frame for participants with high need for autonomy (HCOS score ≥3.8) consisted of feedback messages with autonomy-supportive language and choice, and the message frame for participants with low need for autonomy (HCOS score <3.8) consisted of feedback messages with controlling language and no choice. The flow of the redesigned PAS program with content tailoring and message frame–tailoring is presented in To optimize the PAS program with the tailored message frames, a usability test among experts and smokers was conducted. Regarding user experience, it is argued that, besides the aspect of ease of use, perceived usefulness is also important, which refers to the extent to which the content of the program satisfies the information needs of the participant . TherefoBoth smokers and experts were asked to evaluate the program using the think-aloud method, based on which they were asked to verbalize their thoughts while using the program . As verbAs the program will be used on different devices, smokers and experts were instructed to use the program on a laptop, tablet, or mobile phone. The entire procedure took approximately 1 hour to complete, and the participants were rewarded with a shopping voucher worth €25 (US $27.5). Experts and smokers were recruited through the network of the research team. A total of 5 experts  and 7 smokers  participated in the usability test. All sessions were video-recorded, which were selectively transcribed and coded using ATLAS.ti 8.0 . The datAs we aimed to test the content of the program and identify problems with its use, user experience was divided into 2 dimensions: the content of the program and the usability of the program. Modifications that were made regarding the content of the program included the following: replacing difficult words, shortening the introduction and instructions, reformulating questions, changing the labels of answer categories, and adding the quit date to the summary. Modifications that were made regarding the usability of the program included the following: adding a sidebar to show the different parts of the program, modernizing the logo and the colors, displaying only the core messages in bold font, aligning the illustrations on a mobile phone, adding a red frame signaling an unanswered question on the mobile phone, and adding the option to directly add the quit date to a personal agenda. An overview of the codes, subcodes, definitions, examples, and modifications is presented in It is worth noting that participants also wished to receive feedback messages with more illustrations and that some participants wished for shorter feedback messages with more bullet points. However, as the original feedback messages were effective in supporting smokers to quit smoking  and makiAfter incorporating the modifications in response to the usability test, the redesign process was completed. The redesigned PAS program—including message frame–tailoring—is shown in This study was approved by the institutional review board of the University of Amsterdam (reference number 2017-PC-7599).what information is presented , we wanted to improve the effectiveness of a digital health communication intervention by tailoring how this information is presented . This paper offers a detailed description of the incorporation of message frame–tailoring in a web-based computer-tailored smoking cessation program, PAS. The PAS is taken as an example to explore the effects of—in addition to the known effects of content tailoring—the promising strategy of message frame–tailoring [This study aimed to extend the message framing theory, tailoring theory, and SDT by including message frame–tailoring in a digital health communication intervention. In addition to tailoring ailoring . The prowhat health information is provided based on individuals’ current health behavior or their self-reported scores on known predictors of the desired health behavior (change) [how information is provided, in addition to tailoring what information is given, appears to be a promising strategy [what information is provided to additionally tailoring how this information is provided takes into account individual differences in communication style preferences. As such, message frame–tailoring can be considered as the next step in the field of tailored and person-centered health communication. Self-management support interventions, such as the PAS program, have shown to be the most frequent category of interventions with the potential to result in positive health impact for patients with chronic diseases [This study has several potential strengths. First, to the best of our knowledge, this study is the first to explore message frame–tailoring in web-based computer-tailored health communication. The existing literature on message framing mostly includes studies on gain and loss framing, focusing on positive  outcomes and costs in terms of health loss, respectively. Regarding tailoring, so far, scholars have mainly tailored the content of web-based interventions; that is, adjusting (change) . To builstrategy ,32. To ostrategy . These rstrategy -6, and tstrategy ,48. Thisstrategy ,50. Movidiseases . TherefoAnother strength concerns the approach taken in developing the redesigned PAS program: scientific and nonscientific experts, smokers, and communication science students were actively involved throughout the process. Involving different types of stakeholders, including end users, in research removes barriers regarding the implementation of research findings and interventions, such as the redesigned PAS program, in practice ,53. By dFinally, we chose to use an existing, already effective intervention . Using aThis study also has few limitations. First, in the 2×2 web-based experiment, most participants’ need for autonomy was moderately high. This may not be representative of the need for autonomy in the general population; therefore, the cutoff point of the need for autonomy, based on which the message frame is tailored, might be very high, resulting in suboptimal message frame–tailoring. In addition, research has shown that the need for autonomy might be different for different groups of people . More recould in the autonomy-supportive condition and must in the controlling condition. Moreover, in the case of the quit date, we also tried to design the way of responding in an autonomy-supportive versus controlling manner; that is, the smokers in the choice conditions received different types of calendars to enter their quit date based on their individual choices in this regard; for example, a calendar to choose a date from or a commenting section in which they could enter the date themselves, whereas smokers in the no-choice conditions were given a prespecified date by the intervention. This method of designing could be further explored as a way to make the interface more compatible with the individual’s need for autonomy. For instance, more questions can be designed such that individuals with high need for autonomy would receive open entry fields, whereas individuals with low need for autonomy would receive limited multiple-choice answers. In addition, how the program is run can be adapted to an individual’s need for autonomy; for example, a fixed order for those with low need for autonomy and a self-determined order for those with high need for autonomy. More attention to the design of the intervention as tailored to an individual’s need for autonomy could possibly further increase the effects of this and similar interventions—therefore, such possibilities warrant more attention in future research.Second, we mainly focused on the communication of information in an autonomy-supportive or controlling manner, especially pertaining to the type of words used; for example, Third, although using an existing, already effective intervention is a cost-effective and efficient approach, it also has limitations. For example, some participants requested shorter feedback messages with more bullet points or more illustrations. However, as we wanted to be able to make a comparison between the effectiveness of the PAS program with and that without message frame–tailoring, it was decided to make no adaptations regarding these aspects. By changing the content of the program, it would not be possible to attribute any differences in effectiveness between the original PAS program and the redesigned PAS program to the effect of message frame–tailoring. When choosing between developing a new intervention from scratch and redesigning an existing effective intervention, we recommend considering both the cost-effectiveness and efficiency of the approaches and the potential limitations of the approaches, such as (not) being able to meet all participants’ needs regarding the usability of the program.


