Participatory Health Promotion Research Articles

Mental health promotion research in co-creation: Lessons from a multisite study in six countries

Abstract Background Mounting public health threats associated with climate change, epidemiological and economic crises, digitalisation, rising migration, and population aging have uncovered at-risk groups’ increased vulnerability to mental ill health. Developing mental health promotion interventions tailored to their specific needs and expectations is essential to protect their wellbeing. However, researchers may find it challenging to identify and implement needed adaptations without engaging with end-users, and other stakeholders, to co-create tailor-made interventions. This study aimed to explore co-creators’ views about opportunities and constraints in participatory mental health promotion research. Methods Between September 2023 and July 2024, a qualitative study drawing on participant observation of bimonthly meetings and semi-structured interviews with six co-creation facilitators was conducted in the scope of Horizon Europe’s project ADVANCE. The multi-methods research approach to co-creation entailed desk reviews and online Delphi surveys co-developed with locally-established Society Advisory Groups, and scenario-based workshops held with stakeholders in the six partner countries: Denmark, Germany, Italy, Lithuania, Netherlands, Switzerland. Thematic analysis of the data was carried out. Results Research teams’ epistemic stances impact research planning, resource allocation, partnership nourishing and the unravelling of co-option risks during participatory research implementation. Research co-creation adds pressure onto research teams’ agenda, skillset and performance, but it also encourages power sharing, mutual learning and greater alignment of research design and implementation with end-users’ priorities and aspirations. Conclusions Research co-creation is a partnership-based and resource-intensive endeavour that can provide a valuable pathway to improve the relevance, acceptability and sustainability of public mental health promotion research. Key messages • Research co-creation demands planning, adequate resource allocation, flexibility and continuous investment to sustain academy-society partnerships. • Engaging stakeholders in knowledge co-creation can increase the relevance, acceptability and sustainability of public mental health promotion research.

Cost-Effectiveness of a Multi-faceted Workplace Intervention to Reduce Musculoskeletal Pain in Nursing Staff: A Cluster-Randomized Controlled Trial (INTEVAL_Spain).

To evaluate the cost-effectiveness of a multifaceted workplace intervention to reduce musculoskeletal pain (MSP) in nursing staff. The study was a 1-year cluster-randomized controlled trial. The intervention combined participatory ergonomics, health promotion, and case management. The control group received usual care. Societal and health system perspectives were used. Costs included direct health and indirect costs. The effects were MSP and quality-adjusted life years (QALYs). MSP was measured using the Standardized Nordic Questionnaire at baseline and 6- and 12-month follow-up. QALYs were measured using the EuroQol-5D-3L at 6- and 12-month follow-up. Incremental costs and QALYs were modelled using generalized linear models. MSP was analysed through generalized logistic models. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness planes and acceptability curves were constructed. Total mean costs per person were €614 and €216 for the intervention and control group, respectively, with a societal perspective. The intervention mean cost was €38/person. From the societal perspective, the ICER showed that overall additional €68 (€9 from a health system perspective) were required to achieve 1-extra-percentage-point reduction of MSP. ICERs were €34 from the societal and €4 from the health system perspectives for neck, shoulders and upper back pain; €53 and €7 for low back; €179 and €23 for hands; €39 and €5 for legs; €115 and €14 for the knees; €36 and €5 for feet For MSP in the elbows. For participants with pain in the elbow, and for QALYs, the ICER showed that the intervention group was dominated by the control group. This intervention was not cost-effective in terms of QALYs. However, in terms of MSP, with a willingness to pay of €100, the probability of the intervention being cost-effective was around 90%. Further studies incorporating our recommendations are needed to confirm these findings. ISRCTN15780649, retrospectively registered.

Effectiveness of a community-based participatory health promotion intervention to address knowledge, attitudes and practices related to intimate partner violence: a quasi-experimental study.

