Health Promotion Programs Research Articles

Exploring the policy context of Whole School in eight EU countries: the Schools4Health project

Abstract Background Moving from the recognition of WHO principles of health promoting school (HPS) to concrete practices is challenging. The Schools4Health project is an EU initiative with the aim to introduce, strengthen, and sustain the adoption of a participatory whole-school approach to health and wellbeing. The aim of this work is to present an update about the policy environment around HPS approaches in eight EU countries. Methods Between September-November 2023, Schools4Health partners from Spain, Belgium, Hungary, Greece, Latvia, the Netherlands, Romania and Slovenia carried out a preliminary scoping exercise to investigate the policy conditions which can influence the national uptake of HPS approaches. A three-step methodology was developed: a. identification of core stakeholders b. Rapid Situation Analysis survey and c. national roundtable meetings, to assess stakeholders’ awareness of and engagement in health promotion programs in schools. Results In total, n = 192 responses from stakeholders from health, education, social and agricultural sectors were selected. Most experts were aware or partly aware of the HPS concept. While there is consensus that health promotion at school is essential, there is a lack of, or weak implementation of legislation and voluntary initiatives due to barriers such as limited time and financial resources, teachers burnout and insufficient interaction between education and health governmental bodies. Conclusions Effective advocacy can highlight the potential of HPS in addressing the urgent challenges related to wellbeing in youth, and the associated decline in educational performance across Europe. Policymakers, public authorities and the broader community should also be engaged. Key messages • Creating HPSs should not solely fall on schools and teaching staff. • Policymakers, public authorities and the broader community around schools have responsibility to ensure that policy measures and instruments embed the key considerations for HPS approach.

Adapting a cultural dance program to prevent cognitive decline: insights from experts and educators

Abstract Leveraging activities such as cultural dance shows promise as an effective basis for chronic disease prevention and management with at-risk populations. In fact, recent WHO reports and resolutions advocate utilizing cultural context to achieve health equality. Hula, the Native Hawaiian indigenous dance has been successfully utilized in interventions with statistically significant improvement in medication resistant hypertension management and heart disease prevention. In this study, Alzheimer’s Disease and Related Dementia (ADRD) experts and kumu hula (hula experts and educators) provide insights to developing a hula-based lifestyle program for prevention of cognitive decline. Informant interviews were used to collect information for developing a hula-based program for individuals with mild cognitive impairment from 4 ADRD experts and clinicians, and 4 kumu hula. The 60-90 minute semi-structured interviews were conducted, recorded, then transcribed. Separate thematic analysis allowed distinct themes for each group to emerge. Themes with greatest between group alignment informed the adaptation of an existing hula-based chronic disease intervention. The clinical and cultural experts were unanimous on multiple themes. First, a hula-based program was well positioned to promote social functioning. Second, hula facilitated integrated multi-dimensional benefits including physical, cognitive, social, and cultural. Third, facilitating learning included: repetition done in creative forms; utilization of aids such as dance notation and audio recordings; and educational approaches such as project-based learning. Cultural activities such as dance have been underutilized in health promotion initiatives. A significant challenge in health promotion programs is engagement and retention of participants. Cultural dance programs are popular and can be effective interventions, particularly when both clinical and cultural experts are engaged in program development. Key messages • Inclusion of clinical and cultural experts in health promotion program development leads to unique collaboration and impactful insights. • ADRD clinicians and Hawaiian cultural dance educators identify social, cultural, physical, and cognitive benefits of hula as instrumental for individuals with mild cognitive impairment.

Association between objectively-measured sleep duration and early cardiac and hepatic imaging changes in adolescents: insights from the EnIGMA study

