Public Health Education and Promotion Commons^™

The Effect Of Dental Insurance Coverage And Economic Fluctuations On Oral Health Outcomes In The United States, Laura Singletary

Senior Theses

Proper oral health is imperative to overall health, but obstacles often persist in

receiving proper oral health care. Lack of dental insurance coverage and economic recessions are two main factors contributing to oral health outcomes. Extended time without cleanings or addressing current oral health concerns exacerbates oral health problems into more costly procedures for the patient that are conveniently not covered by many insurance plans. This thesis investigates the oral health outcomes associated with periods following economic downturns, specifically citing the time of the Great Recession from 2007-2009.

Covid-19 Vaccine Hesitancy And Vaccination Rate Among The Latino Population In South Carolina, Brynn E. Lynagh

Senior Theses

It is common knowledge that COVID-19 disproportionately impacts racial and ethnic minorities in the United States. Furthermore, these sects of the population exhibit increased vaccine hesitancy and lower vaccination rates as compared to the aggregated population of the United States, furthering the risk posed by COVID-19 to these communities. In particular, this study focuses on the Latino population in South Carolina, the vaccination rate among this community, and the perspectives which contributed to their vaccination decision. Two hundred Spanish and Portuguese speaking residents of South Carolina were interviewed using a paper survey conducted by pre-trained interviewers. The survey gathered data …

The Intersectionality Of Race And Rurality In Polysubstance Use During Pregnancy In The United States: A Study Of National Survey On Drug Use And Health, Sophia Tavakol

Senior Theses

Importance: Though detrimental consequences, many pregnant individuals are still binging alcohol, smoking, and/or using illicit drug. Yet, little is known regarding variations in such behaviors across pregnant people in the United States.

Objective: To examine alcohol, tobacco, and drug use during pregnancy in 2015-2020 and assess their racial, ethnic, and rural disparities.

Design: This cross-sectional descriptive study derived maternal characteristics and self-reported prenatal substance use data from 2015 and 2020 National Survey on Drug Use and Health, considering the complex sampling weight per participant per year produced by NSDUH.

Setting: United States.

Participants: A scientific random sample of non-institutionalized residents …

Girls Just Want To Be Safe: An Analysis Of Drugged Drinking And Prevention Amongst Students At The University Of South Carolina, C. Gray Forsberg

Senior Theses

Drink-spiking has become a well-known phenomenon since the turn of the century, especially on college campuses in the United States. Drink-spiking or drugging can be defined as “adding alcohol or drugs into someone’s drink without their knowledge or permission” (Alcohol and Drug Foundation, 2006). Drink-spiking is not just relevant to the concern of an illicit substance being placed into an alcoholic drink, but adding additional alcohol to drinks or adding alcohol or drugs to non-alcoholic drinks is considered drugging as well. This study collected data through a survey sent to 250 current students at the University of South Carolina regarding …

Wernicke's Encephalopathy: Mapping The Risk Factors Throughout The State Of South Carolina, Shannon M. Rychener

Senior Theses

Wernicke’s Encephalopathy is a consistently underrecognized neurodegenerative brain disorder resulting from prolonged thiamine deficiency. Clinical presentation of the disease results from brain lesions attributable to thiamine deficiency. Because these lesions occur in various locations in the cerebral cortex, symptoms can vary significantly. Varied presentation of symptoms, in addition to the lack of a widely accepted biomarker for the disorder cause challenges to clinicians when identifying and diagnosing the disorder. Due to these challenges, healthcare providers must heavily rely on patient history and risk factor prevalence when multiple symptoms of the disorder are present. By mapping the prevalence of the four …

Perspective: Food Environment Research Priorities For Africa-Lessons From The Africa Food Environment Research Network, Amos K. Laar, Phyllis Addo, Richmond Aryeetey, Charles Agyemang, Francis Zotor, Gershim Asiki, Krystal K. Ramapalli, Gideon S. Anevinya, Akua Tandoh, Silver Nanema, Akosua Pokua Adjei, Matlida E. Laar, Kobby Mensah, Dennis Laryea, Daniel Sellen, Stefanie Vandevijvere, Christopher Turner, Hibbah Osei-Kwasi, Mark Spires, Christine E. Blake, Dominic Rowland, Suneetha Kadiyala, Isabel Madzorera, Adama Diouf, Namukolo Covic, Isaac M. Dzudzor, Reginald Annan, Peiman Milani, John Nortey, Nicholas Bricas, Sukati Mphumuzi, Kenneth Yongabi Anchang, Ali Jafri, Meenal Dhall, Amanda Kee, Sally Mckay, Samuel O. Oti, Karen Hofman, Edward A. Frongillo Jr. Ph.D., Michelle Holdsworth

