Preview: Health Promotion International - current issue
Health Promotion International Current Issue
Published: Wed, 08 Feb 2017 00:00:00 GMT
Last Build Date: Thu, 09 Feb 2017 01:43:53 GMT
A tribute to Dr Halfdan Mahler, 1923–2016
After a glorious life, inspiring millions and advancing insights that to this day are on the more cutting edge of health sciences and public health, Danish Dr Halfdan Theodor Mahler (21 April 1923) passed away on 14 December 2016.
Private troubles to public issue: empowering communities to reduce alcohol-related harm in Sabah, Malaysia
SummaryAlcohol is the number three contributor to the burden of disease worldwide so must remain a priority health promotion issue internationally. Malaysia is a Muslim country and alcohol-related harm was not seen as a priority until recently, because it only affects a minority of the population. Sabah has more than 30 different ethnic groups, and alcohol has a traditional role in the cultural practices of many of these groups. In 2009, the Intervention Group for Alcohol Misuse (IGAM) was formed, under the umbrella of Mercy Malaysia by a group of healthcare workers, academics, members of the Clergy and people who were previously alcohol-dependent concerned about the harmful effects of excessive alcohol consumption. IGAM in collaboration with other bodies have organized public seminars, visited villages and schools, encouraged the formation of a support group and trained healthcare professionals in health promotion intervention. The focus later changed to empowering communities to find solutions to alcohol-related harm in their community in a way which is sensitive to their culture. A standard tool-kit was developed using WHO materials as a guide. Village committees were formed and adapted the toolkit according to their needs. This strategy has been shown to be effective, in that 90% of the 20 committees formed are actively and successfully involved in health promotion to reduce alcohol-related harm in their communities.
Health literacy and the social determinants of health: a qualitative model from adult learners
SummaryHealth literacy, ‘the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health’, is key to improving peoples’ control over modifiable social determinants of health (SDH). This study listened to adult learners to understand their perspectives on gathering, understanding and using information for health. This qualitative project recruited participants from community skills courses to identify relevant ‘health information’ factors. Subsequently different learners put these together to develop a model of their ‘Journey to health’. Twenty-seven participants were recruited; twenty from community health literacy courses and seven from an adult basic literacy and numeracy course. Participants described health as a ‘journey’ starting from an individual's family, ethnicity and culture. Basic (functional) health literacy skills were needed to gather and understand information. More complex interactive health literacy skills were needed to evaluate the importance and relevance of information in context, and make health decisions. Critical health literacy skills could be used to adapt negative external factors that might inhibit health-promotion. Our model is an iterative linear one moving from ethnicity, community and culture, through lifestyle, to health, with learning revisited in the context of different sources of support. It builds on existing models by highlighting the importance of SDH in the translation of new health knowledge into healthy behaviours, and the importance of health literacy in enabling people to overcome barriers to health.
Do the foods advertised in Australian supermarket catalogues reflect national dietary guidelines?
SummaryUnhealthy diets are the major contributor to poor health in Australia and many countries globally. The majority of food spending in Australia occurs in supermarkets, which stock and sell both healthy and unhealthy foods. This study aimed to compare the foods advertised in the marketing catalogues (circulars) from four Australian supermarket chains with the Australian Guide to Healthy Eating. The content of national online weekly supermarket catalogues from four major Australian supermarket retailers was audited from June–September 2013 (12 weeks). Advertised products were categorized as (i) foods in the five core food groups (plus water); (ii) discretionary foods plus fats and oils; (iii) alcohol and (iv) other (food not fitting into any other category). Across all chains combined, 34.2% of foods advertised were from the five core food groups, 43.3% were discretionary foods, 8.5% were alcohol and the remaining 14.0% were ‘other’ foods. The percentage of advertised foods in the five core food groups varied between 29.3 and 38.3% across the four chains, whereas the percentage of discretionary foods varied between 34.8 and 49.0%. Australian supermarket catalogues heavily promote discretionary foods and contribute towards an environment that supports unhealthy eating behaviour. Strategies to increase the ratio of healthy-to-unhealthy foods need to be explored as part of efforts to improve population diets.
