Family-based Health Promotion Research Articles

The effect of fine particulate matter (PM2.5) pollution on health inequality: an intergenerational perspective.

Air pollution poses a serious challenge to public health and simultaneously exacerbating regional & intergenerational health inequality. This research introduces PM2.5 pollution into the intergenerational health transmission model, and estimates its impact on health inequality in China using Ordered Logit Regression (OLR) and Multi-scale Geographically Weighted Regression (MGWR) model. The results indicate that PM2.5 pollution exacerbate the intergenerational health inequality, and its impacts show inconsistency across family income levels, parental health insurance status, and area of residence. Specifically, it is more difficult for offspring in low-income families to escape from the influence of unhealthy family to become upwardly mobile. Additionally, this health inequality is more significant in households in which at least one parent does not have health insurance. Moreover, the intergenerational solidification caused by PM2.5 pollution is higher in the east and lower in the west. Both the PM2.5 level and solidification effect are high in Beijing-Tianjin-Hebei region, Yangtze River Delta region and central areas of China, which is the focus of air pollution management. These findings suggest that more emphasis should be placed on family-based health promotion. In areas with high PM2.5 pollution levels, resources, subsidies and air pollution protection should be provided for less healthy families with lower incomes and no health insurance.

A systematic review and meta-analysis of the child-level effects of family-based interventions for the prevention of type 2 diabetes mellitus.

The purpose of this systematic review and meta-analysis was to investigate the effects of family-based health promotion interventions on child-level risk factors for type 2 diabetes in vulnerable families. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for systematic reviews formed the methodological framework. CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science were searched on January 12, 2024. The NTP-OHAT Risk of Bias Assessment Tool was used to assess the risk of bias in the individual studies, and meta-analyses were performed. The 4723 studies were identified, and 55 studies met the inclusion criteria. Results showed significant effects on children's body mass index (mean difference [MD], -0.18, 95% CI [-0.33 to -0.03], p =0.02), body fat percentage (MD, -2.00, 95% CI [-3.31 to -0.69], p = 0.003), daily activity (standardized mean difference [SMD], 0.23, 95% CI [0.01; 0.44], p = 0.04), physical activity self-efficacy (SMD, 0.73, 95% CI [0.36 to 1.10], p < 0.01), intake of snacks (MD, -0.10, 95% CI [-0.17 to -0.04], p = 0.002), and sugar-sweetened beverages (SMD, -0.21, 95% CI [-0.42 to -0.01], p = 0.04). Subgroup analyses suggested that interventions aiming to change child and parent behavior simultaneously have larger effect on fasting glucose and nutrition consumption, and that interventions longer than 26 weeks have larger effects on body composition and physical activity behavior than shorter interventions.

Multilevel Factors Associated with Participation in Group Well-Child Care.

To identify factors associated with participation in group well-child care (GWCC), wherein families share preventive health care visits. We extracted electronic health record data of mother-infant dyads with infants born 2013-2018 at Yale New Haven Hospital and followed at the primary care center. Using chi-square analysis and multivariate logistic regression, we examined the extent to which (1) maternal/infant characteristics and recruitment timing were associated with GWCC initiation and continued engagement and (2) initiation was associated with primary care visits. Of 2,046 eligible mother-infant dyads, 11.6% initiated GWCC. The odds of initiation were higher among mothers with Spanish versus English primary language (OR:2.36 [95% CI:1.52-3.66]), with 1 child versus >3 children (1.58 [1.13-2.22]), and of non-Hispanic Black versus non-Hispanic White infants (2.72 [1.39-5.32]). Initiation was lower among infants born in 2016 (0.53 [0.32-0.88]) and 2018 (0.29 [0.17-0.52]) versus 2013. Among GWCC initiators with follow-up data (n=217), continued engagement (n=132, 60.8%) was positively associated with maternal age of 20-29 years (2.85 [1.10-7.34]) and >30 years (3.46 [1.15-10.43]) compared with <20 years, and mothers with 1 child versus ≥3 (2.28 [1.04-4.98]). GWCC initiators, versus non-initiators, had 5.06 times higher adjusted odds of attending >9 primary care appointments in the first 18 months (95% CI:3.74-6.85). As evidence builds on health and social benefits of GWCC, recruitment efforts may gain from considering multi-level socio-economic, demographic, and cultural factors associated with GWCC participation. Higher participation among systemically marginalized groups may present unique opportunities for family-based health promotion to mitigate health inequities.

