Health Promotion Practice Research Articles

2.C. Workshop: Our Food, Our Health, Our Earth: the health literacy pillar of health promotion for sustainability

Abstract Health Literacy (HL) is one of the three pillars of Health Promotion (along with Good Governance and Healthy Cities) (The Shanghai Declaration, WHO 2016). In the dilemma of a sustainable future for humanity, there is a cross-section meeting point where fundamental issues activate the ingredients that either jeopardize that future or respond to the foundations of sustainability. These ingredients are the Food chain (preferences, choices, production, distribution and consumption), the Health dimension (perceptions, concepts, theoretical implications to whole system & society approaches and activation of strategies to promote health) and the Planet (where limited resources do not mitigate humanity hunger of their appropriation, transformation and use). Therefore at the public health level, it is crucial to deepen the discussion, research the best options, facilitate the correct decisions, empower the way forward while we envision a global response that will move humanity to respond positively to the foundations of sustainability. A component that might impinge either of these two options, above referred, is the level of HL that citizens, communities, societies as a whole, possess and integrate in their everyday decision & action processes. This workshop aims to establish a ground approach to the articulation between health promotion and HL when sustainability is at stake. Therefore, it discusses how this third pillar (i.e. HL) may be translated into the everyday practice of Health Promotion “ensuring that people can cope with the challenges they face, through health literacy, ...to lead lives ...in harmony with Nature” (WHO 2021). In the first presentation HL is explored as a situational social practice. In the second presentation, a closer look to “Our Food” is made by the means of a research that investigated 852 adolescents’ health literacy. In the third presentation the conceptualization of Health and HL are considered. The forth presentation will lead the audience to the theoretical discussion of Health Promotion and Positivism. This discussion triggers the floor to a debate around seminal ideas and action processes in the realm of Health Promotion in the context of best practices. From the public health perspective the aim of this workshop is to share with the audience an opportunity to immerse in two different social contexts and explore their HL practices as tracer approaches. This workshop offers a forum for researchers, practitioners and policy-makers interested in health promotion pillars (e.g., health literacy), facilitate the dialogue and lively interaction and vivid discussions to improve policy research, practice, and policy-making, support further synergies, facilitate networking and collaboration, and support international capacity building towards sustainability. Key messages • Explore concepts (e.g. on health literacy) and theories to ensure that a coherent takeover is aiming at sustainable health promotion implementation strategies. • The third pillar of Health Promotion (i.e. health literacy) demands a broader reflection of theoretical versus practice approaches when looking at our Food, our Health & our Planet.

Associations between parent-adolescent health-related conversations and mealtime media use among Hispanic families.

Whereas parents play an important role in shaping the home environment, it is unknown whether health-related parent-adolescent conversations may be associated with different health-promoting parenting practices, such as limiting adolescent mealtime media use in Hispanic families. For this cross-sectional analysis, Hispanic parents (n = 344; 40.4 ± 6.6 years; 89.2% female) of sixth- to eighth-grade adolescents self-reported the frequency of having health- or weight-related conversations with their adolescent child, and the frequency of adolescent mealtime media device use. Spearman's rank correlations were used to assess whether parent-adolescent health-related conversations are associated with mealtime media device use by adolescents. Over 75% of parents reported having conversations about healthy eating and being physically active at least a few times per week. Fewer parents reported having frequent weight-related conversations. Frequency of mealtime media use was low, except for television/movie watching (only 30% of parents reported their child rarely/never watching television during family meals). Having conversations related to the adolescent weighing too much was correlated with the mealtime use of television (r = .207; p < .001), cellphones (r = .134; p = .018), and headphones for music listening (r = .145; p = .010). Conversations about exercising to lose weight were correlated with television/movie watching during mealtimes (r = .129; p = .035). Findings suggest the co-occurrence of less health-promoting parenting behaviors, such as focusing on weight-related conversations and allowing the use of media devices during mealtimes. Focusing on health- rather than weight-related parent-adolescent conversations and implementing mealtime media use rules may have the potential to shape a home food environment which ultimately could improve an adolescent's overall health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Rapid review: Guides and frameworks to inform planetary health education for health professions.

