Public Health Institute Journal (LJMU)
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Knowledge, attitude, perception, and practice of exclusive breastfeeding among lactating mothers in low-income countries: A systematic review
No full textBackground: Exclusive breastfeeding is one of the critical determinants of maternal and child health, particularly in low-income countries, where it can considerably impact infant survival and development. Notwithstanding this, the rates of exclusive breastfeeding remain very low in such places, often being influenced by a host of factors. This present research has sought to review knowledge, attitudes, perceptions, and practice (KAPP) on exclusive breastfeeding among lactating mothers in low-income countries.
Methods: A systematic review methodology involved sourcing and compiling data from multiple studies on exclusive breastfeeding in low-income countries. The review included qualitative studies, community-based cross-sectional studies, systematic reviews, and meta-analyses. Data were extracted about the participants\u27 knowledge and understanding of exclusive breastfeeding; participants\u27 attitudes and perceptions; actual breastfeeding practice; and the socio-economic, cultural, individual, and health system factors that impact these elements. This is a systematic review that appraises and summarises all available studies regarding KAPP on exclusive breastfeeding among lactating mothers from low-income countries.
Results: Several determinants at the different levels that impact exclusive breastfeeding practice were identified through this review. Accordingly, attitudes toward and practice of breastfeeding are highly influenced by social norms and cultural beliefs, with community and family expectations often at the forefront in driving mothers\u27 decisions. Socioeconomic factors, such as income, education, and accessibility to health facilities, may also influence; lower socioeconomic classes tend to have a reduced rate of exclusive breastfeeding.
Conclusion: Results suggest the interplay of social, economic, cultural, and environmental factors in shaping the practice of exclusive breastfeeding in low-income countries. Target interventions aimed at changing such determinants could be effective for shifting breastfeeding rates significantly higher and hence improving maternal and child health outcomes. This research would, therefore, strongly emphasise comprehensive approaches to education, formulate policies, and involve communities in the support and promotion of exclusive breastfeeding among lactating mothers. 
A systematic review on tackling obesity in children through effective interventions in primary school-based settings in the United Kingdom
No full textBackground: Childhood obesity is a significant public health concern world-wide and in the UK. The long-term effects of obesity are dangerous when not addressed and this includes diabetes, chronic heart diseases, lower quality of life and many more. Interventions have been developed to aid in tackling childhood obesity in primary school-based settings, as children tend to spend the majority of their awake time in schools. This systematic review aimed to identify interventions that effectively tackle childhood obesity in primary schools and evaluate the quality of the evidence provided.
Methods: A comprehensive search was conducted in 2024 using EBSCO Medline, CINAHL and grey literature from Google Scholar. A search strategy was developed using the PICO framework as recommended for quantitative studies. The inclusion criteria included studies in the UK published between the year 2014 to 2024, and interventions with outcome measures aimed at tackling childhood obesity, such as a healthy body mass index, waist circumference, increased levels of physical activity, and a healthy lifestyle. The review included children between the ages of 5 and 11 years old.
Results: The systematic review included a total of eight studies that met the inclusion criteria. The results showed that five of these interventions were effective in tackling childhood obesity in primary schools. The results also addressed the limitations of the studies and reasons for the ineffectiveness of the other studies. The results showed that various intervention methods, when combined, effectively tackle childhood obesity such as walking, healthy eating in school and nutritional education.
Conclusion: This systematic review provided information on possible effective interventions to tackle childhood obesity in primary schools in the UK. The review identified the limitations of the studies and provided some recommendations to aid in filling the gap in this research. 
Exploring socioeconomic mechanisms that drive harmful alcohol consumption in the UK: A scoping review
No full textBackground: Alcohol, one of the oldest and most widely consumed psychoactive substances, holds a complex role across diverse societies. It can induce pleasure and relaxation but also poses significant risks, including cognitive decline, addiction, and a range of physical and mental health issues. In the UK, the Chief Medical Officers\u27 guidelines recommend a maximum of 14 units of alcohol per week to minimize health risks, with consumption exceeding this threshold classified as harmful. Harmful alcohol consumption contributes to over 200 diseases and is responsible for approximately 3 million deaths annually, accounting for 5.3% of global fatalities. Beyond its health impacts, excessive drinking imposes substantial social and financial burdens. Socioeconomic status plays a critical role in these outcomes, with individuals in lower socioeconomic groups more likely to engage in harmful drinking due to factors such as economic stress, limited access to resources, and cultural norms. This disparity is evident in higher rates of alcohol-related illness and death in disadvantaged areas, underscoring the need for targeted public health interventions to address these socioeconomic inequalities.
