In this era of technology development, every business wants to equip its salesforce with a sustainable salesforce automation system to improve sales performance and customer relationship management (CRM) capabilities. This study investigates the impact of big data analytics (BDA) on CRM capabilities and the sales performance of pharmaceutical organizations. A research model was tested based on 416 valid responses collected from pharmaceutical companies through a structured questionnaire. Structural equation modeling (SEM) was employed using Smart-PLS3 to confirm the contribution of BDA to improving CRM capabilities and sales performance. The study finds that individual characteristics such as self-efficacy, playfulness, and social norms, along with organizational characteristics such as voluntariness, user involvement, user participation, and management support, are positive predictors of salesforce perception of BDA. This positive perception of BDA increased the person-technology fit in the salesforce, which ultimately increased the CRM capabilities and sales performance. Current advances in information technology (IT) and the rising trend of social media have changed the way salespersons perform daily routine activities. Most often, the salesforce is equipped with a salesforce automation (SFA) system to enhance customer relationship management (CRM) capabilities and sales performance . SFA sysIn the recent past, data about sales and CRM have been generated at a very high pace. Traditional systems are unable to store and analyze such high volume, variety, and velocity data  to obtain information for decision making . In thisIn this study, the individual means employees of the organization and these are the most important entity in the context of big data analytics because employees are responsible for dealing with BDA at the organizational level, e.g. hardware, software, and other technical aspects. Employees are key stakeholders in the organization, they not only use the output of the big data analytics but also need to operate BDA to produce valuable results for customers and end users. Several studies from the literature –25 identMost of the literature highlights the rejection of SFA by several organizations because a positive perception about the system has not been created or maintained due to its deficiencies, and ultimately, the negative perception creates a belief in a job and professional misfit between the system and the salesforce , 6, 7. TIn this study context, individual characteristics mean the characteristics of organization’s employees. An individual’s beliefs affect the association between external characteristics and consequences . A persoH1: Individual characteristics  are positively associated with the individual’s perception of BDA.Previous studies highlighted some organizational factors that have a significant impact on the perception of the system , 44–46, H2: Organizational characteristics  are positively associated with the individual perception of BDA.Prior studies by Moore and Rogers , 53 explThe theory of social identity concluded that individual positive perception of the system or technology user create the positive perception about the job and profession fit that ultimately increase the performance of the organizations . FurtherH3: Individual perception of BDA  are positively associated with the person-technology fit.The social identity theory sheds light on the different roles that the employee performs in personal and professional life . The modThe question is how a specific system can affect these roles. It is evident from the previous literature that a specific system can increase or decrease competency depending upon the individual’s socially constructed expectations . The sysTherefore, a positive perception of person-technology fit will increase the socially constructed expectations and hopes that ultimately bring positive outcomes in terms of adoption of the system and will increase employee performance in sales and CRM capabilities; in contrast, a negative perception of person-technology fit brings negative outcomes. Therefore, this study proposes the following:H4: Person-technology fit (job fit and profession fit) is positively associated with CRM capabilities.H5: Person-technology fit (job fit and profession fit) is positively associated with sales performance.CRM is a cross-functional mechanism by which organizations create, maintain, and strengthen a long-lasting relationship with the customer –65. CRM In addition, CRM capabilities help strategy makers and salespeople increase sales performance , 69. TheH6: CRM capabilities are positively associated with sales performance.Sales performance effectively and efficiently achieves the targets in the sales process by examining opportunities and improving closing rates . The infA theoretical model that organizes this study is presented in Table A1 in We adapted measures from previous studies that are appropriate in this study context. The reflective nature of scales used in this study. Table A2 in The final questionnaire items were measured on a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The seven-point Likert scale is the most important and widely used scale in survey instruments , 80. FurThis study is related to the quantitative research method. Therefore, a survey was conducted to examine the hypotheses and the relationships among constructs , 82.We sTable 1 and describethat77.9% of the participants are male, and 63.7% are between the ages of 30–39 years. The majority of participants are highly educated, i.e., 31.5% are graduates, and 21.6% are postgraduates. Therefore, our participants were young and highly educated. Furthermore, the study also considered gender, age and education as control variables and all the control variables are insignificant.The demographics of participants are displayed in Common method bias (CMB) is a serious issue to be addressed if the data are gathered from a single source and at the same point of time . TherefoPartial least squares-structural equation modeling (PLS-SEM) was applied to test the hypotheses by means of Smart-PLS v3. PLS-SEM is an important analysis technique to test the theoretical framework from the perspective of prediction . As studThe study followed the method proposed by  to evaluTable 2 describes the results and shows that the factor loadings of all items are above 0.7, which is acceptable. The threshold values of Cronbach’s alpha, AVE, and CR are 0.70, 0.50, and 0.70, respectively [ectively . All theTable 3 shows that the values of the square root of AVE are greater than the coefficients of correlation of all variables with each other. Second, the cross-loadings and item loadings of all corresponding variables are higher than the cross-loadings and item loadings of other latent variables that proves that there is no issue regarding discriminant validity. The HTMT ratio criterion was established to specify insensitivity of cross loadings technique and Fornell-Larcker technique. The HTMT is estimation of factors correlation and in other words the upper boundary. HTMT should be less than 1 to clearly distinguish two factors [Table 4 described that highest value is 0.665 that is under the threshold value and confirms the no discriminant validity issue in this study. All the results illustrate that no issue of content, convergence, or discriminant validity existed in this study and grants the go-ahead to use the data for the structural model.Discriminant validity was achieved by using three techniques as suggested by . The fir factors . Table 4Table 5 presents the path coefficient, t-values, and p-values. The results in Table 6 show that the model explains 43.1% of the variance in sales performance, 38.1% of the variance in CRM capabilities, 57.9% of the variance in profession fit, 55.9% of the variance in job fit, and 37.6%, 35.9%, 42.5%, 40.8%, 42.9%, and 40.4% of the variance in relative advantage, visibility, image, compatibility, complexity, and results demonstrability, respectively. i: playfulness and image, H1n: social norms and visibility, H1p: social norms and compatibility, and H1r: social norms & result demonstrability. Our results are consistent with the findings of [Smart PLS3 was used to test the relationship among constructs based on standardized paths . Table 5dings of , as selfdings of . This stdings of . Therefodings of . On the Table 7 presented the results of PLS predict test. According to the results all the values of Q2_predict are above zero that shows there is nothing wrong with it. Furthermore, mostly the differences between the values of PLS-RMSE and ML-RMSE are below zero that concluded that the research model of the present study have the moderate predictive power [Moreover, the study conducted the PLS predict test to confirm the predictive accuracy of the model. The data of the present study is symmetrical distributed so we considered RMSE values. ve power .The present study results investigated specific concern of organizations regarding the integration of technology to strength the boundary spanning relationship of customers and sales managers. The overall results of this study proved that individual characteristics of employees of pharmaceutical organizations along with the organizational characteristics are strong influencers of Individual perception of BDA and measuring factors about individual perception of BDA is strong predictor of person technology fit. These results of the study are consistent with the general theories of technology acceptance , 101. FuAccording to the specific results of this study, all the relationships among individual characteristics  and individual perception of BDA characteristics  have significant relationships with each other except for the relationships between playfulness and image, social norms and visibility, social norms and compatibility, and social norms and results demonstrability. Self-efficacy is a strongest individual characteristic that influence the individual perception of BDA. Playfulness is not concerned with the image of the BDA because if playfulness increases, the ease of BDA in the mind of the user also increases, which means that playfulness does not have a significant relation with the image. The study of Jeffrey  also conSince self-efficacy is the most important predictor of individuals’ perception, organizations should pay more attention to self-efficacy. Playfulness and social norms are the second and third most important predictors of individual perception of BDA, respectively. The pharmaceutical organizations also consider that these factors help develop a better perception of BDA. Moreover, organizational characteristics  and individual perception of BDA characteristics  have