Human actions have led to a range of global environmental changes. Health professionals must be prepared to deliver systemic changes to mitigate and adapt to the ecological crisis. This rapid review aimed to describe exemplar frameworks that inform planetary health education across health professions. The rapid review methodology was informed by a scoping review process. A targeted search strategy was conducted using one representative database and additional strategies such as expert consultation and citation searching were used. Results are described narratively. Of the 11 637 articles, 17 were eligible for inclusion. The frameworks differed, with many recently developed for health professions broadly using a range of methodologies, including qualitative research, opinion/consensus data, literature reviews, and adaptation of previous models. Models such as metric-based scoring indicators and Sustainable Quality Improvement were featured in the frameworks, as were the application of First Nations Natural Laws. This rapid review identifies and showcases accessible, interdisciplinary frameworks to inform the integration of planetary health in curricula, highlighting a rapidly evolving field through which interdisciplinary collaborations in healthcare are important to inform its pedagogy and application. Health education is an important component of health promotion; and thus this rapid review offers a range of approaches that health professionals, health promotion practitioners, and educators can use to inform the integration of planetary health, including sustainable healthcare, into curricula. SO WHAT?: Educational frameworks are informed by research and practice and provide key guidance to practitioners and educators; summarising key available planetary health education frameworks consolidates and guides effective education and builds on the existing body of knowledge to support urgent pro-environmental change.

Developing a toolkit to enhance nursing students’ health promotion practice

Developing a toolkit to enhance nursing students’ health promotion practice

Analyzing mechanisms of interdisciplinary cooperation in promoting students’ health at university

BackgroundInterdisciplinary cooperation among university actors and resulting intersectoral synergies are considered cornerstones in the process of incorporating health promotion practices in everyday university life in order to break down barriers and provide better access to health promotion services. To date, no network of a health-promoting university has been examined regarding the processes underlying tie formation, network emergence, and maintenance.Objectives and methodsThe goals of this study are to obtain insight into the mechanisms of cooperation between university actors in a health-promoting network and to identify the structural and attributive factors associated with establishing cooperation between actors in the observed network in order to better understand how to build and develop successful networks in the future. For this purpose, a social network analysis was carried out and exponential random graph models were estimated to test corresponding hypotheses.ResultsThe network at hand consists of 33 actors (e.g. University Sports Center, General Student Committee) and shows a flat, non-hierarchical structure. Data reveal that attributed competence predicts cooperation (0.32; p < 0.05). Significant homophily effects among student actors (1.31; p < 0.05) and among university actors (0.59; p < 0.05) were found. All structural predictors examined were significant (0.22–5.40; p < 0.05) and are therefore essential in determining the likelihood of cooperation between actors involved in the network.ConclusionThe results of this study provide for a better understanding of the mechanisms of cooperation and can be used to further develop the network at hand (e.g. selection of key actors for information dissemination or integration of peripheral actors). In addition, the findings offer starting points for sustained network development at other universities (e.g. significance of network governance form or goal consensus). Knowing the factors that influence the network structure, here the conditions of cooperation, results in opportunities to encourage empowerment among actors. However, the analysis of the network undertaken does not directly bear on the success of the network.

Mental health promotion practice in Aotearoa New Zealand: findings from a qualitative study.

Mental health promotion (MHP) is integral to improving the overall health and well being of individuals, communities, and populations. However, knowledge and reporting about MHP which occurs throughout Aotearoa New Zealand (NZ) is limited. This article reports findings from a qualitative study that sought to understand NZ health promotion practitioners' (HPPs) MHP practice. Semi-structured interviews were undertaken with 15 HPPs employed at various health promotion organizations. Thematic analysis of interview transcripts identified three key themes. Two themes (planning and evaluation) related to practice directly and included various subthemes: needs assessment; principles/approaches/frameworks; operationalizing equity and te Tiriti o Waitangi; collaborative approaches; planning for evaluation; process evaluation domination; and evaluation challenges. The third theme related to the context of practice and encompassed various system influences restricting HPPs from practising as they wished. These were represented in four subthemes: contractual agreements; field fragmentation; in the shadows of mental ill-health and workforce capacity. Study findings highlight several opportunities to improve MHP practice in NZ. Most pertinently, the need for system-level action to address the factors restricting HPPs' practice.