Intimate partner violence is the most common form of violence experienced by women. It has detrimental consequences. A range of determinants cause intimate partner violence and to reduce it, effective interventions are required to address the determinants. Health promotion interventions have been recommended as effective to enable people to control over the determinants and to improve health. Hence, a community based participatoryhealth promotion intervention was developed and tested in a selected study setting. The objective was to evaluate the effectiveness of a health promotion intervention in terms of addressing knowledge, attitudes and practices related to intimate partner violence. A quasi-experimental study was conducted by recruiting ninety women aged 15 to 49years separately from two health administrative areas identified as the intervention area and the control area from the Kandy district of Sri Lanka. A pretested interviewer-administered questionnaire was used in both pre- and post-assessments. Selected groups of women from the intervention area were facilitated with a health promotion intervention to improve knowledge, attitudes and practices related to intimate partner violence. To evaluate the effectiveness of the intervention descriptive summaries and bivariate analysis were used. The response rate was 90.9% (N = 90) during the pre-assessment and 87.9% (n = 87) and 82.8% (n = 82) from the intervention and control areas, respectively, during the post-assessment. Statistically significant improvement was reported in the total mean score comprising knowledge, attitudes, practices and identification of determinants from 59.6 to 80.8 in the intervention area [Pre-assessment: Mean = 59.6 (standard deviation-SD) = 17.5; Post-assessment: Mean = 80.8, SD = 19.0; p < 0.001) compared to the improvement in the control area from 62.2 to 63.0 (Pre-assessment: Mean = 62.2, SD = 17.3; Post-assessment: Mean = 63.0, SD = 18.9; p = 0.654). The intervention was effective to improve knowledge, attitudes and practices related to intimate partner violence. Hence, the present approach can be used in similar contexts to address the knowledge, attitudes and certain practices related to intimate partner violence.

Community Engagement in Health Promotion: Results from a Realist Multiple Case Study

Community engagement (CE) has long been endorsed by policy makers and health practitioners. However, uncertainties remain about the workings and outcomes of CE. This study aims to provide in-depth insights into them. In a multiple case study, we investigated three participatory health promotion projects for families in vulnerable situations in the Netherlands. We adopted a realist approach combined with a theory of change (ToC) model. We then analysed the qualitative data for context–mechanism–outcome (CMO) configurations to refine this ToC. Results show that CE can strengthen social networks, empower families, and increase perceived health. However, specific contexts in combination with CE project approaches may or may not trigger positive responses. Participants may feel that they matter when asked to actively contribute to a project, which in turn can enhance their self-confidence. In another context, we found that families were overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We present a list of CMO configurations and refine the ToC accordingly. Our main conclusion is that flexibility is key when CE is implemented in health promotion. Also, our findings question physical health outcomes as a realistic ambition for CE projects with groups in vulnerable situations.

Democratising participatory health promotion: power and knowledge involved in engaging European adolescents in childhood obesity prevention

Public policy aimed at preventing undesired phenomena has increasingly sought to engage representatives of the target population. Little is known, however, about how power dynamics function to shape the processes and outcomes of risk governance engagement interventions. In order to study the ways in which, and the extent to which, power differentials can be reduced in participatory health promotion initiatives, we develop a conceptual framework synthetising theories of participatory action, phenomenology and governmentality. Based on the empirical research into youth participation in the EU project CO-CREATE, involving 15–19-year-old adolescents in five European countries (2019–2021), we show that diverse forms of knowledge may become available in engagement interventions. We analyse the use and relative inclusion and exclusion of these different forms of knowledge in terms of a three-level framework of different depths of democratisation in participatory health promotion: risk management, risk definition and risk negotiation. Advanced democratisation can only be achieved if risk negotiation is carried out in ways which embrace and encourage a range of different, and potentially conflicting forms of knowing.

Healthy immigrant community study protocol: A randomized controlled trial of a social network intervention for cardiovascular risk reduction among Hispanic and Somali adults

BackgroundImmigrants to the United States face structural barriers that contribute to rising cardiovascular risk factors and obesity after immigration. This manuscript describes the development of the Healthy Immigrant Community protocol and baseline measures for a stepped wedge cluster randomized trial to test the effectiveness of a social network intervention for cardiovascular risk reduction among two immigrant populations. MethodsWe developed a social network-informed, community-based, participatory research-derived health promotion intervention with Hispanic and Somali immigrant communities in Minnesota consisting of mentoring, educational and motivational sessions, group activities, and a community toolkit for healthy weight loss delivered by culturally concordant health promoters (HPs) to their social networks. Using a stepped wedge cluster randomized design, social network-based groups were randomly assigned to receive the intervention either immediately or after a delay of one year. Outcomes, measured at baseline, 6 months, 12 months, and 24 months, were derived from the American Heart Association's “Life's Simple 7”: BMI and waist circumference, blood pressure, fasting blood glucose, total cholesterol, physical activity level, and dietary quality. ResultsA total of 51 HPs were enrolled and randomized (29 Hispanic; 22 Somali). There were 475 participants enrolled in the study, representing a mean social network group size of 8 (range, 5–12). The mean BMI of the sample (32.2) was in the “obese” range. ConclusionProcesses and products from this Healthy Immigrant Community protocol are relevant to other communities seeking to reduce cardiovascular risk factors and negative health behaviors among immigrant populations by leveraging the influence of their social networks.