significant relationships with each other, except for the relationships of voluntariness with relative advantage and complexity; user involvement with visibility, image, and complexity; user participation with relative advantage and image; and management support with compatibility and result demonstrability.The perception is general, and this study also develops the same belief that voluntariness will increase the image and compatibility of BDA in the mind of the user; user involvement and user participation will also increase compatibility between the needs of the user and the BDA; and management support will significantly influence the visibility, image, and complexity of the BDA. These study results justify the study requirements, and the results are consistent with those of previous studies , 51, as Furthermore, all factors of the individual perception of BDA have significant relationships with job fit and profession fit except for image and compatibility with job fit and results demonstrability with profession fit. Previous studies’ results and the identity theory have already elaborated that relative advantage is the key predictor of job fit and profession fit , 58. AnoThe findings of this research try to address the unique challenge of the salesforce by strengthening the relationship between the salesforce and customers through technology. Empirical analytics of data demonstrate that individual characteristics  and organizational characteristics  along with innovation diffusion theory (IDT) factors  are positive predictors of individual perception of BDA. This means that if pharmaceutical organizations want to adopt BDA in the organization, they should focus on individual, organizational, and IDT factors.According to the results of this study, individual perception of BDA creates person-technology fit. This means that if the employees of the organizations feel that BDA has a relative advantage over other systems or technologies and if it has a good image in the mind of employees, better visibility, is more compatible with their job needs, decreases complexity and has better demonstrability of the results, then they feel more job fit and profession fit. Therefore, organizations that achieve a person-technology fit belief in employees should focus on these factors, especially relative advantage and complexity, because according to the results of this study and prior literature, these two are the most important constructs that influence person-technology fit . EmployeThe results of this study also provide evidence that job fit and profession fit have a positive influence on CRM capabilities and sales performance. This indicates that the salesforce perceives that BDA will facilitate a stronger relationship with customers and increase sales performance. Moreover, CRM capabilities also have a positive influence on sales performance. Therefore, pharmaceutical organizations should focus on individual, organizational and IDT factors to build positive perceptions of BDA, adopt BDA in organizations, and build job and profession fit perceptions in organizations, which will ultimately lead organizations to increase sales performance and CRM capabilities.Based on the study finding, organizations need to equipped their salesforce with BDA to strengthen their relationships with customers and sales. This study empirically offers a strong basis for further extending the research of BDA in sales and CRM capabilities. The study concluded that individual characteristics, organizational characteristics and innovation diffusion theory factors  can build a positive perception of BDA in the mind of the salesforce. The positive perception of BDA will push the salesforce towards BDA acceptance in organizations. The study also highlighted that a positive perception of BDA increases the sense of job and profession fit in the mind of the salesforce. The study concluded that positive perception of BDA creates a person-technology fit belief in the salesforce, and this positive perception increases the sales performance and CRM capabilities of pharmaceutical organizations.This study contributes greatly to theory and practice. First of all, the study extends the identity theory in the context of big data analytics. This study contributes by providing BDA as a substitute for failed SFA systems and provides a basis to extend the literature on the role of BDA in sales performance and CRM capabilities. This study contributes in theory by investigating a theory-driven framework that may be an important lens through which to examine BDA importance in sales performance and increments in CRM capabilities. Furthermore, this study investigated the combined effects of general technology acceptance theory factors and identity theory in the context of BDA which is lacking in the BDA literature. Moreover, the study also contributes to theory by extending innovation diffusion theory with the identity theory along with individual and organizational characteristics in the context of BDA. This study also enriches theory by exploring BDA in sales and CRM capabilities, which could be an important lens for technologically enhancing sales performance and CRM capabilities. Furthermore, this study provides the basis to further extend research regarding the role and impact of BDA in sales and CRM capabilities.This study also practically contributes from many perspectives, similar to a theoretical contribution. First, this study provides an empirically tested model that helps in the adoption of BDA in pharmaceutical organizations. Furthermore, this study increases understanding in pharmaceutical organizations that the positive perception of the salesforce regarding BDA and person-technology fit are the most important factors in the acceptance of BDA and the resulting increase in their sales performance and CRM capability. This study also contributed practically in that it provides an alternative for organizations that are dissatisfied with the SFA system. The model provided an understanding of BDA implementation in particular and user acceptance of technology in general. Moreover, this study provides a basis for pharmaceutical organizations to start practicing BDA in sales and CRM to obtain the benefits of BDA and efficiently counter the challenges of sales and CRM capabilities.In addition to the contributions of this study, we recognize some limitations, and some future directions of research are proposed on the basis of these limitations. First, the data gathered for this research from Pakistan and the results of this research might change in a cross-cultural context. Future research could pay more attention to a multicultural context to increase the generalizability of the model. Furthermore, future research should focus on longitudinal research to strengthen the results. Second, the data were collected from a developing country, and the results of this research may be different in developed countries. Therefore, in the future, researchers can test this model in developed countries and study this research model to compare different countries and increase its generalizability and effectiveness. Although the research results explain a high percentage of variance in sales performance and CRM capabilities, there are also some variables that might have an impact on these two dependent variables, such as role conflict and role ambiguity. In the future, research can test these two variables in addition to the given model. Furthermore, researchers can also include the moderating influence of demographical factors such as age, gender, income, and experience in this research model to strengthen it further. In addition, future research can be conducted after the implementation of BDA and then the post-implementation perception of BDA in the salesforce can be investigated. The future studies also study the important direct relationships pf individual characteristics, organizational characteristics and individual perception of BDA directly with the CRM capabilities and sales performance.S1 Appendix(DOCX)Click here for additional data file.S1 Data(XLSX)Click here for additional data file.


This study is aimed at assessing the current status of ACS patients' health literacy and medication compliance, analyzing the relationship between the two, and providing ideas for clinically improving the medication compliance of ACS patients and preventing the recurrence of cardiovascular events. ACS patients need long-term medication to prevent vascular restenosis after surgery, and bad living habits and mood swings will affect postoperative recovery, so clinical interventions are needed to help patients establish a healthy lifestyle. The effect of conventional care is not ideal. Therefore, this paper uses regression analysis to analyze the correlation between the health literacy status of ACS patients and the compliance behavior, combines the investigation and experiment to perform regression analysis and uses mathematical statistics to process data. The connection between health literacy level and compliance behavior is discovered via a study, providing a point of reference for future research. Cardiovascular disease is now the most common illness in the world, and it is on the rise in our nation year after year. Cardiovascular disease is the leading cause of mortality among the different causes of death. Every year, more than 15 million individuals worldwide die from cardiovascular disease . The burAccording to the 2010 Global Adult Tobacco Survey (GATS) China Project report, there are 356 million smokers over 15 years old, and the number of passive smokers is even more, which is 738 million. In the 2010 national survey, the prevalence of hypercholesterolemia in men and women over 18 years old was 3.4% and 3.2%, respectively, and the prevalence of hypertriglyceridemia in men and women is 13.8% and 8.6%, respectively [This article investigates the health literacy level and compliance behavior of patients with acute coronary syndromes, focusing on scientific and effective treatment techniques and nursing methods, as well as effective theories for the treatment and rehabilitation of acute coronary syndromes.Clinically, about 20% of patients with acute coronary syndromes have atrial fibrillation, which is associated with reduced left ventricular ejection fraction and age . In addiIn my nation, the age distribution of coronary heart disease is now dominated by the elderly. A number of studies have shown a link between age and the risk of acute myocardial infarction . AccordiIn this study, 280 ACS patients were enrolled in the study from the hospital, and they all signed the informed consent form. The general data survey scale uses the general data survey scale self-made in the hospital, which