Approximately 160 million children work as child laborers globally, 39% of whom are female. Ghana is one of the countries with the highest rates of child labor. Child labor has serious health, mental health, and educational consequences, and those who migrate independently for child labor are even at higher risk. Yet, evidence-based efforts to prevent unaccompanied child migration are limited. In this study, we examined the acceptability of a family-level intervention, called ANZANSI  combining two evidence-based interventions, a family economic empowerment intervention and a multiple family group family strengthening intervention, to reduce the risk factors associated with the independent migration of adolescent girls from the Northern region to big cities in Ghana. We conducted semi-structured interviews separately with 20 adolescent girls and their caregivers who participated in ANZANSI. Interviews were conducted in the local language and transcribed and translated verbatim. Informed by the theoretical framework of acceptability, the data were analyzed using thematic analysis. The results showed high intervention acceptability among both adolescent girls and their caregivers, including low burden, positive affective attitude, high perceived effectiveness, low opportunity costs, and high self-efficacy. The study findings underline the high need for such interventions in low-resource contexts in Ghana and provide the foundation for testing this intervention in a larger randomized trial. Approximately 160 million children ages 5–17) across the globe work as child laborers, 39.3% of whom are female ,3. Child–17 acrosChild labor constitutes a significant threat to children’s education, undermining their chance to break the cycle of poverty ,8,9. Thiwork which, by its nature or the circumstances in which it is carried out, is likely to harm the health, safety or morals of children” in Article 3(d) of International Labor Organization Convention 182  and how to save in the bank.Initial concerns about program participation“There was nothing preventing us from joining. Whenever there was a meeting, I was ready to go.” Similarly, Karim weighed the pros and cons of participating in this program as opposed to his other responsibilities and decided that the benefits were worth investing time in.We also asked adolescent girls and their caregivers what made them hesitate to participate when they first heard about the ANZANSI program. Most of the caregivers said that they had no concerns, as illustrated by Jumai, a female caregiver who was eager to join the sessions: Karim: When you are faced with two issues, you look at the most important one because I found that the benefit I was gaining here, I realized that even if I left everything to take part in meeting it would be useful for me. Because they taught me how to take care of my child, my family, and so on. That is why I left everything just to participate in the program.A few caregivers were initially worried about the potential time commitment and that they would not have time for their business. For instance, Taufiq was concerned that the program would take time away from his trading activities and hinder his income. However, he eventually realized that attending the program did not cost him much.Taufiq: Actually, my fear was about the time it was consuming. And I was afraid that it will take all the time that I was supposed to spend on my trading activities from where I get my little earnings to feed myself and my family. However, I just pursued it with great courage. And indeed, when I joined, it has not cost me much.Zakiya mentioned that while the timing of the sessions did not initially work for her, she adjusted her schedule to be able to attend. Similarly, Waramatu expressed time commitment as an initial challenge, which she accommodated by adjusting her schedule.Waramatu: Whenever there is something to prevent me from attending the program, I try to do all that I can and put aside that thing and attend the program. After I close from the program, then I will come back and do that work.“Some people said this project was a lie but we had confidence in the project and followed it till now and we are benefiting from it”.Similarly, almost none of the adolescent girls had any initial concerns about the program. Two participants, Sherifa and Leila, mentioned that some people in the community said they should not trust the program, but they decided to participate anyway, as illustrated by Leila, The attendance rates, including late arrival, for the 4 FLT and 16 MFG sessions were 98% and 99%, respectively, for the 47 dyads who participated in the intervention. The attendance for the two IGA sessions was 88%, lower than other components due to one of the sessions being scheduled on a heavy rain day. Hence, the overall attendance rate across sessions was 95 percent. Families were allowed in the sessions until 10 min after the session started. However, there were instances where more flexibility was needed and sessions started 10–15 min later than the usual start time, especially during the rainy season. Both the caregiver (or their delegate) and the adolescent girl had to be present to participate in the sessions.For many caregivers in our qualitative sample, the relevance of the session content to their families was what motivated them to attend the sessions. Abiba noted that the benefits of attending outweighed everything else.Abiba: I was looking at the benefits I will gain from it because what we were learning gave me some motivation and courage, and also made me learn things I do not know. Even if I had something challenging me [to attend], I would come for the training and later go to solve the problem.“was the information they were giving us because they taught us how to make money and to save money without spending it” and that he did not miss any session.Karim shared similar thoughts that what made it easy for him to attend “because the training was always scheduled on Saturdays, I used to come and after the training, I returned to my daily activities”.For a couple of caregivers, another facilitator was that the sessions were delivered on the weekend, which did not interfere with the caregivers’ work. For instance, Samira mentioned that Some caregivers mentioned the transport refund provided at the end of the session as a facilitator. Given that the program was implemented in resource-poor communities, covering the cost of weekly transportation would have been a financial burden on the families. Zaina spoke about how it would have been hard for her to attend the sessions without the reimbursement.Zaina: What made it easy for me is the transportation money they used to give us whenever we ended the meetings because from my village to this place the fare is 10.00ghc. So, if the transportation money was not part, that would have made me not be able to come even when I didn’t intend to miss it. But because there was transportation money, if you are just ready and you come out, you will attend the meeting.She went on to add that her husband always encouraged her to attend the sessions. He became a firm believer in the program as Zaina shared with him what she learned at the end of each session.Zaina: Whenever we just attend these sessions and I go home, I will tell my husband what happened. This is what they said, this is what they said. I will also explain this to him. So because of that, whenever we have work to do and they call, he will say that you should leave work and come and listen to what they have for you.They were teaching us how you will save money, how to fill the deposit slip, and what you supposed to do when you go to a bank…. They were educating us on how a child should live.” She added that she experienced no challenges in attending the sessions. Similarly, Patricia who never missed a session shared, “We never missed a session because we know it is something that is going to help us in relation to our family and education”.Adolescent girls also mentioned the content of the sessions as one of the reasons that motivated them to come to the sessions. For instance, when asked about what made it easy for her to attend the sessions, Ayat said, “From the beginning till the end, I was only absent once which I told my wife to represent me, and this absenteeism was a result of a journey I could not avoid”.Some caregivers mentioned that other family responsibilities or sickness interfered with their attendance at times. However, even in those instances, caregivers attempted to make sure that another adult family member attended the session in their place, as illustrated by Taufiq, “Though most adolescents did not identify any challenges to attendance, among the few who did, transportation was a common theme, especially finding a taxi. Sherifa mentioned that it was not easy to find taxis and one had to stand in line for a long time before getting a ride. Jamila had a similar experience. While she made sure she completed all her other responsibilities before the session, she also reported struggling with finding a taxi though that did not prevent her and her caregiver from attending all the sessions.Jamila: Because we were aware of the day of the training, we usually prepared accurately by performing other obligatory duties before the meeting day. Getting a taxi was my challenge, they always leave early in the morning, and they do not usually return till they get passengers.Some adolescents expressed other commitments, such as travel and housework that made it challenging to attend the sessions. For instance, Halima shared that she had housework before attending the sessions, which made her come late to some sessions. Hajara had housework, work for income, and an Arabic class that she stopped going to so that she could attend ANZANSI sessions.Hajara: The challenge was that there were a lot of tasks on me in the house. And if I also leave it and attend the program, I will still have to go back home to do it. And after finishing the work in the house, I will still have to go and work to get money to feed myself. And I did my best to do the work well to be able to overcome it.The participating families found the content of the different components of ANZANSI highly relevant to their needs. Karim shared everything he learned in the program, touching upon all its components.Karim: They taught us how to trade, save, what to do to be healthier, and how to take care of your family, your household, and your friends. How to relate with people in the community, I learned all these through ANZANSI.I wanted to have a bank account, but I didn’t know what to do. It was through this program that I had the opportunity to open one and I have benefited a lot in the program”.Most caregivers noted that they did not have a bank account prior to the program and did not know how to open one until they participated in the intervention, as expressed by Saudatu, “Actually, the challenge [to save money] was that sometimes we may not be able to even get what we are supposed to survive on. And so, when the day comes, it would be a challenge for me”.Asiya shared that it was through ANZANSI that she learned how to save money at the bank. The matched saving was appreciated by the caregivers. Yet, it was also a challenge given the limited resources as illustrated by Waramatu, “Even when it was not much, caregivers made every effort to save. For instance, a male caregiver, Isaac, made sure to deposit at least some of the transport refund provided at the end of each session, especially given the unpredictable nature of farming.Isaac: The transportation refund that you gave us helped me… I used the transport refund to open the account. Every month I go to save 50 Ghana cedis and continue to do my work again. We farmers, sometimes it would take days and you would not work. But with the accounts, I always made sure to get the 50 Ghana cedis to save at the end of the month.Zaina, who did not know how to open an account before the intervention, made every effort to deposit during the program. She continued to do so even after the matching ended. She shared that as a result of the savings, she did not have any concerns about paying the school-related expenses for when her daughter resumed school.Zaina: I didn’t know how I can open an account. So, we are very happy about it. The payments have finished but we still have not stopped depositing money into it. We keep doing it. We will be selling and saving little by little. Every day, you will save 2ghc, by the time the day is due, it will be up to the target amount and then you will go and deposit it into the account…… When they resume school, I no longer have any problem regarding how we will be buying her school stuff.“poor people” could save in the bank until she joined the program. Since then, she deposited even the little money she had.Saudatu did not think that Saudatu: I have put the knowledge that I acquired into practice in opening a savings account in the bank. I didn’t know poor people could do savings in the bank and now that I know, even if I have pesewas (coins) I can deposit them in the bank.Isaac discussed how bank account opening and financial literacy helped both his family and extended kin.Isaac: The skills I have gained with regards to the opening of bank accounts and the financial literacy aspect have helped my family. Now if we have a family financial issue, I will be the one they will contact to resolve the issue. So, it has helped all of us.Another caregiver, Hadiza, shared what she learned in financial literacy training with her mother and sister. She added that she was able to expand her business using the knowledge she acquired in the financial literacy and income-generating sessions.Hadiza: I taught my mother and my sister about the skills in financial literacy training, which enlightened me about my business management.… I was able to expand my business through the knowledge I acquired in the training. The knowledge of savings and banking activities helped me much, and it enlightened me about the need to engage in savings.misbehaved”, which she found satisfying.Caregivers also commented on the relevance of the family strengthening sessions to their families and proceeded to expand on how their families benefited. Waramatu shared that the skills and knowledge she learned in the sessions helped her to deal effectively with her children who “Waramatu: Yes, I used it to work. And honestly, there was satisfaction because after acquiring this information and getting home, when a child was misbehaving, and then I talked to her, I realized that she would also listen to me, and behaved well.