Timely support for promoting mental wellbeing among families with young children –an interview study exploring the experiences of multi-professional practitioners in Finland

BackgroundChildhood is a critical period for promoting mental wellbeing and previous research suggests that various family-focused mental health promotion and early prevention initiatives are effective. The aim of the study was to explore Finnish health and social care practitioners’ views and experiences of mental health promotion practice targeting families with young children.MethodsIndividual semi-structured interviews with 14 practitioners representing various municipal services, faith-based and third sector organizations were conducted in 2021 and analysed using thematic analysis.ResultsVarious challenges and opportunities for supporting mental health related to both structural features of the health and social care landscape and the varying needs of families were identified. The lack of resources as well as the social stigma associated with mental health problems and with public welfare services, hindered proactive work approaches and timely support. However, low-threshold initiatives and adapted information to families as well as further training about mental health for practitioners together with multi-professional collaboration and teamwork were suggested as potential enablers for mental health promotion.ConclusionsThe study highlights the importance of reaching families in a timely manner in order to promote mental wellbeing and prevent mental health problems. The findings, bringing to the fore the practitioners’ own experiences and views, suggest how current practice could be developed in order to safeguard mental health and wellbeing for all families with young children. The practitioners’ views and experiences are key components when building future sustainable and proactive health and social care services.

Roles of the interaction with children and families in mediating the association between digital health literacy and well-being of early childhood teachers in Portugal: A cross-sectional study.

To analyze the associations between early childhood education (ECE) teachers´ digital health literacy (DHL) and well-being, and to determine whether the ECE teachers´ interaction with children and family mediated these associations. A total of 853 early childhood teachers, predominantly women (99.4%) participated in this cross-sectional study. The participants had a mean age of 39.9 years (standard deviation SD = 8.2). Data was collected through an online survey. DHL was assessed using five subscales adapted to the new coronavirus context, and the professionals´ well-being was measured using the WHO-5 well-being scale. Binary logistic regression and mediation analysis were used to analyze the data. ECE teachers' DHL in dimensions of "information searching" and "determining relevance" had both direct and indirect effect on their well-being. Specifically, higher DHL in these dimensions was associated with better well-being. The dimension "evaluating reliability" had an indirect positive effect on well-being by promoting interaction with children. These findings suggest that improving ECE teachers´ DHL could have a positive effect on their well-being and their interactions with children. Therefore, it is recommended to develop health promotion practices aimed at enhancing DHL among ECE teachers. Additionally, integrating DHL contents and competencies more prominently into the qualification, further education and training of ECE teachers may help equip them with the necessary skills to access and apply health information effectively. This, in turn, can enhance interactions with children and contribute to their overall well-being.

An Invitation to Imagine: Conclusion of the HPP Series "What Is Anti-Racism in Health Promotion Practice?"

Throughout Volume 24 (2023) of Health Promotion Practice, we presented responses to our Call for content addressing the question, "What is Anti-Racism in Health Promotion Practice?" With Editorial Board colleagues, Aditi Srivastav Bussells and Carlos Rodríguez-Diaz, we (Keon L. Gilbert and Kathleen M. Roe) sought frameworks for action and practical examples that would catalyze, support, and (re)invigorate the field in response to the urgent need to eliminate racism as a cause of inequalities in health. This conversation with artist Wriply Bennett concludes the series. We invite scholars and practitioners to review all 17 contributions to the series and to continue to ask - and address - the question 'What is anti-racism in our practice, scholarship, and lives?"

Development and piloting of a Community of Practice to support learning and improvement in health promotion practice within NSW local health district.

Health Promotion Units within New South Wales (NSW) local health districts (LHDs) frequently collaborate and test innovations to address priority health issues or approaches to support the implementation of a health promotion program in a way that is consistent with the needs, resources, and contexts of their regions. Compatible with learning health system approaches, mechanisms to facilitate the exchange of evidence and expertise across districts could improve the collective impact of health promotion services across the state. This study aimed to assess the use of a health promotion Community of Practice (CoP) model as a strategy to achieve this. Type of program or service: This paper describes and shares experiences from the development and piloting process of a CoP model to develop, evaluate and exchange learnings to improve approaches to support the adoption of an effective healthy lunchbox program ('SWAP IT') across three LHDs. The functioning of the CoP was supported by key activities, funding and infrastructure over a 2-year period, including: planning workshops, implementation check-ins, and knowledge exchange meetings. A particularly novel aspect of the CoP was the harmonised evaluation of different, locally developed strategies to facilitate program adoption across the three LHDs. The alignment of the CoP with local and state priorities, as well as the operation of the CoP in a way that did not impose significant time demands, was seen as important for the sustainability of the CoP. Findings from the piloting process suggest that a formalised CoP shows promise as an effective model to enhance health promotion collaboration, information sharing and practice across LHDs, which may be suitable for broader application across the state.

