Ecological Model Of Health Promotion Research Articles

Barriers and Drivers of Physical Activity Participation Among Older Adults in Malaysia: A Systematic Review

Introduction: Ageing is commonly linked with physical inactivity. This review was performed to identify the factors associated with participation in physical activity among older adults in Malaysia. Methods: A systematic review was conducted using five databases; Pubmed, Sagepub, Scopus, Cochrane Library and Science Direct. Observational and intervention studies published between January 2010 and December 2020 were included, with Malaysian older adults aged 55 years and older being the main subject. Results: A total of 9 articles were included in the review. Analysis was guided by the Social Ecological Model for Health Promotion. The review had successfully identified gender, age, education level, health reasons, ethnicity and attitude as intrapersonal factors, social support (friend) and marital status as interpersonal factors, and locality as well as availability of facilities as environmental factors. Conclusions: Physical activity participation among Malaysian older adults were mainly determined by intrapersonal factors, particularly gender, health condition and educational level.

Qualitative Analysis of Men's Involvement in Family Planning in The Philippines: An Ecological Assessment.

While family planning (FP) programs have the capacity to empower women, support gender equality, and reduce poverty, male involvement is an influential factor for the uptake of FP that has been lacking. In the past decade, there have been more progressive FP policies and growing attention on male involvement in FP in the Philippines, providing an opportunity to develop evidence-based interventions to better integrate men into FP services by approaching care delivery from a family-focused perspective. This paper sought to understand the current role of men in FP services and explore how to strengthen facilitators and overcome barriers to optimize men's involvement in FP in the Philippines. Using the Ecological Model for Health Promotion, this qualitative study used convenience sampling to collect data through in-depth interviews and focus group discussions at all levels of the ecosystem. All data were collected in the Albay area, with the exception of some policy data collected in Manila. Qualitative analysis was guided by content analysis. The final sample included 66 participants across the ecosystem. Two primary themes emerged: (1) Resources and health care systems structure impact on male involvement in FP and (2) Education and training that support male involvement in FP. The findings of our qualitative study suggest that while men in the Philippines and their ecosystems support men's FP involvement, the inconsistent health care systems and protocols are not yet reaching men with information and education they need to help them make informed FP decisions with their female partners.

Empowering interventions for people living with dementia: A European survey.

We aim to identify existing empowerment interventions for people living with dementia and to explore which used interventions and projects are considered empowering and why. This was an online survey. We conducted an online survey between May 2018 and July 2018 amongst professionals interested in dementia care in Europe. Interventions were clustered within the ecological model for health promotion. Reasons from respondents as to why they considered interventions to be empowering were analysed and structured according to a recently developed conceptual framework of empowerment for people living with dementia. Seventy-three respondents from 23 countries together mentioned 98 interventions or projects, of which 90 were unique. Interventions focused on the (inter)personal (n=54), organizational (n=15), communal (n=6) and societal (n=15) levels. A broad range of interventions were considered empowering, but no interventions were specifically developed for, nor aimed at, empowerment. Reasons as to why respondents considered these interventions as empowering fitted the framework's domains. This European survey provides insights into interventions considered empowering for people living with dementia. An important step that needs to be taken is to develop and test interventions that specifically aim to promote empowerment for people living with dementia. Empowerment may encourage people with dementia to live the life they choose, and focus on what is possible, instead of what is no longer possible. Many interventions are considered as empowering for people living with dementia, however no interventions could be identified that were specifically developed for or aimed at empowerment. This study shows that for promoting empowerment, it is necessary to develop and test interventions that specifically aim for empowerment, do this in collaboration with relevant stakeholders, and in this way support people living with dementia to live according to their competencies, talents and wishes.

Men's Involvement in Sexual and Reproductive Health Care and Decision Making in the Philippines: A Systematic Review of the Literature.