Methods: A systematic search of electronic databases PubMed and MEDLINE for pertinent studies on the socioeconomic factors influencing harmful alcohol intake in the UK in order was conducted. The initial search involved screening titles and abstracts for relevance, followed by a detailed review of full-text articles to ensure inclusion based on predefined criteria. This comprehensive approach enabled a broad range of literature and insights on the interplay between socioeconomic factors and harmful alcohol use.
Results: A total of 11 studies were included in this scoping review. There were a variety of methodologies across the included literature including cross-sectional designs, longitudinal studies and birth cohorts. Five themes were identified: economic status, education, employment, social environment, and life course socioeconomic disadvantage.
Conclusion: This scoping review highlights the significant impact of socioeconomic factors on harmful alcohol consumption in the UK, revealing that economic stress, educational attainment, employment status, and social environment play crucial roles in influencing drinking behaviours. The findings underscore the need for targeted public health interventions to address these socioeconomic disparities and reduce the burden of alcohol-related harm. 
A qualitative study exploring how young people aged 18-25 in the UK feel about alcohol content on social media outlets and does this influence alcohol-related attitudes and behaviours
No full textBackground: It is known that young people are the biggest users of social media on sites Instagram and TikTok they the highest number of users with the age range of 18-25. In recent years content creators have begun making profit from promoting products and giving an opinion to their following. In turn this has generated brand exposure and increases in sales for brands. Influencers are an important part of today\u27s culture, have a massive social media presence and their opinions are important to young people. Young people are known to engage in binge drinking, however over recent years there has been a decrease in young people drinking alcohol with sober content creators are now present on Instagram and TikTok. This study aimed to explore how young people feel about alcohol content on social media outlets and how this influenced their alcohol-related behaviours.
Methods: A qualitative approach was undertaken. Six participants were selected by a constructed social media post and an email on the University Canvas by chosen gatekeepers at Liverpool John Moores University. Semi-structured interviews were conducted on Microsoft Teams, recorded and transcribed. The results were analysed using thematic analysis.
Results: Eight themes were generated: 1) Personal relationships with alcohol, identified variations in young people\u27s relationships with alcohol between controlled drinking and binge drinking. 2) The normalisation of alcohol on social media found that alcohol content is being shared and glamorised frequently 3) Influencers are promoting alcohol in a way to potentially encourage people to drink alcohol regularly. 4) The portrayal of gender within Instagram and TikTok alcohol content with many participants feeling alcohol brands promote products and utilise masculine and feminine social norms to create content. Young people felt more likely to consume alcohol products if seeing online content promoted by someone from the same gender. 5) Young people\u27s influence from alcohol content with frequent exposure influencing young people to drink alcohol more regularly or consume products they are seeing online. 6) Social media influencers and relatability, young people do express that they find influencers relatable and if the alcohol content appears authentic and more likely to consume alcohol brands if an influencer promotes it. 7) Sober content creators are now a prominent figure on Instagram and TikTok, young people feel that their presence is a positive thing for young people to normalise alcohol issues within that age group. Although it was suggested that unrealistic expectations may be put on individuals to live alcohol free. 8) Paid brand collaborations were explored, and many young people felt this new marketing technique was not an issue online, although the recurrent daily exposure may cause issues for young people.
Conclusion: To conclude young people have expressed that seeing alcohol content online encourages young people to drink alcohol. Young people recognise influencers are a vital part of modern marketing and that advertisement via social media influencers is more likely to encourage them to purchase an alcohol product. The risks of alcohol where often not discussed by brands or influencers and while sober content creators were said to bridge this gap young people felt there could be some bias in this content. Overall, young people felt exposed and often venerable to marketing of alcohol and use of alcohol on Instagram and TikTok.  
How poor access to health care impact on maternal health in Nigeria
No full textBackground: The presence of society inequalities, inadequate infrastructure, and cultural elements that aggravate the limited access to healthcare in Nigeria has made it progressively difficult to achieve ideal maternal health in Nigeria. Nigeria still boasts among the highest maternal mortality rates globally even with several interventions. This paper aims to investigate carefully qualitative studies on how limited access to healthcare influences mother health outcomes in Nigeria. The objective is to identify main factors either facilitating or hindering these outcomes.
Methods: The follwing databases were searched extensively: PubMed, CINAHL, and Medline. The search was limited to research publications published between 2015 and 2024. The chosen keywords were "Nigeria," "maternal health," and "healthcare access." The inclusion criteria was qualitative research observing elements allowing or blocking access to maternal healthcare, and the researchers followed the PRISMA guidelines and applied thematic analysis to identify repeating patterns.