Can reflexivity be learned? An experience with tobacco control practitioners in Canada
SummaryTo explore an example of a reflexive intervention with health professionals working in tobacco control (TC). This study reports the perceived intervention effects regarding: (i) participants' understanding of reflexivity and personal learning and (ii) conditions needed in order to integrate reflexivity into professional and organizational practices. This is a qualitative study using an interpretative evaluation framework to assess the perceived effects of a reflexive intervention in Montréal, Québec. Semi-structured qualitative interviews (n = 8) gathered data. Data analysis began deductively, guided by the broad categories found in research questions. Sub-categories to populate these broad categories captured the inhibitors and facilitators through an inductive thematic analysis. Our study reveals that, following the intervention, most participants had a generally good understanding of reflexivity and described concrete learning in association with the intervention. Main facilitators and inhibitors to conducting a reflexive workshop pertained to the organizational context as well as to the professional and individual characteristics of the participants. Some participants implemented sustainable changes as a result of the intervention, such as creating a tool, reviewing work plans and developing new mechanisms to integrate the voice of their clientele in the planning process. The need and interest for dialogue among health professionals about how TC intervention activities may inadvertently contribute to social inequalities in smoking is apparent. While there appears to be potential for reflexive practice, the integration of reflexivity into practice is reliant upon the organizational context (financial and time constraints, culture, support, and climate) and the reflexivity concept itself (intangibility, complexity and fuzziness).
HIA in Switzerland: strategies for achieving Health in All Policies
SummaryThe purpose of this article is to review the status of Health Impact Assessment (HIA) in Switzerland and assess whether HIA can be used to implement Health in All Policies (HiAP) in this highly decentralized country. The methods include expert opinion and an extensive literature review, as well as targeted interviews with key informers in the cantons of Geneva, Jura and Ticino. HIA has been implemented successfully since the early 2000s in Switzerland. However, integration has been heterogeneous with only a few cantons taking the lead. Integration of HIA at the federal level was attempted in 2012 but failed due to resistance from a pro-business lobby. HIA in Switzerland has the potential to contribute to HiAP, but success depends on a wider dissemination of HIA and on some form of integration at the national level. In this respect, a ‘bottom-up’ approach based on inter-cantonal collaborations appears more promising than the ‘top-down’ federal level approach.
Perceptions of success of a local UK public health collaborative †
SummarySuccessful public health initiatives require multi-sector collaboration. AVONet was a UK collaborative developed to provide evidence-based strategies for active ageing. This study explored the success of AVONet in the achievement of its objectives as perceived by all partners. A convergent parallel mixed-methods design was employed, utilizing a quantitative survey and qualitative semi-structured interviews. Data collection was undertaken in September 2010, 18 months after establishing the collaborative and 6 months after funding had ceased. AVONet partners (n = 24) completed a 27-item survey. A sub-sample of four academics and four practitioners participated in semi-structured interviews. Quantitative and qualitative comparisons were made between academics' and practitioners' perceptions of success, potential for sustainability and satisfaction with structure and relationships. Participants perceived the AVONet collaborative positively. Significant between-group (academic v practitioner) differences in survey responses were observed for success (U = 19.5; p = 0.003) and structure (U = 125.5; p = 0.001). Strong positive correlations were observed between success and structure and balance between information transfer and exchange (r = 0.756; p < 0.001). Interviews confirmed positive perceptions and perceived importance of the collaborative and highlighted the need for further integration and tangible outcomes for practitioners. Suggestions to enhance sustainability were provided, such as smaller working groups and local council-led governance. Perceived success in building a multi-sectoral collaborative can be achieved during a 10-month period, despite differing needs of contributors. For collaboratives developed as a result of external funding aimed primarily at facilitating research, involvement of practitioners at an early stage may help set more comprehensive goals, supportive communication strategies, and increase potential for sustainability.
Sustainability of the good behaviour game in Dutch primary schools
SummarySustainability of health promotion programs is essential to maintain their positive effects. However, few studies have examined the extent of program sustainability and the factors influencing it. We examined these issues through the Good Behaviour Game (GBG), a classroom-based program in primary schools with beneficial behavioural and health-related effects that was implemented in 2008. GBG coordinators of 17 participating schools were invited in the study 2 years after the initial program implementation. Sustainability was measured using a 20-item checklist comprised of four dimensions of routinization including: memory, adaptation, values and rules. A semi-structured interview was then completed with 16 of the GBG coordinators to discuss the checklist scores and to probe in more depth the current level of sustainability. Based on the checklist scores, sustainability of the GBG was considered ‘high’ in five schools, ‘medium’ in another five and ‘weak’ in six. Factors influencing sustainability identified by GBG coordinators were organizational strength, strong leadership, program championship and the perceived modifiability and effectiveness of the GBG. Also, different factors were related to different dimensions of routinization. The combination of a sustainability checklist and an interview about influential factors may help to further clarify the sustainability construct and reveal which implementation sites, routinization dimensions and influential factors should be explored to further facilitate the sustaining of programs with proven effectiveness.
