Health Promotion Experts Research Articles

Evaluating Health Communication Programs to Enhance Health Care and Health Promotion

Health communication programs are essential and ubiquitous tools in the delivery of care and promotion of health. Yet, health promotion experts are not always well informed about the influences communication programs have on the audiences they are designed to help. Too often health communication programs evoke unintended, and even negative, responses from diverse audiences. It is critically important to conduct regular, rigorous, ongoing, and strategic evaluation of health communication programs to assess their effectiveness. Evaluation data should guide program refinements and strategic planning. This article outlines key strategies for conducting meaningful evaluation research for guiding the development, implementation, refinement, and institutionalization of effective health communication programs.

Youth sports clubs’ potential as health-promoting setting: Profiles, motives and barriers

Setting and Objective: For decades, the World Health Organisation has promoted settings-based health promotion, but its application to leisure settings is minimal. Focusing on organised sports as an important leisure activity, the present study had three goals: exploring the health promotion profile of youth sports clubs, identifying objective club characteristics (e.g. size, type of sport), predicting the presence/absence of health promotion in youth sports clubs and identifying perceived motives and barriers to health promotion in youth sports clubs, thereby improving the basis for policy guidelines. Method: Respondents were representatives from the board of 154 youth sports clubs. Data were collected through an online survey, including the health-promoting sports club index (HPSC-I). Linear regression and analysis of variance were used to identify predictors and differences. Results: Even though the motives were strongly supported, a majority of youth sports clubs were rated as low health promoting on the HPSC-I (59%). Overall, linear regression indicated that clubs founded more recently, offering multiple types of sports and offering both recreation and competition scored higher on the health promotion indices. Health promotion not being a priority of the board and lack of expertise were identified as the most important barriers. Conclusion: Progress is needed before youth sports clubs can truly be considered health-promoting settings. Policy suggestions are made to address the barriers, for example, financial incentives to maximise efforts and establishing collaborations between sports clubs and health promotion experts.

Moving the worksite health promotion profession forward: is the time right for requiring standards? A review of the literature.

Standards in any profession are adopted to assure that the individuals hired are adequately trained and the programs that they oversee are of the highest quality. Worksite health promotion should be no different from any other field. A review of the research conducted by experts in worksite health promotion is examined, along with an assessment of skills needed to ensure that wellness programs are effective and employees, their families, and even their communities are educated on the ways to best prevent chronic diseases and occupational incidences through healthy and safe behaviors. This article is consistent with Health Promotion Practice's mission and focuses on the exploration of the processes used to plan effective worksite health promotion programs, and it suggests initial discussions on whether these processes should become standards for professionals in the worksite health promotion field.

Examining the quality of the 'Healthy Eating and Physical Activity in Schools' (HEPS) quality checklist: German results on usability and reliability.

The aim of the present study was to examine the usability and reliability of the HEPS quality checklist (Healthy Eating and Physical Activity in Schools), an instrument developed to assess the quality of school-based programmes on healthy eating and physical activity. With regard to usability, health promotion experts (n = 15) were asked to apply the HEPS quality checklist and to fill out a questionnaire about its comprehensibility and usability. To examine inter-rater reliability (IRR) a criteria-based selection of German school programmes on healthy eating and physical activity (n = 14) was randomly allocated to two programme pools and assessed independently by the authors. Results of the pilot testing revealed a high overall satisfaction with the HEPS quality checklist and a high willingness to use it or to recommend it to others. Furthermore, the checklist was perceived to be comprehensive and clearly structured. The assessment results of programme pool 1 revealed unsatisfactory Cohen's Kappa coefficients (IRR) and moderate intra-class correlations (ICC). After the HEPS manual guide had been amended with regard to its anchoring, the results of programme pool 2 showed substantial improvements with regard to IRR and ICC. In summary, the adapted HEPS quality checklist is a usable and reliable instrument for the quality assessment of school-based programmes on healthy eating and physical activity. The findings suggest that the HEPS checklist should be applied by two sufficiently trained raters.