Promoting healthy learning: A participatory health promotion project with healthcare students

Abstract Background Health promotion is of great importance during education to prepare future health professionals for their work. Students need to cope with long periods of sitting, stress and high workload through practical training in the healthcare sector. Based on students’ experiences, we developed a project to promote healthy learning at a University of applied Sciences for Health in Germany. Objectives The project is part of an ongoing quality improvement in education initiative. Our aim was to inform students about health promotion in everyday study life. Based on a participatory approach, 3 employed occupational therapy students designed two videos with their peers. For evaluation, we sent three e-mails and conducted a survey among all 1730 students from 17 to 30 April 2023. Questions related to three aspects: how much students like the videos, whether they find them helpful, and whether they intend to use them in their everyday studies. Results Students identified two video topics: 1. Ergonomic adjustment of the desk with tips for improvement at no or low cost; 2. A short exercise programme to take part in, tailor-made for breaks between lectures or learning phases. 193 students opened the survey, 92 completed the questionnaire. The ergonomics video was rated good to very good by 83 (90%) of the participants; 83 (90%) found it helpful to optimize their workplace. 62 students (67%) wanted to adapt their workplace, 30 (33%) did not, already had an optimal workplace or abstained. The exercise video was rated good to very good by 76 (83%); 78 (85%) of the participants found it helpful. While 61 (66%) wanted to use it in their daily student life, 34% did not, used other exercises or abstained. Conclusions A consultation with the students in the project revealed that the survey's low response rate reflects the general burden of e-mail floods and study workload. Tailored videos were rated by most participants as helpful in promoting health in everyday study life. Key messages • Tailored health promotion is of great importance for healthcare students. Measures need to be affordable and easy to integrate in everyday student life. • Participatory approaches to health promotion for students are essential, because students’ expertise for student life leads to measures that best suit their needs.

Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial.

Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women's self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN. DERR1-10.2196/42450.

O.5.3-8 Prospects and challenges of real-world labs in physical activity promotion

Abstract Purpose Participatory health promotion uses an array of different concepts to describe project processes and effects, including empowerment, capacity building, and capabilities. In practice, however, these concepts may hamper project scalability, compatibility with state-of-the-art health concepts, and efforts to counteract social inequities. We introduce the concept of real-world labs as a potential solution for current problems in participatory health promotion and investigate its practical applicability using the case example of an existing physical activity promotion project. Methods We analyze current problems in participatory health promotion that emanate from the utilization of certain popular theoretical concepts. We then introduce real-world labs as a potential solution. Using the PArC-AVE-Project (Physical Activity-related Health Competence in Apprenticeship and Vocational Education) as a case example, we show how the approach can be used retrospectively to address the aforementioned issues. Results Real-world labs are a type of transdisciplinary approach at the intersection of research and society. They help create an environment for flexibly testing innovative solutions under changing conditions using small-scale “real-world experiments” and feedback loops. However, the approach is so far not commonly used in participatory health promotion. The example of PArC-AVE illustrates that existing participatory projects can potentially be developed towards becoming real-world labs. Relevant perspectives for this include (a) the targeted integration of different actors into the participation process, (b) more variable approaches to scaling-up interventions, (c) a more flexible utilization of different participation methods, and (d) a better recognition of concepts such as planetary health. Conclusions The real-world lab approach has the potential to increase the range of options available to participatory health and physical activity promotion. However, only further practical testing will show whether it is indeed effective in overcoming social inequities and ameliorating the high degree of context-dependence of many participatory projects.

O.4.6-4 Engagement and knowledge in a participatory systems approach to promote physical activity and mental health at vocational schools in Denmark: the Data Health study

