Participation In Health Promotion Activities Research Articles

A Multi-component Living Lab on Health Engagement for Advancing Self-care Agency among Migrant Workers in South Korea: A mixed methods study

Purpose: Migrant workers battle to access health services and adapt to a new culture. Self-care agency can be essential for health self-management. This study examines the effects of a health engagement program to improve self-care agency using a living lab approach among migrant workers living in South Korea.Methods: This study used a mixed-methods design, including a non-equivalent pre-post-test control group and three focus group interviews. Participants included 42 migrant workers from nine countries recruited via flyers, posters, and internet bulletins posted by a migrant community organization. During the 12 weeks, only the intervention group participants received four workshops addressing healthy physical activity, healthy dietary habits, effective cultural adaptation, stress management, and two outdoor cultural activities. They also participated in focus group interviews after the second, third, and fourth group activities and discussed the benefits of healthy behaviors and specific ways to implement them in real life.Results: Participants in the intervention group showed an increase in self-care agency, health literacy, and acculturation after the 12- week intervention. Themes were derived based on the lessons from living lab activities, barriers to health behavior practices, and methods to overcome these.Conclusion: This study demonstrated that multi-component intervention using a living lab effectively increased migrants’ participation in health promotion activities by strengthening health in their self-care agency. The qualitative and living lab approach effectively obtained comprehensive results on strategies to enhance healthy behavior engagement.

Which workplace health initiatives work, for whom, in what contexts, and how? A rapid realist review

BackgroundThe work environment is an important determinant of health and health inequalities. Workplaces have a key role in preventing ill health. The WHO and Office for Health Improvement and Disparities encourage implementing employer-led workplace health award schemes tailored to specific contexts. Therefore, when designing and developing workplace initiatives it becomes imperative to know what works, for whom, and in what circumstances. This research aims to facilitate understanding of the various contexts and mechanisms through which workplace health initiatives are implemented while considering how these might affect employee health outcomes. MethodsWe did a rapid realist review to explore the different contexts (C) in which workplace initiatives are implemented that may fire a mechanism (M), leading to a change in employee health-related and business outcomes (O). We searched 12 databases for peer-reviewed papers published from June 1, 2019, to March 31, 2022 that referred to a workplace health and or wellbeing programme or intervention. There were no restrictions placed on study design. We recorded the impact of context and mechanisms on any health and business-related outcomes. The review was carried out in accordance with RAMESES publication standards. Findings26 articles were included. Most studies were conducted in North America (n=13) and Europe (n=9), with four conducted in Australia and Oceania and one in Asia. We developed eight realist CMO programme theories. For example, when leaders are committed to employee health and wellbeing (C) (identified in 16 studies), demonstrated by role modelling healthy behaviours and actively promoting workers to engage in initiatives, employees feel valued and “permitted” to engage in healthy and wellbeing initiatives (M) which might lead to greater participation in health promotion activities (O). This review is registered with PROSPERO, CRD42022303262. InterpretationFindings contribute towards raising employers' awareness of what interventions might work for their employees. For instance, those interventions that encompass engagement of leadership at all levels to promote health and wellbeing are likely to leave employees feeling valued, motivated, and permitted to engage in interventions. Limitations of this study include potential biases arising from using rapid review processes and the inability to produce standardised recommendations. However, knowledge gained, which considers complexity and flexibility, might help inform, tailor, and support the implementation of future workplace health initiatives. FundingNational Institute for Health and Care Research (NIHR).

Reach and effectiveness of a worksite health promotion program combining a preventive medical examination with motivational interviewing; a quasi-experimental study among workers in low socioeconomic position