Fatalism and short‐termism as cultural barriers to cardiac rehabilitation among underprivileged men

Cardiovascular diseases are a leading cause of death and disability in Canada, and individuals of low socioeconomic status appear particularly vulnerable to such disorders. Although many health-related institutions have promoted cardiovascular health and have created cardiac rehabilitation programmes, they have not attained their desired outcomes, especially amongst socioeconomically deprived men. Drawing on Pierre Bourdieu's sociocultural theory, this qualitative study aims to understand the social mechanisms underpinning the lifestyles and health practices of men who had suffered a cardiovascular incident requiring hospitalisation. In all, 20 interviews were conducted with francophone men aged 40 to 65years living in the province of Québec, Canada. The analysis strongly suggests that the respondents' living conditions and disease were significant obstacles to their adoption of a healthy lifestyle. Their despair and pessimism, apparently originating in the harshness of their financial realities, physical limitations and social networks, led them to believe that they could do little to control their lives, thereby limiting the fulfillment of any long-term ambitions. Therefore, the adoption of a habitus characterised by fatalistic and short-term perceptions of health influenced their lifestyle choices, leading them to maintain lives that were in stark contrast with the recommendations made by health promotion experts.

The role of alcohol in forging and maintaining friendships amongst Scottish men in midlife.

Men drink more heavily and are more likely to die from alcohol-related causes than women. Most alcohol research focuses on young drinkers. We describe the context of men's drinking in midlife and explore how alcohol is associated with the construction of masculinities. Qualitative research was used to examine the social context of drinking alcohol. We conducted 15 focus groups (single and mixed sex) with respondents in the west of Scotland, United Kingdom. Here we focus on the findings from 22 men aged 28 to 52 years. Men regarded drinking pints of beer in the pub together as an "act of friendship" and this functioned as a hegemonically appropriate way to communicate with and support each other. However, male friends also constructed some nonhegemonic behaviors as forgivable-and indeed acceptable-while drinking alcohol together. This included practices such as the explicit discussion of emotions and mental health and the consumption of "feminine" drinks under certain circumstances (e.g., in private, with close friends). This exploration of drinking reveals the fluidity of gender constructions-and the strategic ways in which men take up positions around hegemonic masculinity-in midlife. The close interweaving of drinking pints in the pub with notions of male friendship could lead to both health-damaging (excessive drinking) and potentially health-promoting (social support) behaviors. Health promotion experts need to be sensitive to cultural constructions of gender to address the high rates of drinking in this age group.

The CompHP Core Competencies Framework for Health Promotion in Europe

The CompHP Project on Developing Competencies and Professional Standards for Health Promotion in Europe was developed in response to the need for new and changing health promotion competencies to address health challenges. This article presents the process of developing the CompHP Core Competencies Framework for Health Promotion across the European Union Member States and Candidate Countries. A phased, multiple-method approach was employed to facilitate a consensus-building process on the development of the core competencies. Key stakeholders in European health promotion were engaged in a layered consultation process using the Delphi technique, online consultations, workshops, and focus groups. Based on an extensive literature review, a mapping process was used to identify the core domains, which informed the first draft of the Framework. A consultation process involving two rounds of a Delphi survey with national experts in health promotion from 30 countries was carried out. In addition, feedback was received from 25 health promotion leaders who participated in two focus groups at a pan-European level and 116 health promotion practitioners who engaged in four country-specific consultations. A further 54 respondents replied to online consultations, and there were a number of followers on various social media platforms. Based on four rounds of redrafting, the final Framework document was produced, consisting of 11 core domains and 68 core competency statements. The CompHP Core Competencies Framework for Health Promotion provides a resource for workforce development in Europe, by articulating the necessary knowledge, skills, and abilities that are required for effective practice. The core domains are based on the multidisciplinary concepts, theories, and research that make health promotion distinctive. It is the combined application of all the domains, the knowledge base, and the ethical values that constitute the CompHP Core Competencies Framework for Health Promotion.