“There was no unity in the family. Everyone was doing their own things. But since we started this thing, we are now united in the family and there is peace in the family”.For some caregivers, like Jumai, the family strengthening sessions helped the family come together and feel united, something she thought was missing in her family, Caregivers also mentioned that they learned how to better relate with their children. For Zaina, she learned that she could sit and have a conversation with her children –something she thought was not possible before.Zaina: We didn’t know that it is important for you and your child to sit together and have a conversation. So, we got all those skills in ANZANSI. There are certain issues that when you are sitting with the child, you can be asking her about them, and she will tell you. But we, as members of the Dagbamba tribe, we had it that you cannot be sitting at a place and your child too will be sitting there. And it is here that we received all those skills, and we have not stopped using them.really a program for family wellbeing because each and everyone, all of us who were sitting here, we all had each other’s mobile contacts, calling one another. So that is the family we became”.She went on to add that this was “For Karim, it was learning about adjusting his expectations from his children in terms of what work they can and cannot do given their capacity. Through the sessions, Asiya realized that being harsh with her children was not the best solution and that she should instead have a conversation with them.Asiya: I didn’t know that it is not good to be harsh on your child, you don’t have to make your child fear you. Always make sure you converse with your child or when you are to talk to your child, you should not shout at her. If that continues and she has a problem she can’t share that with you.Now, I showed more support for the child’s educational needs, as compared to before [the program] where I used to perceive some of her educational needs to be unnecessary.” As a result of the program, Jumai decided to continue with her daughter’s education and use their savings to pay for school expenses: “Our plan is for her to progress with her education. When she goes further, we can use the savings together with the help you are offering us to pay her fees”.For some caregivers, the focus on girls’ education was important. For Nabila, content covered about girls’ education shifted her perspective on their educational needs, ““united” because of the family strengthening sessions.Adolescent girls also raised similar points regarding content relevance and perceived impact. Many of them discussed how both the economic empowerment and family strengthening components were beneficial to them and their families. For instance, Fawzia shared how she was able to save and the potential of expanding their business. She also spoke about how her family was more Fawzia: We thought that with the savings we have made and the money you added, when we withdraw it, we can expand our business. I used to do little savings at home and when it’s reasonable then I will go and deposit it in the bank. It was great…. [The family strengthening component] has helped to unite my family. They used not to sit together, even they will drive me away anytime I wanted to sit with them but now we can sit together.“build peace” in the family and community.Patricia echoed similar thoughts. She explained how the program taught them they could start saving in small amounts and eventually have enough to start their business. She also discussed how she learned to be respectful towards her elderly and how to Patricia: They taught us that if you have small money already, don’t spend it. Save it in your bank account or mobile money and you keep contributing little by little so that it if gets to the amount that you want to use for the business you remove the money and start the business. The program has helped my family because they used to struggle for money but since they started savings, it is better….The program taught me how to be respectful in life like respecting the elderly so that you will also be respected; and how you’ll build peace in the household and the community.Nura shared how she and her family did not know about bank accounts and savings. She also underlined that the main benefit for her was the emphasis on the importance of educating girls. As a result of the program, she saw that her grandmother paid more attention to her education and educational expenses.Nura: We didn’t know how to go to a bank to save money or get money and then manage your spending. We didn’t know all this until they came and taught us this….As for me the key benefit of this program was that some people think that it is not compulsory to educate the girl child. But this program made us know that it is good to educate the girl child. I have seen changes in my grandmother. At first, you will come from school and ask for your exam fees, and she will tell you that she doesn’t have money. Now that this program educated her about the benefits of girl child education, when I need something for school, even if she doesn’t have the money, she will give you the day that she will be able to provide it for you.Both Felicia and Leila discussed how they benefited from the economic empowerment component. Felicia shared how she learned to make a profit.Felicia: I used [the knowledge] in my trading activities, buying with a little amount. For example, I’ll buy a toffee at 0.10p and sell it at 0.20p and go and buy two at 0.20p and sell it at 0.20p each to make an extra 0.20p as a profit.“united”.In addition to learning how to save, Leila talked about how her family benefited from the family strengthening component as her family was able to come together and feel more Leila: My difficulty was how can I save money or where can save my money but after the ANZANSI project came we now know how to save money. They educated us that when you engage in a trade and the little profit you make, you should be able to save some continuously and by that you will be able to gather money. Dang-Malgu [family strengthening component] has helped my family members a lot because there was no unity among most of them but through what I learned here, I was able to share with them and they are now united.“stressful and difficult” and did not have any experience with depositing money until they joined ANZANSI. She also shared that through the family strengthening component, she was no longer feeling nervous when speaking to her family members.Hamamat said that her family found going back to the bank Hamamat: We thought that going to the bank was stressful and difficult because we had never gone to the bank. We used not to deposit money in the bank because we didn’t know how to do that. After we joined it, we have now seen how simple it is to do anything in the bank. And now know the banking rules as well. Thanks to Dang-Malgu, now, when you want to tell your family something or when you have any challenge, you know how you will address it with them. You won’t be nervous or feel intimidated anymore.In this study, we explored the acceptability of the ANZANSI program, a family-level combination intervention seeking to prevent the unaccompanied migration of adolescent girls in Northern Ghana for work in big cities, among adolescent girls and their caregivers. We qualitatively explored their expectations and concerns that contributed to their decisions to participate in the overall program, facilitators, and barriers to their participation, as well as thoughts on content relevance and perceived impact, all aspects relevant to program acceptability.Both the caregivers and adolescent girls were motivated to participate in the ANZANSI and highlighted the different aspects of the program as motivating factors. For caregivers, the economic empowerment aspect was frequently mentioned. Caregivers were excited about the opportunity to open bank accounts and learn about savings, financial literacy, and income-generating activities. Another frequently mentioned motivator was the potential of this program for improving family relations. Only one caregiver mentioned the focus on girls and their education as a motivation. On the contrary, this focus was more frequently mentioned as a motivation among adolescent girls, suggesting the need among this population for more gender-specific programming addressing their unique needs. Adolescent girls also tended to mention the family strengthening aspect more frequently than the economic empowerment aspect of the program as a motivation. When mentioned, economic empowerment was discussed in combination with family strengthening. This difference may be a function of financial stability being more of an immediate concern for adults responsible for their household finances. Regardless of the differences, the motivation for both adolescents and caregivers was to acquire more knowledge that applies to multiple aspects of their lives, which underscores the need for such programs in these communities. In addition, the high motivation of the families to participate in the intervention point to a positive anticipated affective attitude, one of the acceptability dimensions of TFA .Most caregivers and adolescent girls had no initial concerns about participating in the program. The concern expressed by a few caregivers was the time commitment that the program required. While this is a common concern in interventions that require an extended period of time for participation ,44,45, tThe attendance rates for this multi-session program were higher compared to other multi-session family interventions in LMICs ,49 and pOther facilitators included the timing of the sessions (weekends) and transportation refund, though mentioned by fewer participants. Costs associated with transportation are widely cited as a barrier to program/ intervention attendance ,50, espeWhile barriers and facilitators to attendance are not included in the TFA, a better understanding of the contextual factors contributing to attendance may have important implications for assessing intervention acceptability. In fact, Casale et al.  underlinWhile ethicality did not emerge as a theme in our data, at least some participants likely considered whether the program would be in direct conflict with their value system when enrolling or continuing to attend. It is also important to note that some participants discussed how some aspects of their value systems shifted as a result of the intervention, including their perspectives on girls’ education and expectations in child-caregiver relations.Caregivers and adolescents found the content and skills provided during the intervention highly relevant to their life circumstances and needs. Perceived content relevance has been cited as an indicator of intervention acceptability in other studies ,55. ContRelatedly, not only did participants appreciate acquiring knowledge and skills but they also discussed how the intervention made a positive impact on their families. Other studies also identified positive impact as a reason for intervention acceptability ,57,58,59Overall, our findings suggest that both caregivers and adolescents found the ANZANSI intervention highly acceptable, an important and promising step for this pilot study. Furthermore, the narratives about the perceived effectiveness of the intervention -anticipated and experienced- also point to the high need for this intervention in the communities where the study was implemented, with potential implications for other low-resource communities in sub-Saharan Africa experiencing similar challenges. Finally, our results show that when relevant and acceptable, interventions with multiple sessions can still attain high attendance rates. The next step for this intervention would be to determine its acceptability and effectiveness in a larger sample of participants and schools. Given the barriers around transportation, other potential venues or provision of transport from a primary location to the program site could be considered.Study results should be interpreted in light of the study limitations. The qualitative interviews were conducted cross-sectionally upon completion of the intervention. Hence, the data do not capture any changes that may occur in families’ perspectives about the intervention over time. Additionally, the TFA was used at the stage of data analysis, rather than at the stage of developing the interview protocol. Relatedly, the interviews did not explicitly explore certain constructs such as ethicality and intervention coherence. In addition, future research should examine the acceptability and potential adoption of the intervention from the perspectives of intervention facilitators and school leadership as these would have implications for intervention sustainability. In addition, further research should be conducted to examine the impact of the intervention as acceptability may not always translate to intervention impact on targeted outcomes.Despite these limitations, our study provides important insights into the acceptability of a family combination intervention, ANZANSI Family Program, aiming to reduce the risk of unaccompanied migration of adolescent girls from the Northern region to big cities in Ghana to work as load carriers. Guided by the TFA, our results suggest that both caregivers and adolescent girls found the intervention highly acceptable and that the intervention filled a significant gap for families in the study region. Given that ANZANSI was tested in a pilot study, its acceptability provides a strong ground to further test the acceptability and effectiveness of this preventive intervention in a larger randomized clinical trial in the study area. This is particularly promising as preventive efforts to curtail adolescent girls’ unaccompanied migration for child labor is limited.


