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Preview: Health Promotion International - recent issues

Health Promotion International - recent issues



Health Promotion International - RSS feed of recent issues (covers the latest 3 issues, including the current issue)



 






Health literacy in Mainland China: Validation of a functional health literacy test in simplified Chinese

2016-12-07T00:52:49-08:00

Health literacy tests in the Chinese-speaking parts of the world have been mainly developed in traditional Chinese to be used in Hong Kong or Taiwan. So far no validated tool in simplified Chinese to assess functional health literacy in Mainland China has been developed. The aim of the study was to validate the simplified Chinese version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA). The traditional Chinese version was translated into simplified Chinese and 150 interviews in an outpatient department of a public hospital in Mainland China were conducted. Predictive validity was assessed by known predictors for health literacy and convergent validity by three health literacy screening questions. The Cronbach's α for the reading comprehension part was 0.94 and 0.90 for the numeracy items. Participants with lower education and men had significantly lower levels of health literacy. The reading comprehension part was significantly correlated with two of the health literacy screening questions. Our results indicate that the simplified Chinese version of the S-TOFHLA is a reliable measure of health literacy to be used in Mainland China.




The DECIDE evidence to recommendation framework adapted to the public health field in Sweden

2016-12-07T00:52:49-08:00

Organizations worldwide compile results from scientific studies, and grade the evidence of interventions, in order to assist policy makers. However, quality of evidence alone is seldom sufficient to make a recommendation. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) framework aims to facilitate decision making and to improve dissemination and implementation of recommendations in the healthcare and public health sector. The aim of this study was to investigate whether the DECIDE framework is applicable in the public health field in Sweden. The DECIDE framework was presented and discussed in interviews with stakeholders and governmental organizations and tested in panels. Content analyses were performed. In general, the informants were positive to the DECIDE framework. However, two questions, the first regarding individual autonomy and the second regarding method sustainability, were by the stakeholders felt to be missing in the framework. The importance of the composition of the DECIDE stakeholder panel was lifted by the informants, as was the significant role of the chair. Further, the informants raised concerns about the general lack of research evidence based on RCT design regarding universal methods in the public health sector. Finally, the local, regional and national levels’ responsibility for dissemination and implementation of recommendations were lifted by the informants. The DECIDE framework might be useful as a tool for dissemination and implementation of recommendations in the public health field in Sweden. Important questions for further research are whether these findings are suitable for other public health topics and in other public health settings.




Corporate responsibility for childhood physical activity promotion in the UK

2016-12-07T00:52:49-08:00

The alarming epidemic of obesity and physical inactivity at paediatric age urges societies to rise to the challenge of ensuring an active lifestyle. As one response to this, business enterprises are increasingly engaged in promoting sport and physical activity (PA) initiatives within the frame of corporate social responsibility (CSR). However, comparative analyses among industry sectors of CSR strategies for PA promotion with a particular focus on children are still lacking. This study aimed to explore (i) what are the CSR strategies for PA promotion adopted in different industry sectors and (ii) whether corporate engagement in promoting PA for children is supportive of children's rights to play and be physically active. Corporate pledges pertaining to CSR initiatives to promote PA were analysed. The hypothesis was that companies from different sectors employ different CSR strategies and that companies with a higher profile as regard to public health concerns for children tend to legitimate their action by adopting a compensatory strategy. Results show that the issue of PA promotion is largely represented within CSR commitments. CSR strategies for PA promotion vary across industry sectors and the adoption of a compensatory strategy for rising childhood obesity allows only a limited exploitation of the potential of CSR commitments for the provision of children's rights to play and be physically active. Actors within the fields of public health ethics, human rights and CSR should be considered complementary to develop mainstreaming strategies and improve monitoring systems of PA promotion in children.




How Health in All Policies are developed and implemented in a developing country? A case study of a HiAP initiative in Iran

2016-12-07T00:52:49-08:00

Population health is influenced by many factors beyond the control of health system which should be addressed by other sectors through inter-sectoral collaboration (ISC). Countries have adopted diverse initiatives to operationalize ISC for health such as establishment of Councils of Health and Food Security (CHFSs) and development of provincial Health Master Plans (HMPs) in Iran. The literature, however, provides meager information on how these initiatives have been moved into the top policy agenda, how and by whom they have been formulated and what factors enable or inhibit their implementation. In addressing these knowledge gaps, we employed a qualitative case study approach, incorporating mixed methods: in-depth interviews and a textual analysis of policy documents. Iran founded the Supreme Council of Health and Food Security (SCHFS) at national level in 2006 followed by provincial and district CHFSs to ensure political commitment to ISC for health and Health in All Policies (HiAPs). In 2009, the SCHFS mandated all provincial CHFSs across the country to develop provincial HMP to operationalize the HiAP approach and Kerman was among the first provinces which responded to this call. We selected Kerman province HMP as a case study to investigate the research questions raised in this study. The study revealed two types of leverage, which played crucial role in agenda setting, policy formulation and implementation of HMP including politics (political commitment) and policy entrepreneurs. The multiple streams model was found to be informative for thinking about different stages of a policy cycle including agenda setting, policy formulation and policy implementation. It was also found to be a useful framework in analyzing HiAP initiatives as these policies do not smoothly and readily reach the policy agenda.




Development of a theory-guided pan-European computer-assisted safer sex intervention

2016-12-07T00:52:49-08:00

HIV is a growing public health problem in Europe, with men-having-sex-with-men and migrants from endemic regions as the most affected key populations. More evidence on effective behavioral interventions to reduce sexual risk is needed. This article describes the systematic development of a theory-guided computer-assisted safer sex intervention, aiming at supporting people living with HIV in sexual risk reduction. We applied the Intervention Mapping (IM) protocol to develop this counseling intervention in the framework of a European multicenter study. We conducted a needs assessment guided by the information–motivation–behavioral (IMB) skills model, formulated change objectives and selected theory-based methods and practical strategies, i.e. interactive computer-assisted modules as supporting tools for provider-delivered counseling. Theoretical foundations were the IMB skills model, social cognitive theory and the transtheoretical model, complemented by dual process models of affective decision making to account for the specifics of sexual behavior. The counseling approach for delivering three individual sessions was tailored to participants' needs and contexts, adopting elements of motivational interviewing and cognitive-behavioral therapy. We implemented and evaluated the intervention using a randomized controlled trial combined with a process evaluation. IM provided a useful framework for developing a coherent intervention for heterogeneous target groups, which was feasible and effective across the culturally diverse settings. This article responds to the need for transparent descriptions of the development and content of evidence-based behavior change interventions as potential pillars of effective combination prevention strategies.




A 2-year young adult obesity prevention trial in the US: Process evaluation results

2016-12-07T00:52:50-08:00

Our objective was to conduct a process evaluation of the CHOICES (Choosing Healthy Options in College Environments and Settings) study, a large, randomized, controlled trial designed to prevent unhealthy weight gain in young adults (aged 18–35) attending 2-year community colleges in the USA. The 24-month intervention consisted of participation in an academic course and a social networking and support website. Among intervention participants, completion rates for most course activities were >80%, reflecting a high level of dose received. Course retention and participant satisfaction were also high. Engagement results, however, were mixed with less than half of participants in the online and hybrid sections of the course reporting that they interacted with course materials ≥3 h/week, but 50–75% reporting that they completed required lessons ‘all/very thoroughly’. Engagement in the website activities was also mixed with more than half of intervention participants logging onto the website during the first month, but then declining to 25–40% during the following 23 months of the intervention. Intervention engagement is a challenge of online interventions and a challenge of working with the young adult age group in general. Additional research is needed to explore strategies to support engagement among this population, particularly for relatively long intervention durations.




A content analysis of food advertising on Turkish television

2016-12-07T00:52:50-08:00

The aim of this study was to conduct a comprehensive content analysis of Television (TV) food advertising and compare various food advertisements on free-to-air Turkish national TV channels by broadcast time (duration) and frequency over the period of a week (19–25 April 2012). TV food advertisements were the unit of content analysis in this study. Each advertisement identified as promoting a food product was analysed for content; non-food advertisements were not analysed, although they were counted as a proportion of the advertisements aired. We recorded all programmes for 4 h each per day (7 p.m.–11 p.m.), totalling 84 h. Five types of food-related advertisements were identified (basic foods, junk foods, meat products, beverages and fast food), and six types of non-food advertisements. The Student t-test and ANOVA were used to compare the mean broadcast time of all prime time advertising for the two groups. The mean broadcast times for prime time, non-food advertisements showed a statistically significant difference (p < 0.05). This difference is related to the prime time period 7 p.m.–8 p.m. being considered dinner time for most Turkish families. Additionally, the number and broadcast times of beverage advertisements increased during this time period, while the broadcast time per beverage advertisement decreased (ratio = 20.8 s per ads). As a result, TV food advertising increased not only during dinner time but also in overall broadcast time (per advertisement). These findings may be useful for explaining how advertising can negatively influence food choices, thereby increasing public awareness of the need for health messages targeting obesity.




Systematic review of empowerment measures in health promotion

2016-12-07T00:52:50-08:00

Empowerment, a multi-level construct comprising individual, community and organizational domains, is a fundamental value and goal in health promotion. While a range of scales have been developed for the measurement of empowerment, the qualities of these have not been rigorously assessed. The aim of this study was to evaluate the measurement properties of quantitative empowerment scales and their applicability in health promotion programs. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was done to evaluate empowerment scales across three dimensions: item development, reliability and validity. This was followed by assessment of measurement properties using a ratings scale with criteria addressing an a priori explicit theoretical framework, assessment of content validity, internal consistency and factor analysis to test structural validity. Of the 20 studies included in this review, only 8 (40%) used literature reviews, expert panels and empirical studies to develop scale items and 9 (45%) of studies fulfilled ≥5 criteria on the ratings scale. Two studies (10%) measured community empowerment and one study measured organizational empowerment, the rest (85%) measured individual empowerment. This review highlights important gaps in the measurement of community and organizational domains of empowerment using quantitative scales. A priority for future empowerment research is to investigate and explore approaches such as mixed methods to enable adequate measurement of empowerment across all three domains. This would help health promotion practitioners to effectively measure empowerment as a driver of change and an outcome in health promotion programs.