Abstract Introduction Inadequate sleep duration (SD) has been associated with adverse cardiovascular (CV) events in adults and adiposity in all life stages. Furthermore, previous cross-sectional studies have shown a possible association between self-reported SD and cardiac structural alterations as detected with echocardiography and cardiovascular magnetic resonance (MR), even in young healthy people. However, there is a lack of longitudinal studies demonstrating an association between objectively-measured SD and structural cardiac alterations. Purpose To assess the association between SD and MR-derived cardiac and hepatic parameters in adolescents. Methods This study used longitudinal data collected as part of the SI! Program for Secondary Schools trial in Spain (2017-2021), which enrolled 1326 participants (mean age: 12.5±0.5 years at baseline). Measurements were taken at three different time-points: baseline, 2-year follow-up and 4-year follow-up. SD and physical activity were assessed by accelerometry for seven consecutive days at each follow-up. The participants were offered to undergo a MR scan in the final follow-up as part of the Early imaging markers of unhealthy lifestyles in adolescents (EnIGMA) study. The imaging protocol included a cine SSFP to provide images for chamber size and function, myocardial tagging acquisitions to assess myocardial strain, T1 and T2 mapping sequences to provide precise myocardial relaxation time properties, and a liver mDixonQuant sequence to obtain liver fat content, using a 3-T scanner. The cumulative effect of the independent variable (SD) and the covariates was assessed using the area under the curve (AUC) method, calculating the integral of the curve parameters during the follow-up period for each subject. To facilitate interpretation, AUC values were divided by the years of follow-up. The participants were included in the analysis if they had available data for SD in at least 2 of the 3 time-points. The association between SD and the MR parameters was assessed by linear regression models. Results 109 participants (61 girls [56.0%]; mean age=16.0±0.5 years) were included in this study. Indexed left ventricular (LV) mass, as well as indexed end-diastolic biventricular volumes were higher in boys than in girls (Figure 1). SD AUC (hours/day) was independently and inversely associated with indexed LV mass and liver fat fraction in the unadjusted and adjusted (age, gender, physical activity, body mass index percentile, and systolic and diastolic blood pressure percentiles AUCs) models (Figure 2). There were no significant associations between the SD AUC and other MR-derived parameters. Conclusion Shorter SD is independently associated with initial stages of cardiac remodeling and liver fat accumulation as assessed with state-of-the-art MR as early as in adolescence. Considering these results, health promotion programs should be implemented early in life emphasizing the importance of good sleep habits.Participant characteristicsAssociation between SD and MR

Cost per kilogram weight-lost - Lifestyle change program at the Public Health Institute in Croatia

Abstract According to the 2019 European Health Survey, 42% and 23% of the Croatian adult population were affected by overweight or obesity, respectively. Counselling services are available in some Public Health Institutes for free or paid out-of-pocket. The estimated cost per kilogram lost in programs in Europe and the USA ranges from 100-340€, with a justifiable cost estimation for a weight loss intervention being 120-210€. Aim was to demonstrate the cost of losing one kilogram by analysing necessary initial material and human resources, including equipping counselling centres, and estimating the cost of continuous implementation. In the year 2023, 47 participants (31F,10M) with a BMI higher than 30 kg/m2 enrolled in the three-month free Program in the County Public Health Institute in Pozega. The program consisted of personalized assessment, habit change plan, education, counselling and follow-up. An analysis of the minimal required equipment and working hours of physician and a nurse (contracted gross hourly wage rates) was conducted. The main outcome measure was the cost of one kilogram lost by participants at the end of the Program. Program was completed by 41 (22F, 9M) participants (87.2%). Their initial BMI ranged from 30.3 to 47.4 kg/m2. Collectively, they lost 323.2 kg (1.3-24.4kg), with an average of 7.9 kg or 7.4% (1.7-19.8%) of their initial weight lost. The estimated total cost of medical, IT and office equipment, was 9363€. The human resources cost was 9509€, with a specialist and nurse spending 249 and 116 hours, respectively (27.6€/hour and 13€/hour). The initial cost per kilogram lost, including the prerequisites for the work of the counselling centre, was 58.4€. The continuous program cost with equipment already in place is estimated at 27.9€ per kilogram lost. We have shown that the lifestyle management program in the Croatia without extra cost to patients delivers results with a cost of 27.9€ per kilogram weight-lost in continuous implementation. Key messages • The significant impact of obesity on premature mortality and healthcare systems calls for the systematic implementation of effective weight management programs that are available to patients for free. • It is possible to implement effective weight management program in Croatia without extra cost to patients for 27.9 € per kilogram weight-lost.

Visualizing patterns of factors influencing school health promotion implementation

Abstract Background The school setting offers a special opportunity for health-promotion (HP) interventions, as children spend 1/3 of their daily time there. Yet, implementing HP remains challenging due to the complexity of schools and unique contextual factors influencing implementation. While common influencing factors have been described, the aim of this study is to explore how influencing factors co-occur within and vary across schools, forming potential patterns of barriers and facilitators. Methods As part of a school HP program involving 258 institutions across Germany, nine schools were selected using maximum heterogeneity sampling for in-depth interviews on influencing factors by employing the Consolidated Framework for Implementation Research (CFIR). The interviews were transcribed verbatim and analyzed deductively using the CFIR as category system. Identified influencing factors were quantified [-5; +5] whether being a major barrier (-5) or a major facilitator (+5). To visualize potential patterns, a matrix heat map (MHM) displaying all influencing factors across all schools was created. Preliminary results Influencing factors in almost all CFIR categories were identified and all schools reported factors as barriers, such as parental engagement or (in)sufficient time. From the MHM, patterns of influencing factors, co-occurring within and differing across schools, emerged. For instance, some schools found the physical environment to be a barrier, while others considered it a facilitator, often in conjunction with financing as another facilitator. Conclusions Qualitative analysis and visualization of results with a MHM served as a way to navigate the complexity of the school setting and to highlight patterns of factors influencing implementation. Understanding these patterns can enhance tailoring implementation strategies, thereby improve implementation of school HP interventions and, ultimately, foster child health outcomes. Key messages • Influencing factors for school HP implementation manifest in varied patterns of barriers and facilitators across schools, which has implications for tailoring implementation strategies. • Using qualitative analysis guided by the CFIR and a MHM for visualization can aid in navigating the complexity of schools.

