Health Promotion Programs Research Articles

Utilizing an Environmental Framework to Explore the Acceptability of a Health Promotion Program for Youth with Disabilities

ABSTRACT This study explored the acceptability of Children and Teens in Charge of their Health (CATCH), a program for children with spina bifida or cerebral palsy to enhance their physical activity and diet. Qualitative interviews were conducted with children (n = 6) and their parents (n = 6) who participated in CATCH. Analysis used an environmental systems framework. Microsystem factors impacting acceptability of the program were: Children’s motivations for change, their age, and their physical health. Mesosystem factors were: Use of virtual coaching and the relationship between coach and child. Macrosystem factors (e.g. Covid-19), did not impact acceptability, but affected some goal attainment strategies. CATCH was broadly acceptable to children and parents and shows promise as a health promotion program tailored to children with disabilities. An environmental systems framework can potentially help other health promotion programs enhance their acceptability and success.

Mental Disorders and Mental Health Promotion in Police Officers.

The number of police officers suffering from mental illnesses is becoming a significant public health concern. Police officers are more likely to experience mental health problems than the general population. The use of effective mental health promotion programs can assist in reducing police officers' psychological problems. In this paper author reviews existing literature on mental disorders and mental health promotion among police officers. This review emphasizes the importance of mental health promotion and programs in improving police officers' well-being and decreasing mental disorders. The prevalence of mental disorders, risk factors, and negative consequences are explained. Furthermore, examples of programs or interventions to promote mental health, and recommendations for further study are presented. Therefore, this review could be useful in developing intervention program to support police officers' health.

Factors influencing gestational diabetes self-care among pregnant women in a Syrian Refugee Camp in Jordan.

The main objective of this study is to identify the level of self-care practices and the determinants of Gestational Diabetes Mellitus (GDM) among pregnant women residing in one of the refugee camps in Jordan. A cross-sectional study was conducted on a convenient sample of forty women diagnosed with GDM from the high-risk maternity clinic in one of the Syrian refugee camps in Jordan. The study used the Gestational Diabetes Management Self-Efficacy Scale (GDMSES), Diabetes Knowledge (DMK) assessment, and Diabetes Self-Care Activities Questionnaire (SDSCA) to measure the variables of interest. Descriptive analysis and Multiple logistic regression were used to assess for significant factors. Significant associations were found between the subcategories of diet, exercise, and blood sugar control in both the self-efficacy and self-activity scales (p < 0.01, p < 0.01, p < 0.05), respectively. Two factors were associated with higher GDM self-care: diabetes knowledge and higher self-efficacy toward GDM self-care (p < 0.05). The findings of this study highlight that pregnant women with GDM who have higher levels of self-efficacy and diabetes knowledge are more likely to achieve higher levels of GDM self-care. Beside developing health promotion programs to enhance women's self-efficacy in adhering to GDM care, adequate support and relevant resources to facilitate GDM management among refugee women are recommended. Future research for identifying other potential factors affecting GDM self-care among refugees is highly recommended.

Integrating Sexual Medicine in Obstetrics and Gynecology Practice: Highlights from The Sexual Medicine Fellowship Program

Background: The health system is least prepared to manage sexual dysfunctions and lacks trainedprofessionals who can adequately assess and manage individuals with sexual dysfunctions because theneed for the service has not been documented. This is because routine data are not collected on sexualdysfunctions. This study aimed to outline the distribution of sexual dysfunctions among patients seekinghealth services in a specialized sexual medicine clinic in Nairobi (Sexology Clinic).Methods: Records of all patients seen at the clinic for 12 months were analyzed. A total of 396 patientfiles were reviewed (362 males and 34 females) using a standard tool. The sociodemographic andmedical details of the patients were analyzed. Data were entered in SPSS and summarized using tablesand figures. Disease associations with sociodemographic characteristics were analyzed. Classification ofsexual disorders was performed using the International Classification of Diseases (ICD)-11.Results: The most prevalent sexual disorders in both genders were sexual arousal disorders (76.4%),sexual desire problems (16.42%), and orgasmic disorders (3.6%). Disease distribution was found to bedependent on patient age and sex. Ethnicity, religion, and profession did not affect disease distribution.Conclusion: The distribution of sexual dysfunctions observed in Nairobi was found to be similar to thoseobserved in other populations.Recommendation: Health promotion and treatment programs for sexual dysfunction should bedeveloped to mirror those in more liberal countries because sexual medicine needs are the same. Thehealth system should collect routine sexual health data to help with future planning.