includes gender, age distribution, occupation, education level, family income, and health knowledge acquisition channels. Moreover, this paper collects disease-related data of ACS patients, including body mass index (BMI), heart disease history, number of hospitalizations, course of disease, degree of coronary artery disease, and revascularization .All investigators in this study are trained and qualified. The questionnaire was distributed and collected on the spot. Patients should be informed about the study's aim and procedures, as well as any confusing questions, by questionnaire investigators. They cannot, however, utilise inductive or suggestive language, nor can they check for missing elements and add them in a timely manner. Two medical statistics experts are in charge of data input and verification once the questionnaires have been gathered.The purpose of this essay is to look at medication compliance as a key component of compliance behavior. In addition, the statistical information acquisition ability, communication and interaction ability, willingness to improve health, willingness to receive financial support, and total score of health literacy are used as the main reference indicators for examining the relationship between patients' health literacy and compliance behavior, and the results are counted .The logistic multifactor analysis affecting the health literacy of ACS patients is shown in The statistics of patients' medication compliance and health literacy status are shown in Tables 22Most patients with ACS have health knowledge and attitudes but lack the capacity to translate these into healthy habits and skills, according to one research. Furthermore, due to a variety of reasons, the health literacy level of ACS patients is not encouraging. The findings of most research show that age is a risk factor that influences the health literacy of patients with ACS. The reason may be that the older the patients are, the more they emphasize their own experience and reject new things and ideas. Therefore, even if they have the desire to learn actively, due to the decline of physical skills, cognition, understanding, and action ability, there are many difficulties in mastering health knowledge and practicing healthy behaviors. Therefore, the health promotion ability is low. However, most of the career families of patients under the age of 50 are at the peak period, and they can use their own personal networks or various media to obtain health-related information, knowledge, and skills to maintain their own health. This study shows that the higher the level of education, the higher the health literacy, which is consistent with the conclusions of a large number of studies. The main reason is that people with a higher education level have significantly higher access to health resources and attitudes than those with a relatively low level of education, and they have relatively strong restraint and control over unhealthy behaviors, and they pay more attention to their own health management capabilities. People with lower educational levels, on the other hand, have worse reading and comprehension abilities and are unable to interact effectively with medical personnel, resulting in more misunderstanding regarding their own health habits as well as illness diagnosis and treatment. Even some patients have negative emotions, which seriously hinders the effective development of treatment work and is not conducive to timely and effective treatment. This result also suggests that health education is a strong tool for promoting health literacy in patients with ACS and that it can significantly enhance patients' health literacy levels. This study shows that the history of heart disease can significantly affect the health literacy of patients. The reason may be that patients with a history of heart disease have a certain degree of knowledge about heart disease. As a result, they have a higher degree of awareness of ACS-related symptoms and prevention, a more positive attitude, and a higher health literacy ability. This study shows that the more severe the coronary artery disease, the lower the level of health literacy. The reason for the analysis is that patients with severe coronary artery disease have limited ability to obtain health information, leading to insufficient confidence in coping with the disease. However, people with low health literacy usually have resistance to health behaviors, leading to further deterioration of the disease. This indicates that patients with severe coronary artery disease should be aware of their health literacy level and that healthcare providers should assist patients understand the significance of health literacy in the illness's outcome.This study shows that the history of revascularization is the main factor that affects the health literacy of patients with ACS. The reason is that patients who have undergone a history of revascularization have improved disease awareness to a certain extent and have a higher desire for health information and are more sensitive. At the same time, patients undergoing revascularization are often in serious illness. After experiencing this pathological process, patients are more aware of the importance of healthy behaviors, so they can adhere to reasonable diets, compliance behaviors, etc. and have a higher level of health literacy.ACS patients' medication adherence has to be improved. ACS patients should be treated with secondary preventive medicines if there are no obvious contraindications, according to current domestic and international recommendations, independent of their pathological type or whether they need stent intervention. Medication compliance is an important outcome factor for evaluating the prognosis of ACS patients since secondary preventive pharmacological therapy is necessary to minimise the recurrence of unfavourable cardiovascular events in ACS patients. This group of patients had a medication noncompliance rate of 68.52 percent, indicating that more than two-thirds of ACS patients had poor drug compliance. The present state of drug compliance among ACS patients is said to be concerning. The percentage of patients who forgot to take medicine and who discontinued taking medication after their symptoms improved was quite high among the four issues of medication noncompliance. The following may be the reason: (1) ACS patients often require combination medication. Although epidemiology has shown that the population of ACS patients tends to be younger, this group is still dominated by middle-aged and elderly people. Moreover, middle-aged and elderly patients often have a decline in their understanding and recognition of drug information, which affects their medication compliance. (2) The patient has insufficient understanding of the significance of secondary preventive drug treatment and prevention of cardiovascular events, or due to financial constraints and other factors, the drug is discontinued without authorization when the symptoms are relieved. (3) The low level of medication literacy of ACS patients directly affects medication compliance. In clinical practice, for forgetting to take medication, we can use smart portable devices based on smart medical care, such as “Internet +” to remind patients to take medication regularly, or form a multidisciplinary cooperation model including pharmacists to conduct comprehensive interventions. Nurses may also use innovative forms of health education, such as APP software and a WeChat official account, to raise patient knowledge of the need of sticking to secondary preventive medicine. Simultaneously, we may dig deeper into the precise causes for patients' noncompliance behavior in order to offer more focused nursing solutions.The health literacy of ACS patients needs to be improved. After studying the health literacy status of patients with cardiovascular disease, it is found that it is closely related to the patient's prognosis. The health literacy level of patients with acute myocardial infarction is similar, showing a low level. Patients with low health literacy have a poor understanding of disease knowledge, and their ability to screen, acquire, and absorb health knowledge is also limited, which affects their self-management ability. Therefore, we recommend that clinical nurses take the following measures: (1) the evaluation and reevaluation of health literacy can be incorporated into the clinical nursing work of ACS patients to explore the influencing factors of health literacy and formulate intervention plans. (2) Medical staff can produce ACS disease-related knowledge and first aid education manuals that are both illustrated, easy to understand, and popular. In particular, it is necessary to highlight the identification of typical and atypical symptoms, the timely dosage of nitroglycerin, the interval time, the total amount taken, and the best way of prehospital first aid. (3) It is necessary to rely on the medical consortium and the “Internet +” platform to build a continuous care method and increase the popularization rate of disease common sense and first aid knowledge among the discharged ACS population, thereby improving the health literacy of patients.This study shows that ACS patients with low health literacy have worse compliance with medication. Moreover, patients with low health literacy may have varying degrees of difficulty in reading drug labels and understanding drug side effects and drug prescriptions. The resulting unsafe medication situation will lead to unsatisfactory medication treatment and affect medication compliance. Patients with low health literacy have difficulty understanding drug-related information such as drug usage, dosage, and indications. Their real drug use may differ from what the medical system records. Furthermore, some study findings suggest that health literacy refers to the information and abilities needed for optimal drug adherence. Nurses are reminded that when it comes to increasing medication compliance, the impact of the variable of health literacy should not be overlooked. They can first evaluate and improve the health literacy level of ACS patients and then improve medication compliance on this basis.The medication compliance and health literacy level of ACS patients need to be improved urgently. Therefore, clinical nurses should pay attention to evaluate and improve the health literacy level of ACS patients and then improve their medication compliance. However, this study did not analyze in detail the influencing factors that lead to unsatisfactory medication compliance and health literacy of ACS patients and did not pay attention to ACS patients at different periods or discharged from the hospital, which needs to be verified in future studies.