The Workplace Health Promotion project in an Italian manufacturing

Abstract Introduction The Workplace Health Promotion (WHP) program aims to improve employee’s health and well-being in the workplace by intervening in lifestyles. The objective of our study was to assess the impact of the WHP promoted by the Local Health Authority Tuscany South-East at a manufacturing. Methods The program was set at the STOSA Company in Radicofani (Siena, Italy) between 31 May 2017 to 31 December 2021, with a one-year interruption due to the COVID-19 pandemic. Based on an assessment of the workers’ health status, we identified nutrition and fighting smoking as areas of intervention. The WHP project was integrated into the company policy and targeted all staff. Evaluation of interventions was conducted using an anonymous paper questionnaire (Regional Decree no. 1565, Annex 3) administered in three moments: at the beginning of the project (T0), one year later (T1), and at the end (T2). We conducted a descriptive and inferential analysis (chi-square test) with R. Results We collected 131 (T0), 136 (T1), and 123 (T2) responses. The cohort is composed entirely of males (T0 M:F 122:8, T1 130:6, T2 109:14). The median age is 40 years (SD 8.24 (T2)). There is a statistically significant difference in the perception of health status by education (p<.001), type of work (p<.001), smoking habit (p<.001), and the change in smoking habit (p<.001). The whole sample positively evaluated the interventions on nutrition and fighting to smoke. Moreover, the entire sample reported improvements in their diet since the beginning of the project. Conclusions The COVID-19 pandemic caused difficulties in carrying out the project and possible changes in workers’ lifestyles. However, positive outcomes were observed in the targeted areas. The company has evaluated positively the WHP’s project and decided to maintain the good practices acquired. Key messages • The workplace represents a privileged setting to promote healthy lifestyles and prevent non-communicable diseases. • Collaborations between health authorities and other sectors are strategic to reach the general population.

Artificial intelligence to predict estimates of physical activity in small geographic areas

Abstract Background Artificial intelligence (AI) predictive models have been used to estimate the risk of a certain outcome occurring, using all available variables. Methods Using AI methods we have developed a small area estimation (SAE) technique to estimate the prevalence of leisure-time physical activity (LTPA), or who practices 150 minutes of LTPA per week, in small areas, in Belo Horizonte, Brazil, between 2009 and 2018, by the usage of k-means clustering. The VIGITEL, national telephone survey of Risk Factors for non-communicable diseases, was the main source. We applied available data to estimate prevalence of LTPA in 3300 census tracts, aggregated in 150 Primary Health Care (PHC) areas. The prevalence of PA was analyzed between two time periods, due to the low number of census tract interviews. With the available data, we estimate vulnerability clusters, derived from a Health Vulnerability Index (IVS), for the city of Belo Horizonte, according to socioeconomic, sanitation and health indicators, which measure the percentage of the population living in areas of vulnerability in the city. The index main purpose is to support public policy implementation. Results Nine clusters were identified according to the Silhouette coefficient analysis, i.e.: low (LO-0, LO-1), medium (ME-0, ME-1), high (HI-0, HI-1, HI-2) and very high) vulnerability (VH-0, VH-1. The prevalence of physical activity ranged from 23.7% (worst prevalence), in area of high vulnerability cluster (VH-1) to 45.5% in a low-risk cluster (LO-1) in period from 2009 to 2014. The prevalence of physical activity increased to 31.4% (high vulnerability cluster) to 52.81% (low-risk cluster) from 2014 to 2018. Conclusions The use of AI to estimate the prevalence of physical activity in small areas proved to be effective and highlighted important differences in the city. Thus, national surveys, with a small number of interviews per census sector, can be used to predict risks and health outcomes for small areas. Key messages • The study highlights the importance of using artificial intelligence to predict estimates of risk factors for chronic non-communicable diseases in small geographic areas. • The study showed less physical activity (PA) in areas of greater vulnerability. This can support health promotion policies and programs that encourage PA.