Communication, social capital and workplace health management as determinants of the innovative climate in German banks

ObjectiveThe present study aims to measure the determinants of the innovative climate in German banks with a focus on workplace health management (WHM).MethodsWe analyze the determinants of innovative climate with multiple regressions using a dataset based on standardized telephone interviews conducted with health promotion experts from 198 randomly selected German banks.ResultsThe regression analysis provided a good explanation of the variance in the dependent variable (R² = 55%). Communication climate (β = 0.55; p < 0.001), social capital (β = 0.21; p < 0.01), the establishment of a WHM program (β = 0.13; p < 0.05) as well as company size (β = 0.15; p < 0.01) were found to have a significant impact on an organization’s innovative climate.ConclusionsIn order to foster an innovation-friendly climate, organizations should establish shared values. An active step in this direction involves strengthening the organizations’ social capital and communication climate through trustworthy management decisions such as the implementation of a WHM program.

The Second National Sun Survey: Overview and Methods

The Second National Sun Survey (NSS2) was carried out in 2006 to estimate ultraviolet radiation (UVR) exposure, sun protection and related knowledge, attitudes and beliefs among Canadians. This paper provides a detailed overview of NSS2 methods and discusses the strengths and limitations of the survey. The NSS2 consists of two questionnaires administered to two samples of adults (age 16+ years). The base sample provides in-depth information on UVR exposure, protective behaviours, tanning, and knowledge, attitudes and beliefs about sun safety for adults, as well as some sun behaviour information for a sample of their children aged 1-12 years. The shorter comparison sample facilitates direct comparison with the 1996 first national sun survey. Data were collected using computer-assisted telephone interviewing, and sample weights were computed for all respondents for estimation and analysis of both adult and child data. Base sample interviews were completed for 7,121 adults, of whom 1,437 reported on the sun behaviour of one of their children, and the comparison sample yielded 2,115 interviews. Response rates were 63% for both surveys. The NSS2 provides in-depth and up-to-date UVR exposure information among Canadians. The results of this survey will aid health promotion experts and policy-makers in developing effective programs to minimize UVR exposure. A public use data file and training in statistical analysis of the NSS2 has been made available to data analysts from across Canada. Key strengths and limitations identified in this survey will inform the development and implementation of future sun surveys. Key words: Survey methods; ultraviolet radiation exposure; skin neoplasms

The Second National Sun Survey: overview and methods.

The Second National Sun Survey (NSS2) was carried out in 2006 to estimate ultraviolet radiation (UVR) exposure, sun protection and related knowledge, attitudes and beliefs among Canadians. This paper provides a detailed overview of NSS2 methods and discusses the strengths and limitations of the survey. The NSS2 consists of two questionnaires administered to two samples of adults (age 16+ years). The base sample provides in-depth information on UVR exposure, protective behaviours, tanning, and knowledge, attitudes and beliefs about sun safety for adults, as well as some sun behaviour information for a sample of their children aged 1-12 years. The shorter comparison sample facilitates direct comparison with the 1996 first national sun survey. Data were collected using computer-assisted telephone interviewing, and sample weights were computed for all respondents for estimation and analysis of both adult and child data. Base sample interviews were completed for 7,121 adults, of whom 1,437 reported on the sun behaviour of one of their children, and the comparison sample yielded 2,115 interviews. Response rates were 63% for both surveys. The NSS2 provides in-depth and up-to-date UVR exposure information among Canadians. The results of this survey will aid health promotion experts and policy-makers in developing effective programs to minimize UVR exposure. A public use data file and training in statistical analysis of the NSS2 has been made available to data analysts from across Canada. Key strengths and limitations identified in this survey will inform the development and implementation of future sun surveys.

From service delivery to solution delivery: Commissioning for health improvement

The further division of responsibilities between commissioners and providers in England will have far-reaching consequences and opportunities for developing and enhancing health improvement. Commissioners will have the opportunity to craft local solutions to local issues. To be effective, these local responses need to tackle the core determinants of health and to build the social capital that is at the heart of all communities that enjoy high standards of health. This paper argues that the new arrangements mark an evolution of the Beveridge model of healthcare (centralized, top down and professionally prescribed) to a post-Beveridge model characterized by it being decentralized, localized and utilizing professional skills in the pursuit of client and community satisfaction and engagement rather than a narrowly defined professional perspective. This paper indicates some of the key conceptual changes commissioners need to employ to take advantage of the emerging opportunities. It is argued that the new arrangements will only be fully effective if commissioners of health improvement programmes ensure they factor in health promotion and social marketing expertise, both in the strategic and operational phases of commissioning. Finally, predictions are made about changes in the values and characteristics of current health improvement organizations.

