Community-based Health Promotion Programs Research Articles

A microcosting approach for planning and implementing community-based mental health prevention program: what does it cost?

BackgroundEstimating program costs when planning community-based mental health programs can be burdensome. Our aim was to retrospectively document the cost for the first year of planning and implementing Healthy Minds Healthy Communities (HMHC), a mental health promotion and prevention multi-level intervention initiative. This Program is among the first to use the Community Initiated Care (CIC) model in the US and is aimed at building community resilience and the capacity for communities to provide mental health support, particularly among those disproportionately impacted by COVID-19. Our objective is to share our methods for costing a program targeting 10 zip codes that are ethnically and linguistically diverse and provide an example for estimating the cost of a mental health prevention and promotion programs consisting of multiple evidence-based interventions.MethodsWe used a semi-structured interview process to collect cost data through the first year of program planning, start-up and initial implementation from key staff. We calculated costs for each activity, grouped them by major project categories, and identified the cost drivers of each category. We further validated cost estimates through extensive literature review. The cost analysis was done from the provider’s perspective, which included the implementing agency and its community partners. We delineated costs that were in-kind contributions to the program by other agency, and community partners. Sensitivity analyses were conducted to estimate uncertainty around parameters.ResultsFor the first year of the development and implementation of the program, (funded through program and in-kind) is estimated at $1,382,669 (2022 US$). The costs for the three main activity domains for this project are: project management $135,822, community engagement $364,216 and design and execution $756,934. Overall, the cost drivers for the first year of this intervention were: hiring and onboarding staff, in-person community building/learning sessions, communications and marketing, and intervention delivery.ConclusionImplementation of community-based mental health promotion and prevention programs, when utilizing a participatory approach, requires a significant amount of upfront investment in program planning and development. A large proportion of this investment tends to be human capital input. Developing partnerships is a successful strategy for defraying costs.

Designing a Community-Based Health Promotion Program for Older Adults Based on Perceived Usefulness, Service Experience, Perceived Value, and Behavioral Intention

ABSTRACT Improving nutritional intake contributes to maintaining the health and quality of life of the older population and reducing individual and societal healthcare costs. We collaborated with two community service hubs and a public health center in Taipei’s Daan District to develop a personalized community-based health and nutrition program using service design. The design was validated through a model encompassing perceived usefulness, service experience, perceived value, and behavioral intention, analyzed using PLS-SEM modeling on 76 individuals. The results showed bidirectional influences among these factors. This study provides practical recommendations for formulating public health policies and health promotion programs for older adults.

Economic, Cultural, Social Determinants of Black Women Obesity

Obesity is a widespread problem in the United States, particularly affecting Black communities. It is a public health problem, a long-term, cumulative issue of economic and social justice and inequality for this demographic group. Thus, the key to solving it is to eliminate persistent structural root causes. According to the Centers for Disease Control and Prevention (CDC), in 2022, the prevalence of obesity among African American adults is 49.5%, with Black women having the highest prevalence compared to other racial and ethnic groups. The main purpose of this study is to provide a comprehensive literature review that examines the multifaceted factors contributing to obesity among African American women, as well as systematise the determinants related to the economic well-being of the community, social factors, cultural patterns of lifestyle in the community, etc. The analysis revealed a clear inverse relationship between income and obesity among African Americans, with this trend being particularly pronounced among women than men and differing across age groups in black communities. The economic determinants of obesity in Black women are related to the fact that low-income households have limited access to affordable and nutritious food and are regularly exposed to stress related to financial difficulties, with so-called “food swamps” and “food deserts” being common in low-income areas. The social determinants of obesity are related to the fact that Black women face higher levels of racism and sexism than other demographic groups, and unequal social conditions cause structural disparities in health, education and employment. Psycho-social and cultural determinants (cultural norms of body image, social influencers, religion, social networks and family upbringing, etc.) play a key role in the emergence of the problem under study, so Black women often model their eating and physical activity habits by cultural traditions, and those who struggle with overweight may face stigma, social isolation and discrimination. The article makes recommendations for reducing obesity among Black women, which primarily relate to the development of culturally sensitive nutrition education programs, community-based health promotion programs, community-centered food policy advocacy, technology-based health platforms, public-private partnerships for affordable healthy food retail, etc.