Faculty Publications

Over the last 2 decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization, and development. These changes have altered African food environments and, subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition—obesity and other diet-related noncommunicable diseases (DR-NCDs)—along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and offer energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food …

Greenspace Across The United States: Exploring Equity And Associations With Physical Activity, Obesity, And Health-Related Quality Of Life, Ellen W. Stowe

Theses and Dissertations

Neighborhood greenspace is important for health and well-being but may not be equitably present in neighborhoods across the United States. Also, many adults are physically inactive, have obesity, and report poor health-related quality of life. Greenspace has been tied to these health conditions, but with mixed findings. The purpose of this study was to 1) use an environmental justice perspective to examine variations in 11 measures of greenspace by neighborhood race/ethnicity, income, and rurality in block groups across the contiguous United States and 2) examine 11 greenspace measures in connection to physical activity, obesity, and health-related quality of life in …

Nutrition Facts Label Use Among U.S. Adolescents, Jennifer Beth Mandelbaum

Theses and Dissertations

Despite the promise of Nutrition Facts label (NFL) use as a population-level intervention with broad reach, few studies have examined determinants of adolescents’ NFL use, and how this label use may be associated with nutrition behaviors. This study used data from the International Food Policy Study, an online cross-sectional survey of trends in dietary patterns and policy-relevant behaviors in the U.S. and five other countries. First, this study examined 1) whether NFL use was associated with healthy eating efforts and 2) whether there were sociodemographic differences in NFL use among U.S. adolescents. Results demonstrated that NFL use was positively associated …

Mindfulness, Psychological Distress, And Somatic Symptoms Among Women Engaged In Sex Work In China, Cheuk Chi Tam, Yuejiao Zhao, Shan Qiao, Xiaoming Li, Zhiyong Shen

Faculty Publications

Women engaged in sex work (WSW) in China encounter numerous disadvantages (e.g., exposure to violence) and have substantial risk for psychological distress and somatic symptoms. Intervention literature has attended to mindfulness, which is a protective factor for psychological outcomes, and its influences can further improve physical health. However, mindfulness has not been well studied in WSW. We aimed to examine the association among mindfulness, psychological distress, and somatic symptoms among Chinese WSW. Data were collected from 410 WSW in Guangxi, China, using an anonymous, self-administered survey evaluating demographics, mindfulness, psychological distress (i.e., depression, loneliness, and perceived stress), and somatic symptoms …

The Effect Of Social Exclusion On Trust Among Youth Orphaned By Hiv/Aids: Evidence From An Event-Related Potentials Study, Jiaojiao Wan, Qi Zhao, Yafei Zhang, Lili Ji, Junfeng Zhao, Shan Qiao Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Grounded in a follow-up study among children who lost one or both parents to HIV in central China in the early 2000s, we conducted an event-related potentials (ERPs) experiment to explore the effect of social exclusion on trust and the corresponding neurophysiological mechanism among youth orphaned by HIV/AIDS (“AIDS orphans”). A sample of 31 AIDS orphans (26.16 ± 3.34 years old; 15 female) and 32 age and development status matched controls (25.02 ± 3.45 years old; 14 female) participated in the study. They were all assigned to play Cyberball, a virtual ball-tossing game that reliably induced social exclusion (15 orphans, …

Three Dimensions Of Covid-19 Risk Perceptions And Their Socioeconomic Correlates In The United States: A Social Media Analysis, Shan Qiao Ph.D., Zhenlong Li Ph.D., Chen Liang Ph.D., Xiaoming Li Ph.D., Caroline Rudisill Ph.D.

