Public Health Agenda Research Articles

Health Impacts of Disasters and Social Indicators: An Ecological Study

Abstract The objective of this study is to investigate the correlation between certain social indicators and the mortality and morbidity in disasters recorded in the EM-DAT database within countries in the last decade. The correlation between the mortality and morbidity in disasters recorded in the EM-DAT database between March 1, 2014-2024 and the most recent data on Human Development Index (HDI), Gender Inequality Index (GII), Gini Coefficient (GC), Government Health Expenditure as a share of GDP (GHE/GDP) and Corruption Perception Index (CPI) were analyzed. During the period of the study, disasters from a total of 207 countries/regions were recorded in the database. The median (IQR) values of countries in disasters were found to be 35.1 (67.5) for death per million and 76.3 (783.0) for injury per million. The most frequent types of disasters, the most frequent cause of mortality and the most frequent cause of injury in each country were found to be floods, extreme temperatures, and epidemics, respectively. While there was no significant difference between the social indicators analyzed and the total number of deaths, there was a negative correlation between the number of injuries and the HDI, CPI, GHE/GDP values of the countries, and a positive correlation between the GC and GII values (for all tests, Spearman correlation test, p < 0.001). The correlation coefficient was interpreted as ‘weak’ in all other pairwise analyses except for the GHE/GDP value (moderate). Countries with social indicators closer to the positive threshold have been found to have less injuries in disasters. The possible reason for the insignificant correlation with the mortality is thought to be the difficulties in detecting mortality, especially in ‘extreme temperatures’, and the fact that it is mostly recorded in countries where social indicators are relatively more advanced. More research is needed to investigate the relationality between social indicators and disaster harms. Key messages • Disasters are critical mediators between social determinants and health. Addressing and reducing inequalities should remain on the public health agenda to prevent disasters and protect health. • Analysis of disasters shows that ‘extreme temperatures’, which cause the most deaths in some countries, are barely detected in developing countries. Disaster recording systems need to be strengthened.

Quitting with pride: Differences in smoking behaviour across sexual identity groups in Ireland

Abstract Background As smoking prevalence reduces, smoking inequalities across population groups is emerging as a key challenge. Despite recognition of specific needs among members of the Lesbian, Gay, Bisexual, Transexual Plus (LGBT+) community, differences in smoking across sexual identity groups is uncharted in Ireland and the community is not represented in tobacco policy agenda setting. This study aimed to measure and compare the prevalence of smoking, quitting intention and quitting behaviour across sexual identify groups in Ireland. Methods Secondary analysis of the 2023 “Healthy Ireland” cross sectional survey of health status was conducted (n = 7,411). For the first time, this survey included a question on self-reported sexual identify, along with standard questions on smoking prevalence, quitting intention and quitting behaviour. Prevalence of smoking, quitting intention and quitting behaviour were calculated with 95% Confidence Intervals (CI) and compared across groups with Chi Square tests. Results In total, 2.3% (95% CI 2.0-2.7%) of respondents reported an LGB+ identity. Compared to those reporting straight identity, LGB+ respondents reported higher smoking prevalence (17.6% versus 21.4% respectively); intention to quit was similar across groups, however, LBG+ respondents also reported a higher prevalence of making at least one quit attempt in the previous 12 months (51.3% versus 78.0% respectively, p < 0.0001). Conclusions While this study highlighted tobacco-use as a health challenge for the LGB+ community in Ireland, it also identified an opportunity for tailored stop smoking approaches to support quit success. As a consequence, an innovative Fulbright-sponsored policy dialogue was convened between leaders in tobacco control, LGBT+ community leaders, health services and academia across Ireland and the USA to explore solutions, underlining the important role equity stratifiers and population surveillance play in agenda setting for public health. Key messages • Including sexual identity in the national population health survey enabled tobacco-use needs across sexual identity groups in Ireland delineated for the first time. • Equity-stratified population health surveillance informed a policy dialogue to better represent needs of LGBT+ community in public health agenda setting.