Delivering ADAPT+ to Latino Families Living in Rural Communities: Feasibility and Acceptability of Implementing a Health Promotion Program Including Mindfulness.

Obesity is a major public health crisis in Latino youth. Mounting evidence implicates stress in the development and maintenance of obesity. This study examined the feasibility and acceptability of having community health workers, i.e., promotoras, deliver Adaptando Dieta y Acción Para Todos (ADAPT)+, a family-based health promotion program integrating mindfulness strategies for stress reduction to underserved Latino families in rural communities. In an ORBIT model Phase IIb longitudinal quasi-cluster feasibility study, promotoras delivered the 6-session ADAPT+ intervention and 1-session Enhanced Usual Care (EUC) in rural Florida. Feasibility was assessed via sample size and recruitment, randomization by community, data collection completion, and intervention fidelity. Acceptability was assessed via participant retention and program satisfaction. Effect sizes of differences in parent stress and mindful eating between conditions at baseline, end of treatment, and 3-month follow-up were calculated. Feasibility and acceptability were demonstrated. The recruitment target was 99% met (n = 95 recruited). Randomization was limited to site level due to coronavirus disease 2019-related challenges. Data collection procedures were feasible (100% completion). Retention was 86% at post-assessment and 82.6% at 3-month follow-up. All sessions were completed (100% fidelity). Mean program satisfaction was 3.91/4.00. ADAPT+ parents reported lower stress (difference = -3.04, medium-to-large effect, d = .70) and more mindful eating (difference = 2.00, medium effect, d = .44) than EUC parents at 3-month follow-up. Study implementation and intervention delivery to rural Latino families using promotoras were feasible and acceptable. Promising findings regarding parent stress and mindful eating support a larger (ORBIT Phase III) efficacy trial. This trial was registered with ClinicalTrials.gov under identifier NCT04800432.

The problem of heteronormativity in family-based health promotion: centring gender transformation in Ontario, Canada.

Social scientists have demonstrated that family health work is interlinked with heteronormative gender inequities. Yet family-based public health interventions rarely incorporate a gender transformative approach or address heteronormativity as a potential health barrier in North America. Instead, attention to gender surfaces primarily in family health interventions conducted in low- to middle-income countries with majority Black and racialized populations. The objective of this article is to establish the importance of designing health interventions that account for heteronormative relations in Ontarian families by drawing on empirical data from the Guelph Family Health Study (GFHS). We draw on data (February-October 2019) from (1) semi-structured interviews with 20 families and with 4 health educators facilitating the GFHS home visits and (2) observational data of 11 GFHS home visits and 1 health educator training day. Informed by gender transformation theory, data were analyzed and coded to understand the impact of gender, sexuality, and place in family health interventions. Pre-existing heteronormative parenting relations were reinforced through GFHS participation: the GFHS was mother-led, increasing some mothers' stress levels. Fathers tended to consider paid work a justification for disengaging from the GFHS, and their detachment sometimes obstructed mothers' intervention efforts. Health educators (all women) were caught in these relations, feeling like because of their gender, they were viewed by parents as confidants and marriage counsellors. Findings emphasize the need for expanding the epistemic and methodological approaches to family-based health interventions, changing the demographic and geographic emphasis within the field, and designing interventions that focus on societal-level changes. Heterosexuality has not been analyzed as a risk factor within the public health field, but our findings indicate the need for further study.

Integrated care: Health Promotion Hospital Model to Improve Family Support for Patients with Chronic Disease