BackgroundThis study aimed to evaluate individual characteristics associated with participation and effectiveness of a worksite health promotion program with motivational interviewing targeting health and health behaviour among Dutch workers in low socioeconomic position.MethodsIn a production company and a hospital, 838 workers were invited for a Preventive Medical Examination and subsequent coaching with motivational interviewing up to 7 sessions within 6 months. Follow-up information was collected after 6 months. Characteristics associated with participation in coaching were assessed with logistic regression models. The effectiveness of coaching on body mass index (BMI), bodyweight, self-rated health, vigorous physical activity, smoking, alcohol intake, fruit- and vegetable consumption, work ability, and sickness absence was evaluated with linear regression models and on participation in health promotion activities with logistic regression analysis. The analyses on effectiveness were performed without and with propensity score adjustment.ResultsOf the 838 invited workers, 313 workers participated in the Preventive Medical Examination and follow-up data were available for 176 workers, of whom 100 workers with increased cardiovascular risk attended coaching. The majority of workers with obesity (73%), overweight (60%), and unhealthy behaviours (58%-69%) at baseline participated in motivational interviewing. Males, workers with overweight or obesity, workers at the production company, workers with insufficient vigorous physical activity, and workers with a low educational level were most likely to participate in coaching. Coaching with motivational interviewing after the Preventive Medical Examination was associated with a 4.74 times higher likelihood [95% confidence interval (CI): 1.99;11.32] to participate in health promotion activities and 10.9% (95%CI: 0.6;21.3) more persons who quit smoking compared to workers without coaching. No statistically significant effects were observed on BMI, bodyweight, health, health behaviour, work ability and sickness absence.ConclusionsThe program combining a Preventive Medical Examination with follow-up coaching reached – as intended – workers with obesity or overweight, those with a low education and with unhealthy behaviours. Adding coaching with motivational interviewing to a Preventive Medical Examination contributed to higher participation in health promotion activities and an increase in smoking cessation after 6 months among workers with a lower socioeconomic position, but was not effective on other outcomes.Trial registrationThe study was registered retrospectively in the Netherlands Trial Register as NL8178 on 22/11/2019.

Importance and efficacy of health promotion by primary care nurses

The core of many countries' primary care strategies has been increasing community engagement in primary care, greater efforts in preventive illnesses and promoting health, and greater harmony and synergy of current services in accordance with the community's needs. Primary care nurses have a lot of opportunity to provide strategies for health promotion and prevention, and prior research has revealed the multitude of functions that nurses can play, such as managing complex medical problems. Nurses employed in general practices have been observed to be effective in providing a number of preventative initiatives, including smoking cessation. It has been seen that though nurses who work in this environment are eager to counsel patients about physical exercise but have major deficiencies in their understanding of existing recommendations, suggesting a dearth of training preparation for such tasks. Very often, primary health care nurses' ability to undertake health promotion is restricted by the general practice environment, their skillset, and general practitioners' perspectives toward nurses' participation in health promotion activities. Primary care nurses may be able to bridge the gap between societal expectations of this field and how patients view prevention in the context of general practice. Primary care nurses have a lot of room to grow in their ability to collaborate with other healthcare providers and work outside the confines of general practice settings. In primary care settings, nursing appears to be underused despite its potential to be working more successfully in HPP. The effectiveness of present primary health care changes depends on identifying and addressing the enablers and hurdles to health promotion and prevention among primary care nurses.

Gender dynamics of community-led total sanitation interventions in Mpwapwa District, Tanzania

ABSTRACT Gender equity is an important element of health promotion and is vital to ensuring that the benefits and burdens of participation in health promotion activities are fairly distributed. Yet, the gendered consequences of participatory interventions are often overlooked. This is particularly relevant for water and sanitation initiatives, given that women are generally responsible for maintaining domestic hygiene and procuring water. This study uses a qualitative approach to assess the gender dynamics of participation in community-led total sanitation (CLTS) activities in Mpwapwa District, Tanzania. We used semi-structured interviews and focus-group discussions to investigate men’s and women’s involvement in health promotion initiatives and their key motivators for and challenges to participation. We interviewed 77 community members from four villages and analysed the responses using qualitative content analysis. The study supports the notion that participation reinforces gender inequity and reproduces gendered norms due to activity-specific participation, women’s passive participation within activities, and their limited opportunities for decision-making. However, there were also indications that participation provided a platform to increase the status of women, prioritise women’s needs and demand a stronger position in decision making within the household and the community. CLTS organisers should, therefore, harness the opportunity to address gender inequalities within the community.

Applying the Pender's Health Promotion Model to Identify the Factors Related to Older Adults' Participation in Community-Based Health Promotion Activities.

Aging societies have garnered global attention regarding issues related to older adults’ health promotion. This cross-sectional study aimed to identify factors associated with older adults’ participation in community-based health promotion activities. The Older Adults’ Health Promotion Activity Questionnaire was developed to collect data, and a total of 139 older adults were recruited from a community care center in Taoyuan City. Participants’ mean age was 72.7 years (SD = 6.0 years), 74.8% were females, 64.7% were married, 59% had a lower level of education, 51.8% had lower income, 59% reported their health status not good, and 76.3% had chronic disease. Our findings indicated that age, perceived benefits, and self-efficacy were identified as significant predictors of participation in health promotion activities. Among them, perceived benefits were found to have the strongest association with participation in health promotion activities (β = 0.305; p < 0.05). The findings showed that the Pender’s Health Promotion Model is useful to provide information for predicting and detecting significant factors related to older adults’ participation in community-based health promotion activities. By using this model as a framework, researchers can design more specific studies that are directed towards improving healthy lifestyles and detecting the key components of health-related behaviors among different age groups.