Zipped Trousers, Crossed Legs, and Magical Thinking: Sex Education in the Age of AIDS

Health-promotion experts and historians generally concur that the federal government's response to HIV/AIDS during the 1980s and early 1990s was inadequate and constrained by moralism. President Ronald Reagan famously refused to publicly address the issue of AIDS until five years after the first reported cases of AIDS (and only after it was clear that HIV was spreading outside so-called "deviant" groups, such as homosexuals and injecting drug users). The U.S. surgeon general, C. Everett Koop, fought a losing battle against Reagan and Secretary of Education William J. Bennett to introduce pragmatic sex education classes into American high schools or even mention the word "condoms" in literature mailed to U.S. households. Congress was reluctant to fund gay-based organizations, such as New York's Gay Men's Health Crisis, to devise and deliver HIV prevention programs to their constituencies, despite evidence from countries such as Australia that peer-provided education was more successful and cost-effective than having medical professionals and public health bureaucrats design campaigns and disseminate information. And successive presidents and Republican- and Democrat-controlled Congresses have failed to provide funding for needle-and-syringe exchange programs, even though there is overwhelming evidence that they are effective in preventing HIV transmission among injecting drug users. Federal public health officials claimed (and continue to assert) that there is less incentive for drug users to seek treatment once they are supplied with sterile equipment that reduces the danger of injecting, and fear that young people will experiment with drugs if needles and syringes are readily available. Yet between 1991 and 2001, eight comprehensive federally funded evaluations of the effectiveness of needle-exchange programs (both domestic and foreign-country based) concluded that such schemes reduced the rate of HIV transmission and did not lead to an increase in drug use.

Prevalence and time trends in obesity among adult West African populations: a meta‐analysis

The objective of this study was to determine the distribution of and trends in obesity in adult West African populations. Between February and March 2007, a comprehensive literature search was conducted using four electronic databases. Journal hand searches, citations and bibliographic snowballing of relevant articles were also undertaken. To be included, studies had to be population-based, use well-defined criteria for measuring obesity, present data that allowed calculation of the prevalence of obesity and sample adult participants. Studies retrieved were critically appraised. Meta-analysis was performed using the DerSimonian-Laird random effect model. Twenty-eight studies were included. Thirteen studies were conducted in urban settings, 13 in mixed urban/rural and one in rural setting. Mean body mass index ranged from 20.1 to 27.0 kg(2). Prevalence of obesity in West Africa was estimated at 10.0% (95% CI, 6.0-15.0). Women were more likely to be obese than men, odds ratios 3.16 (95% CI, 2.51-3.98) and 4.79 (95% CI, 3.30-6.95) in urban and rural areas respectively. Urban residents were more likely to be obese than rural residents, odds ratio 2.70 (95% CI, 1.76-4.15). Time trend analyses indicated that prevalence of obesity in urban West Africa more than doubled (114%) over 15 years, accounted for almost entirely in women. Urban residents and women have particularly high risk of overweight/obesity and obesity is rising fast in women. Policymakers, politicians and health promotion experts must urgently help communities control the spread of obesity in West Africa.

Predictors of Inactivity in the Working-Age Population

Burden of diseases attributable to low physical activity is increasing worldwide mainly among working age populations. The aim of the study was to evaluate the association between selected (including demographic and socioeconomic) factors and leisure-time physical activity. The study was performed in the randomly selected group of 450 men and 502 women in the working age. Logistic regression models were applied to assess factors related to physical activity limitations. Physical activity was determined by the physical activity questionnaire. Over 55% of the study participants were inactive, 34.1% were insufficiently active, and only 10.6% of the subjects achieved the level of physical activity recommended by experts in health promotion. Significant differences in physical activity behaviors across age, education, income levels, and marital status were found in the study participants. Unhealthy weight and smoking habit also formed certain barriers to exercise in both men and women. Low number of physically active working-age citizens is a challenge for public health, and it confirms the need for promoting active lifestyles. Effective strategies to encourage leisure-time physical need to be targeted at specific age and socioeconomic groups.