Sex, gender and sexual orientation are diverse, as are the ways of living associated with them. The extent to which people can live a free and self-determined life according to their own body, gender, sexuality and way of life influences their social resources, opportunities for participation and discrimination and has an influence on their life situation and health. A narrative review of lesbian, gay, bisexual, transgender and intersex (LGBTI) health was conducted including international and German reviews, meta-analyses and population-based studies. The focus of this article is the legal, social and medical recognition as well as health status of LGBTI people in Germany. While the legal framework in Germany for homosexual and bisexual people has gradually improved, many civil society stakeholders have pointed to major deficits in the medical and legal recognition of transgender and intersex people. In addition, scientific findings frequently have not yet found its way into medical practice to an adequate extent. Available data on LGBTI health indicate a need for action in the areas of mental health and health care provision. However, due to a lack of comprehensive data, conclusions cannot be drawn on the general health situation and health resources of LGBTI people. For the concrete planning and implementation of measures as well as the differentiated portrayal of the situation in Germany, the databases must be expanded, not least via population-representative surveys. The diversity of sexes, genders, sexual orientations and ways of living is part of the diversity of society. Although developments must be viewed as differentiated and are in many areas only in their infancy, lesbian, gay, bisexual, transgender and intersex people LGBTI,  have gaiThe degree to which people can live a free and self-determined life according to their own body, gender, sexuality and way of life influences their social resources, opportunities for participation and discrimination and has an influence on their life situation and health. It is not an individual’s sex, gender identity or sexual orientation that can lead to different health outcomes from the overall population, but rather the determining factor of social context. The predominant social model of the heterosexual sex/gender binary can have a negative impact on the lives and health of lesbian, gay, bisexual, transgender and intersex people. Conversely, an increase in recognition of diversity may translate into greater life satisfaction and health.Although there are many similarities between the health needs of LGBTI people and the overall population, there are also LGBTI-specific issues. The self-reported physical health of lesbian, gay and bisexual people, for example, does not differ from that of heterosexual people . RegardlThe present article provides an overview of the social situation and health status of LGBTI people and indicates where action is most urgently needed. Initially, we discuss the number of LGBTI people living in Germany and identify the social, legal and medical frameworks in which they find themselves. We then describe the health situation of LGBTI people and the healthcare they receive based on findings from German and international scientific findings. Finally, efforts to improve the information base in the field of epidemiology and survey research are discussed that aim at further developing the evidence for health and social reporting.When interpreting the results, it must be noted that existing research often focuses on particular topics such as the sexual health of gay men and the mental health of LGBTI people in general. Little consideration has been given until now to the general health status of LGBTI people and the factors that benefit their health. It should therefore be noted that this review is based on a selective presentation of certain topics. Data gaps and limitations are identified in the discussion, which also presents an outlook on positive developments regarding the information base on LGBTI health.This article is based on a literature research on the health of LGBTI people from the PubMed and Web of Science databases as well as other relevant web sites. Studies on the situation in Germany were included, as well as international English-language reviews, meta-analyses, and population and community-based studies published between 2000 and January 2020. The size of Germanys LGBTI population was estimated based on published findings from population-based surveys, namely the German Socio-Economic Panel (SOEP) from 2016 , the MicThe proportion of the population of lesbian, gay, bisexual, transgender and intersex people living in Germany can only be roughly estimated.Sexual orientation can be distinguished into three dimensions: sexual identity , sexual desire or attraction, and sexual behaviour. These three dimensions are not necessarily in line with one another and can change throughout a person’s life . In 2016According to Microcensus data, the number of samesex couples who live together increased by 57% from 60.000 to 94.000 between 2005 and 2015 . HoweverIn addition, SOEP data allows to identify social differences between lesbian, gay and bisexual people on the one hand and heterosexual people on the other. More than half of those who identify as lesbian, gay or bisexual live in cities with more than 100.000 inhabitants, compared to one-third of heterosexuals . Over thEstimating the size of Germany’s intersex and transgender population is considerably more difficult. On the basis of the country’s Transsexual Act , some transgender people apply to have their sex/gender entry and first name changed. Between 2008 and 2016, the number of these applications increased from 903 to 1,868 per year . An inteSocial movements and LGBTI civil society organisations have encouraged a positive self-image and positive external perception of LGBTI people. They have also made a key contribution to increasing social recognition. However, despite various advances, there are still deficits in social and legal equality and in medical recognition.The heteronormative orientation of society can pose a health risk for LGBTI people. The concept of heteronormativity conveys the idea that there are only two sexes which are each congruent with two genders (women and men) which are sexually oriented towards one another . HeteronHeteronormativity can express itself socially in the non-recognition of congenital variations of sex characteristics, sexual identity, self-representation of gender or sexual orientation. This lack of recognition can range from prejudice and discrimination to physical and sexualised assault . It is aThese experiences as part of a gender or sexual minority can cause stress and consequently have a negative effect on physical and mental health as well as health behaviour  and Council of Europe human rights convention ratified by Germany ensures that all people have an equal opportunity to participate in society. On an international level, UN resolutions have been demanding recognition of gender and sexual minority rights and an end to criminal prosecution for years . ArticleFor many years, homosexual women and men in Germany were systematically denied certain rights and were subject to persecution. Gay men were criminalised when West Germany adopted paragraph 175 of the penal code (‘fornication between men’), a provision which had been strengthened by the National Socialists. In the German Democratic Republic (GDR), the paragraph was effectively invalidated in 1957 and finally abolished in 1968. However, these legal developments in the GDR should not be equated with a generalised social acceptance of homosexuality. Paragraph 175 was abolished in West Germany in 1994 after the German reunification.For a long time, non-heterosexual partnerships were not legally recognised and partners could not assert mutual rights and obligations. This changed with the introduction of registered civil partnerships in 2001 and the extension of marriage to include same-sex couples in 2017. This also enabled the right of same-sex partners to jointly adopt non-biological children.In 2011, the Ethics Council of Germany held a hearing on the situation in Germany for intersex people . ChangesAlthough the amendment to the law was designed for intersex people, transgender people also try to use this regulation to change their sex/gender entry. Transgender people regard the Transsexual Act from 1980 as discriminatory in many respects. A change of first name and sex/gender entry must be confirmed by two expert opinions paid for by the applicant as well as a court decision . Until 2The degree to which sex, gender and sexual diversity are legally recognised has a significant effect on equal opportunities for social participation and health , 43. It The degree of structural stigma in Germany is relatively low compared to other countries. However, despite legal advances, the reality for sex/gender and sexual minorities is still marked by disadvantage. To further promote the equality of LGBTI people under the rule of law provides an essential foundation for a self-determined life and strengthens social recognition.The past years have seen an increase in the medical recognition of sex, gender and sexual diversity, with decreasing levels of pathologisation by healthcare professions and their associations. However, there is still a need for action, particularly in regard to transgender and intersex people. An important step for the recognition of sexual diversity was made in 1990 when the General Assembly of the World Health Organization (WHO) removed homosexuality from the list of mental illnesses . At the Until now, the WHO’s International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), classifies ‘transsexualism’ (F64.0) as a mental disorder. The 11th revision of this classification (ICD-11), which was adopted by the WHO in 2019 and will come into effect in 2022, no longer defines being transgender as a mental disorder, but instead as ‘gender incongruence’ in the category ‘sexual health conditions’. ‘Gender incongruence’ describes identification with either a gender other than that assigned at birth or with no gender , and thuIn 1987, the Federal Social Court of Germany ordered health insurance providers to cover the costs of sex reassignment surgery for transgender people. In 1997, the German Society for Sexual Research (DGfS), the Academy of Sexual Medicine (ASM) and the Society of Sexology (GSW) published the German ‘Standards for the Treatment and Diagnostic Assessment of Transsexuals’ (Standards der Behandlung und Begutachtung von Transsexuellen). These standards define the psychiatric and psychotherapeutic treatment processes, the process of diagnosis and the timeframe for treatment indications of sex reassignment measures. Based on these standards, the Medical Commission of the National Association of Statutory Health Insurance Funds (MDS) published a binding ‘Guideline for the Assessment of Transsexuality’  in 2009 , which iThe ‘Guideline for the Assessment of Transsexuality’ has been met with criticism because it medically perpetuates the heteronormative orientation of society by failing to recog nise sex/gender diversity. Health insurance coverage for sex reassignment is thus bound to the diagnosis criterion ‘transsexual’, which means that transgender people must first clearly identify as either a woman or a man. This excludes people situated outside of the gender binary such as those who identify as queer or agender  51]. Fo. Fo51]. This should change with the new guideline from 2018 titled ‘Gender Incongruence, Gender Dysphoria and Trans Health: S3 guideline for clinical diagnostics, counseling and treatment’ , although so far, it is not binding for the MDS . The S3 The discussion of variations of sex characteristics (intersex) is taking place between the two poles of medicalisation  and depaSex modifying surgery on intersex children that is not medically necessary can be traced to research from the 1950s on psychosexual development, which assumed that gender identity could be moulded by society. It was believed that an intersex child raised as a girl or boy would develop a corresponding identity and that this process could be assisted by surgery early in life , 57. SurIn recent years, medical guidelines recommend restraint in regard to sex modifying surgery on intersex people. In a 2012 statement on the subject of intersex, the German Ethics Council stressed the need to