Results: The study revealed several main challenges to maternal healthcare accessibility in Nigeria including insufficient healthcare infrastructure, outrageous medical costs, poor attitudes of healthcare professionals, and societal preferences for traditional birth attendants. Rural areas presented special challenges because of their clear geographical and socioeconomic differences. Accessibility was improved by elements including health insurance coverage, community involvement, and educational campaigns meant to raise knowledge of the advantages of official mother healthcare. While social responsibility initiatives and the Midwives Service Scheme could help to increase service use, their success has shown variations depending on the area.
Conclusion: In essence, the present systematic review highlights the complicated interaction of elements preventing the availability of maternal healthcare in Nigeria, so aggravating the high rates of mother mortality and morbidity in the nation. To address these problems, a comprehensive strategy including bettering the quality of care given by healthcare professionals, motivating community involvement, increasing health insurance coverage, and modernising infrastructure is needed. Policymakers, legislators, and medical professionals wishing to create specific interventions to improve mother health outcomes in Nigeria and support world health initiatives including Sustainable Development Goal 3.1 will find great benefit from the results of this study.
The attitudes and perceptions of international university students towards organ donation in the United Kingdom: A qualitative empirical study
No full textBackground: Organ transplantation is one of the ultimate treatment modalities for patients with end-stage diseases. However, the demand for organs is not met because the demand always surpasses the supply which makes it a public health concern. Attitudes and knowledge of international students towards organ donation in the UK has been shown to affect donation rates among ethnic groups in the UK. The main aim of this study is to explore the knowledge, attitudes and perceptions of international students in Liverpool John Moores University towards organ donation in the United Kingdom.
Methods: A generic qualitative approach was used to gain insights into international students’ understanding and awareness of organ donation at LJMU. It involved four focus group discussions with a total of 19 participants among international students studying at LJMU. Thematic analysis was used to identify, analyse and interpret meaningful themes.
Results: The results of this study showed that participants had a basic knowledge of what organ donation is and zero knowledge of the organ donor register and opt-out system in the UK. Also, most of the participants stated they were not willing to donate their organs, except for a family or a loved one. Most participants would not be willing to register on the UK organ donor scheme. Participants had a negative attitude and reaction towards the opt-out system currently in place. Furthermore, the data showed that religion, cultural beliefs, mistrust of the healthcare system, compatibility issues, and lack of awareness and knowledge are major barriers to international students enlisting on the organ donation scheme in the UK.
Conclusion: These findings highlight a crucial challenge for public health initiatives aimed at increasing organ donation rates as there is a gap between international students’ general willingness to help loved ones and their broader acceptance of organ donation as a societal norm. The study’s findings emphasize the urgent need for targeted education and awareness campaigns to address knowledge gaps about specific organ donation mechanisms and systems. Enhancing familiarity with the organ donor register and understanding the opt-out system can significantly increase donor registration rates and public trust in the organ donation process. 
A quantitative study investigating the influence health content on TikTok has on 18–27-year-olds supplement purchasing decisions
No full textTikTok launched globally in 2018 and has evolved from a lip-syncing app into a significant social media platform known for its short-form video content, which continues to grow. What began as a platform for dance challenges and comedy sketches has transformed into a space where content creators can build substantial followings and influence consumer behaviour across industries. Influencers have played a significant role in purchasing decisions for years, predating TikTok on platforms like Instagram. These influencers aim to influence consumers with their thoughts, attitudes, and opinions and, in return, significantly impact trends in demand for a particular product. With this upper hand, companies have begun to utilise these influencers as a channel to market and sell their products. This poses a health risk and a potential public health risk when promoting particular health products or practices that may be potentially dangerous, including health supplements. In addition to influencer content, users also post health content on the platform, recommending products they have used and sharing their experiences with various health situations. This sharing allows communities to build with the platform, but it also breeds misinformation that may contribute to unsafe supplement purchases. This study aimed to investigate the relationship between health influencers\u27 marketing on TikTok and the supplement purchases of young adults. A survey was conducted with participants who had been using TikTok for six months or more between the ages of 18 and 27. The researcher used convenience and snowball sampling to gain responses from 71 people. The data produced was analysed using SPSS, and question responses were compared with TikTok dynamics, such as how often respondents use TikTok, and if they follow any health or wellness influencers. The results of these analyses were presented in bar charts, pie charts, and tables. This study revealed a statistically significant relationship between TikTok usage and the frequency with which participants encounter health content. It was revealed that 24.29% of participants have purchased supplements through TikTok. A significant relationship was also identified between following health influencers and trust in their recommendations, with those following multiple influencers showing higher trust levels. The findings of this study suggest that while young adults maintain some critical evaluation of influencer claims, a contradiction exists between stated preferences and actual behaviour. The research indicates that exposure frequency, trust in relationships, and engagement intensity with influencers impact purchasing decisions, highlighting the powerful and persuasive nature of TikTok\u27s delivery system. This calls for a need for higher levels of health literacy within society and better guidelines when it comes to advertising on social media