Personality trait predictors of adjustment during the COVID pandemic among college students.

Personality traits have been found to be related to a variety of health outcomes. The aim of this study was to examine how personality traits were associated with adjustment to the COVID pandemic in college students. The sample included 484 first-year university students (76% female) attending a northeastern university who completed the Big Five Inventory (BFI) personality assessment at the beginning of a semester that was disrupted by the COVID pandemic. Using a phone-based app, students completed daily ratings of mood, perceived stress levels, and engagement in a number of health promotion activities (exercise, mindfulness, adequate sleep, etc.) throughout the semester both before and after the onset of the pandemic (e.g., a within-person longitudinal design). Results, as expected, showed that mood and wellness indices generally declined during the COVID period, although stress levels actually decreased. Further, irrespective of COVID, improved mood, less perceived stress and greater participation in health promotion activities were significantly associated with a number of personality traits including neuroticism (lower), extraversion (higher), agreeableness (higher), and conscientiousness (higher). Of primary interest, mixed-effects models were used to test how major personality traits interacted with any changes in daily ratings from the pre-COVID to COVID period. Significant interactions terms were found suggesting differential impacts of the COVID epidemic for students with low versus high levels of particular traits. Higher levels of extraversion, for example, were found to be related to decreases in mood as the pandemic progressed in contrast to those with lower extraversion, for whom there was a slight increase in mood over time. These data support the conclusion that personality traits are related to mental health and can play a role in a person’s ability to cope with major stressful events. Different traits may also be more adaptive to different types of stressors.

Impact of the village health center project on contraceptive behaviors in rural Jordan: a quasi-experimental difference-in-differences analysis

BackgroundAppropriate contraceptive use remains a major health challenge in rural Jordan. The Japan International Cooperation Agency implemented a project aimed at enhancing the capacity of village health centers (VHCs) to improve the quality and quantity of family planning (FP) services in rural Jordan in 2016–2018. Facility- and community-based approaches were integrated into the interventions. We evaluated the project’s impacts on contraceptive behaviors and the effectiveness of the two approaches.MethodsWe used a difference-in-differences analysis based on the project baseline and endline surveys, and logistic regression analysis to assess associations between eight primary outcomes and three secondary outcomes (impacts). The unit of intervention was five target VHCs; the unit of analysis was currently married women of reproductive age (15–49 years) in five intervention and five control villages.ResultsOverall, 2061 married women participated; 83.8% were in need of FP. Compared with the control villages, significant effects, ranging from + 0.4% points (pp) to + 11.5 pp., were observed in the intervention villages for six primary outcomes in these categories: increasing the use of FP services at VHCs, participation in health promotion activities, and changing the sources of reproductive health information. There was a trend toward improved secondary outcomes in the intervention villages, but no significant differences were observed between the intervention and control villages regarding modern contraceptive use (mCU; + 4.3 pp), traditional contraceptive use (tCU; − 0.5 pp), and spousal agreement on contraception (+ 5.1 pp). mCU was positively associated with five primary outcomes: obtaining contraceptives at VHCs [adjusted odds ratio (AOR) 3.44, 95% confidence interval (CI) 1.26–9.40], education sessions at VHC (AOR 7.41, 95% CI 1.60–34.39), health activities in communities (AOR 7.41, 95% CI 3.28–16.78), counseling by private doctor/clinic (AOR 0.62, 95% CI 0.40–0.97), and information gained through TV (AOR 0.50, 95% CI 0.32–0.76). Spousal agreement on contraception showed similar positive trends. tCU was associated only with TV.ConclusionsThe project had impacts on increased mCU and husbands’ perception of contraception in rural Jordan. The integration of facility- and community-based approaches may be effective in shifting from tCU to mCU in other rural areas.

Quality of motivational interviewing matters: the effect on participation in health-promotion activities in a cluster randomized controlled trial.

