P068 Exploring the impact of COVID-19 on self-management and healthcare provision in people with Inflammatory Arthritis: A qualitative study

Abstract Background/Aims Inflammatory arthritis (IA) patients have been identified as being at greater risk of severe illness from COVID-19. It is likely that lockdown restrictions enforced by the UK government in response to the COVID-19 pandemic, and subsequent changes made to healthcare provisions, could impact patients’ abilities to effectively manage their condition. The aim of this study was to qualitatively explore the impact of COVID-19 and lockdown on self-management behaviours and healthcare provision in people with IA. Methods Semi-structured interviews were conducted with 21 patients with IA from across the UK (as part of a larger longitudinal survey study exploring the impact of COVID-19 on health-related quality of life for people with IA). Participants who gave consent for contact, following the completion of the baseline survey study, were approached to take part in the qualitative interviews. The interview schedule was developed with a Patient Research Partner and consisted of eight main questions to explore participants’ experiences of the COVID-19 pandemic, including the impact of COVID-19 on their self-management behaviours and access to healthcare services. The interviews were conducted via telephone and were recorded and transcribed before being analysed using inductive thematic analysis. Results Participants were aged between 24-72 (mean age 50.0, SD 15.6) and were mostly female (71%) and White British (86%). Four main themes were identified: impact of COVID-19 on medication adherence, impact of COVID-19 on physical activity, impact of COVID-19 on diet, and impact of COVID-19 on healthcare access. Subthemes focused on positive and negative changes made to these areas, as well as behaviours which remained consistent. Some participants expressed that the lockdown period had enabled them to increase their physical activity, improve their diet and maintain their usual medication regimen, whilst others noted that lockdown had had a negative impact on their self-management behaviours. For example, some patients decided to discontinue their medication during the pandemic due to concerns that it would make them more susceptible to severe consequences from COVID-19. In relation to healthcare provision, the most commonly reported change was the introduction of telephone appointments to replace face-to-face consultations. Several patients found the telephone appointments ineffective, especially if their disease was relatively uncontrolled. Nevertheless, participants understood why a remote approach had been implemented during the pandemic. Conclusion COVID-19 has had an impact on patients’ abilities to manage their IA. Healthcare professionals need to recognise the impact of COVID-19 on patient self-management and healthcare provision to ensure that adequate understanding and support is available to patients who may have inadequate disease control as a result. Disclosure E. Caton: None. H. Chaplin: None. L. Carpenter: None. M. Sweeney: None. H. Tung: None. S. de Souza: None. S. Norton: None.

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The impact of COVID-19 on self-management behaviours and healthcare access for people with inflammatory arthritis

BMC Rheumatology ◽

10.1186/s41927-021-00231-1 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Emma Caton ◽

Hema Chaplin ◽

Lewis Carpenter ◽

Melissa Sweeney ◽

Hsiu Yen Tung ◽

...

Keyword(s):

Inflammatory Arthritis ◽

Healthcare Access ◽

Self Management ◽

Severe Illness ◽

Structured Interviews ◽

Healthcare Provision ◽

June July ◽

The Uk ◽

The Impact

Abstract Background Inflammatory arthritis (IA) patients have been identified as at greater risk of severe illness from COVID-19. It is likely that lockdown restrictions (enforced by the UK government in response to the COVID-19 pandemic) and subsequent changes made to healthcare provision could impact patients’ abilities to effectively manage their condition. The aim of this study was to qualitatively explore the impact of COVID-19 on self-management behaviours and healthcare access for people with IA. Methods Semi-structured interviews were conducted with 21 IA patients in June-July 2020, with nine follow-up interviews in November 2020. Interview schedules were developed with a Patient Research Partner and explored participants’ experiences of the COVID-19 pandemic. Interviews were conducted via telephone and analysed using inductive thematic analysis. Results Participants were aged between 24 and 79 years (mean = 50.1, SD = 15.8), largely female (71%) and White British (86%). Four initial themes were identified: (1) Impact of COVID-19 on medication adherence, (2) Impact of COVID-19 on physical activity, (3) Impact of COVID-19 on diet, and (4) Impact of COVID-19 on healthcare access and delivery. Subthemes focused on positive and negative changes made to these areas, as well as behaviours which remained consistent. Follow-up interviews highlighted differences in participants’ experiences during the two lockdown periods. Conclusion COVID-19 has affected patients’ abilities to manage their IA. Healthcare professionals need to recognise the ongoing impact of COVID-19 on patient self-management and healthcare access to ensure that adequate understanding and support is available to patients who may have inadequate disease control as a result.