Faculty Publications

Social media analysis provides an alternate approach to monitoring and understanding risk perceptions regarding COVID-19 over time. Our current understandings of risk perceptions regarding COVID-19 do not disentangle the three dimensions of risk perceptions (perceived susceptibility, perceived severity, and negative emotion) as the pandemic has evolved. Data are also limited regarding the impact of social determinants of health (SDOH) on COVID-19-related risk perceptions over time. To address these knowledge gaps, we extracted tweets regarding COVID-19-related risk perceptions and developed indicators for the three dimensions of risk perceptions based on over502 million geotagged tweets posted by over 4.9 million Twitter users …

Three Dimensions Of Covid-19 Risk Perceptions And Their Socioeconomic Correlates In The United States: A Social Media Analysis, Shan Qiao, Zhenlong Li, Caroline Rudsill

Faculty Publications

Social media analysis provides an alternate approach to monitoring and understanding risk perceptions regarding COVID-19 over time. Our current understandings of risk perceptions regarding COVID-19 do not disentangle the three dimensions of risk perceptions (perceived susceptibility, perceived severity, and negative emotion) as the pandemic has evolved. Data are also limited regarding the impact of social determinants of health (SDOH) on COVID-19-related risk perceptions over time. To address these knowledge gaps, we extracted tweets regarding COVID-19-related risk perceptions and developed indicators for the three dimensions of risk perceptions based on over 502 million geotagged tweets posted by over 4.9 million Twitter …

Living With Ulcerative Colitis: Exploring Dietary Inflammatory Intake, Physical Activity, And Methods To Manage The Burden Of Illness, Kelli E. Dubois

Theses and Dissertations

Ulcerative Colitis (UC) is a chronic illness under the umbrella of Inflammatory Bowel Disease (IBD). IBD is becoming a global health issue as incidence rates are rising throughout the world. UC is characterized by chronic inflammation and ulcerations in the colon’s mucosal lining due to abnormal inflammatory and immune system responses. Patients with UC experience a range of gastrointestinal and extraintestinal symptoms as well as psychosocial challenges throughout the course of illness that generate a significant burden on daily life. Periods of active disease, or flares, present exacerbations of disease symptoms and the greatest burden on daily functioning, yet disease …

Hiv-Related Stigma, Sexual And Gender Minority-Related Stigma, And Health Outcomes Among Msm Living With Hiv: Measurement, Impact, And Intersectionality, Tianyue Mi

Theses and Dissertations

Background: Many men who have sex with men (MSM) living with human immunodeficiency virus (HIV) experience suboptimal health outcomes compared to nonMSM males living with HIV, including a faster decline in CD4 count before initiating antiretroviral therapy (ART), slower immune recovery after initiating ART, more mental health problems, suboptimal ART adherence, and lower retention in care. MSM living with HIV are often exposed to multiple layered stigmas, including, but not limited to, stigma related to being infected with HIV and stigma related to sexual and gender minority (SGM) status. Although various scales of HIV-related stigma have been frequently used for …

Food Insecurity Resilience Of Refugee Families In The United States: A Qualitative Study, Maryam Suliman Alhabas

Theses and Dissertations

Refugee families living in the United States often encounter a number of challenges while trying to build a new home and maintain their household food security. Refugee families at high risk of experiencing food insecurity in the resettlement country. Food insecurity among US refugee families is a major public health concern as it adversely impacts their health and wellbeing, since it affects dietary intake and mental health and associated with illness, poor nutrition, and obesity. Little is known about what happens when refugee families face food insecurity experience, and the role of their social contexts in that experience. The objective …

“Where The Truth Really Lies”: Listening To Voices From African American Communities In The Southern States About Covid-19 Vaccine Information And Communication, Ran Zhang, Shan Qiao, Brooke Mckeever, Bankole Olatosi, Xiaoming Li

Faculty Publications

The high uptake of COVID-19 vaccines is one of the most promising measures to control the pandemic. However, some African American (AA) communities exhibit vaccination hesitancy due to mis- or disinformation. It is important to understand the challenges in accessing reliable COVID-19 vaccine information and to develop feasible health communication interventions based on voices from AA communities. We conducted 2 focus group discussions (FGDs) among 18 community stakeholders recruited from 3 counties in South Carolina on 8 October and 29 October 2021. The FGDs were conducted online via Zoom meetings. The FGD data were managed and thematically analyzed using NVivo …

How Different Pre-Existing Mental Disorders And Their Co-Occurrence Affects Covid-19 Clinical Outcomes? A Real-World Data Study In The Southern United States, Shan Qiao Ph.D., Jiajia Zhang Ph.D., Shujie Chen, Bankole Olatosi Ph.D., Suzanne Hardeman, Meera Narasimhan, Larisa Bruner, Abdoulaye Diedhiou, Cheryl Scott, Ali Mansaray, Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Background: Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes.