Background: One of the strategies to hold down such economic burden is to improve health promotion services. Family involvement can be used to increase the success in health promotion program. Family involvement in chronic disease management is associated with successful chronic disease treatment.The aim of this study is designing health promotion hospital model to improve family support for patients with chronic disease. Method: This qualitative study was conducted through four focused group discussion (FGD) and six in-depth interview. The data were collected from June-October 2021. The analysis used in this study is Miles and Huberman qualitative data analysis. The analysis was carried out starting from data collection, data reduction, data presentation, and drawing conclusions. Result: From the transcript of four FGDs and six interviews, a family-based health promotion model was obtained. The family-based health promotion model to increase family support for chronic disease patients in hospitals is formed from eight (8) elements, namely: 1) Health literacy, 2) The preferred method is peer-led discussion, group discussion, 3) Social media using WhatsApp Groups, 4) Forming groups involving families, 5) Involving community leaders, 6) Relaxing and entertaining activities, 7) Effective communication, and 8) Nurse engagement. Conclusion: The health promotion hospital model to increase family support for patients with chronic diseases consists of: Supporting the patient's family to increase the patient's knowledge about the disease and how to treat it. Peer-led discussion, group discussion, and face-to-face meeting along with giving of leaflet with materials as desired by the patients and their family are the education methods preferred by the patients and their family.

The Effects of Parent-Adolescent Acculturation Gaps on Adolescent Lifestyle Behaviors: Moderating Role of Family Communication.

This study examined 1) associations between parent-adolescent acculturation gaps in Americanism and Hispanicism and adolescents' lifestyle behaviors (fruit and vegetable intake and physical activity), and 2) the moderating roles of adolescent- and parent-reported family communication on these associations. Hispanic adolescents who have overweight or obesity (n=280; 52% female, 13.0±0.8 years old) and their parents (88% female, 44.9±6.5 years old) completed baseline measures on acculturation, family communication, weekly physical activity, and daily fruit and vegetable intake as part of their participation in a family-based health promotion efficacy trial. Acculturation gaps were calculated by taking the product of adolescent and parent scores for each subscale (Americanism and Hispanicism). We conducted multiple linear regression analyses with three-way interaction terms (e.g., parent Americanism x adolescent Americanism x family communication) to assess for moderation. Family communication significantly moderated the association between parent-adolescent acculturation gaps in Americanism and adolescent fruit and vegetable intake. For families with low adolescent-reported family communication, parent-adolescent discrepancies in Americanism were associated with lower adolescent fruit and vegetable intake whereas there were no significant associations for families with high family communication. There were no effects on weekly minutes of physical activity. Acculturation gaps in Hispanicism were not significantly associated with either outcome. Findings highlight the importance of parent-adolescent acculturation gaps and family communication on fruit and vegetable intake for Hispanic adolescents. Targeting parent-adolescent acculturation gaps for families with low levels of communication may be important to improve dietary behaviors in Hispanic adolescents, who are already disproportionately affected by obesity.

O9-2 Participants' and leaders' experiences of a family-based health promotion programme: A Healthy Generation

BackgroundFamily-based interventions may be a promising solution to increase children's physical activity, but there is a lack of knowledge on how to facilitate such interventions, specifically in socioeconomically disadvantaged areas. The aim of this study was to explore participants' and leader's experiences of the content and delivery of the family-based programme A Healthy Generation.MethodA Healthy Generation is a health-promoting programme, for families with children in grade 2 (8-9 years) including siblings. Intervention components are: activity sessions, parental support groups, healthy meals and health information. The programme is delivered twice a week for one school year in collaboration with local municipalities, health coordinators and a variation of invited sport organisations in socioeconomically disadvantaged areas. Data was collected through participant observations during activity sessions, interviews with leaders (n = 11), and four focus groups with parents (n = 27) who had participated in the programme. Data was transcribed verbatim and analysed using content analysis.ResultsLeaders' and participants' experienced the programme to have an appealing ?Family-concept for joy, activity and integration?. The variation of activities provided opportunities and challenges to new interests, and the family approach were perceived as valuable for parental engagement and integration. To be ?A suitable programme for all participants?, activities directed to whole families needed to be simple and fun to keep all participants engaged, but also provide a progression for learning. Free and locally situated activities, meals and equipment for whole families facilitated participation, whereas lack of time and socio-cultural differences were barriers. The programme delivery consisted of ?A fruitful leadership collaboration? where health coordinators played an important role as coordinators of a heterogeneous group, so the invited leaders could focus on the content of their sport. They also provided participants with continuity and important reminders for participation during and in-between activity sessions.ConclusionsParticipants' and leaders' experiences of a family-based health promoting programme give insight to the importance of local involvement, collaborative leadership and a well-adjusted family programme for health promotion. The study also draws attention to opportunities and barriers for increased integration through health promotion aimed at families in socioeconomically disadvantaged areas.