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P095 The impact of COVID-19 lockdown on clinical care, self-management, and mental health in patients with inflammatory arthritis

Rheumatology ◽

10.1093/rheumatology/keab247.093 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Melissa Sweeney ◽

Lewis Carpenter ◽

Savia de Souza ◽

Hema Chaplin ◽

Hsiu Tung ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Emotional Distress ◽

Inflammatory Arthritis ◽

Clinical Care ◽

Self Management ◽

Disease Outcomes ◽

Reduced Physical Activity ◽

Vas Scores ◽

The Impact

Abstract Background/Aims COVID-19 lockdown affected access to clinical care for many vulnerable patients, including those with inflammatory arthritis (IA). It also had the potential to alter self-management behaviours. These changes could in turn impact mental health, especially given that IA patients are already at higher risk of mental health disorders. Thus, the aims of this study were to determine how IA care and self-management were affected by lockdown and assess the impact of these changes on disease outcomes and mental health. Methods Online questionnaires were completed by 338 participants between June and July 2020. The questionnaires assessed demographics, IA condition, IA self-management, COVID-19 clinical information, quality of life, and mental health. Visual analogue scale (VAS) scores for patient global assessment (PGA) of disease activity, pain, fatigue, and emotional distress were completed relating to the previous week and retrospectively for pre-lockdown (March) and early-lockdown (April). Improvement/worsening in each VAS was considered as a change of 10 points or more from pre-lockdown to the current rating. Linear regressions were conducted to determine factors associated with worse outcomes, controlling for potential confounders including self-reported pre-lockdown status. Results Mean VAS scores worsened during lockdown for all outcome measures, with over half reporting a more than 10-point worsening (Table 1). Changes to clinical care affected 87% of patients. The most commonly affected services were hospital outpatient appointments (77%), GP appointments (59%), and blood tests (53%). Changes to clinical care were significantly associated with worse PGA (b = 8.95, p=0.01), pain (b = 7.13, p=0.05), fatigue (b = 17.01, p<0.00) and emotional distress (b = 12.78, p<0.01). Regarding self-management, 64% of patients reported changes to diet while 51% reduced physical activity. Change in diet was not significantly associated with any of the outcomes, whereas physical activity was associated with PGA (b=-2.42, p<0.01), pain (b=-2.43, p<0.01), fatigue (b=-2.5, p < 0.01), and emotional distress (b=-2.41, p<0.01). Conclusion Most patients (87%) had at least one area of clinical care affected by the lockdown. These changes in IA clinical care were associated with worse disease outcomes across all measures and greater emotional distress. In self-management, reduced physical activity was associated with worse outcomes in all physical and mental health measures. P095 Table 1:Mean VAS (0-100) scores and percent changesPGAMarch April June/JulyMean (SD) 44.51 (23.70) 53.18 (24.67) 57.69 (25.29)Better Same WorsePercent 7.9936.6855.33[95% CI] [5.33-11.41][31.54-42.07][49.85-60.71]PainMarch April June/July42.60 (25.60) 51.11 (26.01) 56.66 (26.40)Better Same Worse7.6937.8754.44[5.09-11.07] [32.68-43.28][48.96-59.84]FatigueMarch April June/July46.86 (26.17) 57.11 (25.83) 61.35 (26.51)Better Same Worse10.0634.0255.92[7.07-13.77] [28.98-39.35][50.44-61.29]Emotional DistressMarch April June/July30.96 (26.28) 49.06 (29.09) 48.75 (29.15)Better Same Worse8.2833.14 58.58[5.58-11.75] [28.14-38.43][53.12-63.88] Disclosure M. Sweeney: None. L. Carpenter: None. S. de Souza: None. H. Chaplin: None. H. Tung: None. E. Caton: None. J. Galloway: None. A. Cope: None. M. Yates: None. S. Norton: None.

