Guide Health Promotion Efforts Research Articles

Bringing ethical thinking to social change initiatives: Why it matters

ABSTRACT Norms-shifting interventions (NSI) seek to improve people’s well-being by facilitating the transformation of harmful social norms, the shared rules of acceptable actions in a group that prop up harmful health behaviours. Community-based NSI aim for incremental normative change and complement other social and behaviour change strategies, addressing gender, other inequalities, and the power structures that hold inequalities in place. Consequently, they demand that designers and implementers–many who are outsiders-grapple with power, history, and community agency operating in complicated social contexts. Ethical questions include whose voices and values, at which levels, should inform intervention design; who should be accountable for managing resistance that arises during implementation? As interest and funding for NSI increases in lower and middle-income countries, their potential to yield sustained change is balanced by unintentionally reinforcing inequities that violate human rights and social justice pillars guiding health promotion efforts. A review of 125 articles on ethical considerations in public health, social justice, and human rights–where NSI actions intersect–indicated little guidance on practice. To begin to address this gap, we propose ten ethical values and practical ways to engage ethically with the social complexities of NSI and the social change they seek, and a way forward.

Sudden Infant Death Syndrome and Safe Sleep on Twitter: Analysis of Influences and Themes to Guide Health Promotion Efforts.

BackgroundIn the United States, sudden infant death syndrome (SIDS) is the leading cause of death in infants aged 1 month to 1 year. Approximately 3500 infants die from SIDS and sleep-related reasons on a yearly basis. Unintentional sleep-related deaths and bed sharing, a known risk factor for SIDS, are on the rise. Furthermore, ethnic disparities exist among those most affected by SIDS. Despite public health campaigns, infant mortality persists. Given the popularity of social media, understanding social media conversations around SIDS and safe sleep may assist the medical and public health communities with information needed to spread, reinforce, or counteract false information regarding SIDS and safe sleep.ObjectiveThe objective of our study was to investigate the social media conversation around SIDS and safe sleep to understand the possible influences and guide health promotion efforts and public health research as well as enable health professionals to engage in directed communication regarding this topic.MethodsWe used textual analytics to identify topics and extract meanings contained in unstructured textual data. Twitter messages were captured during September, October, and November in 2017. Tweets and retweets were collected using NUVI software in conjunction with Twitter’s search API using the keywords: “sids,” “infant death syndrome,” “sudden infant death syndrome,” and “safe sleep.” This returned a total of 41,358 messages, which were analyzed using text mining and social media monitoring software.ResultsMultiple themes were identified, including recommendations for safe sleep to prevent SIDS, safe sleep devices, the potential causes of SIDS, and how breastfeeding reduces SIDS. Compared with September and November, more personal and specific stories of infant loss were demonstrated in October (Pregnancy and Infant Loss Awareness Month). The top influencers were news organizations, universities, and health-related organizations.ConclusionsWe identified valuable topics discussed and shared on Twitter regarding SIDS and safe sleep. The study results highlight the contradicting information a subset of the population is exposed to regarding SIDS and the continued controversy over vaccines. In addition, this analysis emphasizes the lack of public health organizations’ presence on Twitter compared with the influence of universities and news media organizations. The results also demonstrate the prevalence of safe sleep products that are embedded in safe sleep messaging. These findings can assist providers in speaking about relevant topics when engaging in conversations about the prevention of SIDS and the promotion of safe sleep. Furthermore, public health agencies and advocates should utilize social media and Twitter to better communicate accurate health information as well as continue to combat the spread of false information.

Achieving Consensus on Principles of Good Practice for School Health in Independent Schools: A Delphi Study.

Although the 8 components of the coordinated school health (CSH) framework have been implemented to various degrees in the nation's public schools, principles of good practice (PGPs) to guide health promotion efforts in independent schools do not exist. The purpose of this study was to generate PGPs and rate their feasibility of implementation. A modified Delphi process was used to generate PGPs for school health in independent schools and develop consensus regarding their feasibility of implementation. A working group of 6 independent school health professionals (ISHPs) was convened to propose draft PGPs based on the CSH framework. The proposed PGPs were then reviewed by a national and geographically diverse expert panel of 10 school health researchers and 23 ISHPs that completed 3 Delphi rounds to achieve consensus on the PGPs. Of 33 participants originally invited to participate, 27 completed the Delphi process. A total of 27 panelists rated 67 PGPs, provided 399 comments, and achieved consensus using interquartile range on 56 (84%) of the proposed PGPs, 41 of which were rated feasible and 15 somewhat feasible. This study has generated empirical support for the feasibility of PGPs for school health in independent schools.