Readiness for health behavior changes among low fitness men in a Finnish health promotion campaign

2016-12-07T00:52:50-08:00

Men have been a hard-to-reach population in health behavior programs and it has been claimed that they are less interested in health issues than women. However, less is known about that how ready men are to adopt new health behaviors. This study examined readiness for change in physical activity (PA) and eating behavior (EB) among low fitness and overweight working-aged Finnish men who participated in a PA campaign. Associations among perceived health knowledge, health behaviors, psychosocial factors and readiness for change were studied. Data comprised 362 men aged 18–64. Physical fitness was assessed with a body fitness index constructed on the basis of the Polar OwnIndex Test, a hand grip test and an Inbody 720 body composition analysis. Health behavior information was gathered by questionnaire. Descriptive and comparative analyses were conducted by 2 test and Kruskall–Wallis and Mann–Whitney U tests. Associations between health knowledge and health behaviors were explored with logistic regression analyses. Readiness to increase PA and change EB was positively related to higher scores in psychosocial factors, PA and healthy eating habits. Self-rated knowledge on health issues was not related to PA or readiness to change health behaviors; however, it was positively associated with healthy eating and greater perceived promoters of PA. Participants' self-rated knowledge reflected not only an interest in health but also the differences in age and education. Health programs are needed that target both PA and healthy eating in low-fit men at different ages and motivational stages.




A cultural analysis of New Zealand palliative care brochures

2016-12-07T00:52:50-08:00

Low utilization of palliative care services by Māori remains despite increases in services designed to meet Māori needs. The purpose of this study is to explore palliative care information brochures in the context of Māori principles of well-being and communication protocols, and health literacy. We examined 99 brochures from palliative care services in New Zealand and held two focus groups with 12 Māori elders (kaumātua) and extended family (whanau) members. Taking a cultural-discursive approach incorporating Māori worldviews, we analysed textual and conceptual features of the brochures. The findings centred on cultural connection and disconnection within the brochures and serve as a critique of the prominent messages currently presented in these brochures. The findings raise questions about the capacity of agencies to convey culturally resonant messages to kaumātua and their whānau. We identify implications of palliative care brochures for health literacy of provider organizations as well as kaumātua and whanau.




Audit of workplace walkability in an Irish healthcare setting

2016-12-07T00:52:50-08:00

Recent studies suggest that time spent sitting is associated with greater risks of all causes of mortality and cardiovascular disease even for those who live a healthy lifestyle. As part of a healthier worksite initiative, we conducted a worksite walkability audit and staff survey of a large hospital-based administrative campus with a high proportion of health staff working in largely office-based roles. The US Centre for Disease Control (CDC) Healthier Worksite Initiative Walkability Audit Tool was used to audit 20 walking segments. The audit further examined the walkability of segments most likely to be used by outpatients and the families of residents visiting and attending the campus. The second phase of this research involved an employee electronic survey to understand staff requirements from a workplace physical activity initiative. Overall, the campus scored a medium risk to walkability on the CDC audit tool. This means that with some key minor alterations the walking route could be made safe and attractive for walking. There was a 20% (n = 151) response rate to the staff survey with 66% of respondents sitting at their desk for most of the day with the majority spending 5–7 h a day sitting at work. Evidence suggests that reducing sedentary time may be important to public health. The worksite is an ideal location for targeting a large number of individuals. Key public health messages that promote daily recommended physical activity targets should also carry additional messages about reducing occupational sitting time.




Childhood nutrition in the Mississippi Delta: challenges and opportunities

2016-12-07T00:52:50-08:00

Childhood obesity in the USA has more than tripled in the last three decades, and the prevalence is higher in the Mississippi Delta. Insight into the social, cultural and environmental factors that influence inequity can inform efforts to mediate health disparities. Focus groups (n = 12) among parents/guardians of elementary school children (n = 44) and teachers (n = 59) in the Mississippi Delta were used to investigate barriers and facilitators of healthy eating. Transcriptions were analyzed for themes. A strong preference for junk food among children and the pervasiveness of junk foods in schools and communities were cited as barriers to healthy eating. Potential facilitators of healthy eating included desire to avoid chronic disease, effort to limit junk food consumption and school support. Despite support for efforts to improve nutrition in the Delta, participants voiced a sense of inevitability related to children's consumption of unhealthy foods. This study suggests that parents and teachers express concern related to eating habits of children, yet they experience barriers to healthy eating which contribute to a sense of disempowerment. Improving health in the Mississippi Delta requires comprehensive strategies that offer its citizens a sense of agency.




Strengthening sense of coherence: opportunities for theory building in health promotion

2016-12-07T00:52:50-08:00

Sense of coherence (SOC) reflects a coping capacity of people to deal with everyday life stressors and consists of three elements: comprehensibility, manageability and meaningfulness. SOC is often considered to be a stable entity that is developed in young adulthood and stabilizes around the age of 30. Recent studies have questioned this stability of SOC and some studies report on interventions that have been successful in strengthening SOC in adult populations. Currently, however, there is no clear understanding of the mechanisms underlying SOC. As a consequence, it is a challenge to determine what is needed in health promotion activities to strengthen SOC. This article aims to explore the mechanisms underlying SOC as these insights may underpin future health promotion efforts. An exploration of the salutogenic model suggests two important mechanisms: the behavioural and the perceptual. The behavioural mechanism highlights the possibility to empower people to use their resources in stressful situations. The perceptual mechanism suggests that, in order for people to deal with life stressors, it is essential that they are able to reflect on their understanding of the stressful situation and the resources that are available. Based on these mechanisms, we suggest that both empowerment and reflection processes, which are interdependent, may be relevant for health promotion activities that aim to strengthen SOC. The successful application of resources to deal with stressors is not only likely to have a positive influence on health, but also creates consistent and meaningful life experiences that can positively reinforce SOC levels.




Food capacities and satisfaction in participants in food security community interventions in Montreal, Canada

2016-12-07T00:52:50-08:00

Food insecurity is steadily increasing in Canada. The objective of this paper is to determine if food capacities and satisfaction of recently enrolled participants in food security interventions are associated with the intervention having either a traditional or an alternative type of approach. Participants having recently accessed traditional (n = 711) or alternative community interventions (n = 113) in the Montreal metropolitan area, Canada, were interviewed with a questionnaire. The categorizing variable was participation in a community organization providing either traditional interventions, aimed to help people cope with the urgent need of food, or alternative interventions, aimed at first assistance, in addition to the creation of long-term solutions such as social integration and skills development. Participants' food and nutrition-related capacities and food satisfaction are studied. Multilevel regression models were used to assess whether participants took part in a traditional or alternative interventions. These interventions do not reach the same population. Relative to participants in alternative food security interventions, participants in traditional interventions demonstrated less capacity for accessing information about food safety and healthiness, and perceived their diet as less healthy. Traditional food security participants also paid less attention to the nutritional properties of food and reported less satisfaction with quantity, variety and taste of the food they accessed. The reasons why individuals who may benefit the most from alternative interventions were unlikely to participate should be investigated. The potential that food security interventions may inadvertently reinforce social inequalities in health should be considered in future intervention research.




Health in All Policies in South Australia: what has supported early implementation?

2016-12-07T00:52:50-08:00

Health in All Policies (HiAP) is a policy development approach that facilitates intersectoral responses to addressing the social determinants of health and health equity whilst, at the same time, contributing to policy priorities across the various sectors of government. Given that different models of HiAP have been implemented in at least 16 countries, there is increasing interest in how its effectiveness can be optimized. Much of the existing literature on HiAP remains descriptive, however, and lacks critical, empirically informed analyses of the elements that support implementation. Furthermore, literature on HiAP, and intersectoral action more generally, provides little detail on the practical workings of policy collaborations. This paper contributes empirical findings from a multi-method study of HiAP implementation in South Australia (SA) between 2007 and 2013. It considers the views of public servants and presents analysis of elements that have supported, and impeded, implementation of HiAP in SA. We found that HiAP has been implemented in SA using a combination of interrelated elements. The operation of these elements has provided a strong foundation, which suggests the potential for HiAP to extend beyond being an isolated strategy, to form a more integrated and systemic mechanism of policy-making. We conclude with learnings from the SA experience of HiAP implementation to inform the ongoing development and implementation of HiAP in SA and internationally.




With or without the group: Swedish midwives' and child healthcare nurses' experiences in leading parent education groups

2016-12-07T00:52:50-08:00

The aim of the study was to describe and to understand midwives' and child healthcare nurses' experiences of working with parent education groups through their descriptions of the role and what they find rewarding and challenging in that work. Data were collected through three open-ended questions from a web survey: ‘How do you refer to your role when working in parent education?’, ‘What is the biggest challenge or difficulty for you when working in parent education?’ and ‘What is most rewarding when working in parent education?’ The answers were analysed by using qualitative content analysis and correlation analysis. The results show that the midwives and child healthcare nurses either included or excluded the group when describing their role as leaders and their influence on parents. The same applies to what they found rewarding and what was difficult and challenging for them in working with the groups. Primarily, the leaders who excluded the group expressed a lack of competence on a professional level in managing groups and using the right teaching methods to process the knowledge content. One important question to deal with is how to best support midwives and nurses in child healthcare to be prepared for working with parent education groups. One obvious thing is to provide specialized training in an educational sense. An important aspect could also be providing supervision, individually or in groups.




Targets to promote swimming between the flags among Australian beachgoers

2016-12-07T00:52:50-08:00

Visiting the beach is a popular activity, but the risk of drowning is real. Drownings are preventable, and swimming between the patrol flags can save lives. The aim of this study is to understand the beliefs people hold in relation to this important water safety behaviour. Participants (N= 514; females = 58%) who were residents of/visitors to coastal areas in South-East Queensland, Australia, completed a theory of planned behaviour belief-based questionnaire. The survey was designed to measure behavioural, normative and control beliefs guiding beachgoers' intentions to swim between the patrol flags. Controlling for age, gender and swimming ability, four critical beliefs (along with self-reported swimming ability) were identified as independently predicting intention. Specifically, the benefits of feeling safe and the cost of feeling limited in choice of where to swim, the social approval from partners and the inhibitor belief about better waves being outside the flags predicted intentions to swim between the flags. This study provides an understanding of the beliefs underlying Australian beachgoers' intentions to swim between the patrol flags. Attention to these targeted beliefs may assist in promoting more regular performance of this beach safety behaviour, thereby combating the increasing rates of drownings and surf rescues.