Are health promotion activities and preventive health practices predictors of adolescent eHealth literacy?

Adolescents' general health status and health behaviors have been closely monitored in recent years. It is estimated that adolescents comprise one-sixth of the world's population. This study examined whether eHealth literacy was predicted via health promotion activities and preventive health practices among Turkish adolescents. This cross-sectional study was conducted between March and May 2022 with 706 adolescents in Çorum, Turkey. A face-to-face questionnaire form was used, including socio-demographic characteristics, preventive health practices, eHealth literacy scale and Adolescent Health Promotion Scale. The data of the research were analyzed with the SPSS 22.0 program. Percentage, mean, Pearson Correlation analysis, and multiple regression analysis were used in the analyzes. The p < 0.05 value was considered statistically significant in the evaluations. In the study, 55.8% were female, and the mean age of the whole group was 16.09 ± 2.63 years. The mean score on the eHealth literacy scale was 29.40 ± 6.29. The mean of the total scores obtained from the Adolescent Health Promotion Scale was 137.97 ± 21.87. There was a significant positive correlation between eHealth literacy and the Adolescent Health Promotion Scale (p < 0.001). Multiple linear regression analysis was performed to predict eHealth literacy using the variables of Adolescent Health Promotion and preventive health practices. eHealth literacy positively and significantly predicts health promotion activities (β = 0.27, t (695) = 7.54, p < 0.001). eHealth literacy increased annual weight measurement by more than 0.13 (β = 0.13), annual blood iron measurement by more than 0.16 (β = 0.16) and annual dental examination by more than 0.11 (β = 0.11). Developing eHealth literacy interventions will be necessary for environments with a high concentration of adolescents (schools and courses). Also, primary health care services should be integrated with the school environment.

Perceived Behavior Analysis to Boost Physical Fitness and Lifestyle Wellness for Sustainability among Gen Z Filipinos

The recommended moderate-intensity physical activity per week is 150–300 min for adults and 60 min of moderate-to-vigorous physical activity for adolescents. However, 81% of adolescents and 23% of adults globally do not meet the recommendations for physical activity. With the increasing business in the fitness industry on the rise, sedentary activities were also seen to be prevalent—especially due to the COVID-19 pandemic lockdown. This study aimed to identify and evaluate factors affecting the perceived behavior of Filipinos to boost physical fitness and lifestyle wellness by incorporating the Theory of Effort Minimization (TEMPA) and Protection Motivation Theory (PMT). About 565 Filipinos answered a self-administered questionnaire with 54 adapted questions (45 indicators and 9 latent variables). With the use of a convenience sampling approach, valid responses were evaluated using Structural Equation Modeling (SEM). The results showed that self-efficacy, response efficacy, automatic precursors, and controlled precursors significantly and indirectly affect perceived behavior. It was explained how self-efficacy, or one’s ability to perform a specific behavior, connects with response-efficacy, which covers an individual’s perception of the effectiveness of a task, in this case, health-promoting practices. The influence of others on the individual was presented as conscientiousness, neuroticism, and agreeableness. The effect on other people influences an individual’s positive relationship with adaptable behavior for physical activities. Similarly, the effects of other people may influence individuals to perform healthier lifestyles. These precursors had a direct significance with the intention to adapt, which subsequently led to the perceived behavior of Filipinos in boosting physical fitness and lifestyle wellness. The results of this study could be utilized by the fitness industry, government, local government units (LGUs), and private and public institutions. Further implications were discussed both from a theoretical and practical standpoint, which can help to create successful fitness and wellness programs. Finally, the SEM constructs can be modified and extended to evaluate factors affecting perceived behavior to boost physical fitness and lifestyle wellness among other nationalities.

The impact of Exergames on emotional experience: a systematic review.