Abstract Purpose Strong community engagement and capacity have been associated with positive intervention outcomes in community-based participatory health promotion interventions. The Data-driven Health Promotion at Vocational schools (Data Health) study aims to catalyze systems change in vocational school settings through community-led collective health promoting actions targeting physical activity and mental health among students. Three Group Model Building (GMB 1-3) sessions were delivered at eight intervention sites to build capacity and engage schools, municipalities, and communities. As part of the process evaluation, we assessed level of stakeholder knowledge, used as an indicator for capacity, and engagement prior to implementation of actions. Methods Data were collected among participants at GMB-3 during 2022 using a modified version of the validated Stakeholder-driven Community Diffusion Survey assessing two factors: knowledge (eight items) and engagement (16 items). Five-point Likert scale scores were recoded to values between 0 (strongly disagree) to 1 (strongly agree) and means for each factor were calculated. T-tests and one-way ANOVA were used to compare level of knowledge and engagement by type of community actor and health theme. Results Across intervention sites, 120 completed the survey; &amp;gt;95% of all participants. Four sites (71 respondents) had chosen mental health as their focus area prior to GMB-3 while four sites had chosen physical activity (49 respondents). Most respondents were students (58%), followed by Civic society actors (19%), vocational school staff (19%), Municipal staff (6%) and vocational management (3%) (2% missing). Mean level of engagement was 0.89 and mean level of knowledge was 0.78. Significant differences were found for both factors by chosen health theme (with lower levels at mental health sites, p &amp;lt; 0.05) and type of community actor (with lower levels among student and municipal staff, p &amp;lt; 0.001). Conclusions High levels of knowledge among local stakeholders are needed to understand and support diffusion of evidence-informed interventions through the community; high levels of engagement are a prerequisite for inducing collaborative and sustainable efforts. Assessment of knowledge and engagement prior to implementation of actions is important to understand outcomes across intervention sites in the Data Health study. Support/Funding Source The Danish Regions, Tværspuljen, Helsefonden, University of Southern Denmark, in-kind contributions.

How to Conduct a Photovoice Systematic Review: Lessons Learned and Recommendations

Photovoice distinguishes itself from other qualitative research methods for its visual features and participant empowerment. As a powerful tool for community-based participatory research and health promotion programs, researchers and practitioners are paying more attention to this method in recent years. Accordingly, some photovoice systematic reviews have been published and more are underway to synthesize evidence in various research fields. However, due to the exploratory nature of the photovoice method, broad research questions for photo taking, flexible steps in photo discussion and analysis, and lack of standardized qualitative review guidelines, it could be challenging to conduct a photovoice systematic review. The purpose of this paper is to provide an overview of the photovoice method, debrief the process of a previous review, summarize lessons learned, and provide suggestions to facilitate future photovoice systematic reviews. This paper may also be of benefit to researchers who intend to apply photovoice to their research topics, or plan to conduct other types of photovoice literature reviews (e.g., scoping reviews).

Sharing of Best Practices from an Emergency Medical Team Deployment in Papua New Guinea: Piloting a Health Promotion Program Targeting COVID-19 Vaccine Uptake

Background/Introduction:COVID-19 tremendously affected Papua New Guinea in late 2021, which accompanied by a low vaccination rate (&lt;4%), lead to an International EMT Request for Assistance.Objectives:Study’s aim is to share how UK-Med, a part of the UK EMT, developed best practices related to risk communication and community engagement integration within a COVID-19 emergency response.Method/Description:A participatory health promotion program was piloted in Western Highland Province among 71 health care workers. Training of trainers approach was adopted to build the capacity of health workers in advocating for vaccines uptake. Perception survey was used at the baseline and at the end of the program to assess the knowledge, skills, and attitude of the participants towards COVID-19 vaccine acceptance. A descriptive analysis and paired t-test were used.Results/Outcomes:Health care professionals are not well-equipped with accurate, scientific, and up-to-date information related to COVID-19 vaccines; which leads to increase in concern and fear among them. Health care workers affect community members’ decision to take the COVID-19 vaccine, being viewed as referents within their communities. The paired t-test showed a significant increase in the knowledge, skills, and attitude (P value &lt;.001) of the participants toward COVID-19 vaccines. Participants described being ready to engage community influencers and cascade training to further reach out to community groups.Conclusion:Integrating RCCE within EMT deployments plays a crucial role in leveraging health care capabilities to influence community members and advocate for COVID-19 vaccines uptake; which will ultimately decrease morbidity and mortality. Further research is required to strengthen the role of health promotion in emergencies.

Participatory Approaches in Family Health Promotion as an Opportunity for Health Behavior Change-A Rapid Review.

Background: With their influence on health behavior of children, families are important addressees in health promotion and prevention of chronic diseases. However, they are often difficult to reach, partly due to the open approach of health promotion services. Therefore, they should be addressed directly and be involved in shaping their living environment. The aim is to examine which approaches are used in participatory family health promotion and what practical experiences are made. Methods: A systematic literature search in PubMed, Web of Science, LIVIVO and a supplementary hand search were conducted. Ten of 718 screened publications were analyzed qualitatively. Results: Most included publications applied the community-led participatory approach CBPR. In seven publications, family actors could make decisions at any or all project phases. One finding is that positive effects on desired behavior change and improved health of target groups were observed. Frequently described success factors are the type of interaction, and a common goal. Conclusion: The forms of family participation in health promotion vary widely, with the lack of participatory practices being a major challenge. Family participation is a useful approach in shaping health promotion and should be further developed. This overview provides support for planning future participatory projects with families.