Typologies of Rural Lay-Health Advocacy Among Rural Women in Australia

SUMMARY Background: Public health advocacy effects changes in health behaviors and outcomes through applying health promotion expertise to specific groups. Advocacy occurs through the provision of tools to empower those who are either experiencing, or at risk of, a particular health status. Research objectives: Health care experiences of women living in rural Victoria, Australia, were explored in the context of generally poor access to reproductive health services. Women's experiences are investigated within the theoretical framework of lay-health advocacy, i.e., relying on individual health care experience and knowledge to promote and improve the health care of others. Methodology: The study applied a qualitative design, and a self-identified sample of women was recruited through network sampling techniques. Fifty-seven women participated in in-depth interviews. Results: Three types of lay-health advocacy emerged. Advocacy-seekers expected the researchers to use their experiences of poor health care to educate health professionals to provide better quality care. Advocacy-providers used their knowledge and experiences to take an active part in promoting the health care of other women. Story-tellers expected their narratives to empower other women or unidentified social groups to feel less isolated in their health care experiences. Discussion: In providing narratives of their health care, women were critical of social inequalities facing people living in rural Australia. Lay-health advocates offer a cost-effective and appropriate option for reducing adverse health outcomes within resource-poor settings. Informed by women's narratives, we suggest strategies to enhance rural women's health care.

The health promoting sports club in Finland--a challenge for the settings-based approach

The purpose of this article is, first, to compile a frame of reference for the health promoting sports club and, second, to develop standards for the concept. This concept is based on the settings-based health promotion approach. Sports clubs are a new setting for health promotion, which until now has been little examined from a settings point of view. Nevertheless, this concept has much potential. For example, sports clubs attract a large number of children and adolescents and their educational nature can be considered to be informal. The present standards were developed using the Delphi method. The researcher, in cooperation with a panel of experts (experts in health promotion, n = 11, and experts in sports clubs, n = 16), sought to create a consensus statement on the standards. At the preliminary stage of the study 64 original standards were created on the basis of existing literature and the principles of the Ottawa Charter. During the three rounds of the Delphi process 15 standards were evaluated as the most important. After the Delphi process, the researcher modified the standards by eliminating overlap, interpolating seven standards to involve all strategic areas of the Ottawa Charter and creating a preliminary typology of the standards. At the subsequent stages of the study, indicators for these standards will be drafted and tested in practice. Therefore, this study would provide tools for determining and evaluating how health promoting a particular sports club is.

The Blue Book Oral Health Program: a collaborative partnership with statewide implications

Basic oral health knowledge and skills are essential for parents and child health professionals to promote good oral health and the prevention of dental disease in young children. The aim of the Blue Book Program was to provide accurate and appropriate oral health information to all parents of newborn babies and young children in New South Wales (NSW), Australia, and child health professionals to address the serious issue of early childhood caries (ECC) and to increase general health involvement in oral health promotion. Oral health information sheets were developed based on a review of current literature plus input from paediatric dental specialists. Information was pre-tested with child and family health nurses and their clients. Two hundred and forty child health professionals, predominately child and family health nurses, attended in-service education in early childhood oral health in 2004. Following this, a trial run of 40,000 oral health information sheets were printed and distributed to participating nurses. The NSW Department of Health approved the request for inclusion of oral health information in the Blue Book for the 2006 print run. A precondition for re-inclusion was the development of oral health guidelines for child health professionals. The Centre for Oral Health Strategy NSW has begun work on these guidelines and has incorporated this strategy into a new and comprehensive plan for a statewide Early Childhood Oral Health Program. The methods used in this program support a collaborative partnership approach between oral health professionals, health promotion experts, child and family health nurses and NSW regulatory bodies. This approach is essential to address the serious issue of early childhood caries.