Sexual and reproductive health care (SRH) and family planning (FP) services have been primarily female centered. In recent decades, international groups have advocated for men’s involvement in SRH and FP, yet related research remains limited and implementation not fully realized in many countries. This systematic review of literature seeks to summarize the barriers and facilitators to men’s involvement in SRH/FP services in the Philippines. It is limited to publications in English from 1994 to 2021 regarding studies conducted in the Philippines whose research questions focused on men’s involvement in SRH/FP. Eligible studies were assessed for methodological quality using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Evidence Rating Scale. The Ecological Model for Health Promotion was used as the guiding theoretical framework for analysis and to report findings. Barriers and facilitators were identified at every ecological level except that of policy. The most common barrier identified was men’s deficit in knowledge about SRH/FP; the most common facilitator was the positive influence of their social network on men’s attitudes, beliefs, and practices pertaining to SRH/FP. A range of factors from the individual to the community level influenced men’s involvement, including religious beliefs, economic means, and cultural gender roles. More studies are needed to provide a fuller understanding of the multilevel ecological factors influencing men’s involvement in SRH/FP and inform interventions with men that can positively affect their behavior related to SRH/FP decision making.

Facilitators and barriers to condom use among Filipinos: A systematic review of literature.

Background: Between 2010 and 2018, the Philippines had a 203% increase in new human immunodeficiency virus (HIV) infections. The use of condoms is an effective and practical means to prevent HIV transmission. The purpose of this study was to identify facilitators and barriers to condom use among Filipinos guided by the Ecological Model of Health Promotion. Methods: A systematic review of literature using electronic databases was performed using the following keywords: "condom," "Filipinos," and "Philippines." To be included in this review, papers should be (1) research studies, (2) studies that examined condom use, and (3) studies that sampled Filipinos residing in the Philippines. The final sample comprised of 27 articles. Results: Multiple and interrelated factors at the individual and social environment levels influence condom use among different groups of Filipinos. Majority of these factors originated at the intrapersonal level. Some of the facilitators to condom use were knowledge on HIV, higher perceived HIV risk, peer support, positive manager attitude, health provider engagement, and city ordinances. In contrast, some of the barriers to condom use were discomfort and displeasure on condom use, low parental communication, lack of sex education, social stigma, and the high price of condoms. Conclusion: A collaborative, culturally-sensitive, and population-specific approach is essential to develop and implement acceptable, sustainable, and successful condom use interventions.

Explaining the determinants of hookah consumption among women in southern Iran: a qualitative study

BackgroundThe prevalence of hookah consumption has been on the increase in Iran over the past two decades. This rate is higher among women than men in the south of Iran than other geographical areas. The purpose of this study was to explain the determinants of hookah consumption among indigenous women of Bandar Abbas city, southern Iran.MethodsThis is the first qualitative study with the conventional content analysis approach that has examined the factors affecting the consumption of hookah at all ecological levels in 2018–2019. Participants, with a maximum variation in terms of age, education, occupation, hookah consumption and geographical areas of the city, were selected purposefully to take part in a semi-structured interview. The data were recorded, typed and analyzed according to the framework of the ecological model of health promotion at five levels (intrapersonal, interpersonal, organizational, social and political). The interview continued until data saturation. MAXQDA software version 10 was used for data management.ResultsInterviews were conducted with 56 participants (21 female hookah smokers, 15 female ex- smokers, and 20 experienced experts). A total of eight main categories were extracted from the data including; positive attitude towards hookah consumption, psychosocial needs, sensory charms of hookah, individual factors, family factors, cultural-environmental backgrounds, social-political backgrounds, and economic challenges.ConclusionsThe results indicated the extensive influence of internal and external factors on the consumption of hookah. In order to successfully reduce the consumption of hookah, it is essential to consider intrapersonal, interpersonal, organizational, social and political factors.