Objectives This study aims to evaluate the effectiveness of a "blended" workplace health-promotion intervention, alongside identification of key components beneficial for future implementation strategies. Methods Within a cluster randomized controlled trial, 491 employees at increased risk of cardiovascular disease were allocated to the limited (N=217; 9 clusters) or extensive (N=274; 8 clusters) intervention. The extensive intervention consisted of motivational interviewing (MI) within the framework of a web-based health risk assessment (HRA), a blended care approach. The limited intervention received solely the web-based HRA. Occupational health physicians (N=21) within three organizations delivered the intervention. Implementation components investigated included: HRA (reach and participation), newsletters (percentage read), and MI sessions (number and quality). MI quality was determined by scoring audiotaped MI sessions, using the MI treatment integrity code. After 6 and 12 months, effects on participation in health-promotion activities and its associations with components of implementation were determined by mixed-effects models. Results Over 80% of employees participated in health-promotion activities, with an additional 8% in the extensive compared to the limited group. In the extensive intervention, those with more or better quality MI sessions were more likely to participate in health-promotion activities. Increased MI quality was associated with sustained participation. Conclusions This study suggests that participation in health-promotion activities can be increased by adding MI to a web-based approach and improving the quality of the MI delivered. Interventions with MI should include optimized delivery and quality of MI sessions.

Participação de usuários da atenção primária em práticas de promoção da saúde

Objective: To analyze the factors associated with the participation of primary health care users in health promotion practices. Methods: Descriptive and analytical cross-sectional study carried out in the municipality of Vitoria de Santo Antao, Pernambuco, in 2016 with 148 participants aged over 20 years enrolled in three Family Health Care Centers or in the Small Waist Project. Data were collected using a semi-structured questionnaire addressing sociodemographic data, clinical profile, eating habits, and knowledge about and participation in health promotion practices and activities. Association between variables was checked using Pearson’s Chi-squared test with a significance level of p<0.05. Results: A total of 148 individuals participated in the study, 76.4% (n=113) of whom were interviewed in the Family Health Care Center and 23.6% (n=35) in the extension project. The mean age was 52.9 years. In addition, 93.2% (n=138) of the participants were women and 57.4% (n=85) had a household income of up to one minimum wage. Participation in health promotion groups/activities was directly proportional to increasing age (p=<0.001), presence of comorbidities (p=0.005), continuous use of medications (p=0.001) and knowledge about the existence of groups/activities (p=0.001). On the other hand, users’ participation was lower among those who worked (p=0.049) and those who lived in households with greater number of people (p=0.001). Conclusion: The variables that were associated with participation in health promotion activities were age, presence of comorbidities, use of medications, knowledge about the existence of educational practices, work and number of people in the household.

Amendments and corrections

This erratum concerns the numbers in table 3 regarding participation in health promotion in a subsample of participants. The reported numbers in the original report are identical to the numbers in the whole study population reported in table 2. The changes imply that we find a significantly lower participation in health screenings among fixed night workers (OR 0.3, 95% CI 0.1–0.8) and a significantly higher participation in health promotion activities involving contact with health professionals among employees working variable shifts without night work (OR 1.8, 95% CI 1.1–2.8). These changes do not alter the conclusion that – contrary to our hypothesis – overall, day and shift workers did not differ systematically with respect to their participation in workplace health promotion once it was available to them. Click on link to view the table.

Participation in health promotion activities and related factors among the elderly in a selected district in Taipei City, Taiwan

Participation in health promotion activities and related factors among the elderly in a selected district in Taipei City, Taiwan

Participants’ Perceptions of Worksite Health-Promotion Educational Activities

ABSTRACTAdults spend a significant amount of time at work making the worksite a convenient venue for participation in health-promotion activities. This research project examined participants’ perceptions of gaining knowledge and changing health behavior practices as a result of knowledge gained through participation in health-promotion activities provided at the worksite. The worksite health-promotion activities were offered as a result of an innovative collaboration effort between nursing faculty in an academic setting and a community partner in the private sector. The findings demonstrate that participation in health-promotion activities at the worksite can result in increased knowledge and changes in health behavior practices as a result of knowledge gained.

Opportunities for involving men and families in chronic disease management: a qualitative study from Chiapas, Mexico.