A study investigating the knowledge and awareness university students have surrounding Pre-exposure prophylaxis (PrEP) and any stigma that surrounds taking it
No full textPre-exposure prophylaxis (PrEP) is a somewhat of a taboo topic in the UK with low public knowledge and awareness and research still emerging. PrEP is a revolutionary and highly effective new drug but the uptake levels are still lower than they should be. A higher understanding of PrEP is crucial. Educating in schools, universities and colleges would be extremely beneficial for the uptake of PrEP. The aim of this research was to investigate the knowledge and awareness of PrEP in young people and the stigma surrounding it. A total of 25 university students completed a online anonymous questionnaire, the questionnaire investigated the knowledge of what PrEP was, how it is used, the effectiveness of PrEP, their knowledge of HIV and AIDs, how sexually transmitted diseases are spread, where to access PrEP and the knowledge of stigma and self- stigma in university students. The main findings of the study were that most individuals had heard of PrEP and when trying to explain what it was used for or who would benefit most from it, answered the question wrong or did not know. Another main finding was that the majority of the participants knew how sexually transmitted infections were spread but did not know that PrEP was a preventive rather than treatment. It is evident that there needs to be more education and research to maintain the uptake of PrEP use. Even though my study was small scale I would hope that the research completed and the questions asked have contributed to some people researching PrEP and possibly even considering taking it in the future
The effect of infertility on women’s sexual behaviours and attitudes
No full textThis literature-based dissertation provides an exploration into the experience of women facing an infertility diagnosis. Infertility, defined as the inability to become pregnant after 12 months of regular and unprotected intercourse, effects millions of people worldwide. This dissertation will focus on the effect it has on women excluding any impact on men. This review delves into the impact of infertility on a woman’s psychological well-being, social experiences, and relationship dynamics. However, the main focus of this dissertation is to investigate what impact an infertility diagnosis has on a woman’s sexual attitudes and behaviours. It hopes to examine how cultural and societal expectations of motherhood influence the sexual well-being of infertile women as well as, to investigate the psychological and emotional impact of infertility on the sexual well-being of affected women. Consistent themes are highlighted within this review such as, a decline in sexual desire, the psychological toll that infertility has on women and an emotional disconnection within relationships. This study also highlights the significant role of cultural and societal expectations in shaping a woman’s experience of infertility. Moreover, it explores the impact on a woman’s self-esteem and self- worth and how this impacts their attitudes towards sex and their sexual behaviours. The dissertation provides recommendations on how better support can be provided for infertile women, for example, implementing psychosexual support into fertility treatments. Additionally further research into the link between female infertility and sexual orientation has been suggested in this dissertation as a way to harness a deeper understanding of infertility’s sexual, psychological and relational impacts as well as to improve the inclusivity of fertility support
Perceptions of vaccine ideology following COVID-19 (regarding AstraZeneca and Pfizer): Health and Social Care Dissertation Prize Winner
No full textThe COVID-19 vaccination rollout to date has been a momentous and rapid response to a worldwide pandemic taking the lives of over 7 million people. Undoubtedly, the most effective method of disease transmission prevention is through immunisation and the COVID-19 vaccines have had a significant impact on protecting the public. The Medicines and Healthcare products Regulatory Agency (MHRA), working alongside Public Health England, has developed and performed clinical trials to initiate the rollout of vaccines such as AstraZeneca/Oxford and Pfizer/BioNTech to the UK public. By August 2022, it was estimated 50 million individuals had received their first dose of the vaccine. With the prominence of vaccinations over the past years, the perception of vaccination ideology has been at the forefront of individuals’ lives, with the media and organisations presenting conflicting opinions. With this, vaccine hesitancy and the spread of misinformation have become contending factors in the prevention of vaccination rollout, therefore sparking an uproar of mistrust in the UK government and healthcare organisations. This study aims to explore these issues further by understanding personal experiences in relation to AstraZeneca and Pfizer and potential Adverse Drug Reactions (ADRs), further exploring individuals’ perceptions related to vaccine ideology. A sample of 100 participants were recruited via snowball sampling to complete an online questionnaire to provide quantitative results, with partial qualitative data to allow for interpretation of their attitudes linked to the COVID-19 pandemic and vaccines. Although current epidemiology acknowledges potential minor side effects of the vaccine, as well as rarer more significant effects, this undergraduate study explores the more extreme ADRs experienced by participants, especially the experiences of individuals who were part of a vaccine damage forum, and the effect this has had on their perceptions of vaccine ideology and hesitancy. Results emphasised the overall mistrust individuals feel towards the UK government and NHS and the need to control the spread of misinformation and conspiracies spread via the media in order to suppress levels of vaccine hesitancy amongst the UK population
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