Use of population-referenced total activity counts percentiles to assess and classify physical activity of population groups

ObjectivesPopulation-referenced total activity counts per day (TAC/d) percentiles provide public health practitioners a standardized measure of physical activity (PA) volume obtained from an accelerometer that can be compared across populations. The purpose of this study was to describe the application of TAC/d population-referenced percentiles to characterize the PA levels of population groups relative to US estimates. MethodsA total of 679 adults participating in the 2011 NYC Physical Activity Transit survey wore an ActiGraph accelerometer on their hip for seven consecutive days. Accelerometer-derived TAC/d was classified into age- and gender-specific quartiles of US population-referenced TAC/d to compare differences in the distributions by borough (N=5). ResultsMales in Brooklyn, Manhattan, and Staten Island had significantly greater TAC/d than US males. Females in Brooklyn and Queens had significantly greater levels of TAC/d compared to US females. The proportion of males in each population-referenced TAC/d quartile varied significantly by borough (χ2(12)=2.63, p=0.002), with disproportionately more men in Manhattan and the Bronx found to be in the highest and lowest US population-referenced TAC/d quartiles, respectively. For females, there was no significant difference in US population-reference TAC/d quartile by borough (χ2(12)=1.09, p=0.36). ConclusionsThese results demonstrate the utility of population-referenced TAC/d percentiles in public health monitoring and surveillance. These findings also provide insights into the PA levels of NYC residents relative to the broader US population, which can be used to guide health promotion efforts.

P14.12 Nsw sexual health promotion

Background Sexual health promotion is central to the prevention of human immunodeficiency virus (HIV) and sexually transmissible infections (STIs) and to achieving the targets of the NSW HIV Strategy 2012–2015 and the forthcoming NSW STI Plan. In NSW sexual health promotion targeting young people is delivered by local health district HIV and Related Programs (HARP) Units, non-government organisations and state-wide services. In the past state level leadership and coordination of sexual health promotion has been limited, consequently many services have been working in isolation and delivering small scale programs with limited evaluation. Methods During 2014 the NSW Ministry of Health (MOH) undertook a review with the aim of strengthening the State’s response to sexual health promotion. The review involved a staged approach including: An evidence check of evidence-based practice in HIV, STI and viral hepatitis health promotion and Aboriginal community engagement; A review of data; Consultation with key stakeholders to map existing infrastructure and resources, current sexual health promotion work and to identify barriers and enablers for the services. Results The evidence check found patchy evidence to guide health promotion efforts. The review of current sexual health promotion across NSW identified a gap in state-wide prevention activity targeting young people aged 16 to 29 was. Young people have high notification rates for chlamydia, high rates of partner change and barriers to accessing health services. Conclusions In response to these findings MOH developed the NSW Sexual Health Promotion Framework for the delivery of an integrated population-based prevention program that aims to increase consistent condom use and health seeking behaviours (STI/HIV testing and treatment) among young people. The Framework also aims to reduce duplication, strengthen partnerships across the sector and enable robust evaluation and monitoring of program outcomes. Implementation of the Framework has commenced. Disclosure of interest statement Nil.

A Strategy by Which to Face the Future

Although the western world is the most technologically advanced civilization to date, it is also the most addicted, obese, medicated, and in-debt adult population in history. Experts had predicted that the 21st century would be a time of better health and prosperity. Although wealth has increased, our quest to quell health problems using a pathogenic approach without understanding the interconnectedness of everyone and everything has damaged personal and planetary health. While current efforts help identify and eliminate causes of problems, they do not facilitate the creation of health and well-being as would be done with a salutogenic approach. Sociologist Aaron Antonovsky coined the term salutogenesis in 1979. It is derived from salus, which is Latin for health, and genesis, meaning to give birth. Salutogenesis, the study of the origins and creation of health, provides a method to identify an interconnected way to enhance well-being. Salutogenesis provides a framework for a method of practice to improve health promotion efforts. This article illustrates how quality management methods can be used to guide health promotion efforts focused on improving health beyond the absence of disease.

Adapting and Using Quality Management Methods to Improve Health Promotion

Although the western world is the most technologically advanced civilization to date, it is also the most addicted, obese, medicated, and in-debt adult population in history. Experts had predicted that the 21st century would be a time of better health and prosperity. Although wealth has increased, our quest to quell health problems using a pathogenic approach without understanding the interconnectedness of everyone and everything has damaged personal and planetary health. While current efforts help identify and eliminate causes of problems, they do not facilitate the creation of health and well-being as would be done with a salutogenic approach. Sociologist Aaron Antonovsky coined the term salutogenesis in 1979. It is derived from salus, which is Latin for health, and genesis, meaning to give birth. Salutogenesis, the study of the origins and creation of health, provides a method to identify an interconnected way to enhance well-being. Salutogenesis provides a framework for a method of practice to improve health promotion efforts. This article illustrates how quality management methods can be used to guide health promotion efforts focused on improving health beyond the absence of disease.