BackgroundA healthy lifestyle intervention was implemented in primary care health centers in urban parts of Tuxtla Gutiérrez, Chiapas, Mexico with an aim of reducing cardiovascular disease risk for patients with type 2 diabetes and/or hypertension. During implementation, research questions emerged. Considerably fewer men participated in the intervention than women, and an opportunity was identified to increase the reach of activities aimed at improving disease self-management through strategies involving family members. A qualitative study was conducted to identify strategies to involve men and engage family members in disease management and risk reduction.MethodsNine men with hypertension and/or type 2 diabetes with limited to no participation in disease self-management and health promotion activities, six families in which at least one family member had a diagnosis of one or both conditions, and nine health care providers from four different government health centers were recruited for the study. Participants took part in semi-structured interviews. During interviews with families, genograms and eco-maps were used to diagram family composition and structure, and capture the nature of patients’ relationships to the extended family and community resources. Transcripts were coded and a general inductive analytic approach was used to identify themes related to men’s limited participation in health promotion activities, family support and barriers to disease management, and health care providers’ recommendations.ResultsParticipants reported barriers to men’s participation in chronic disease management and healthy lifestyle education activities that can be grouped into two categories: internal and external factors. Internal factors are those for which they are able to make the decision on their own and external factors are those that are not related solely to their decision to take part or not. Four primary aspects were identified related to families’ relationships with disease: different roles within the family, types of support provided to patients, the opportunity to prevent disease among family members without a diagnosis, and - in some cases - lack of family support or stress-induced by other family members. There was an overlap in recommended strategies for engaging men and family members in chronic disease management activities.ConclusionsThere is an opportunity to increase the reach of interventions aimed at improving disease self-management by engaging men and family members. The proposed strategies presented by patients, family members, and providers have implications for health education and service provision at primary care health centers and for future research.

Design and baseline characteristics of the PerfectFit study: a multicenter cluster-randomized trial of a lifestyle intervention in employees with increased cardiovascular risk.

BackgroundThe prevalence of unhealthy lifestyles and preventable chronic diseases is high. They lead to disabilities and sickness absence, which might be reduced if health promotion measures were applied. Therefore, we developed the PerfectFit health promotion intervention with a “blended care”-approach, which consists of a web-based health risk assessment (HRA) including tailored and personalized advice, followed by motivational interviewing (MI). We hypothesize that adding MI to a web-based HRA leads to better health outcomes. The objective is to describe the design and baseline characteristics of the PerfectFit study, which is being conducted among employees with high cardiovascular risk in the military workforce, the police organization and an academic hospital.MethodsPerfectFit is a cluster randomized controlled trial, consisting of two arms. Based on cardiovascular risk profiling, done between 2012 and 2014, we included employees based on one or more risk factors and motivation to participate. One arm is the ‘limited’ health program (control) that consists of: (a) an HRA as a decision aid for lifestyle changes, including tailored and personalized advice, and pros and cons of the options, and (b) a newsletter every 3 months. The other arm is the ‘extensive’ program (intervention), which is additionally offered MI-sessions by trained occupational physicians, 4 face-to-face and 3 by telephone, and is offered more choices of health promotion activities in the HRA. During the follow-up period, participants choose the health promotion activities they personally prefer. After six and twelve months, outcomes will be assessed by online questionnaires. After twelve months the cardiovascular risk profiling will be repeated. The primary outcome is self-reported general health. Secondary outcomes are self-reported work ability, CVD-risk score, sickness absence, productivity loss at work, participation in health promotion activities, changes in lifestyle (smoking, alcohol consumption, physical activity, stress management) and body mass index. Furthermore, a process evaluation and an economic analysis will be performed.DiscussionAdditional coaching using MI is expected to be a key factor for success of the web-based HRA in employees with increased cardiovascular risk. This “blended care”-approach may be an essential strategy for effective health promotion activities.Trial registrationDutch Trial Register by registration number NTR4894, 14/11/2014.

Health behaviors and participation in health promotion activities among hospital staff: which occupational group performs better?

BackgroundStaff health behaviors affect not only their own health but also their provision of health promotion services to their patients. Although different occupational groups work in hospitals, few studies have compared health behaviors among them. The objectives of this study were to examine health behaviors, including physical activity, eating 5 portions of fruits and vegetables per day (5 a day), and stress adaptation, and participation in hospital-based health promotion activities by occupational groups in hospitals.MethodsThis cross-sectional survey was conducted among full-time employees in 100 hospitals across Taiwan. This analysis included 4202 physicians, 31639 nurses, 2315 pharmacists, 8161 other health professionals, and 13079 administrative personnel.ResultsAdministrative personnel attended more health promotion lectures and clubs/groups than other health professionals, pharmacists and physicians, and those workers participated more than nurses. Participation in health promotion activities provided by hospitals was associated with better practice of health behaviors. After adjustment for socio-demographics and participation in health promotion activities, physicians, pharmacists, and other health professionals reported more 5 a day than administrative staff. Other health professionals reported more physical activity than administrative staff, and they reported more than physicians. Nurses reported the lowest level of physical activity, 5 a day, and stress adaptation of all occupational groups.ConclusionsNurses had worse health behaviors and less participation in health promotion activities than other groups. Workplace health promotion program for health professionals is needed, with special emphasis on nurses. Hospital-based health promotion programs could take the differences of occupational groups into consideration to tailor programs to the needs of different occupational groups.