carefully weigh up all the advantages and disadvantages of an intervention and its long-term consequences . SimilarIn 2019, the EU parliament passed a resolution calling for an end to medically unnecessary sex modifying surgery for intersex people . In GermThe selection of topics that follow is heavily dependent on the availability of findings from German and international studies. Although the estimates from international studies are not directly applicable to Germany, they do reveal important statistical associations and can give indications of possible health inequalities.The groups included in the description below are intrinsically heterogeneous. Sex, gender and sexual orientation  interactAccording to a survey on the health of lesbian women in Germany from 2005, 55% of respondents stated that they had good or very good subjective well-being. Only 1.1% reported poor physical health and 1.7% reported poor mental health . A SwediConclusions on the cancer morbidity and mortality of lesbian women cannot be drawn from German cancer registry data. Findings from the few existing international epidemiological studies, in particular from the US, indicate either a higher incidence specifically for breast cancer among non-heterosexual women or no difference according to sexual orientation . A DanisIt is discussed that behavioural risk factors, particularly health behaviour  infection among gay men in comparison with heterosexual people or lesbian women. However, this focus risks reducing the life of gay men to their sexual behaviour. Comparatively little is known about the overall health of gay men. Data are available mainly for men who have sex with men (MSM), a group which includes gay and bisexual men as well as men who have sex with men but do not identify as gay or bisexual.MSM face a higher risk of sexually transmitted infections compared to the general population. In the 2017 European MSM Internet Survey (EMIS), 14.2% of participants reported having ever been diagnosed with syphilis . This riMen who have sex with men also have a higher risk of HIV infection. In the EMIS study, 10% of all participants reported having been diagnosed with HIV. In Germany, the number of new HIV diagnoses among MSM has been decreasing since 2014 . HoweverHomophobia and the criminal prosecution (in West Germany until 1994) of gay men can have an impact on mental health, health behaviour and physical health. Several international systematic reviews and meta-analyses show that gay and bisexual men, or MSM, are more likely to suffer from anxiety and depressive disorders, to be addicted to alcohol or drugs, or to be suicidal than heterosexual men , 83, 84.Mental illness and stress can also negatively impact healthy behaviour. A population-based cross-sectional study from the USA examined the 12-month prevalence of drug use and addiction. This showed that gay men have a slightly higher prevalence of heavy alcohol consumption (18.1% vs 13.7%), although this is not statistically significant , 86. HowThe life and health situation of bisexual people is rarely considered as they are usually included in the groups of lesbian or gay people. The few available findings on bisexual people refer almost exclusively to women or men. Other sexes or genders such as non-binary or queer are very rarely taken into account.There is less evidence of sexually transmitted infections in bisexual women compared to bisexual men. However, the frequency of such infections is rarely discussed in this group. In women who have sex with women, there is evidence of more frequent bacterial vaginosis . With reA population-based cross-sectional study from the USA examined the 12-month prevalence of drug use and addiction among men and women. Levels of heavy alcohol consumption were higher among bisexual women compared to heterosexual women (25.0% vs 8.4%), and prevalence of marihuana use (22.2% vs 2.6%), other drug use (14.1% vs 3.1%) and alcohol addiction (15.6% vs 2.5%) was also higher . FurtherBisexual people are not always accepted by society or by lesbian, gay and queer communities , and areTransgender activism over the past few years has led to greater recognition of transgender people by the medical professions . DespiteInternational surveys indicate a high prevalence of depressive disorders among transgender people , 95. FinAt present, little data is available on the sexual health of transgender people in Germany. International studies show that HIV prevalence is higher among transgender people than the overall population. A survey of transgender people in the USA revealed that 1.4% of the participants were HIV positive, compared to 0.3% of the overall population . In addiWith regard to physical activity, health behaviour of transgender people is also negatively influenced by institutional barriers. Exercise opportunities are usually geared towards a binary sex/gender norm, making access to public and private facilities such as swimming pools and sports clubs more difficult for transgender people. Furthermore, the anticipation and past experience of discrimination in organised sport is a barrier to beneficial health behaviour . Some ciCurrently, there is scarce data on the overall health of intersex people. After many years of activism of intersex organisations, the discussion about the social and health situation of intersex people has received more public attention, particularly over the last decade. Sex modifying surgery on intersex people that is not medically necessary has been labelled a central health issue. Intersex organisations particularly criticise surgical and drug interventions that are performed without full, free and informed consent (for example on children) or aim to align intersex bodies with binary sex/gender norms, for example with the surgical alteration of intersex genitalia . MedicalSuch measures are either irreversible or very difficult to reverse and can have serious health consequences such as infertility, chronic pain, incontinence, sexual dysfunction and mental disorders . In a stIn recent years, guidelines have cautioned against any sex modifying surgery on intersex people that is medically unnecessary . HoweverThe Charter of Fundamental Rights of the European Union includes the principle of non-discrimination and calls for equal access to healthcare . As descA further barrier to good healthcare is found at the level of interaction between service providers and patients . A 2017 Structural, organisational and regional barriers to access can be seen at the level of the healthcare system. One problem is the orientation of care towards a sex/gender binary and a heterosexual norm . TransgeIn recent years, civil society activists and organisations have achieved a greater degree of legal equality for lesbian, gay and bisexual people, a gradual depathologisation of transgender and intersex people, and a revision of medical guidelines for transgender and intersexual people. Nevertheless, sex, gender and sexual diversity have yet to gain full social acceptance and legal recognition. There are still strongly heteronormative social structures and cultural patterns that can affect the lives of LGBTI people and, as a consequence, their health. Services aimed at prevention, care and health promotion tend to be geared towards a sex/gender binary and a heterosexual norm. This affects the ability of LGBTI people to participate in society, the resources available to them and the levels of discrimination they face. However, with increasing social acceptance and legal equality, further improvements in terms of health equality for LGBTI people can be expected.The available data on LGBTI health indicates that there are specific needs to be met. With regard to mental health, internalised negative attitudes towards one’s own sex characteristics, gender identity or sexual orientation can impede the development of a positive self-image. Gender and/or sexual orientation themselves are not the cause of higher prevalence of depression and suicidality. Rather, a lack of acceptance and experiences of discrimination and violence are psychologically stressful and can lead to mental illness. The health of LGBTI people would benefit from a social environment in which they feel accepted and supported together with an availability of peer support centres providing information, advice and networking opportunities. Overall, there is a lack of research on the factors that promote LGBTI health.Moreover, there are many indications that healthcare may still be insufficiently adapted to the needs of LGBTI people and that expert knowledge and sensitivity when dealing with LGBTI-specific health issues are often lacking. This is particularly evident in the stable figures for sex modifying surgery on intersex children too young to provide informed consent, despite the fact that medical guidelines caution against interventions that are medically unnecessary. For this reason, greater consideration and recognition should be given to sex, gender and sexual diversity within healthcare.In regard to the health issues described above, it should be noted that the majority of these are statistical estimates and probabilities which do not allow conclusions to be made about individuals. Furthermore, gaps in the data necessitated the use of international studies in addition to the findings from Germany. These international studies cannot be readily transferred to Germany due to different social constellations and other healthcare and social security systems.Existing research on the individual groups is strongly focused on specific topics, with little information on LGBTI health in general. While research on sexual health primarily focuses on MSM due to the higher prevalence of HIV, there are large gaps in the data on the sexual health of other groups. There is also a need for in-depth research on physical and mental health to identify further health needs. Furthermore, many studies have their main focus on risk factors. In addition, a more detailed description and analysis of LGBTI health resources should be undertaken in order to better describe the everyday reality of LGBTI people.Finally, in writing the present report we found it difficult to adequately portray the heterogeneity of each group within the LGBTI collective. The life situations of LGBTI people are influenced not only by sexual orientation and sex/gender, but also by other social categories  that included questions on sexual orientation for the first time in 2016 .2Wissensportal LSBTI) to include an interactive self-learning module on intersex and transgender that is aimed at healthcare professionals. Furthermore, the European Union Agency for Fundamental Rights (FRA) conducted a second Europe-wide survey on LGBTI people’s experiences of discrimination in 2019, the results will be published in 2020 [Information is also needed on specific concerns and on the living conditions of LGBTI people. The Queergesund*-Study, for example, carried out a participatory needs analysis on the promotion of health for lesbian, bisexual and queer women. It identified an extensive need for action relating to social anti-discrimination policy, reducing heteronormativity in healthcare and support for LGBTI people and women’s/lesbian community projects as a central health resource. Currently, the Federal Ministry of Health funded InTraHealth project (2019–2022) is dedicated to improving access to healthcare for intersex and transgender people by reducing discrimination on the part of care providers that can be a barrier to access . This pr in 2020 . This kiIt is essential that the findings of studies are always viewed in their social context and that besides health risks also resources that promote health need to be considered. This can help prevent discrimination and stigmatisation of LGBTI people through the way of health reporting. Moreover, health reporting that is sensitive to discrimination should involve the concerned subjects in the design of the study, the survey itself, and the evaluation and presentation of results.Sex, gender, sexual orientations and ways of living are diverse.The heteronormative orientation of society represents a health risk for LGBTI people.While progress has been made on legal equality for homosexual and bisexual people both in Germany and internationally, this is still underdeveloped for transgender and intersex people.LGBTI people face specific barriers to healthcare access.The data basis on the health of LGBTI people should be improved.