Community Paramedicine Program in Social Housing and Health Service Utilization

Community Paramedicine at Clinic (CP@clinic) is a chronic disease prevention program that decreases 911 calls for emergency medical services, but its wider system effects are unknown. To evaluate the effects of CP@clinic vs usual care on individual-level health service utilization outcomes. This open-label, pragmatic cluster randomized clinical trial evaluated all residents 55 years or older in 30 social housing buildings in Ontario, Canada, that had (1) a unique postal code, (2) at least 50 apartments, (3) 60% or more residents 55 years or older, and (4) a similar building for pairing (15 intervention and 15 control buildings, pair-matched randomization). The 12-month intervention had a staggered start date from January 1, 2015, to December 1, 2015, and ended between December 31, 2015, and November 30, 2016. Administrative health data analysis was conducted in May 2022. CP@clinic was a health promotion and disease prevention program led by specially trained community paramedics who held weekly drop-in sessions in social housing buildings. These paramedics conducted 1-on-1 risk assessments, provided health education and referrals to relevant community resources, and, with consent, sent assessments to family physicians. Control buildings received usual care (universal health care, including free primary and specialty medical care). Individual-level health service utilization was measured from administrative health data, with ED visits via ambulance as the primary outcome; secondary outcomes included ED visits for any reason, primary care visits, hospitalizations, length of hospital stay, laboratory tests, receipt of home care, transfer to long-term care, and medication initiation. Generalized estimating equations were used to estimate intervention effects on individual-level health service utilization, accounting for trial design and individual-level baselines. The 30 social housing buildings had 3695 residents (1846 control and 1849 intervention participants; mean [SD] age, 72.8 [9.1] years; 2400 [65.0%] female). Intention-to-treat analysis found no significant difference in ED visits by ambulance (445 of 1849 [24.1%] vs 463 of 1846 [25.1%]; adjusted odds ratio [AOR], 0.97; 95% CI, 0.89-1.05) but found higher antihypertensive medication initiation (74 of 500 [14.8%] vs 47 of 552 [8.5%]; AOR, 1.74; 95% CI, 1.19-2.53) and lower anticoagulant initiation (48 of 1481 [3.2%] vs 69 of 1442 [4.8%]; AOR, 0.68; 95% CI, 0.53-0.86) in the intervention arm vs the control arm. CP@clinic attendance was associated with higher incidence of primary care visits (adjusted incidence rate ratio, 1.10; 95% CI, 1.03-1.17), higher odds of receiving home care (AOR, 1.07; 95% CI, 1.01-1.13), and lower odds of long-term care transfers (AOR, 0.32; 95% CI, 0.13-0.81). In this cluster randomized clinical trial of CP@clinic, the intervention did not affect the rate of ED visits by ambulance; however, there were increased primary care visits and connections to home care services, which may have increased antihypertensive medication initiation and reduced long-term care transfers from social housing. Health policymakers should consider CP@clinic's impact as an upstream approach to improve care for older adults with low income. ClinicalTrials.gov Identifier: NCT02152891.

Correlates of using behavioural sciences to design health promotion interventions and programs

Abstract Background The World Health Organization highlighted the need to better integrate behavioural science in the field of public health. Based on the theoretical domains framework, this study examined correlates of public health practitioners’ use of behavioural science principles to plan public health actions aim at promoting physical activity and healthy eating. Methods This study adopted a cross-sectional design. A convenience sample of 160 public health practitioners were recruited from different public health agencies (non-profit organizations, governmental and para-governmental agencies). They were asked to complete a survey questionnaire online and self-reported their use of behavioural science to plan health promotion interventions. Regression analyses were conducted to examine correlates of behaviour and behavioural intentions. All analyses were controlled for sex, number of years of experience in public health and the type of organization they work for. Results Skills (OR = 4.1, 95%CI: 1.3, 13.5) and intentions/goals (OR = 9.2, 95%CI: 2.3, 36.1) were the two domains significantly associated with the use of behavioural science. Perceived capacity to overcome the fact that none of their colleagues rely on behavioural sciences in their organization (OR = 7.2, 95%CI: 1.7, 30.3) was also associated with behaviour. Knowledge (OR = 8.6, 95%CI: 1.9, 39.1) and beliefs about consequences (OR = 4.0, 95%CI: 1.1, 14.7) were in turn associated with intentions/goals. Conclusions This unique study provides important insights for the development of future knowledge transfer activities aim at supporting positive attitudes and motivations toward the use of behavioural science as well as developing competencies and a normative use of behavioural science. The development of a strong knowledge basis would also need to be a core component of trainings to support the integration of behavioural science in public health to design physical active lifestyles and healthy eating interventions. Key messages • Increasing knowledge and skills in behavioural sciences is a key for a better integration in public health practices. • Changes in norms and attitudes toward the use of behavioural sciences will also support a better uptake.