Barriers to healthy dietary choice amongst students in Sri Lanka as perceived by school principals and staff
SummarySri Lanka has experienced a massive demographic, environmental, economic and social transition in recent decades. Over this period of time the country has undergone rapid urbanization leading to accompanying shifts in lifestyle and it suffers a double burden of under- and over-nutrition. Current programmes in the country focus on improving the dietary behaviour of secondary school students. The purpose of this study was to investigate principal's perceptions on barriers to healthy dietary choice among pupils within a socio-ecological framework. Focus groups (n = 11) were carried out with school principals and staff (n = 55) in two rural districts of Sri Lanka. Principals identified a number of barriers to healthy dietary choice by students, which could be found at a number of levels of influence of a socio-ecological framework: (i) structural level barriers included educational and agricultural policies, (ii) living and working level barriers included employment opportunities and local food production, (iii) social and community level barriers included traditions and social/cultural beliefs and (iv) individual level barriers included knowledge and preference. Findings from this study suggest that the barriers to healthy dietary choice amongst secondary school students in Sri Lanka occur at many levels supporting the use of multifactorial programmes to promote healthy eating. Only from understanding these barriers and finding ways to counter them can we hope to reduce the double burden of under- and over-nutrition the country is currently suffering.
‘Side effects’ of health promotion: an example from Austrian schools
SummaryWhile the existence of side effects of medical interventions is common knowledge and widely investigated, possible unintended effects of health promotion (HP) interventions are only sparsely discussed in the HP literature. Drawing on qualitative evaluation data generated within an on-going process evaluation of a regional health-promoting schools network in Austria, we demonstrate which desirable and undesirable effects HP practice can have for teachers. Thirteen group discussions with teachers (n = 63) and headteachers (n = 9) acting as health coordinators in the network schools were conducted between 2010 and 2013. These data were analysed using systems and thematic analyses. In our example, desirable side effects included health coordinators gaining new relationships, new skills and benefiting from improved infrastructure. The undesirable side effects centred on stress, work overload and frustration, due to the additional work brought about by HP practice, negative reactions by colleagues as well as by technicalities of the network. The undesirable side effects of HP predominated in our study, pointing to several implications like the need to accommodate the concept of HP in the teachers' core responsibilities; the participation of all staff members and students in a whole-school approach toward SHP, and the need for changes on an organizational level. Based on this study, we come to the conclusion that a systematic approach to investigating and analysing side effects of HP is currently lacking in HP research and suggest that theoretical examination and more empirical research is needed.
Social cognitive intervention reduces stress in Hungarian university students
SummaryA social cognitive intervention was developed and delivered as a credit course to improve mental distress of university students, based on findings in a previous health survey showing notable mental distress among future teachers in Hungary in 2007. The intervention included increasing information on psychoactive substances used for stress reduction; skills development in stress reduction methods; improving skills in communication and problem-solving. All students who participated in the previous health survey were targeted. Mental status of the participants was assessed by a questionnaire before (n: 128, 22% male, mean age 23.21 years) and after (n: 148, 30% male, mean age 23.54 years) the intervention. Specifically, self-efficacy as outcome was approximated by a trait measure (sense of coherence); psychological distress was measured by the 12-item General Health Questionnaire (Goldberg et al., 1997. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191–197) after the intervention compared with that before. After the intervention, psychological distress was reduced among the participants (p: 0.013). Non-significant improvement occurred in the mean score for sense of coherence (from a mean 60.8 points before to 61.4 points after, p: 0.688). The intervention produced a modest but significant decrease in psychological distress in students at a cost of 54 US$ per 1 point improvement in mental distress. The intervention, a first example of the translation of the social cognitive theory into practice among students in higher education can be integrated into the curriculum as a standardized optional course.
Participatory systems approach to health improvement in Australian Aboriginal children
SummaryThe factors underlying poor child health in remote Australian Indigenous (Aboriginal and Torres Strait Islander) communities are complex. There is a lack of consistent and reliable information that allows: (i) the identification of priorities or areas of particular need at household and community levels; (ii) monitoring progress over time; and (iii) the assessment of the impact of interventions. This paper describes the process and methods used to identify the factors that underlie high rates of poor child health in remote Aboriginal communities in the Northern Territory (NT). This work has led to the development of indicators and tools suitable for use within a continuous quality improvement programme. Indigenous and non-Indigenous individuals from a range of disciplines and backgrounds participated in study activities. This allowed for a range of perspectives, including scientific, lay and Aboriginal perspectives, to be accommodated and reflected in study outcomes and outputs. Study participants identified a wide range of physical and social factors that they believe underlies poor child health in remote Aboriginal community contexts in the NT. The approach taken in this study provides some confidence that the indicators developed will be seen as meaningful and appropriate by the residents of remote communities and key stakeholders. Two tools have been developed and are now in use in the practice setting. One assesses social determinants of health at the community level, for example water supply, food supply. The second applies to individual households and assesses the social and environmental indicators that are recognized as placing children at greater risk of poor health and development outcomes.