Implementing Comprehensive School Health in Alberta, Canada: the principal's role

2016-12-07T00:52:50-08:00

Comprehensive School Health (CSH) is an internationally recognized framework that moves beyond the individual to holistically address school health, leading to the development of health-enhancing behaviors while also improving educational outcomes. Previous research has suggested that principal support for CSH implementation is essential, but this role has yet to be explored. Therefore, the purpose of this research was to examine the role of the principal in the implementation of a CSH project aimed at creating a healthy school culture. This research was guided by the grounded ethnography method. Semi-structured interviews were conducted with APPLE School principals (n = 29) to qualitatively explore their role in creating a healthy school culture. A model consisting of five major themes emerged, suggesting that the principal played a fluid role throughout the CSH implementation process. Principals (i) primed the cultural change; (ii) communicated the project's importance to others; (iii) negotiated concerns and collaboratively planned; (iv) held others accountable to the change, while enabling them to take ownership and (v) played an underlying supportive role, providing positive recognition and establishing ongoing commitment. This research provides recommendations to help establish effective leadership practices in schools, conducive to creating a healthy school culture.




Does school health and home economics education influence adults' food knowledge?

2016-12-07T00:52:50-08:00

Home economics and health teachers are to be found in many parts of the world. They teach students about food in relation to its nutritional, safety and environmental properties. The effects of such teaching might be expected to be reflected in the food knowledge of adults who have undertaken school education in these areas. This study examined the food knowledge associations of school home economics and health education among Australian adults. Two separate online surveys were conducted nationwide among 2022 (November 2011) and 2146 Australian adults (November–December 2012). True/false and multiple choice questions in both surveys were used to assess nutrition, food safety and environmental knowledge. Knowledge scores were constructed and compared against respondents' experience of school health or home economics education via multiple regression analyses. The results from both studies showed that home economics (and similar) education was associated with higher levels of food knowledge among several age groups. The associations of home economics education with food knowledge differed across several Australian states and recall of home economics themes differed across the age groups. These findings suggest that home economics education may bring about long-lasting learning of food knowledge. Further research is required, however, to confirm the findings and to test the causal influence of home economics education on adults' food knowledge.




Health promoting leadership practices in four Norwegian industries

2016-12-07T00:52:50-08:00

The aim of this article is to address health promoting leadership; what do leaders actually do to promote health at work? Leadership practice plays a crucial role in the workplace and greatly affects the working environment and working conditions. Through a theoretical and empirical approach, we seek to find characteristics/patterns of health promoting leadership. The definition of health promoting leadership is a democratic and supportive leadership style, where leaders seek to motivate and inspire their employees. The study in this article is based on qualitative research methods. We have investigated and compared leadership practice in four different organizations/industries in Norway: construction, oil and gas, health care and cleaning. These organizations and professions are quite different, and thus leadership must be understood and developed within its context. However, we found some generic characteristics of health promoting leadership: hands-on, accessible, supportive, inclusive and democratic. Current literature only rarely addresses how leadership affects health promotion at work. Consequently, more knowledge is needed about how leaders really succeed in creating healthy workplaces and healthy employees.




Problematics of empowerment: sex worker HIV prevention in the Pacific

2016-12-07T00:52:50-08:00

A recent overview of HIV/STI prevention programmes for sex workers in the Pacific region indicates that, despite a regional policy shift from universal to targeted interventions, Pacific Island countries currently lack core HIV/STI prevention services for sex workers. Across the region, condom distribution, peer outreach and support services for sex workers have ceased even in countries where such programmes had previously existed. This article cautions that the endorsement of empowerment projects does not negate the important role of condom access in HIV and STI prevention efforts for Pacific sex workers. While community empowerment underpins, and is essential to the sustainability of, effective interventions, it does not constitute an adequate form of HIV and STI prevention in and of itself. We contend that in the context of the Pacific Islands, timely and effective HIV prevention measures must specifically attend to the implementation of, and sustained support for, behavioural interventions such as sex-worker-specific peer education, condom and lubricant distribution, and access to appropriate sexual health services. Further, the responsibility for delivery of these should not be borne solely by fledgling sex worker organizations and communities. The evolution of targeted interventions in the Pacific and the current lack of funded condom distribution programmes highlight a more generalizable imperative within HIV prevention to ensure that behaviour change efforts are not considered to be extraneous to, or rendered redundant by, empowerment-based interventions.




Young adults: beloved by food and drink marketers and forgotten by public health?

2016-12-07T00:52:50-08:00

Young adults are a highly desirable target population for energy-dense, nutrient-poor (EDNP) food and beverage marketing. But little research, resources, advocacy and policy action have been directed at this age group, despite the fact that young adults are gaining weight faster than previous generations and other population groups. Factors such as identity development and shifting interpersonal influences differentiate young adulthood from other life stages and influence the adoption of both healthy and unhealthy eating behaviours. EDNP food and beverage marketing campaigns use techniques to normalize brands within young adult culture, in particular through online social media. Young adults must be a priority population in future obesity prevention efforts. Stronger policies to protect young adults from EDNP food and beverage marketing may also increase the effectiveness of policies that are meant to protect younger children. Restrictions on EDNP food and beverage marketing should be extended to include Internet-based advertising and also aim to protect vulnerable young adults.




How international is health promotion?

2016-09-01T22:42:09-07:00




Integrating health promotion with quality improvement in a Swedish hospital

2016-09-01T22:42:09-07:00

Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.




Health promoting interactive technology: Finnish, Norwegian, Russian and Swedish students' reflections

2016-09-01T22:42:09-07:00

The aim of this study was to elucidate Finnish, Norwegian, Russian and Swedish students' reflections and ideas on how interactive technology can be used to promote health in school. The data were collected in the northern part of these four countries, and 630 students aged 13–15 filled out the World Health Organization's ‘Health Behavior in School-Aged Children’ self-completion questionnaire with one additional open question, which is analyzed in this article (n = 419). The phenomenological analysis resulted in four themes: A sense of control, Balancing enjoyable options, Sharing with others and Learning made easier. The students point out that interactive technology promotes empowerment and independence, reduces stress and makes learning easier. They argue for a healthy balance of Internet use for it to be health promoting. According to the students, good relationships increase well-being; and interactive technology can offer a way to socialize, provide a tool for meeting and making new friends, help when not feeling well and give support when encouraging classmates. We argue, based on the findings of the present study and previous research, that students need a combination of freedom and meaningful relationships with adults who have an empowered child perspective, to fully take advantage of the empowering effects of interactive technology. We suggest, as implications for practice, that teachers, school leaders and health care professionals find ways to act as partners using an appreciative process, asking questions on what works well, to make interactive technology an enabling technology to increase health literacy, thus improving health and well-being in students.




Promoting aging well: evaluation of Vital-Aging-Multimedia Program in Madrid, Spain

2016-09-01T22:42:09-07:00

This article attests to the effectiveness of Vital Aging-Multimedia (VA-M, ‘Vivir con Vitalidad-M’), a psycho-educational multimedia program designed to promote successful aging. The program was implemented over 3 months through 35 h of video lessons grouped into 15 thematic units addressing four domains of experience commonly associated with aging well: health and healthy habits, cognitive functioning, aging self-efficacy and well-being and social participation. In accordance with a quasi-experimental design, a total of 115 senior citizens (aged 54–82) participated: 73 subjects attended the VA-M, while 42 subjects with similar characteristics served as controls. All subjects were assessed before and after the program on target variables related to the above domains of functioning. Significant changes in most of the examined variables documented the positive effects of the program.




Digital marketing of unhealthy foods to Australian children and adolescents

2016-09-01T22:42:09-07:00

The emergence of new media—including branded websites, social media and mobile applications—has created additional touch points for unhealthy food and beverage companies to target children and adolescents. The aim of this study was to perform an audit of new media for three top selling food and beverage brands in Australia. The top selling brand in three of the most advertised food and beverage categories was identified. Facebook, websites and mobile phone applications from these three brands were assessed using a combination of descriptive analyses and structured data collection during June and July 2013. Information on target audience, main focus of the activity, marketing strategies employed and connectivity were collected. Promotional activities were assessed against industry self-regulatory codes. McDonald's, Coca-Cola and Cadbury Dairy Milk were audited, with 21 promotional activities identified. These promotional activities appeared to use a number of marketing strategies, with frequent use of indirect product association, engagement techniques and branding. We identified strategic targeting of both children and adolescents. We found that while all promotional activities technically met self-regulatory codes (usually due to media-specific age restrictions) a number appeared to employ unhealthy food or beverage marketing directed to children. Brands are using engaging content via new media aimed at children and adolescents to promote unhealthy food and beverages. Given the limitations of self-regulatory codes in the context of new media, strategies need to be developed to reduce exposure of children and adolescents to marketing of unhealthy food and beverage products via these avenues.




Researching health-related quality of life at a community level: results from a population survey conducted in Burgas, Bulgaria

2016-09-01T22:42:09-07:00

Researching health-related quality of life (HrQoL) at a community health promotion level is an approach to understand the health inequalities. The objective of this study is to measure the health of a representative sample by conducting a population survey in Burgas by using the EuroQoL EQ-5D-3L questionnaire, and further to assess the influence of socio-economic, demographic and behavioural factors on HrQoL. The relationship between HrQoL and social capital is analysed through a network-based approach. The achieved ambition was to build the public health capacity of the key stakeholders in order to support decision making. A cross-sectional study was conducted in 2011 using a representative sample of the citizens of Burgas (n = 1050, >18 years old). Respondents were selected through the method of two-stage random selection. HrQoL was assessed by the standardized EQ-5D-3L questionnaire. People without any problem in all five dimensions represent only 26.5% (n = 278) of the respondents, whereas 52.2% (n = 548) reported a moderate problem in at least one dimension; any extreme problem reported 11.6% (n = 122) of the respondents. The mean state of health recorded on the Visual Analogue Scale was 70 (SD ±23). There were differences in self-reported health based on the respondent's age, occupation, education, income, smoking behaviour and membership in community groups. People who have hobby and practice sports assessed their health status higher. The results were communicated in a following Delphi-study; a consensus has been reached that the combination of routine measures of health with measurement of self-rated health could provide better understandings of the community health needs.