Untangling the complex implementation process of community-based health promotion: a multiple-case study in the Netherlands.

Community-based programmes are a widely implemented approach for population health promotion. Due to the context-dependent and dynamic nature of these programmes, evaluating their implementation is challenging. Identifying key events in the implementation process in evaluation could enable us to support future implementation, while acknowledging the complexity of real-world implementation. We studied the nationwide implementation of the Dutch Healthy Youth, Healthy Future (JOGG) approach, a community-based programme for childhood overweight prevention. The aims of our study were (i) to gain insights into the implementation process of the JOGG approach, and (ii) to identify key events that influenced said process. In nine communities, we conducted interviews (n = 24) with coordinators and stakeholders involved in the implementation of the JOGG approach and collected documents on the programme's implementation. We applied the analytical tool 'Critical Event Card' to identify key events in the implementation process. Results showed that in 5-10 years of implementing the JOGG approach, communities have undergone different phases: preparation, upscaling, resource mobilization, integration with other policy initiatives and adaptation of the implementation strategy. Key events influencing the implementation process included national policy developments (e.g. new health programmes), framing of the JOGG approach in local policy, staff turnover and coordination teams' experiences and actions. Furthermore, changes in implementation were often triggered by the destabilization of the implementation process and linked to opportunities for change in the policy process. The identified key events can inform future implementation of the JOGG approach as well as other community-based health promotion programmes.

"It Takes a Village": Reflections from participants after a Hispanic community-based health promotion program.

Physical activity (PA) among Hispanic and other minority adolescents in the U.S. lag behind White, non-Hispanic adolescents. Previous studies have examined the beneficial impact of culturally informed, community-based health programs within the Hispanic community on PA levels. There is a need for longer term follow up to determine the impact on family and individual habits over time. Our study aims to explore the aspects of a two-year PA and nutrition program, Families Inspired Together 4 Youth Empowered to Succeed (FIT4YES), that continue to influence family health habits and child development. Community-based focus groups were held in Milwaukee, WI with Hispanic parent participants of the FIT4YES program three years after program conclusion. A semi-structured guide of open-ended questions was used to facilitate the discussion of the lasting impact of FIT4YES. Each group was audio recorded, transcribed, and translated from Spanish when necessary. Four student researchers utilized a grounded theory qualitative approach to identify overarching themes. Three focus groups with 16 total parents (N = 16) spoke about the program. Three overarching themes emerged from the transcripts indicating that cultural exposure, relationships, and self-growth were necessary for families to sustain the healthy behaviors promoted in FIT4YES. Specifically, parents discussed increased comfort levels with their children participating in school sports, the impact of shared experiences with community members, and continued skills initially taught and practiced during active programming. Our group adapted our previously published model to a "post-program" state that incorporated the major themes and sub-themes with levels of the social-ecological model. Although the FIT4YES program ended, multiple ideals instilled by the program continued, we believe, due to the common themes illustrated by our model. This study utilized a community check-in approach to gain insight into the long-term impacts of the FIT4YES program. We propose three recommendations for consideration in the creation of community-based health programs: utilize dynamic, culturally appropriate components based on the intended community; understand the strength of the program as a whole is dependent on the strength of each individual component; and incorporate an anchor institution for consistency and trust within the community.

Prevalence of multimorbidity and its associated risk factors among population of Mechinagar municipality of Nepal.