Cryobiopsy is advantageous for collecting larger specimens with minimum crushing compared to forceps biopsy and transbronchial needle aspiration (TBNA), but it has not been widely used for mediastinal tumors. In this report, a leiomyoma of the thoracic esophagus was diagnosed with endobronchial ultrasound‐guided transbronchial mediastinal cryobiopsy (EBUS‐cryo). An asymptomatic 49‐year‐old woman had a 2.6‐cm sized submucosal tumor (SMT) of the esophagus adjacent to the trachea and left main bronchus. EBUS‐TBNA and EBUS‐guided intranodal forceps biopsy were performed, followed by EBUS‐cryo. The biopsy forceps could not be inserted into the tumor, but the cryoprobe was smoothly inserted. EBUS‐TBNA could not obtain enough spindle‐shaped tumor cells for immunohistochemical staining, but EBUS‐cryo provided sufficient specimens for diagnosing the leiomyoma. Adding EBUS‐cryo to EBUS‐TBNA has recently been reported to achieve high diagnostic yields for lymphomas, uncommon tumors, and benign diseases. EBUS‐cryo seems a valid diagnostic option for esophageal SMTs that are difficult to diagnose with needles and forceps. We present a case of leiomyoma of the thoracic esophagus diagnosed with endobronchial ultrasound‐guided transbronchial mediastinal cryobiopsy (EBUS‐cryo). Unlike endobronchial ultrasound‐guided transbronchial needle aspiration, EBUS‐cryo provided sufficient specimens for a leiomyoma diagnosis without serious complications. EBUS‐cryo is a valid option for esophageal submucosal tumors that are difficult to diagnose with needle and forceps biopsy. Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is a standard sampling technique widely used for benign and malignant mediastinal and hilar lesions.Endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA), which is also a needle‐based technique, is commonly used to diagnose gastrointestinal submucosal tumors (SMTs).Here, we report a case of SMT of the thoracic esophagus diagnosed with EBUS‐cryo without serious complications.A 49‐year‐old woman was referred for the diagnosis of a mediastinal tumor. She was asymptomatic and without a previous history of tumor. Chest computed tomography showed a 2.6‐cm sized tumor adjacent to the trachea and left main bronchus, which was contiguous with the thoracic esophagus Figure  and did For diagnosis, EBUS‐TBNA, comprising three punctures with a 22‐gauge needle  and a convex probe ultrasound bronchoscope , was performed Figure , followePathologically, EBUS‐TBNA specimens showed some spindle‐shaped cells, but they were insufficient for diagnostic immunostaining Figure . The cryWe presented a case of esophageal SMT diagnosed with EBUS‐cryo. EBUS‐TBNA has high sensitivity of 88–93% for staging non‐small‐cell lung cancer.Cryobiopsy is widely used in transbronchoscopy and is advantageous for collecting larger specimens, with minimum crushing, compared to forceps biopsy and TBNA.One disadvantage of EBUS‐cryo and EBUS‐IFB techniques is that the devices can be obstructed by the airway wall and tumor capsule during insertion into the target lesion via the tract formed by TBNA. Previous studies have reported failure rates of 10–28% in EBUS‐IFB.In conclusion, we reported a case of esophageal SMT diagnosed with EBUS‐cryo. EBUS‐cryo can be an option for diagnosing esophageal SMTs that are difficult to diagnose with needle‐based procedures.Yuki Ishiguro drafted the manuscript. Keigo Uchimura, Hideaki Furuse, Tatsuya Imabayashi, Yuji Matsumoto, Shun‐Ichi Watanabe, and Takaaki Tsuchida were in charge of the patient. Keigo Uchimura, Hideaki Furuse, Tatsuya Imabayashi, Yuji Matsumoto, Shun‐Ichi Watanabe, and Takaaki Tsuchida helped to draft the manuscript. All authors read and approved the final manuscript.The authors declare that they have no competing interests.Video S1 Endobronchial ultrasound (EBUS) videos during EBUS‐guided intranodal forceps biopsy and EBUS‐guided transbronchial mediastinal cryobiopsyClick here for additional data file.