Guatemalan school food environment: impact on schoolchildren's risk of both undernutrition and overweight/obesity

2016-09-01T22:42:09-07:00

Guatemala suffers the double burden of malnutrition with high rates of stunting alongside increasing childhood overweight/obesity. This study examines the school food environment (SFE) at low-income Guatemalan elementary schools and discusses its potential impact on undernutrition and overweight/obesity. From July through October 2013, direct observations, in-depth interviews with school principals (n = 4) and food kiosk vendors (n = 4, 2 interviews each) and also focus groups (FGs) with children (n = 48, 8 FGs) were conducted. The SFE comprises food from school food kiosks (casetas); food from home or purchased in the street; and food provided by the school (refacción). School casetas, street vendors and children's parents largely provide sandwiches, calorie-rich snacks and sugar-sweetened beverages. Refacción typically serves energy dense atol, a traditional beverage. The current school food program (refacción), the overall SFE and the roles/opinions of vendors and principals reveal persistent anxiety concerning undernutrition and insufficient concern for overweight/obesity. Predominant concern for elementary schoolchildren remains focused on undernutrition. However, by the time children reach elementary school (ages 6–12+), food environments should encourage dietary behaviors to prevent childhood overweight/obesity.




Intersectoral collaboration for physical activity in Korean Healthy Cities

2016-09-01T22:42:09-07:00

Intersectoral collaboration (ISC) is important in the health field because the complexity of determinants of health makes it difficult for one institution to resolve all health issues. Promotion of physical activity can especially benefit from a multi-sectoral approach. Despite so much emphasis on its importance in both primary health and health promotion, ISC has been underachieved in the field. This study aimed to examine the characteristics and level of ISC among physical activity programs in Healthy Cities as compared to non-Healthy Cities. I conducted a postal survey where 24 people from Healthy Cities and 72 people from non-Healthy Cities participated. The survey included questions to measure the level of ISC as well as to determine ISC partners and activities. Among the entire 393 physical activity programs, 336 (85.5%) had some kind of collaboration with one or more partners. The percentage having one or more partners was greater in Healthy Cities than in non-Healthy Cities. However, there were no statistical differences between the two groups in terms of the level of ISC within a municipal organization. Collaboration activities of the other departments were mostly supportive, such as providing a venue, recruiting participants and publicizing, and other kinds of administrative support. To strengthen ISC in Korean Healthy Cities, various actions including providing a legal basis, specific and substantive supports, financial incentives, and organizational recognitions will be helpful as well as the development of partnerships with other departments in urban planning, transport, urban design, and communication.




Parental provision of alcohol: a TPB-framed review of the literature

2016-09-01T22:42:09-07:00

There is evidence that parents are a common source of alcohol provision for teenagers, and increasing evidence that this provision is associated with current and future drinking. This review examines the current literature on parental provision of alcohol to children and teenagers, through the lens of the Theory of Planned Behavior: attitudes, subjective norms and perceived behavioral control. A search of the databases ProQuest, PsycINFO, Medline, Expanded Academic, Scopus and PBSC identified 826 articles. Of these, 810 did not meet the inclusion criteria, and 16 were included in the review. In summary, the reviewed articles demonstrated positive attitudes toward parental supply of alcohol (often driven by misperceptions), strong subjective norms, but little exploration of perceived behavioral control. There is a need for further research which clearly differentiates between adolescents of different ages and genders, and which explores the predictors and role of perceived behavioral control. There is also a need for further research to more fully understand this behavior and to develop appropriate interventions which address all three predictors (attitudes, subjective norms and perceived behavioral control).




Overcoming disparities in organized physical activity: findings from Australian community strategies

2016-09-01T22:42:09-07:00

Organized physical activity through sport and recreational activities is beneficial for physical and psychosocial well-being and community connectedness. However, many who could gain significantly from this have lower participation, especially the socioeconomically disadvantaged, Indigenous people, culturally diverse communities and people with a disability. This study examined barriers to participation by these underserved groups and the success of strategies for overcoming these used in 22 community projects over 3 years in the VicHealth Participation in Community Sport and Recreation Program, in Victoria, Australia. Each year, in-depth interviews were undertaken with 50–60 activity providers and 30–40 project partners. Major barriers to participation were cost, lack of transport, cultural differences, the environment of sporting groups and inaccessible facilities for people with disabilities. Projects that overcame these selected one or two priority groups, put significant effort into communication and building partnerships with community organizations, provided training to staff and volunteers and created new or modified forms of activity. Strategies were put in place to reduce cost and provide transport, but these did not appear to be sustainable. Many organizations found engaging the underserved was more difficult than anticipated and require information and support about how to develop acceptable, accessible and flexible opportunities for disadvantaged groups. Cost and lack of transport are persistent barriers to participation that need to be addressed by the sport and recreation sector and policy-makers.




A snapshot of the scope of obesity prevention practice in Australia

2016-09-01T22:42:10-07:00

Community-based initiatives (CBIs) that build capacity and promote healthy environments hold promise for preventing obesity and non-communicable disease, however their characteristics remain poorly understood and lessons are learned in isolation. This limits understanding of likely effectiveness of CBIs; the potential for actively supporting practice; and the translation of community-based knowledge into policy. Building on an initial survey (2010), an online survey was launched (2013) with the aim to describe the reach and characteristics of Australian CBIs and identify and evaluate elements known to contribute to best practice, effectiveness and sustainability. Responses from 104 CBIs were received in 2013. Geographic location generally reflected population density in Australia. Duration of CBIs was short-term (median 3 years; range 0.2–21.0 years), delivered mostly by health departments and local governments. Median annual funding had more than doubled since the 2010 survey, but average staffing had not increased. CBIs used at least two strategy types, with a preference for individual behaviour change strategies. Targeting children was less common (31%) compared with the 2010 survey (57%). Logic models and theory were used in planning, but there was low use of research evidence and existing prevention frameworks. Nearly, all CBIs had an evaluation component (12% of budget), but dissemination was limited. This survey provides information on the scope and varied quality of the current obesity prevention investment in Australia. To boost the quality and effectiveness of CBIs, further support systems may be required to ensure that organizations adopt upstream, evidence-informed approaches; and integrate CBIs into systems, policies and environments.




HIV risk and sexual health among female migrants in China

2016-09-01T22:42:10-07:00

Sexual behavior is the dominant mode of HIV transmission in China, and young female migrants are among the populations at highest risk. This article examines how HIV-related risk behaviors among female migrants might vary according to workplace settings. Participants were young female migrants recruited from three workplace settings—factories, restaurants and entertainment venues. In a cross-sectional survey, we assessed 457 participants' sociodemographic characteristics, HIV/AIDS-related knowledge, condom use knowledge, sexual behaviors, condom use behavior and reproductive health factors. Participants working in entertainment venues were significantly more likely than those working in factories and restaurants to report sexual behavior, unprotected sex, multiple pregnancy terminations and sexually transmitted infections (STI). However, participants working in factories and restaurants reported significantly lower levels of HIV/AIDS knowledge, condom use knowledge, condom use self-efficacy and history of HIV/AIDS counseling and testing. Independent correlates of unprotected sex included employment in an entertainment venue, abortion history and sexual self-efficacy. Independent correlates of STI or genitourinary tract infection included employment in an entertainment venue, abortion history, recent migration and recent unprotected sex. These findings indicate a need for sexual and reproductive health interventions prioritizing young female migrants, and call for programs that can be incorporated into different workplace settings.




Home smoking restrictions before, during and after pregnancy--a qualitative study in rural China

2016-09-01T22:42:10-07:00

Worldwide, many nonsmokers (often women and children) are exposed to second-hand smoke (SHS) in home settings, as men retain their traditional power and control within their family and women and children have limited agency to intervene. This study, set up to explore home smoking management in rural China, found that some women were able to positively intervene to restrict men's smoking at three key stages: prior to conception, during their pregnancy and at the early years of their children's lives. By utilizing dominant social, health and political narratives about the importance of raising a healthy child supported by the One-Child Policy in China, combined with the fear of health risks of SHS to young children, the women were able to use their elevated status as bearer and carers of the only children to subvert the pre-eminence of men in domestic environments, enabling them to positively influence home smoking. While this study highlights the possibility for future smoking cessation initiatives in China by incorporating family carers' elevated awareness of protection of children's health in key stages of childhood, there is also a need for further health education, as family members were unsure why they needed to keep children smoke-free, which may partially explain why few households were smoke-free.




Mothers' perceptions of Melbourne InFANT Program: informing future practice

2016-09-01T22:42:10-07:00

Intervention programs to prevent childhood obesity are more likely to be successful when mothers are involved and engaged. Yet programs that involve mothers do not often employ process evaluation to identify aspects of the intervention that participants enjoyed or viewed as useful. The aims of this study were to describe how participants of the Melbourne InFANT Program—an early childhood obesity prevention intervention—engaged in the program and perceived its usefulness. Process evaluation data were collected at multiple time points during and after the intervention, using mixed methods drawing upon both quantitative and qualitative data. Results from short surveys (n = 271) and interview transcripts (n = 26) revealed that the Melbourne InFANT Program was perceived as useful and relevant by most (82–93%) participants. The formats through which the knowledge and skills were delivered were considered concise and effective, and aspects considered particularly useful included group sessions and advice on practical strategies to minimize stress around mealtimes. Findings from this study are important to inform future practice and the development of interventions which are well received by participants.




Persian Diabetes Self-Management Education (PDSME) program: evaluation of effectiveness in Iran

2016-09-01T22:42:10-07:00

Despite increasing rate of diabetes, no standard self-management education protocol has been developed in Iran. We designed Persian Diabetes Self-Management Education (PDSME) program using intervention mapping. Effectiveness of program was assessed in newly diagnosed people with type 2 diabetes and those who had received little self-management education. Individuals aged 18 and older (n = 350) were recruited in this prospective controlled trial during 2009–2011 in Tehran, Iran. Patients were excluded if they were pregnant, were housebound or had reduced cognitive ability. Participants were randomly allocated in intervention and control groups. PDSME patients attended eight workshops over 4-week period following two follow-up sessions. Validated questionnaires assessed cognitive outcomes at baseline, 2 and 8 weeks. HbA1c was assessed before and 18–21 months after intervention in both groups. The CONSORT statement was adhered to where possible. A total of 280 individuals (80%) attended the program. By 18–21 months, the PDSME group showed significant improvements in mean HbA1c (–1.1 versus +0.2%, p =0.008, repeated measure ANOVA (RMA)). Diabetes knowledge improved more in PDSME patients treated with oral antidiabetic agents than in those receiving usual care over time (RMA, F = 67.08, p < 0.001). Statistically significant improvements were seen in PDSME patients for self-care behaviors, health beliefs, attitudes toward diabetes, stigma, self-efficacy and patient satisfaction. PDSME program was effective in improving self-management cognitive and clinical outcomes. Results support use of intervention mapping for planning effective interventions. Given the large number of people with diabetes and lack of affordable diabetes education, PDSME deserves consideration for implementation.