Epidemiology of sexual dysfunctions in Kenya: The case of patients seen at the Sexology Clinic, Nairobi, Kenya

Background: The health system is least prepared to manage sexual dysfunctions and lacks trainedprofessionals who can adequately assess and manage individuals with sexual dysfunctions because theneed for the service has not been documented. This is because routine data are not collected on sexualdysfunctions. This study aimed to outline the distribution of sexual dysfunctions among patients seekinghealth services in a specialized sexual medicine clinic in Nairobi (Sexology Clinic).Methods: Records of all patients seen at the clinic for 12 months were analyzed. A total of 396 patientfiles were reviewed (362 males and 34 females) using a standard tool. The sociodemographic andmedical details of the patients were analyzed. Data were entered in SPSS and summarized using tablesand figures. Disease associations with sociodemographic characteristics were analyzed. Classification ofsexual disorders was performed using the International Classification of Diseases (ICD)-11.Results: The most prevalent sexual disorders in both genders were sexual arousal disorders (76.4%),sexual desire problems (16.42%), and orgasmic disorders (3.6%). Disease distribution was found to bedependent on patient age and sex. Ethnicity, religion, and profession did not affect disease distribution.Conclusion: The distribution of sexual dysfunctions observed in Nairobi was found to be similar to thoseobserved in other populations.Recommendation: Health promotion and treatment programs for sexual dysfunction should bedeveloped to mirror those in more liberal countries because sexual medicine needs are the same. Thehealth system should collect routine sexual health data to help with future planning.

Effectiveness of a telehealth-delivered clinician-supported exercise and weight loss program for hip osteoarthritis – protocol for the Better Hip randomised controlled trial

BackgroundHip osteoarthritis (OA) is a leading cause of chronic pain and disability worldwide. Self-management is vital with education, exercise and weight loss core recommended treatments. However, evidence-practice gaps exist, and service models that increase patient accessibility to clinicians who can support lifestyle management are needed. The primary aim of this study is to determine the effectiveness of a telehealth-delivered clinician-supported exercise and weight loss program (Better Hip) on the primary outcomes of hip pain on walking and physical function at 6 months, compared with an information-only control for people with hip OA.MethodsA two-arm, parallel-design, superiority pragmatic randomised controlled trial. 212 members from a health insurance fund aged 45 years and over, with painful hip OA will be recruited. Participants will be randomly allocated to receive: i) Better Hip; or ii) web-based information only (control). Participants randomised to the Better Hip program will have six videoconferencing physiotherapist consultations for education about OA, prescription of individualised home-based strengthening and physical activity programs, behaviour change support, and facilitation of other self-management strategies. Those with a body mass index > 27 kg/m2, aged < 80 years and no specific health conditions, will also be offered six videoconferencing dietitian consultations to undertake a weight loss program. Participants in the control group will be provided with similar educational information about managing hip OA via a custom website. All participants will be reassessed at 6 and 12 months. Primary outcomes are hip pain on walking and physical function. Secondary outcomes include measures of pain; hip function; weight; health-related quality of life; physical activity levels; global change in hip problem; willingness to undergo hip replacement surgery; rates of hip replacement; and use of oral pain medications. A health economic evaluation at 12 months will be conducted and reported separately.DiscussionFindings will determine whether a telehealth-delivered clinician-supported lifestyle management program including education, exercise/physical activity and, for those with overweight or obesity, weight loss, is more effective than information only in people with hip OA. Results will inform the implementation of such programs to increase access to core recommended treatments.Trial registrationAustralia New Zealand Clinical Trials Registry (ACTRN12622000461796).