Non-fungible Tokens (NFTs) are ownership records stored on a blockchain, and they are typically digital items such as photos and videos. In many ways, an NFT is like a conventional proof-of-purchase document, such as a paper invoice or an electronic receipt. NFTs are attractive among other things because of verifiability; each sale is recorded as a blockchain transaction, allowing ownership to be tracked. Also, NFTs can be used to transfer digital assets between two mutually distrusting parties, since both the crypto payment and the asset transfer take place in one transaction. With NFTs, all marketplaces can freely trade with the help of decentralized applications (DApps). It is currently estimated that there are over 245 NFT marketplaces (NFTM) listed with over 1000 blockchains as of August 2022 with 68 million blockchain wallet users. With the expansion of markets, they must face challenges and issues. The objective of this review is to study the market dynamics of NFT ecosystems. It also focuses on technical components that enable NFTs and their marketplace. The review provides a deeper understanding of its components, how they are related, and why they are important. The paper analyses the challenges faced by NFTs and marketplaces in terms of security, transparency, scalability, and the consequences leading to these issues and how they will address them, as well as future opportunities. An NFT (non-fungible token) represents ownership of virtually anything, from digital art to music, videos, memes, and virtual real estate. Additionally, the value of each NFT is unique, and they are considered non-fungible. The term NFT originated with the eToro CEO Yoni Assia who coined the term “colored coins” and co-authored a whitepaper entitled, “Colored Coins” with Ethereum creator Viralik Buterin and their associate ,2 In thiNFTs play a major role not only in the digital domain but also in linking physical assets  in a digital domain through blockchain. Examples include NFTs for real estate , diamondThe first NFT was created in May 2014 by Kevin McCoy and referred to as Quantum on the Namecoin blockchain. Namecoin is a peer-to-peer naming system-based software built from the bitcoin blockchain . SeveralThe process of recording and processing NFTs can be seen in The NFT serves as a means of identifying something or someone uniquely. These tokens are subject to their own standards, among which are the Ethereum Request for Comments 721  and the These standards helped to make NFTs, and the characteristics they are known for today. As new industries enter the marketplace, the NFT is finding new ways to provide value across a wide range of digital assets, including videos, collectibles, and digital arts. According to NFTs are new and there are not many review articles in the literature. One survey paper  deals wiThe purpose of this study is to survey the NFT and its marketplaces as well as to examine the most critical elements in the NFT ecosystem, which are scalability, transparency, and security. These three elements are essential to the NFT ecosystem and are needed for the system to function correctly and efficiently. The research process involves several qualitative methods which are used to gather the information for this study for the purposes of measuring, categorizing, identifying, and generalizing. All these research data have been gathered from secondary sources, and they can be understood by beginners and will provide a better understanding of the current landscape in the field of NFTs.This review article contains seven distinct sections, starting with the introduction and research methods. Thirdly, a literature review on the pillars of NFT mechanisms such as blockchain, smart contracts, and transactions focusing on scalability, transparency, and security issues. The fourth section analyses the top five blockchains influenced by current market conditions. The fifth section introduces the NFT marketplace and analyses its underlying components. The sixth section summarizes the challenges currently being faced in the categories of scalability, transparency, and security. The conclusions and future direction for NFTs are discussed in the final section.The blockchain is a distributed ledger that is shared among nodes in a computer network. Blocks are communicated between nodes by a peer-to-peer network, and a consensus protocol is used to validate new blocks. In essence, blockchains are collections of information that are held in groups known as blocks, which store a variety of information. Each block can hold a certain amount of information and once each block has been filled, it closes and links with the previous block to form a chain.The first decentralized blockchain proposal was made by Satoshi Nakamoto in 2008, a peer-to-peer electronic cash system , and in A bitcoin uses a Proof of Work (PoW) consensus mechanism, which is the basis for all other blocks in the bitcoin network. Arthur Gervais describes PoW as a way of verifying the accuracy of new transactions on a blockchain . In the In terms of market capitalization, Ethereum is the second largest blockchain after Bitcoin . EthereuA smart contract is a type of transaction protocol. They are self-executing contracts in which the terms of the agreement between buyer and seller are written in code and are automatically verified and executed via a computer network . Nick SzAn address in the context of blockchain typically consists of a string of 26 to 35 characters and is a particularly distinctive identification for an entity, a wallet, or a smart contract and a public ledger known as blockchain is the hub of NFT which handles transactions ,28. Anot-The first is the gas fee, which is mainly used for storing and transacting NFTs on the blockchain.-The second fee is the account fee, which is charged by the NFT marketplace for each account.-The third charge is the listing fee, which is charged to list a digital asset (NFTs) for sale.Among the biggest and most important aspects of a blockchain is transaction speed. When you need to issue thousands or even millions of NFTs at once, or even trade at once, speed becomes necessary. Transaction speeds are determined by both the complexity of the transaction and the network traffic. The minting  process In general, NFT prices differ between blockchains and markets, and are mostly based on what the user wants, such as the amount of data used, the speed, and availability.Each transaction in the system is organized in blocks, which are then linked in a chain. Several metrics can be used to measure scalability, including maximum throughput, latency, bootstrapping, and cost per confirmed transaction (CPCT) , where aThe term “layer 1” refers to the base level of a blockchain architecture. It’s the main structure of a blockchain network. Ethereum, BNB chain, etc. are popular examples of layer 1. The polygon (MATIC) that runs on top of Ethereum is an example of a layer 2. Within the blockchain infrastructure, scalability refers to a blockchain network’s ability to support high transactional throughput and future growth. Layer −1 solution changes the rule of the protocol directly to increase transaction capacity and speed, while accommodating more users and data. They can increase the amount of data that are continued in each block or increase the rate at which blocks are confirmed, which will then increase overall network traffic going in and out. This is directly impacted by the blockchain consensus protocols. Some consensus mechanisms are more efficient than others. Here we briefly discuss the popular consensus algorithms.Proof-of-Work (PoW): The Proof of Work protocol is used by Bitcoin and Ethereum and many other blockchains (Ethereum will be switching to Proof-of-Stake consensus protocol by September 2022). Every time a new round of computational power competition is held, selected nodes are required to create a new block by solving a cryptographic puzzle. In a PoW puzzle, the node that solves the puzzle first has the right to create a new block, but the puzzle is hard to solve . Each blProof-of-stake (PoS): The Proof-of-Stake (PoS) system was first adopted by Ppcoin (Peercoin) in 2012 . In PoS,“Layer 2” refers to a network that runs on top of the existing blockchain protocol to improve its scalability, efficiency, and security while maintaining its decentralization. The framework is designed to handle transactions off-chain  so that Sidechains: the first concept of sidechains was introduced in 2014 . In addiRollups: Ethereum co-founder Vitalik Burerin first described rollups as shadow chains in 2014. Through rollups, transactions can be aggregated off-chain inside a smart contract, reducing fees and congestion by doubling the blockchain’s transaction throughput from its current 10–15 transactions per second (tps) to more than 1000 tps. Within minutes you can move funds between different applications like fiat accounts, top-up cards like Revolut  to exchaAs of 2019, John Adler  was the Among the most important features of both NFTs and Blockchain is transparency. Blockchain is responsible for recording all digital ledger data publicly, and everyone can access it. NFTs are essential elements for digital art, and they are supposed to regulate and make all transactions transparent, wallets, and ownership relationships of digital artwork, regardless of their platform. As transparency is not always clean or decipherable, the ideal of transparency associated with NFTs is partly manifested, for example, looking back towards the beginning of that NFT, as to who owned it in the past, and seeing the movements of that NFT  to determine where it was taken from there.As an example, the first CryptoKitties were priced at $3.24 each in December 2017 and 105 CryptoKitties were created with a total of $340.63 worth of ETH spent by different collectors. At present, the average price of CryptoKitties is $256.99 with an all-time average return of over 7800% . In addiMany factors contribute to NFTs’ transparency, but the most prominent reason is the public permissionless blockchain, which serves as the basis for all cryptocurrency-related activities. The NFT system allows users to check ownership and transaction histories of all NFTs which have been issued up to the most recent transaction without needing any permission. As a result of this access, you can verify that you have bought the original work directly from the artist. Blockchains can be classified into three types: public, private, and hybrid but we will only discuss a public blockchain as it is the only one which is primarily used for NFTs; for example, the Ethereum blockchain. In fact, a few Ethereum networks do indeed have a private, e.g., permission-based, Ethereum codebase network used for business-to-business transactions , but allIn a public blockchain, also known as a permissionless blockchain, users may join any blockchain network and become nodes of the network , with liPermissionless blockchain technology allows users to trade NFTs without divulging their identities or undergoing Know-Your-Customer (KYC)  checks