What Do Public Housing Residents Say About Their Health?

Residents of public housing have poorer health indicators than comparably resourced individuals from the larger community. To identify major health concerns, issues, and barriers to health of community members living in public housing developments, especially as related to cardiovascular disease prevention. To identify similarities and differences between data collected using two methods to inform future health promotion programs and policies. Key informant interviews were conducted with resident leaders and analyzed qualitatively in eight housing developments. Results were compared with quantitative data collected from a resident health survey with a large sample that analyzed individual and development-level characteristics, major health concerns, and barriers. Several development-level characteristics were significantly associated with residents' health concerns and barriers, including development size, percentage of Spanish speakers, and presence of a tenant task force (TTF); important health promotion barriers included lack of resident engagement, inconsistency in programming, lack of knowledge of actions to prevent chronic disease, and lack of resources for health promotion. Safety-related health concerns were named as a priority. Multiple data collection methods can yield important data about community health priorities and barriers; areas of difference and similarity between methods are especially useful in guiding health promotion efforts and opportunities.

Knowledge of Cardiovascular Health Among Chinese, Korean and Vietnamese Immigrants to the US

Cardiovascular disease (CVD) is the leading cause of death among Asian Americans, the majority of whom are foreign-born. However, CVD and risk factor data is sparse for specific Asian immigrant populations. To assess knowledge and understanding of CVD and risk factors within Chinese, Korean and Vietnamese immigrant populations, we conducted eight focus groups of 77 participants between 36 and 84 years old. Participants correctly identified signs and symptoms for heart attacks while knowledge about stroke was incomplete. While poor diet, lack of exercise, older age, and high cholesterol were frequently discussed as risk factors, mechanisms perceived as contributing to heart disease were influenced primarily by non-Western paradigms. Non-Western remedies were discussed in detail among Chinese and Vietnamese participants. All participants desired more information, and identified barriers to effective communication with healthcare providers. A deeper understanding of beliefs and barriers faced by Asian immigrants can help guide health promotion efforts.

Physical Activity Patterns of American Indian and Alaskan Native People Living in Alaska and the Southwestern United States

Assessment of self-reported physical activity (PA) and effects on health measures. Cross-sectional analysis of baseline data from a cohort study. Education and Research Towards Health study participants from Alaska and the Southwestern United States enrolled from 2004 to 2007. Total of 10,372 American Indian and Alaskan Native people (AI/AN) of at least 18 years. Participants completed computer-assisted, self-administered questionnaires, and anthropometric and health measurements were taken of each participant. Analysis of variance, chi2 tests, and multiple linear regressions were used. Almost 23% of participants reported less than 30 minutes per week of moderate or vigorous activities. Half (49%) reported no vigorous activities. Characteristics associated with more time spent performing vigorous activity were male gender, age less than 40 years, higher income and education levels, and living in a rural area. Almost 70% of Alaskan participants and 36% of Southwest participants engaged in wild food-harvesting activities. Participants with higher levels of activity had significantly better clinical characteristics (high-density lipoprotein cholesterol, triglycerides, body mass index, and waist circumference). AI/AN people engage in many different physical activities, including traditional harvesting activities. Women had lower levels of PA than men, and participation in vigorous PA was associated with better clinical characteristics. These data can be used to guide health promotion efforts in AI/AN populations.

Testing the Feasibility of Developmental Asset Measures on College Students to Guide Health Promotion Efforts

The purpose of this investigation was to assess the reliability and validity of eight developmental asset measures among a stratified, random sample (N = 540) of college students to guide health promotion efforts. The sample was randomly split to produce exploratory and confirmatory samples for factor analysis using principal axis factoring and varimax rotation and structural equation modeling techniques. Items were retained on factors if they had high loadings greater than .40 and were not complex. Concurrent validity was examined among substance use (including alcohol and tobacco) and sexual risk-taking variables. Exploratory and confirmatory samples did not differ on demographics. Parallel analysis confirmed the eight theorized constructs. Exploratory factor loadings were greater than .40. Concurrently, validity analyses were in the predicted direction. Cronbach alphas were .70 or greater with the exception of the Future Aspirations asset. Preliminary analyses support the reliability and validity of measuring developmental assets among emerging adults. Implications and potential uses are discussed.

Guiding Health Promotion Efforts with Urban Inuit

Objective: To develop a community-specific perspective of health information sources and dissemination strategies of urban Inuit to better guide health promotion efforts.

Guiding health promotion efforts with urban Inuit: a community-specific perspective on health information sources and dissemination strategies.