The Doctor Is In and Health Body Light. The results revealed that these two programs presented information about what CVDs and CVRFs are, how the former are treated, and what strategies are used to communicate health information. A new topic also stood out: discussions on how traditional Chinese medicine prevents and cures these diseases.This study aims to add to the knowledge about information depicted in television health programs in China. Cardiovascular diseases (CVDs) are the leading cause of death in the country. The threat it poses is particularly notable among the Hui ethnic minority people, who have a higher prevalence of cardiovascular risk factors. Little research has been conducted thus far on content concerning CVDs in Chinese television health programs, and this study aims to fill this lacuna. Qualitative content analysis was conducted to analyze  Despite the great popularity of the internet, social media and apps in China, television (TV) remains a prominent source of information on health and well-being for many people ,2. PreviThe Doctor Is In and Health Body Light, which are, respectively, broadcast across China and in the Liaoning province.There are differences in the prevalence of CVRFs in the various ethnic groups in China, and previous data highlights the high prevalence of CVRFs among the Hui group  due to tThis study examines content related to CVDs shown on Chinese TV health programs. Diffusion theory provides a basis for legitimizing this focus. Diffusion theory can be seen as a repository collecting concepts from various social sciences concerned with the transfer of knowledge and spreading of information to the population . PreviouThe Doctor Is In and Health Body Light?RQ1. What kinds of CVD-related health content are depicted in The depiction of health information can reinforce or hinder its impact on knowledge, attitudes, and behaviors . It has The Doctor Is In and Health Body Light broadcast health information related to CVDs?RQ2. In what ways do In China, there are 55 ethnic minority groups and the Han majority group . Among tOur major reason for investigating the depiction of CVD-related information on Chinese TV is the high prevalence of CVDs and CVRFs among the Hui minority . Even thPrevious research that has built on the culture-centered approach (CCA) shows that health communication tends to focus on dominant groups in multicultural and multiethnic societies, which often means that the health needs of minorities are ignored ,26,27,28RQ3. What health content specifically related to Hui people is included in the two TV programs?The Doctor Is In and Health Body Light. We used qualitative content analysis to answer the research questions, following previous studies concerning health-related media coverage . Contenl., 2012 .The Doctor Is In, is transmitted by the national TV station, China Central Television (CCTV), while the second, Health Body Light, is aired by the local station, LRTV-City. Both programs are targeted at the general public and are set in the indoor studios of the respective stations.National and local TV stations in China both broadcast health programs. The first program examined in this study, The Doctor Is In and 89 of Health Body Light. Chinese spring festival holidays meant that six of the 89 episodes of the latter were repeats of programs aired in January 2017, and these were therefore removed from our corpus.This study is part of a larger project carried out in Shenyang City from 19 December 2016 to 9 February 2017. A survey was conducted in that period to investigate the Hui’s access to and evaluation of health information concerning CVDs, available on various communication channels and sources . The curThe Doctor Is In and 12 from Health Body Light. These episodes were downloaded in the MP4 format and stored. We only analyzed the CVD-related content, meaning that messages shown in advertisements, public service announcements, and promotions of other TV programs were excluded.Relevance sampling was used in the study, with the aim being to select all the textual units that contributed to answering the research questions . The twoThe Doctor Is In and Health Body Light is around 37 ± 2 and 28 ± 1 min long, respectively. We examined what was presented and discussed in relation to CVDs and CVRFs in the selected episodes. The coding unit of analysis was a sequence. According to Iedema [Our unit of analysis was an individual episode of a program, which included the introduction, main content, and the ending. Each episode of o Iedema : “SequenWe then hand-coded the episodes. Thematic analysis was used to scrutinize the sequences, as this is a systematic procedure with enough flexibility to provide  freedom in the interpretation . An induThe Doctor Is In generally started with a brief live drama acted out by two special guests to highlight the subject-matter of an episode. The female host then appeared to introduce the topic and the two guests sat on the stage in front of the audience. In what followed, the host asked the audience topic-related questions and welcomed an expert, who answered these and provided medical explanations. The two guests who had acted in the live drama asked the expert relevant follow-up questions based on their experiences to facilitate further clarification. There were also interactions between the host, the guests and the expert that made the explanations clear and easy for the audience to understand. Sometimes, the audience had the opportunity to talk to the expert. An assistant was used when the expert needed to demonstrate practical medical knowledge. At the end of the program, the host summarized what had been covered in that day’s episode.The two programs investigated included various amounts of CVD-related health information. Health Body Light started with a card located in a ‘love mailbox’ related to the topic to be covered, which was read by one male and one female host. There was then a brief video of people outside the studio asking questions related to this theme. The assistant host, who sat with the live audience, introduced the subject matter and welcomed an expert guest. After a brief discussion between the expert and the two hosts, the former started to answer questions and provided medical explanations. There were also interactions between the live audience, the hosts and the expert. In some episodes, an assistant in cartoon dress turned up to help the expert distribute something to drink that was related to the topic or to show samples of medicines to the audience. At the end of an episode, the two hosts and the expert used three to five short sentences to summarize the important information discussed.Most of the episodes of Our thematic analyses of the content showed that the two TV programs mainly depicted health information about three related topics: (1) what CVDs and CVRFs are; (2) how CVDs are treated; and (3) what strategies are used to communicate CVD-related health information. A fourth topic also stood out: how traditional Chinese medicine prevents and cures CVDs. Despite the high prevalence of CVDs and CVRFs among the Hui, there was no information specifically targeted at this minority in our corpus.The Doctor Is In and Health Body Light, almost all of the episodes of the two programs we examined (23 of 25) contained general health information related to CVDs. The characteristics and symptoms of the diseases were described, and then the causes and high-risk populations were identified. The dangerous consequences of CVDs, the relationships between them and other diseases, and between CVRFs and lifestyles were also discussed. The general information was usually presented by the experts, who were depicted in a way that affirmed their professionalism and credibility; for example, when they appeared on the set, their academic titles were shown on the screen immediately.To answer our first research question about the kinds of CVD-related health content depicted in Health Body Light was a typical example. Its subject matter concerned overweight/obesity. The expert, Dr. Fan (Director of Chinese Nutrition Society), explained what this was, and then clarified the differences between being overweight and being strong, as it was claimed that many people confused the two. She then also corrected other misunderstandings; for example, she stated: “Many people think that overweight people’s intake of nutrients is more than needed, but that is not right”.The experts present in both programs provided information to counter any misunderstandings that people may have about CVDs. The 18 December 2016 episode of Health Body Light on 2 January 2017 concerned hypertension. Dr. Fan explained that eating at irregular intervals was one of the causes of this, and then promoted a few healthy dietary habits .The experts who appeared on the two programs explained the causes of CVDs and promoted dietary and lifestyle-related health behaviors that could prevent these conditions or reduce CVRFs. The episode of The Doctor Is In, the host introduced its topic by asking the audience the following question: “What signs should you be aware of regarding myocardial infarction?” The expert, Prof. Yang , explained each symptom of the condition in detail and, at the end of the program, suggested that viewers should go to hospital or call for an ambulance without delay if they experienced any of them.The episodes in our corpus contained health information that people could use to identify the symptoms of CVDs by themselves. The experts also stressed that if symptoms were present, a doctor should be seen as soon as possible. In the 16 January 2017 episode of Overall, both programs contained health information about what CVDs and CVRFs are. The experts also corrected any misunderstandings, promoted healthy behaviors for disease prevention, and helped the audience to recognize any symptoms to ensure they were treated quickly.The Doctor Is In and Health Body Light.The treatment of CVDs can be viewed as solutions to health issues. In the different episodes of the two programs, treatments were mainly discussed in the context of giving first aid and the use of medicines. Thus, this is also an important part of CVD-related health content that is depicted in The Doctor Is In, the expert, Prof. Li , explained what to do if someone suddenly collapsed and stopped breathing. Two special guests were invited to perform cardiopulmonary resuscitation (CPR) on a model of the human body, but did so incorrectly. Thereafter, Prof. Li’s assistant demonstrated the right way to provide this type of first aid.The issue of delivering first aid was prominent in both programs. The hosts stressed the importance of having first-aid skills, as these can save lives in medical emergencies, particularly because patients with CVDs are high risk. The experts also demonstrated