tThere are many assets that require significant effort and time to acquire, but NFTs do not fall into that category. NFT marketplaces  are some digital platforms where NFTs can be bought and sold. On this platform, users can store and display NFTs, as well as sell them for cryptocurrencies or money. Additionally, there are several NFT marketplaces  in which users can mint their own NFTs, making the process of processing and rendering them faster. There is also a straightforward process for listing your NFT on most NFT marketplaces . The NFTIn contrast to public blockchains, this type requires a permissioned blockchain, where members are strictly controlled, information is managed, and transactions are validated. Despite being a decentralized network and doing distributed structures, this network is controlled by one organization where the central authority decides who can be a node. The focus is on scalability, and they remove the idea of full transparency, as there is no consensus and only leaders can nominate validators. There is a private NFT ownership field that is currently available, but it is not part of the Ethereum, Solana, Binance Smart Chain, or other similar platforms; rather, it is an optional private metadata field. Through these, users can conceal ownership and transactions from the public, and everything happens on a secret network  and workEach version of blockchain has its own strengths and weaknesses, as you can see in Verifying transaction histories is very straightforward; depending on what blockchain you are using to buy, sell, and create NFTs, you can obtain data from a variety of sources. Every NFT purchase, sale, and cancelling the order, as well as all gas fees paid will generate a unique ID in a blockchain transaction. It all depends on the cryptocurrency used to purchase the NFT; for example, Ethereum, which is one of the most popular blockchains and comes with a tracking system called Etherscan . The plaThere are other blockchains as well, such as polygon—polygonscan  or SolanOver the past year, the NFT has grown, and a large amount of attention  has beenThis authentication ensures the identity of the digital user by requesting at least two pieces of evidence that the individual is who they claim to be. The factors must be categorically different from each other, but must be something they own, possess, or know. Using these factors when logging into an online account helps ensure that the user’s information will be protected, and even if one factor is compromised, the chance of another being compromised is low. In addition to a password, the second factor can be anything such as a security code sent to the user’s phone via SMS, voice, email, or biometric verification of your thumb or even face ID from the phone.These standard features are available on many cryptocurrencies’ exchanges and NFT platforms as of now as they revolve around buying and selling as well as storing digital assets. In the past, authentication methods were not required and were only optional. In March 2021, Nifty Gateway user accounts were compromised  and indiNFT is mainly intended to capture and claim ownership of digital assets, which are easy to access. Nonetheless, digital collectibles may also be the first sign of NFT vulnerabilities since they provide easy access to criminals. Due to the fact that cryptocurrencies lack a physical form, they’re difficult to trace when converted from cash into digital assets; also, as there is no physical form of cryptocurrency, laundering money is much easier in recent cases. Money laundering opportunities are increasing, and a BBC report said that crypto money laundering had risen to 20% in 2022 . A majorInterplanetary file system (IPFS)—in addition, it is one form of storing NFTs on the Sidechain, which decreases the chances of it being hacked. This includes a pinata, NFT storage, etc. The IPFS  content A link to an HTTP address where anyone can access the content if they pay the bills, but the content of that link isn’t guaranteed to be the same as the NFT created since the server owner can easily replace it with something new. In contrast, CID addresses are accessible by anyone if at least one copy is present on the network, and if the original provider disappears, the data in that address is still accessible and smart contracts can be used to update the ULR of a token by allowing you to change its URL while keeping a record of the original version in the blockchain transaction to ensure everyone knows who, what, and when the changes were made. IPFS makes for a more secure option when it comes to NFT storage, however, they remain vulnerable to computer hacking.It is important for users to consider storing their NFTs in a highly secure location since they don’t just cost money, but also hold sentimental value. This is where crypto  wallets In a crypto wallet, a series of words known as a seed phrase or recovery phrase is automatically generated at the beginning of the wallet creation process . This seAlso known as software wallets, these applications can be downloaded and installed on your computer, device, or any other electronic device. These include MetaMask, Wallet Connect, etc. A software wallet is generally more convenient and easier to use than a hardware wallet since it stores private keys online and is always connected to the internet. The use of a software wallet facilitates transactions on many marketplaces, making it easier to trade. However, since they are continually connected to the internet, they are more prone to scams, and malware attacks. Even with high-profit security measures, online wallets that store users’ security keys and codes remain vulnerable to hackers. A small mistake can wipe away all the assets forever. The best option in such situations is insurance .This type of wallet is also known as a hardware wallet and is essentially a USB stick that stores crypto keys and NFTs. Among these are Trezor and Ledger. With a cold wallet, it is necessary to physically plug into your computer to access your wallet, as all digital assets are stored within the device rather than online. The reason that they are often considered to be “cold storage” and far more secure than hot wallets  is that they can be completely isolated from the network. The other thing is that even if these devices are connected to the Internet, the items that are stored will be difficult (but not impossible) to compromise. This is because transactions are signed with the private key on the device and then the signature is broadcasted to the network. As a result, the private key will never leave the USB device. Due to this, malware, keylogger hackers, etc. won’t be able to receive the information required to falsify signatures (43). As far as wallets go, cold storage wallets are regarded as the most secure and impenetrable.NFTs are not all created equal and choosing a blockchain for an NFT can be extremely difficult. Unlike other blockchains, NFTs are non-fungible, which means prior assets do not appear on level blockchains, so there is also a difference in importance of mining based on the block times of each blockchain (mine a new block), which are all determined by the person who mines the NFTs, as shown in Ethereum is the largest and most popular blockchain for NFT projects . NFT marHowever, Ethereum’s popularity has come with its own set of drawbacks, such as its high transaction fees and energy usage. The main reason is Proof-of-Work (PoW) , which rA short time later, on 6 September 2022, Ethereum’s two-stage merger, codenamed Bellatrix, began, which has been completed, as well as the post-merge on 16 September 2022. Despite the success of the switch to proof of stake networking, ETH prices plummeted shortly thereafter by 8% to $1485; however, Glassnode predicts this drop was coming . The swiTPS performance: With sharding and Proof-of-Stake, it can process anywhere between 20,000 and 100,000 transactions. Moreover, Vitalik Butherin, the co-founder of Ethereum, has stated that Ethereum 2.0 will allow the primary smart contract platform to scale to 100,000 TPS according to the roadmap he has outlined .The Ethereum price fluctuates frequently and may increase or decrease within a short period of time. In any case, some analyses have been conducted that provides some of the forecast values for the future, and Anton Kharitonov of TU predicts Ethereum prices will range between $960.640 (the minimum price) and $2508.528 (the maximum price) by the end of the year, bringing the price to $1642 with its current volume at $17,781,331,143. Ethereum’s price is expected to increase up to $4781 (maximum) by 2025, and to $36,815 (maximum) by 2030 .After launching in 2019, Solana (Yakovenko n.d.) is one of the biggest candidates to potentially outsell Ethereum with NFTs. There are over 400 projects in NFTs, DeFi, and general Web 3.0 applications. Aside from its high performance , it is oA unique feature of Solana is that it combines Proof-of-history (PoH)  with ProDue to its lack of widespread use, Solana has fewer NFT markets and fewer people trading on the Blockchain. Despite it being relatively new, Solana still shows great promise and with its high performance and low fees, it deserves attention as a mining and trading ecosystem for NFTs.TPS performance: on average, Solana network currency processes data at a speed of 3000 transactions per second. In spite of this, it can provide up to 65,000 transactions per second due to a feature called byzantine fault tolerance that reduces time and increases efficiency. In the future, it is expected to be capable of reaching 710,000 transactions per second .A price decline of 8.88% has been recorded in the past 7 days for Solana. According to analyses, the price will be at least $33.43 and as high as $36.63 in 2022. With a trading volume of $1,406,822,560 as the year carries on, analysts have predicted a minimum price of $65 and a maximum price of $85, by 2030, and further down the line, the minimum price will be $160, and the maximum price will be $200 [The Polygon project is based on Ethereum and offers scalable, secure, and instance-based transactions. As well as being known as layer 2  solutionIn various markets, like OpenSea and others, Polygon has been used to sell NFT projects. Due to its scalability and compatibility with Ethereum virtual machines (EVM) (Ethereum 2022), this blockchain can build scalable solutions that are also compatible with faster transactions. As Polygon is a dynamic platform, there are no upfront costs when you create an NFT, but there is a fee when you sell it. Since many people are unfamiliar with Polygon, there are a limited number of people willing to buy NFTs built with Polygon, as well as their reputation for being challenging for beginners.Despite Polygon being a partnership, it still uses the ERC-20 tokens , which aTPS performance: Polygon currently offers the fastest transaction speed, which can reach 65,000 transactions per second. It is layer 2 of Ethereum that provides a hybrid environment. The other thing to keep in mind is that even with the