Effective and resource efficient strategies for recruiting families in physical activity, sedentary behaviour, nutrition, and obesity prevention research: A systematic review with expert opinion

Background: The recruitment of participants into intervention research has been notoriously difficult for research teams around the world, where many researchers fail to recruit 100% of their target sample size within their pre-agreed timescale. The recruitment of families into experimental research projects is also challenging, yet there has not been a comprehensive assessment of how to recruit families to family-based health promotion research. Therefore, we systematically identified effective and resource-efficient strategies for recruiting families into health promoting intervention research. Methods: Four databases were searched for published reviews. Intervention studies were extracted from included reviews. Subsequently, a Delphi study was conducted with 35 experts in relevant family-based research. We assessed extracted data from our review and Delphi participants’ opinions by collating responses into overarching themes based on recruitment setting and recruitment strategies to identify effective and resource-efficient strategies for recruiting families into intervention research. Results: A total of 64 articles (n = 49 studies) were included. Data regarding recruitment duration (33%), target sample size (32%), reach (18%), expressions of interest (33%), and enrolment rate (22%) were scarcely reported. Recruitment settings (84%) and strategies (73%) used were available for most studies. However, the details were vague, particularly regarding who was responsible for recruitment or how recruitment strategies were implemented. The Delphi showed recruitment settings and strategies fell under 6 themes: school-based, print/electronic media, community settings-based, primary care-based, employer-based, and referral-based strategies. The most common recruitment setting was in schools and the most common recruitment strategies were passive strategies (e.g., sending letters). Of the Delphi participants, 62% reported under-recruitment in their most recent family-based experimental study. Discussion: Under-recruitment in family-based trials is a major issue. Moreover, most studies applied similar recruitment strategies, predominantly through schools, despite known challenges of recruiting in schools. Our findings suggest that researchers should employ a multifaceted recruitment approach that targets adults and children and provides potential participants with repeated exposure to study information. Reporting on recruitment can also be improved by better adherence to existing guidelines. Improved reporting around effectiveness of recruitment will give future researchers the ability to better budget their time, resources, and provide greater confidence in meeting their target sample size. Future research should investigate the estimated cost of recruiting families into trials; as well as more sophisticated and innovative research strategies (e.g., consulting experts in data science, marketing, advertising, graphic design, social media). Conflict of interest: We have no conflicts of interest to declare.

Systematically developing a family-based health promotion intervention for women with prior gestational diabetes based on evidence, theory and co-production: the Face-it study

BackgroundWomen with prior gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes; however, this risk can be reduced by engaging in positive health behaviours e.g. healthy diet and regular physical activity. As such behaviours are difficult to obtain and maintain there is a need to develop sustainable behavioural interventions following GDM. We aimed to report the process of systematically developing a health promotion intervention to increase quality of life and reduce diabetes risk among women with prior GDM and their families. We distil general lessons about developing complex interventions through co-production and discuss our extensions to intervention development frameworks.MethodsThe development process draws on the Medical Research Council UK Development of complex interventions in primary care framework and an adaptation of a three-stage framework proposed by Hawkins et al. From May 2017 to May 2019, we iteratively developed the Face-it intervention in four stages: 1) Evidence review, qualitative research and stakeholder consultations; 2) Co-production of the intervention content; 3) Prototyping, feasibility- and pilot-testing and 4) Core outcome development. In all stages, we involved stakeholders from three study sites.ResultsDuring stage 1, we identified the target areas for health promotion in families where the mother had prior GDM, including applying a broad understanding of health and a multilevel and multi-determinant approach. We pinpointed municipal health visitors as deliverers and the potential of using digital technology. In stage 2, we tested intervention content and delivery methods. A health pedagogic dialogue tool and a digital health app were co-adapted as the main intervention components. In stage 3, the intervention content and delivery were further adapted in the local context of the three study sites. Suggestions for intervention manuals were refined to optimise flexibility, delivery, sequencing of activities and from this, specific training manuals were developed. Finally, at stage 4, all stakeholders were involved in developing realistic and relevant evaluation outcomes.ConclusionsThis comprehensive description of the development of the Face-it intervention provides an example of how to co-produce and prototype a complex intervention balancing evidence and local conditions. The thorough, four-stage development is expected to create ownership and feasibility among intervention participants, deliverers and local stakeholders.Trial registrationClinicalTrials.gov NCT03997773, registered retrospectively on 25 June 2019.