Gamification has proven to be a significant tool for health promotion, with a particular focus on physical activities such as Exergames, which improve not only physical, but also cognitive health. However, it is still not clear what effect the practice of Exergames has on changing the emotional experience. The objective of this systematic review is to evaluate the impact of Exergames training on emotional experience. A systematic search was conducted in the PUBMED and SCOPUS databases. The relevant articles were screened independently by three researchers. Data concerning emotional measures and Exergame practice were extracted for analysis. The search yielded 38 articles, of which 16 were included. Exergames were found to significantly impact happiness, anxiety, depressive symptoms, mental health-related quality of life, self-worth, self-esteem, self-efficacy, perceived behavioral control, vigor, vitality, intrinsic motivation, perceived energy, and relaxation. Our review supports the evidence that the practice of physical activity through Exergames, on the emotional experience generally generates an increase in positive emotions. In this sense, the results found support both the use of Exergames as a leisure activity that promotes wellbeing and emotional regulation, as well as for health promotion, public health, and clinical practice purposes. Our review strongly supports the notion that engaging in physical activity through Exergames generally leads to an increase in positive emotions. As a result, these findings endorse the utilization of Exergames as a leisure activity to promote well-being and emotional regulation. Moreover, Exergames hold potential for health promotion, public health, and clinical practice purposes.

Development and piloting of a Community of Practice to support learning and improvement in health promotion practice within NSW local health districts

Development and piloting of a Community of Practice to support learning and improvement in health promotion practice within NSW local health districts

Human is a Social Being: Socializing in Pandemic Times

Objective: It was aimed to evaluate the news of national television that revealed the ways people socialize during the first year of the pandemic in Turkey.&#x0D; Methods: According to the ethnographic qualitative research design, the news showed between 11 March 2020 and 11 March 2021 in the news of six national channels in Turkey and containing the forms of socialization were analyzed by content analysis.&#x0D; Results: Life did not fit at home, the form of socialization changed and this new form of socialization evolved in the direction of digitalization. Those who have kept up with the digital age have realized their socialization experiences by spending time on social media. Neighbors began communicating by gathering on balconies, rather than being guests in one another's homes. Society have made an effort to cope with uncertainty and obscurity by returning to localness and living its traditions. Coping with challenges in the belief that they would be resolved together has enabled Turkish society to cope more successfully with the pandemic process.&#x0D; Conclusions: This study will be a precursor to support multidisciplinary studies in community mental health studies in times of crisis, will provide important data for community mental health promotion practices.

Mandating COVID-19 Vaccination on Campus: A Qualitative Analysis of a Cross-Sectional Study of California College Students.

The purpose of this study was to examine college student perceptions related to institutional vaccine mandates. We utilized qualitative data (n = 2,212) from five open-ended questions in a cross-sectional study of students enrolled or intending to enroll in an institute of higher education in California in fall 2021. Data were collected between June and August 2021. Thematic analysis was employed to analyze student beliefs, and four themes were developed from the data: (1) Polarizing views and language, (2) deciding who to trust, (3) conveying rights and risk, and (4) staying focused on education. The themes represented vaccinated and nonvaccinated student perspectives, capturing views about trust, rights, and risk. Many responses were polarizing and included language that was emotional and political. Despite the range of responses, most students expressed appreciation and approval of the vaccination mandate on college campuses. Findings illustrate the important contributions of qualitative research and suggest opportunities for public health practitioners to lead and engage in critical dialogue about science and public health practices as we aim to promote public perceptions of vaccination programs and health promotion practice.

Braiding the Healing Gifts of Photovoice for Social Change: The Means Are Ends in the Making.

Photovoice is an important participatory action method for motivating social change. The potential for this change within the processes of the method remains under-explored. We present the voice and perspectives of three health promotion practitioners who have important connections to photovoice: a grandmother and co-founder of the method, a nurse from Wales, and an early adopter seeking change. Through braided storytelling, the voices describe their history with photovoice and how their relationship to the method has changed over time, arguing ultimately that in photovoice the means are as important as the ends for advancing relations with others, understanding and working with power, and realizing the gifts the processes bring.