The impact of a health promotion program on toddlers’ socio-emotional development: a cluster randomized study

BackgroundThe first 3 years of life are a critical period for the development of socio-emotional skills, highlighting the importance of socio-emotional development in early childhood. This study aimed to evaluate the effectiveness of a health promotion intervention program on the socio-emotional development of children aged 12 to 42 months during the COVID-19 pandemic.MethodsA total of 344 children from 15 childcare centers participated in this study, with six centers in the intervention group and nine in the control group. Childcare teachers in the intervention group received a 6-month training program aimed at promoting healthy lifestyles, including topics such as diet, sleep, physical activity, and sedentary behavior. Sociodemographic and anthropometric measures were assessed at baseline, and socio-emotional development was assessed using the Bayley Scales of Infant and Toddler Development – Third Edition (Bayley-III) at baseline and post-intervention.ResultsAfter the intervention, a significant difference in socio-emotional development was observed between children with mothers of varying education levels. Specifically, children whose mothers had lower education levels demonstrated significantly greater socio-emotional development (B = 19.000, p = 0.028) compared to the control group. In contrast, there was no significant difference in socio-emotional development among children with mothers from higher education levels.ConclusionThese findings suggest that intervention programs for childcare teachers can effectively promote healthy socio-emotional development in children from socioeconomically disadvantaged backgrounds. Future intervention programs should consider tailoring their approaches to target disadvantaged populations.Trial registrationThis cluster randomized controlled trial was registered in the Clinical Trials database/platform on 09/09/2019 (number NCT04082247).

Community-Based Action Research Intervention to Promote Occupational Health Nursing of Portuguese Quarry Workers.

The northern region of Portugal has the largest number of companies manufacturing granite and stone products, which has become the region's trademark. In the municipalities of Marco de Canaveses and Penafiel, the economic activity of this area is important. However, the lack of attractiveness of this activity, combined with the high prevalence of silicosis and tuberculosis in this population, has led to a growing shortage of labor. In order for this project to be the result of collaborative, integral work centered on the people who are the target of health promotion, we used the Participatory Health Research (PHR) approach, based on the PRECEDE-PROCEED model, to implement a mixed-methods study, including participant observation, interviews and document analysis. These data were used to co-create a study design. In 2021, a total of 102 interviews were carried out and self-completion surveys were distributed: the Fantastic Lifestyle Questionnaire (FLQ) and the EQ-5D-3L. Within the scope of occupational health nursing and in the field of action of public health nurses, with the interviews and self-completed surveys carried out, we identified potential focuses for occupational health nursing intervention to promote the health of stone industry workers: adherence to protective measures, energy balance deficit, tobacco and alcohol consumption and access to health services. Data analysis made it possible to assess the prevalence of risk behaviors by order and to involve managers and workers in the co-creation of a health promotion program. The accurate identification of the focuses for nursing intervention not only improves the effectiveness of occupational health services, allowing for targeted interventions adapted to workers' needs, but also contributes considerably to health promotion in the workplace, resulting in safer working environments, a reduction in occupational diseases and, consequently, a healthier and more productive workforce. This protocol of this study was not registered.

Just in case: undergraduate students identifying and mitigating barriers to their sexual and reproductive health needs

BackgroundMany U.S. colleges and universities offer access to a healthcare center that provides sexual and reproductive health (SRH) resources, services, and products. The importance of health centers in college and university settings in reducing sexual health disparities in student populations cannot be stressed enough. This article evaluates a student-led, mutual-aid, grassroots health promotion strategy for students with limited access to healthcare services, supplies, and tools via an anonymous and discrete distribution of SRH resources without charge.MethodsIn partnership with faculty, undergraduate students worked to address their school’s unmet SRH needs by increasing on-campus access to comprehensive, evidence-based, and sex-positive resources. Referred to as Just in Case, this student-led, grassroots health promotion program provided students with supply kits containing contraceptives, sexual health wellness products, basic hygiene supplies, and education materials. Students were surveyed in a pre- (n = 95) post- (n = 73) pilot study to identify contraception acquisition barriers, discern perceptions of on-campus SRH resources, and elucidate trends in this program’s use and impact. Chi-square tests of independence were used to compare survey group responses, and association rule mining was employed in tandem to identify SRH items that students requested.ResultsStudents identified cost and privacy as significant barriers to acquiring sexual health products on campus. Of the 182 Just in Case supply kits requested by students during the 2022–2023 academic year, condoms were requested most frequently in 75% of fulfilled kits, while emergency contraception and pregnancy tests were asked most often in 61% of kits. 50% of students reported access to contraceptives on campus before this program’s implementation, growing to 75% (p < 0.001) 1 year later post-implementation. Similar jumps were observed for reported access to sexual health education (30 to 73%, p < 0.001) and services (36 to 73%, p < 0.001).ConclusionA student-led SRH supply and resource delivery strategy may immediately reduce SRH inequities and decrease barriers to contraceptive use for students with limited access to on-site SRH product availability.