Empirical relations between sense of coherence and self-efficacy, National Danish Survey

2016-09-01T22:42:10-07:00

Salutogenic orientation is a health promotion paradigm focusing on the resources of the individual. This study analyzed the relationship between sense of coherence (SOC) and self-efficacy (SE) based on population data. By conducting an empirical analysis of the two models, we wanted to see whether we could make a valid judgement as to whether both SOC and SE could be utilized in health promotion practice, or whether one is preferable to the other. The study population was randomly selected from the Danish Central Population Register and consisted of five birth-year cohorts (1920, 1930, 1940, 1965 and 1975). The study used the 13-item SOC scale and the general SE scale. The main findings were that SOC score increased by age cohort (p = 0.0004), and there is a positive and graded correlation between SOC and SE (r = 0.39; p < 0.0001) and adjusted OR = 10.3 (CI = 6.7–15.4). We found the strongest association at the lowest level of SOC. For health promotion practice, this finding signifies the importance of focusing on improving SOC in people with a low SOC score, as they are most in need and most likely to increase their SOC level. The finding of higher SOC scores in the older age cohorts indicates that SOC changes over lifetime. Public health work focusing on lifestyle change by increasing SOC can be effective throughout life, however early intervention is important. The finding of a positive correlation between SOC and SE indicates that health promotion altering one of the constructs is paralleled in the other.




Does social capital protect mental health among migrants in Sweden?

2016-09-01T22:42:10-07:00

Poor mental health is common among migrants. This has been explained by migration-related and socio-economic factors. Weak social capital has also been related to poor mental health. Few studies have explored factors that protect mental health of migrants in the post-migration phase. Such knowledge could be useful for health promotion purposes. Therefore, this study aimed to analyse associations between financial difficulties, housing problems and experience of discrimination and poor mental health; and to detect possible effect modification by social capital, among recently settled Iraqi migrants in Sweden. A postal questionnaire in Arabic was sent to recently settled Iraqi citizens. The response rate was 51% (n = 617). Mental health was measured by the GHQ-12 instrument and social capital was defined as social participation and trust in others. Data were analysed by means of logistic regression. Poor mental health was associated with experience of discrimination (OR 2.88, 95% CI 1.73–4.79), housing problems (OR 2.79, 95% CI 1.84–4.22), and financial difficulties (OR 2.14, 95% CI 1.44–3.19), after adjustments. Trust in others seemed to have a protective effect for mental health when exposed to these factors. Social participation had a protective effect when exposed to experience of discrimination. Social determinants and social capital in the host country play important roles in the mental health of migrants. Social capital modifies the effect of risk factors and might be a fruitful way to promote resilience to factors harmful to mental health among migrants, but must be combined with policy efforts to reduce social inequities.




Translating primary into 'positive prevention for adolescents in Eastern Africa

2016-09-01T22:42:10-07:00

There is an urgent need to develop positive prevention interventions for adolescents living with HIV in high endemic regions. Adapting existing evidence-based interventions for resource-constrained settings is effective when the intervention's theoretical core elements are preserved while achieving cultural relevance. We describe the process of adapting a primary prevention to a secondary/positive prevention programme for adolescents living with HIV in Kenya and Uganda. The systematic adaptation was guided by the Centers for Diseases Control's map for the adaptation process, describing an iterative process. The procedure included: assessing the target positive prevention group's needs (safer sex; fertility-related issues), identifying the potential interventions through a literature review, conducting qualitative adaptation research to identify areas for adaptation by ensuring cultural relevance (revising the intervention logic by adding topics such as adherence; HIV-related stigma; HIV-disclosure; safer sex), pilot-testing the adapted programme and conducting a process evaluation of its first implementation. Areas added onto the original intervention's logic framework, based on social cognitive theory, the theories of reasoned action and planned behaviour were information and skills building on sexual relationships and protection behaviour, prevention of vertical HIV transmission, contraception, HIV-disclosure, HIV-related stigma, HIV-treatment and adherence. The process evaluation using mixed methods showed that we delivered a feasible and acceptable intervention for HIV-positive adolescents aged 13–17 years. The systematic approach adopted facilitated the development of a contextualized and developmentally appropriate (i.e. age-specific) intervention for adolescents living with HIV.




Development of a radical foster care intervention in Glasgow, Scotland

2016-09-01T22:42:10-07:00

Services for maltreated children are inadequate and lack infant mental health input in many parts of the world. A recent audit of Glasgow services revealed that children frequently ‘revolve’ between maltreating birth parents and various temporary foster placements for many years. Addressing infant mental health in this population will require radical change to current services. The New Orleans programme developed by the Tulane Infant Team in Louisiana is one such radical programme. Prior to the design of a randomized controlled trial (RCT) to test this programme in Glasgow, it was essential that policy-makers had some insight into the local model of service delivery and how a New Orleans model could impact. This article explores the structure and costs of the current Glasgow system and the potential costs and consequence impact of implementing a New Orleans model in Glasgow, using data obtained from the research literature, Glasgow City Council audit data and expert's opinion. A New Orleans-Glasgow model would likely shift resources from social services on to the NHS. The resource intensive nature of this model could increase the cost of an episode in care from £66 300 in the current system to £86 070; however, the probability of repeated episodes in care is likely to fall substantially, making the cost per child fall from £95 500 in the current system to £88 600. This study informed the design of a phase II explorative RCT, identified appropriate outcomes for measurement and areas of uncertainty for further research.




It is pleasant and heavy: convergence of visual contents in tobacco, alcohol and food marketing in Brazil

2016-09-01T22:42:10-07:00

The tactical use of visuoperceptual content in marketing may encourage impulsive consumption of unhealthy products. In this study, the application of visuoperceptual content was compared in advertisements used by industries of tobacco, alcohol and food. The aim was to ascertain whether similarities exist in the strategies used as variables for the selection of commercial stimuli, such as color, position and size. Scion Image and Corel Draw Graphics Suite software were used to analyze the content of a non-probabilistic sample of advertising images (N = 150). Differences were identified in the use of the colors green (p = 0.04) and red (p = 0.01), but not in the use of the color blue (p = 0.64), suggesting that induction of feelings of pleasantness resulting from the use of the color blue may be associated with the advertising in the alcohol and tobacco industries. Regarding the position of the commercial stimuli, a predominance of the use of quadrants ‘C’ (p = 0.00) and ‘D’ (p = 0.01) was found in all three industries, indicating a similar use of areas perceived as being ‘heavier’. As to the size, 78% of advertisements placed the commercial stimuli within a range of 0–25% of the total image. The results showed some similarities in the use of visuoperceptual content in advertisements for tobacco, alcohol and food, especially between tobacco and alcohol. The article offers a convergence analysis of these three industries altogether, providing additional subsidies for the formulation of protection policies.




Developing a framework for estimating the potential impact of obesity interventions in a European city

2016-09-01T22:42:10-07:00

Obesity is a global challenge for healthy populations. It has given rise to a wide range of public health interventions, focusing on supportive environments and lifestyle change, including diet, physical activity and behavioural change initiatives. Impact is variable. However, more evidence is slowly becoming available and is being used to develop new interventions. In a period of austerity, momentum is building to review these initiatives and understand what they do, how they do it and how they fit together. Our project seeks to develop a relatively straight forward systematic framework using readily accessible data to map the complex web of initiatives at a policy, population, group and individual level aiming to promote healthy lifestyles, diet and physical activity levels or to reduce obesity through medical treatments in a city or municipality population. It produces a system for classifying different types of interventions into groupings which will enable commissioners to assess the scope and distribution of interventions and make a judgement about gaps in provision and the likely impact on mean body mass index (BMI) as a proxy measure for health. Estimated impact in each level or type of intervention is based upon a summary of the scientific evidence of clinical and/or cost effectiveness. Finally it seeks, where possible, to quantify the potential effects of different types of interventions on BMI and produce a cost per unit of BMI reduced. This approach is less sophisticated but identifies the areas where more sophisticated evaluation would add value.




A case of standardization? Implementing health promotion guidelines in Denmark

2016-09-01T22:42:10-07:00

Guidelines are increasingly used in an effort to standardize and systematize health practices at the local level and to promote evidence-based practice. The implementation of guidelines frequently faces problems, however, and standardization processes may in general have other outcomes than the ones envisioned by the makers of standards. In 2012, the Danish National Health Authorities introduced a set of health promotion guidelines that were meant to guide the decision making and priority setting of Denmark's 98 local governments. The guidelines provided recommendations for health promotion policies and interventions and were structured according to risk factors such as alcohol, smoking and physical activity. This article examines the process of implementation of the new Danish health promotion guidelines. The article is based on qualitative interviews and participant observation, focusing on the professional practices of health promotion officers in four local governments as well as the field of Danish health promotion more generally. The analysis highlights practices and episodes related to the implementation of the guidelines and takes inspiration from Timmermans and Epstein's sociology of standards and standardization. It remains an open question whether or not the guidelines lead to more standardized policies and interventions, but we suggest that the guidelines promote a risk factor-oriented approach as the dominant frame for knowledge, reasoning, decision making and priority setting in health promotion. We describe this process as a case of epistemic standardization.