Empowering Young Roma Women in matters of health and primary care: an innovative training program

Abstract Background Roma communities are rather diverse groups with different level of knowledge, beliefs and motivations in relation to their health. Raising awareness and self-efficacy of these individuals is a challenging field in the EU public health agenda. Objectives To address this challenge, the program entitled “Empowering Young Roma Women in matters of health, prevention and human rights: a new methodological approach” was developed with the aim to empower Roma women in terms of health and prevention topics pilot testing different educational methods. A two-step co-design approach was performed to determine the training content, tools, methods. The training was implemented in 5 areas throughout Greece (Volos, Chalkida, Thiva, Agia Varvara, Zefyri) in Jan-Oct 2023, including 3 phases: a. Train-the-trainers, b. Training the Roma women and c. Training evaluation. Results The educational material developed for health and prevention included 4 units (gynaecological health issues, vaccinations, smoking and nutrition). Each unit consisted of a theoretical background to develop the material, a presentation for future trainers, a presentation for trainees, a brochure, and a poster. For the training a new methodological approach was tested i.e. a health professional or Roma women (after being trained) to deliver the training. In total, 548 pre-post questionnaires were collected. Most trainees, understood the content of the training, acquired new knowledge and found the information interesting and possible to include in their daily life. 80% trainees expressed their satisfaction with the overall presentation. Regarding knowledge improvement based on the type of trainer only a slightly greater degree of improvement was observed for Roma trainers. Conclusions It is crucial to develop culturally appropriate health interventions by directly working with communities, to understand their particular needs, and to ensure they receive the information needed to make informed decisions. Key messages • Maintaining and promoting health is a decisive factor of social inclusion. • Tailor-made training of ethnic minorities shall be an integral part of the EU public health agenda.

The adoption and implementation of local government planning policy to manage hot food takeaways near schools in England: A qualitative process evaluation

IntroductionAccess to hot food takeaways, particularly near schools, is of growing concern for policymakers seeking to reduce childhood obesity globally. In England, United Kingdom (UK), local government jurisdictions are implementing planning policies to reduce access by restricting or denying planning permission for new takeaway outlets near schools. We used a qualitative approach to explore local government officers’ perspectives on the barriers to and facilitators of the adoption, implementation, and perceived effectiveness of these policies. MethodsIn 2021–2022, we conducted semi-structured interviews with 29 local planning (‘planners’) and public health government officers from 15 different local authorities across England who adopted a policy to restrict new takeaways. Data were analysed thematically. ResultsParticipants explained that they mostly thought the policies facilitated the refusal of applications for new takeaways near schools. However, participants speculated that businesses identified alternative opportunities to operate including functioning as ‘restaurants’ or within other locations. Effective working relationships between planners and public health officers were important for adoption and implementation, although planning and public health agendas did not always align and there were tensions between economic development and health improvement goals. The policy was adapted to suit local needs and priorities; in some cases, the policy was not used in areas where economic growth was prioritised. Clarity in policy wording and establishing a formal process for implementing policies including a designated individual responsible for checking and reviewing takeaway applications helped ensure consistency and confidence in policy implementation. ConclusionAlthough sometimes challenging, the policies were commonly described as feasible to implement. However, they may not completely prevent new takeaways opening, particularly where takeaways are relied upon to enhance local economies or where takeaway businesses find alternative ways to operate. Nevertheless, the policies can serve to shift the balance of power that currently favours commercial interests over public health priorities.

The public health challenges of female migration: the Venezuelan diaspora in Andean countries

BackgroundVenezuelan migration has experienced an unprecedented increase in the last decade, with approximately 7.7 million Venezuelan-born individuals residing in other countries as of 2024. Our study aims to identify the potential and actual demand for healthcare services (SRH) in the Venezuelan diaspora’s four primary destinations within the Andean Countries: Colombia, Ecuador, Peru, and Chile.MethodsUsing official data from administrative records, censuses, and sample surveys reported by the host countries and international agencies, we estimate the annual evolution of Venezuelan-born women of reproductive age (WRA) and their offspring. Additionally, we conduct two case studies focusing on Colombia and Chile to analyse the groups most vulnerable to unmet health needs.ResultsThe population of WRA has increased to between 5 and 6.8%, and births have risen to approximately 3–8% in host countries due to Venezuelan migration. Yet, we found a general decrease in health coverage for certain age groups of Venezuelan female migrants in host countries for the period 2017–2022, particularly in Chile. By 2022, an estimated 20% of healthcare needs remained unmet among children, girls, and younger Venezuelan women, contributing to greater health inequalities between Venezuelan-born adolescents and those from other countries of birth.ConclusionsOur findings highlight the escalating demand for and limited access to healthcare services among Venezuelan WRA in their destinations. Unmet healthcare needs are particularly prevalent among younger women by 2022, underscoring the urgency for health system to incorporate gender-responsive, equitable interventions and ensuring health rights for high-risk migrant groups such as infants, children, adolescents, and younger women. Addressing these challenges remains a critical task for the regional public health agenda in Latin America.