Methods: Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data …

Multilevel Determinants Of Racial/Ethnic Disparities In Severe Maternal Morbidity And Mortality In The Context Of The Covid-19 Pandemic In The Usa: Protocol For A Concurrent Triangulation, Mixed-Methods Study, Jihong Liu, Peiyin Hung Ph.D, Chen Liang Ph.D., Jiajia Zhang Ph.D., Shan Qiao Ph.D., Berry A. Campbell, Bankole Olatosi Ph.D., Myriam E. Torres Ph. D., Neset Hikmet, Xiaoming Li Ph.D.

Faculty Publications

Introduction The COVID-19 pandemic has affected communities of colour the hardest. Non-Hispanic black and Hispanic pregnant women appear to have disproportionate SARS-CoV-2 infection and death rates.

Methods and analysis We will use the socioecological framework and employ a concurrent triangulation, mixed-methods study design to achieve three specific aims: (1) examine the impacts of the COVID-19 pandemic on racial/ethnic disparities in severe maternal morbidity and mortality (SMMM); (2) explore how social contexts (eg, racial/ethnic residential segregation) have contributed to the widening of racial/ethnic disparities in SMMM during the pandemic and identify distinct mediating pathways through maternity care and mental health; and …

Examining Social Determinants Of Health During A Pandemic: Clinical Application Of Z Codes Before And During Covid-19, Xueying Yang Ph.D., Brooks Yelton, Shujie Chen, Jiajia Zhang Ph.D., Bankole Olatosi Ph.D., Shan Qiao Ph.D., Xiaoming Li Ph.D., Daniela B. Friedman Ph.D.

Faculty Publications

Recognition of the impact of social determinants of health (SDoH) on healthcare outcomes, healthcare service utilization, and population health has prompted a global shift in focus to patient social needs and lived experiences in assessment and treatment. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provides a list of non-billable “Z codes” specific to SDoH for use in electronic health records. Using population-level analysis, this study aims to examine clinical application of Z codes in South Carolina before and during the COVID-19 pandemic. The study population consists of South Carolina residents who had a healthcare visit and had …

Social Capital, Urbanization Level, And Covid-19 Vaccination Uptake In The United States: A National Level Analysis, Shan Qiao, Zhenlong Li, Jiajia Zhang, Xiaowen Sun, Camryn Garrett, Xiaoming Li

Faculty Publications

Vaccination remains the most promising mitigation strategy for the COVID-19 pandemic. However, existing literature shows significant disparities in vaccination uptake in the United States. Using publicly available national-level data, we aimed to explore if county-level social capital can further explain disparities in vaccination uptake rates when adjusting for demographic and social determinants of health (SDOH) variables, and if association between social capital and vaccination uptake may vary by urbanization level. Bivariate analyses and a hierarchical multivariable quasi-binomial regression analysis were conducted, where the regression analysis was stratified by urban–rural status. The current study suggests that social capital contributes significantly to …

Exploration Of The Role Of Neighborhood Residential Segregation By Race And Ethnicity In Obesity Risk Among School-Aged, Melissa L. Fair

Theses and Dissertations

Youth obesity prevalence remains high, despite decades of intervention. Grounded in the social ecological model, neighborhoods and schools are important settings in addressing the complex systems that influence obesity. Contributing to disparities, by race/ethnicity, Black and Hispanic youth are more likely to live in segregated neighborhoods and attend segregated schools, which are also more likely to have high rates of poverty and are less likely to have high quality nutrition and built environments. Leveraging data from local school district (district and state department of education) and national datasets (ACS, Childhood Opportunity Index 2.0), this study examined the associations between school …