Changes of lifestyle and mental health among COVID-19 situation: resident-centered health promotion

Abstract Background Yuzawa town, located in the Niigata prefecture of Japan, is famous for its hot springs and ski resorts. A sustainable action plan for resident-centered regional health promotion (Yuzawa family health plan) was initiated in 2002. Surveys have been conducted every five years. This study aims to evaluate changes of their habits and mental health status between in 2017 and in 2022. Methods The survey of Yuzawa family health plan was conducted in 2017 and in 2022. Questionnaires were composed with living alone, living with marriage partner, living with son or daughter, living with grandchildren, living with brother or sister, health consciousness, attention to health, health concern, awakening in a morning, clockwork life, fitness habits, smoking, taking alcohol, anxiety, loneliness, consultation, resolve suffering, economic problem, handle stress, taking a rest, risk breaching, communication, life satisfaction, talking with family, job at home, intercommunion with friends, greeting with neighbors, relationship with neighbors, occupations, good sleep, taking breakfast, nutritional balance, mastication status, confirmation of food compositions, exercise habits, yearly health check-up, dental check-up, brushing teeth habits, and sleep satisfactions. Chi square tests were used to evaluate changes between in 2017 and in 2022. This study was approved by the ethics committee of Tokyo Women’s Medical University. Results Passive smoking, intercommunions with neighborhood and friends, exercises, and Salt reduction awareness reduced in 2022. Talking with family, taking a rest, attention to health, clockwork life, and sleep satisfactions increased. Conclusions Many changes were shown between in 2017 and in 2022. Because elderly has been able to use a mobile phone, loneliness was not increased. But numbers of elderly living alone have been increased from 2002. Health promotion programs giving health information for elderly is needed. Key messages • Many lifestyle changes were shown between in 2017 and in 2022. • Passive smoking reduced. Taking a rest and attention to health increased.

The relationship between sleep quality and emotional eating during the pandemic in Croatian adults

Abstract Background Social isolation during pandemics has adverse effects on sleep quality which in connection with COVID-19 distress facilitates the development of emotional eating patterns in various populations. This study aimed to evaluate the interconnection between sleep quality and emotional eating in the Croatian adult population during the COVID-19 pandemic. Methods This cross-sectional questionnaire study was conducted from February to June 2021 period. A validated, anonymous questionnaire that contained questions regarding demographic data, data on eating habits, and the Pittsburgh Sleep Quality Index (PSQI), was self-administered to a convenient sample of Croatian adults from central and northwestern Croatia. Results The study sample included 939 subjects with, a median age of 42 years (interquartile range 35-48), 35.4% males, and 64.6% females. At the PSQI 22.6% of subjects presented sleep disturbances. Sleep disturbances were more frequent among females (p < 0.001), and inhabitants of the Croatian capital Zagreb (p = 0.001). Subjects with sleep disturbances detected by PSQI during pandemics consumed a larger amount of food than usual (p < 0.001), consumed snacks more frequently (p < 0.001), and cooked more in their households (p = 0.006). Conclusions Poor sleep quality caused by the COVID-19 pandemic led to emotional eating patterns in the Croatian adult population. Health promotion programs directed toward healthy lifestyle choices need to be implemented to successfully tackle observed poor health indicators in the studied population. Key messages • Following the COVID-19 pandemic the obvious deterioration of sleep quality and eating habits is seen in the Croatian general population. • Comprehensive health promotion programs directed toward healthy lifestyle choices adoption are needed.

Implementation of organizational health literacy depending on school characteristics in Germany

Abstract Background Children and adolescents are important target groups for health promotion measures to sustain a healthy upbringing. Organizational health literacy in schools is a promising environmental intervention to strengthen health literacy in school children. This study examines the relationship between school characteristics and the implementation of organizational health literacy. Methods School principals in Germany were invited to complete a 20-minute online survey between November 2022 and July 2023. An 8-item self-report tool was used to measure organizational health literacy in schools (OHLS-Q-SF) that comprehends eight different areas within schools to become health literate. A hierarchical cluster analysis was carried out to identify groups according to the composition of the socioeconomic status of the student body. Descriptive statistics, Mann-Whitney-U tests, and Kruskal-Wallis tests were performed. Results 598 school principals (73.6% female, Ø 52.3 years old) who worked at primary schools (49.1%), secondary schools (37%), and special education schools (13.9%) completed the survey. Cluster analysis revealed two groups. The first one (36.8%) contains schools with mainly students with lower socioeconomic status, and the second group (63.2%) contains schools with more students from middle or higher socioeconomic status. The socioeconomic status of students within the schools showed no significant results for any area of organizational health literacy, whereas all eight areas are more likely implemented if the schools already participate in a school health promotion program or network (p < 0.001). Conclusions Participating in a school health promotion program was associated with higher levels of implementation in all areas of organizational health literacy in schools. This finding highlights the importance of those programs. Integrating organizational health literacy into those interventions can be a beneficial approach to sustaining health literate schools. Key messages • Participating in a school health promotion program or network might facilitate schools to become health literate organizations. • In Germany, the socioeconomic status of the students within the schools is not associated with the implementation of organizational health literacy.