Multimorbidity is a group of conditions, it has significant impact on the population as a whole, resulting in lower quality of life, higher mortality, frequent use of medical services, and consequently higher healthcare costs. The objective of this study is to document the prevalence of common multimorbidity and its associated risk factors among population of Mechinagar Municipality. Community-based cross-sectional study was conducted where selected multimorbidity were assessed in selected areas of Mechinagar municipality of Jhapa District . Systematic random sampling technique was used to select 590 adult participants from three pre-defined pocket areas. Pre-designed semi-structured multimorbidity assessment questionnaire for primary care (MAQ-PC)was used to assess prevalence of multimorbidity. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity. The prevalence of multimorbidity was 22.4%.Hypertension, Diabetes mellitus and COPD was seen in 39.2%, 7.8.% and 4.4% of the participants respectively . Participants with advancing age i. e. 40-49yrs were 12.62 times (AOR) more likely to have multimorbidity compared to their counterparts who were 20-29yrs old( p=<0.01,CI3.01-15.28) after adjusting for occupation, physical activity and family history of kidney disease. Working individuals, Physical inactivity and positive family history of kidney disease were the strongest determinates of multimorbidity. The study revealed that participants with increasing age, working individuals, physical inactivity and family history of kidney disease were more vulnerable of having multimorbidity. The findings of our study indicate need of intervention strategies and community-based health promotion programs in reducing burden of chronic disease among adult population.

Physical Activity among Older People with Chronic Illnesses: A Cross-sectional Study

BSTRACT Article History: Received: November 21, 2023 Accepted: January 31, 2024 Background: The significance of physical activity in preventing and treating chronic illnesses has long been established. However, there are limited studies focusing on the physical activity among old people with chronic illnesses in Jordan. Purpose: This study aimed to explore the association between physical-activity level, chronic illnesses, and multimorbidity among people 60 years old and above in Jordan. Methods: A crosssectional design was used in the northern region of Jordan. A survey was conducted among 200 old people aged 60 years and above. The survey included sociodemographic data and the International Physical Activity Questionnaire (IPAQ). The statistical analyses included descriptive statistics, correlation coefficient, and logistic-regression analysis. Results: Approximately 41% of old people had a sufficient level of physical activity. Gender, level of schooling, smoking, heart conditions, diabetes, and multimorbidity were significantly associated with physical activity. In the logistic-regression analysis, gender (OR 0.221, 95% CI 0.096-0.507), heart condition (OR 0.093, 95% CI 0.011-0.760), and diabetes (OR 0.312, 95% CI 0.120-0.810) were found to be significantly associated with physical activity among old people. Conclusion: This study revealed a low physical activity among old people. It is important to develop policies that support regular physical activity for old people with chronic illnesses. Implications for Nursing: Community-based healthpromotion programs should be developed to encourage regular physical activity among older people with chronic illnesses. Keywords: Physical activity, Older people, Chronic illnesses, Cross-sectional study.

건강증진을 위한 지역사회 기반 비대면 운동프로그램의 개발 및 적용 지역사회 주민 대상 건강증진프로그램 참여 효과 검증을 위한 일차 연구

건강증진을 위한 지역사회 기반 비대면 운동프로그램의 개발 및 적용 지역사회 주민 대상 건강증진프로그램 참여 효과 검증을 위한 일차 연구

Pilot Randomized Controlled Trial of Multi-Disciplinary Community-Based Biofeedback Vs Health Promotion Programs on Mental Health And Drug Use Among People Experiencing Homelessness