EDUKASI TENTANG KESEHATAN REPRODUKSI PADA REMAJA AWAL DI SD NEGERI 2 JABON MOJOANYAR KABUPATEN MOJOKERTO

Reproductive health promotion is still not free to convey, and is considered taboo, so some formal school-level institutions are still hesitant to carry out reproductive health counseling for their students. Adolescents are a group that has a high vulnerability to reproductive health problems. The purpose of this activity as a form of community service carried out by the Lecturer Team and students of Majapahit College of Health Sciences is as an effort to educate students at SD Negeri 2 Jabon Mojoanyar Mojokerto Regency about reproductive health education in early adolescents. Education by lectures, discussions and counseling demonstration. The activity which was carried out for one month was able to improve students' understanding of reproductive health in early adolescents and how to overcome if they experience problems related to reproductive health. This activity is expected to be a concern, especially in the world of education, increasing education on reproductive health promotion programs&#x0D; Keywords: reproductive health, early adolescence, health promotion

Subjective assessment by employees of health-saving technologies at the individual level and in the workplace

Aim to study the attitude to a healthy lifestyle of employees of various professions by means of a questionnaire and their assessment of the health-saving technologies used in the workplace.&#x0D; Material and methods. 210 workers took part in the survey. The questionnaire included 24 questions that allow us to evaluate employees' ideas about a healthy lifestyle, technologies for self-preservation of health and a system of health-saving measures at the enterprise. The obtained data were subjected to mathematical and statistical processing.&#x0D; Results. The analysis of respondents' responses revealed the formation of respondents' ideas about a healthy lifestyle (HLS), however, the proportion of people following the principles of HLS in each of the two groups formed by industry is low. Respondents consider lack of time, material difficulties and lack of perseverance and will to be the main reasons preventing compliance with the requirements of a healthy lifestyle, and the most popular measures of self-preservation of health are compliance with sleep and rest, annual medical examination. It should be noted the prevalence of such behavioral risk factors in both groups as poor nutrition and low physical activity, which, apparently, is the reason for a significant proportion of positive responses about being overweight, exceeding the national average. Among men of the first group, the proportion of smokers is also high. Insufficient attention is paid at enterprises to ensuring safe working conditions using innovative technologies and collective means of protection. Various ways of compensating employees for working in harmful working conditions are rarely used, as well as means of encouraging and increasing employees' motivation for healthy lifestyle.&#x0D; Conclusions. In order to solve the problem of protecting the health of employees and achieving work longevity, it is necessary to tighten the legislative requirements for the introduction of comprehensive health promotion programs in the workplace, the promotion of healthy lifestyle.&#x0D; Ethics. The study was conducted in compliance with all ethical standards set out in the Helsinki Declaration of the World Medical Association and the Directives of the European Community.

Infant 2 School: A structured health promotion programme for community nursery nurses

Infant 2 School (I2S) is a new, individualised family-centred early intervention, and health and development promotion programme that is designed to be delivered by community nursery nurses (CNN) from within health visiting teams. The programme aims to address identified service gaps by supporting and complimenting the work that health visitors do so that vulnerable families needing additional help have access to evidence-based interventions in a timely manner. I2S was recently launched in the UK and this paper provides an overview of the programme including its origin, structure, content, benefits and anticipated outcomes for children and families.

Prevalence of premenstrual syndrome and its associations with dietary and other lifestyle factors among university female students in Dubai: A cross-sectional study.