Ethereum 2.0 merge, it will not be able to beat Polygon’s TPS.The current trading volume for Polygon is $242,728,655. Trading Beasts estimates MATIC will reach $1.17 by year’s end, but there is a possibility that the price could drop. However, by 2024 there is a possibility that MATIC prices will rise again, potentially reaching a $2.2 maximum with an average price of $1.8 and in 2030 there is a possibility that MATIC prices will reach a maximum of $19.14 (maximum) and that prices will average around $16.26 on average .In 2017, Binance , the worThis blockchain (BSC) is now known as BNB (build and build) chain network and it supports Ethereum DApps and tools, which makes it easier for developers to import projects from Ethereum blockchain with ease. As BNB chains are superfast, they can accommodate high levels of transaction rate with low fees in most of their NFTs projects.Despite this, BSC is largely centralized, and centralized systems are more prone to system failure, threats, regulations, and even hacking. However, the consensus model  known asAs they are a fast and affordable blockchain for one’s project, BNB NFTs is a good option to exchange NFT earnings without breaking into other apps.TPS performance: There are only a few cents charged per transaction in Binance smart chains, and their network speeds reach around 300 transactions per second. As of now, Binance has transitioned to a new blockchain network known as BNB chain, which is currently capable of supporting 100 million addresses and 10,000 transactions per second .The current trading volume of BNS is $1,029,723,473. The coin is currently trading at $273.82, and the prediction is that in the long run, it can be a profitable investment. In 2025, its price is expected to increase by a massive amount, reaching $2394 at its maximum and $840 at its minimum. It has been predicted that coin prices could even increase to $15,622 at the highest and $10,949 at the lowest by 2030, based on input from multiple sources including Trading Beasts, Wallet Investor, Bitcoin Price Forecast, etc. (Education 2022).Founded by Ethereum co-founder Charles Hoskinson, Cardano is a distrusted proof-of-stake blockchain. With its 2017 release, it has become one of the top five cryptocurrencies on the market. It was primarily created by experts in the blockchain industry without whitepaper and was peer-reviewed. With its platform, transactions are settled in its native currency and scalability is prioritized. Additionally, cardano is an eco-friendly blockchain.Its slow upgrades have been criticized recently, and the value growth in NFT trading hasn’t been spectacular. In accordance with an analysis done by Adilin Beatrice (Beatrice 2021), they start at $2 in 2022 and rise to $4.1 by year’s end so it is unclear if Cardano will rise above or fall short because of their poor value, which could lead to them falling short.It did, however, gain some traction in November when it hit 200,000 transactions per day, and they are currently working on optimizing the growth of the network and scaling to handle more TPS . Aside fSimilar to Binance’s blockchain, Cardano uses Ethereum Virtual Machine to support Ethereum-based smart contracts and DApps. This is a great starting point for newcomers to start minting NFTs as it has low gas charges, and fast transactions, as well as being the most accessible blockchain for those interested in minting NFTs. This is due to the fact that the API for working on the blockchain is provided as a free community service, allowing them to communicate directly with the blockchain nodes or client networks.TPS performance: The Cardano scaling solution hydra will be a game-changing upgrade because they have previously said it will be able to handle 1 million transactions per second (TPS), but nothing is certain yet. However, Cardano has increased its block size by 12.5% to allow more transactions per block, resulting in a higher transaction rate .As of right now, Cardon has a trading volume of $937,024,032. Based on price predictions for 2022, the minimum cost of cardano will be $0.419, while the maximum will be $0.44996. According to the previous estimates, prices might drop to $1.27 as of 2025, but there is a possibility that it can reach $1.62. According to the various crypto exerts, the coin price is estimated to average around $8.41 by 2030 with a maximum peak of $9.41 [NFT marketplaces  are platforms to buy, sell, and trade NFT assets, and this includes OpenSea , which iPeople are increasingly interested in digital assets these days. From a purely economic standpoint, the reason people are so interested in the NFT ecosystem and market is that they outperform cryptocurrency in sales volume and conversation. As the wheels of the NFT movement have turned and grown in this recent month, the number of NFT buyers has skyrocketed. In late 2017, the popularity of collectible CryptoKittes led to the first significant growth of NFTs, with the total weekly sales increasing from 100 to an average of 15,000 to 50,000. This occurred after around 22 November 2017, when a rare cat was sold for an extremely high price, and since CryptoKitties have so many attributes, it is difficult to put an actual value on them, but due to their rarity and Gen 0 status, they were worth over 200 Ether, and many people started looking for their own rare cats. Within the next few years, the sales went from 30,000 to 80,000 per week . AccordiConsidering the high level of sales, it should come as no surprise that so many people want to participate. The NFT marketplace is the gateway to buying and selling these digital assets.NFTs are commonly used to sell digital collectibles  and can be sorted, shared, and traded through emerging NFT marketplaces. To accomplish this, there needs to be a transparent, immutable ledger  that logs who owns what and where the files are located. The blockchain secures all of these, including transactions, cryptographically. As part of the blockchain, there is a digital proof of ownership, and this ownership is represented as tokens for all NFTs/digital collectibles. In addition, it is because of the blockchain that we can buy, sell, and trade these digital goods without the fear of double spending  or tampeThe ecosystem of NFTs is divided into three parts: content creators, sellers, and buyers. As you may be aware, content creators create digital content from raw data and upload it to hosting services. Host services are an external database outside of the blockchain that makes raw data  available to the public. Some content creators are not technically skilled enough to convert their work into an NFT and sell it on the blockchain. This is where marketplaces permit sellers to mint NFTs for sale, but creators can also sell them if they have the skills. Upon listing the digital assets on a marketplace  , buyers On-chain, all events related to the NFTM are live on the blockchain, which means that tokens and images are validated by an attribute-based signature (ABS) [Off-chain, all events are recorded in a centralized database (cloud) and are encrypted; that encrypted data is then stored in an off-chain database (apps) rather than directly on the blockchain, making it less expensive for the user to operate in NFTM. These models are utilized by marketplaces such as NFTrade, Nifty, among others. If stored on a Hybrid-chain, this hybrid model combines both On-chain and Off-chain events, ensuring data transparency and integrity while connecting On-chain and Off-chain with cryptographic checks, providing the level of decentralization and security that users expect. These models are used by marketplaces like OpenSea and Rarible.A decentralized app platform is an essential component of the NFT ecosystem, through which NFT assets are traded. Users can send transactions through the web app to a smart contract that implements the NFTM protocol and blockchain, as well as a token contract on their behalf, allowing them to perform a variety of tasks, such as mining and trading, and each of these tasks is referred to as an Event. In NFTM protocols, these events can be stored off-chain, on-chain, or in a hybrid chain . If storre (ABS)  and direSeveral serious security incidents have occurred because of the influence of the Non-fungible Token (NFT). Since they are one of the most well-known digital assets right now, they are bid on and sold for millions of dollars. According to OpenSea, which is one of the largest marketplaces, 2.4 million NFTs  were solNFT marketplaces require cryptocurrency wallets to participate. The challenge here for NFT holders is that attackers can find their way into users’ crypto wallets through the marketplace accounts they have created. The NFTM platform is also more like a centralized platform, similar to Open Sea and Nifty Gateway, where all assets on the platform are controlled by them. If the platform/Marketplace is compromised, hackers could take large amounts of NFTs just as they did with Nifty Gateway . The folThe easiest tasks for malignant actors are often those that require low effort and are often automated, such as phishing and social engineering. Moreover, these types of attacks a wide range of users because most NFTs or high-value operators are well-known, which makes it easier for malicious actors to study them.The purpose of phishing attacks  is to trPossible Solution: There are many different kinds of Phishing attacks, and the solutions for these kinds of attacks vary. To mitigate this risk, never click on links that seem random or suspicious. Use an anti-phishing toolbar on your electronic devices to prevent malicious attacks and install a firewall to protect your device from untrusted networks. It is a smart idea to regularly check one’s account for fraudulent transactions and perhaps change passwords as well. On 18 February, OpenSea was preparing to implement a smart contract upgrade that asked all users to migrate NFT from the Ethereum blockchain to a new smart contract. As the upgrade was happening, hackers launched a sophisticated phishing campaign, which allowed them to steal NFT from the storage platform. During the investigation, it was discovered that the attack originated outside of OpenSea website. This was done by sending fake emails that clearly stated that users should be educated and that marketplaces would never contact users via email besides registering with them. Another possible solution would be to use hardware wallets since software wallets and other custodial solutions are too vulnerable in their design and operation externally .In rug pulls, a team pumps a project’s token, then disappears with the funds, leaving investors with worthless assets. Essentially, this issue comes in two forms: hard pulls, in which developers walk away or add malicious code to tokens from the start, which affects the token value (liquidity pulls), and soft pulls, in which creators sell large amounts of tokens or sell them in increments, lowering the value and making them worthless. Due to the free market, developers are not illegally selling their tokens, which makes them harder