Australian rural, remote and urban community nurses' health promotion role and function

2016-09-01T22:42:10-07:00

Community nurses have often been ‘touted’ as potential major contributors to health promotion. Critical literature, however, often states that this has not been the case. Furthermore, most studies examining nurses' role and function have occurred mainly in hospital settings. This is a sequential mixed-methods study of two groups of community nurses from a Sydney urban area (n = 100) and from rural and remote areas (n = 49) within New South Wales, Australia. A piloted questionnaire survey was developed based on the five action areas of the Ottawa Charter for Health Promotion. Following this, 10 qualitative interviews were conducted for both groups, plus a focus group to support or refute survey results. Findings showed that rural and remote nurses had more positive attitudes towards health promotion and its clinical implementation. Survey and interview data confirmed that urban community nurses had a narrower focus on caring for individuals rather than groups, agreeing that time constraints impacted on their limited health promotion role. There was agreement about lack of resources (material and people) to update health promotion knowledge and skills. Rural and remote nurses were more likely to have limited educational opportunities. All nurses undertook more development of personal skills (DPS, health education) than any other action area. The findings highlight the need for more education and resources for community nurses to assist their understanding of health promotion concepts. It is hoped that community nurse leaders will collectively become more effective health promoters and contribute to healthy reform in primary health care sectors.




Peer support groups, mobile phones and refugee women in Melbourne

2016-09-01T22:42:10-07:00

In this article, we discuss qualitative findings basing on the experiences of refugee women living in Melbourne, Australia, who participated in a peer support training programme and received a free mobile phone. We pay attention to social support as a health enhancing strategy and empowerment that occurred among the participants. Participation in peer support groups and access to a mobile phone were beneficial for the women. Peer support functioned as social support among group members. The programme allowed the women to be connected to their families and the wider communities and assisted them to access health care and other settlement aspects with greater ease. It also increased personal empowerment among the women. Our programme shows that by tapping on community resources to ameliorate personal or resettlement issues, the burden on service providers can be reduced. Our findings also offer a model for future research and programmes regarding refugee people elsewhere.




Singing for respiratory health: theory, evidence and challenges

2016-09-01T22:42:10-07:00

The premise that singing is a health promoting activity for people with respiratory conditions of chronic obstructive pulmonary disease (COPD) and asthma is a growing area of interest being investigated by researchers from various disciplines. The preliminary evidence, a theoretical framework and identification of methodological challenges are discussed in this perspective article with an eye to recommendations for further research to advance knowledge. After a brief summary of main research findings on singing in healthy people to provide background context, research is reviewed on singing in people with COPD and asthma. Studies include published research and as yet unpublished work by the authors. Methodological challenges arising from the reviewed studies are identified such as attrition from singing or control groups based on weak and strong, respectively, beliefs about singing's effectiveness. Potential solutions for these problems are considered with further recommendations made for other singing research.










Informal settlements and a relational view of health in Nairobi, Kenya: sanitation, gender and dignity

2016-05-11T16:08:09-07:00

On an urban planet, slums or informal settlements present an increasing challenge for health promotion. The living conditions in complex informal settlements interact with how people navigate through their daily lives and political institutions to shape health inequities. In this article, we suggest that only a relational place-based characterization of informal settlements can accurately capture the forces contributing to existing urban health inequities and inform appropriate and effective health promotion interventions. We explore our relational framework using household survey, spatial mapping and qualitative focus group data gathered in partnership with residents and non-governmental organizations in the Mathare informal settlement in Nairobi, Kenya. All data interpretation included participation with local residents and organizations. We focus on the inter-relationships between inadequate sanitation and disease, social, economic and human rights for women and girls, who we show are most vulnerable from poor slum infrastructure. We suggest that this collaborative process results in co-produced insights about the meanings and relationships between infrastructure, security, resilience and health. We conclude that complex informal settlements require relational and context-specific data gathering and analyses to understand the multiple determinants of health and to inform appropriate and effective healthy city interventions.




Perceived vulnerability and HIV testing among youth in Cape Town, South Africa

2016-05-11T16:08:09-07:00

The importance of perceived vulnerability to risk-reducing behaviors, including HIV testing, is fairly established, especially among youth in sub-Saharan Africa. Yet, the majority of studies that examined this important relationship used cross-sectional data that inherently assume that perceived vulnerability does not change. While these studies have been useful, the assumption of perceived vulnerability as time invariant is a major flaw and has largely limited the practical usefulness of this variable in AIDS prevention and programing. Using longitudinal data and applying random-effects logit models, this study makes a major contribution to scholarship by examining if changes in perceived vulnerability associate with a change to test for HIV among 857 young people in Cape Town, South Africa. Results show that female youth who changed their risk perceptions were more likely to also change to test for HIV, but the effects were completely attenuated after controlling for theoretically relevant variables. No significant relationships were observed for males. Also, females who were virgins at wave 2 but had sex between waves were significantly more likely to have changed to test for HIV. Of most importance was that sexual behavior eliminated the effects of change in risk perceptions suggesting that a change in perception may have occurred as a result of changes in sexual behavior. AIDS prevention programs must pay particular attention to helping youth become aware of their vulnerability to HIV risks, especially as these have implications for risk-reducing behaviors, especially for females who are burdened.




Participatory photography gives voice to young non-drivers in New Zealand

2016-05-11T16:08:09-07:00

Youth have the highest crash injury risk in New Zealand. Māori and Pacific youth have an even higher risk. Highlighting and promoting benefits of modal shift from cars to active and public transport may increase health and safety. We aimed to create a discussion surrounding transport issues to gain a better understanding of attitudes and behaviours of non-driving youth, to empower our participants and to promote health and social change by making participants' opinions and experiences known to the broader community through a public exhibition. We engaged nine non-drivers aged 16–24 years in photovoice. Through sharing their photos and stories, participants used the power of the visual image to communicate their experiences. This method is an internationally recognized tool that reduces inequalities by giving those who have minimal decision-making power an opportunity to share their voice. By the end of the project, it was clear that the participants were comfortable with their non-driving status, noting that public and active transport was more cost-effective, easy and convenient. This attitude reflects recent studies showing a marked decrease in licensure among young people in developed countries. This project uniquely prioritized young Māori, Pacific and Asian non-drivers.




Manifestations of integrated public health policy in Dutch municipalities

2016-05-11T16:08:09-07:00

Integrated public health policy (IPHP) aims at integrating health considerations into policies of other sectors. Since the limited empirical evidence available may hamper its further development, we systematically analysed empirical manifestations of IPHP, by placing policy strategies along a continuum of less-to-more policy integration, going from intersectoral action (IA) to healthy public policy (HPP) to health in all policies (HiAP). Our case study included 34 municipal projects of the Dutch Gezonde Slagkracht Programme (2009–15), which supports the development and implementation of IPHP on overweight, alcohol and drug abuse, and smoking. Our content analysis of project application forms and interviews with all project leaders used a framework approach involving the policy strategies and the following policy variables: initiator, actors, policy goals, determinants and policy instruments. Most projects showed a combination of policy strategies. However, manifestations of IPHP in overweight projects predominantly involved IA. More policy integration was apparent in alcohol/drugs projects (HPP) and in all-theme projects (HiAP). More policy integration was related to broad goal definitions, which allowed for the involvement of actors representing several policy sectors. This enabled the implementation of a mix of policy instruments. Determinants of health were not explicitly used as a starting point of the policy process. If a policy problem justifies policy integration beyond IA, it might be helpful to start from the determinants of health (epidemiological reality), systematically transform them into policy (policy reality) and set broad policy goals, since this gives actors from other sectors the opportunity to participate.




Implementing 'self-help friendliness in German hospitals: a longitudinal study

2016-05-11T16:08:09-07:00

In Germany, the term ‘self-help friendliness’ (SHF) describes a strategy to institutionalize co-operation of healthcare institutions with mutual aid or self-help groups of chronically ill patients. After a short explanation of the SHF concept and its development, we will present findings from a longitudinal study on the implementation of SHF in three German hospitals. Specifically, we wanted to know (i) to what degree SHF had been put into practice after the initial development phase in the pilot hospitals, (ii) whether it was possible to maintain the level of implementation of SHF in the course of at least 1 year and (iii) which opinions exist about the inclusion of SHF criteria in quality management systems. With only minor restrictions, the findings provide support for the usefulness, practicability, sustainability and transferability of SHF. Limitations of our empirical study are the small number of hospitals, the above average motivation of their staff, the small response rate in the staff-survey and the inability to get enough data from members of self-help groups. The research instrument for measuring SHF was adequate and fulfils the most important scientific quality criteria in a German context. We conclude that the implementation of SHF leads to more patient-centredness in healthcare institutions and thus improves satisfaction, self-management, coping and health literacy of patients. SHF is considered as an adequate approach for reorienting healthcare institutions in the sense of the Ottawa Charta, and particularly suitable for health promoting hospitals.




Alcohol-branded merchandise: association with Australian adolescents' drinking and parent attitudes

2016-05-11T16:08:09-07:00

There is growing evidence that young people own alcohol-branded merchandise (ABM), and that ownership influences their drinking intentions and behaviours. However, there is a paucity of research on parents' knowledge or attitudes in relation to ownership of ABM. Study 1 (n = 210) identified high levels of ownership of ABM and associations between ABM and drinking attitudes and behaviours. In Study 2, focus groups with Australian parents found that they were aware of ABM—and many had items of ABM in their home—but they had generally not engaged in consideration of the potential impact on their children. They clearly perceived ABM as advertising and, on reflection, acknowledged that this form of marketing may influence children's decisions about drinking. There is a need to raise parental awareness of the effects of ABM and to endeavour to reduce children's exposure to this influential form of alcohol marketing.




Adapting health promotion interventions for ethnic minority groups: a qualitative study

2016-05-11T16:08:09-07:00

Adaptation of health interventions has garnered international support across academic disciplines and among various health organizations. Through semi-structured interviews, we sought to explore and understand the perspectives of 26 health researchers and promoters located in the USA, UK, Australia, New Zealand and Norway, working with ethnic minority populations, specifically African-, South Asian- and Chinese-origin populations in the areas of smoking cessation, increasing physical activity and healthy eating, to better understand how adaptation works in practice. We drew on the concepts of intersectionality, representation and context from feminist, sociology and human geography literature, respectively, to help us understand how adaptations for ethnic groups approach the variable of ethnicity. Findings include (i) the intersections of ethnicity and demographic variables such as age and gender highlight the different ways in which people interact, interpret and participate in adapted interventions; (ii) the representational elements of ethnicity such as ancestry or religion are more complexly lived than they are defined in adapted interventions and (iii) the contextual experiences surrounding ethnicity considerations shape the receptivity, durability and continuity of adapted interventions. In conclusion, leveraging the experience and expertise of health researchers and promoters in light of three social science concepts has deepened our understanding of how adaptation works in principle and in practice for ethnic minority populations.