how to provide first aid. On the 6th December 2016 episode of The Doctor Is In contained a typical example: in a live scene of a dinner, a mom and son ate food containing a lot of sugar and fat. The son then said that he would take another pill containing hypoglycemic agents to counteract the extra sugar he had eaten that day. The live audience echoed that they did the same thing by increasing the dose of the medications they had been prescribed. Prof. Li  then explained why this was wrong and what the consequences were, before describing the proper way of taking these drugs. In doing so, he not only corrected the audience’s misunderstandings about using medicines, but also provided instructions on how to take them properly.In our corpus of 25 episodes, information on medicines related to CVDs is commonly included. This mainly focused on: (1) how to take the medications correctly; (2) their functions; (3) the consequences of misusing them; and (4) which ones to use in emergencies. Both programs covered the important role medicines play. The experts highlighted that many patients did not take them correctly and explained why particular methods were right or wrong. The 18 December 2016 episode of Health Body Light concerned the medical effects of okra water. A member of the live audience in the studio shared that she had learned from WeChat that drinking this water could lower blood sugar levels and even eliminate the need for hypoglycemic agents, although she was not sure whether this was true. A nutrition expert, Director Wang , corrected this misunderstanding, stating that okra water is helpful but could not replace these medications: “As long as you don’t stop taking hypoglycemic agents, then it (drinking okra water) is fine.” In this episode, other members of the live audience revealed that they also obtained and shared health information within their social networks on WeChat. As an example, a young man’s friend on the platform told him that soda water could kill cancer cells, causing him to buy a few bottles. The two programs also have their own WeChat official accounts, which implies that they intersect TV broadcasting with social media. The contents of these accounts were not, however, analyzed in this study.Another interesting sub-theme that emerged from our analysis concerned the discussion of the credibility of health information obtained from social media platforms such as WeChat. Each day, approximately 570 million users, 93% of whom live in first-tier cities in China, log in to their WeChat accounts , and theThe Doctor Is In and Health Body Light.The episodes in our corpus provided information about traditional Chinese medicine in relation to CVDs, in particular its role in preventing them and relieving their symptoms. Thus, traditional Chinese medicine is also an important part of CVD-related health content that is depicted in The Doctor Is In, Prof. Jia showed the audience two important acupoints—Zhiyang and Jiuwei—using a picture that was clearly marked, then he commented: “Pressing these two acupoints can help people relieve their discomfort and cure themselves of angina pectoris.”Three aspects of traditional Chinese medicine were covered in both programs: (1) acupressure; (2) making food with traditional Chinese medical ingredients; and (3) scraping. In relation to the first, Prof. Jia (from Beijing University of Chinese Medicine) explained that patients can press specific acupoints to prevent diseases, relieve symptoms, or save themselves in emergencies. The experts showed the audience how to identify and press their acupoints, which they explained was necessary because many patients did not know how to do this properly. For example, in the 4 January 2017 episode of Health Body Light introduced home-made drinks and food produced using such elements as a form of adjuvant therapy. On Health Body Light, the episode on 3 January 2017 focused on cardio issues. The expert, Dr. Wu , explained how to make ‘Happiness tea’ with traditional ingredients that could make the heart feel better and relieve symptoms.The experts also presented information about preparing specific kinds of food  that use traditional Chinese medical ingredients to prevent and relieve the symptoms of CVDs. Five episodes of The Doctor Is In. She argued that scraping had become more popular in China, but some had doubts about its effectiveness. She then explained that many people carry it out incorrectly, which could cause serious side effects, before showing the audience the proper way to relieve hypertension by scraping a particular acupoint. She also explained that the strength of scraping and the time of its application matter a great deal for its efficacy.Scraping was the third aspect of traditional Chinese medicine discussed in the two programs. Dr. Wang  was the expert on the 12 February 2017 episode of The experts who appeared on these two programs emphasized the importance of applying interventions based on traditional Chinese medicine properly, as they were convinced that patients often did not do so.To answer our second research question, our analyses revealed that the two programs in our study used simple entertainment strategies to disseminate health information. Different approaches were identified in the 25 episodes examined see .The Doctor Is In, after the experts had verbally explained the principles of using medicines to lower blood pressure, the host said: “Some audience members may not understand what you’ve just explained, so let’s use tools to explain it to them again, okay?” The cardiovascular specialist, Prof. Xu , used pictures of a rabbit with a carrot, a turtle with a fish, and a giraffe with some leaves to explain why it is necessary to use medicines in the correct manner. The cartoons in this episode clearly aimed to explain complex health information in an easy-to-understand way.Cartoons were used as a tool in both programs to help the experts explain medical phenomena or theories. For example, in the 16 December 2016 episode of The Doctor Is In and one from Health Body Light incorporated live dramas to present health information. In some cases, these were used to introduce the program’s topic, but also made the program more entertaining. The 15 January 2017 episode of The Doctor Is In started with a live drama played out by the host and two guests, which brought laughter from the live audience. After the drama, the expert, Dr. Zhang , explained that the traditional Chinese medicine ‘an gong niu huang wan’ can only be used in cerebral infarctions, hemorrhages or heart attacks with specific symptoms, and not in the emergency case shown in the drama.Of the 25 episodes we examined, five from Both programs included quizzes to engage the participants with the health information. When the live audience, special guests and hosts took part in these, they also disclosed their health conditions and shared their opinions. The 6 December 2016 episode of The Doctor Is In started with a health knowledge quiz between a blue and a red team. The live audience and special guests were divided into two teams and the expert was the judge. The two special guests were celebrities and the team captains. After the two guests provided answers on behalf of each team, the expert judge gave the right answer and explained the medical issue in more detail. During the quiz, the guest captains of the two teams made fun of each other, which caused much laughter in the audience.This is an exploratory study to focus on CVD-related health content in Chinese TV health programs. Previous research has shown that misunderstandings of health information exist in the US, e.g., concerning the use of medicines ,36,37. TTraditional Chinese medicine emerged as an important theme. China has two kinds of medical system, traditional Chinese and Western, which are different in how they conceptualize health and deal with illness. Traditional Chinese medicine is rooted in Chinese philosophy and is an important part of the Chinese culture . TraditiThe two TV programs used basic entertainment strategies to make them more amusing and appealing. Cartoons were used in combination with written text in an attempt to explain medical facts in an easy-to-understand way. This is logical from the perspective of the multimedia principle, which holds that individuals will comprehend information better when words and pictures are presented together . Other sThis study has several limitations. First, it is difficult to make generalizations across other health programs. A large-scale study examining a variety of Chinese TV health programs is therefore needed in the future. Additionally, this research focuses on one national and one local health program. Accordingly, future studies could be conducted to make comparative analyses of more national and local programs to investigate their differences in terms of the health information they disseminate. Second, the current study mainly focused on the text used in the programs, which may be seen as a limitation by some researchers. Although the visuals or comments of the audience also communicated meanings, text was prioritized because it enables an audience’s interpretations to be better understood , which wDespite the limitations, our findings have implications for future health communication in China. Previous research has shown that the Hui have the highest prevalence of hypertension , and botThis research only examined the kinds of CVD-related health information depicted in the selected health programs on Chinese TV, and if this content is related to the Hui minority. The scientific–medical validity of the content of the information was not studied in this project. In response to the first research question, the results revealed that both programs: contained a great deal of health information concerning what CVDs and CVRFs are; discussed how to clarify relevant misunderstandings; promoted healthy behaviors for prevention purposes; and helped people to recognize symptoms to ensure they are treated in time. The two programs mainly presented information about treatment for CVDs in the contexts of the use of medicines and first aid. In addition, a few episodes of both programs focused on traditional Chinese medicine, which led us to conclude that this plays an important role in China’s medical systems.The second research question examined how the two programs depicted health information related to CVDs. Overall, the communication styles were similar, with an emphasis on serious advice, but both also included entertainment elements such as cartoons and quizzes.Our third research question concerned how CVD-related health content was targeted at the Hui minority. It was found that, even though the Hui have a high prevalence of CVRFs and CVDs, no health information was specifically targeted at them in the corpus we analyzed.