Tobacco use in local authority children's homes: a socioecological exploration of influences

BackgroundResearch on tobacco use among looked-after children (LAC) has primarily focused on the individual characteristics of young people in care. We aimed to conceptualise additional factors influencing tobacco use by young people living in English local authority children's homes from a policy and provider perspective. MethodsWe did a socioecological analysis of existing data, which included an evaluation of LAC health assessment documentation (n=31 cases), a survey of residential carers in six local authorities in the East Midlands (n=42 respondents), and semi-structured interviews with residential carers (n=14) working in three children's homes operated by one local authority in the East Midlands. We thematically coded and mapped these data to the social ecological model for health promotion to identify and understand the interplay of influences on tobacco use. Collaborative consensus was reached on coding and interpretation. We chose the social ecological model for its potential to answer questions about how to address tobacco use and highlight potential leverage points. Findings32 factors influencing tobacco use were identified: intrapersonal level (n=10), interpersonal level (n=9), institutional level (n=6), community level (n=3), and macro-organisational (policy) level (n=4). The challenge of balancing child protection responsibilities and safeguarding, with expected parenting practices were highlighted. Institutional, organisational, and community strategies were found to facilitate tobacco use. For example, provision of designated smoking areas in the grounds of the homes and the ease at which young people can purchase tobacco in the local area were compounded by the scarcity of policy monitoring and information sharing at the macro-organisational level. Some data fell outside of individual chose the social ecological model levels, requiring a degree of researcher interpretation. InterpretationVarious influences across and within multiple levels of the care system might complicate and compound typical youth smoking influences and measures to address them. We recommend that, in the development of smoke-free children's home policies, local authorities should be guided by the experiences and knowledge of carers and be cognisant of previous implementation challenges or successes to enable informed and contextually relevant strategies to be developed and implemented. This study offers a much-needed direction for developing and testing tobacco-related interventions targeting this vulnerable population. FundingUniversity of Nottingham PhD studentship and the UK Centre for Tobacco and Alcohol Studies.

An investigation of physical activity among adults in Turkey using the Omaha System.

The aim of this study was to investigate the physical activity (PA) and associated factors among insufficiently active adults attending Family Health Centers in Istanbul, Turkey using the Omaha System. This descriptive-correlational study guided by the Ecological Model for Health Promotion used a convenience sample of 335 Turkish adults with insufficient PA behavior defined as an Omaha System PA Behavior rating <4. Measures included Omaha System problems; Knowledge, Behavior, and Status ratings; demographics; and ecological factors operationalized with the Omaha System Problem Classification Scheme. Data were analyzed using chi-square, independent t tests, and logistic regression. Participants were females (76.7%) and males (23.3%) with a mean age of 38.5years. Almost half (43.6%) engaged in no appropriate PA Behavior. The most common Physiological, Psychosocial, and Environmental domain problem were oral health (61.2%), mental health (21.5%), and neighborhood/workplace safety (41.2%), respectively. Logistic regression revealed marital status, age, sex, and physiological and environmental domain problems significantly predicted PA behavior. Interventions tailored to insufficiently active Turkish adults should include assessing for physiological health problems; targeting older, married adults; and advocating for policy change that supports the provision of safe, affordable, accessible, and culturally appropriate places for physical activity.

Reflections on Directions in Health Education: Implications for Policy and Practice. AAHE Scholar Address Revisited - Fast Forward 30 Years

ABSTRACTThe purpose of this paper is to update and enhance the 1989 Association for Health Education (AAHE) Scholar presentation, Reflections on Directions in Health Education: Implications for Policy and Practice, at the American Association for Health Education (AAHE) National Convention in Boston. It describes and complements the notion of shifting health from one based on disease and a medical model by advancing our understanding that many premature deaths are preventable and by noting the importance of risk factors with behavioral influences as an important component. However, while recognizing the importance of individual responsibility and personal behavior, it labels the shift to focusing on individual health behaviors as “micro myopia” and highlights several negative implications. It also suggests using a macro approach on a population level that may be equal or more effective and efficient. Recognizing the value and need to incorporate both micro and macro approaches, this article suggests the use of a social ecological model for health promotion that takes into consideration public policy, community, institutional, interpersonal and intrapersonal factors. Health educators should consider utilizing an ecological approach in both practice and professional preparation. As in the 1989 paper, the goal is to stimulate thought and discussion.