Computer and online health information literacy among Belgrade citizens aged 66-89 years

2016-05-11T16:08:09-07:00

Computer users over 65 years of age in Serbia are rare. The purpose of this study was to (i) describe main demographic characteristics of computer users older than 65; (ii) evaluate their online health information literacy and (iii) assess factors associated with computer use in this population. Persons above 65 years of age were recruited at the Community Health Center ‘Vračar’ in Belgrade from November 2012 to January 2013. Data were collected after medical checkups using a questionnaire. Of 480 persons who were invited to participate 354 (73.7%) agreed to participate, while 346 filled in the questionnaire (72.1%). A total of 70 (20.2%) older persons were computer users (23.4% males vs. 17.7% females). Of those, 23.7% explored health-related web sites. The majority of older persons who do not use computers reported that they do not have a reason to use a computer (76.5%), while every third senior (30.4%) did not own a computer. Predictors of computer use were being younger [odds ratio (OR) = 2.14, 95% confidence interval (CI) 1.30–4.04; p = 0.019], having less members of household (OR = 2.97, 95% CI 1.45–6.08; p = 0.003), being more educated (OR = 3.53, 95% CI 1.88–6.63; p = 0.001), having higher income (OR = 2.31, 95% CI 1.17–4.58; p = 0.016) as well as fewer comorbidities (OR = 0.42, 95% CI 0.23–0.79; p = 0.007). Being male was independent predictor of online health information use at the level of marginal significance (OR = 4.43, 95% CI 1.93–21.00; p = 0.061). Frequency of computer and Internet use among older adults in Belgrade is similar to other populations. Patterns of Internet use as well as non-use demonstrate particular socio-cultural characteristics.




Upgrading physical activity counselling in primary care in the Netherlands

2016-05-11T16:08:09-07:00

The systematic development of a counselling protocol in primary care combined with a monitoring and feedback tool to support chronically ill patients to achieve a more active lifestyle. An iterative user-centred design method was used to develop a counselling protocol: the Self-management Support Programme (SSP). The needs and preferences of future users of this protocol were identified by analysing the literature, through qualitative research, and by consulting an expert panel. The counselling protocol is based on the Five A's model. Practice nurses apply motivational interviewing, risk communication and goal setting to support self-management of patients in planning how to achieve a more active lifestyle. The protocol consists of a limited number of behaviour change consultations intertwined with interaction with and responses from the It's LiFe! monitoring and feedback tool. This tool provides feedback on patients' physical activity levels via an app on their smartphone. A summary of these levels is automatically sent to the general practice so that practice nurses can respond to this information. A SSP to stimulate physical activity was defined based on user requirements of care providers and patients, followed by a review by a panel of experts. By following this user-centred approach, the organization of care was carefully taken into account, which has led to a practical and affordable protocol for physical activity counselling combined with mobile technology.




Validation of Turkish health literacy measures

2016-05-11T16:08:09-07:00

This study aimed to validate a Turkish version of the Short Test of Functional Health Literacy (S-TOFHLA) (Baker et al., Development of a brief test to measure functional health literacy. Patient Educ Counsel 1999;38:33–42) and a Turkish version of the Chew self-report scale (Chew et al., Brief questions to identify patients with inadequate health literacy. Family Med, 2004;36:588–94) for measuring functional health literacy. The original English version of the S-TOFHLA and the Chew items were translated by applying standardized translation methods and cultural adaptations, and both were administered to a sample of diabetes patients (N = 302) in two diabetes clinics in one of the major cities in Turkey. Self-administered paper–pencil questionnaires were distributed to eligible outpatients who had a clinic appointment. In addition to the S-TOFHLA measurement and the Chew screening questions, gender, age, educational attainment, income, marital status and diabetes knowledge were obtained. The Turkish version of S-TOFHLA showed high internal consistency. Both S-TOFHLA and the Chew screening scale correlated significantly with known predictors of health literacy: age, education and income. The Chew scale was also related weakly but significantly with general diabetes knowledge. It is expected that the Turkish versions of S-TOFHLA and the Chew scale will be used in Turkey as well as in other countries with large Turkish communities.




Evaluation of a pilot hypertension management programme for Guatemalan adults

2016-05-11T16:08:09-07:00

Corazón Sano y Feliz is a hypertension management intervention developed to address deficiencies in the management of hypertensive patients in Guatemala. From 2007 to 2009, Corazón Sano y Feliz was pilot-tested in the community of Mixco. Corazón Sano y Feliz comprises a clinical risk assessment and treatment component implemented primarily by nurses, and a health education component implemented by community health workers. To accomplish our secondary objective of determining Corazon Sano y Feliz's potential for change at the patient level, we implemented a one-group pretest-posttest study design to examine changes in clinical measures, knowledge and practices between baseline and the end of the 6-month intervention. Two nurses and one physician set up a hypertension clinic to manage patients according to risk level. Twenty-nine community health workers were trained in CVD risk reduction and health promotion and in turn led six educational sessions for patients. Comparing baseline and 6-month measures, the intervention achieved significant improvements in mean knowledge and behaviour (increase from 54.6 to 59.1 out of a possible 70 points) and significant reductions of mean systolic and diastolic blood pressure (27.2 and 7.7 mmHg), body mass index (from 26.5 to 26.2 kg/m2) and waist circumference (89.6–88.9 cm). In this pilot study we obtained preliminary evidence that this community-oriented hypertension management and health promotion intervention model was feasible and achieved significant reduction in risk factors. If scaled up, this intervention has the potential to substantially reduce CVD burden.




Practitioner insights on obesity prevention: the voice of South Australian OPAL workers

2016-05-11T16:08:09-07:00

Knowledge based on science has been central to implementing community-based childhood obesity prevention interventions. The art of practitioner wisdom is equally critical to ensure locally relevant responses. In South Australia (SA), the OPAL (Obesity Prevention and Lifestyle) program has been implemented to reduce childhood obesity across 20 communities reaching nearly one quarter of the state's population. Staff from across the State come together at regular intervals to share practice challenges and insights and refine the model of practice. Over a 3-year period 12 reflective practice workshops were held with OPAL staff (n = 46). OPAL staff were guided by an external facilitator using inquiring questions to reflect on their health promotion practice within local government. Three themes were identified as central within the reflections. The first theme is shared clarity through the OPAL obesity prevention model highlighting the importance of working to a clearly articulated, holistic obesity prevention model. The second theme is practitioner skill and sensitivity required to implement the model and deal with the ‘politics’ of obesity prevention. The final theme is the power of relationships as intrinsic to effective community based health promotion. Insights into the daily practices and reflections from obesity prevention practitioners are shared to shed light on the skills required to contribute to individual and social change. OPAL staff co-authored this paper.




Cluster-randomized trial of a German leisure-based alcohol peer education measure

2016-05-11T16:08:09-07:00

Because of scarce research, the effectiveness of substance abuse prevention in leisure settings remains unclear. In this study, we evaluated the effectiveness of a peer-led educational prevention measure with adolescent groups in unstructured leisure settings, which is a component of the complex German nationwide ‘Na Toll!’ campaign. Using a cluster-randomized two-group post-test-only design, we tested whether the measure influenced component-specific goals, namely risk and protective factors of alcohol use such as risk perception, group communication and resistance self-efficacy. The sample consisted of 738 adolescents aged 12–20 years who were recruited at recreational locations and completed an online questionnaire 1 week after the peer education or recruitment event. Sixty-three percent of the sample participated in the 3-month follow-up assessment. Data analysis revealed post-test effects on risk perception, perceived norm of alcohol communication in the peer group and resistance self-efficacy. Follow-up effects were not observed, with the exception of a significant effect on risk perception. In conclusion, the peer-led education measure in leisure settings might have supported the adolescents in this study to perceive alcohol-related risks, to feel accepted to talk about alcohol problems with their friends and to be more assertive in resisting alcohol use in the short term.




Housing influences among sleep-related infant injury deaths in the USA

2016-05-11T16:08:09-07:00

This article examines the role of housing conditions in sleep-related infant injury death, a leading cause of infant mortality in the USA. The use of an unsafe sleep surface is a major risk factor for sleep-related infant injury. This exploratory study examined contextual circumstances, specifically those related to the physical environment, which may contribute to caregivers' decisions to place an infant on an unsafe sleep surface. It employed a retrospective review of 255 sleep-related infant injury death cases in a large urban area from 2004 to 2010 where an infant was found sleeping on an unsafe sleep surface, including 122 cases where a crib or bassinet was identified in the home. Quantitative findings indicated no differences in demographic or risk characteristics between infants with cribs or bassinets and those without them. Qualitative findings suggested the lack of crib or bassinet use may be related to environmental factors influenced by poverty, specifically crowded living space, room temperature and vermin infestation. This study suggests that infants may be at risk of sleep-related injury deaths even when a crib or bassinet is present in the home and supports the consideration of housing conditions in health promotion efforts to reduce infant mortality. Understanding environmental factors that may contribute to infants sleeping on an unsafe surface can help maternal child health and public health professionals develop more appropriate interventions that address deleterious living conditions.




Alcohol and drug usage; and adolescents' sexual behaviour in Nigeria

2016-05-11T16:08:09-07:00

This study determined students' perception of the influence of alcohol and drug usage on adolescents' sexual behaviours in Nigeria. The instrument for data collection was a researcher-made questionnaire. The population for the study comprised all students in government secondary schools in Enugu state, Nigeria. The sample was made up of 600 students randomly selected from the population. Means, t-test and ANOVA were used for data analysis. The result of the study revealed that there were significant differences at 0.05 level of significance in the mean perception of the students of the influence of alcohol and drug usage on adolescents' sexual behaviours when they were classified by gender and class. All the students irrespective of age agreed that alcohol and drug usage negatively influence sexual behaviour. The students perceived that students who do not take alcohol usually control their sexual desires while rape is common with students who are drug users. It was recommended among others that preventive health programmes meant to address adolescents' sexuality should be combined with appropriate drug education for maximum benefit.