A One Health Approach to Public Safety: A Review of Police Canines in the United States.

Working dogs are an essential part of modern society, and police canines (K9s) in the United States are amongst the most recognizable of all working dogs. Given the dearth of published data on active police canines in the U.S. and the calls for police reform, an interdisciplinary effort is necessary to comprehensively understand how these dogs are best used for the benefit of society. This review paper relies on veterinary public health expertise to present a comprehensive overview of police canine use by municipal law enforcement in the United States, including known impacts and gaps in knowledge. The existing literature from animal-assisted interventions (AAI) provides evidence to ensure working dog well-being, while human-animal bond research contributes to officer safety and canine partnership. Lastly, law enforcement and public health agendas (LEPH) assure the team's successful efforts in built environments and local neighborhoods. These frameworks acknowledge the complexity of police dog use, spanning from punitive to public relations, which mirrors the role of law enforcement in U.S. society. This paper proposes the use of a One Health framework to ensure police canine contributions to society, including suggested approaches to partner municipal police with veterinary medicine and public health, and integrate One Health in promoting public safety for local communities.

Comparing place meanings of recreational visits to coastal and inland nature

Blue spaces are being increasingly linked to a public health agenda, as the presence of water increases perceived restorativeness. Much research has examined coastal nature experiences and sense of place in coastal areas specifically, but little research has attempted to compare sense of place across different types of natural environments. In this study, we used place meanings to investigate how people perceive, experience, and attach to coastal and inland natural environments, providing new insights into human-nature relations in coastal and inland environments in Denmark. The study uses a mixed methods approach, combining qualitative analysis of free-text responses from a national online PPGIS survey with statistical analysis of background information. Responses from 500 coastal and 500 inland nature visitors were analysed through an inductive coding process, which elicited one hundred different place meanings. These meanings were categorized according to Williams’ (2014) layers of tangible and intangible place meanings. The meaning layer distribution was similar between coastal and inland nature visits, just as the most frequent place meanings were similar across the environments (e.g., Nature, Nice, Forest, Walk). However, significant differences were found among some individual place meanings (e.g., Wild, Vacation, Healing and comfort were more frequent for coastal visits), suggesting special coastal place meanings that should be further explored in future research. The analysis of place meanings was supplemented by an analysis of relevant visit characteristics behind the 500 coastal and 500 inland visits, suggesting great attraction coupled to coastal places (e.g., longer travel distance).

Health care needs and barriers to care among the transgender population: a study from western Rajasthan

BackgroundTransgender people comprise an estimated 0.3–0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. Methodology: A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. Results: Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual’s health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. Conclusion: Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.

Exploring perceptions of anti-vaping message themes: A qualitative study of Australian adolescents and adults.

Minimising electronic cigarette (e-cigarette) uptake and encouraging vaping cessation have become important components of public health agendas. Given the success of well-designed anti-smoking campaigns, attention has turned to developing health communications that target vaping. Although prior work has identified a range of potentially effective campaign messages, several gaps in the literature remain. We aimed to (i) identify message themes perceived to be effective at minimising e-cigarette use and (ii) elicit opinion on how these message themes could be optimised in terms of message execution and delivery. Focus groups (n = 16) were conducted with adolescents (14-15 and 16-17 year olds), young adults (18-24 year olds), and adults (25-39 year olds). The groups reported on message themes they believed would assist with minimising e-cigarette use. They then provided feedback on 14 message themes developed by the research team. Data were analysed using reflexive thematic analysis. Groups discussed a range of message themes they believed would be effective. These included themes focused on the health harms associated with vaping, the chemical ingredients in e-cigarettes, use dependence, and social attitudes to use. Groups discussed the importance of using evidence-based personal testimonies, and reported that messages would be most effectively communicated via social media, in public places, and at point of sale. Results build on existing research by identifying message themes perceived to be most effective, and how these would best be executed. Results have the potential to inform the development of co-designed health communication campaigns addressing youth vaping. Using a stratified focus group methodology, we collected rich and detailed qualitative data on Australians' perceptions of anti-vaping message themes. Themes considered most effective were those that addressed the health harms of vaping, the chemical ingredients in e-cigarettes, social consequences of use and the impacts of dependence. We recommend further work to develop and trial a range of specific anti-vaping messages based on the themes identified as having the most potential. This process should include iterative co-design with the target audience to optimise future health communication campaigns.