Knowledge and Awareness of Vitamin D Among Pregnant or Lactating Iraqi Refugee Women: a Call for Different Approaches in Health Education and Outreach

Vitamin D deficiency during pregnancy and lactation has negative impacts on maternal, fetal, and infant health. Low health literacy and other social determinants of health may increase the risk of deficiency among refugee women. This qualitative study used a survey and in-depth individual interviews to examine knowledge of vitamin D among ten pregnant or breastfeeding Iraqi refugee women in the United States, and sought participants’ recommendations on culture-centered and participatory health promotion strategies. All participants reported having insufficient information and understanding of vitamin D, its health benefits, and the risks of deficiency. The four primary themes that emerged from the interviews were the quality of available vitamin D information, barriers to seeking such information, intersectionality of health and environment, and power differentials and the control of the health agenda. Participants’ recommendations included bridging the language barrier and training health care providers to deliver the information needed to raise awareness. The findings of this study provide an opportunity for public health systems to design culture-centered health education and promotion strategies to ensure vitamin D adequacy among this vulnerable population.

What fuels the research truck? Participatory health promotion research for sustainable change.

What fuels the research truck? Participatory health promotion research for sustainable change.

Scaling Up Physical Activity Promotion Projects on the Community Level for Women in Difficult Life Situations and Older People: BIG-5 and GET-10-A Study Protocol.

IntroductionPhysical inactivity is a major risk factor for a population's health, especially among socially disadvantaged groups. Many health promotion projects focus on increasing physical activity among their respective target groups. However, because they are mostly developed and implemented under laboratory conditions, they fail when being scaled to real-world settings. The community-based participatory research projects BIG and GESTALT have demonstrated their effectiveness regarding the physical activity promotion in real-world settings by employing a participatory method.Material and AnalysisWithin the context of the BIG-5 and GET-10 projects, these previously implemented and tested participatory projects are scaled to 15 additional settings in Bavaria, Germany. By applying an overarching mixed-methods evaluation framework, the aim is to gain insights into a) the recruitment of communities for scale-up; b) the specific results of the projects according to the RE-AIM framework. In the recruitment of communities, standardized information on the first contact, the consultation process, the person in charge, and previously implemented health promotion projects are collected. A systematic web search will complete information on each community and their health promotion activities. Results will be compared with information on those communities most in need, here according to the deprivation index of communities in Bavaria, Germany. The scale-up process and its results will be measured using semi-structured interviews with project coordinators. A standardized questionnaire will be used with the course's participants. Applying the RE-AIM framework, the collected data will be analyzed deductively.DiscussionWe expect the results to be highly relevant for the effective scale-up of any health promotion project. The study will enhance the understanding of how to reach those communities most in need of health promotion projects and will identify the barriers coordinators face in reaching socially disadvantaged groups.ConclusionAlthough participatory projects are often used as individual projects, little is known about the scaling up of participatory health promotion projects. This cross-cutting evaluation of two projects aims at producing data on the barriers and facilitators for the reach of settings most in need, and those success factors for a durable implementation.

Eliciting critical hope in community-based HIV research with transgender women in Toronto, Canada: methodological insights.

SummaryCritical hope centres optimism and possibilities for change in the midst of struggles for social justice. It was a central tenet of early participatory pedagogy and HIV research. However, critical hope has been overlooked in contemporary HIV research that largely focuses on risk and biomedical interventions in ways that obscure collective agency and community strengths. We conducted a community-based study with transgender (trans) women of colour in Toronto, Canada to adapt an evidence-based HIV prevention intervention. Participants resisted a focus on HIV, instead calling researchers to centre journeys to self-love in contexts of social exclusion. In response, we piloted three arts-based, participatory methods generated with community collaborators: (i) affirmation cards sharing supportive messages with other trans women, (ii) hand-held mirrors for reflecting and sharing messages of self-acceptance and (iii) anatomical heart images to visualize coping strategies. Participants generated solidarity and community through shared stories of self-acceptance within contexts of pain, exclusion and loss. Narratives revealed locating agency and self-acceptance through community connectedness. Critical hope was a by-product of this participatory process, whereby participants shared personal and collective optimism. Participatory and arts-based methods that centre self-acceptance and solidarity can nurture resistance to pathologizing discourses in HIV research. Centring critical hope and participant-generated methodologies is a promising approach to transformative health promotion and intervention research. These methodological insights can be engaged in future participatory work with other marginalized groups facing dominant biomedical risk discourses. Critical hope holds potential as a participatory health promotion strategy for envisioning possibilities for sustainable change.