Permissiveness toward tobacco sponsorship undermines tobacco control support in Africa

2016-05-11T16:08:09-07:00

School personnel, who are respected members of the community, may exert significant influence on policy adoption. This study assessed the impact of school personnel's permissiveness toward tobacco industry sponsorship activities on their support for complete bans on tobacco advertisements, comprehensive smoke-free laws and increased tobacco prices. Representative data were obtained from the Global School Personnel Survey for 29 African countries (n = 17 929). Adjusted prevalence ratios (aPR) were calculated using multi-variable Poisson regression models to assess the impact of permissiveness toward tobacco sponsorship activities on support for tobacco control policies (p < 0.05). The median of prevalence of support for different tobacco control policies among all countries was as follows: complete ban on tobacco advertisements (84.9%); comprehensive smoke-free laws (92.4%) and tobacco price increases (80.8%). School personnel who believed that the tobacco industry should be allowed to sponsor school events were significantly less likely to support complete bans on tobacco advertisements [aPR = 0.89; 95% confidence interval (CI) 0.84–0.95] and comprehensive smoke-free laws (aPR = 0.95; 95% CI 0.92–0.98). In contrast, support for complete tobacco advertisement bans was more likely among those who believed that the tobacco industry encourages youths to smoke (aPR = 1.27; 95% CI 1.17–1.37), and among those who taught about health sometimes (aPR = 1.06; 95% CI 1.01–1.11) or a lot (aPR = 1.05; 95% CI 1.01–1.10) compared with those who did not teach about health at all. These findings underscore the need to educate school personnel on tobacco industry's strategies to undermine tobacco control policies. This may help to build school personnel support for laws intended to reduce youth susceptibility, experimentation and established use of tobacco products.




Yoga, as a transitional platform to more active lifestyle: a 6-month pilot study in the USA

2016-05-11T16:08:09-07:00

A 6-month pilot study explored the effects of a yoga program on the physical activity (PA) level of overweight or obese sedentary adults. Fourteen community-dwelling overweight or obese sedentary adults participated in a 6-month program (2-month yoga program and 4-month follow-up) delivered by two types of instruction [the direct guidance of an instructor (face-to-face group) vs. the self-learning method of using a DVD (DVD group)]. Measurements included program adherence (class attendance and home practice; min/week) and level of PA [metabolic equivalent (MET)—hour/week] at baseline, 2, 4 and 6 months. Descriptive statistics and nonparametric tests were used to describe the sample and examine differences by group and time. There were no significant differences in demographic variables by group assigned. Participants showed significant PA changes from baseline to each measurement point. The direct guidance of an instructor was preferred over the self-learning method. At each time interval, the DVD group showed higher levels of PA than the face-to-face group; the only difference that achieved statistical significance occurred at 4 months. The PA level significantly changed over 6 months in the DVD group, but not in the face-to-face group. The results indicate that a yoga program may be utilized as a ‘stepping-stone’ toward regular exercise among overweight sedentary adults. Research with a larger sample is needed to further evaluate the effects of the program on the level of PA among this population.




Integrating research evidence and physical activity policy making--REPOPA project

2016-05-11T16:08:09-07:00

Evidence shows that regular physical activity is enhanced by supporting environment. Studies are needed to integrate research evidence into health enhancing, cross-sector physical activity (HEPA) policy making. This article presents the rationale, study design, measurement procedures and the initial results of the first phase of six European countries in a five-year research project (2011–2016), REsearch into POlicy to enhance Physical Activity (REPOPA). REPOPA is programmatic research; it consists of linked studies; the first phase studied the use of evidence in 21 policies in implementation to learn more in depth from the policy making process and carried out 86 qualitative stakeholder interviews. The second, ongoing phase builds on the central findings of the first phase in each country; it consists of two sets of interventions: game simulations to study cross-sector collaboration and organizational change processes in the use of evidence and locally tailored interventions to increase knowledge integration. The results of the first two study phases will be tested and validated among policy makers and other stakeholders in the third phase using a Delphi process. Initial results from the first project phase showed the lack of explicit evidence use in HEPA policy making. Facilitators and barriers of the evidence use were the availability of institutional resources and support but also networking between researchers and policy makers. REPOPA will increase understanding use of research evidence in different contexts; develop guidance and tools and establish sustainable structures such as networks and platforms between academics and policy makers across relevant sectors.




A community-engaged infection prevention and control approach to Ebola

2016-05-11T16:08:09-07:00

The real missing link in Ebola control efforts to date may lie in the failure to apply core principles of health promotion: the early, active and sustained engagement of affected communities, their trusted leaders, networks and lay knowledge, to help inform what local control teams do, and how they may better do it, in partnership with communities. The predominant focus on viral transmission has inadvertently stigmatized and created fear-driven responses among affected individuals, families and communities. While rigorous adherence to standard infection prevention and control (IPC) precautions and safety standards for Ebola is critical, we may be more successful if we validate and combine local community knowledge and experiences with that of IPC medical teams. In an environment of trust, community partners can help us learn of modest adjustments that would not compromise safety but could improve community understanding of, and responses to, disease control protocol, so that it better reflects their ‘community protocol’ (local customs, beliefs, knowledge and practices) and concerns. Drawing on the experience of local experts in several African nations and of community-engaged health promotion leaders in the USA, Canada and WHO, we present an eight step model, from entering communities with cultural humility, though reciprocal learning and trust, multi-method communication, development of the joint protocol, to assessing progress and outcomes and building for sustainability. Using examples of changes that are culturally relevant yet maintain safety, we illustrate how often minor adjustments can help prevent and treat the most serious emerging infectious disease since HIV/AIDS.




Examining an Australian physical activity and nutrition intervention using RE-AIM

2016-05-11T16:08:09-07:00

Translating evidence-based interventions into community practice is vital to health promotion. This study used the RE-AIM framework to evaluate the larger dissemination of the ManUp intervention, an intervention which utilized interactive web-based technologies to improve the physical activity and nutrition behaviors of residents in Central Queensland, Australia. Data were collected for each RE-AIM measure (Reach, Effectiveness, Adoption, Implementation, Maintenance) using (i) computer-assisted telephone interview survey (N = 312) with adults (18 years and over) from Central Queensland, (ii) interviews with key stakeholders from local organizations (n = 12) and (iii) examination of project-related statistics and findings. In terms of Reach, 47% of participants were aware of the intervention; Effectiveness, there were no significant differences between physical activity and healthy nutrition levels in those aware and unaware; Adoption, 73 participants registered for the intervention and 25% of organizations adopted some part of the intervention; Implementation, 26% of participants initially logged onto the website, 29 and 17% started the web-based physical activity and nutrition challenges, 33% of organizations implemented the intervention, 42% considered implementation and 25% reported difficulties; Maintenance, an average of 0.57 logins and 1.35 entries per week during the 12 week dissemination and 0.27 logins and 0.63 entries per week during the 9-month follow-up were achieved, 22 and 0% of participants completed the web-based physical activity and nutrition challenges and 33.3% of organizations intended to continue utilizing components of the intervention. While this intervention demonstrated good reach, effectiveness, adoption and implementation warrant further investigation.




Building healthcare workers' confidence to work with same-sex parented families

2016-05-11T16:08:09-07:00

This article reports on a qualitative study of barriers and access to healthcare for same-sex attracted parents and their children. Focus groups were held with same-sex attracted parents to explore their experiences with healthcare providers and identify barriers and facilitators to access. Parents reported experiencing uncomfortable or anxiety-provoking encounters with healthcare workers who struggled to adopt inclusive or appropriate language to engage their family. Parents valued healthcare workers who were able to be open and honest and comfortably ask questions about their relationships and family. A separate set of focus groups were held with mainstream healthcare workers to identity their experiences and concerns about delivering equitable and quality care for same-sex parented families. Healthcare workers reported lacking confidence to actively engage with same-sex attracted parents and their children. This lack of confidence related to workers' unfamiliarity with same-sex parents, or lesbian, gay and bisexual culture, and limited opportunities to gain information or training in this area. Workers were seeking training and resources that offered information about appropriate language and terminology as well as concrete strategies for engaging with same-sex parented families. For instance, workers suggested they would find it useful to have a set of ‘door opening’ questions they could utilize to ask clients about their sexuality, relationship status or family make-up. This article outlines a set of guidelines for healthcare providers for working with same-sex parented families which was a key outcome of this study.




Feasibility of a mindfulness-based intervention to address youth issues in Vietnam

2016-05-11T16:08:10-07:00

Youth problems including risky sex, drug use, violence and mental health issues are on the rise in Vietnam. Mindfulness is proposed as one way to address unskillful responses to stress that give rise to these behavioral and psychosocial issues in Vietnam. This study explores the feasibility of a mindfulness program for adolescents and young adults in a central city in Vietnam. The mindfulness-based intervention was comprised 1-h daily session over 3 weeks that was conducted at two different sites, one with handicapped adolescents/young adults at the Vocational School for Handicapped and the other with at-risk youth at a semi-private high school. Forty-two Vietnamese youth participants and five Vietnamese teachers/facilitators who were trained in the mindfulness program provided personal reflections of their experiences. Analyses of the qualitative data suggest that mindfulness was enthusiastically received and accepted by both youth and teachers. There is strong indication that mindfulness is promising as a prevention strategy to help with stress and to build important life skills among Vietnamese youth.




Health promotion in Danish schools: local priorities, policies and practices

2016-05-11T16:08:10-07:00

This article discusses the findings from a study mapping out the priorities, policies and practices of local authorities concerning health promotion (HP) and health education (HE) in primary and lower secondary schools in Denmark. The aim of the study was to identify the gaps, tensions and possibilities associated with the demand to increase the quality and effectiveness of HP in schools. The recent national school reform, which emphasizes the importance of health and well-being while simultaneously increasing the focus on performance and accountability in terms of subject proficiency and narrowly defined academic attainment, provides the broader political context for the study. Data were generated through a structured online survey administered to all 98 Danish municipalities. Respondents were educational consultants or others representing the administrative units responsible for the municipality's schools. The findings were discussed within the conceptual framework of Health Promoting Schools. The study points to a potential tension between the health and education sectors, despite evidence of intersectoral collaboration. While there is a strong policy focus on health and well-being in schools, it is disconnected from the utilization of the HE curriculum by the municipal consultants. The study also points to a lack of professional development opportunities for teachers in the field of HP in schools. On the basis of these findings and theoretical perspectives used, we argue that HP in schools needs to (re)connect with the core task of the school, education, and to integrate both health and education goals in local priorities, policies and practices.