Background: PEH are most vulnerable to COVID-19 due to high levels of chronic disease and social isolation. However, in Skid Row Los Angeles, there are limited resources for mental health and drug treatment services. Biofeedback (BF) has been found to decrease depression and substance use among drug users; however, no studies have assessed the impact of BF on PEH during the COVID-19 pandemic.&#x0D; Aim: Our multi-disciplinary team designed and pilot tested an 8-week Heart Rate Variability-Biofeedback (HRV-BF) intervention, utilizing a nurse-led, Community Health Worker model of care with 50 people experiencing homelessness (PEH) as compared with a Health Promotion (HP) program. Our goal was to establish feasibility of the program, and to assess effects HRV-BF on measures of HRV, mental health and drug use as compared to HP.&#x0D; Methods: Utilizing Community Based Participatory Research (CBPR) principles, a community advisory board was established to refine the HRV-BF intervention and assess acceptability and feasibility. We enrolled 40 PEH and randomized into HRV-BF vs HP program and assessed a) impact on anxiety and depression; b) HRV and cortisol indices; and c) drug and alcohol use among all participants.&#x0D; Results: In total, 40 PEH were enrolled with 36 completing the intervention; 17 HRV-BF and 19 HP. Majority were male (80%) and were equally Black (37.5%) or Hispanic (35%). The mean age of PEH was 49 (SD 16.7), median age 53. The HRV measure RMSSD (root mean square of successive differences between normal heart beats, a time-based variable reflecting vagally mediated HRV), assessed during the resting 5-minute period, showed significant increases in 71% of participants (75% among HRV-BF and 68% among HP), using paired t-tests with natural log transformed variables, p=0.004, and by non-parametric tests, p= 0.006 (p values one-sided). Across the sample, PHQ-9 (depressive symptoms) showed marginally significant improvement (p= 0.09). Anxiety and Mental Health Inventory scores showed improvement, though not significant. Between-group analysis showed the HRV-BF group had better GAD-7 and MHI scores at 8 weeks (post-intervention), though not statistically significant. Chronic disease was found to be high in both groups (67% among HRV-BF and 82% among HP). No significant differences were found in terms of substance use.&#x0D; Conclusions: As the first known study to date examining the role of a biofeedback self-regulation training on biomarkers of stress/mental health measures among PEH, our study shows feasibility and acceptability among the study population and positive initial results for both arms of the study. We plan to extend the follow-up period beyond the intervention period of 8 weeks to establish the sustainability of the intervention.&#x0D; Funding: Susan Samueli Integrative Health Institute Pilot Studies Award&#x0D;

Role of Gardening in Mental Health, Food Security, and Economic Well-Being in Resettled Refugees: A Mixed Methods Study

Executive Summary Home and community gardening is emerging as a beneficial intervention for resettled refugee populations. Using an interdisciplinary lens, we examined whether gardening influences mental health, food security, and economic well-being. A mixed methods study ( n = 29) was conducted with quantitative surveys to assess indicators of mental health, food security, and economic well-being. Qualitative, semi-structured interviews explored gardener participants’ experience of gardening benefits ( n = 10). Participants had on average been in the United States for seven and a half years, with most having lived in refugee camps prior to arrival. Findings showed gardeners reporting fewer symptoms of anxiety, depression, and trauma, and lesser food insecurity than non-gardeners, and similar indicators of economic well-being. Non-parametric regression analysis showed that being a gardener significantly predicted less psychological distress. Qualitative data substantiated these findings with gardeners reporting improved mental health, closer family, social relationships and connections with culture, and more access to fresh and organic food. The multiple, simultaneous benefits of gardening reported here provide strong support for building community-based health promotion programs to assist refugee integration, including long after arrival. The study further highlights the importance of examining these interrelated factors of mental health, food security, and economic well-being simultaneously and reevaluating the established goals of refugee resettlement, particularly in the United States. We offer the following recommendations: • Policymakers and refugee resettlement practitioners should integrate culturally appropriate community-based health promotion efforts in refugee programs long after the initial resettlement period. • Researchers on refugee integration outcomes should include interdisciplinary perspectives that offer comprehensive understanding of processes related to health outcomes. • Policymakers on refugee resettlement and integration should consider the linkages between mental health, food security, and economic well-being.