Comparative study of plan for promoting physical activity for health between the territories of Strasbourg, Nice and Brest (France)

The economic, health and societal consequences of inactive lifestyles encourage local governments to develop health promotion programs through physical activity PA for Health, WHO. The aim of this article is to better understand the mechanisms that have emerged in three territories (Strasbourg, Nice, Brest) and to bring them closer to the socio-ecological model of health promotion Booth [1]. Public and private funding, combined with a platform of centralized and cooperative organization for information and user orientation, and supplemented by the mobilization of insurance, health and sports actors, seem to be the first components of an ecological model of health promotion through physical activity in the French context.

Greening Health: The Role of Parks, Recreation, and Tourism in Health Promotion

In this paper we describe the role of parks, recreation, and tourism in health promotion. We begin by proposing a new definition of health that is rooted in an ecologically based worldview. Our definition sees human health and environmental health as being inextricably intertwined. Indeed, we see them as being one in the same. We then discuss ecological insights rooted in biomimicry that illuminate the kinds of contributions parks, recreation, and tourism professionals can make to health promotion. This application requires us to see ourselves, in the words of Aldo Leopold, as “plain members and citizens of a larger community of life” (Leopold, 1949, p. 224), citizens who recognize that we have much to learn from other species about how to live our lives in a manner that ensures a sustainable future for us all. We then place the principles of biomimicry into a larger global context by explicating a model of ecologically-based health promotion through which park, recreation, and tourism professionals might better understand how the work they do contributes to health promotion. We offer two examples--one international and one local—of what this work looks like in practice, emphasizing how they reflect the principles of biomimicry and an ecological model of health promotion. Finally, we invite readers to ponder the implications of what we propose for the work they do in parks, recreation, and tourism.Subscribe to JPRA

A qualitative analysis of smokers\u2019 perceptions about lung cancer screening

BackgroundIn 2013, the US Preventive Services Task Force (USPSTF) began recommending lung cancer screening for high risk smokers aged 55–80 years using low-dose computed tomography (CT) scan. In light of these updated recommendations, there is a need to understand smokers’ knowledge of and experiences with lung cancer screening in order to inform the design of patient education and tobacco cessation programs. The purpose of this study is to describe results of a qualitative study examining smokers’ perceptions around lung cancer screening tests.MethodsIn 2009, prior to the release of the updated USPSTF recommendations, we conducted 12 120-min, gender-specific focus groups with 105 current smokers in Charlotte, North Carolina and Cincinnati, Ohio. Focus group facilitators asked participants about their experience with three lung cancer screening tests, including CT scan, chest x-ray, and sputum cytology. Focus group transcripts were transcribed and qualitatively analyzed using constant comparative methods.ResultsParticipants were 41–67 years-old, with a mean smoking history of 38.9 pack-years. Overall, 34.3% would meet the USPSTF’s current eligibility criteria for screening. Most participants were unaware of all three lung cancer screening tests. The few participants who had been screened recalled limited information about the test. Nevertheless, many participants expressed a strong desire to pursue lung cancer screening. Using the social ecological model for health promotion, we identified potential barriers to lung cancer screening at the 1) health care system level (cost of procedure, confusion around results), 2) cultural level (fatalistic beliefs, distrust of medical system), and 3) individual level (lack of knowledge, denial of risk, concerns about the procedure). Although this study was conducted prior to the updated USPSTF recommendations, these findings provide a baseline for future studies examining smokers’ perceptions of lung cancer screening.ConclusionWe recommend clear and patient-friendly educational tools to improve patient understanding of screening risks and benefits and the use of best practices to help smokers quit. Further qualitative studies are needed to assess changes in smokers’ perceptions as lung cancer screening with CT scan becomes more widely used in community practice.