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The impact of COVID-19 on clinical care, self-management, and mental health of patients with inflammatory arthritis

Rheumatology Advances in Practice ◽

10.1093/rap/rkab095 ◽

2021 ◽

Author(s):

Melissa Sweeney ◽

Lewis Carpenter ◽

Savia de Souza ◽

Hema Chaplin ◽

Hsiu Tung ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Emotional Distress ◽

Inflammatory Arthritis ◽

Clinical Care ◽

Care Quality ◽

Self Management ◽

Physical And Mental Health ◽

Disease Outcomes ◽

The Impact

Abstract Objectives The COVID-19 lockdown and ongoing restrictions in the UK affected access to clinical care, self-management, and mental health for many patients with Inflammatory Arthritis (IA). This study aimed to determine the impact of lockdown on IA clinical care, self-management, disease outcomes, and mental health. Methods In total, 338 people with IA participated in a prospective study completing a series of online questionnaires. The questionnaires assessed demographics, IA condition and management, clinical care, quality of life, and mental health. Visual analogue scales (VAS) were completed at each assessment. Linear regression, controlling for confounders, was conducted to determine factors associated with physical and mental health outcomes. Results Over half of participants reported worsening VAS by more than 10 points for Patient Global Assessment (PGA), pain, fatigue, and emotional distress during the initial lockdown. Changes in clinical care were associated with worse PGA (b = 8.95, p = 0.01), pain (b = 7.13, p = 0.05), fatigue (b = 17.01, p < 0.01) and emotional distress (b = 12.78, p < 0.01). Emotional distress and depression were also associated with worse outcomes in PGA, pain, and fatigue, while loneliness was not. In contrast, physical activity seemed to mitigate these effects. Loneliness did not show any associations with outcomes. Over time, these effects decreased or disappeared. Conclusions Changes to clinical care due to lockdown were associated with worse disease outcomes in patients with IA. There has been a clear impact on mental health as well, with possibly complex relationships between mental health and psychosocial factors. Physical activity emerged as a key influence on disease outcomes and mental health.

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How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the UK? A cross-sectional online survey

BMJ Open ◽

10.1136/bmjopen-2020-043397 ◽

2021 ◽

Vol 11 (5) ◽

pp. e043397

Author(s):

Austen El-Osta ◽

Aos Alaa ◽

Iman Webber ◽

Eva Riboli Sasco ◽

Emmanouil Bagkeris ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Social Isolation ◽

Online Survey ◽

Female Gender ◽

School Age Children ◽

School Age ◽

Cross Sectional ◽

The Uk ◽

The Impact

ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age children.DesignCross-sectional online survey of parents of primary and secondary school-age children.SettingCommunity setting.Participants1214 parents of school-age children in the UK.MethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA Three-Item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression models.Main outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.ResultsHalf of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely during the first 100 days of lockdown. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. The sustained adoption of two modifiable health-seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) wmay help reduce feelings of social isolation and loneliness during lockdown.

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Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2021-048772 ◽

2021 ◽

Vol 11 (6) ◽

pp. e048772

Author(s):

Toby O Smith ◽

Pippa Belderson ◽

Jack R Dainty ◽

Linda Birt ◽

Karen Durrant ◽

...

Keyword(s):

Mixed Methods ◽

Qualitative Study ◽

Online Survey ◽

Musculoskeletal Diseases ◽

Community Dwelling ◽

Secondary Outcome ◽

Healthcare Provision ◽

Social Restriction ◽

The Uk ◽

The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

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The impact of sitting time and physical activity on mental health during COVID-19 lockdown

Sport Sciences for Health ◽

10.1007/s11332-021-00791-2 ◽

2021 ◽

Author(s):

Matthew Pears ◽

Susanna Kola-Palmer ◽

Liane Beretta De Azevedo

Keyword(s):

Mental Health ◽

Physical Activity ◽

Health Outcomes ◽

Online Survey ◽

Depression Score ◽

Sitting Time ◽

Multiple Stepwise Regression Analysis ◽

Previous Diagnosis ◽

The Uk ◽

The Impact

Abstract Objective The primary aim of this study was to investigate the association between physical activity (PA) and sitting time on adults’ mental health (i.e., depression, anxiety and wellbeing) and the influence of mediators and confounders. Methods An online survey was disseminated in the UK between May and June 2020. A total of 284 participants (33.5 ± 12.4 years) self-reported their PA, sitting time and mental health through validated questionnaires. Results Multiple stepwise regression analysis revealed that being of younger age, female, on a lower income, with one or more comorbid health conditions, with a previous diagnosis of mood disorder and increased sitting time independently correlated with higher depression scores (F (13,219) = 12.31, p < 0.001), and explained 42% of the variance. Similar results were found for wellbeing where socio-demographic, health outcomes and sitting time influenced the subjective wellbeing (F (14,218) = 5.77, p < 0.001, 27% variance), although only socio-demographic and health outcomes contributed to the variation in anxiety score (F (13,219) = 7.84, p < 0.001, 32% variance). PA did not explain variation when sitting time was taken into account in any of the models. Combined analysis revealed that participants with lower sedentary time (< 8 h) and with both low or moderate and high PA presented a significantly lower depression score [low PA: (B = −2.7, 95% CI −4.88, −0.52); moderate and high PA (B = −2.7, −4.88, −0.52)]. Conclusion Sitting time was strongly associated with adverse mental health during COVID-19 lockdown and should be considered in future public health recommendations.