Differential of physical activities and its association with hypertension and diabetes in Myanmar

Background: Myanmar has been facing a high and growing burden of NCDs. Since regular physical activity has been recognized as one of the effective strategies in prevention and control of NCDs, promotion of physically active lifestyle might help in combatting a number of NCDs. This study was conducted to assess the sociodemographic differentials of physical activity and to identify the association between the insufficient physical activity and occurrence of hypertension and diabetes using data extracted from Myanmar STEP-2014-data. Methods: This study was further data analysis on 2014 STEP survey and included (5791) 40-64-year-aged participants, a subsample of STEP survey. Binary logistic regression with clustered robust standard error method was applied to estimate the effect of insufficient physical activity on occurrence of hypertension and diabetes. Results: The findings revealed that 17.5% [95%CI: 16.5%, 18.5%] of participants had the insufficient physical activity, 41.9% [95%CI: 40.6%, 43.2%] had raised blood pressure and 16.9% [95%CI: 15.9%, 17.9%] had raised blood glucose. After adjusting other covariates, the significant association between insufficient physical activity and raised blood pressure was not found; whereas insufficient physical activity was significantly contributed to occurrence of raised blood glucose. Conclusions: The present study highlighted the importance of physical activity in occurrence of raised blood glucose. The proportions of insufficient physical activity, raised blood pressure and raised blood glucose were observed as a rising pattern with increasing in age. Community-based health promotion program targeted at promoting physically active lifestyle should be adapted to interventions that are appropriate to different age structures.

How to Conduct a Photovoice Systematic Review: Lessons Learned and Recommendations

Photovoice distinguishes itself from other qualitative research methods for its visual features and participant empowerment. As a powerful tool for community-based participatory research and health promotion programs, researchers and practitioners are paying more attention to this method in recent years. Accordingly, some photovoice systematic reviews have been published and more are underway to synthesize evidence in various research fields. However, due to the exploratory nature of the photovoice method, broad research questions for photo taking, flexible steps in photo discussion and analysis, and lack of standardized qualitative review guidelines, it could be challenging to conduct a photovoice systematic review. The purpose of this paper is to provide an overview of the photovoice method, debrief the process of a previous review, summarize lessons learned, and provide suggestions to facilitate future photovoice systematic reviews. This paper may also be of benefit to researchers who intend to apply photovoice to their research topics, or plan to conduct other types of photovoice literature reviews (e.g., scoping reviews).

Unravelling mechanisms underlying the action principles of a community-based health promotion programme: a realist evaluation

BackgroundSince 1986, WHO has advised that applying action principles such as citizen participation and intersectoral collaboration leads to better health. However, less is known about the workability of these principles and how they trigger specific outcomes in interaction with the context. A critical realist perspective was applied to get a better understanding of what worked, and why it worked, in the context of a Dutch community-based health promotion programme (CBHPP). The aim of the study was to unravel the mechanisms underlying the action principles and find combinations of contextual factors and mechanisms that trigger outcomes in a CBHPP.MethodsIn this single case study, a critical realist methodology was followed. Qualitative data used in this study originated from multiple sources and methods to ensure validity. They include evaluation sessions with coalition members (n = 6) and individual interviews (n = 6); group sessions with community workers (n = 1), a health broker (n = 1), and citizens (n = 12); and seven semi-annual progress reports and minutes of the coalition meetings. The collected data were then compared with the programme theory through a heuristic process of constructing, exploring, and refining context-mechanism-outcome configurations.ResultsThe programme initiated a variety of new activities that differed in content, intensity, duration, and number of participants, organised and implemented together with citizens. The most prominent mechanism underlying both action principles were programme-related, namely, patience, personal contact, contribution of budget, and the programme coordinator’s leadership. Another important mechanism was creating visibility, which resulted in the involvement of the municipality and a budget to sustain the programme.ConclusionIn this case study, personal contact, patience, perseverance, participatory action research activities, and visibility were found to be the most notable mechanisms underlying the citizen participation and intersectoral collaboration action principles. As the principle-based approach added value to the existing context and introduced most of the mechanisms that triggered the outcomes, it is recommended to include citizen participation and intersectoral collaboration not only as action principles but explicitly as targets in a CBHPP.