Accuracy of body weight perception: The Case of Türkiye

Abstract Background Accuracy of body weight perception is defined as the extent to which an individual’s self-assessment of their body weight aligns with their actual body weight. Our study evaluates the accuracy of body weight perception, an important factor in preventing and managing obesity and overweight, according to sociodemographic factors. Methods This study utilizes data from the nationwide cross-sectional ‘Nutrition and Health Survey 2017’. The survey includes 12,266 participants who were interviewed face-to-face. Factors influencing the accuracy of body weight perception were evaluated using the chi-square test. Subsequently, the logistic regression models were constructed to assess factors that were statistically significant (p < 0.05). Results The prevalence of obesity and overweight was found to be 36.3% and 71.5%, respectively. The accuracy of body weight perception was 39.2%, underestimation was 57.0%, and overestimation was 3.8%. There was no significant difference in accuracy of body weight perception between sexes (p = 0.94). According to logistic regression analysis (n = 12.168), accuracy of body weight perception was higher among individuals who were not overweight compared to those who were overweight (p < 0.001, OR: 4.56, CI: 4.16-4.98), among those aged 15-44 compared to those aged 45 and over (p < 0.001, OR: 1.47, CI: 1.35-1.60), among those with high school and higher education compared to those with middle school education or less (p < 0.001, OR: 1.43, CI: 1.31-1.56), among unmarried individuals compared to married ones (p = 0.011, OR: 1.12, CI: 1.03-1.23), and in individuals with poor income status compared to good (p = 0.005, OR: 1.13, CI: 1.04-1.22). Conclusions In health promotion programs aiming to perceive body weight accurately, priority should be given to people with overweight, those with low education levels, married individuals, people aged 45 and over, and individuals with low income. Key messages • Accuracy of body weight perception is important in fighting obesity. • Individuals with overweight, have a low level of education, are married, aged 45 and over, and have low income are misperceive their body weight to a greater extent.

Development of Digital Health Gender and Sexual Health Literacy scale

Abstract Introduction Health literacy, as the ability to obtain, process and understand health information, including gender and sexuality awareness, appears to be underdeveloped in terms of measurement tools and thematic materials. The literature indicates the existence of serious deficits in gender and sexual health literacy at all levels, with implications for relationships with citizens and patients. Methods Delphi study agreement was conducted and a pool of potential scale items was generated, reflecting a range of skills and abilities within each domain. Items were carefully worded to ensure clarity, cultural sensitivity and relevance to different gender identities and sexual orientations. Expert review and cognitive pre-testing were employed to refine item wording, assess content validity, and ensure that the 10-item scale was comprehensible and relevant to the target population. Results The theoretical development of the 10-item Digital Health Gender and Sexual Health Literacy Scale was successfully completed. The scale items were designed to provide a comprehensive measure of an individual’s ability to navigate the digital landscape for gender and sexual health information. Conclusions The theoretical validation of the Digital Health Gender and Sexual Health Literacy Scale (DiGeSHeL) provides the community with a promising tool to assess individuals’ confidence and ability to use digital technologies for sexual health information and resources. However, further research is needed to validate the scale and test its reliability with a diverse group of participants. Once validated, this scale could be a valuable tool for sexual health promotion programmes to identify gaps and evaluate the impact of digital literacy interventions. Key messages • Gender and sexual literacy are crucial for health. • Health literacy as six vital sign.

Health promotion at local level in Portugal: is childhood obesity a concern in municipal programs?

Abstract Health promotion programs targeted at distinct health outcomes such as childhood obesity, at local level are increasingly used worldwide. There is a need to better understand the role of local governments (municipalities) as key public health promoters namely in the prevention of obesity in children. This study aims to provide some input regarding this issue in Portugal. In order to achieve this goal, health enhancing programs promoted by Portuguese municipalities in which children could participate were identified. The search of such programs was limited to the municipalities that were part of the Portuguese Network of Healthy Municipalities in 2021 (N = 57). A subsequent document analysis was conducted to describe how municipalities conceptualized children’s health by retrieving information on which topics the programs were focused on, or acted upon, and identify which socio-ecological model levels of health determinants were addressed (or not) by each program. The 77 identified programs were promoted by 30 municipalities and only 11 programs addressed childhood obesity. Most programs focused on the individual health determinants (N = 27) and provided limited information overall, which hindered a more in-depth analysis. The findings suggest that Portuguese municipalities seem to disregard their potential as public health promoters. Childhood obesity is a major public health concern at national level, as reflected in the National Health Plans, but not perceived as such locally. Municipalities are the closest government entities to the population, and it is their responsibility to ensure the population’s quality of life, by addressing the social and environmental determinants of health. Hence, municipalities should instill health concerns in all their actions/interventions, taking in consideration the most recent evidence, specifically in the case of childhood obesity. Key messages • This study findings suggest that, despite childhood obesity being a major public health concern at national level, as reflected in the National Health Plans, it is not perceived as such locally. • There is a need to better understand the role of municipalities as key public health promoters considering they are responsible to intervene on the social and environmental determinants of health.