Promoting mental health in Swedish preschool–teacher views
SummaryThe promotion of childhood mental health is an important investment for the future. Many young children spend a large amount of time in preschool, which have unique opportunities to promote mental health at an early stage. The aim of this study was to illuminate teachers’ views of what they do in ordinary work to promote mental health among preschool children. This qualitative study had a descriptive and exploratory design and qualitative content analysis was utilized. Six focus group interviews with preschool teachers, concerning families from different cultural, geographical and socioeconomic backgrounds, were conducted in a county in the southwest of Sweden. Both manifest and latent content appeared. Three categories, ‘structured world’, ‘pleasant climate’ and ‘affirming the child’ and 10 subcategories emerged. The latent content of these categories is described under the theme ‘creating an atmosphere where each child can flourish in harmony with their environment’. The results show teachers different working approaches with mental health in preschool and together with previous research these results can provide a basis of knowledge for preschool teachers and inspire them to develop and maintain their health-promoting work. In future studies it should be particularly interesting to investigate how the promotive way to work can be transferred to strengthen mental health throughout the school years.
An ethnography of health-promoting faculty in a Thailand university
SummaryUniversities are important locations to develop best practice in becoming healthy places, within the focus of the Healthy Cities movement of the World Health Organization. This ethnographic study determined the meaning of the concept of ‘health-promoting faculty’ with 46 key and general informants in two faculties at a health sciences campus in northern Thailand. The campus developed as a healthy campus setting over a 6-year period and so gathering information from informants regarding their understandings about health-promoting faculty (HPF) are important to ensure that common goals are achieved. Data were collected using in-depth individual and focus group interviews, documents and field observations. Spradley's ethnographic approach was employed for data analysis. Findings revealed that those within the faculties of pharmacy and nursing had different meanings regarding ‘health-promoting faculty’. Twenty informants of the pharmacy faculty had been encouraged to adopt their own perspectives about health promotion (HP) meanings. However, 26 informants from the faculty of nursing collaboratively considered the meaning to be ‘a well-being organization where the members aimed to create holistic health among the faculty's population in an environment supportive of health’. We concluded that how an HPF is to be developed should be taken into consideration, and that goals and directions should be clear faculty members are to share common goals to promote a healthy university. In addition, to evaluate the quality of HPF development, procedures should be processed consistently within the meaning of the concept of HP in relevant settings.
Effect of TV food advertising restriction on food environment for children in South Korea
SummaryThis study attempted to determine the effects of restrictions on television (TV) food advertising on children's food environments in South Korea. It examined changes that occurred in the marketing mix of food companies following enactment of those restrictions. An on-line survey was conducted with marketers or R&D managers of 108 food companies. A questionnaire was used to inquire about changes that occurred in Product, Place, Price and Promotion as a result of the restrictions placed on TV food advertising. Analysis was performed on the data collected from the responding 63 food companies (58.3%). The results of their answers showed that among the four marketing mix components the restrictions exerted relatively stronger effects on Product. Effects were stronger on companies that produced foods within the product categories of Energy-Dense and Nutrient-Poor foods (EDNP companies) in comparison with companies that did not (non-EDNP companies). The restrictions exerted positive effects on EDNP companies with respect to compliance with labeling requirements and reinforcement of nutritional contents examination, as well as changes to products such as reducing unhealthy ingredients and fortifying nutrients. Overall, the results revealed the possibility that restrictions on TV food advertising could improve children's food environments by encouraging EDNP companies to make favorable product changes. On the one hand, the results also found that some food companies attempted to bypass the regulations by changing marketing channels from TV to others and by reducing product serving sizes. Thus, future measures should be implemented to prevent food companies from bypassing regulations and to control children's exposure to marketing channels other than TV.