Systematic review of yoga for depression and quality of sleep in the elderly

Aging and age-related health problems are major issues of concern for community health services. Yoga is an exercise with both physiological and psychological effects on aging. Although many studies have assessed the effectiveness of yoga in the elderly, little information is available in the literature to support empirical conclusions. This review synthesizes and characterizes findings related to the effects of yoga on depression and quality of sleep in the elderly. Researchers used keywords including yoga, elderly, aged / older adult, depression, sleep, and quality to search 6 electronic databases for relevant studies published prior to March 2013. Inclusion and exclusion criteria were used to screen identified study abstracts. The Jadad scale appraised the quality of identified studies. Seven studies met the inclusion criteria. Five studies found significant changes in participant depression symptoms after doing yoga. Three studies found significant effects on the quality of sleep of participants after 6 months of doing yoga. Yoga significantly reduced the depressive symptoms of elderly participants and improved their quality of sleep after 6 months. Findings were similar for elderly living in institutions and in the community. However, the majority of participants in the assessed studies were women characterized by a high level of social participation and proactive participation in health promotion activities. Future studies should broaden the scope of research to address different aging populations and use long-term cohort observations in order to better elicit the effectiveness of yoga and to develop strategies to introduce yoga into daily activities.

Teachers’ ideas about health: Implications for health promotion at school

Objectives: The study explores the relationships among teachers’ health representations, their ideas about health promotion, their working conditions and their involvement in health-promotion activities at school. Methods: A questionnaire was administered to 107 teachers in 86 schools in Milan (Italy). The questionnaire was structured in four parts: teachers’ involvement in health-promotion programmes, teachers’ representations of health and their ideas regarding methods for promoting health; some dimensions of teacher’s job characteristics (job overload, work group, collaboration with relatives); burn-out and job satisfaction; socio-demographics data of teachers and characteristics of the schools. Results: The results show that teachers have ambiguous health representations; however, the traditional idea of health as absence of illness was prevalent among the teachers surveyed. Regarding health-promotion activities, the teachers seemed to prefer health education programmes based on informative techniques. Some representations of health were connected to the importance that teachers attributed to health promotion and to teachers’ participation in health-promotion activities. Teachers’ working conditions appear not to be related to their involvement in health promotion. Conclusions: The majority of teachers involved in this study remained substantially linked to health education models and have not switched to the health-promotion approach. This could be related to teachers’ health representations. To encourage the adoption of the health promotion approach at school, changing teachers’ health representations could be a first step.

Pakistani children’s participation in health promotion activities

This paper examines the effects of a Child-to-Child (CtC) health education programme designed to assist children in Pakistan to greater participation and voice in both their own education and their families’ health by empowering them as change agents. The study compares parental involvement in their children’s participation in health promotion activities in two disadvantaged, community-based, primary schools in rural and urban settings. Children’s health knowledge and behaviours improved as a result of the intervention but they were less successful in communicating with and influencing their families. This may have arisen from tensions between CtC assumptions and prevailing norms and beliefs in Pakistan (e.g. about family relationships, girls’ security and honour). However, there was greater influence when parental education levels and socioeconomic status were higher. Parents in village communities were more accepting of children’s health initiatives than city parents, perhaps because of a greater sense of security and familiarity with each other. Programmes that tackle social change must be cognisant not only of the judged desirability of their aims but also of the contextual and cultural realities of the ‘Southern’ societies to which they are imported.

Finding a Balance: Health Promotion Challenges of Military Women

In this study, we explored what may determine, or predict, United States military women's health promotion behaviors. Using a descriptive correlational design grounded in Pender's Health Promotion model, 491 military women completed instruments measuring their demographic variables, perception of health, definition of health, self-efficacy, and interpersonal influences to determine the significant factors affecting participation in health promotion activities. The outcome indicated that self-efficacy and interpersonal influences were the most influential in determining health promotion. This research illuminates some of the challenges working women face in meeting health promotion activities and how best to support their ability to participate in healthy behaviors.