Increasing step count of employees through the Semmelweis Workplace Health Promotion Program

Abstract Background Lifestyle greatly contributes to the development of age-related diseases. The goal of the Semmelweis University’s ‘Semmelweis Workplace Health Promotion Program’ is to develop interventions that facilitate healthy ageing. The aim of its first intervention was to increase the step count of participants by incorporating motivational elements offered through the university’s Center of Preventive Services. Methods A randomized controlled trial was conducted in spring 2024 with three study groups: those undergoing motivational interviews (MI, n = 49), those receiving motivational emails (ME, n = 51), and a control group (n = 53). Intervention groups (MI+ME) received weekly emails for 8 weeks emphasizing the benefits of increased step count and providing feedback on achievements. The MI group also took part in 4 biweekly consultations. Mean step counts of last week and energy expended while walking (MET) calculated from the International Physical Activity Questionnaire were recorded five and three times, respectively. Mixed model regressions were conducted for two pre-planned comparisons: MI+ME vs. controls, and MI vs. ME. Results Intervention groups exhibited a significant increase in average step count (1001 steps; 95% Confidence Interval [95% CI]: 349-1651) as a result of the program, while the control group experienced a non-significant decrease. This was accompanied by a significant increase in energy expenditure for walking (45 MET; 95% CI: 4-87) in intervention groups and a non-significant decrease for the control group. The study found no significant differences in step count and energy expenditure between the two intervention groups (MI vs. ME). Conclusions Our results suggest that workplace health promotion programs may effectively increase physical activity, and thus may be key in tackling the challenges posed by aging demographics. Preliminary findings did not indicate a superiority between email-based and motivational interview-based motivation. Key messages • Workplace health promotion is an essential tool in promoting healthy aging among the working-age population. • Step-count programs based on motivational interviewing serve as an effective and simple tool in increasing physical activity.

Conversation circles – an inventive way to talk about and address migratory related mental health

Abstract Refugees in European countries face psychological stressors stemming from pre-, peri- and post-migration experiences. In Sweden, a mental health promotion program for newly settled refugees “Ways Forward - After the escape”, was tried out to mitigate the consequences of negative migratory experiences. The program included training of course leaders and implementation of conversation circles for participants, i.e., short in-depth courses for smaller groups led by a trained leader. The objective of the program was to equip civic communicators working within the Introduction program for refugees with the necessary skills to lead conversation circles on mental health in cities in the south of Sweden. During 2020-2023, 43 course leaders were trained and 55 refugees participated in conversation circles. The course leader training included 50 hours of training on themes of the program “Ways Forward”; health and well-being, loss and identity, grief and forgiveness, reconciliation and acceptance, stress and stress management, trauma and trauma-conscious care. The conversation circles for participants were given in 3-hour modules x 10 occasions. 1. How did the course leaser perceive the utility of the training for their work with the target group? 2. In what ways has the intervention assisted the participants in navigating their mental and well-being in Sweden? The results showed that course leaders acquired new knowledge and practical skills and tools to lead reflective conversations about mental health related to migration. Participants reported a higher awareness of mental health issues, less stigma, trying out new coping techniques and increased motivation to seek help. Short training courses for civic communicators on migratory mental health increased knowledge and gave new skills and tools to lead conversation circles. Newly settled refugees reported higher awareness, new tools and less stigma to talk about mental health following participation in conversation circles. Key messages • Short training courses on mental health related to migration increased knowledge and gave new skills and tools to lead conversation circles. • Newly settled refugees reported higher awareness, new tools and less stigma to talk about mental health following participation in conversation circles.