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The impact of COVID-19 quarantine on dietary habits and physical activity in Saudi Arabia: a cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-11540-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Manar Abduljalil Bakhsh ◽

Jomana Khawandanah ◽

Rouba Khalil Naaman ◽

Shoug Alashmali

Keyword(s):

Physical Activity ◽

Body Weight ◽

Weight Gain ◽

Dietary Habits ◽

Negative Impact ◽

Adult Population ◽

Cross Sectional Study ◽

Future Health ◽

Cross Sectional ◽

The Impact

Abstract Background The COVID-19 pandemic has forced governments around the world to impose strict hygiene and national lockdown measures, which in turn has changed the dietary and lifestyle habits of the world’s population. Thus, the aim of this study is to evaluate whether dietary and physical activity behaviors of Saudi Arabia’s adult population changed during the COVID-19 quarantine. Methods An electronic questionnaire which assessed changes in body weight, dietary habits, and physical activity of Saudi Arabia’s adult population (n = 2255) during the COVID-19 quarantine was distributed on social media between June and July 2020. To test the differences between changes in dietary and physical activity behaviors in relation to changes in body weight a Chi-square test was used. Results Over 40 and 45% of participants reported eating and snacking more, respectively, which led to weight gain in around 28%. Most participants reported that they consumed home-cooked (73%) and healthy meals (47%), while only 7% reported that they consumed foods from restaurants. Feelings of boredom and emptiness (44%) and the availability of time for preparing meals (40%) were the main reasons for changing dietary habits. Honey (43%) and vitamin C (50%) were the most consumed immune-boosting food and dietary supplement, respectively. COVID-19 also had a negative impact on physical activity, lowering the practice in 52% subjects, which was associated with significant weight gain (p < 0.001). Conclusion Assessing the changes to the population’s dietary habits and physical activity during the lockdown will help predict the outcome of the population’s future health and wellbeing after the pandemic.

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Impact of the implantable cardioverter defibrillator on confidence to undertake physical activity in inherited heart disease: A cross-sectional study

European Journal of Cardiovascular Nursing ◽

10.1177/1474515117715760 ◽

2017 ◽

Vol 16 (8) ◽

pp. 742-752 ◽

Cited By ~ 4

Author(s):

Joanna Sweeting ◽

Kylie Ball ◽

Julie McGaughran ◽

John Atherton ◽

Christopher Semsarian ◽

...

Keyword(s):

Physical Activity ◽

Heart Disease ◽

Implantable Cardioverter Defibrillator ◽

Vigorous Physical Activity ◽

Survey Study ◽

Accelerometer Data ◽

Cross Sectional ◽

Physical Activity Guidelines ◽

Cardioverter Defibrillator ◽

The Impact

Background: Physical activity is associated with improved quality of life. Patients with an implantable cardioverter defibrillator (ICD) face unique clinical and psychological challenges. Factors such as fear of ICD shock may negatively impact on physical activity, while a sense of protection gained from the ICD may instil confidence to be active. Aim: We aimed to examine the impact of an ICD on physical activity levels and factors associated with amount of activity. Methods: Two cross-sectional studies were conducted. Accelerometer data (seven-day) was collected in March–November 2015 for 63 consecutively recruited hypertrophic cardiomyopathy patients, with or without an ICD, aged ⩾18 years. A survey study was conducted in July–August 2016 of 155 individuals aged ⩾18 years with an inherited heart disease and an ICD in situ. Results: Based on the International Physical Activity Questionnaire, mean leisure time physical activity was 239 ± 300 min/week with 51% meeting physical activity guidelines. Accelerometry showed that mean moderate–vigorous physical activity was the same for patients with and without an ICD (254 ± 139 min/week versus 300 ± 150 min/week, p=0.23). Nearly half of survey participants ( n=73) said their device made them more confident to exercise. Being anxious about ICD shocks was the only factor associated with not meeting physical activity guidelines. Conclusions: Patients with inherited heart disease adjust differently to their ICD device, and for many it has no impact on physical activity. Discussion regarding the appropriate level of physical activity and potential barriers will ensure best possible outcomes in this unique patient group.