to identify.This ice-cream-themed NFTs collection had built a sizable community by marketing itself as “cool, delectable, and unique” and priced their NFTs at 0.004ETH per mint. After the entire collection of that project was sold out, the founder  withdrewIn Solanart Marketplace, the first and largest fully fledged NFT marketplace mined using Solana blockchain, another rug pull occurred. There were over 2222 ape-themed NFTs included in the collection titled Big Daddy Ape Club (BDAC), but things went sideways here . It is rPossible solution: The first step to avoiding scams or rug pulls is to identify the RED FLAGs of the project prior to investing. Look at the community and personal information of the team and check their social media for updates to determine the status of their development. Due to the fact that they can have fake Twitter or Discord followers or accounts, it is a smart idea to do a quick check. For example, if an account has 120 k followers and only 50 likes, this is a red flag . Low traAs an asset-ownership record, NFTs that can be stored on the blockchain by using smart contracts as blockchain technology are extremely transparent, allowing one to view the total amount of coins and volume of transactions. The NFT project is divided into 2 parts—the smart contract and the metadata for the artwork itself. A smart contract exists on a blockchain  and is governed by rules and regulations that facilitate transactions and provide a description of the artwork’s content. Conversely, digital artwork is stored outside blockchain, or “off-chain”. With off-chain servers, images are centralized within the Interplanetary file system (IPFS) or a company. One problem is that if the server goes down, the images will be lost, thereby losing the NFT collection. Aside from the content of the artwork, each transaction within the marketplace includes information regarding each transaction: the address of the seller, the price, the time of transfer, and the price at which it was sold. Due to the fact that all these records and transactions are stored off-chain, it is impossible to verify any trades or ownership history. A malicious NFTM could take advantage of this situation by forging spurious sales records, tampering with the records, censoring, etc. if the NFTM database were to collapse. Some of the marketplaces that maintain off-chain records include OpenSea, Nifty, NFTrade, and Fauna . In essePossible Solution: In some cases, these issues are also about trust. Do you believe that NFTs are legitimate markets, or just the ones you’re buying from, and did the organization behind them ensure reliable access? These are the questions you should ask before purchasing an NFT project. Two main blockchain-related differences exist among these marketplaces: 1. The public network is extremely secure (immutability because the hash function serves as a security protocol), public, anonymous, and fully decentralized. Finally, there are no regulations, and it is completely transparent, which means that corruption and discrepancies are impossible. 2. In private blockchains, all information is private. Users are protected from unauthorized access, the service is stable, and transaction fees are low. No illegal activities are permitted, and regulations are clearly outlined. In both cases, each has its own pros and cons, and it is up to the user to decide which one will be most suitable .Peer-to-peer trustless transactions have been possible due to blockchain technology. With this technology, every transaction is recorded on the public network and cannot be changed because of its immutable digital ledgers. As an added bonus, creators can also pre-programme their royalty condition into their work. EIP-2981  an NFT rIt Is currently difficult to integrate different markets within the NFTM since they are not designed to be compatible with each other. Despite the fact that smart contracts enable peer-to-peer transactions, they are unable to communicate across different blockchains, so royalties set on one NFTM platform are not visible to others. By exploiting this lack of coordination, malicious sellers may be able to evade royalties by trading NFTs on platforms where the royalty is not set, and the creator cannot prevent buyers from listing the NFTs on other marketplaces, resulting in the sale of every NFT and missing out on these sales royalties .Fee evasion is another issue, as the ERC-721 token contract does not enforce the royalty or marketplace fees, so even though NFT royalty fees are incorporated into the NFT contract themselves, they are completely voluntary since there is no way to distinguish between a transfer and a sale, and only marketplace contracts/off-chain infrastructure pay creator royalties. Therefore, malicious sellers have the option of transferring NFTs directly to the buyer to avoid this payment or settling the payment off-platform. They can also be levied (Tax), making the API  transferPossible Solution: A solution for royal distribution and marketplace fee evasion is to use the universal token standard. In doing so, creators are able to keep their royalties and have them accepted across all marketplaces. This ensures they receive credit for the work they have put into their creations. New generations of smart contracts designed to facilitate new types of transactions, such as subscriptions, can be used to share future sales of NFTs with creators . Co-founWith the growth of NFTMs in 2021, the level of interest and financial gains in NFTMs has been immense, and as most people are aware, NFT collectibles are minted and traded using the Ethereum blockchain network, with the most popular marketplace being OpenSea and SuperRare. An NFT, however, despite its price range from $10–$10 million, is not an immutable asset, but rather an immutable link that points to a location where the assets are held on Wallet or IPFS.During research into the structure and storage being offered on the platform, it was discovered that there were two types of data being offered on the platform: on-chain and off-chain, a result of scaling limitations and the cost of supporting large amounts of on-chain content data because the more often the network was used, the more expensive it became. As the price of each transaction increases, so does the cost of storage, which is why many marketplaces use off-chain storage, such as SuperRare, which collects and trades digital art. It is indicated that the assets’ metadata that is associated with NFTs on SuperRare has been stored on Interplanetary Files (IPFS) indicating that these assets were created authentically by creators (artists) . This foPossible solution: Use smart contacts to store files in a network of storage via peer-to-peer sharing. For example, multiple copies of a file can be kept. In the event that one storage location is unavailable, the data is still available elsewhere. Aside from this technology, there is also Distributed Hash Table (DHT), which stores data in a storage location purchased by the consumer. In addition, there are other options available for storing NFT, including Software wallets, which are encrypted with a password and done by a browser, Interplanetary File Systems, which act as an off-chain storage solution for NFT, reducing the risk of a hack, as well as the Hard wallet, which is the most secure method of keeping NFTs and your data offline with a password that makes them unbreakable .As far as the NFT marketplace is concerned, gas costs are currently the biggest issue, especially when minting NFTs on a large scale that requires storing their metadata. Due to the computational power and storage requirements of blockchain networks, even a straightforward transaction can be very expensive. A huge gas fee is currently required for Ethereum NFTs users to purchase NFTs on the Ethereum network, which is a difficult experience for them. The gas cost for all NFT transactions skyrocketed to $3300 during the recent Bored Ape NFT sales . Even foAnother purchase cost $44,000 in gas fees for a plot of virtual land known as OtherDeeds which will soon launch a metaverse game called Otherside and was purchased by Yuga Labs (the company that created the Board Apes Yacht collection) . As the A possible solution would be to use layer 2, as the polygon is the largest on the Ethereum network right now with its sidechain. Immutable X is another marketplace that uses Immutable X as layer 2 and offers zero gas fees for its on-chain NFTs. The other way to reduce the cost is by choosing the right timing, such as the peak period of the Ethereum network where gas costs 40 GWEI and the low point 8.1 GWEI (on the same day). If time isn’t a concern for the user, then choosing a slower transaction may actually help you to save on gas fees; however, it’s critical not to make it too slow .This article reviews the pillars of NFT and NFT marketplaces and analyses them in terms of their security, scalability, and transparency. An evaluation was conducted on the top 5 blockchains for NFT, as well as the top NFT marketplaces. The challenges facing the NFT marketplace in terms of scalability, transparency, and security are also reviewed. Currently, the NFT is being adopted into a growing number of fields and has created several opportunities for the industry. For this reason, many blockchains are now adopting and developing layer 2 protocols, which will speed up transactions and reduce gas charges. They are also working to have two or more authentication factors and verification methods, in order to mitigate the majority of security threats. This would increase the size of the NFT market and allow NFT mechanisms to be applied to various new domains. Some of the future NFT applications that would impact the mass populations are summarized below:There are many forms of NFT ticketing, from physical paper to smart cards/wristbands with electronic codes, which can provide access credentials to any event such as sports or culture. Ticketing systems allow customers to purchase tickets directly from the event organizer or from authorized sellers on the primary market. By creating tickets with NFTs, consumers are protected from malicious invaders because they have more control over the resale market  than theThroughout the history of the video game industry, players have always had this need for digital properties whether it is skins for customizing the game or in-game items  and the ability to trade them, but there is no alternative to trading them in-game, so most people just sell their whole account, which is linked to their email address, . In factA virtual reality where people live, work, shop, and interact remotely. The combination of these technologies indicates what’s next for the internet. The Metaverse was originally developed for online multiplayer games, but now both gamers and non-gamers can benefit from it. The Metaverse of Decentraland  is a 3D In addition to these, there are many more areas where NFTs have the potential to benefit, but I believe these are some of the closest to being achieved and are those being worked on by many now.