The Effects of A Community-based Health Program on Adolescents’ Smoking Prevention – A Quasi-Experimental Study

Background: Tobacco Smoking is considerably high among adolescents in Indonesia, indicating the potential proportion of tobacco smoking effects experienced by young Indonesians in the future and the need of program interventions to halt the tendency. This study aims to investigate effects of a community-based health promotion intervention on smoking prevention among Indonesians’ adolescents.Methods: The quasi-experimental study with a pre-and-posttest control group design involved 104 adolescents aged between 12 to 14 years. The adolescents were convieniently assigned into one intervention (55 adolescents) or a control group group (49 adolescents), with participants in the intervention group received four health promotion sessions using smoking prevention videos for one month. Effects of the intervention were measured by a questionnaire at one week before and after the intervention completed and then analyzed by an approprite data analysis technique.Results: After the intervention completion, there was a significant positive effect of the community-based health promotion intervenstion program in improving adolescents tobacco smoking knowledge, attitude, intention and behavior (p = &lt;0.001).Conclusion: Community-based health promotion program provides positive impact on adolescents smoking prevention and therefore should be considered as one of stretegies for tobacco smoking prevention program.

Best practices in prenatal health promotion: Perceptions, experiences, and recommendations of Ottawa, Canada, prenatal key informants.

Prenatal health promotion includes the provision of evidence-based information and practical skills to optimize maternal-fetal outcomes. Increasingly, prenatal education is delivered by both healthcare professionals and allied childbirth educators, in community- or hospital-based group classes, targeted outreach programs, and online modules. To better understand how prenatal health promotion relates to a diverse urban community, we assessed the perspectives of Ottawa, Canada prenatal key informants. This is a qualitative research with key informant interviews. Semi-structured interviews were conducted with 11 prenatal key informants, responsible for the design, delivery, or promotion of publicly available prenatal health services. Interviews explored concepts and delivery of prenatal health promotion, strategies to address existing and emerging prenatal topics, identification of barriers to prenatal health services, and recommendations. Key informants recommended a lifespan approach to prenatal health promotion, with an emphasis on healthy behaviors, emotional health, labor and delivery, and postpartum/early parenting. Recognizing community health disparities, key informants used community outreach, and intersectoral collaborations for Indigenous and other at-risk communities to mitigate barriers to prenatal service uptake. Ottawa key informants conceptualized prenatal health promotion as inclusive, comprehensive, and as an extension of preconception, school-based sexual education. Respondents recommended the design and delivery of prenatal interventions as culturally safe and trauma informed, using online modalities to complement in-person activities. The experience and intersectoral networks of community-based prenatal health promotion programs represent potential capacity to address emergent public health risks to pregnancy, particularly among at-risk populations. A broad and diverse community of professionals deliver prenatal education to help people have healthy babies. We interviewed Ottawa, Canada experts in prenatal care/education to learn about the design and delivery of reproductive health promotion. We found that Ottawa experts emphasized healthy behaviors beginning before conception and through pregnancy. Community outreach was identified as a successful strategy to promote prenatal education to marginalized groups.

Addressing Health Inequities: An Exploratory Assessment of Extension Educators' Perceptions of Program Demand for Diverse Communities.

Land grant universities are a key provider of community-based health promotion programs through the Cooperative Extension Service. However, Extension's current approach to addressing systemic social determinants of health is incomplete and inconsistent. The purpose of this study was to explore Extension health educators' perceptions of demand for health promotion programming targeting audiences most likely to experience health inequities. Health educators within 2 state Extension systems were invited to complete an online survey based on a capacity building model. Survey questions included rating perceptions of demand for programming for health disparate populations: low-income; Black and African American; Hispanic, Latino/a, Latinx; persons with disabilities; immigrants and refugees; and lesbian, gay, bisexual, and transgender. Analysis of variance and Bonferroni post hoc testing was used to determine differences in perceived demand between populations. Ninety-six educators completed the survey. Perceived demand for low-income population programming was significantly higher than for other populations. Perceived programming demand for immigrants and refugees and lesbian, gay, bisexual, and transgender people was significantly lower than for other populations. Individual and organizational-level factors, including racism and Extension's historical scope, likely contribute to the results. Engaging historically excluded Extension audiences requires time and resources to improve the Extension system and educator capacity for relationship building, trust building, and communication.