An Examination of COVID-19-Related Stressors among Parents.

The circumstances of the COVID-19 pandemic have taken a psychological toll on parents. Thus, understanding the impact of these contextual stressors on parents is important to help inform the development of family-based health promotion interventions. The present study examined parents’ perception of various sources of stress resulting from the COVID-19 pandemic. Participants (N = 294) completed an open-ended question about their primary source of stress during the pandemic, which we coded into one or more of the following categories: family, work, health, and finance. We used chi-square tests to determine whether gender, marital status, financial strain, and education level were significantly related to each of the four primary sources of stress. We found that female, married, and financially strained participants were more likely to report family-related stressors. Further, we found that participants who expressed concern over health-related stressors were more likely to have pre-existing health conditions. Finally, we found that single participants were more likely to express concerns over financial stressors. Our findings shed light on parental concerns following the pandemic and inform new research directions, clinical approaches, and policy issues at the individual, community, and societal levels.

A Qualitative Study of Stress and Coping to Inform the LEADS Health Promotion Trial for African American Adolescents with Overweight and Obesity.

The purpose of this study was to conduct in-depth individual interviews with 30 African American adolescents with overweight and obesity and their families (caregiver/adolescent dyads) to gain a better understanding of how to integrate stress and coping essential elements into an existing family-based health promotion program for weight loss. Interview data from 30 African American adolescents with overweight and obesity (Mage = 15.30 ± 2.18; MBMI%-ile = 96.7 ± 3.90) were transcribed and coded for themes using inductive and deductive approaches by two independent coders. Inter-rater reliability was acceptable (r = 0.70–0.80) and discrepancies were resolved to 100% agreement. The themes were guided by the Relapse Prevention Model, which focuses on assessing barriers of overall coping capacity in high stress situations that may undermine health behavior change (physical activity, diet, weight loss). Prominent themes included feeling stressed primarily in response to relationship conflicts within the family and among peers, school responsibilities, and negative emotions (anxiety, depression, anger). A mix of themes emerged related to coping strategies ranging from cognitive reframing and distraction to avoidant coping. Recommendations for future programs include addressing sources of stress and providing supportive resources, as well as embracing broader systems such as neighborhoods and communities. Implications for future intervention studies are discussed.

Screen-time during the after-school period: A contextual perspective

Sedentary screen-time is an increasingly prevalent behaviour, associated with a range of adverse health outcomes. Sedentary time and screen-use increase during adolescence, making this age group a prime target for behaviour change interventions. Better understanding the context in which sedentary screen-behaviours occur is important for ensuring future interventions have maximum impact. This study aimed to describe the prevalence of adolescents' sedentary screen-time in the after-school and weekday evening periods, and to examine associations between contextual factors (location within the home and who they were with) and after-school/evening screen-time. Time that UK adolescents (N=204, aged 11 or 12years, 61.4% girls) spent using various screens was measured using a detailed three-day time-use diary completed at home. Adolescents reported the start and end time for each screen-based activity, where they were, and who they were with. Weekday (Monday-Friday) data were analysed with a focus on the after-school (3-6pm) and evening periods (6-10.45pm). Young adolescents spend around a third of their weekday evening leisure-time using screens, with boys engaging in slightly more screen-use than girls. The majority of after-school and weekday evening time at home was spent with family or siblings, with less than 1% spent with friends. Adolescents who spent more time alone after school reported greater screen-use. Greater time spent at home, in the lounge (living room) or bedroom was associated with greater screen-use. These findings highlight the value of devising family-based health-promotion interventions which target after-school/leisure-time screen-use in an effort to reduce young adolescents' sedentary recreational screen-time behaviours.