Implementation of community-based rehabilitation in Colombia in mental health: barriers, facilitators, and purposes

Abstract Mental health holds a crucial position within global public health agendas, particularly in the context of developing and implementing community-based approaches. Despite this, there remains a scarcity of evidence regarding the methodologies and anticipated outcomes associated with community-based rehabilitation (CBR) in low- and middle-income countries. This study aims to address this gap by identifying the barriers and facilitators. Through a qualitative approach involving focus groups conducted within a CBR training programme in Colombia, thematic analysis was employed to discern, analyze, and present patterns within the data. The findings, drawn from the participation of 208 individuals including clinical and administrative mental health professionals, as well as community leaders, underscored recurring themes such as the necessity for alliances across various sectors with a shared mental health goal, the importance of contextual considerations in programme development, the need for increased economic resources allocated to mental health, and the significance of empowering community autonomy. Ultimately, the study highlights the imperative of fostering equitable dialogue between communities and decision-makers to facilitate the effective transition of CBR from theory to implementation.

Qualitative exploration of uterine cancer care for lesbian, gay, bisexual, trans and queer (LGBTQ+) patients in the UK: shifting from equality to equity

ObjectivePatients identifying as lesbian, gay, bisexual, transgender and/or queer/questioning (LGBTQ+) report significant disparities in cancer care and are disproportionally affected by a cancer diagnosis on a number of health-related indicators....

Persistent Challenges of Micronutrient Deficiencies in Latin America Need Action.

Micronutrient deficiencies affect growth and development and are critical for maintaining health at all ages. Their critical role in exacerbating complications of infections and chronic diseases continues to impact morbidity, mortality, and quality of life for many. Raising awareness and advocating for micronutrient deficiencies in Latin America is urgent to reduce this preventable burden. Globally, an estimated 372 million preschool-aged children and 1.2 billion non-pregnant women of reproductive age suffer deficiency from 1 or more micronutrient. Data is limited and often old, and the true burden of problem in the region remains unclear. There are also limited data on dietary intake and on the double burden of malnutrition. Latin America has been a leader in the design and implementation of innovative and effective actions to reduce excess energy intake and curb the consumption of unhealthy Actions to address deficiency have been implemented in many countries in the region over the years, but current evidence suggests that micronutrient deficiencies have fallen off the public health agenda in Latin America. Effective programming can be developed / appropriately adapted only with knowledge of the current burden. Such data can also help guide and predict future areas of risk and priorities to missing upcoming nutrition issues in the population. Renewed commitment to quantify and monitor micronutrient deficiencies in the region is essential. Abundant evidence and guidance exist to inform effective program selection, design and implementation to address this public health problem.

Development and psychometric testing of a questionnaire for the Korea Youth risk behavior survey to assess physical activity behaviors

BackgroundPhysical activity is essential for physical, mental, and cognitive health. Providing evidence to develop better public health policies to encourage increased physical activity is crucial. Therefore, we developed an in-depth survey as part of the Korea Youth Risk Behavior Survey to assess the current status and determinants of physical activity among Korean adolescents.MethodsWe developed an initial version of the questionnaire based on a review of validated questionnaires, recent trends and emerging issues related to adolescent physical activity, and the national public health agenda pertaining to health promotion. Content validity was confirmed by a panel of 10 experts. Face validity was confirmed through focus group interviews with 12 first-year middle school students. The test-retest reliability of the questionnaire was evaluated by administering it twice, approximately two weeks apart, to a sample of 360 middle and high school students. Additionally, the frequency or average number of responses was analyzed in a sample of 600 students who participated in the initial test-retest reliability evaluation of the questionnaire developed in this study.ResultsThrough item pool generation and content and face validity test, the final 15 questionnaire items were developed across five themes: levels of physical activity, school sports club activities, transportation-related physical activity, physical activity-promoting environments, and factors mediating physical activity. The test-retest reliability ranged from fair to substantial. Results from the newly developed survey reveal that only a minority of adolescents engage in sufficient physical activity, with only 17.2% and 21.5% participating in vigorous and moderate-intensity activities, respectively, for at least five days per week. Among school-based activities, 44.3% of students do not participate in school sports clubs due to reasons including absence of clubs and disinterest in exercise. The major motivators for physical activity are personal enjoyment and health benefits, whereas preferences for other leisure activities and academic pressures are the predominant barriers.ConclusionsThis study developed valid and reliable in-depth survey items to assess physical activity among Korean youths. It will hopefully enhance our understanding of adolescent physical activity, offering essential preliminary evidence to inform the development of public health strategies aimed at promoting adolescent health.