Premenstrual syndrome is a relatively prevalent condition that affects a significant number of menstruating women worldwide. It can range from mild to severe and may interfere with daily activities. This study aims to investigate the prevalence of premenstrual syndrome and its associated factors among female university students in Dubai. This study was designed as a cross-sectional study. The analysis for this study involved 217 female university students (aged ⩾18 years old) who completed a self-reported online questionnaire. Participants were recruited through simple random sampling, and the study received ethical approval from the Zayed University Ethical Committee. All participants reported that they experienced at least one premenstrual syndrome symptom with different levels of severity. The prevalence rate of psychological, physical, and behavioral symptoms was 83.0%, 79.4%, and 76.6%, respectively. The most frequently reported premenstrual psychological symptoms were loss of control (69.6%). Most reported physical premenstrual symptoms included lethargy/fatigue/decreased energy (56.7%); premenstrual syndrome symptoms interfered with participants' daily routines (45.2%). Normal body mass index, no smoking, milk consumption, cruciferous vegetables, fruits, animal foods, fish oil supplements, and no fast-food consumption were all significant factors associated with decreasing premenstrual syndrome. Premenstrual syndrome is a common menstrual disorder among university students that interferes with their daily routines. Dietary habits and other lifestyle factors were highly related to premenstrual syndrome. Therefore, health promotion programs are highly recommended to encourage healthy diets and lifestyles for females as early as adolescence at the school level.

Gender and the Relationship Between Knowledge, Self-Efficacy, and Behaviors for Cardiovascular Health Among Adults - The Effects of Conditional Process Modeling.

Cardiovascular diseases are the main causes of morbidity and premature mortality among men and women in most industrialized and many developing countries. Cardiovascular health (CVH) is a relatively new term that focuses on maintaining good health not only on the prevention of cardiovascular diseases. To demonstrate gender differences in selected elements regarding CVH, such as cardio-protection knowledge, behaviors for CVH, and self-efficacy and in the relationships between them. In this cross-sectional study, a convenience sample of 157 respondents (70% women) aged 20-60 was included. The research tool consisted of four parts: the List of Health Behaviors - CVH version, the Test of Cardio-protection Knowledge, the Generalized Self-Efficacy Scale (GSES), and a sociomedical survey. To estimate the direct and indirect effects between the variables, a bootstrapping procedure was adopted, as recommended for small- and medium-sized samples. There were no gender differences in cardio-protection knowledge, but the groups differed in the levels of behaviors for CVH and self-efficacy. Women generally declared a higher level of healthy behaviors, whereas men demonstrated a higher level of self-efficacy. Women reported more healthy activities related to diet. Men more frequently practiced resistance exercise. The relationships between cardio-protection knowledge, self-efficacy, and behaviors for CVH were different in men and women. Further research should focus more on gender differences in mechanisms underlying health behaviors. Health-promoting programs should give more attention than before to how to differentiate the messages sent to men and women.

Abstract TMP106: Use of Net Promoter Score to Quantify the Participant Experience With a Telehealth Lifestyle Management and Cardiovascular Risk Reduction Coaching Program

Introduction: Improving the patient experience of care is 1 of the 3 dimensions of healthcare’s “Triple Aim.” The net promoter score (NPS) measures willingness to recommend a company’s services and is widely used by Fortune 500 companies as an indicator of customer loyalty/satisfaction. The NPS is increasingly being used to assess patients’ healthcare experience. We sought to quantify the experience of participants in the same telehealth lifestyle management and CVD risk reduction coaching program used in multiple NIH/PCORI-funded stroke-related multi-center RCTs (namely, SAMMPRIS, CREST-2, CAPTIVA and TEAMS-BP) by measuring the NPS in real-world (i.e., non-RCT) program participants. Methods: Participants in the coaching program typically have an opportunity to complete a voluntary satisfaction survey after 12 weeks and 1 year of participation and annually thereafter. The survey is conducted online or via telephone. For this analysis the NPS was calculated, from 17,929 consecutive surveys completed by non-RCT program participants, using responses on an 11-point scale (10 = "strongly agree"; 0 = "strongly disagree") to this item: “I would recommend the program to others.” Scores can range from -100 (worst) to +100 (best). In industry, a positive NPS is well regarded, and scores ≥50 are thought to highlight an excellent experience. Results: Three categories of responders were identified and classified as ‘promoters’ (rating = 9 or 10; i.e., those who would likely recommend the program = 78% of responses), ‘passives’ (rating = 7 or 8; i.e., those who are satisfied but would probably not actively promote the program = 16% of responses) and ‘detractors’ (rating = ≤6; i.e., those who might actively discourage participation = 6% of responses). The NPS (calculated from the % of promoters minus the % of detractors) was +72, a score comparable to that achieved by the most popular/successful commercial organizations in other industries. Conclusion: This is the first study to utilize the NPS to evaluate the participant experience with a telehealth coaching program that has been/is currently being successfully deployed in multiple stroke-related multi-center RCTs. The data show that real-world program participants have an NPS indicative of very high satisfaction.