Model-Based Family Health Promotion To Improve The Quality Of Life Of Children Aged 2-4 Years

Children aged 2-4 years are a golden period as a basis for the next development. Because the primary care role of children under five is by families, it is necessary to do family-based health promotion. Model health promotion information-motivation-behavioral skills s implemented in the form of family assistance activities. Namely the family assistance model by providing information, motivation, and examples of behavioral skills in parenting children under five.&#x0D; The purpose of this research is knowing the effectiveness family-based model of health promotion models in formation-motivation-behavioral (IMB) skill s to the quality of life for toddlers 2-5 years. Pure design experiment using Randomized Controlled Trial with pre-post test with a single-blind control group. The research subjects are toddlers aged 2-4 years many 60, who meet the criteria have significant congenital abnormalities and not multiple. The instrument of this study is a Guide to family-based health promotion models, with the research instrument being the Pediatric Quality of Life Inventory (PedsQL ™) Questionnaire.&#x0D; The health promotion model of information-motivation-behavioral skills (IMB) is carried out in the form of family mentoring activities to improve the quality of life of children aged 2-4 years ( p-value0,000). The average enhancement child's quality of life score, more large ( mean difference 16.90, p-value 0,000 ) in the group experiment ( IMB Model ) compared the control group. External variables that affect the quality of life of children aged 2-4 years are income and parenting parents.

Development of rabies eradication package, a family-based health promotion media to prevent rabies in Buleleng, Bali, Indonesia

Background : Rabies occurred in Bali since 2008, and in 2017 rabies cases were still found in Bali, including in Buleleng Regency. Prevention of rabies in Bali must involve the participation of the community especially family, which is in direct contact with dogs. This study aims to develop family-based health promotion media, which is later called as the rabies eradication package, to overcome rabies in Buleleng, Bali.Methods:Â This study uses the research and development (R&amp;D) method. which consists of 5 phases, namely analysis, design, development, implementation and evaluation. at the implementation and evaluation stage researchers used a quasi-experimental approach. The total number of samples used was 100 families taken from 2 villages. The variables measured were the level of knowledge and attitudes towards prevention of rabies. data analysis using the Mann-Whitney U test.Result : Â Â This study develop rabies eradication package as a family-based health promotion media. This package consists of a rabies eradication book, a dog vaccination card, a medical history cards and bite wound treatment tools. Of the 100 respondents in the study sample, 50 respondents who were included in the treatment group, which received a rabies eradication package for 1 month, experienced a significant increase in knowledge (p &lt;0.001) and attitudes (p &lt;0.001) in prevention of rabies compared to the control group.Conclusion : Rabies eradication package can be used as a family-based health promotion media to increase rabies prevention efforts because it can increase knowledge and attitudes in preventing rabies

Project SHINE: effects of a randomized family-based health promotion program on the physical activity of African American parents.

This study examined the effects of a family-based health promotion intervention on the moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior, and fruit and vegetable intake of African American parents. Eighty-nine African American parents (41.5 ± 8.5years; 92% females; 74% obese; 64% < $40K income) and adolescents (12.5 ± 1.4years; 61% girls; 48% obese) were randomized to a 6-week behavioral skills plus positive parenting and peer monitoring intervention grounded in social cognitive, self-determination, and family systems theories or a general health comparison program. Parents wore accelerometers for 7days and completed three 24-h dietary recalls at baseline and post-intervention. Multilevel regression models (controlling for baseline variables) demonstrated a significantly greater increase in parent MVPA for those in the intervention versus comparison condition (b = 9.44, SE = 4.26, p < 0.05). There were no other significant effects. Family-based approaches that include African American parents and youth may increase parent MVPA and hold promise for preventing chronic diseases.

가족기반 건강증진 프로그램 참여가 소아청소년의 비만도, 체력수준 및 대사성질환 위험요인에 미치는 영향

본 연구는 소아청소년의 가족기반 건강증진 프로그램 참여가 비만도, 체력수준, 대사성질환 위험요인의 개선 효과를 규명하는데 목적이 있다. 연구대상은 32가족을 선정하였고, 총 16주간 주 1회 J대학교 체육관에서 운동프로그램과 교육프로그램으로 구성된 가족기반 건강증진 프로그램을 진행하였다. 가정 운동프로그램은 개인별 운동처방에 맞추어 매주 3회 이상 자율적으로 수행하였고, 건강생활습관 수행 일지를 작성하였다. 건강증진 프로그램 참여 전, 후 소아청소년의 비만도가 감소하였고, 근력, 근지구력, 유연성, 심폐체력이 향상되었다. 또한 대사성질환 위험요인 중 수축기혈압, 총콜레스테롤, 저밀도지단백콜레스테롤이 통계적으로 유의하게 개선되었으며, 부모의 심폐체력이 향상되었다. 본 연구를 통해 가족기반 건강증진 프로그램 참여는 가족 모두의 건강증진에 긍정적 효과를 주는 것으로 나타났다. 결론적으로 가족이 함께 참여할 수 있는 다양한 건강증진 프로그램이 개발되어야 할 것을 제안한다.