A tabletop exercise approach to global disaster preparedness: insights from Nepal's first international conference on disaster preparedness and management.

Considering recent earthquakes and the COVID-19 pandemic, disaster preparedness has come to the forefront of the public health agenda in Nepal. To strengthen the developing health system, many initiatives are being implemented at different levels of society to build resiliency, one of which is through training and education. The first International Conference on Disaster Preparedness and Management convened in Dhulikhel, Nepal on December 1-3, 2023. It brought together international teaching faculty to help deliver didactic and simulation-based sessions on various topics pertaining to disaster preparedness and management for over 140 Nepali healthcare professionals. This paper focuses on the tabletop exercise-based longitudinal workshop portion of the conference on disaster leadership and communication, delivered by United States-based faculty. It delves into the educational program and curriculum, delivery method, Nepali organizer and US facilitator reflections, and provides recommendations for such future conferences, and adaptation to other settings.

Dynamics of Community Resilience in Flood-prone Areas of Southeast Asia: A Key Component of the Public Health Agenda

Communities across Southeast Asia face challenges posed by natural disasters, including floods, which disproportionately impact vulnerable populations. In light of the growing frequency and severity of extreme weather events attributed to climate change, there is a pressing need to explore and strengthen community flood resilience. Community resilience is pivotal in mitigating flood-related damages and fostering successful recovery efforts. This paper examines the socio-economic and environmental factors shaping community resilience in flood-prone areas of Southeast Asia. Socio-demographic determinants, exposure to floods, social cohesion, communication networks, socio-economic status, and cultural diversity significantly influence resilience capabilities, with disparities exacerbating socio-economic inequality. The interplay of these factors underscores the complexity of community disaster resilience, with some factors acting as moderators, mediators, or confounders in shaping outcomes. The paper highlights that understanding the dynamics of community resilience formation is imperative for informed policy interventions to enhance disaster preparedness and response in flood-prone areas of Southeast Asia. The contributors to flood resilience are interrelated with social determinants of health, underscoring the vital role of broader socio-economic and environmental factors in shaping community well-being. Future research should explore the relationships within these complex dynamics to guide effective resilience-building strategies tailored to local contexts.

Envisioning how to advance the MASH field.

Since 1980, the cumulative effort of scientists and health-care stakeholders has advanced the prerequisites to address metabolic dysfunction-associated steatotic liver disease (MASLD), a prevalent chronic non-communicable liver disease. This effort has ledto, among others, the approval of the first drug specific for metabolic dysfunction-associated steatohepatitis (MASH; formerly known as nonalcoholic steatohepatitis). Despite substantial progress, MASLD is still a leading cause of advanced chronic liver disease, including primary liver cancer. This Perspective contextualizes the nomenclature change from nonalcoholic fatty liver disease to MASLD and proposes important considerations to accelerate further progress in the field, optimize patient-centric multidisciplinary care pathways, advance pharmacological, behavioural and diagnostic research, and address health disparities. Key regulatory and other steps necessary to optimize the approval and access to upcoming additional pharmacological therapeutic agents for MASH are also outlined. We conclude by calling for increased education and awareness, enhanced health system preparedness, and concerted action by policy-makers to further the public health and policy agenda to achieve at least parity with other non-communicable diseases and to aid in growing the community of practice to reduce the human and economic burden and end the public health threat of MASLD and MASH by 2030.