Research Centers Collaborative Network Workshop on Digital Health Approaches to Research in Aging.

Digital health technologies are ubiquitous in the healthcare landscape. Older adults represent an important user group who may benefit from improved monitoring of physical and cognitive health and in-home access to care, but there remain many barriers to widespread use of digital health technologies in gerontology and geriatric medicine. The National Institute on Aging Research Centers Collaborative Network convened a workshop wherein geriatricians and gerontological researchers with expertise related to mHealth and digital health applications shared opportunities and challenges in the application of digital health technologies in aging. Discussion broadly centered on 2 themes: promises and challenges in (i) the use of ecological momentary assessment methodologies in gerontology and geriatric medicine, and (ii) the development of health promotion programs delivered via digital health technologies. Herein, we summarize this discussion and outline several promising areas for future research.

Unraveling Lifestyle Disease Vulnerabilities among Adolescents: A Comprehensive Comparative Analysis of Private and Government School Students in Rawalpindi and Islamabad

Purpose: The increasing prevalence of lifestyle diseases in adults necessitates a closer examination of risk factors that manifest during adolescence. This study addresses this imperative, aiming to comprehensively compare lifestyle disease risk factors among adolescents attending private and government schools, with a specific focus on the distinctive nuances present within diverse educational environments. The primary objective of this cross-sectional study is to provide a thorough exploration of lifestyle disease risk factors, thereby contributing to a more nuanced understanding of the complexities inherent in adolescent health within different school settings. The study's aim is to not only identify prevalent risk factors but also to highlight the variations that exist between students in private and government schools.&#x0D; Methodology: The study engaged 600 adolescents from secondary schools in Rawalpindi and Islamabad, with 300 participants from each sector, employing purposive sampling for selection. Beyond the standard measurements of Body Mass Index (BMI), height, and weight, a comprehensive assessment encompassed dietary habits, physical activity levels, screen time, family history of lifestyle diseases, and active/passive smoking.&#x0D; Findings: Noteworthy findings include a substantial 81% of overweight individuals affiliated with private schools, indicating a distinct prevalence in this demographic. Dietary disparities were evident, with private schools displaying a 60% daily consumption of fruits and vegetables, in contrast to 40% in government schools. Further distinctions were observed in daily dairy intake (54% in private schools vs. 46% in government schools) and weekly meat consumption (56% in private schools vs. 44% in government schools). Private schools exhibited higher rates of daily and weekly fast food (54%) and soft drink consumption (67%) compared to government schools (46% and 33%, respectively).&#x0D; Physical activity engagement was reported by 45% of private school students and 55% of government school students, while screen time exceeding 2 hours was reported by 55% of private school students and 45% of government school students. Family history of lifestyle diseases was more significant among government school students. Additionally, 8% of private school students and 7% of government school students reported smoking, with 20% of private school students and 24% of government school students indicating a history of passive smoking.&#x0D; Unique Contribution to Theory, Practice, and Policy: The study enriches theoretical understanding by offering a nuanced exploration of lifestyle disease risks and disparities among adolescents. In practical terms, the findings provide insights for designing targeted interventions tailored to the specific needs of private and government school students, informing health promotion programs and strategies. Policy relevance is emphasized through recommendations for school-specific health policies, considering socioeconomic factors, and advocating for long-term monitoring to facilitate effective public health planning. The identification of nuanced lifestyle disease risks within distinct school environments adds a critical dimension to our understanding of adolescent health and informs future policies and interventions

Untangling the complex implementation process of community-based health promotion: a multiple-case study in the Netherlands.