Heavy Work Investment (HWI) and Its Effect on Employees’ Physical and Mental Health

Abstract Background Economic reality and centrality of work have led to employees investing much time and effort in work. However, The number of hours spent at work may not be the only explanation, and other characteristics, such as type of work, employees’ personality, economic status, motivations, etc., need to be considered. The Heavy Work Investment model (Snir & Harpaz, 2012) considers these variables and classifies employees into four types of investors. This study examines the physical and mental health consequences of each HWI group. Methods Participants (N = 962) were workers who came to a medical center for annual medical screenings. About 70% were males, and the average age was 50.13 years (SD = 9.53). They divided into 5 groups: Typical full-time workers (N = 208, 29.2%), ‘Needy’ (N = 111, 15.6%), ‘Employer directed’ (N = 111, 15.6%), ‘Workaholic’ (N = 192, 26.9%) and ‘Work devoted’ (N = 91, 12.7%). The personal data was cross-referenced with the respondents’ health data. Differences for categorical variables were examined with Chi-square analyses. Results ‘Employer-directed’ employees, more than ‘work-devoted’ employees, perceived their health status as preventing them from performing mild activities. ‘Employer-directed’ and ‘needy’ employees, more than ‘work-devoted’ employees, perceived their health status as interfering with their social activities and their pain as interfering with their regular activities. ‘Workaholic’ employees suffered from more diseases than ‘work-devoted’ employees, and they were found to be 3.70 times more likely to be at a high risk of cardiovascular disease than typical full-time workers. Conclusions It is possible to anticipate types of health damage according to occupation type and develop occupation-adjusted health promotion programs. It is necessary to base labor laws on protecting employees’ health, particularly regarding time and workload’ outside of work’ in both hours (additional or flexible) and location (hybrid work). Key messages • Inspire organizations to be aware of potential injuries caused by HWI and promote the creation of intervention programs, potentially significantly improving employees’ health and well-being. • Evidence for the necessary laws that protect employees’ health, particularly regarding time and workload ‘outside of work’ in both hours (additional or flexible) and location (hybrid work).

Promoting mental health in higher education students: a pilot study

Abstract Introduction The mental health and well-being of higher education students is a relevant topic today, given the high prevalence of mental disorders and their increasing trend. Therefore, it is imperative to develop health education programs that aim to develop strategies to promote psychological well-being and reduce suffering in this population. Objectives To develop and implement a mental health promotion program, with interventions based on Yoga/meditation and Auriculotherapy, and evaluate its impact on the mental health of higher education students. Methodology Pretest-posttest design, with assessment before (T0), after the intervention (T1) and with a three-month follow-up (T2). Evaluation with the Portuguese version of the Mental Health Inventory (Pais-Ribeiro, 2001), and physiological assessment (heart rate, respiratory rate and blood pressure). 22 students participated in the intervention, randomly divided into two groups: Yoga/meditation group (GY) and Auriculotherapy group (GA), each with 11 students. Results The physiological parameters evaluated showed, in all sessions, a decrease in averages, regardless of the technique implemented. In the assessment at T0 and T1, it was found that there was a significant decrease in the Distress (p = 0.037) and Anxiety (p = 0.031) dimensions. In the evaluation over time (T0, T1 and T2), it was found, regardless of the technique implemented, that the intervention had a positive effect on the mental health of the students. Discussion The results point to the importance of developing mental health promotion programs in higher education.

State of oral health in the Portuguese population and associated psychological and social aspects

Abstract Background Oral diseases are a global public health challenge and remain among the most prevalent non-communicable diseases. This study aims to characterize the self-assessment of oral health state, degree of edentulism, oral rehabilitation and the quality of life, namely chewing capacity, and the associated psychological and social aspects in the Portuguese Population. Methods Data were collected by telefone survey, on the 2nd half of 2018 and 1st half of 2019, using the Portuguese population representative, ECOS panel. Descriptive statistics, as well as prevalence estimates, were obtained with weighting for age, sex, region and sample design, for 95% confidence intervals. The modified F-statistic, a variant of the 2nd order Rao-Scott chi-square adjustment, was used to test the bivariate analyses. Results For 53% of the population, the health status of the mouth was perceived as Good or Very Good, for 37% Fair and, in 11% of cases as Bad or Very Bad. It is estimated that around 76% of the population has good oral hygiene habits, approximately 26% have all of their teeth and 8% the total absence of teeth. It is estimated that only around half (49%) underwent rehabilitation using, in the vast majority of cases (78,5%), removable prostheses. It is estimated that 32% of its users have difficulty chewing hard foods and, of these, around 20% have great difficulty or are unable to chew at all. Psychological discomfort due to oral health was higher in the Portuguese population when compared to the European population (17% vs 7 %), psychological limitations due to the appearance of teeth or dentures were equally higher (7% vs 4%), as were social limitations (8,8% vs 4%). Conclusions The oral health panorama in Portugal remains bleak, so strengthening the application and deepening of the national oral health promotion program should constitute a priority aspect in the development of public policies in the country Key messages • Integrating oral health into general health promotion strategies and assessing oral health needs to include psychological and social aspects in the Portuguese Population. • Strengthening the strategies that have been developed in the context of health promotion, prevention and early treatment of oral diseases in Portugal.