Evaluation Methods in Community Microgrant Programs for Health Promotion: A Scoping Review.

Evaluating community-based health promotion programs is an essential aspect of public health programming to ensure evidence-based practices, justify limited resource allocation, and share knowledge about promising strategies. Community microgrant schemes represent a viable strategy to strengthen local health promotion, yet limited guidance exists surrounding the evaluation of such programs. This research aimed to map methods used in evaluating community microgrants programs for health promotion. A scoping review in accordance with Joanna Briggs Institute methodology. Peer-reviewed academic and gray literature, which evaluated processes and/or outcomes of nonprescriptive community-based microgrant program for health promotion in high-income countries. Literature was identified through MEDLINE, Scopus, CINAHL, and EMBASE databases, Google and DuckDuckGo browsers, and hand-searching key reference lists. Articles were screened by title, abstract, and then full-text. Review findings were mapped according to included sources' evaluation methodologies. Eighteen academic publications describing 14 microgrant programs met the inclusion criteria. These spanned the years 1996 to 2020 and were located across 5 countries. Evaluation methods were very similar in terms of design (mixed-methods case studies) and focus (both processes and outcomes) and yet varied widely with regard to measurements and data collection. Few made explicit the use of an evaluation framework, chose to involve stakeholders in the evaluation process, or discussed application and dissemination of evaluation findings. Community-based microgrant programs for health promotion are a promising model in diverse settings and with various health priorities and targets, yet robust evaluations of their implementation and effectiveness are lacking. The review highlights the need to further develop and support evaluation practices in public health, even in small-scale programs with limited budgets.

O9-6 Shedding Light on men's health: Evaluating the impact and scalability of a community-based men's health promotion programme “Sheds for Life” in Irish Men's Sheds

BackgroundSheds for Life (SFL) is a ten-week health and wellbeing programme delivered in the community setting of Men's Sheds in Ireland that uses gender-sensitive approaches to engage typically hard-to-reach men (?Shedders') with health. SFL consists of a health check, core modules of physical activity (consisting of a walking programme or chair-based exercises for older adults), mental wellbeing, healthy eating and other elective wellbeing components. SFL is implemented across two phases with four regions per phase. The purpose of the research is to evaluate SFL using an implementation science approach to assess programme impact and implementation effectiveness with a view to enhancing its sustainability and scalability while also informing gender-sensitive strategies that engage hard-to-reach men with health and wellbeing.MethodsThis study is a hybrid typology ?effectiveness-implementation? design. A community-based participatory research, and mixed methods approach has been adopted to measure the effects of the SFL intervention on Shedders across implementation phases and identify and monitor implementation barriers and facilitators that can inform future sustainability and scale-up of SFL. Central to effective implementation of SFL is a partnership approach between the Irish Men's Sheds Association (IMSA) and other health-related partner organisations (POs). This research engages key stakeholders (at individual (Shedder), provider (POs) and organisational (IMSA) levels) and prioritises implementation outcomes. Purposive sampling is used to recruit a diverse sample of participants (Shedders n = 420 and SFL providers n = 20).ResultsFindings from phase 1 will inform phase 2 implementation. Preliminary physical activity outcome results from phase one across four regions (baseline to ten weeks) suggest days active per week increased from 3.07 to 4.32 days (p =.00) days walking increased from 4.29 to 5.28 days (p=.00) minutes walking per day increased from 33.31 to 38.15 (p=.005)ConclusionsPreliminary findings highlight the potential of the SFL initiative to address the increasing calls for gender-specific health promotion programmes that target lifestyle and health behaviour change in men. Shed settings are unique and effective in attracting men from more marginalised male subpopulations, reaching men who would typically not engage with health services.This study is funded by the Irish Research Council (ID: EBPPG/2018/256)

P02-02 Evaluating community-based programmes for health promotion: a novel approach considering the complexity perspective