Health lifestyles of pre-school children in Nordic countries: parents' perspectives
SummaryHolistic understanding of health is one of the key principles of health promotion indicating that the health status of individuals and populations is determined by a variety of environmental, economic, social and personal factors. Traditionally, research focus has been on school-aged children and school-based interventions and less on pre-school children and their families' engagement in promoting health in everyday life. The aim of the present study was to explore factors that parents of pre-school children in the Nordic countries experienced as influencing health lifestyles in their children's everyday lives. Semi-structured interviews were conducted with 25 parents of pre-school children in the five Nordic countries. Qualitative content analysis was used to analyse the data. The parents identified themselves as the primary shapers of their children's lifestyles and described influencing factors related to themselves as well as to their immediate surroundings and the larger society. Attaining a health lifestyle in everyday life of Nordic parents with pre-school children appeared to be all about the ‘management of time when attempting to live up to expectations’. Pre-school children's lifestyles are to a great extent intertwined with their parent's lifestyles and should be approached, both in research and practice, accordingly. Parents of pre-school children in the Nordic countries appear to be living their everyday lives straining to adapt to norms prevailing in society and may need encouragement and support in managing time in order to promote health lifestyles for themselves and their children.
Does cohort matter in the association between education, health literacy and health in the USA?
SummaryGrowing empirical evidence supports the generally positive relationship between education, health literacy and health outcomes. However, little is known about cohort in this relationship. This study examined the role of cohort defined by 10-year age period in the association between educational attainment, health literacy and self-rated health. The data were obtained from the 2003 National Assessment of Adult Literacy survey restricted file. Focusing on nationally representative community-dwelling adults age 25 years and older, self-rated health was modeled as a function of health literacy, educational attainment, cohorts (defined by 10-year age periods), other demographic characteristics and socio-economic status. While the youngest cohort was positively associated with self-rated health, middle-age cohorts were more likely to have lower self-rated health (compared with the age 65 years and older cohort). Interestingly, age was no longer statistically significant after adjusting for cohort and other covariates. Recognition of possible cohort effects in education, health literacy and health should be reflected in future health literacy research and intervention programs for addressing health disparities in the USA.
How can the functioning and effectiveness of networks in the settings approach of health promotion be understood, achieved and researched?
SummaryNetworks in health promotion (HP) have, after the launch of WHO's Ottawa Charter [(World Health Organization (WHO) (eds). (1986) Ottawa Charter on Health Promotion. Towards A New Public Health. World Health Organization, Geneva], become a widespread tool to disseminate HP especially in conjunction with the settings approach. Despite their allegedly high importance for HP practice and more than two decades of experiences with networking so far, a sound theoretical basis to support effective planning, formation, coordination and strategy development for networks in the settings approach of HP (HPSN) is still widely missing. Brößkamp-Stone's multi-facetted interorganizational network assessment framework (2004) provides a starting point but falls short of specifying the outcomes that can be reasonably expected from the specific network type of HPSN, and the specific processes/strategies and structures that are needed to achieve them. Based on outcome models in HP, on social, managerial and health science theories of networks, settings and organizations, a sociological systems theory approach and the capacity approach in HP, this article points out why existing approaches to studying networks are insufficient for HPSN, what can be understood by their functioning and effectiveness, what preconditions there are for HPSN effectiveness and how an HPSN functioning and effectiveness framework proposed on these grounds can be used for researching networks in practice, drawing on experiences from the ‘Project on an Internationally Comparative Evaluation Study of the International Network of Health Promoting Hospitals and Health Services’ (PRICES-HPH), which was coordinated by the WHO Collaborating Centre for Health Promotion in Hospitals and Health Services (Vienna WHO-CC) from 2008 to 2012.
The impact of redistributing power to disadvantaged families in Hungary
SummaryThe Commission on Social Determinants of Health (CSDH) formulated recommendations along which health inequalities can be successfully tackled anywhere in the world. The situation of the Roma minority in Europe provides countless opportunities for the translation of these guidelines into action that should be guided by coherent and evidence-based strategies integrating lessons learned in smaller-scale field projects. Our paper describes the long-term evaluation of a locally initiated housing project in Hungary carried out more than a decade after implementation, which highlights the salience of the CSDH's recommendations and critical factors for success and sustainability. The project provides evidence for the long-term positive impact on education of the social housing project implemented by an empowered community through delegating decision making to a board of representatives of the beneficiaries in all decisions, including financial ones. Educational level greatly improved, and all houses–inhabited by 17 out of 20 families who initially entered the project—remained in good condition, properly equipped and decorated after 13 years of implementation, in spite of an increase of unemployment during the same period which led to reduced income and deterioration of the families' economic situation. Better housing conditions for vulnerable people can be sustained and result in increased educational level if incremental improvement is aimed for and coupled with the redistribution of power at the local level.