On the other hand, the age and time they have been working for the organization did not significantly influence risk perception. Finally, risk perception can vary in construction workers according to different variables. It is essential to investigate the factors that influence it, to prevent risky behaviors that can lead to accidents.Risk perception is used to quantify risks in the industry and is influenced by different socio-demographic variables. This work aims to determine significant differences in the risk perception between Mexican American migrants and first-generation Mexican American construction workers. This study used a sample of 112 construction workers. A guided questionnaire was applied to collect socio-demographic information. For workplace risk behaviors, we used a 21-item questionnaire adapted from the previous instrument. Each question asked the participant’s perception of the frequency with which they carried out risky activities during routine work activities and the severity of the possible injuries, using a five-level Likert scale. Then, an inferential analysis was carried out using analysis of variance (ANOVA). The main results highlight that time of residence in the United States had a significant influence ( Within the construction industry research community, there is agreement that construction work is, first, one of the largest industries in the United States, and second, one of the most dangerous and indicative of a deteriorating situation of the construction industry . AccidenInternational and local construction firms helped the economy of the USA, providing at the same time employment opportunities for many . ConstruIn the United States, there has been an increase in the foreign-born population, even though the general population growth rates have decreased steadily since the 2007 great recession. The role of immigrant workers in the USA construction industry has become of great significance. An increasing number of foreign-born individuals from the Hispanic population are joining the construction industry workforce. An estimated quarter of the total industry workforce comprises foreign-born workers, out of which 84% come from Latin-American countries . HoweverInterestingly, considering an estimated working lifespan between 20 and 65 years of age, construction workers in the United States have an overall 75% probability of undergoing a disabling injury . HoweverAccording to recent statistics from the Bureau of Labor Statistics, accidents in the construction industry increased by 5% since 2007 in the United States of America, and 1061 cases of fatal occupational injuries were registered . CurrentRisk perception can be defined as a process used to evaluate the amount of risk present in a certain situation; it reflects uncertainty, and it is different from person to person . While iIn addition, besides the construction industry, risk perception has been addressed in different contexts such as manufacturing , tourismAs stated before, a worker’s internal factors such as attitude, perception, and efficacy play a vital role in safety performance. Risk perception has important effects not only on safety behaviors, but also on the decisions of workers for the use or non-use of personal protective equipment  (12), moParticipants were recruited at different construction worksites throughout the El Paso (Texas) and Dona Ana (New Mexico) Counties. Eligible candidates for enrollment were self-reported Mexican migrants, and first-generation Mexican American workers from construction contractors and companies, and non-governmental organizations (NGOs) associated with construction work in the Paso Del Norte region. Participants involved in the study were either male or female construction workers. All participants were 18 years of age and older, able-bodied, with at least a six month history of uninterrupted construction work history, and currently living in the Paso del Norte region. Workers who did not meet inclusion criteria or had a known self-reported history of musculoskeletal, neurological, and metabolic chronic disease were not included in the study. Afterward, eligible participants were invited and selected at convenience until the sample size quota was met. The study was approved by the University of Texas at El Paso’s Institutional Review Board (FWA No: 00001224). All eligible participants received an explanation of the study’s purpose and procedures and signed informed consent.A guided questionnaire was employed to collect demographic, socio-economic, and cultural information from participants. Workplace risk behaviors were explored using a 12-item questionnaire adapted from a previous instrument from Xia et al.  to assesA list of major construction companies in the Paso Del Norte border region was used as a source to identify potential participants. Data collection was carried out during the period of December 2017 and January 2018. During that period, there were 2570 construction workers in El Paso, TX . TherefoAfter completing the questionnaire, participants were assigned to one of two groups: (1) foreign-born Mexican migrants and (2) first-generation Mexican immigrants. Descriptive analyses were conducted for both groups through the statistical analysis software SPSS for Windows version 25.0 . KMO and Bartlett’s tests were obtained to analyze the adequacy of the data to a factor analysis model.ANOVA tests were performed using SPSS statistical software to identify significant differences between the place of birth, residence time in the USA, and time worked in the organization, intending to determine if these factors influence risk perception. Finally, a Tukey test was developed to find differences between groups of the study regarding the variables with significant differences in risk perception.Results of analysis of variance for risk perception are shown in A Tukey test was performed for the variable time of residence in the United States, which obtained significant differences between the groups. The results are shown in This work aimed to determine differences in risk perception in construction workers as a result of socio-demographic variables such as age, time of residence in the United States, and time working for the organization. The sample of construction workers for this study showed that age and time working for the company did not influence risk perception. These results agree with Chan et al. .The results found in this work coincide with those found by Lopez et al.  and RiccThe results found in the analysis of variance showed no significant differences in the risk perception of construction workers concerning age. These findings agree with Oah et al. . On the In this study, the time workers have been working in the organization did not significantly influence risk perception. This finding agrees with Rodríguez-Garzón et al. , who alsThis research also has some limitations. First, this work used a cross-sectional design investigation with a non-probabilistic sample due to the availability of the participants. The CoWoRP scale from Man et al.  was not It is recommended to explore other cultural variables that could influence the risk perception of construction workers and inquire about the accident history of the participants. It would also be interesting to analyze whether this same phenomenon occurs in workers from other work contexts who have lived in the United States for a longer time.In addition, some organizational factors can also have impact on the risk perception, such as safety climate, leadership levels, workloads, motivation of workers, and knowledge and safety training; it is important to consider the effect of these variables so as to expand information about risk perception.Additionally, personal traits, attitudes, and personality, as well as history of accidents at work or experiences with fatalities, must be included in following works. It is considered essential to determine the factors from which workers may perceive risk differently, as it can serve as a basis for future interventions that help manage risks in the workplace and prevent risk behaviors.Construction is a risky industry and understanding the sources of the risks is essential to implementing appropriate risk prevention and mitigation methods . DespiteWe found that time of residence in the United States had a significant effect on risk perception. This finding brings more clarity that nationality or cultural characteristics of subjects are factors that can interfere with the risk perception. It can provide some clarity on the reason why workers can face the same risk situation but may make different decisions regarding it. Despite this, the study sample perceived that among the activities commonly carried out in the construction industry, those with the highest risk were helping other colleagues and when using work tools.However, the main results of this work highlight that time of residence in the United States of America had a significant influence on risk perception. Our results identified differences associated with the length of residence. This review should provide a basis for conducting research focused on work-related risk perception among immigrant workers, which will influence accident rate reduction in this particular worker population.