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The perception of biopsychosocial impacts of COVID-19 during lockdown restrictions over time in the UK – a mixed methods study

Journal of Ideas in Health ◽

10.47108/jidhealth.vol4.issspecial2.131 ◽

2021 ◽

Vol 4 (Special2) ◽

pp. 402-414

Author(s):

Samuel Grimwood ◽

Kaz Stuart ◽

Ruth Browning ◽

Elaine Bidmead ◽

Thea Winn-Reed

Keyword(s):

Social Issues ◽

Negative Impact ◽

Mixed Methods Study ◽

Biological Domain ◽

Data Points ◽

Integrated Recovery ◽

Biopsychosocial Health ◽

The Uk ◽

The Impact ◽

Over Time

Background: The COVID-19 pandemic has profoundly impacted the health of individuals physically, mentally, and socially. This study aims to gain a deeper understanding of this impact across the pandemic from a biopsychosocial stance. Methods: A survey created by the research team was employed between November 2020 and February 2021 across social media, relevant organizations, and networks. The survey incorporated 5-time points across the different stages of the pandemic, covering biological, psychological, and social. There were 5 items for each survey (Very Positive affect to Very Negative affect), and analysis was undertaken using SPSS version 16. Descriptive statistics and non-parametric Friedman and Wilcoxon Tests, as well as correlations between the three domains, were implemented. Results: This study included 164 participants (77.0% female and 35.0% male) across 24 out of 38 counties in the UK. The impact of COVID-19 on biological domain was significant across the five data points χ2(4) = 63.99, p < 0.001, psychological χ2(4) = 118.939, p <0.001 and socially χ2(4) = 186.43, p <0.001. Between the 5 data points, 4 out of 5 had a negative impact, however between the first stage of lockdown and the easing of restrictions, findings for biological (Z=-2.35, p <0.05), psychological (Z=-6.61, p < 0.001), and socially (Z = -8.61, p <0.001) were positive. Negative correlations between the three domains across the pandemic are apparent, but in later stages, the biological domain had a positive correlation r = 0.52, p < 0.001. Conclusion: The data shows a negative impact from the self-reported perception of wellbeing from a biopsychosocial stance over time, as well as perceiving the three domains to interact negatively. To address these biopsychosocial issues, the research implies a place-based integrated recovery effort is needed, addressing biological, psychological, and social issues simultaneously. Further research should investigate biopsychosocial health among a more generalizable population.

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Legacies of a mega sporting event for healthy adolescent development: a case study of the 2010 Vancouver Olympic and Paralympic Games

10.7190/shu-thesis-00313 ◽

2020 ◽

Author(s):

◽

Ann Smith

Keyword(s):

Physical Activity ◽

Adolescent Development ◽

Homeless Youth ◽

Negative Impact ◽

Sports Participation ◽

Sporting Events ◽

Healthy Adolescent ◽

Sporting Event ◽

The Impact

Numerous studies have considered the impact of hosting a mega sporting event on adults. Using the 2010 Vancouver Winter Olympics and Paralympics as a case study, this thesis is the first to consider the impact of such an event on adolescents over a decade pre and post the event. It investigates the legacies of the 2010 Games on physical activity, employment, and community connectedness, and the environmental, psychological and social mechanisms through which any legacies may have occurred. A mixed-methods approach was used which combined analyses of cross-sectional data from the BC Adolescent Health Survey and Homeless and Street Involved Youth Survey, with sports club membership data and stakeholder consultations. Using selfreport data from over 60,000 adolescents—including three subpopulations typically excluded from mega events (adolescents with a disability, experiencing homelessness, and at risk of incarceration)—the study considered positive and negative, planned and unplanned, tangible and intangible legacies, and the time and space in which they occurred (Preuss, 2016). Results differed by age, gender and location. For example, the 2010 Games were more likely to have both a positive and negative impact on homeless youth in host communities compared to non-host communities. However, across British Columbia, a positive perception of the Games’ impact was associated with regular physical activity. Vulnerable subpopulations generally reported more negative impacts of the Games, but those who reported positive impacts experienced some reduction in health disparities with the general population. However, rather than serving as a catalyst to close the gap in organised sports participation between adolescents with a physical disability and their peers, the disparity increased following the Games. Stakeholder consultations provided context to these findings, and offered insight into how future mega sporting events might be leveraged to support healthy adolescent development at the population and subpopulation level.

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