Determinants Of Hiv Treatment Disparities In The Latino Population Of South Carolina, Elizabeth G. Caulk

Senior Theses

The Latino population in the United States faces a heightened risk in terms of contracting HIV/AIDS and experiencing negative health outcomes from said infection. HIV/AIDS continues to disproportionately impact ethnic/racial minorities, and the Latino population exemplifies this unfortunate trend, with Latino Americans making up around 18.4% of the national population, but nearly 30% of the HIV/AIDS infections (US Office of Minority Health, 2021). More enduring changes to the current resources available to this population will need to be made in order to address this disparity. Thus, the current study examined social determinants, how they increase risk of infection, and how …

The Age Of E-Cigarette Initiation And Association With Frequency Of Use And Risk Of Combustible Tobacco Cigarette Smoking Initiation, Andy Hu

Senior Theses

Background - Studies have shown that electronic nicotine delivery systems (ENDS) are unsafe for consumption. However, the prevalence of e-cigarette use among adolescents and young adults continues to increase, which is being addressed by research. Little attention has been paid to the effects of earlier age of ENDS initiation.

Purpose - This paper examined published research studies on the topic of the age of initiation of e-cigarette use in relation to 1) frequency of e-cigarette use and 2) risk of combustible tobacco cigarette smoking initiation. This research tested the hypothesis that an earlier age of e-cigarette initiation was associated with …

Homestead Vegetable And Poultry Production And Related Practices: An Assessment In Nepal, Shiva Bhandari

Theses and Dissertations

Consumption of nutrients-rich foods like diverse vegetables, eggs, and meat throughout a year remains a challenge in low- and middle-income countries due to poor availability, accessibility, and affordability. One important way to overcome the challenge is to promote households’ own production of these foods and encourage individuals to consume. Improving household production of the foods necessitates understanding whether active participation and performance of frontline workers in the communities and performing improved production-related practices can translate into improved production of nutrients-rich foods. This study had two specific aims. The first aim was to examine demographic, socio-economic, and programmatic determinants of active …

Perspectives About Food Safety In Diverse Low- And Middle-Income Countries, Sejla Isanovic

Theses and Dissertations

Concerns about unsafe food influence food choice, and consumption of unsafe foods increases morbidity and mortality, particularly in low- and middle-income countries. Actions to ensure safety of food are dominated by mitigation of biological and chemical hazards through supply-side risk management, disregarding individuals’ experiences and perspectives of food safety. We aimed to identify and categorize perspectives about food safety in five countries. Five Drivers of Food Choice projects provided transcripts from 17 focus groups discussions and 303 interviews in Kenya, Ghana, India, Guinea, and Vietnam. We analyzed transcripts using a priori and emergent codes. Individuals constructed meaning about food safety …

Hiv-Related Stigma, Sexual Identity, And Depressive Symptoms Among Msm Living With Hiv: A Moderated Mediation Modeling Analysis, Tianyue Mi, Guanghua Lan, Xueying Yang Ph.D., Xiaoming Li Ph.D., Shan Qiao Ph.D., Zhiyong Shen, Yuejiao Zhou

Faculty Publications

Depression is one of the biggest health issues among men who have sex with men (MSM) living with HIV, where sexual identity might play an intricate role. Yet, findings of the relationship between sexual identity and depression were mixed and few studies explored its underlying mechanisms. This study aimed to examine the association between sexual identity and depression, and the potential mediating role of HIV-related stigma and moderating role of age. A cross-sectional survey was conducted among 203 MSM living with HIV in Guangxi, China. Participants provided information on sexual identity, depression, HIV-related stigma, and background information. Descriptive statistics, bivariate …

The Relationship Of Hair Glucocorticoid Levels To Immunological And Virological Outcomes In A Large Cohort Of Combination Antiretroviral Therapy Treated People Living With Hiv, Quan Zhang, Xiaoming Li Ph.D., Shan Qiao Ph.D., Shuaifeng Liu, Yuejiao Zhou, Zhiyong Shen

Faculty Publications

Background

Existing literature mostly investigated the relationship of acute or short-term glucocorticoid exposure to HIV disease progression using cortisol levels in serum, saliva, or urine. Data are limited on the relationship of long-term glucocorticoid exposure to HIV disease progression. This study examined whether hair glucocorticoid levels, novel retrospective indicators of long-term glucocorticoid exposure, are associated with two common indicators of HIV disease progression (CD4 count and HIV viral load) among a large cohort of combination antiretroviral therapy treated Chinese people living with HIV (PLHIV).