Stroke Risk, Practice and Health Promotion Guidance among Geriatric Patients: Randomized Control Trail

Background: Stroke is one of the world’s chief reasons of death and infirmity among geriatric. Objective: The research at hand analyzed the association among the rFSRP and health promotion lifestyle and practice about stroke prevention among geriatric patients. Design: A randomized controlled experimental study was used in this study. This study included 85 study and 85 control participants. Methods: Participants were randomly selected and provided with an educational intervention on health-promoting lifestyle behaviors. Data were collected via Tool (I): demographic and clinical data of geriatric patients, Tool (II): Revised Framingham Stroke Risk Profile (R- FSRP) Tool (III): geriatric patients’ practices about stroke prevention, and Tool IV: Health Promoting Lifestyle Profile II (HPLP II) pre, and three months after the program intervention. Results: The data analysis revealed noteworthy dissimilarities between the experimental and control groups, which were deemed statistically significant and pre and follow - up intervention regarding (R- FSRP), practice and health promotion (p &lt; 0.05.). Conclusion:The study concluded that the intervention program had a positive effect on stroke risk, practices and health promotion lifestyle.

Health promotion in family practice—a qualitative study on the role of health care assistants

Zusammenfassung Hintergrund Die Hausarztpraxis ist ein wichtiger Ort für Gesundheitsförderung und Prävention in Deutschland. Es besteht jedoch eine Forschungslücke bezüglich der Einbindung nichtärztlichen Praxispersonals in Aktivitäten der Gesundheitsförderung. Unser Ziel war es daher, einen vertiefenden Einblick zu gewinnen, welche Rolle Medizinische Fachangestellte (MFA) hinsichtlich Gesundheitsförderung in der Hausarztpraxis einnehmen. Methoden Wir führten 21 telefonische qualitative Leitfadeninterviews mit 14 Hausärzt:innen und sieben MFA und fragten beide Gruppen nach der Rolle der MFA in Bezug auf Gesundheitsförderung in der Hausarztpraxis. Die Interviews wurden nach thematischer Analyse gruppenspezifisch ausgewertet. Ergebnisse Neben organisatorischen Aufgaben wie der Terminvereinbarung übernehmen MFA vor allem als erste Kontaktperson eine Schlüsselfunktion hinsichtlich Gesundheitsförderung: Sie erkennen Bedarfe, kommunizieren Auffälligkeiten an Hausärzt:innen, filtern anspruchsberechtigte Patient:innen bereits am Empfang heraus und sprechen sie aktiv auf Vorsorgeleistungen an. In einigen Praxen führen MFA selbst gesundheitsfördernde Maßnahmen wie Schulungen durch. In Bezug auf weitere Aufgabenübertragung äußerten jedoch insbesondere Hausärzt:innen Hemmnisse, da sie die MFA nicht überlasten wollten. Schlussfolgerungen MFA übernehmen hinsichtlich Gesundheitsförderung in der Hausarztpraxis häufig organisatorische Tätigkeiten, können aber aufgrund ihrer Funktion in der Praxisstruktur die Hausarztpraxis auch als gesundheitsförderndes Setting für Patient:innen mitprägen. Insbesondere navigieren MFA die Patient:innen hinsichtlich präventiver und gesundheitsfördernder Angebote. Entsprechend ihrer Schlüsselfunktion als Erstkontakt sollte mit MFA gemeinsam erarbeitet werden, wie Gesundheitsförderung bereits am Empfang strukturiert adressiert werden kann.

Qualitative Research on Obstacles and Hesitates of Healthcare Students Before Public Speaking for Supporting Health Promotion

Public speaking ability is essential for healthcare students as educators and health promoters. However, students need more confidence in their ability to deliver education in public. Students also experience anxiety before becoming a public speaker. The study aims to identify common barriers that hinder students from feeling comfortable while speaking in public. The method used a phenomenological approach. Research location at Faletehan University, Indonesia. The sample in this study was 12 healthcare students to explore experiences related to barriers in preparing for public speaking. The technique used purposive sampling to select participants who have experienced difficulty or fear in public speaking. Data were analyzed using thematic analysis. Results show that through thematic analysis, it was observed that the participants encountered physical and psychological obstacles. The findings revealed six themes, including physical anxiety, traumatic experiences, lack of technical methods and practice, the importance of personal branding, self-actualization, and the impact of social media. Self-actualization, a deeper understanding of personal branding, and the combination of EFT techniques emerge as effective ways to address the obstacles and hesitations faced by healthcare students before public speaking. This research provides information on overcoming barriers and hesitations in health promotion practices carried out by students in the community.