A prospective evaluation of first people's health promotion program design in the goulburn-murray rivers region.

BackgroundAboriginal Community Controlled Organisations (ACCOs) provide community-focussed and culturally safe services for First Peoples in Australia, including crisis intervention and health promotion activities, in a holistic manner. The ecological model of health promotion goes some way towards describing the complexity of such health programs. The aims of this project were to: 1) identify the aims and purpose of existing health promotion programs conducted by an alliance of ACCOs in northern Victoria, Australia; and 2) evaluate the extent to which these programs are consistent with an ecological model of health promotion, addressing both individual and environmental determinants of health.MethodsThe project arose from a long history of collaborative research. Three ACCOs and a university formed the Health Promotion Alliance to evaluate their health promotion programs. Local community members were trained in, and contributed to developing culturally sensitive methods for, data collection. Information on the aims and design of 88 health promotion activities making up 12 different programs across the ACCOs was systematically and prospectively collected.ResultsThere was a wide range of activities addressing environmental and social determinants of health, as well as physical activity, nutrition and weight loss. The design of the great majority of activities had a minimal Western influence and were designed within a local Aboriginal cultural framework. The most common focus of the activities was social connectedness (76 %). Physical activity was represented in two thirds of the activities, and nutrition, weight loss and culture were each a focus of about half of the activities. A modified coding procedure designed to assess the ecological nature of these programs showed that they recruited from multiple settings; targeted a range of individual, social and environmental determinants; and used numerous and innovative strategies to achieve change.ConclusionFirst Peoples’ health promotion in the Goulburn-Murray Rivers region encompasses a broad range of social, cultural, lifestyle and community development activities, including reclaiming and strengthening cultural identity and social connectedness as a response to colonisation.

Interpretation of Ecological Theory for Physical Activity with the Omaha System.

Physical inactivity is a global health problem. Public health nurses (PHNs) have great potential to influence population health outcomes in this area. However, methods are needed to increase understanding of the problem and the impact PHNs may have on measuring and changing health behavior. One promising option is PHN documentation of client health data. However, literature examining how health behavior theories align with nursing documentation systems that use standardized terminology is sparse. The purpose of this article was to operationalize an ecological theory with the Omaha System standardized terminology using physical activity as an exemplar. The goal was to provide a method for using PHN clinical documentation to examine physical activity from a theoretical perspective in research and practice. We designed and used a three-phase process informed by the literature to conceptually map the ecological model for health promotion and the Omaha System. The results of the mapping process reveal the ecological nature of the Omaha System and provide support for measuring and analyzing health-related behavior problems from an ecological perspective with Omaha System data. This process could be replicated with other health-related problems and standardized terminologies to guide theoretically based nursing care and research.

Socio-Cultural Determinants of Physical Activity among Latin American Immigrant Women in Alberta, Canada

Acculturation has been associated with decreased physical activity among immigrants. This study assessed the process of changing physical activity patterns within the context of Latin American immigrant women’s migration experiences to Canada. Using the ecological model of health promotion, we applied a mixed methods research design. Thirty-six Latin American immigrant women, 18 recent ( 10 years in Canada), participated. Six focus groups and 14 in-depth individual interviews were conducted. The Godin Leisure-Time Exercise Questionnaire was administered. Overall, 86 % of the participants reported gaining weight since coming to Canada. Participants reported becoming more sedentary upon arriving in Canada. Only 27.3 % of recent and 41.7 % of non-recent immigrant women were considered sufficiently physically active. Lack of time, resources, social support, and migration stress were identified as key barriers to physical activity. Migration stress associated with social integration barriers strongly influence physical activity among Latin American immigrant women.

The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally

ObjectiveThe objective of this narrative review is to highlight the determinants of the epidemic rise in waterpipe tobacco smoking (WTS) among youth globally. The Ecological Model of Health Promotion (EMHP)...