BackgroundFor the past decade, community-based programmes have been a popular strategy for physical activity promotion. The implementation of these programmes is a complex process, characterized by (a) objectives that vary locally, (b) adaptions to the programme over time in response to a community's shifting needs, challenges and opportunities, (c) emergent outcomes, and (d) non-linear causality. This poses several challenges for evaluation, as commonly used evaluation designs mainly focus on predetermined programme components and outcomes. Such a traditional evaluation approach may overlook necessary but unanticipated programme developments or outcomes and provide limited opportunity to learn from these. The aim of this study was to develop a novel evaluation approach that considers the complexity perspective, in order to evaluate a large community-based programme for children's physical activity and health promotion in the Netherlands.MethodsAn exploratory review of theoretical and methodological literature regarding community-based health promotion, complexity theory, developmental evaluation and theory based evaluation was conducted. Based on this review a novel evaluation approach was developed.ResultsThe developed evaluation framework focusses on elements of the complex and adaptive implementation process of community-based health promotion. These include the local programme theory, implementation, adaption, the influence of context and feedback loops, and intended as well as emergent and unintended outcomes. By studying each of these elements in practice using innovative qualitative methods, including Ripple Effects Mapping and the Critical Event Card tool, principles that guide effective health promotion across community contexts can be extracted. Practice-based knowledge can subsequently be validated in other contexts.ConclusionsThe proposed evaluation approach aims to inform both research and practice (local and national programme planners and policy makers), by considering the implementation of community-based programmes as a complex process in evaluation. Using this evaluation approach will provide insight in how community-based health promotion programmes impact communities, and which mechanisms underly success or failure. The proposed evaluation approach may be relevant for other physical activity promotion programmes or policies. Since considering complexity in evaluation is a relatively new challenge in public health, we believe it is essential to share and deliberate on innovative evaluation approaches and methods.

Sheds for life: health and wellbeing outcomes of a tailored community-based health promotion initiative for men’s sheds in Ireland

BackgroundGender is increasingly recognised as a critical factor in designing community-based health promotion programmes. Men’s Sheds (‘Sheds’) are community-based informal environments that represent a safe space in which to engage cohorts of hard-to-reach (HTR) men in health promotion. Sheds for Life (SFL), the first structured health promotion initiative evaluated globally in Sheds, is a 10-week initiative co-designed with Shed Members (Shedders) and delivered directly in the Shed setting in Ireland. This research describes the health and wellbeing outcomes experienced by SFL participants.MethodsPurposive sampling was used to recruit a diverse representation of Shedders (n = 421) participating in SFL alongside a wait list control (n = 86). Questionnaires assessing constructs of health and wellbeing were administered one-to-one in Sheds at baseline, 3, 6 and 12 months. Descriptive data for health outcomes were generated for each time point and assessed for significant changes using inferential testing, while considering COVID-19 impact.ResultsOutcomes related to subjective wellbeing, mental wellbeing, physical activity, social capital and healthy eating significantly increased post SFL (p < 0.05). Mental wellbeing scores (SWEMWBS) post SFL remained significantly higher than baseline despite COVID-19 impact (p < 0.05). Binary logistic regression indicated that the odds of a meaningful SWEMWBS change was significantly higher for shedders that had lower SWEMWBS (OR 0.804), less loneliness (OR 0.638) and lived alone (OR 0.456) at baseline. Shedders with lower SWEMBWS had higher odds of experiencing positive changes in life satisfaction (OR 0.911) and trust (OR 0.928), while Shedders who lived alone had also higher odds of experience positive changes in healthy eating (OR 0.481). Finally, inactive Shedders at baseline had higher odds of experiencing increased levels of physical activity (OR 0.582).ConclusionsFindings suggest that the inclusive, community-based SFL model is effective in engaging Shedders and facilitating positive and sustained changes in health and wellbeing outcomes. Using gender-specific approaches in the informal and safe environment of the Shed are effective in engaging men in structured health and wellbeing initiatives, particularly those who may be more vulnerable, isolated or lonely.Trial registrationThis study has been retrospectively registered with the ‘International Standard Randomised Controlled Trial Number’ registry (ISRCTN79921361) as of 05/03/2021.