To develop a community-specific perspective of health information sources and dissemination strategies of urban Inuit to better guide health promotion efforts. Through a collaborative partnership with the Tungasuvvingat Inuit Family Resource Centre, a series of key informant interviews and focus groups were conducted to gather information on specific sources of health information, strategies of health information dissemination, and overall themes in health information processes. Distinct patterns of health information sources and dissemination strategies emerged from the data. Major themes included: the importance of visual learning, community Elders, and cultural interpreters; community cohesion; and the Inuit and non-Inuit distinction. The core sources of health information are family members and sources from within the Inuit community. The principal dissemination strategy for health information was direct communication, either through one-on-one interactions or in groups. This community-specific perspective of health information sources and dissemination strategies shows substantial differences from current mainstream models of health promotion and knowledge translation. Health promotion efforts need to acknowledge the distinct health information processes of this community, and should strive to integrate existing health information sources and strategies of dissemination with those of the community.

Early termination of breast-feeding in periurban Santo Domingo, Dominican Republic: mothers' community perceptions and personal practices

The objectives of this study were to determine: 1) whether mothers' perceptions of typical community practice for breast-feeding duration influence their personal practices and 2) whether the mothers' reports of community reasons for terminating breast-feeding identify barriers not elicited through self-report. The study was conducted in 1997 in a sample of poor neighborhoods in a periurban district of Santo Domingo, the capital of the Dominican Republic. A representative sample of 220 mothers from these neighborhoods was interviewed with a structured questionnaire. While the duration of breast-feeding was similar for self-report and for mothers' perceptions of typical community practice, there was no statistically significant correlation between these two variables. "Mother-driven" reasons for early termination of breast-feeding, such as "fear of loss of figure or of breast shape" and "not wanting to breast-feed," were frequently perceived as community reasons but rarely given as personal reasons. Personal reasons were predominately "child-driven," including "the child not wanting the breast," or reasons beyond the mother's control such as having "insufficient" milk. Maternal report of community reasons for early termination may be a useful way to identify factors that would not otherwise be revealed on self-report. These additional reasons may guide health promotion efforts aimed at increasing breast-feeding duration.

To boil or not: drinking water for children in a periurban barrio

Boiling water, or other water purification methods, are common recommendations of health promoters in developing countries to improve the quality of drinking water in an attempt to decrease the incidence of childhood diarrhea. Health education programs frequently employ an approach based on knowledge deficits to promote this practice. However, there has been little published about water purification practices or associated variables such as knowledge deficits. We interviewed 266 randomly selected child caregivers about water purification in a poor periurban district of Santo Domingo, Dominican Republic. Though most reported that they provided purified drinking water for their children when they were babies, only half of the children five years of age and under were regularly drinking purified water at the time of the study. Only one knowledge variable remained significantly related to purifying drinking water in the final multivariate model. Other factors that remained in the final model were level of maternal education, endorsing being too tired to boil water and a global measure of social support. Several other hypothesized variables were not related to purifying water. Knowledge deficits may play only a limited role in determining this prevention practice. Further work is required to better identify key factors to improve this practice and hence guide health promotion efforts.

HIV/AIDS prevention for migrants and ethnic minorities: three phases of evaluation

There are now a number of HIV/AIDS prevention programmes for migrant and ethnic minority communities throughout the world, both ‘top down’ programmes organised, for example, by governments and large NGOs, and ‘bottom up’ programmes, organised by migrant groups themselves. Evaluation of such programmes, however, is in most cases sorely lacking. The Swiss ‘Migrants Project’ is, to the authors’ knowledge, the only such programme to have been systematically accompanied by evaluation throughout. This paper describes three phases of evaluation of the Migrants Project (exploratory studies, process, and outcome evaluations). The evaluations have highlighted the need for culturally and linguistically appropriate prevention efforts which use already-existing community structures, as well as the need to identify and train people from within communities to carry out local prevention efforts. Outcome evaluation has shown that: a government sponsored HIV/AIDS prevention programme can meet with acceptance by migrant communities; considerable engagement in prevention activities can be mobilised; and AIDS prevention among such communities can be effective. Such efforts can create levels of sensitivity to HIV issues and of protective behaviour that are equal to those of the host country population. The strategy adopted by the programme is thus supported. Key elements are to avoid potential for stigmatising by: (1) placing HIV/AIDS prevention efforts for migrant populations within an overall national HIV/AIDS prevention strategy; (2) informing and sensitising general populations within migrant communities before initiating more targeted prevention with migrant IDUs, MSM, and CSWs; (3) encouraging, facilitating and guiding health promotion efforts which emerge from within migrant communities themselves.