Toward the economic evaluation of participatory approaches in health promotion: lessons from four German physical activity promotion projects.

Health promotion increasingly employs participatory approaches, but the question arises whether the likely higher costs of participation also translate into greater benefits. This article takes a first step toward a full health economic evaluation by comprehensively reporting the costs of a specific participatory approach, Cooperative Planning, in a German research consortium to promote physical activity. We conducted a costing analysis of Cooperative Planning at 22 sites across six settings. Project teams used a custom template to record resource use. We calculated average costs per meeting, site and setting using the opportunity costs approach, and obtained feedback from participating researchers. A total of 144 planning meetings with an average of nine participants were conducted. Costs per meeting varied significantly across settings. Differences were mostly attributable to varying meeting duration, preparation time and numbers of participants. Across settings, human resources accounted for roughly 95% of the costs. Implementing researchers reported challenges regarding the logic and methods of the health economic analysis. A participatory approach to physical activity promotion may cause substantially varying costs in different settings despite similar cost structures. However, their value for money could turn out comparably favorable if (and only if) the expected benefits is indeed forthcoming. Despite some challenges implementing the costing exercise into the logistics of ongoing participatory projects, this analysis may pave the way toward a full health economic evaluation, and the template may be useful to future participatory health promotion projects.

Health promotion through digital means: Refugee women using video and social media in times of COVID-19

BackgroundForced migration is particularly hard on women and families. On arrival in host countries, living conditions (e. g. accommodation in camps) and various restrictions connected with the process of seeking asylum severely restrict women's abilities to care for themselves and their families. Gender-based violence is just one of many problems. These problems are exacerbated during the COVID-19 pandemic.MethodsAs part of the EMPOW project at the study site in Hannover, Germany, community partners who are female refugees themselves, are committed to improving the health of other refugee women and families. To pursue this aim, a digital network was established using social media. Short videos were created in Farsi and Arabic addressing various aspects relevant to the health of refugee women and families. These include: a) information on hygiene and how to wear a mask to reduce the spread of Corona, b) activities during COVID related lockdown phases (e.g. games to play with children indoors and gymnastics and sports for adults), and c) further questions and answers on general health and health care.ResultsMore than 80 women have joined the digital network within a few months. The videos are distributed and discussed using WhatsApp groups. The community partners collect health related questions from the participating refugee women, which are then answered by a medical doctor in Farsi. The groups provide an opportunity for mutual exchange and advice regarding women's health and the wellbeing of families.ConclusionsDigital means including short, self-made videos and social media such as WhatsApp groups are valuable means for participatory health promotion with refugee women. Limitations of the digital format are discussed.Main messages Refugee women can be reached via social media messages and short video clips.Peer-based health promotion holds great value for women and families affected by forced migration.

Key elements and effects of cardiovascular disease management programs based on community-based participatory research: protocol for a scoping review

BackgroundCardiovascular diseases (CVDs) are health problems that demonstrate high death and prevalence rates, and exhibit large health inequalities across different socio-economic status. Although interest in community-based participatory research (CBPR) is increasing because of the efforts to improve health equity, not enough literature review has been conducted on CBPR-based CVD management programs. The objective of this scoping review is to identify the key elements that should be considered when developing CBPR-based CVD management programs, and explore the effects of CBPR-based CVD management programs.MethodsThis study will use the databases of PubMed, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) including grey literature. The criteria for selecting literature will be research that was published in or after 2000, applied CBPR, and either developed or implemented CVD management programs. No limit will be placed on the research design or method. Data extraction will be conducted independently by two researchers, and in the case of data mismatch, a consensus will be reached through discussion. The extracted data will be combined through narrative synthesis.DiscussionThis scoping review will identify specific methods in the development and implementation process of CBPR-based CVD management programs, as well as the characteristics of the programs that were shown to be effective. Therefore, it will be able to provide specific guidelines to researchers, government agencies, and local organizations to design and implement participatory health promotion programs related to CVDs.Systematic review registrationOpen Science Framework https://doi.org/10.17605/OSF.IO/ZW2UY