A review of professional competencies in health promotion: European perspectives

Competencies have been increasingly used in education and the labour market since the 1970s. Within the Health Promotion framework, however, attempts to discuss specific competencies are rather incipient. This paper aims to introduce a discussion on the most essential and desirable health promotion competencies using the EUMAHP (European Masters in Health Promotion) framework. In preparation of this review, we considered three main sources to lead the identification of health promotion competencies: a) a review of the history, culture and identity of health promotion in Europe, b) an analysis of what competencies could be drawn from the health promotion most significant milestones and practice, c) a consultation with health promotion experts, practitioners and trainees. As a result of this exercise a number of competencies were selected and tentatively grouped into the four EUMAHP training core curriculum components: Foundations for Health Promotion (understanding of social, cultural and subjective determinants of health and wellbeing, to identify, document and analyse equity issues, understanding of public sectors, policies and services and understanding of local policies and governments); Health Promotion Practice (to interpret and address cultural and social diversity, to identify, analyse and use scientific evidence; sensitivity towards group and institutional dynamics and ability to deal with such dynamics, democratic and empowering leadership skills, including motivation, dialogue, active and careful listening, empathy and conflict resolution skills, creative and critical thinking, team building and negotiation and partnership building skills, writing skills, to produce and use media resources, language and oratory skills, management skills, planning and monitoring skills); Research Methods (social research skills, to generate and manage socio-economic and epidemiological information, critical appraisal, policy analysis and policy evaluation, technical and report- writing); and European Dimension of Health Promotion (comparative analysis, ability to communicate in a second language, enabling people to use the European context and European cultural diversity as a health promotion resource). Despite the fact that this classification was different to the one used in other competence studies, the results are quite similar to competencies identified by studies made in Australia and New Zealand. Taken into account that these coincidences relate to countries that share cultural similarities with Europe, it can be inferred that the final results are significant and can be useful for further development of the EUMAHP core curriculum and other future developments in health promotion education and training.

Prevención del VIH/sida en el medio penitenciario: una experiencia de planificación participativa

To describe the application of participatory methodology in the prison setting for the determination of the most appropiate contents and methods of a HIV/AIDS prevention program. Community study in the Centro de Cumplimiento del Establecimiento Penitenciario in Valencia (1250 inmates) in Spain. The study was carried out in two phases: identification of key informants and collection of information. In the second phase, a community forum composed of the center's male and female inmates was created, personal interviews with convicted female prisoners were carried out and a self-administered questionnaire was distributed to the center's health professionals and management as well as to health promotion experts. Community forum. The following proposals for HIV/AIDS prevention were made by the male and female prisoners: a) those directed at the prisoners themselves: increasing preventive mesures in material used in injection and in sexual relationships; b) those directed at the prison management: increased distribution of condoms, safety razors and bleach and the introduction of sterile injection material. In the personal interviews, agreement on a future prevention program was high among the female inmates and the other key informants. Preferred measures were the acquisition of information on the mechanisms of HIV transmission and prevention and on the differences between HIV carriers and those suffering from AIDS and the acquisition of skills for disinfecting material used for drug injection and in negotiating the use of condoms with partners. The preferred methodology was based on groups that would allow for an interchange of experience and would deal with the difficulties of putting preventive measures into practice. The participation of the prison's inmates and staff supplied information that facilitated the design (choice of aims, measures, methods and resources) of an HIV prevention program adapted to the needs and preferences of all the interested parties.

A workforce survey of health promotion education and training needs in the State of Victoria

ObjectiveThis study investigates the education and training needs of health professionals and factors affecting participation in education and training. ResultsHealth promotion professionals were involved in the widest variety of health promotion activities, including more evaluation, research and planning than GPs and other health professionals who were involved in more client-focussed activities. Professionals' preference for training content reflected the type of activities in which they were most frequently involved. Practical courses, of short duration, delivered by experienced peers or health promotion experts were preferred over university and TAFE courses. Professionals in rural and provincial locations require both greater access to information on training and conveniently located training. More organisational support, funding and time release would encourage the training of professionals in government departments, community health centres and public hospitals. ConclusionsTo be most effective, training must be tailored to suit the specific needs of different professionals involved in health promotion and take into consideration how factors, such as financial incentives and time release, influence participation across different settings and locations. ImplicationsFurther development of the health promotion workforce will require recognition of its professional diversity and a more responsive and organised approach to education and training programs.