Methods

A total of 1198 treated PLHIV provided hair samples for glucocorticoid (cortisol and cortisone) assay …

Evaluation Of A Community-Based Performance Arts Programme For People Who Have Experienced Stroke In The Uk: Protocol For The Shaper-Stroke Odysseys Study, Carolina Estevao, Maria Baldellou Lopez, Rachel E. Davis, Lucinda Jarret, Tayana Soukup, Ioannis Bakolis, Andy Healey, Jean Harrington, Anthony Woods, Nikki Crane, Fiona Jones, Carmine Pariante, Daisy Fancourt, Nick Sevdalis

Faculty Publications

INTRODUCTION: Stroke survivors, once in the community, face challenges with their long-term rehabilitation care and present higher levels of loneliness, depression and anxiety than the rest of the population. A community-based performance arts programme, Stroke Odysseys (SO), has been devised to tackle the challenges of living with stroke in the UK. In this study, we aim to evaluate the implementation, impact and experiences of SO for stroke survivors. METHODS AND ANALYSIS: Scaling-up Health Arts Programmes: Implementation and Effectiveness Research (SHAPER)-SO aims to scale-up SO to 75 participants and 47 stakeholders, while simultaneously evaluating the effectiveness and implementation of the programme. …

Specificity Matters: Unpacking Impact Pathways Of Individual Interventions Within Bundled Packages Helps Interpret The Limited Impacts Of A Maternal Nutrition Intervention In India, Shivani Kachwaha, Phuong H. Nguyen, Lan Mai Tran, Rasmi Avula, Melissa F. Young, Sebanti Ghosh, Thomas Forissier, Jessica Escobar-Alegria, Praveen Kumar Sharma, Edward A. Frongillo Jr., Purnima Menon

Faculty Publications

BACKGROUND: To address gaps in coverage and quality of nutrition services, Alive & Thrive (A&T) strengthened the delivery of maternal nutrition interventions through government antenatal care (ANC) services in Uttar Pradesh, India. The impact evaluation of the A&T interventions compared intensive ANC (I-ANC) with standard ANC (S-ANC) areas and found modest impacts on micronutrient supplementation, dietary diversity, and weight-gain monitoring. OBJECTIVES: This study examined intervention-specific program impact pathways (PIPs) and identified reasons for limited impacts of the A&T maternal nutrition intervention package. METHODS: We used mixed methods: frontline worker (FLW) surveys (n = ∼500), counseling observations (n = 407), and …

Study Protocol: Randomised Controlled Hybrid Type 2 Trial Evaluating The Scale-Up Of Two Arts Interventions For Postnatal Depression And Parkinson’S Disease, Tayana Soukup, Rachel Davis, Maria Baldellou Lopez, Andy Healey, Carolina Estevao, Daisy Fancourt, Paola Dazzan, Carmine Pariante, Hannah Dye, Tim Osborn, Rebecca Bind, Kristi Sawyer, Lavinia Rebecchini, Katie Hazelgrove, Alexandra Burton, Manonmani Manoharan, Rosie Perkins, Aleksandra Podlewska, Ray Chaudhuri, Fleur Derbyshire-Fox, Alison Hartley, Anthony Woods, Nikki Crane

Faculty Publications

INTRODUCTION: Research on the benefits of 'arts' interventions to improve individuals' physical, social and psychological well-being is growing, but evidence on implementation and scale-up into health and social care systems is lacking. This protocol reports the SHAPER-Implement programme (Scale-up of Health-Arts Programmes Effectiveness-Implementation Research), aimed at studying the impact, implementation and scale-up of: Melodies for Mums (M4M), a singing intervention for postnatal depression; and Dance for Parkinson's (PD-Ballet) a dance intervention for Parkinson's disease. We examine how they could be embedded in clinical pathways to ensure their longer-term sustainability. METHODS AND ANALYSIS: A randomised two-arm effectiveness-implementation hybrid type 2 trial …