Leisure-Time Physical Activity among University Students in Mauritius

Mauritius has Type 2 Diabetes mellitus as public health issue, whereby unhealthy modes of eating and sedentary lifestyles are factors to be addressed in the primary prevention of the disease among the youth. This study was thus designed to investigate the prevalence of Leisure-time physical activity (LTPA) among university students in Mauritius and to explore their motivations and constraints to engage in LTPA, using the ecological model of health promotion. Data were collected from a representative group of university students in Mauritius using a self-administered questionnaire. Qualitative and quantitative data pertaining to LTPA issues were collected. Three-fifths of the participants met the recommended levels of LTPA. The majority of inactive participants were female. Motivations provided by participants to engage in LTPA were predominantly intrapersonal. The three most mentioned motivations were improvement in physical health, improvement in physical appearance and to have fun. Constraints faced by participants to engage in LTPA were mainly of an intrapersonal nature. The three main constraints provided by students were lack of time, having to study and not being motivated. Therefore, interventions to promote LTPA among university students should simultaneously address development of time-management skills and provision of incentives to perform LTPA.

A pilot study of Aboriginal health promotion from an ecological perspective

BackgroundFor health promotion to be effective in Aboriginal and Torres Strait Islander Communities, interventions (and their evaluation) need to work within a complex social environment and respect Indigenous knowledge, culture and social systems. At present, there is a lack of culturally appropriate evaluation methods available to practitioners that are capable of capturing this complexity. As an initial response to this problem, we used two non-invasive methods to evaluate a community-directed health promotion program, which aimed to improve nutrition and physical activity for members of the Aboriginal community of the Goulburn-Murray region of northern Victoria, Australia. The study addressed two main questions. First, for members of an Aboriginal sporting club, what changes were made to the nutrition environment in which they meet and how is this related to national guidelines for minimising the risk of chronic disease? Second, to what degree was the overall health promotion program aligned with an ecological model of health promotion that addresses physical, social and policy environments as well as individual knowledge and behaviour?MethodsRather than monitoring individual outcomes, evaluation methods reported on here assessed change in the nutrition environment (sports club food supply) as a facilitator of dietary change and the 'ecological' nature of the overall program (that is, its complexity with respect to numbers of targets, settings and strategies).ResultsThere were favourable changes towards the provision of a food supply consistent with Australian guidelines at the sports club. The ecological analysis indicated that the design and implementation of the program were consistent with an ecological model of health promotion.ConclusionsThe evaluation was useful for assessing the impact of the program on the nutrition environment and for understanding the ecological nature of program activities.

Impact of an intervention on the availability and consumption of fruits and vegetables in the workplace

To evaluate the impact of an educational and environmental intervention on the availability and consumption of fruits and vegetables in workplace cafeterias. This was a randomized intervention study involving a sample of companies that were divided into intervention and control groups. The intervention, which focused on change in the work environment, was based on an ecological model for health promotion. It involved several different aspects including menu planning, food presentation and motivational strategies to encourage the consumption of fruits and vegetables. The impact of the intervention was measured by changes (between baseline and follow-up) in the availability of fruits and vegetables that were eaten per consumer in meals and the consumption of fruits and vegetables in the workplace by workers. We also evaluated the availability of energy, macronutrients and fibre. Companies of São Paulo, Brazil. Twenty-nine companies and 2510 workers. After the intervention we found an average increase in the availability of fruits and vegetables of 49 g in the intervention group, an increase of approximately 15 %, whereas the results for the control group remained practically equal to baseline levels. During the follow-up period, the intervention group also showed reduced total fat and an increase in fibre in the meals offered. The results showed a slight but still positive increase in the workers' consumption of fruits and vegetables (about 11 g) in the meals offered by the companies. Interventions focused on the work environment can be effective in promoting the consumption of healthy foods.

The context of unintended pregnancy among married women in the USA

Background and methodologyUnintended pregnancy is a concern in the USA due to its association with adverse physical, mental, social and economic outcomes. Few studies have examined this issue among married...