A patient perspective on kidney disease in the public health agenda.

A patient perspective on kidney disease in the public health agenda.

Revisiting the beyond BMI paradigm in excess weight diagnosis and management: A call to action.

Adolphe Quételet, a 19th-century Belgian sociologist and statistician, pioneered the incorporation of statistics into social sciences. He initiated the development of anthropometry since he was interested in identifying the proportions of the 'ideal man'. He devised a ratio between weight and height, originally termed the Quételet Index, and today widely known and used as the body mass index or BMI. In 1835, he demonstrated that a normal curve accommodates the distribution of human traits articulating his reasoning on human variance around the average. Quételet's long-lasting legacy of the establishment of a simple measure to classify people's weight relative to an ideal for their height endures today with minor variations having dramatically influenced public health agendas. While being very useful, the limitations of the BMI are well known. Thus, revisiting the beyond BMI paradigm is a necessity in the era of precision medicine with morphofunctional assessment representing the way forward via incorporation of body composition and functionality appraisal. While healthcare systems were originally designed to address acute illnesses, today's demands require a radical rethinking together with an original reappraisal of our diagnosis and treatment approaches from a multidimensional perspective. Embracing new methodologies is the way forward to advance the field, gain a closer look at the underlying pathophysiology of excess weight, keep the spotlight on improving diagnostic performance and demonstrate its clinical validity. In order to provide every patient with the most accurate diagnosis together with the most appropriate management, a high degree of standardization and personalization is needed.

Chronic kidney disease and the global public health agenda: an international consensus.

Early detection is a key strategy to prevent kidney disease, its progression and related complications, but numerous studies show that awareness of kidney disease at the population level is low. Therefore, increasing knowledge and implementing sustainable solutions for early detection of kidney disease are public health priorities. Economic and epidemiological data underscore why kidney disease should be placed on the global public health agenda - kidney disease prevalence is increasing globally and it is now the seventh leading risk factor for mortality worldwide. Moreover, demographic trends, the obesity epidemic and the sequelae of climate change are all likely to increase kidney disease prevalence further, with serious implications for survival, qualityoflife and health care spending worldwide. Importantly, the burden of kidney disease is highest among historically disadvantaged populations that often have limited access to optimal kidney disease therapies, which greatly contributes to current socioeconomic disparities in health outcomes. This joint statement from the International Society of Nephrology, European Renal Association and American Society of Nephrology, supported by three other regional nephrology societies, advocates for the inclusion of kidney disease in the current WHO statement on major non-communicable disease drivers of premature mortality.

Acceptability and perceived feasibility of the KaziKidz health promotion intervention among educators and caregivers in schools from South Africa: a qualitative descriptive study

BackgroundDespite the uncontested benefits of physical activity, its promotion lags behind in the public health agenda of low- and middle-income countries (LMICs). School-based interventions are promising strategies to foster health during childhood, but evidence of their effectiveness is limited and inconclusive for LMICs. Thus, further investigation is needed on contextual factors associated with intervention implementation in low-resource settings. We studied the acceptability and feasibility of the KaziKidz health promotion intervention and its implementation and make recommendations to improve future adoption and sustainability.MethodsKaziKidz was implemented in four primary schools from low-income communities in South Africa in 2019. Semi-structured interviews with four school principals, three focus group interviews with 16 educators, and another three with 16 caregivers were conducted between October and November 2021. Participants were purposively recruited. Interview transcripts were analyzed via thematic analysis using a deductive and reflexive approach.ResultsThree main themes influencing intervention implementation and adoption were identified: (1) prioritizing teachers’ needs (2), integrating the program into the school structure, and (3) creating opportunities in the community. Supporting recommendations included: (theme 1) adopting intervention approaches that are inclusive of educators’ health and providing them with capacity development and external support; (theme 2) fostering a feeling of ownership and belonging among school stakeholders to adapt interventions to specific resources and needs; and (theme 3) raising community awareness to encourage individuals to claim power over and actively engage with the program.ConclusionsComprehensive interventions comprising health support, adequate training, and ongoing assistance for educators combined with school-wide and community outreach actions seeking to strengthen program ownership, accountability, and engagement can enhance uptake of school-based interventions and long-term maintenance.Trial registrationISRCTN15648510, registered on 17/04/2020.