Process Evaluation of the Project SHINE Intervention for African American Families: An Integrated Positive Parenting and Peer Monitoring Approach to Health Promotion.

This study describes the process evaluation of Project SHINE, a randomized family-based health promotion intervention that integrated parenting and peer monitoring for improving sedentary behavior, physical activity, and diet in African American families. Adolescent-parent dyads (n = 89) were randomized to a 6-week behavioral, positive parenting, and peer monitoring skills intervention or a general health education comparison condition. Process evaluation included observational ratings of fidelity, attendance records, psychosocial measures, and qualitative interviews. Results indicated that the intervention was delivered with high fidelity based on facilitator adherence (>98% of content delivered) and competent use of theoretically based behavior change and positive parenting skills (100% of ratings >3 on a 1-4 scale). Although only 43% of peers attended the "bring a friend" session, overall attendance was high (4.39 ± 1.51 sessions) as was the retention rate (88%). Parents in the intervention condition reported significant improvements in communication related to adolescents' engagement in health behaviors both on their own and with peers. These findings were supported by qualitative themes related to improvements in family communication and connectedness. This study provides an innovative example of how future family-based health promotion trials can expand their process evaluation approaches by assessing theoretically relevant positive parenting variables as part of ongoing monitoring.

Abstract 19765: Barriers to Implementation of a Health Promotion Program in Harlem, New York: The FAMILIA Study, an AHA Strategically Focused Research Network Study

Objective: The Harlem area of New York City has among the highest obesity and diabetes prevalence rates in the city. Nearly half of the children in the Head Start program and about 94% of adults are overweight or obese. We sought to identify factors that may impact the implementation of an integrated family-based health promotion program for children aged 3-5 years and their caregivers in Harlem. Methods: We conducted a qualitative study consisting of 5 focus group discussions (FGD) at two Head Start preschool centers in Harlem, NY. The FGDs included the following participants: parents, teachers, directors, educational directors, nutritionists, cooks, health, mental health and social service professionals. Content analysis of the transcript and notes was performed to identify salient themes. Relationships between and among themes were formulated. Findings: Twenty-five individuals participated in the FGDs. Seven themes emerged as potential barriers to program implementation. Program implications and specific strategies to address them were generated (Table). Conclusions: Formative work prior to program implementation has revealed important, actionable issues that will be addressed during the intervention period. This type of approach may be useful for other health promotion programs in similar settings.

Health promotion interventions to prevent early childhood human influenza at the household level: a realist review to identify implications for programmes in Hong Kong.

To identify factors affecting the delivery of health promotion interventions to prevent early childhood human influenza at the household level. Yearly, influenza epidemics seriously affect all age groups, particularly those with weakened immune systems, including children. Influenza is transmitted easily from person to person through droplet and direct contact. Maintaining personal hygiene, avoiding close contact with the infected person and proper hand washing are recommended as the most effective means of preventing the transmission of influenza. However, it is not clear what programme-related mechanisms and contexts are crucial to the successful delivery of interventions in the home. This study systematically reviewed published research studies to identify factors influencing the effective delivery of health promotion programmes targeting influenza in a household. Realist review. A realist review methodology was selected to examine what interventions are effective in preventing and managing influenza at the household level and in what circumstances. A structured search of the peer-reviewed primary research literature was undertaken using a defined search protocol. Eight studies were retrieved for the analysis. Mechanisms impacting on intervention delivery were identified, including timing of implementation, programme reach, organisational and healthcare worker involvement, mode and place of delivery, contact with infected person, health practice compliance and sustainability at home. These findings suggest contextual factors that could be identified through ecological approaches to health promotion that are crucial for policymakers to consider when designing interventions. The active involvement of community nurses through an integrated household visiting programme may help to better deliver family-based health promotion interventions to prevent illnesses such as influenza in children.