Community-based programmes are a widely implemented approach for population health promotion. Due to the context-dependent and dynamic nature of these programmes, evaluating their implementation is challenging. Identifying key events in the implementation process in evaluation could enable us to support future implementation, while acknowledging the complexity of real-world implementation. We studied the nationwide implementation of the Dutch Healthy Youth, Healthy Future (JOGG) approach, a community-based programme for childhood overweight prevention. The aims of our study were (i) to gain insights into the implementation process of the JOGG approach, and (ii) to identify key events that influenced said process. In nine communities, we conducted interviews (n = 24) with coordinators and stakeholders involved in the implementation of the JOGG approach and collected documents on the programme's implementation. We applied the analytical tool 'Critical Event Card' to identify key events in the implementation process. Results showed that in 5-10 years of implementing the JOGG approach, communities have undergone different phases: preparation, upscaling, resource mobilization, integration with other policy initiatives and adaptation of the implementation strategy. Key events influencing the implementation process included national policy developments (e.g. new health programmes), framing of the JOGG approach in local policy, staff turnover and coordination teams' experiences and actions. Furthermore, changes in implementation were often triggered by the destabilization of the implementation process and linked to opportunities for change in the policy process. The identified key events can inform future implementation of the JOGG approach as well as other community-based health promotion programmes.

Neutrosophic Evaluation of Health Promotion Programs for Resource Allocation

The efficient allocation of resources to health promotion and disease prevention programs in the field of healthcare is a multidimensional and highly sensitive challenge that requires the simultaneous consideration of multiple criteria and objectives. In this context, neutrosophic logic emerges as a promising tool capable of addressing the inherent uncertainty and imprecision in health decision-making. This article explores the application of neutrosophic logic in decision-making regarding the allocation of resources to health promotion and disease prevention programs, taking into account a wide range of criteria. The main objective of this research is to validate the importance of using neutrosophic logic in resource allocation for these programs, emphasizing its ability to handle ambiguity and uncertainty effectively and equitably. The results obtained have demonstrated that neutrosophic logic is an effective tool in decision-making in the field of public health.

Health Educations about Steps for early Breastfeeding on Successful Breastfeeding in Post-Partum Mothers in the Kampak Health Center Area, Trenggalek Regency

The ineffective implementation of health promotion programs is one of the factors influencing exclusive breastfeeding coverage. The behavior of giving exclusive breast milk will emerge after there is socialization about the importance of giving exclusive breast milk to pregnant and breastfeeding mothers. The aim of the research is to determine the effect of health education regarding early breastfeeding steps on the success of breastfeeding in post-partum mothers in the Kampak Community Health Center area, Trenggalek Regency. Research designs is quasi – experimental with a plan one group pretest-posttest. The research population was all post-partum mothers in the Kampak Trenggalek Community Health Center area, an average of 35 people per month. Using sampling technique accidental sampling with a sample of 31 people. Independent variable is health education regarding initial breastfeeding steps, dependent variable is breastfeeding success in post-partum mothers. Data was taken using an observation sheet instrument and analyzed using statistical tests Wilcoxon signed rank. The results of the research were obtained before health education was carried out regarding the steps for initial breastfeeding, all respondents were unsuccessful in breastfeeding, as many as 31 respondents (100%) while after health education was carried out regarding the steps for initial breastfeeding, the majority of respondents were successful in breastfeeding, as many as 22 respondents (71%) . There is an influence of health education about the steps for early breastfeeding on the success of breastfeeding in post-partum mothers in the Kampak Community Health Center area, Trenggalek Regency, where the results of statistical tests Wilcoxon signed ranks test obtained p value 0.000 &lt; 0.05. Health education can increase breastfeeding success, so that health education influences breastfeeding success. Providing health education about early breastfeeding will help post-partum mothers to breastfeed properly so that breastfeeding success will be achieved.